Cutaneous Anthrax on the Upper Eyelid.

A 46-year-old female patient, who presented with a black, crusty lesion on the upper eyelid, was diagnosed with cutaneous anthrax after the detection of Bacillus anthracis in the skin culture. It was determined that the symptoms started after she cooked the meat she bought from a butcher. Anthrax is a disease that should be kept in mind in cutaneous infections even in isolated lesions, especially in endemic areas.

Paralytic Strabismus in Turkish Children Examined at Three Tertiary Care Services: A Retrospective Cohort Study.

PURPOSE: To assess the etiology and distribution of pediatric ocular motor nerve palsy manifesting as paralytic strabismus. METHODS: The authors retrospectively examined the medical files of patients younger than 18 years who were suspected to have strabismus between January 1999 and June 2012 in three Turkish clinics and followed up for at least 6 months. Patients with paralytic strabismus were stratified according to age, sex, affected cranial nerve, and etiology (congenital, traumatic, neoplastic, post-viral, vascular, undetermined, or other), and compared the proportions between groups. RESULTS: Paralytic strabismus was observed in 33 of 1,263 patients (2.6%), with a mean age of 5.9 ± 4.4 years (range: 6 months to 16 years). Seventeen patients (51.5%) were boys and 16 (48.5%) were girls. Twelve patients (36.4%) had congenital paralytic strabismus, and 21 patients (63.6%) had acquired strabismus. The most prevalent cause of acquired paralytic strabismus was trauma in 11 patients (52.4%), undetermined in 6 patients (28.6%), post-viral cranial nerve paralysis in 3 patients (14.3%), and a history of hydrocephalus in 1 patient (9.1%). The fourth cranial nerve was the most frequently affected (45.5% [15 of 33]), followed by the sixth (39.4% [13 of 33]) and the third (15.2% [5 of 33]). CONCLUSIONS: Evaluating the incidence and etiology of paralytic strabismus in children in a clinical setting may improve disease management and reduce unnecessary invasive examinations. This study will assist clinicians in understanding the clinic-based distribution of pediatric paralytic strabismus. [J Pediatr Ophthalmol Strabismus. 2021;58(5):282-286.].

YKL-40 is a local marker for inflammation in patients with pseudoexfoliation syndrome.

PURPOSE: To investigate the YKL-40, as a marker of inflammation, in aqueous humor and serum of cataract patients with and without pseudoexfoliation syndrome (PEX). METHODS: Aqueous humor and serum samples were obtained from 44 patients who underwent phacoemulsification surgery. All patients were divided into two groups: PEX (n = 24) and control (n = 20). YKL-40 levels were measured with enzyme-linked immunosorbent assay (ELISA). The differences between the groups were assessed by using Chi-square and independent sample t-tests. The Pearson correlation coefficient was used to evaluate the correlation between variables. RESULTS: There was a significant difference between the mean YKL-40 levels in the aqueous humor of PEX group (112.0 ± 35.8 ng/mL) and control subjects (88.2 ± 30.6 ng/mL) (P = 0.025). However, the difference between the mean YKL-40 levels in the serum of PEX group (53.5 ± 29.1 ng/mL) and control subjects (44.6 ± 30.2 ng/mL) was non-significant (P = 0.326). The correlation between aqueous humor and serum YKL-40 concentrations was significant in both the groups (r = 0.833, P < 0.001; r = 0.840, P < 0.001, respectively). CONCLUSIONS: Increased aqueous humor levels of YKL-40 demonstrate that it is local, but not a systemic marker for inflammation in patients with PEX.

Treatment of mixed astigmatism: early clinical outcomes withWaveLight and Technolas excimer lasers.

