Congenital Fibrosis of Extraocular Muscles: A Retrospective Study of 76 Patients.

Background Congenital fibrosis of the extraocular muscles (CFEOM) is a non-progressive sporadic or familial disease characterized by abnormal innervation of the extraocular muscles. This study aims to evaluate the types of diseases, management steps, and surgical outcomes. Methodology A total of 76 patients diagnosed with CFEOM between 2000 and 2022 were evaluated retrospectively. Patients were divided into CFEOM 1, 2, or 3 based on clinical findings. Preoperative and postoperative ocular deviations, as well as abnormal head positions (AHPs), of the patients were evaluated. Excellent outcomes for the head position were defined as less than 5°, good as less than 10°, and poor as greater than 10°. Excellent alignment for strabismus was considered to be less than 10 prism diopters (PD), good as less than 20 PD, and poor as greater than 20 PD. Results The average age at the first surgery in our clinic was 11.6 (1-51) years. The mean follow-up was 28.6 ± 7.4 months (range = 4-56 months). Type 1 disease was detected in 48 (63.2%) patients, type 2 disease in eight (10.5%), and type 3 disease in 20 (26.3%) patients. Of the 49 patients with AHP, 20 achieved excellent outcomes, 17 had good outcomes, and the remaining had poor outcomes. Ocular alignment in the primary position following the latest surgery was excellent in 30 patients, good in 26 patients, and poor in 20 patients. Conclusions No single best surgical method can be universally applied to every patient diagnosed with CFEOM. Patients must be evaluated individually and carefully, and the appropriate surgical procedure must be chosen. In this way, satisfactory gaze alignment and improvement of the AHP can be achieved.

Evaluation of post phacoemulsification inflammation in eyes with and without pseudoexfoliation syndrome according to phaco parameters via laser flare photometry.

BACKGROUND: To compare the changes in anterior chamber laser flare after phacoemulsification and intraocular lens implantation according to phaco parameters in eyes with and without pseudoexfoliation syndrome. METHODS: Patients (39 without pseudoexfoliation (PEX), 28 with pseudoexfoliation) who underwent the surgery with the same device (Centurion System, Alcon Laboratories, USA) and same experienced surgeon were divided according to the presence of PEX. Anterior chamber laser flare was assessed using a laser flare meter (Kowa-FM700, Kowa Company, Japan) by the same blinded researcher. RESULTS: Total CDE, total U/S time, total torsional amplitude on time, average longitudinal power, average longitudinal power (FP3), equivalent average ultrasonic power (FP3) were higher in eyes with pseudoexfoliation (p<0.05 for each). The linear regression model suggested that presence of pseudoexfoliation and total CDE had a positive-correlation with the difference between postoperative day 1 and preoperative anterior chamber laser flare. There were significant differences in preoperative anterior chamber laser flare and those measured on postoperative days 1 and 30 between two groups (p<0.05). CONCLUSIONS: Early-postoperative anterior chamber laser flare is affected by the phaco parameters and there is a positive correlation between intraoperative phaco parameters and anterior chamber laser flare. Anterior chamber laser flare was significantly higher in eyes with pseudoexfoliation both pre- and postoperatively. Patients with pseudoexfoliation especially with high intraoperative total CDE should be followed carefully for early postoperative inflammation.

Effect of clival bone growth on the localization of the abducens nerve at the petroclival region: a postmortem anatomical study.

PURPOSE: To investigate the effect of the clival bone pattern on the abducens nerve (AN) localization in the petroclival region between the Pediatric and Adult Groups. METHODS: This study used 12 pediatric and 17 adult heads obtained from the autopsy. The length and width of the clivus and the length of the petrosphenoidal ligaments (PSLs) were measured. The ratio of the length and width of the clivus was accepted as the clival index (CI). The localization of the AN at the petroclival region below the PSL, classified as lateral and medial, were recorded. RESULTS: The average length of the clivus was 26.92 ± 2.88 mm in the Pediatric Group, and 40.66 ± 4.17 mm in the Adult Group (p < 0.001). The average width of the clivus was 22.35 ± 2.88 mm in the Pediatric Group, and 29.96 ± 3.86 mm in the Adult Group (p < 0.001). The average value of the CI was 1.20 in the Pediatric Group and 1.36 in the Adult Group (p = 0.003). The length of the PSL was 7.0 ± 1.47 mm in the Pediatric Group and 11.05 ± 2.95 mm in the Adult Group (p < 0.001). The nerve was located below the medial side of the PSL in the Pediatric Group and below the lateral side in the Adult Group (p = 0.002). CONCLUSIONS: The petrous apex localization of the AN in adults compared with pediatric subjects could be related to the increased growth in the length of the clivus than its width.

