Non-ocular risk factors in Turkish children with strabismus and amblyopia.

BACKGROUND: To evaluate non-ocular risk factors including family history, febrile seizure, history of trauma, neurological diseases, and prematurity in Turkish children with strabismus and amblyopia. METHODS: The records of patients diagnosed with strabismus and/or amblyopia below 18 years old, were recruited. The current mean age, sex, types and subtypes of strabismus and amblyopia, family history, history of trauma, and febrile seizure were investigated. The presence of neurological diseases and prematurity were noted. Family history was investigated whether the presence of strabismus or amblyopia was maternal or paternal. Blood relatives were divided into 3 groups including first, second, and third-degree relatives. The relationship between blood relative degrees and types of strabismus or amblyopia were assessed. RESULTS: There were 803 patients with a current median age of 8 years (1-29 years). Of these patients, 786 patients could be evaluated and 55% had esotropia (ET), 32.6% had exotropia (XT) and 12.5% had amblyopia as a primary diagnosis. Positive family history of strabismus or amblyopia was more common among all risk factors. There was a statistically significant rate of patients with a positive family history in the first-degree relatives, in the esotropic patient group (p= 0.002). Maternal positive family history was more common in patients with refractive ET (p= 0.024) and paternal positive family history was more common in patients with intermittent XT (p= 0.009). CONCLUSIONS: The rates of positive family history of amblyopia and strabismus were not statistically different. Family history of strabismus in first-degree relatives of patients with esotropia was markedly high. The family history of strabismus on the maternal or paternal side might be different in patients with different subtypes of strabismus.

The effect of pterygium surgery on intraocular lens power and ocular biometric parameters.

AIMS: To evaluate the effect of pterygium surgery on intraocular lens (IOL) power and ocular biometric parameters and to evaluate the factors affecting these parameters. METHODS: Twenty-eight eyes of 25 patients diagnosed with pterygium were evaluated. Axial length (AL), mean keratometry (Sim K), K1, K2, anterior chamber depth (ACD), corneal astigmatism, and ocular biometry parameters were obtained with a dual Scheimpflug analyzer. Pterygium sizes (horizontal, vertical) were measured manually, and pterygium height was analyzed with anterior segment optic coherence tomography. IOL power was calculated according to SRK/T, SRK II, Hoffer Q, Haigis, and Holladay formulas. Limbal conjunctival autograft was performed in all patients after excisional pterygium surgery. Preoperative and postoperative 1st month measurements were analyzed and compared. RESULTS: The mean age of the patients was 51.5 ± 13.8 years. Mean horizontal pterygium length, vertical width, height, and percentage extension of the pterygium were 2.4 ± 0.9, 4.7 ± 1.0 mm, 297 ± 93µm, and 20.2 ± 7.2%, respectively. There was a significant increase in Sim K, K1, and K2 values postoperatively. Postoperative IOL power was significantly lower than preoperative values in all formulas. The change in IOL power after surgery was -0.3 ± 0.6D in the SRKT, -0.3 ± 0.5D in SRK II, -0.4 ± 0.7D in Hoffer Q, -0.5±0.7D in Haigis, and -0.3 ± 0.7D in Holladay 2 formulas. The change in IOL power has a moderate positive linear correlation with the horizontal and vertical sizes of the pterygium and a high positive linear correlation with the percentage extension of the pterygium. CONCLUSIONS: Pterygium surgery causes a significant decrease in calculated IOL power obtained with all formulas. It becomes more pronounced with the increase in the size of the pterygium.

The effect of amblyopia on clinical outcomes of children with astigmatism.