BACKGROUND/AIM: We aimed to compare the results of WaveLight Allegretto Wave Eye-Q 400 Hz and Technolas 217z100 excimer lasers in the treatment of mixed astigmatism. MATERIALS AND METHODS: Forty-nine patients who underwent laser in situ keratomileusis for mixed astigmatism were included in this retrospective study. Twenty-eight eyes of 21 patients were treated with WaveLight and 46 eyes of 28 patients were treated with the Technolas excimer laser. The patients' visual acuities and refractive values were evaluated on postoperative day 1 and at 1 and 3 months. RESULTS: In the WaveLight and Technolas groups, cylindrical refractive errors at month 3 were -0.92 ± 0.28 D and -0.88 ± 0.46 D, respectively. Spherical equivalent values for the groups at month 3 were -0.38 ± 0.73 D and -0.33 ± 0.20 D, respectively. There was no significant difference in postoperative uncorrected distance visual acuity at month 3 between the two groups (P = 0.671). At postoperative month 3, 70% of patients treated with WaveLight and 100% of patients treated with Technolas had an uncorrected distance visual acuity of 20/25 or better (P = 0.211). CONCLUSION: There were no significant differences in refraction and visual acuity between the WaveLight and Technolas groups during a 3-month follow-up period after laser in situ keratomileusis for mixed astigmatism.

Microbiologic, Pharmacokinetic, and Clinical Effects of Corneal Collagen Cross-Linking on Experimentally Induced Pseudomonas Keratitis in Rabbits.

PURPOSE: To determine the effects of corneal collagen cross-linking (CXL) on the penetration of topical 0.5% moxifloxacin, on the number of colony-forming units (CFUs) in the cornea, and on the clinical course in a rabbit eye model of experimentally induced Pseudomonas aeruginosa keratitis. METHODS: In this prospective animal study, experimental Pseudomonas corneal ulcers were induced in 56 corneas of 28 albino New Zealand rabbits. The corneas were randomly divided into the following 4 groups: the control group (14 eyes), the MOX group (moxifloxacin) (14 eyes), the MOX + CXL group (14 eyes), and the CXL group (14 eyes). On day 4 of the experiment, the eyes in the control group were enucleated and CFU counting was performed. On day 10 of the experiment, all eyes were enucleated and CFU counting was performed. In the MOX and MOX + CXL groups, the moxifloxacin level in the cornea, aqueous humor, iris, plasma, and serum was measured by reverse-phase high-performance liquid chromatography. RESULTS: The difference in the corneal CFU count between the MOX group and the MOX + CXL group was not significant (P = 0.317). Clinical improvement was greatest in the MOX + CXL group (P < 0.001). The mean corneal moxifloxacin level was 0.391 ± 0.09 µg·mg in the MOX group versus 0.291 ± 0.09 µg·mg in the MOX + CXL group; as such, CXL did not have a significant effect on antibiotic penetrance (P = 0.386). CONCLUSIONS: Clinical improvement was greatest in the MOX + CXL group. The synergistic effect of CXL on corneal ulcer treatment is not through antibiotic penetrance.

What is the effect of pseudoexfoliation syndrome on renal function in patients without glaucoma?

PURPOSE: To evaluate renal function in patients with pseudoexfoliation syndrome. MATERIALS AND METHODS: This prospective, cross-sectional, case-control study involved 49 patients with pseudoexfoliation syndrome (PEX) and 42 control subjects. Renal function was examined by biochemical parameters and Doppler ultrasonography. Serum creatinine, blood urea nitrogen, urea levels, urine microalbumin level and creatinine clearance were measured. Renal volume, resistive index and pulsatility index were calculated using Doppler ultrasonography. RESULTS: The mean laboratory values for both groups were as follows: Creatinine, PEX: 0.81 ± 0.28 mg/dL - Control: 0.79 ± 0.22 mg/dL; urea, PEX: 31.6 ± 9.7 mg/dL - Control: 32.2 ± 8.4 mg/dL; blood urea nitrogen, PEX: 14.8 ± 4.6 mg/dL - Control: 15.1 ± 4.0 mg/dL; creatinine clearance, PEX: 89.1 ± 35.6 mL/min - Control: 99.0 ± 47.2 mL/min; microalbumin, PEX: 5.8 ± 22.7 mg/dL - Control: 2.7 ± 6.0 mg/dL. The differences between groups were not significant (p > 0.300). Renal volume, resistive index and pulsatility index values were similar in both groups (p > 0.200). CONCLUSIONS: This study showed that pseudoexfoliation syndrome does not affect biochemical and ultrasonographic parameters associated with renal function.

