Refractive change in pediatric patients with intermittent exotropia.

PURPOSE: To determine the relationship between intermittent exotropia (IXT) and refractive change and the effects of the methods applied in IXT follow-up on refractive change. METHOD: The medical records of 228 patients with IXT (group 1) and 110 patients without strabismus (group 2) who were followed between 2008 and 2022 were analyzed retrospectively. Group 1 was divided into three subgroups: overminus correction (group 1A), patients who underwent surgery (group 1B), and patients who were observed (group 1C). RESULTS: Annual myopic progression was -0.21 ± 0.32 D (range, -1.26 to +1.92) in group 1 and -0.07 ± 0.30 D (range, -1.13 to +1.00) in group 2 (P < 0.001). Annual myopic progression was -0.26 ± 0.29 D (range, -1.26 D to +0.12 D) in group 1A, -0.25 ± 0.35 D (range, -1.15 D to +0.25 D) in group 1B, and -0.19 ± 0.33 D (range, -1.12 D to +1.92 D) in group 1C. There was no difference in annual myopic progression between the subgroups (P = 0.670). The annual change in myopic refraction between each of the group 1 subgroups and group 2 was statistically significantly different (P < 0.001, P = 0.023, P < 0.001, resp.). CONCLUSIONS: Myopia progression was significantly greater in children with IXT than in the normal population. Myopia progression did not vary with exotropia treatment.

Surgical treatment of consecutive exotropia: Comparison of different surgical methods applied to one eye in one session.

PURPOSE: To compare the different surgical methods performed on a single eye in a single session and the factors that affect the success of patients having consecutive exotropia (XT) developed after esotropia surgery. METHODS: The medical data of the patients who underwent surgery for consecutive XT were reviewed retrospectively. Patients with followed of 6 months or more were divided into four groups; patients with medial rectus (MR) advancement (Group 1 = 10), MR advancement and MR resection (Group 2 = 12), MR advancement and lateral rectus (LR) recession (Group 3 = 13), MR advancement, MR resection, and LR recession (Group 4 = 14). Success results and possible risk factors were investigated. RESULTS: Forty-nine patients with consecutive XT (21 female, 28 male) were enrolled in the study. The mean age of overall patients was 22.97 years at surgery for consecutive XT. The groups did not display significant differences in terms of surgery ages, gender, refraction values, visual acuity, amblyopia, inferior oblique overaction, limitation of adduction, surgical success rates, and follow-up time (p > 0.05). Patients of Group 4 had larger preoperative and postoperative deviation, while Group 1 had smaller (p < 0.05). The surgical success rates of Groups 1, 2, 3, 4 were 90%, 75%, 76.9%, and 50%, respectively (p = 0.192). Statistically, no factor was found to be effective in surgical success rates (p > 0.05). CONCLUSION: Surgical treatment of consecutive XT is successful in most of the patients with numerous surgical options performed on a single eye in a single session. Patients, particularly with a high amount of deviation should be warned about the possibility of additional surgery.

Factors Affecting Binocular Sensorial Function in Accommodative Esotropia.

OBJECTIVES: This study was an assessment of factors related to the development and maintenance of binocular sensory function after successful alignment of accommodative esotropia (AE). METHODS: A total of 107 patients aged <12 years with ≥6 months follow-up were included in the study. The variables of age at onset of deviation, duration of deviation before treatment, the amount of uncorrected distance and near deviation, hyperopia, anisometropia, and accommodative convergence to accommodation ratio (AC/A) were evaluated. RESULTS: The study patients had a mean age of 4.9±2.5 years and a mean length of follow-up of 34.3±28 months. Anisometropia was identified in 26.1% of the participants. Anisometropic patients had a greater degree of hyperopia (mean: 5.02±2.07 D) than the patients without (p>0.05). Amblyopia was seen in 25% of the patients with anisometropia, and in 19% of those without (p<0.05). The binocular visual function of the 2 groups was not significantly different (p>0.05). The age at onset of deviation and the duration of deviation did not affect the final outcome (p>0.05 for all). The degree of initial uncorrected distance deviation had a significant effect on the development of amblyopia, fusion, and contoured stereopsis (p<0.05 for all), while the degree of near deviation without correction had a significant effect only on contoured stereopsis. CONCLUSION: The degree of uncorrected distance and near deviation had a negative impact on binocular vision and stereopsis in AE. The presence of anisometropia, age at onset of deviation, duration of deviation before treatment, high hyperopia, and high AC/A did not pose a significant risk for impaired binocular function.