BACKGROUND: Amblyopia is more common in children with high astigmatism, but factors contributing to development of amblyopia and visual outcomes are not fully understood. OBJECTIVE: To evaluate the effect of amblyopia on the clinical outcomes in children with ⩾1.75 diopter (D) astigmatism. METHODS: We reviewed the medical records of children with ⩾1.75 D astigmatism with and without amblyopia (amblyopes group and non-amblyopes group). The mean age, gender, amount and type of ocular deviation, presence of convergence insufficiency (CI), stereopsis, time of initial spectacle use and follow-up time, differences in best-corrected visual acuity (VoD) and spherical equivalent (SE) between eyes were assessed and compared between the groups. Best-corrected visual acuity (BCVA), mean SE, astigmatism measurements were assessed and compared between amblyopic, fellow, and non-amblyopic eyes. RESULTS: The records included 68 eyes of 34 children with amblyopia and 56 eyes of 28 children without amblyopia. The mean age, gender, amount and type of ocular deviation, presence of CI, stereopsis, time of initial spectacle use, follow-up time, and the difference in SE did not differ between groups. In amblyopes, exodeviation was more common and statistically greater in near (33 cm) than at distance (6 m) (p = 0.005). The mean BCVA and astigmatism values were statistically different between amblyopic, fellow, and non-amblyopic eyes. CONCLUSION: A greater near than distance exodeviation and higher mean astigmatism value were found in amblyopic children with astigmatism.

Strong fixation preference in patients with manifest exotropia: Does it matter or not?

PURPOSE: To evaluate the influence of strong fixation preference on clinical and surgical outcomes, in non-amblyopic patients with basic-type intermittent exotropia (IXT). MATERIALS AND METHODS: The records of patients were retrospectively investigated. Non-amblyopic patients with the diagnosis of basic-type IXT were enrolled and divided into two groups according to the presence of strong fixation preference (SFP). Best-corrected visual acuity, refractive errors, deviations in near and distance, convergence patterns, motor fusion, stereopsis were evaluated and compared. Patients who underwent surgery in each group composed subgroups and postoperative deviations, convergence patterns, motor fusion, and stereopsis were compared. RESULTS: Seventy-seven patients were enrolled and divided into two groups according to the presence of SFP: patients with SFP composed Group 1 and patients with alternating fixation composed Group 2. Statistically significant difference was seen between groups in terms of motor fusion (p: 0.02). Other parameters did not differ between groups. Data obtained from patients in subgroups of each group were not statistically different. CONCLUSION: The evaluation of basic-type exotropic patients according to their fixation preference revealed us that motor fusion might be affected by strong fixation preference. We also observed that SFP did not affect surgical success rates, convergence patterns, and stereopsis of exotropic patients.

Corneal topography, anterior segment and high-order aberration assessments in children with ≥ 2 diopter astigmatism.

PURPOSE: To assess topographic findings, anterior segment parameters and high-order aberrations (HOAs) by using corneal tomography in children with 2 diopters (dp) or more astigmatism. METHODS: Children with 2 dp or more astigmatism (study group) and children with astigmatism less than 1 dp (control group) were recruited. Corneal astigmatism, mean, steep, flat keratometry (K) findings, anterior and posterior K results and anterior segment parameters including anterior chamber depth, kappa distance, horizontal corneal diameter, mean, central, middle, peripheral corneal thicknesses (CT), white-to-white (WTW) distance and pupil diameter were measured by Galilei G4 Dual Scheimpflug corneal tomography. HOAs were also assessed and compared between groups. RESULTS: Fifty-eight eyes of 37 children in the study group and 37 eyes of 37 children in the control group were enrolled. The mean ages of groups were 9.7 ± 2.4 years and 9.3 ± 1.6 years in study and control groups, respectively. The mean astigmatism was 3.3 ± 1.1 dp and 0.5 ± 0.3 dp in study and control groups, respectively (p < 0.05). Total corneal astigmatism was 3.3 ± 0.84 dp and 1.14 ± 0.47 dp in study and control groups, respectively (p < 0.05). There was a significant difference between groups in terms of posterior steep K and posterior astigmatism values. Among anterior segment parameters, mean CT and WTW values were statistically different between groups. HOAs were found to be statistically different between groups. CONCLUSION: Higher posterior corneal astigmatism, thinner mean CT and lower WTW distance were found in children with 2 dp or more astigmatism. Besides, HOAs were much more in these astigmatic children.

Effects of topical antiglaucomatous medications on central corneal epithelial thickness by anterior segment optical coherence tomography.

