Assessment of the G-ROP study criteria for predicting retinopathy of prematurity: results from a tertiary centre in Turkey.

PURPOSE: The postnatal growth and retinopathy of prematurity (G-ROP) study has proposed a new model for retinopathy of prematurity (ROP) prediction based on gestational age, birth weight and postnatal weight gain. The purpose of the current study is to assess the efficacy of the G-ROP model for predicting ROP among a Turkish cohort of premature infants. METHODS: Records of infants who underwent ROP screening examinations between 2012 and 2019 were reviewed retrospectively. Infants with a documented ROP outcome and regular body weight measurements until day 40 of life were included. The G-ROP model was applied to the study group. The outcome measures were sensitivity and specificity of the model for detecting any stage ROP and treated ROP. RESULTS: A total of 242 infants were included. The G-ROP model identified 168 infants to be screened for ROP. The sensitivity was 88.3% for detecting any stage ROP and 91.2% for treated ROP. The specificity for any stage ROP and treated ROP was 51.7% and 34.1%, respectively. The incorporation of bronchopulmonary dysplasia to the model increased the sensitivity to 100% with 22.7% reduction in the number of screened infants. CONCLUSIONS: The G-ROP model is a simple and effective method for ROP prediction. However, in the current cohort, a small number of infants requiring treatment would be missed if G-ROP criteria were applied. The model may be modified with addition of bronchopulmonary dysplasia to detect all treatment requiring cases. Prospective studies among larger groups are necessary to assess the applicability of the modified model.

Macular thickness in children aged 3-6 years born preterm.

PURPOSE: To determine macular thickness in 3- to 6-year-old children who were born preterm compared with age-matched controls born at term. METHODS: Children 36-72 months of age born ≤34 weeks and age-matched control children born at term were included in this prospective case-control study. Macular thickness measurements obtained using spectral domain optical coherence tomography were compared between groups and correlations of macular thickness were investigated in the preterm group. RESULTS: A total of 45 preterm children (median age, 57.7 months) and 44 controls (median, 56.1 months) were included. Central macula thickness (CMT) was significantly higher (P = 0.010) and perifoveal thickness was significantly lower (P = 0.029) in the preterm group compared with the control group. Moderate negative correlations of CMT with gestational age and birth weight were found in the preterm group. Best-corrected visual acuity was similar between groups and was not correlated with CMT in the preterm group. No significant difference in macular thickness was found between subjects who had retinopathy of prematurity and those who did not. CONCLUSIONS: Compared with controls, children in the preterm group had thicker retinas at the central macula and thinner perifoveal retinas. These subtle alterations were not correlated with visual acuity and may be considered a reflection of prematurity.

Long term motor and sensory outcome after surgery for infantile esotropia and risk factors for residual and consecutive deviations.

Purpose: To present long-term motor and sensory outcomes after surgery for infantile esotropia and assess risk factors for residual and consecutive deviations.Methods: Data of infantile esotropia patients operated between 2002 and 2016 with minimum follow-up of 2 years were retrospectively reviewed.Results: Among a total of 62 patients, 35 had a successful motor outcome (alignment within 10 PD from orthotropia) after one surgery (Group A), while 27 required horizontal reoperation (Group B). Patients with residual esotropia had larger preoperative angle of deviation (P = .005) and younger age at first surgery (P = .01), while consecutive exotropia was associated with longer follow-up (P = .03) and higher rate of DVD (P = .003) compared to patients in Group A. Stereopsis was present in 30.3% of patients in Group A and associated with younger age at first surgery (P = .03).Conclusions: Successful motor alignment may be obtained with single surgery in infantile esotropia; however, reoperations are common. Younger age at first surgery may be associated with both higher rate of stereopsis and risk of reoperation. Careful preoperative assessment and surgical timing, with long-term postoperative follow-up is required to achieve satisfactory outcome.

Breast Carcinoma Metastasis to the Medial Rectus Muscle: Case Report

A 63-year-old woman with metastatic breast carcinoma presented to the ophthalmology clinic with diplopia and right abduction deficit. Magnetic resonance imaging showed isolated enlargement of the right medial rectus muscle. Biopsy of the enlarged muscle revealed metastasis of breast carcinoma. Ocular motility deficit in a patient with breast carcinoma should raise suspicion of metastasis to the orbit involving the extraocular muscles. Orbital imaging and biopsy are necessary for diagnosis and appropriate treatment.