Dural Carotid-cavernous Fistula Mimicking Thyroid Orbitopathy.

In this study, we aim to present a case with dural carotid-cavernous fistula mimicking thyroid orbitopathy. The differential diagnosis of red-eye is very coamplex, and the caregiver should distinguish between all diagnoses.

Central corneal thickness in type II diabetes mellitus: is it related to the severity of diabetic retinopathy?

BACKGROUND/AIM: To compare the central corneal thickness (CCT) of type II diabetes mellitus patients with age- and sex-matched healthy subjects and to determine the association of the severity of diabetic retinopathy and CCT. MATERIALS AND METHODS: Type II diabetes mellitus patients without retinopathy, with nonproliferative retinopathy, and with proliferative retinopathy were organized as the three subgroups of the study group, and an age- and sex-matched control group was formed. All subjects underwent full ophthalmological examination and CCT measurement with ultrasonographic pachymetry. CCT values were compared between diabetic and healthy subjects and between the three diabetic subgroups. Correlation analysis was performed to determine any relationship between CCT and intraocular pressure. RESULTS: The average CCT was significantly higher in diabetic patients than in the control group (P = 0.04). CCT in diabetic patients without retinopathy did not significantly differ from that of patients with retinopathy (P = 0.64). Similarly, there was no significant difference in CCT between nonproliferative and proliferative diabetic retinopathy patients (P = 0.47). In the whole study population, CCT was significantly correlated with intraocular pressure (P < 0.01). CONCLUSION: CCT is significantly increased in type II diabetes mellitus patients with respect to controls. Retinal disease severity does not seem to have an effect on corneal thickness.

Efficacy of topical 0.05% cyclosporine treatment in children with severe vernal keratoconjunctivitis.

We aimed to determine the efficacy of topical cyclosporine in children with vernal keratoconjunctivitis refractory to topical mast cell stabilizer and antihistamine therapy. Thirty-one patients, 24 boys and 7 girls younger than 16 years of age, were included in the study. All patients were scored on a four-point scale from 0 to 3 for symptoms and signs. Each patient received topical cyclosporine 0.05% emulsion (Restasis, Allergan Inc., Irvine, CA, USA) four times daily in addition to preservative-free artificial tears and was followed for 6 months. The data was recorded before the initiation of treatment (day 0) and at the 1st, 3rd, and 6th months following treatment. After six months of treatment, severity of all symptoms and signs showed a statistically significant decrease (p<0.05). Patients did not report any serious adverse effects. Topical cyclosporine 0.05% emulsion treatment is a safe and effective treatment option for controlling the symptoms and signs of vernal keratoconjunctivitis in children.

Unintentional staining of the posterior lens capsule with trypan blue dye during phacoemulsification: case report.

We report a complication related to the use of trypan blue during capsular staining of the anterior lens capsule during phacoemulsification surgery. In phacoemulsification surgery of the left eye, trypan blue was injected using an air bubble technique. Unintentionally, trypan blue was administered under high pressure, dispersing the dye through the zonules leading to staining of the posterior capsule. This caused a temporary disturbance of visual acuity during the postoperative period.

The effect of paracetamol on postoperative nausea and vomiting during the first 24 h after strabismus surgery: a prospective, randomised, double-blind study.

