Examination of the Corneal Endothelium in Pediatric Patients With COVID-19.

PURPOSE: To investigate the effects of coronavirus disease 2019 (COVID-19) infection on the corneal endothelium in children. METHODS: This retrospective study included 46 pediatric patients with COVID-19 infection and 38 healthy controls. Specular microscopy measurements were analyzed, and measurements were obtained from images showing at least 100 cells with clear borders. Mean endothelial cell density, mean hexagonal cell percentage (HEX), mean coefficient of variation (CV), central corneal thickness, and mean cell area were evaluated. RESULTS: Specular microscopy data showed that the CV values were 2.442±6.517 in the healthy control group (HCG) and 2.659±5.119 in the COVID-19-affected group (CAG) ( P =0.003). The hexagonality of the HCG and CAG were 6.916±8.271 and 6.683±5.885, respectively ( P =0.011). CONCLUSION: A decrease in the HEX and an increase in the CV were observed in the corneal specular microscopic examination of children with COVID-19 infection. These results are important in demonstrating the corneal effects of COVID-19 infection in children.

Effect of Irrigation Solution Temperature on the Corneal Endothelial Functions in Posterior Vitrectomy: Room Temperature Versus Cooled.

PURPOSE: To compare the effects of cooled and room temperature irrigation on the preoperative and early postoperative corneal endothelial parameter values in posterior vitrectomy. MATERIALS AND METHODS: In this prospective, randomized, comparative study, 68 patients underwent a standard 3-port, 23-G posterior vitrectomy operation by a single surgeon. Cooled irrigation solution was applied to 36 patients during surgery (group 1), and room temperature irrigation solution was applied to 32 patients (group 2). The patients were also divided into four groups according to their history of noncomplicated cataract surgery (phakic or pseudophakic) and the types of tamponade used (silicone or gas). The central corneal thickness (CCT), endothelial cell density (ECD), mean cell area (MCA), hexagonal cell percent, and coefficient of variation of cell area (CV) parameter values of the groups at preoperative and postoperative 1 month were compared. RESULTS: There were no statistically significant differences between the preoperative and postoperative corneal parameter values in groups 1 and 2 ( P >0.05). However, it was remarkable that the percentage of preoperative-postoperative change in all the corneal parameter values was higher in group 2. When the results of the subgroup analyses of the patients who were pseudophakic and used gas tamponade (Group D) in group 2 were examined, it was determined that the negative effects were significantly higher in the postoperative values for the ECD, MCA, CV, and CCT parameters compared with the preoperative values ( P <0.05). CONCLUSION: In patients with pseudophakia and gas tamponade, cooled irrigation was found to be more advantageous for corneal parameters.

Challenges in pediatric cataract surgery: comparison of intraocular lens power calculation formulas using optical biometry.

PURPOSE: Comparison of the accuracy of intraocular lens (IOL) power calculation formulas (SRK II, SRK/T, Holladay 1, Hoffer Q and Barrett II Universal, Haigis) in pediatric cataract surgery using optical biometry. METHOD: This prospective study included seventy eyes of 70 patients between ages of 3-15 who had undergone cataract surgery with IOL implantation. Anterior segment parameters and axial length (AL) were measured with an optical biometer. Barrett II Universal formula results were used to determine the diopter of implanted IOL. Postoperative refraction was taken at first month, and differences from the estimated refractive value [mean absolute predictive error (APE)] were compared between formulas. Formulas were also compared according to AL. RESULTS: The lowest APE was achieved with Barrett II formula (0.64 ± 0.73D) and the highest with Haigis formula (1.06 ± 0.84D) in the whole study population (p < 0.01). APE values were lowest with Holladay 1 (0.79 ± 0.71D) and highest with Haigis (1.44 ± 0.92D) in patients with an AL ≤ 22 mm; lowest APE was achieved with Barrett II (0.47 ± 0.54D) and highest with Haigis (0.84 ± 0.72D) in patients with an AL > 22 mm. CONCLUSION: Barrett II formula had the best results in eyes with average AL, and SRK/T and Holladay 1 formulas were better in eyes with shorter AL. Haigis formula statistically had the highest predictive error in all formulas.

Outcomes of customized topographic guided epithelial debridement for corneal collagen cross-linking.

