Müller Muscle Conjunctiva Resection for Revision of Residual Ptosis After External Levator Advancement Surgery.

PURPOSE: To evaluate surgical outcomes of Müller muscle conjunctival resection surgery for reoperation of residual ptosis after external levator advancement in patients with aponeurotic ptosis. METHODS: A total of 23 eyes of 23 patients who had undergone Müller muscle conjunctival resection for residual ptosis between January 2016 and July 2018 were reviewed retrospectively. Margin reflex distance (MRD), interlid crease, and show distance measurements were performed with a ruler in millimeters during the office examination, and the photographs of patients were taken before the procedure and on the 10th day, at the first, third, and sixth months after the procedure. The successful outcome was described as MRD1 between 3 and 5 mm, interlid MRD1 difference ≤1 mm, interlid crease difference ≤2 mm, interlid show difference ≤2 mm, and the presence of symmetrical lid contour. RESULTS: The mean increases in MRD1 were statistically significant at the first, third, and sixth months postoperatively when compared with preoperative values both before external levator advancement and before Müller muscle conjunctival resection (p = 0.000). There was statistically significant decrease in interlid MRD1 difference, interlid crease difference, and interlid show difference relative to preoperative values. Interlid crease and show difference within the range of successful outcome criteria were achieved in all patients. However, interlid MRD1 difference exceeded 1 mm in only 1 patient who had overcorrection. CONCLUSIONS: In patients who have residual ptosis without contour abnormality following external levator advancement, and positive response to phenylephrine testing, Müller muscle conjunctival resection is an effective approach.

Lamina cribrosa surface position in idiopathic intracranial hypertension with swept-source optical coherence tomography.

Purpose: The purpose of this study is to compare the thickness and depth measurements of the lamina cribrosa (LC) obtained using a swept-source optical coherence tomography (SS-OCT) device in idiopathic intracranial hypertension (IIH) patients and healthy subjects. Methods: This retrospective, cross-sectional observational study included 16 eyes with IIH and 20 control eyes. The LC measurements with serial horizontal B scans of the optic nerve head were obtained using SS-OCT (Topcon 3D DRI OCT Triton). The anterior lamina surface (ALS) depth, posterior lamina surface (PLS) depth, and LC thickness measurements were evaluated. Results: In patients with IIH, the mean ALS depth was 225.00 ± 58.57 µm and the mean PLS depth was 449.75 ± 63.50 µm. In the IIH control group, the corresponding values were 359.40 ± 105.38 and 570.10 ± 99.41 µm (P < 0.05). The difference in LC thickness between the IIH and control subjects was not statistically significant. Conclusion: LC can be evaluated using an SS-OCT device. LC was displaced anteriorly in patients with IIH compared with normal controls. The assessment of LC level with SS-OCT in IIH cases is a valuable and reproducible adjunctive imaging method in terms of diagnosis and follow-up.

Macular toxicity after short-term hydroxychloroquine therapy.

We report an unusual case of hydroxychloroquine (HCQ) toxicity after only 2 months of starting the treatment. A 42-year-old woman presented with visual impairment. Her visual acuity was 20/20 in the right eye and 20/25 in the left eye. Ophthalmologic examination revealed a bull's eye pattern in both eyes which was more prominent in the left eye. She had received HCQ therapy (400 mg/day) for 1 month, and had been taking 200 mg/day for 1 month for the treatment of rheumatoid arthritis. HCQ macular toxicity is rarely seen in short-term use, before 5 years, and to our knowledge, there is only one other case reported in the literature.

Normative posterior pole asymmetry analysis data in healthy Caucasian population.

PURPOSE: The aim of this study is to evaluate the variability of central retinal thickness asymmetry in healthy Caucasian adults with the posterior pole asymmetry analysis to serve as a reference. METHODS: In total, 404 eyes of 202 subjects who aged between 18 and 80 years, who had no ocular pathology, were included in this cross-sectional observational study. Retinal thickness maps with posterior pole asymmetry analysis mode were taken with the optical coherence tomography (SPECTRALIS SD-OCT; Heidelberg Engineering). Superior and inferior hemifields were divided into five zones resembling to the strategy in Glaucoma Hemifield Test. Mean retinal thickness in each of the five zones was compared with the thickness of the corresponding zone in each eye (paired-samples t-test), and differences in retinal thickness (DRT1-5) and ganglion cell layer thickness between reciprocal locations were measured. Differences in retinal thickness values of two eyes of each subject were also compared (independent-samples t-test). RESULTS: The intra-eye asymmetry was statistically significant in zones 4 and 5. The highest mean intraocular differences in retinal thickness were 5.8 µm (zone 5) in all eyes, 5.8 µm (zone 5) in the right eyes, and 5.9 µm (zones 4 and 5) in the left eyes. The only statistically significant interocular local differences in retinal thickness asymmetries were found in zone 3. The intraocular asymmetry in retinal thickness was found to be the lowest in zone 1. The differences of ganglion cell layer thickness (GCLTs) were not statistically significant. CONCLUSION: There were statistically significant physiological inter-eye asymmetry in zone 3 and intra-eye asymmetries in zones 4 and 5. These measurements must be considered during screening for glaucoma with posterior pole asymmetry analysis in the Caucasian population.