CONTEXT: Strabismus surgery is one of the most common ophthalmic surgical procedures in children and is associated with significant postoperative nausea and vomiting (PONV). OBJECTIVE: We evaluated the effect of intravenous paracetamol on PONV in children after strabismus surgery. DESIGN: Prospective, placebo-controlled, randomised double-blind study. SETTING: University hospital. PATIENTS: Ninety children, between 2 and 14 years scheduled for strabismus surgery, were recruited. Eighty-six completed the study. INTERVENTIONS: After induction of anaesthesia, intravenous dexamethasone 0.1 mg kg was administered to all. The patients were enrolled to receive either intravenous physiological saline (group S) or paracetamol 15 mg kg (group P). MAIN OUTCOME MEASURE: Incidence of PONV in the first 24 h postoperatively. RESULTS: General and clinical characteristics of the children were similar in both groups. PONV during the first 24 h was significantly higher in group S in comparison with group P (group S vs. group P, 33 vs. 14.6%, respectively, P = 0.038 for nausea; 24.4 vs. 7.3%, respectively, P = 0.030 for vomiting). The number of analgesic administrations during the first 24 h was higher in group S compared with group P (1.31 ±â€Š0.85 and 0.73 ±â€Š0.6, respectively, P = 0.001). The repeat number of postoperative analgesic administrations was significantly different between groups during the first 24 h (P = 0.005), but during 24-48 h was not significant. CONCLUSION: Intraoperative administration of intravenous paracetamol decreases the incidence of PONV during the first 24 h in children after strabismus surgery.

Nasolacrimal duct obstruction: clinicopathologic analysis of 205 cases.

PURPOSE: To investigate the histopathological results of lacrimal sac biopsies in patients with primary acquired nasolacrimal duct obstruction. METHODS: In this prospective non-comparative study, 205 consecutive patients, who were diagnosed as primary acquired nasolacrimal duct obstruction, were included. Patients with history of trauma and/ or surgery in the periorbital area, punctum or canalicular obstruction were excluded from the study. Patients were evaluated for age, gender, history, and presenting symptoms. Lacrimal drainage system abnormalities were assessed. Lacrimal system irrigation, dacryocystography, and in selected cases dacryoscintigraphy was performed. All patients underwent external dacryocystorhinostomy. Biopsy specimens were obtained from the posterior inferior flap and examined by the same pathologist. RESULTS: Forty-seven male and 158 females with age ranging from 6 to 81 years (mean 47.5 ± 16.2 years) were included in the study. Only one patient had the diagnosis of chronic leukemia, others had no preexisting history of systemic disease. Pathologic examination revealed chronic inflammation (n= 178), fibrosis without inflammation (n= 19), normal mucosa (n= 4), and lymphoid hyperplasia (n= 1). Three patients had abnormal pathology: Lymphoproliferative disease in the patient with chronic leukemia, granulomatous inflammation, and basosquamous cell carcinoma. CONCLUSION: In primary nasolacrimal duct obstruction, pathological examination of the lacrimal sac revealed chronic inflammatory changes in most patients. Even though rare, malignant or systemic disease in patients with neither specific history nor clinical or radiological finding might be observed in these cases. Thus, we recommend taking biopsy if any suspicion of abnormality of the lacrimal sac exists.

Ophthalmoparesis, papillitis and premacular hemorrhage in a case with endocarditis: a rare presentation of Brucellosis.

We report a rare presentation of brucellosis as bilateral optic nerve and right abducent nerve involvement, and endocarditis complicated by right premacular hemorrhage in a 28-year-old white female. The patient showed improvement with both medical and surgical therapy. Brucellosis should be considered in the differential diagnosis of papillitis, gaze palsy and endocarditis complicated with premacular hemorrhage in endemic regions.

Silicone intubation with the Ritleng method using intranasal endoscopy to treat congenital nasolacrimal duct obstruction.

OBJECTIVE: This study evaluated the technical properties and clinical efficacy of bicanalicular silicone intubation using the Ritleng method in children with congenital nasolacrimal duct obstruction. METHODS: Thirty patients (34 eyes; mean age, 5+/-2.04 years; age range, 2-10 years) with congenital nasolacrimal duct obstruction underwent silicone intubation with the Ritleng lacrimal intubation system under endoscopic transnasal control. Removal of the silicone tube was planned 6 months after surgery. RESULTS: All patients were successfully intubated with the Ritleng system. One patient was lost to follow-up. We successfully evaluated the clinical results in 33 eyes of 29 patients. Stent removal in 29 of 33 eyes took place 6 months after surgery; in the other 4 eyes, the silicone tube was removed 7 to 10 months after surgery because the patients were late for their visits. One eye in which the tube had remained in place for 10 months developed a slit punctum. The mean follow-up after tube removal was 40.32+/-24.46 months (range, 12-96 months). The success rate measured as improvement of signs and symptoms of obstruction was 100%. CONCLUSIONS: Bicanalicular silicone intubations with the Ritleng intubation system using an intranasal endoscope for congenital nasolacrimal duct obstruction is an easy, nontraumatizing procedure that yields a high rate of success.