PURPOSE: To evaluate the outcomes of corneal collagen cross-linking performed with customized epithelial debridement technique in progressive keratoconic corneas. MATERIALS AND METHODS: Forty eyes of 40 patients were included in the study. We performed an ophthalmologic examination and recorded the uncorrected visual acuity, best corrected visual acuity (BCVA), central corneal thickness at the thinnest point (t-CCT), flat meridian keratometry (K1), steep meridian keratometry (K2), endothelial cell density (ECC), hexagonal cells (HEX), and coefficient of variation of cell areas (CV) measured preoperatively and at the 1st, 3rd, 6th and 12th months postoperatively. RESULTS: The mean UCVA and BCVA were increased (p < 0.05). The mean flattest and steepest K readings were decreased (p < 0.05). The mean t-CCT decreased in the first months after treatment and increased after 6 months. The mean t-CCT was thicker at 12 months compared to pretreatment status (p < 0.05). The mean ECC and CV were not significantly different between follow-up intervals (p > 0.05). The mean HEX was statistically increased (p > 0.05). CONCLUSIONS: Corneal collagen cross-linking performed with customized epithelial debridement technique is a successful alternative method for stopping the progression of keratoconus after 12 months of treatment.

Comparison of retinopathy of prematurity incidence between Turkish citizens and Syrian refugees.

Purpose: More than 3.5 million Syrians came to Turkey seeking refuge and over 470,000 Syrian infants were born since the start of the civil war in 2011. Our aim is to compare the incidence of retinopathy of prematurity (ROP) between Syrian refugees and Turkish citizens. Methods: This multicenter, retrospective study was conducted in Gaziantep University, Faculty of Medicine and Gaziantep Children's Hospital in Turkey. We included the data of patients who were screened for ROP between July 2015 and June 2017. Results: The above-mentioned data of 906 Turkish infants and 199 Syrian infants were included in this study. Mean gestational ages (GAs) were (32.9 ± 2.7) and (32.1 ± 2.8) weeks as well as mean birth weights (BWs) were (1937.5 ± 582.9) and (1696.8 ± 485.5) g, in Turkish and Syrian infants, respectively. GA and BW were significantly lower in Syrian infants while time spent in neonatal intensive care unit was significantly higher. The zone of ROP was lower in the Syrian infants in the first examination and for the most advanced ROP (P = 0.001). Any stage ROP was present in 392 (43.3%) and 81 (40.7%) patients in Turkish and Syrian population, respectively (P = 0.490). The number of patients who required treatment for ROP were 95 (10.5%) and 20 (10.1%) in Turkish and Syrian groups, respectively (P = 0.882). Conclusion: Our findings showed that refugee infants had lower BW and GA than native population but the incidence of ROP did not differ between them. Psychosocial stress is an important risk factor for women at reproductive age as it increases the incidence of prematurity. Additional care and psychological support must be given to refugees during perinatal period to decrease the risk of premature birth.

Increased Expressions of ICAM-2 and ICAM-3 in Pterygium.

Purpose: Pterygium, one of the most common ocular surface diseases, is characterized by inflammatory infiltrates, proliferation, angiogenesis, fibrosis, and extracellular matrix breakdown. The objective of this study was to elucidate the levels of the intercellular adhesion molecule (ICAM)-2, and ICAM-3 gene and protein expressions in pterygium. Methods: A total of 59 patients with pterygium were included in this study. mRNA from pterygial and conjunctival autograft tissues were extracted, and real-time polymerase chain reaction on the BioMark HD dynamic array system was performed for the ICAM-2 and ICAM-3 gene expressions. ICAM-2 and ICAM-3 protein expressions using western blot and immunohistochemistry methods were also investigated in pterygial and conjunctival autograft tissues. Results: ICAM-2 and ICAM-3 gene expressions were markedly augmented in pterygial tissues (P = 0.0018 and P = 0.0023, respectively). Significant increases in protein expressions in pterygial tissues were also detected for ICAM-2 and ICAM-3 (P = 0.0116 and P = 0.0252, respectively). In the immunohistochemical studies, there was a marked increase in ICAM-3 (P = 0.0152), but not in ICAM-2 (P = 0.1041), protein expressions in pterygial tissues. Significant positive correlations between pterygia grading with ICAM-2 protein expression (P = 0.0398) and ICAM-3 immunohistochemical scores (P = 0.0138) were observed. Conclusion: These results demonstrate, for the first time, the expressions of ICAM-2 and ICAM-3 in the pterygium. These findings may help to understand the signal transduction mechanisms in the pterygium formation and provide a new therapy strategy for pterygium treatment.