Stabilization Period for Central Corneal Thickness, Anterior Chamber Depth, and Iridocorneal Angle Parameters After Deep Anterior Lamellar Keratoplasty in Keratoconus Patients.

OBJECTIVES: The purpose of this study was to assess the stabilization of anatomical outcomes of central corneal thickness (CCT), anterior chamber depth (ACD), and iridocorneal angle (ICA) in keratoconus-affected eyes after deep anterior lamellar keratoplasty (DALK). METHODS: Keratoconus patients who underwent DALK surgery at Beyoglu Eye Training and Research Hospital between January 2013 and May 2015 were retrospectively analyzed. Patients with data recorded preoperatively, 1 month postoperatively, and 1, 6, and 12 months post suture removal, including refractive status, best corrected visual acuity (BCVA), CCT, ACD, and ICA parameters were included in the study. The CCT, ACD, and ICA parameters were assessed with anterior segment optical coherence tomography. RESULTS: A total of 42 eyes of 37 patients with a mean age of 30.5±10.5 years were analyzed. The mean preoperative and post-suture removal 12th-month BCVA was 1.41±0.43 logarithm of minimal angle of resolution (logMAR), and 0.34 ± 0.1 logMAR, respectively (p<0.001). The ACD (11%; p<0.001) and ICA (3%; p=0.009) values significantly increased, whereas the CCT (2%; p=0.008) decreased after suture removal. The ICA and CCT values demonstrated stability 1 month after suture removal, and the ACD was stable 6 months after suture removal. CONCLUSION: Our study results indicated that the ICA and CCT stabilized 1 month post suture removal and the ACD stabilized 6 months after suture removal. A waiting period of at least 6 months after suture removal is recommended before any post-DALK refractive surgery.

Results of Intravitreal Anti-VEGF Injection in Choroidal Neovascularization Caused by Pathologies Other Than Age-Related Macular Degeneration.

OBJECTIVES: The aim of this retrospective study was to evaluate the efficacy of the intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents to treat choroidal neovascularization (CNV) caused by a pathology other than exudative type age-related macular degeneration (AMD). METHODS: This was a retrospective study of 43 treatment naive eyes of 35 patients who had been diagnosed with CNV caused by a pathology other than exudative- type AMD and who underwent intravitreal injection of anti-VEGF agents. Primary and secondary outcome measures were the best corrected visual acuity (BCVA) and the central macular thickness (CMT). RESULTS: The mean patient age was 44.6±13.1 years. The mean number of injections was 3.3±1.8. The mean logarithm of minimal angle of resolution BCVA at baseline and the 12th month follow-up was 0.89±0.50 and 0.73±0.57, respectively (p=0.120). In all, 44.2% of the eyes gained ≥15 letters of BCVA, whereas 14% lost ≥15 letters of BCVA. The mean CMT at baseline and the 12th month follow-up was 381±121 and 311±73 microns, respectively (p=0.001). CONCLUSION: Stabilized functional and improved anatomic outcomes following intravitreal anti-VEGF agent injection for CNV unrelated to AMD were seen at the 12th month of follow-up.

Comparison of Thalamus Volume on Magnetic Resonance and Cadaveric Section Images.

AIM: To measure and to compare the volume of thalamus using magnetic resonance imaging (MRI) and the anatomical sections. MATERIAL AND METHODS: In this study, 13 brain specimens were used. First, the images were taken in 3 mm sections on MRI, the thickness of the thalamus was measured. Subsequently, 4 mm coronal sections were prepared using a microtome. The thalamic volumes calculated from cadaveric specimens were compared with the measurements obtained using MRI. RESULTS: On MRI, the mean thalamic volumes on the right and left hemispheres were found to be 5843.4 ± 361.6 mm3 and 5377.0 ± 666.2 mm3 respectively. The mean volumes of the cadaveric sections were 5610.8 ± 401.3 mm3 on the right side and 5618.5 ± 604.1 mm3 on the left hemisphere. No statistically significant difference was found between the volume calculated from MRI and that obtained from the cadaveric section (p < 0.05). CONCLUSION: This study shows a correlation between measurement of thalamus volume based on MRI and those calculated from anatomical sections. Our findings support the reliability of DBS procedures using MRI and stereotactic method.

Research on the Effects of Levetiracetam in Spinal Cord Injury Model in Rats: An Experimental Study.