PURPOSE: To evaluate the effect of topical antiglaucomatous medications on central corneal epithelial thickness measured by anterior segment optical coherence tomography. MATERIALS AND METHODS: A total of 153 eyes of 153 patients using topical antiglaucomatous medications and 110 eyes of 110 control subjects were enrolled. Glaucoma type, duration of therapy, the number of drugs, and drops/day were noted in the patient group. Patients and control subjects underwent ocular examinations including Schirmer test, slit lamp examination for tear film break-up time, and anterior segment optical coherence tomography for central corneal thickness and central corneal epithelial thickness. Central corneal epithelial thickness and other data were evaluated separately with regard to glaucoma type, duration of therapy, the number of drops, and drugs in the patient group. RESULTS: The mean ages of the patients and controls were 60.1 ± 10.8 and 58.7 ± 11.2 years, respectively. The groups were similar with regard to mean age and gender (p = 0.058, p = 0.734, respectively). The median (interquartile range) central corneal thickness was 536 (54) µm in patients and 552 (53) µm in controls (p = 0.011). The median (interquartile range) central corneal epithelial thickness of patients and controls were 56 (4) µm and 60 (8) µm, respectively (p < 0.001). The median (interquartile range) tear film break-up time and Schirmer were 12 (6) s and 10 (8) mm in patients and 16 (2) s and 18 (4) mm in controls, respectively (p < 0.001, p < 0.001). In patient group, there was no significant difference in the median central corneal thickness, central corneal epithelial thickness, and tear film break-up time in terms of glaucoma type, duration of therapy, the number of drugs, and the number of daily drops. Only the median Schirmer test was found to be statistically lower in terms of number of daily eye drops (p = 0.039). CONCLUSION: Using topical antiglaucomatous medications seems to affect the central corneal epithelial thickness in glaucoma patients. Central corneal epithelial thickness was thinner in glaucoma patients than controls. Anterior segment optical coherence tomography might be helpful to evaluate the effect of antiglaucomatous medications on central corneal epithelial thickness during treatment.

Evaluation of fundus autofluorescence maging of diabetic patients without retinopathy / Avaliação do exame de imagem de autofluorescência do fundo do olho em pacientes diabéticos sem retinopatia

ABSTRACT Purpose: To evaluate the usefulness of fundus autofluorescence imaging of diabetic patients without retinopathy to investigate early retinal damage. Methods: Fundus autofluorescence images of patients with type 2 diabetes mellitus without retinopathy (diabetic group) and age-sex matched healthy patients (control group) were recorded with a CX-1 digital mydriatic retinal camera after detailed ophthalmologic examinations. MATLAB 2013a software was used to measure the average pixel intensity and average curve width of the macula and fovea. Results: Fifty-six eyes of 28 patients, as the diabetic group, and 54 eyes of 27 healthy patients, as the control group, were included in this study. The mean aggregation index was 168.32 ± 37.18 grayscale units (gsu) in the diabetic group and 152.27 ± 30.39 gsu in the control group (p=0.014). The mean average pixel intensity value of the fovea was 150.87 ± 35.83 gsu the in diabetic group and as 141.51 ± 31.10 gsu in the control group (p=0.060). The average curve width value was statistically higher in the diabetic group than in the control group (71.7 ± 9.2 vs. 59.4 ± 8.6 gsu, respectively, p=0.03). Conclusion: Fundus autofluorescence imaging analysis revealed that diabetic patients without retinopathy have significant fluorescence alterations. Therefore, a noninvasive imaging technique, such as fundus autofluorescence, may be valuable for evaluation of the retina of diabetic patients without retinopathy.