A new surgical technique for scleral fixation using a "knot ball" for scleral-fixated intraocular lenses: impact on clinical outcomes / Uma nova técnica cirúrgica para fixação escleral usando um "nó esférico" (knot ball) para lentes ntraoculares para fixação escleral: impacto nos resultados clínicos

ABSTRACT Purpose: Scleral fixation surgery is a pivotal procedure that depends on the availability of robust and innovative surgical fixation methods. There continues to be a need for innovation in suture fixation techniques, particularly for intraocular lens implantation. Methods: We conceived and designed a "knot ball" scleral fixation technique for suture burial in a retrospective sample of 108 patients with primary (n=40) or secondary (n=68) scleral-fixated intraocular lens. Importantly, our technique did not require additional scleral flap or tunnel procedures. We evaluated pre- and postoperative best-corrected visual aquity (BCVA) and postoperative complications. All data were analyzed and compared between groups. Results: The preoperative mean BCVA improved significantly in both groups using the "knot ball" fixation technique (p<0.01). The extent of the improvement in the best-corrected visual acuity and late complications one month post-surgery were not significantly different between the groups (p>0.05). These clinical outcomes were consistent with those described in the ophthalmology literature. Conclusion: A "knot ball" scleral fixation technique is reported; to the best of our knowledge, this is the first report of such a technique, which offers a less invasive and simplified surgical procedure for transscleral fixation of scleral-fixated intraocular lenses. Moreover, the technique appears to display similar effectiveness and safety compared with existing scleral fixation techniques. We suggest that the "knot ball" technique warrants further research focus and clinical evaluation in future studies.

RESUMO Objetivo: A cirurgia de fixação escleral é um procedimento fundamental que depende da disponibilidade de métodos robustos e inovadores de fixação cirúrgica. No entanto, existe uma necessidade de inovação nas técnicas de fixação de sutura, particularmente para a implantação de lentes intraoculares. Métodos: Concebemos e desenhamos uma técnica de fixação escleral utilizando um "nó esférico" para o encerramento da sutura em uma amostra retrospectiva de 108 pacientes com lente intraocular de fixação escleral (SF-IOL) primária (n=40) e secundária (n=68). Importante considerar que nossa técnica não exigiu procedimentos adicionais de aleta escleral ou de túnel. Observamos a melhor acuidade visual corrigida (MAVC) pré e pós-operatória e as complicações pós-operatórias. Todos os dados foram analisados entre os grupos. Resultados: A melhor acuidade visual corrigida média pré-operatória (logMAR) melhorou significativamente em ambos os grupos com a utilização da técnica de fixação do nó esférico (p<0,01). A extensão da melhora melhor acuidade visual corrigida e as complicações tardias, um mês após a cirurgia, não foram significativamente diferentes entre os grupos (p>0,05). Esses resultados clínicos foram, em geral, comparáveis aos publicados na literatura de oftalmologia. Conclusão: Até onde sabemos, a técnica de fixação escleral de "nó esférico" é relatada pela primeira vez na literatura e representa um procedimento cirúrgico promissor, menos invasivo e simplificado para a fixação transescleral de SF-IOLs. Além disso, a técnica parece exibir eficácia e segurança comparáveis às técnicas de fixação escleral existentes. Sugerimos que a técnica do nó esférico receba mais atenção e avaliações clínicas no futuro.

A new surgical technique for scleral fixation using a "knot ball" for scleral-fixated intraocular lenses: impact on clinical outcomes.