Optic Nerve Head Parameters Measured with Spectral-Domain Optical Coherence Tomography in Healthy Turkish Children: Normal Values, Repeatability, and Interocular Symmetry.

To determine normal values, repeatability, and interocular symmetry of optic nerve head measurements, three spectral-domain optical coherence tomography (SD-OCT) scans were obtained from 128 healthy Turkish children aged 5-17 years consecutively and prospectively. The mean disc area, rim area, cup volume, cup to disc area ratio, and vertical and horizontal cup to disc ratios were 2.30 ± 0.42 mm2, 1.84 ± 0.45 mm2, 0.09 ± 0.10 mm3, 0.20 ± 0.13, 0.37 ± 0.17, and 0.45 ± 0.20, respectively. The intraclass correlation coefficients were >0.9 for repeatability and >0.75 for interocular correlation. Interocular differences were not statistically significant (p > 0.05). Normal paediatric SD-OCT measurements of the optic nerve head are presented, which showed excellent repeatability and no interocular difference.

Recurrence of acute lymphoblastic leukemia manifesting as serous retinal detachments and optic disc swelling.

PURPOSE: The aim of this case report is to describe a patient with acute lymphoblastic leukemia (ALL) who developed bilateral serous retinal detachments and unilateral optic disc swelling. METHODS: A 23-year-old woman with ALL presented to the ophthalmology clinic with bilateral subacute visual loss. RESULTS: Ophthalmologic examination revealed bilateral serous retinal detachments and unilateral optic disc swelling. Magnetic resonance imaging for differential diagnosis was inconclusive; however, cerebrospinal fluid sampling demonstrated leukemic involvement of the central nervous system. The patient's vision improved and fundus findings resolved with the institution of systemic and intrathecal chemotherapy. CONCLUSIONS: Serous retinal detachment and optic disc swelling are unusual ocular manifestations of ALL. They may occur due to leukemic infiltration of ocular structures and may indicate extramedullary recurrence of the disease. Early recognition and treatment is crucial to improve prognosis.

Clinical outcomes of a new diffractive multifocal intraocular lens.

AIM: To evaluate clinical outcomes after implantation of a new diffractive aspheric multifocal intraocular lens (IOL) with +3.00 addition power. METHODS: This is a retrospective, consecutive case series of cataract patients who underwent bilateral implantation of the Optiflex MO/HF D012 (Moss Vision Inc. Ltd, London, UK) multifocal IOL. Patients followed for 6mo were included in the study. Data on distance, intermediate and near visual acuity, refractive error [manifest spherical equivalent (MSE)], contrast sensitivity, adverse events, subjective symptoms, spectacle independence and patient satisfaction [visual function questionnaire (VFQ)-25 questionnaire] were retrieved from electronic medical records and analyzed. RESULTS: Forty eyes of 20 patients with a mean age of 66.7±8.5y (range: 53-82) were included in the study. Mean uncorrected distance, near and intermediate visual acuity remained stable through postoperative visits and was 0.19±0.19 logMAR, Jaeger 4 and Jaeger 3 respectively at the 6mo visit. At the end of postoperative 6mo, MSE was -0.14±0.42 diopters (D) and 98% of the eyes were within 1.00 D of target refraction. Postoperative low contrast (10%) visual acuity remained stable (P=0.54) through follow up visits with a mean of 0.35±0.17 logMAR at the 6mo visit. There were no reported adverse events. None of the patients reported subjective symptoms of halo or glare. Spectacle independence rate was 90%. Mean VFQ-25 questionnaire score was 93.5±6.12. CONCLUSION: The Optiflex MO/HF-DO12 IOL was safely implanted and successfully restored distance, intermediate and near visual acuity without impairing contrast sensitivity. High levels of spectacle independence were achieved at all distances including intermediate distance.

Early clinical outcome with a new monofocal microincision intraocular lens.

The purpose of this study was to evaluate the early visual and refractive outcomes of a new aspheric monofocal microincision intraocular lens (IOL). This retrospective case series included eyes of patients who underwent implantation of a microincision IOL following 1.8 mm manual coaxial microincision cataract surgery and who attended regular postoperative follow-up visits on the first week and first, third, and sixth months. The postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction and predictability, intraoperative and postoperative complications, posterior capsule opacification (PCO), IOL centration, and surgically induced astigmatism (SIA) were evaluated. Sixty-three eyes of 38 patients ranging in age from 51 to 86 were included in the study. The mean preoperative BCVA was 0.52 ± 0.42 logMAR. At the postoperative sixth month, the mean postoperative UCVA and BCVA were 0.12 ± 0.11 and 0.01 ± 0.03 logMAR, respectively. The mean postoperative spherical equivalent refraction (SER) was -0.30 ± 0.49 D. The SER was within ± 1.00 D of the attempted correction in 95.2 % of the eyes. The mean SIA measured with vector analysis was 0.45 ± 0.28 D. Mild PCO was observed in 9 eyes (14.7 %) with none requiring Nd:Yag laser capsulotomy. On centration analysis, the IOL was found to be 0.26 mm on average to the supero-nasal position. The aspheric microincision IOL was safely implanted and provided satisfactory visual and refractive outcomes in the early postoperative period.