Clinical factors associated with floppy iris signs: a prospective study from two centers.

BACKGROUND AND OBJECTIVE: To evaluate the relationship of intraoperative floppy iris syndrome with pseudoexfoliation, diabetes mellitus, hypertension, and alpha-1 adrenergic blocker (A1AB) use. PATIENTS AND METHODS: Five hundred patients were included in this prospective study. Intraoperative adverse events, such as pupillary constriction, iris billowing, and iris prolapse from the wound, were noted. Multinomial regression analysis was used to evaluate the relationship of intraoperative floppy iris syndrome with pseudoexfoliation, diabetes mellitus, hypertension, pupil diameter, and A1AB use. RESULTS: Pupil constriction was significantly associated with pseudoexfoliation (P < .001). Diabetes mellitus was associated with pupil constriction and iris billowing (P = .005 and .003, respectively). Hypertension was associated with pupil constriction (P = .021). Intraoperative floppy iris syndrome was strongly associated with A1AB use and male gender (P < .001 and .039, respectively). CONCLUSION: Intraoperative floppy iris syndrome was observed in 2.8% of patients and was strongly related to A1AB use, particularly in smaller pupil diameters. Pseudoexfoliation, diabetes mellitus, and hypertension were not associated with intraoperative floppy iris syndrome.

p53 expression in pterygium in two climatic regions in Turkey.

PURPOSE: To assess accumulation of p53 protein in samples of primary pterygium from people living in two different climatic regions in Turkey. MATERIALS AND METHODS: Group 1 included 101 pterygium specimens from people in Adana located in southern Turkey. Group 2 included 39 pterygium specimens from people in Ankara, located in the middle of Turkey. Climatic conditions throughout the year are sunnier and warmer in Adana than they are in Ankara. The control group (Group 3) included 30 specimens of conjunctiva that had been excised during cataract surgery from 30 patients without pterygium. The pterygial specimens and control conjunctiva were studied by immunohistochemistry using antibodies against p53 protein. Pearson's chi-square test was used to compare the p53 immunoreactivity. RESULTS: The p53 immunoreactivity in Groups 1 and 2 was greater than it was in the control group ( P 0.001). There were no differences in p53 immunoreactivity between Groups 1 and 2 ( P= 0.060). CONCLUSION: The p53 immunoreactivity was not correlated with ultraviolet irradiation exposure. The p53 immunoreactivity in our pterygium specimens suggests that pterygium could be a result of uncontrolled cell proliferation.

Effect of corneal thickness on intraocular pressure measurements with the Pascal dynamic contour, Canon TX-10 non-contact and Goldmann applanation tonometers in healthy subjects.

PURPOSE: To investigate the effects of central corneal thickness (CCT) on intraocular pressure (IOP) measurements of the Pascal dynamic contour tonometry (DCT), Canon TX-10 non-contact tonometry (NCT) and Goldmann applanation tonometry measurements (GAT) in healthy subjects. METHODS: IOP values of 135 eyes with normal corneas of 135 healthy volunteers were determined by DCT, NCT and by GAT. The CCT was measured using an ultrasonic pachymeter after all IOP determinations had been made. RESULTS: When DCT measurements were compared (IOP = 17.52 +/- 2.0 mmHg) with NCT measurements (IOP = 16.54 +/- 2.77 mmHg) and GAT measurements (IOP = 15.07 +/- 2.35 mmHg), DCT measurements were significantly higher than NCT and GAT (p < 0.001). There was a significant correlation between CCT with both NCT (r = 0.260, p = 0.003) and GAT measurements (r = 0.257, p = 0.005). There was a weak correlation that was not statistically significant between CCT and DCT (r = 0.160, p = 0.079). CONCLUSION: The IOP measurements with DCT seem to be less dependent on CCT. NCT appears to be more affected by variation in CCT than GAT.