PURPOSE: Scleral fixation surgery is a pivotal procedure that depends on the availability of robust and innovative surgical fixation methods. There continues to be a need for innovation in suture fixation techniques, particularly for intraocular lens implantation. METHODS: We conceived and designed a "knot ball" scleral fixation technique for suture burial in a retrospective sample of 108 patients with primary (n=40) or secondary (n=68) scleral-fixated intraocular lens. Importantly, our technique did not require additional scleral flap or tunnel procedures. We evaluated pre- and postoperative best-corrected visual aquity (BCVA) and postoperative complications. All data were analyzed and compared between groups. RESULTS: The preoperative mean BCVA improved significantly in both groups using the "knot ball" fixation technique (p<0.01). The extent of the improvement in the best-corrected visual acuity and late complications one month post-surgery were not significantly different between the groups (p>0.05). These clinical outcomes were consistent with those described in the ophthalmology literature. CONCLUSION: A "knot ball" scleral fixation technique is reported; to the best of our knowledge, this is the first report of such a technique, which offers a less invasive and simplified surgical procedure for transscleral fixation of scleral-fixated intraocular lenses. Moreover, the technique appears to display similar effectiveness and safety compared with existing scleral fixation techniques. We suggest that the "knot ball" technique warrants further research focus and clinical evaluation in future studies.

Comparison of Bevacizumab and Ranibizumab in the Treatment of Type 1 Retinopathy of Prematurity Affecting Zone 1.

PURPOSE: To investigate the effects of bevacizumab and ranibizumab in the treatment of type 1 retinopathy of prematurity (ROP) affecting zone 1. METHODS: Files of the patients who received intravitreal bevacizumab (IVB) or ranibizumab (IVR) treatment for ROP affecting zone 1 were evaluated retrospectively. Spherical equivalent (SE) and axial length (AXL) measurements were performed at 1 year of adjusted age. RESULTS: Sixty-eight eyes of 37 patients were included in the study. All patients had initial disease regression but 6 patients (4 in the IVB, 2 in the IVR group) showed reactivation (p = 0.679). The number of eyes with incomplete vascularization were 15 and 12 in the IVB and IVR groups, respectively (p = 0.725). Mean AXL was 20.50 ± 0.99 mm in the IVB group and 19.30 ± 0.48 mm in the IVR group (p < 0.001). Mean SE was -1.49 ± 2.38 dpt in the IVB group and 0.98 ± 2.18 dpt in the IVR group (p < 0.001). CONCLUSION: Bevacizumab and ranibizumab showed similar effectiveness in the treatment of type 1 ROP affecting zone 1. The AXL was longer and SE was more myopic in eyes treated with IVB. This difference might be caused by the longer intravitreal half-life of bevacizumab than ranibizumab.

Comparison of topical and retrobulbar anesthesia in terms of pain experience during silicone oil extraction.

PURPOSE: To compare the use of topical anesthesia and retrobulbar anesthesia during silicone oil removal with a mixed pars plana technique, through evaluating the pain experience of patients. METHODS: We selected patients according to their behavior during previous vitreoretinal surgery and ophthalmologic examinations and divided them into two anesthesia groups: topical (n=36) and retrobulbar (n=33). We used a mixed technique for the passive removal of silicone oil in both groups. During each step of the surgery, the patients' pain experience and the surgeon's comfort were scored according to a pain scale. RESULTS: The pain experienced during the application of the anesthesia was significantly greater in the retrobulbar group (p<0.001). The topical group experienced greater pain during trocar insertion (p<0.001). There was no significant difference between the groups regarding the overall pain experience or complications. CONCLUSIONS: The pain experience of the selected patients during silicone oil removal was comparable between the topical and the retrobulbar anesthesia. Topical anesthesia with the mixed pars plana technique is an effective and safe alternative option for silicone oil removal surgery.

Comparison of topical and retrobulbar anesthesia in terms of pain experience during silicone oil extraction / Comparação da sensação de dor durante a extração de óleo de silicone sob anestesia tópica e retrobulbar

ABSTRACT Purpose: To compare the use of topical anesthesia and retrobulbar anesthesia during silicone oil removal with a mixed pars plana technique, through evaluating the pain experience of patients. Methods: We selected patients according to their behavior during previous vitreoretinal surgery and ophthalmologic examinations and divided them into two anesthesia groups: topical (n=36) and retrobulbar (n=33). We used a mixed technique for the passive removal of silicone oil in both groups. During each step of the surgery, the patients' pain experience and the surgeon's comfort were scored according to a pain scale. Results: The pain experienced during the application of the anesthesia was significantly greater in the retrobulbar group (p<0.001). The topical group experienced greater pain during trocar insertion (p<0.001). There was no significant difference between the groups regarding the overall pain experience or complications. Conclusions: The pain experience of the selected patients during silicone oil removal was comparable between the topical and the retrobulbar anesthesia. Topical anesthesia with the mixed pars plana technique is an effective and safe alternative option for silicone oil removal surgery.