Purpose: Despite advances in spinal biomechanic research, surgical techniques, and rehabilitation processes, no significant improvement has been identified in the treatment of spinal cord injury (SCI) and neurological recovery. Aim of the Study: This study was designed to investigate the potential therapeutic effects of methylprednisolone and levetiracetam on SCI. Materials and Methods: In this study, 42 male Wistar Albino rats, each weighing 300-350 g, were separated into three main groups: control group, acute and subacute stage groups. With the exception of the control group, a T7-8 dorsal laminectomy was performed on the spinal column of the rats. A temporary vascular aneurysm clip was then applied to the spinal cord for 1 min to create SCI and methylprednisolone or levetiracetam was administered intraperitoneally to all except the control and SHAM control groups. The damaged spinal cord was removed for histopathological and biochemical examinations. Results: Both pharmacological agents were determined to have improved the histopathological architecture in damaged neural tissues during the acute period of SCI, but could not sustain this activity in the subacute period. Neither pharmacological agent affected the biochemical data in the acute nor subacute stages. Conclusions: Both pharmacological agents showed histopathological healing effects in injured tissues during the acute phase of SCI in this rat model but these effects could not be sustained in the subacute period. No effect on biochemical data was seen in either the acute or subacute period. There is a need for further advanced studies to determine the effects of levetiracetam on the healing processes in SCI.

Sonoelastographic evaluation of the sciatic nerve in patients with unilateral lumbar disc herniation.

OBJECTIVE: The aim of this study was to compare strain elastography (SE) and shear wave elastography (SWE) findings of the sciatic nerve in patients with unilateral lumbar disc herniation (LDH) and healthy control subjects. MATERIALS AND METHODS: The study group included patients with complaints of unilateral sciatica for 3-12 months, with foraminal stenosis due to one level of LDH (L4-L5 or L5-S1). An age- and gender-matched control group was formed of healthy subjects. Evaluations were performed on both the axial and longitudinal planes from the bilateral gluteal region using a 5-9 MHz multifrequency convex probe. RESULTS: There were 40 patients (20 male, 20 female) with a mean age of 43.1 ± 12.7 years in the study group, and 40 healthy subjects (22 male, 18 female) with a mean age of 42.9 ± 10.7 years in the control group (p > 0.05). The sciatic nerve stiffness assessed on both the axial (12.3 ± 3.7 kPA) and longitudinal (14.3 ± 3.8 kPA) planes of the involved side was significantly higher than non-involved side (axial: 6.8 ± 2.1 and longitudinal: 8.3 ± 2.3 kPA) in the patient group (p < 0.001). CONCLUSIONS: Patients with unilateral LDH have increased stiffness of the sciatic nerve compared to healthy control subjects. Although the findings in this preliminary study show that shear wave elastography can detect a change in sciatic nerve stiffness in patients with unilateral LDH, larger studies are required to determine the clinical utility of this technique.

Analysis of biochemical laboratory values to determine etiology and prognosis in patients with subarachnoid hemorrhage: a clinical study.

OBJECTIVES: The aim of this study was to establish prognostic and predictive markers in patients with subarachnoid hemorrhage (SAH) using simple laboratory methods. METHODS: A retrospective examination was made of patients with SAH diagnosed secondary to isolated head trauma, isolated anterior communicating artery aneurysm rupture, and angiography-negative SAH. Age, gender, Glasgow Coma Scale (GCS) scores, and Fisher's grade scores, Glasgow Outcome Scale (GOS) scores, leukocyte count, neutrophil count, lymphocyte count, platelet count, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio results (PLR) were evaluated. RESULTS: NLR and PLR values, which were similar in patients with spontaneous SAH, were significantly high in patients with traumatic SAH. NLR and PLR values could be 80% sensitive and 75% specific for distinguishing traumatic SAH from spontaneous SAH. Eosinophil count was lower in patients with angiography-negative SAH and patients with aneurysmal SAH than in patients with traumatic SAH. Initially measured GCS score, Fisher's grade score, eosinophil, neutrophil and lymphocyte counts could be prognostic in all patients with SAH. Moreover, it was concluded that the initially measured number of eosinophils might be directly related to patient prognosis. The eosinophil count was generally found to be high in traumatic SAH patients and it was observed that this parameter could be predictive for these patients. Lymphocyte count and NLR values could be prognostic markers in patients with angiography-negative SAH. CONCLUSION: NLR, PLR and eosinophil count values could be predictive for etiological factors (traumatic SAH or spontaneous SAH) of patients who were admitted unconscious to the emergency room with SAH detected on radiological imaging.