RESUMO Objetivo: Avaliar a utilidade da autofluorescência do fundo de olho de pacientes diabéticos sem retinopatia para investigar lesões precoces na retina. Métodos: Imagens de autofluorescência do fundo de olho de pacientes com diabetes mellitus do tipo 2 sem retinopatia (grupo diabético) e indivíduos saudáveis pareados por idade e sexo (grupo controle) foram registrados com uma câmera retiniana digital midriática CX-1 após exames oftalmológicos detalhados. O software MATLAB 2013a foi usado para medir a intensidade média do pixel e a largura média da curva da mácula e fóvea. Resultados: Cinquenta e seis olhos de 28 pacientes, como o grupo diabético, e 54 olhos de 27 indivíduos saudáveis, como grupo controle, foram incluídos neste estudo. O índice médio de agregação foi de 168,32 ± 37,18 unidades de escala de cinza (gsu) no grupo diabético e em 152,27 ± 30,39 gsu no grupo controle (p = 0,014). O valor médio da intensidade de pixel na fóvea foi de 150,87 ± 35,83 gsu no grupo diabético e de 141,51 ± 31,10 gsu no grupo controle (p=0,060). O valor médio da largura da curva foi estatisticamente maior no grupo diabético do que no grupo controle (71,7 ± 9,2 vs. 59,4 ± 8,6 gsu, respectivamente; p = 0,03). Conclusão: A análise por imagens de autofluorescência de fundo de olho revelou que pacientes diabéticos sem retinopatia apresentam alterações significativas de fluorescência. Portanto, uma técnica de imagem não invasiva, como a autofluorescência de fundo de olho, pode ser valiosa para a avaliação da retina de pacientes diabéticos sem retinopatia.

CORRELATIONS between Functional and Structural Tests Measured by Spectral Domain Optical Coherence Tomography in Severe Glaucoma.

Purpose: To evaluate the relationship between visual acuity, visual field and spectral domain optical coherence tomography (OCT) parameters, including retinal nerve fiber layer (RNFL), ganglion cell-internal plexiform layer (GC-IPL) thicknesses, and optic nerve head parameters in patients with severe glaucoma. Material and Methods: Patients with the diagnosis of severe glaucoma were recruited from the data gathered at our glaucoma department. A detailed ophthalmic examination was performed using the Standard Automated Perimetry (the 30-2 SITA standard program was used for VF testing). Cirrus EDI-OCT was used for peripapillary RNFL and GC-IPL thickness measurements. Optic nerve head parameters, including mean cup-to-disc (c/d) ratio, rim area, vertical c/d ratio, cup volume, were also measured by spectral domain OCT. Correlations between these structural parameters and functional parameters (visual acuity, VF parameters) were investigated. Results: Forty-one eyes of 34 patients with severe glaucoma were enrolled in this study. Correlations between BCVA and mean GC-IPL thickness (p = .03), superior GC-IPL thickness (p = .03), inferonasal GC-IPL thickness (p = .01), superonasal GC-IPL thickness (p = .01), superotemporal GC-IPL thickness (p = .04), and rim area (p = .00) were found to be positive statistically significant. There was also a positive statistically significant correlation between MD and inferotemporal GC-IPL thickness (p = .03). Negative statistically significant correlations were found between BCVA and mean c/d ratio (p = .00), vertical c/d ratio (p = .02) and cup volume (p = .00). Discussion: Mean, superior, inferonasal, superonasal, and superotemporal GC-IPL thicknesses and mean c/d ratio, vertical c/d ratio and cup volume were found to be correlated with BCVA in patients with severe glaucoma.

Evaluation of fundus autofluorescence imaging of diabetic patients without retinopathy.

PURPOSE: To evaluate the usefulness of fundus autofluorescence imaging of diabetic patients without retinopathy to investigate early retinal damage. METHODS: Fundus autofluorescence images of patients with type 2 diabetes mellitus without retinopathy (diabetic group) and age-sex matched healthy patients (control group) were recorded with a CX-1 digital mydriatic retinal camera after detailed ophthalmologic examinations. MATLAB 2013a software was used to measure the average pixel intensity and average curve width of the macula and fovea. RESULTS: Fifty-six eyes of 28 patients, as the diabetic group, and 54 eyes of 27 healthy patients, as the control group, were included in this study. The mean aggregation index was 168.32 ± 37.18 grayscale units (gsu) in the diabetic group and 152.27 ± 30.39 gsu in the control group (p=0.014). The mean average pixel intensity value of the fovea was 150.87 ± 35.83 gsu the in diabetic group and as 141.51 ± 31.10 gsu in the control group (p=0.060). The average curve width value was statistically higher in the diabetic group than in the control group (71.7 ± 9.2 vs. 59.4 ± 8.6 gsu, respectively, p=0.03). CONCLUSION: Fundus autofluorescence imaging analysis revealed that diabetic patients without retinopathy have significant fluorescence alterations. Therefore, a noninvasive imaging technique, such as fundus autofluorescence, may be valuable for evaluation of the retina of diabetic patients without retinopathy.