RESUMO Objetivo: Comparar a sensação de dor de pacientes durante a remoção do óleo de silicone sob anestesia tópica e retrobulbar, usando uma técnica via pars plana combinada. Métodos: Os pacientes foram selecionados, de acordo com suas atitudes durante cirurgia vitreorretiniana prévia e exames oftalmológicos, e divididos em dois grupos: anestesia tópica e retrobulbar. Para a remoção passiva do óleo de silicone, utilizou-se uma técnica combinada em ambos os grupos. A sensação de dor dos pacientes e o conforto do cirurgião foram classificados através de uma escala de dor durante cada etapa da cirurgia. Resultados: Os grupos anestesia tópica e retrobulbar incluíram 36 e 33 pacientes, respectivamente. A sensação de dor durante a aplicação da anestesia foi significativamente maior no grupo retrobulbar (p<0,001). O grupo anestesia tópica sentiu mais dor durante a inserção do trocarte (p<0,001). Não houve diferença significativa entre os grupos em relação à sensação geral de dor e a complicações. Conclusões: A sensação de dor é comparável entre a anestesia tópica e a retrobulbar durante a remoção de óleo de silicone. A combinação de anestesia tópica e uma técnica via pars plana é uma opção alternativa eficaz e segura para a cirurgia de remoção de óleo de silicone.

Doppler ultrasonographic measurement of short-term effects of valsalva maneuver on retrobulbar blood flow.

BACKGROUND: To investigate the effects of Valsalva maneuver (VM) on retrobulbar blood flow parameters in healthy subjects. METHODS: Participants without any ophthalmologic or systemic pathology were examined in supine position with color and pulsed Doppler imaging for blood flow measurement, via a paraocular approach, in the ophthalmic artery (OA), central retinal artery (CRA), central retinal vein (CRV), nasal posterior ciliary artery (NPCA), and temporal posterior ciliary artery (TPCA), 10 seconds after a 35- to 40-mm Hg expiratory pressure was reached. Peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), and resistivity index (RI) values were recorded for each artery. PSV and EDV values were recorded for CRV. RESULTS: There were significant differences between resting and VM values of PSV and EDV of CRA, RI of NPCA, and PI, RI, and EDV of TPCA. Resting CRA-EDV, CRV-PSV, and CRV-EDV were positively correlated whereas resting OA-PSV and CRA-PI, and OA-PSV, CRA-PSV, and CRA-EDV during VM, were negatively correlated with age. CONCLUSIONS: VM induces a short-term increase in CRA blood flow and a decrease in NPCA and TPCA RI. Additional studies with a longer Doppler recording during VM, in a larger population sample, are required to allow definitive interpretation. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:551-555, 2017.

Water pipe (Shisha, Hookah, Arghile) Smoking and Secondhand Tobacco Smoke Effects on CYP1A2 and CYP2A6 Phenotypes as Measured by Caffeine Urine Test.