Risk factors for treatment failure and recurrence of anisometropic amblyopia.

PURPOSE: The aim of this study was to identify factors associated with failed vision improvement and recurrence following occlusion therapy for anisometropic amblyopia in children aged 7-9 years. METHODS: We retrospectively reviewed the medical records of 64 children aged 7-9 years who had been diagnosed as having anisometropic amblyopia and were treated with patching. Functional treatment failure was defined as final visual acuity in the amblyopic eye of worse than 20/32. Improvement of fewer than two logMAR lines was considered relative treatment failure. Recurrence was defined as the reduction of at least two logMAR levels of visual acuity after decreased or discontinued patching. RESULTS: Functional and relative success rates were 51.6 and 62.5 %, respectively. The most important factor for functional treatment failure [adjusted odds ratio (OR) (95 % confidence interval, CI) 11.57 (1.4-95.74)] and the only risk factor for recurrence [adjusted OR (95 % CI) 3.04 (1.13-8.12)] were the same: high spherical equivalent (SE) of the amblyopic eye. A large interocular difference in the best-corrected visual acuity was found to be a risk factor for both functional and relative failure. CONCLUSION: High SE of the amblyopic eye was the most influential risk factor for treatment failure and recurrence in compliant children aged 7-9 years.

Bilateral Choroidal Metastases from Lung Adenocarcinoma: A Case Report.

The most common malignancy of the eye is metastatic tumors, with choroidal metastases being the majority of them. In women, breast cancer is the most common cause of orbital metastases, and in men, it is lung cancer. Despite the fact that there are efficient treatment options for orbital metastases, the benefit of procedures to detect choroidal metastases is debatable due to the quick progression and poor prognosis of lung cancer. In choroidal metastases resulting from lung cancer, patients are usually presented with decreased sight. Defects in the field of vision, flashes of light and floating bodies generally follow. Treatment options of choroidal metastases include many methods including laser photocoagulation, cryotherapy, chemotherapy, radiotherapy, surgical resection, enucleation and photodynamic therapy. There are reports emphasizing radiotherapy as the most efficient treatment option. In this case report, we sum up the case of a male patient presenting with blurry vision in both eyes, who was subsequently detected to have bilateral choroidal metastatic tumor and was diagnosed with primary lung adenocarcinoma.

A comparison of optic nerve head topographic measurements by Stratus OCT in patients with macrodiscs and normal-sized healthy discs.

PURPOSE: To evaluate and compare optic nerve head parameters and retinal nerve fiber layer (RNFL) thickness between large discs and normal-sized vital discs using Stratus optical coherence tomography (OCT). METHODS: A total of 293 healthy eyes (145 with macrodisc and 148 with normal-sized disc) were enrolled in the study. After a complete ophthalmic evaluation, measurement of optic nerve head parameters and RNFL thickness using OCT was performed in all subjects. Optic disc areas larger than 2.80 mm were accepted as macrodiscs. All OCT parameters were compared between normal-sized discs and macrodiscs. RESULTS: Participants' mean age was 46.5±10.6 years (range, 13 to 74 y). Average optic disc areas were 2.19±0.29 and 3.02±0.29 mm in the normal and the macrodisc groups, respectively. The optic disc area (P<0.0001), the cup area (P<0.0001), the horizontal cup disc ratio (P<0.0001), the vertical cup disc ratio (P<0.0001), and the cup disc area ratio (P<0.0001) were found to be significantly different in the macrodisc group and the control group. Rim areas (P=0.57) and RNFL thicknesses (inferior, superior, and mean) were found to be similar in both groups (P=0.75, 0.65, 0.85, respectively). CONCLUSIONS: A macrodisc may have a macrocup and should not be misdiagnosed as glaucoma. The present study showed that macrodiscs are identical to normal-sized discs in terms of rim area and RNFL thickness. We suggest that these 2 OCT parameters can help to differentiate a healthy macrodisc from a glaucomatous optic disc.