Central corneal thickness in type II diabetes mellitus: is it related to the severity of diabetic retinopathy?

BACKGROUND/AIM: To compare the central corneal thickness (CCT) of type II diabetes mellitus patients with age- and sex-matched healthy subjects and to determine the association of the severity of diabetic retinopathy and CCT. MATERIALS AND METHODS: Type II diabetes mellitus patients without retinopathy, with nonproliferative retinopathy, and with proliferative retinopathy were organized as the three subgroups of the study group, and an age- and sex-matched control group was formed. All subjects underwent full ophthalmological examination and CCT measurement with ultrasonographic pachymetry. CCT values were compared between diabetic and healthy subjects and between the three diabetic subgroups. Correlation analysis was performed to determine any relationship between CCT and intraocular pressure. RESULTS: The average CCT was significantly higher in diabetic patients than in the control group (P = 0.04). CCT in diabetic patients without retinopathy did not significantly differ from that of patients with retinopathy (P = 0.64). Similarly, there was no significant difference in CCT between nonproliferative and proliferative diabetic retinopathy patients (P = 0.47). In the whole study population, CCT was significantly correlated with intraocular pressure (P < 0.01). CONCLUSION: CCT is significantly increased in type II diabetes mellitus patients with respect to controls. Retinal disease severity does not seem to have an effect on corneal thickness.

External Dacryocystorhinostomy for the Treatment of Functional Nasolacrimal Drainage Obstruction.

OBJECTIVES: To determine the outcome and long-term efficacy of external dacryocystorhinostomy (ext-DCR) with or without bicanalicular silicon intubation in patients with functional nasolacrimal drainage obstruction (FNLDO). MATERIALS AND METHODS: Patients with epiphora and patent lacrimal systems on nasolacrimal irrigation were prospectively enrolled in the study. Each patient was assessed with lacrimal scintigraphy to differentiate drainage abnormalities as presac (proximal) or postsac (distal) delays. All patients underwent ext-DCR; bicanalicular silicone intubation was performed only in presac delay cases. On follow-up examinations patients were asked to report their symptoms as none, mild, moderate or unchanged. Success was defined as lacrimal patency to irrigation and no or mild epiphora at the end of the follow-up period. RESULTS: Twenty-six lacrimal systems of 23 patients were eligible for inclusion. There were 9 presac delay and 17 postsac delay cases. Average follow-up time was 72.85 weeks (47-88 weeks). A successful outcome was achieved in 76.9% of the operated lacrimal systems. Success rate was 55.5% among presac obstructions and 88.2% among postsac obstructions. CONCLUSION: The long-term efficacy of ext-DCR in FNLDO patients is confirmed with our overall successful outcome of 76.9%. In preoperative assessment, lacrimal scintigraphy is helpful to determine the surgical approach and to predict the surgical outcome.

Myopia, visual acuity and strabismus in the long term following treatment of retinopathy of prematurity.

The purpose of this retrospective study is to evaluate the long-term ophthalmological outcome in children with retinopathy of prematurity (ROP) who were treated for threshold disease with indirect laser photocoagulation. 107 eyes of 56 patients with threshold ROP treated with indirect laser photocoagulation and 202 eyes of 101 control patients with spontaneously regressed ROP were included. Fixation pattern, ocular motility findings, visual acuity, anterior segment examination, cycloplegic refraction and indirect ophthalmoscopic dilated fundus examination findings of all the included subjects were recorded. The incidence of unfavorable visual outcome defined as Snellen acuity of < 0.2, esotropia, strabismus surgery, nystagmus, myopia (≥ -0.50 D) and astigmatism (≥ 1.50 D) was significantly higher in the treated group than in the control group. These results indicate that premature babies with threshold ROP treated with indirect laser photocoagulation require frequent and long-term follow-up in order to determine refractive status and the presence of ocular motility disorders over time.