Public policies to stop or reduce cigarette smoking and exposure to secondhand smoke and associated diseases have yielded successful results over the past decade. Yet, the growing worldwide popularity of another form of tobacco consumption, water pipe smoking, has received relatively less attention. To the best of our knowledge, no study to date has evaluated the effects of water pipe smoking on cytochrome P450 (CYP450) activities and drug interaction potential in humans, whereas only limited information is available on the impact of secondhand smoke on drug metabolism. In a sample of 99 healthy volunteers (28 water pipe smokers, 30 secondhand tobacco smoke exposed persons, and 41 controls), we systematically compared CYP1A2 and CYP2A6 enzyme activities in vivo using caffeine urine test. The median self-reported duration of water pipe smoking was 7.5 h/week and 3 years of exposure in total. The secondhand smoke group had a median of 14 h of self-reported weekly exposure to tobacco smoke indoor where a minimum of five cigarettes were smoked/hour for a total of 3.5 years (median). Analysis of variance did not find a significant difference in CYP1A2 and CYP2A6 activities among the three study groups (p > 0.05). Nor was there a significant association between the extent of water pipe or secondhand smoke exposure and the CYP1A2 and CYP2A6 activities (p > 0.05). Further analysis in a subsample with smoke exposure more than the median values also did not reveal a significant difference from the controls. Although we do not rule out an appreciable possible impact of water pipe smoke and secondhand smoke on in vivo activities of these two drug metabolism pathways, variability in smoke constituents from different tobacco consumption methods (e.g., water pipe) might affect drug metabolism in ways that might differ from that of cigarette smoke. Further studies in larger prospective samples are recommended to evaluate water pipe and secondhand tobacco smoke effects on CYP450 function, particularly at higher smoke exposure conditions.

Comparison of pain experience during 23-G vitreoretinal surgery under topical and retrobulbar anesthesia.

The objective of this study is to compare pain and discomfort scores of patients during 23-G vitreoretinal surgery under topical and retrobulbar anesthesia without using sedation. A total of 157 patients with various vitreoretinal disorders were included in this study. Patients were randomly divided into two groups: topical (group 1, n = 76) and retrobulbar anesthesia (group 2, n = 81). Patients underwent 23-G vitreoretinal surgery without using sedation. All patients rated the level of experienced pain during the surgical procedure using a visual analogue pain scale. Pain and discomfort scores while performing anesthesia were significantly higher in group 2 than group 1 (p < 0.001). Patients in group 1 experienced more pain than group 2 during trocar insertion, endolaser photocoagulation, and scleral indentation steps of surgery (for all; p < 0.001). There was no significant difference in overall pain and discomfort scores and surgeon comfort scores between groups (p = 0.163, p = 0.097; respectively). None of the patients required additional anesthesia or sedation during or after the procedure. Topical anesthesia without using sedation is a safe and effective, alternative method for 23-G vitreoretinal surgeries in selected patients with various vitreoretinal pathologies.

The results of 25-gauge vitreoretinal surgery for optic disc pit-associated maculopathy: a report of three cases and mini-review of the literature.

PURPOSE: We report the outcomes of three consecutive patients with optic disc pit-associated maculopathy who were treated with 25-gauge pars plana vitrectomy, internal limiting membrane (ILM) peeling, fluid-air exchange, barrage endolaser, and sulfur hexafluoride (SF6) gas tamponade. CASE REPORT: Patients with optic disc pit-associated maculopathy were treated with 25-gauge pars plana vitrectomy followed by ILM peeling, fluid-air exchange, barrage endolaser, and gas tamponade with 20 % SF6. All patients were asked to maintain a facedown position for 3 days postoperatively. This technique resulted in complete retinal reattachment after 25-gauge vitrectomy, ILM peeling, fluid-air exchange, barrage endolaser, and 20 % SF6 gas injection. The best-corrected visual acuity (BCVA) improved in all three patients and successful anatomical results were achieved. There wasn't any macular detachment in all cases at 20th week follow-up. CONCLUSIONS: Our outcomes suggest that 25-gauge vitrectomy with ILM peeling, fluid-air exchange, barrage endolaser, and SF6 gas tamponade appears to be an effective treatment option for optic disc pit-associated maculopathy.

Maximal Levator Muscle Resection for Primary Congenital Blepharoptosis with Poor Levator Function.