Comparison of visual acuity, refractive results and complications of femtosecond laser with mechanical microkeratome in LASIK.

AIM: To compare the outcomes of laser in situ keratomileusis (LASIK) performed with a femtosecond laser (Femtec, Technolas Perfect Vision GmbH, Germany) versus a mechanical microkeratome (Hansatome, Bausch and Lomb, USA) for the correction of myopia and astigmatism. METHODS: In this retrospective study, patients who had undergone LASIK using the 80-kHz Femtec femtosecond laser were compared to age- and refraction-matched patients in whom the Hansatome microkeratome was used. Refractive and visual results 1 month and 3 months postoperatively, and complication rates were compared between the two groups. RESULTS: A total of 280 eyes were analyzed (140 in each group). At 3 months postoperatively in the Femtec vs Hansatome group, spherical equivalent refraction was within ±1.00D of emmetropia in 140 vs 138 eyes (P=0.498), the cylinder was within ±0.50D in 137 vs 139 eyes (P=0.622), and the UDVA was 20/20 or better in 136 vs 137 eyes (P=0.724), respectively. There was no statistically significant difference in the complication rates between the two groups (P=0.099). CONCLUSION: LASIK performed both with Femtec femtosecond laser and Hansatome microkeratome achieved satisfactory refractive and visual results at 3 months postoperatively, without significant differences in efficacy, safety, and complication rates between the two procedures.

Tear osmolarity and ocular surface changes in patient with polycystic ovary syndrome.

PURPOSE: To evaluate the tear osmolarity and ocular surface changes in patients with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS: Forty-eight patients with recently diagnosed PCOS and thirty-three control volunteers were enrolled in this prospective, observational study. Ocular surface disease index (OSDI) score was calculated. Tear osmolarity was measured using the TearLab Osmolarity System (Tearlab, San Diego, CA, USA). All subjects also underwent the following ophthalmologic evaluation: Schirmer I test, tear-film breakup time (TBUT), ocular surface flourescein staining, and conjunctival impression cytology. RESULTS: Mean OSDI score was significantly higher in patients with PCOS than control subjects (P = 0.001). Tear osmolarity was similar in both groups (P = 0.404). There were no significant differences between groups in Schirmer I test results, TBUT, and ocular surface flourescein staining scores (P > 0.05). Compared to control group, a statistically significant squamous metaplasia was observed in temporal bulbar conjunctival impression cytology specimens in PCOS group (P = 0.032). CONCLUSIONS: In patients with recently diagnosed PCOS, tear volume and osmolarity are not affected but, conjunctival morphology may be affected, though on a limited scale.

Endothelial cell loss: Biaxial small-incision torsional phacoemulsification versus biaxial small-incision longitudinal phacoemulsification.

PURPOSE: To compare clinical results of biaxial small-incision torsional phacoemulsification and biaxial small-incision longitudinal phacoemulsification. SETTING: Department of Ophthalmology, School of Medicine, Namik Kemal University, Tekirdag, Turkey. DESIGN: Randomized controlled clinical trial. METHODS: Eyes with high-density nuclear cataract were assigned to have biaxial longitudinal (microburst mode) or biaxial torsional phacoemulsification. The main outcomes included corrected distance visual acuity (CDVA), central corneal thickness (CCT), central endothelial cell density (ECD), total ultrasound time (UST), cumulative dissipated energy (CDE), percentage total equivalent power in position 3, and balanced salt solution volume. Postoperative follow-up was at 1 day, 1 week, and 1 and 3 months. RESULTS: Each group comprised 35 patients (35 eyes). Three months postoperatively, the mean CDVA for each group was 0.02 logMAR and the mean CCT returned to the preoperative level (P=.589 and P=.554, respectively). During the postoperative follow-up, the percentage of mean endothelial cell loss in both groups was between 35.4% and 39.1%; there was no statistically significant difference between the groups (P>.05). The mean CDE, UST, percentage total equivalent power in position 3, and balanced salt solution volume values were similar in the 2 groups (P>.05). CONCLUSION: The risk for high endothelial cell loss should be considered when the phacoemulsification of high-density nuclear cataracts is performed using either method. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Comparison of keratometric data obtained by automated keratometer, Dicon CT 200, Allegro Topolyzer, and Pentacam.