The real life data of ranibizumab use among the diabetic macular edema patients in Turkey: Documenting the improvement with clinical optimization during three consecutive years.

PURPOSE: To report the 12 month real life outcomes of ranibizumab treated diabetic macular edema (DME) patients. METHODS: Treatment naïve DME patients treated with ranibizumab were included. Patients were divided into three groups according to their hospital admittance years (2013, 2014, and 2015) and were compared in regards to the treatment outcomes. RESULTS: The mean visual acuity change from baseline to month 12 was not statistically significant in 2013 at month 12. The mean BCVA change from baseline to month 12 was statistically better at month 12 in 2014 and 2015. There was a statistically significant difference among the three groups in regards to both mean visit and injection numbers. The mean visit number in 2013 and 2014 were both lower than 2015. The mean injection number in 2013 was lower than both 2014 and 2015. CONCLUSIONS: It is effortful to obey the strict follow-up criteria of prospective studies in DME patients on a PRN regimen. However, optimizing the clinical processes of patient management may lead to improved clinical outcomes in real life.

An Evaluation of the Quality of Sleep Before and After Surgical Treatment of Patients with Cervical Disc Herniation.

OBJECTIVE: It has been reported in recent studies that 50-80% of patients with cervical disc hernia have concomitant sleep disorders. The aim of this study was to evaluate the quality of sleep before and after surgical treatment in patients with cervical disc hernia and to assess the effects on treatment. METHODS: The study included 32 patients performed discectomy and fusion with an intervertebral cage through the right anterior cervical approach. Oswestry Disability Index (ODI), Visual Analog Scale (VAS) and Pittsburgh Sleep Quality Index (PSQI) were applied to all patients preoperatively and at one month postoperatively. RESULTS: The postoperative PSQI total points and all the PSQI subscale points, the ODI and VAS scores were significantly reduced compared to the preoperative values. A positive correlation was determined between the preoperative ODI points and the PSQI total points and sleep duration, sleep latency and daytime functional loss subscale points. A positive correlation was also found between preoperative ODI points and VAS points. A positive correlation was determined between the preoperative VAS points and and the PSQI total points and sleep duration, and sleep latency subscale points. A negative correlation was determined between the postoperative ODI and the daytime functional loss subscale points. CONCLUSION: The results of the study showed that in patients with cervical disc hernia, sleep quality and daytime functionality were negatively affected by severity of pain that limited daily activities. Bringing the pain under control with surgical treatment was observed to increase sleep quality. It can be concluded that when planning treatment for these patients, it should be taken into consideration that there could be a sleep disorder in addition to the complaints and symptoms such as pain, hypoestesia and loss of strength.

Evaluation of posterior clinoid process pneumatization by multidetector computed tomography.

In the present study, we investigated the types and ratio of posterior clinoid process (PCP) pneumatization in paranasal sinus multidetector computed tomography (MDCT). Paranasal MDCT images of 541 subjects (227 males, 314 females), between 15 and 65 years old, were included into the study. Pneumatization of anterior clinoid process and pneumatization types (I, II, or III) were evaluated in the males and females. PCP pneumatization was detected in 20.7 % of the males and 11.5 % of the females. Right, left, and bilateral PCP pneumatizations were detected in 7.9, 5.7, and 7.0 % of the males and 2.9, 3.2, and 4.5 % of the females, respectively. PCP pneumatization of the males is significantly higher than the females. The most detected type of pneumatization was type I (61.2 %) for all groups. In right, left, and bilateral pneumatizations separately, type I pneumatization was the most detected pneumatization type with the ratio of the 70.4, 65.2, and 50.0 %, respectively. In males, type I (61.7 %), and similarly in females, type I (60.6 %) pneumatization were detected more. Type II and type III pneumatizations were detected in decreasing order in both groups. In younger subjects, pneumatization of posterior clinoid process was found as higher, and in older subjects, PCP pneumatization was found as lower. Sclerosis process related to the aging may be responsible for the lower pneumatization ratios in older subjects. Structure of the surrounding regions of PCP is important for surgical procedures related to cavernous sinus, basilar apex aneurysms, and mass lesions. Preoperative radiological examinations are useful for operative planning. Any anomalies to PCP can cause unnecessary injury to the neurovascular complex structure around the cavernous sinus or postclinoidectomy CSF fistulas. Posterior clinoidectomies should be avoided in patients with type III PCP pneumatization to prevent CSF fistulas.

Investigation of the calcification at the petroclival region through Multi-slice Computed Tomography of the skull base.