PURPOSE: To evaluate the clinical outcomes of maximal levator muscle resection surgery in patients with poor levator function. METHODS: This prospective study included 29 eyelids of 23 patients who underwent maximal levator resection surgery. Pre- and postoperatively, all patients' routine ophthalmic examination including evaluation of upper eyelid skin crease positions; levator muscle function (LF), rima palpebrarum (RP), and margin-reflex distance (MRD) measurements were recorded. Outcome was considered successful when the difference between the two upper eyelids was ≤1 mm; if the difference between the two eyelid margins was more than 1 mm and less than 2 mm, it was considered to be satisfactory. More than 2 mm difference was considered to be poor. RESULTS: Mean patient age was 11.3 ± 8.6 years (3 months to 24 years). Mean follow-up time was 22.8 ± 6.9 months (10 to 36 months). Preoperatively mean RP, MRD, and LF measurements were 5.5 ± 1.7 mm, -0.14 ± 1.6 mm, 2.5 ± 1.4 mm (0-4 mm), respectively. Preoperatively, eight (27,6%) patients had skin crease. Abnormal head posture was detected in eight (34.8%) of the patients. Postoperatively, RP, MRD, and LF values increased significantly (p < 0.05). Mean RP, MRD, and LF measurements were 8.3 ± 1.5 mm, 2.6 ± 1.2 mm, 5.1 ± 2.1 mm, respectively. Fourteen subjects (60.9%) had successful results, two subjects (8.7%) had satisfactory results, and seven subjects (30.4%) had poor results. Abnormal head postures of all patients were resolved. CONCLUSIONS: Maximal levator resection may be a good alternative method to frontalis suspension in congenital blepharoptosis patients with poor levator function.

Bilateral acute angle-closure glaucoma as a first presentation of granulomatosis with polyangiitis (Wegener's).

We report a case of bilateral acute angle-closure glaucoma in a patient with undiagnosed granulomatosis with polyangiitis (Wegener's). A 59-year-old man presented with a severe headache, ocular pain, blurred vision, shortness of breath, and mild fever. Clinical examination revealed conjunctival chemosis, corneal edema, and shallow anterior chambers. Closed angles were observed bilaterally on gonioscopy. The patient was treated with intravenous mannitol, oral acetazolamide, and anti-glaucomatous eye drops. Over the following two days, his vision improved and intraocular pressures decreased. Subsequently, laser iridotomies were performed bilaterally and the patient attended consultations with our departments of respiratory medicine, nephrology, and rheumatology and was subsequently diagnosed with granulomatosis with polyangiitis. Bilateral acute angle-closure glaucoma is a very rare ocular manifestation of granulomatosis with polyangiitis. The association of this clinical entity with Wegener's granulomatosis remains unknown.

Bilateral acute angle-closure glaucoma as a first presentation of granulomatosis with polyangiitis (Wegener's) / Glaucoma de ângulo fechado bilateral agudo como uma primeira apresentação da granulomatose com poliangeíte (de Wegener)

ABSTRACT We report a case of bilateral acute angle-closure glaucoma in a patient with undiagnosed granulomatosis with polyangiitis (Wegener's). A 59-year-old man presented with a severe headache, ocular pain, blurred vision, shortness of breath, and mild fever. Clinical examination revealed conjunctival chemosis, corneal edema, and shallow anterior chambers. Closed angles were observed bilaterally on gonioscopy. The patient was treated with intravenous mannitol, oral acetazolamide, and anti-glaucomatous eye drops. Over the following two days, his vision improved and intraocular pressures decreased. Subsequently, laser iridotomies were performed bilaterally and the patient attended consultations with our departments of respiratory medicine, nephrology, and rheumatology and was subsequently diagnosed with granulomatosis with polyangiitis. Bilateral acute angle-closure glaucoma is a very rare ocular manifestation of granulomatosis with polyangiitis. The association of this clinical entity with Wegener's granulomatosis remains unknown.

RESUMO Relatamos um caso glaucoma bilateral agudo de ângulo fechado em um paciente sem diagnóstico prévio de granulomatose com poliangeíte (Wegener). Um homem de 59 anos apresentou-se com uma forte dor de cabeça, dor nos olhos, visão turva, dificuldade em respirar e febre baixa. Observamos quemose conjuntival, edema da córnea e câmara anterior rasa. A gonioscopia demonstrou ângulos fechados bilateralmente. Ele foi tratado com manitol intravenoso, acetazolamida oral, olho e colírios antiglaucomatosos. Durante os dois dias seguintes a sua visão melhorou e as pressões intra-oculares diminuíram. A seguir, foram realizadas iridotomias a laser bilateralmente e ele foi referido para os departamentos de doenças pulmonares, nefrologia e reumatologia. Ele foi diagnosticado com poliangeíte granulomatosa. Glaucoma bilateral agudo de ângulo fechado é uma entidade clínica muito rara e sua associação com a granulomatose de Wegener é desconhecida e deve acrescentar-se à lista de manifestações oculares de granulomatose com poliangeíte.