Central corneal epithelial thickness changes after half-moon supracapsular nucleofractis phacoemulsification technique.

PURPOSE: To find out the effect of half-moon supracapsular nucleofractis technique on central corneal epithelial thickness (CET) measured by spectral domain anterior segment optical coherence tomography (AS-OCT). MATERIALS AND METHODS: Patients who underwent uneventful cataract surgery by the same surgeon with the same technique were recruited in this study. The effective phaco time (EPT) was recorded in each surgery. Central CET was measured by AS-OCT 1 day before and 1, 3, 7 days after surgery. CET was measured without precorneal tear film layer, and non-epithelial central corneal thickness was also calculated manually. Preoperative and postoperative values were compared by statistical analysis. RESULTS: Thirty-one eyes of 31 patients were included in this study. The mean age of patients was 65.03 ± 11.47 years. On the first day of surgery, increase in mean CET was statistically significant, but on the 3rd and 7th day after surgery, this increase was declined (p = 0.001, p = 0.367, p = 1, respectively). A statistically significant positive correlation was found between mean EPT and mean CET on the first postoperative day (p = 0.013, r = 0.470). On the 3rd and 7th day, this correlation was not statistically significant (p = 0.055, p = 0.454, respectively). CONCLUSION: Mean central CET was statistically thicker and positive correlated with EPT on the first postoperative day. But on the 7th day, it declined to preoperative values.

Factors influencing stereopsis in patients with both refractive accommodative esotropia and amblyopia.

PURPOSE: Potential factors influencing stereopsis were investigated in patients with both refractive accommodative esotropia (RAE) and amblyopia. MATERIALS AND METHODS: A retrospective chart review was performed to find out all patients with the diagnosis of both RAE and amblyopia. Patients are classified into two groups: group 1 (with stereopsis) and group 2 (without stereopsis). Onset age of RAE, history of strabismus in family members, time of amblyopia treatment, mean spherical equivalent, anisometropia, ocular movement disorders, especially, overaction of inferior oblique (IO) muscle, visual acuity difference (VAD) between eyes, best-corrected visual acuity (BCVA) levels of amblyopic and normal eyes and the presence of alternation of fixation (AOF) were investigated as possible factors. These factors were compared statistically between groups. RESULTS: Groups 1 and 2 consisted of 21 and 26 patients, respectively. There was no statistical significant difference in terms of onset age of RAE, family history, amblyopia treatment, BCVA of normal eyes and anisometropia. IO overaction and higher VAD were found to be statistically different between groups (p: 0.019, p: 0.022, respectively). Besides, there was significant difference in terms of AOF and better BCVA in amblyopic eyes (p: 0.000, p: 0.009, respectively). CONCLUSION: IO overaction, BCVA in amblyopic eyes, VAD and AOF were found to be potential risk factors for the development of stereopsis in patients with both RAE and amblyopia.

Toxic anterior segment syndrome after uncomplicated cataract surgery possibly associated with intracamaral use of cefuroxime.

PURPOSE: To report toxic anterior segment syndrome (TASS) after cataract surgery possibly associated with intracameral use of cefuroxime. METHODS: We conducted a retrospective chart review and analysis on the pre- and postoperative conditions of the subjects who had developed TASS. RESULTS: The patient group consisted of 17 patients. Tyndallization and fibrin fibers were positive in all eyes. In four eyes, hypopyon formation developed. These reactions diminished on the third day and fully resolved 1 week after the operations with the use of intensive topical steroid and mydriatic therapy. To determine the etiology of TASS, infusion fluid, viscoelastics, and intracameral antibiotic agent were changed respectively. After changing intracameral antibiotic agent from cefuroxime axetile to moxifloxacin no new cases of TASS were diagnosed. CONCLUSION: All agents injected into the anterior chamber can cause TASS. Ophthalmologists and operating room staff need to pay careful attention to all drugs and irrigating solutions.