OBJECTIVES: The aim of this paper was a retrospective investigation of calcification at the petroclival region using Multi-slice Computed Tomography (MSCT). METHODS: One hundred thirty skull bases were reviewed. The images were acquired with a 64 slice CT (MSCT). At first images were taken at the axial plane; and then coronal and sagittal reconstructions of raw data were performed. Later investigations were carried out on these 3-dimensional images (3-D imaging). Petrosphenoidal ligament (PSL) (Gruber's ligament) and posterior petroclinoid ligament (PPCL) calcifications were evaluated as "none, partial or complete calcification" for the right and left sides. RESULTS: In the right PSL, there were partial calcifications in 9.8% and complete calcifications in 2.3%. Calcification ratio was 9.8% partial and 2.9% complete in the left PSL. In the right side, there were 26.6% partial and 5.2% complete calcifications of PPCL. In the left side, there were 29.5% partial and 4.6% complete PPCL calcifications. PPCL calcification was detected more in males compared to females in the right and left sides. In older patients, left PSL; right and left PPCL calcification were detected more. CONCLUSION: PPCL calcifications cannot be differentiated from PSL calcifications in MSCT slices. The distinction can be easily done in 3-D views. The presence of ossified ligaments may make surgeries in this region difficult, and special care has to be taken to avoid injuries to structures which pass under these ossified ligaments. Particularly in elderly patients, the appropriate surgical instrument for the PSL calcifications should be prepared preoperatively. If PSL is calcified, 6th cranial nerve palsy may not occur even though increased intracranial pressure syndrome is present. Whereas, in lateral trans-tentorial herniations, 3rd cranial nerve palsy occurs in earlier periods when PSL is calcified. Moreover, in subtemporal and transtentorial petrosal approaches, knowing the PSL calcification preoperatively is important to avoid damaging the 6th cranial nerve during surgery.

Long-term Results of Small-incision Lenticule Extraction in High Myopia.

OBJECTIVES: To evaluate two-year results of small-incision lenticule extraction (SMILE) for correction of high myopia. MATERIALS AND METHODS: Forty-five eyes of 35 patients with mean spherical equivalent (SE) of -7.10±0.95 D who underwent routine SMILE by a single surgeon and were followed for at least 2 years were analyzed by retrospective chart review. SMILE was performed with a Visumax femtosecond laser (Carl Zeiss Meditec, Jena, Germany). Follow-up intervals were at 1, 6, 12, and 24 months after surgery. Uncorrected and best corrected distance visual acuity (CDVA), corneal wavefront measurements, and all complications were recorded. RESULTS: After 2 years, 86% of eyes with plano target had an uncorrected distant visual acuity (VA) of 20/20 or better. Two percent of eyes lost 1 line of CDVA, while 32% gained 1 line. The mean SE after 2 years was -0.30±0.50 D. Corneal total high-order aberrations (HOA) increased from 0.43 to 0.92 µm at postoperative 12 months. There were metallic foreign bodies at the corneal interface in 1 eye of 1 patient which caused no decrease in VA. CONCLUSION: SMILE for high myopia seems safe and effective in light of two-year follow-up results. The procedure caused a moderate increase in HOA.

The Presence of Clival Foramen Through Multidetector Computed Tomography of the Skull Base.

OBJECTIVES: Technological advancements in the diagnostic radiology recently permitted reviewing the normal anatomy through multidetector computed tomography (MDCT) imagination. The aim of this paper is retrospectively investigation of the clival foramen and canal through MDCT. MATERIALS AND METHODS: One hundred eighty-six MDCT scans were reviewed. First, images were taken at axial plane, and then coronal and sagittal reconstructions of raw data were performed. Later investigations were carried out on these three-dimensional images (3-D imaging). The images were evaluated as clival foramen "present" or "absent." RESULTS: In our 186 patients, evaluation of MDCT showed that clival foramen was absent in 66.7% (n = 124) of patients. Only 33.3% (n = 62) of patients had a clival foramen. In 3-D images, clival canal and clival foramen were shown more clearly compared with the MDCT. CONCLUSIONS: Knowledge of the clival canal might be useful in patients of questionable clival fracture or during neurosurgical operations in this region. During life the canal contained a vein connecting the basilar plexus with the venous plexus of the vertebral canal, and inferior petrosal sinuses. Before the surgical interventions in the clival region, the presence of the clival canal and foramen should also be known due to its vascular contents. By multidetector computed tomography and 3-D images, clival canal and foramen may be viewed preoperatively.