Dynamic changes in optic disc morphology, choroidal thickness, anterior chamber parameters, and intraocular pressure during Valsalva maneuver.

PURPOSE: To investigate the effects of the Valsalva maneuver (VM) on optic disc morphology, choroidal thickness, and anterior chamber parameters. METHODS: This prospective observational study included 60 eyes of 60 healthy subjects. The anterior chamber parameters, including central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), pupil diameter (PD), axial length (AL), subfoveal and peripapillary choroidal thickness, optic disc parameters, and intraocular pressure (IOP), were measured at rest and during VM. RESULTS: VM did not have any significant influence on AL, subfoveal and peripapillary choroidal thickness, optic disc area, rim area, cup area, cup-to-disc area ratio, vertical cup-to-disc ratio, rim volume, cup volume, and nerve head volume measurements (for all; p >0.05). IOP and PD significantly increased during VM (for both; p <0.001). VM significantly decreased CCT, ACD, ACA, and ACV values (for all; p <0.001). Moreover, the optic nerve cup volume decreased and the horizontal cup-to-disc ratio significantly increased during VM (for both; p <0.05). CONCLUSIONS: VM may cause transient changes in IOP, optic disc morphology, and anterior chamber parameters.

Dynamic changes in optic disc morphology, choroidal thickness, anterior chamber parameters, and intraocular pressure during Valsalva maneuver / Mudanças dinâmicas na morfologia do disco óptico, espessura da coroide, parâmetros de câmara anterior e pressão intraocular durante a manobra de Valsalva

ABSTRACT Purpose: To investigate the effects of the Valsalva maneuver (VM) on optic disc morphology, choroidal thickness, and anterior chamber parameters. Methods: This prospective observational study included 60 eyes of 60 healthy subjects. The anterior chamber parameters, including central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), pupil diameter (PD), axial length (AL), subfoveal and peripapillary choroidal thickness, optic disc parameters, and intraocular pressure (IOP), were measured at rest and during VM. Results: VM did not have any significant influence on AL, subfoveal and peripapillary choroidal thickness, optic disc area, rim area, cup area, cup-to-disc area ratio, vertical cup-to-disc ratio, rim volume, cup volume, and nerve head volume measurements (for all; p >0.05). IOP and PD significantly increased during VM (for both; p <0.001). VM significantly decreased CCT, ACD, ACA, and ACV values (for all; p <0.001). Moreover, the optic nerve cup volume decreased and the horizontal cup-to-disc ratio significantly increased during VM (for both; p <0.05). Conclusions: VM may cause transient changes in IOP, optic disc morphology, and anterior chamber parameters.

RESUMO Objetivo: Investigar os efeitos da manobra de Valsalva (VM) sobre a morfologia do disco óptico, a espessura da coroide e parâmetros câmara anterior. Métodos: Estudo observacional, prospectivo incluiu 60 olhos de 60 indivíduos saudáveis. Os parâmetros da câmara anterior, incluindo da espessura central da córnea (CCT), profundidade da câmara anterior (ACD), ângulo da câmara anterior (ACA), volume de câmara anterior (ACV), diâmetro da pupila (PD), comprimento axial (AL), espessura da coroide subfoveal e peripapilar, parâmetros de disco óptico e pressão intraocular (IOP) foram medidos em repouso e durante VM. Resultados: A VM não apresentou influência significativa em AL, espessura da coroide subfoveal e peripapilar, área de disco óptico, área da rima neural, área da escavação, relação da área escavação-disco, a relação vertical escavação-disco, volume da rima neural, volume da escavação, medidas de volume cabeça do nervo (para todos; p >0,05). IOP e PD aumentaram significativamente durante VM (para ambos; p <0,001). A VM diminuiu os valores CCT, ACD, ACA e ACV significativamente (para todos; p <0,001). Além disso, o volume da escavação do nervo óptico diminuiu e a razão horizontal escavação-disco aumentou significativamente durante VM (para ambos; p <0,05). Conclusões: A VM pode causar alterações transitórias na pressão intraocular, na morfologia do disco óptico e em parâmetros câmara anterior.