PURPOSE: To compare the keratometric values measured by the automated keratometer, two Placido-based computerized topography systems (Dicon CT 200 [Vismed Inc] and Allegro Topolyzer [WaveLight Inc]), and Scheimpflug analysis (Pentacam [Oculus Optikgeräte GmbH]). METHODS: The keratometric data of 200 eyes from 200 patients evaluated for refractive surgery were reviewed retrospectively. Mean simulated keratometry (Sim K) and mean corneal astigmatism measured by the four devices were compared using repeated measures analysis of variance with Bonferroni correction. The analysis of agreement between two measurements was assessed using the method of Bland and Altman. RESULTS: Mean Sim K as measured by the automated keratometer, Dicon CT 200, Allegro Topolyzer, and Pentacam was 43.39±1.50 diopters (D), 43.55±1.50 D, 43.45±1.50 D, and 43.43±1.45 D, respectively. The Dicon CT 200 measured the mean Sim K to be steeper and the automated keratometer measured the mean Sim K to be flatter than the other devices. Significant differences in corneal astigmatism were noted among the four devices except Dicon CT 200 versus Allegro Topolyzer and Allegro Topolyzer versus Pentacam comparisons (P<.013). For mean Sim K, the 95% limits of agreement between the Pentacam and other three devices were significantly wider than the other comparisons. In Bland-Altman plots comparing the Pentacam to the other devices, extreme outliers were present in 11 (5.5%) eyes. CONCLUSIONS: Because of the wide distribution range and presence of extreme outliers, Pentacam data should be used cautiously in IOL power calculation and astigmatic keratotomy procedures.

Intravitreal tigecycline treatment in experimental Acinetobacter baumannii endophthalmitis.

PURPOSE: To investigate the clinical and microbiological effectivity of intravitreal tigecycline in an experimental rabbit endophthalmitis model caused by imipenem resistant Acinetobacter baumannii. MATERIALS AND METHODS: Forty-eight eyes of 24 New Zealand white albino rabbits were divided into six groups (n=8 in each). The right eyes were divided into three groups and defined as infected group; left eyes were divided into three groups and defined as uninfected group. Infected group received 0.1 ml intravitreal A. baumannii suspension. Twenty-four hours after bacterial inoculation, group 1 received 1 mg/0.1 ml tigecycline and group 2 received 0.5 mg/0.1 ml tigecycline. Group 3 eyes received no treatment. In group 4, 0.1 ml of saline solution was injected. Groups 5 and 6 were received intravitreal tigecycline injection of 1 mg/0.1 ml and 0.5 mg/0.1 ml respectively. The eyes were enucleated for histopathological evaluation on the sixth day. Clinical and histological scoring systems were used to evaluate clinical and histological severity of the intraocular infection. RESULTS: The mean clinical scores of the six groups at the sixth day were 11±1.92, 12.4±6.2, 8.5±2.7, 0, 3±1.3, and 3±1.4 respectively. Mean histopathological scores were 7.8±2.8, 7.0±1.5, 5.6±1.4, 0, 0, and 0 respectively. There was no significant difference in mean clinical and histopathological scores of infected group (groups 1, 2 and 3). There was significant difference in mean clinical scores of groups 5 and 6 compared with group 4. Groups 4, 5 and 6 showed normal histological structure in histopathological evaluation and showed no significant difference. Microbiological cure was achieved in all infected eyes. CONCLUSIONS: Experimental rabbit endophthalmitis model caused by imipenem resistant A. baumannii was microbiologically cured by intravitreal tigecycline injection. However, a hypersensitivity-like reaction due to intravitreal application of tigecycline limits the use of this antimicrobial agent in A. baumannii endophthalmitis.

Basal cell carcinoma in a full-thickness skin graft in the upper eyelid.

A 75-year-old woman presented with a nodular lesion on a skin graft in her left upper eyelid. The lesion had grown gradually over the previous 2 years. She had undergone multiple surgeries and full-thickness skin graft procedures 61 years previously, because of cutaneous leishmaniasis. The diagnosis of nodular basal cell carcinoma was made by means of an excisional biopsy of the lesion. During a follow-up period of 27 months, the tumor did not recur. Malignant tumors may rarely develop at the site of traumatic or surgical scar. To our knowledge, this is the first reported case of basal cell carcinoma arising in a skin graft in the eyelid.

Outcome of surgery in long-standing infantile esotropia with cross fixation.

BACKGROUND: This is a retrospective study to determine the outcomes of the surgical correction in long-standing infantile esotropia with cross fixation. METHODS: Medical charts of a group of patients with esotropia who had cross fixation and underwent surgery for strabismus between January 1991 and December 2004 were reviewed. The mean follow-up time was 4.7 years. Binocularity was measured by the Worth 4-dot test and Titmus stereo test. Twenty-six patients underwent surgery for strabismus. Twenty-one patients aged 8 to 26 years with a minimum 3-year postoperative follow-up were included. Five patients were excluded because they were lost to follow-up after surgery. RESULTS: Bimedial recession and resection of one lateral rectus muscle were performed in all patients. Recession of the inferior oblique muscle with anteriorization was performed in patients who had inferior oblique overaction. Orthotropia was attained in 14 patients, whereas residual esotropia was diagnosed in 5 patients. Two patients were diagnosed as having exotropia. Two patients required a second surgery for dissociated vertical deviation. Overall, 9 of the 21 patients had indications of binocular function and 12 remained the same in their stereoacuity. CONCLUSION: Surgical correction of long-standing infantile esotropia with cross fixation in young adults may improve binocular function and allow long-term alignment stability.

Posttraumatic subperiosteal hematomas of the orbit in children.

PURPOSE: To describe 5 pediatric patients with traumatic orbital subperiosteal hematoma and review the relevant literature. METHODS: Retrospective chart analysis of 5 children with posttraumatic subperiosteal hematoma and a systematic review of the English language literature. RESULTS: Five new pediatric cases of orbital subperiosteal hematoma are presented with varying clinical and radiologic manifestations and treatments. Literature review (including the current 5 cases) yielded 23 cases in total. Eighteen (78%) of the patients were boys, and 5 (22%) were girls. The children ranged in age from 5 to 17 years, with the mean and median ages being 12 years. The leading cause was blunt trauma related to falls or direct impact. Two patients (9%) had an inherited coagulopathy, predisposing them to orbital hemorrhage. The hematomas developed in the superior orbit in all cases except one. In 3 patients (13%), orbital hematomas were bilateral. In 9 patients (39%), the hematomas extended in subgaleal or frontal subdural spaces. In 7 patients (30%), subperiosteal hematoma was associated with compressive optic neuropathy. Four patients (17%) had a nondisplaced orbital roof fracture. Seventeen patients were treated with surgical evacuation of hematoma (52%) or with needle aspiration (22%), and 5 patients (22%) were observed for spontaneous resolution. Three patients (13%) experienced a recurrence of hemorrhage. CONCLUSIONS: In children, traumatic subperiosteal hematomas of the orbit typically occur after blunt trauma in the superior orbit. The risk of compressive optic neuropathy may be higher in patients with bilateral hematoma and massive subgaleal hematoma. Most patients are treated with evacuation of the hematoma.