Periorbital necrobiosis lipoidica diabeticorum: case report.

Necrobiosis lipoidica diabeticorum (NLD) is a relatively common manifestation of diabetes mellitus that is thought to be related to immune-complex vasculitis. The legs are the most common site for NLD, but other locations, such as the forearms or hands, have been reported. We describe a case of periorbital NLD that was diagnosed on the basis of histopathology.

Astigmatism induced by oblique clear corneal incision: right vs. left eyes.

BACKGROUND: To compare the induced astigmatism after phacoemulsification in the right vs. the left eye. METHODS: An oblique clear corneal incision was made in a superotemporal location in the right (n = 344) and a superonasal location in the left (n = 292) eye. Retrospectively, patient characteristics, pre- and postoperative visual acuity, and induced astigmatism values were compared. Statistical analysis was performed with the Student t , chi2, and Mann-Whitney U tests. RESULTS: The proportion of against-the-rule astigmatism and surgically induced astigmatism values were significantly larger in the left-eye group (p < 0.001). INTERPRETATION: Surgically induced astigmatism occurred to a greater extent in the left eyes compared with the right, possibly because of structural differences.

Comparison of ultrasonic pachymetry with Orbscan in corneal haze.

BACKGROUND: To compare the results of ultrasonic and Orbscan pachymetry in corneal haze not related to surgery. METHODS: An institutionally based, prospective, controlled clinical trial included 40 eyes of 40 consecutive patients with corneal haze not related to surgery. Fifty normal eyes were used as a control group to calculate the customized acoustic factor. Corneal haze was graded with slit-lamp by a single examiner. Ultrasonic and Orbscan II pachymetry measurements were obtained. Paired t- and Kruskal-Wallis tests were used to evaluate the difference between ultrasonic and Orbscan pachymetry measurements. Correlation of the two methods and haze grade were determined with Kendall's tau-b correlation analysis. RESULTS: Eighty-five percent of patients had moderate haze. With the customized acoustic factor, Orbscan values were significantly smaller than ultrasonic pachymetry measurements (p = 0.001, paired samplet-test). Increased haze grade resulted in smaller Orbscan pachymetry measurements however, this difference was insignificant (p = 0.444, Kruskal-Wallis test). A positive correlation was found between two methods, though insignificant (p = 0.064, Kendall's tau-b correlation). When grouped in respect of diagnoses, differences in pachymetry measurements as well as the correlation were not significant (p > 0.05). CONCLUSION: An insignificant positive correlation was found between the two methods in the presence of corneal haze. Orbscan measurements were inversely related to haze grading, and were significantly lower than ultrasonic pachymetry. According to our results, we recommend that clinicians should not count on Orbscan topography alone in the presence of corneal haze.

The effects of two systemic alpha1-adrenergic blockers on pupil diameter: a prospective randomized single-blind study.

Our aim was to investigate the effects of two alpha(1)-adrenergic blockers-tamsulosin and alfuzosin-on pupil diameter (PD). In this prospective randomized single-blind clinical trial, 64 patients with benign prostatic hyperplasia received treatment with either tamsulosin or alfuzosin. The same ophthalmologist, masked to the given medication, evaluated patients prior to, 4 weeks after and 6 months after the start of the medication (day 0, day 28 and month 6). Best corrected visual acuity and PD under mesopic, scotopic, and dilated conditions were measured. t-test, ANOVA, and Dunnett's multiple comparison post-test were used for statistical analysis. With tamsulosin treatment, both mesopic and scotopic PD decreased, respectively, from 3.9 +/- 0.7 and 5.7 +/- 0.6 mm at day 0 to 3.6 +/- 0.9 and 5.5 +/- 0.8 mm at day 28, and 3.6 +/- 0.7 and 5.4 +/- 0.7 mm at month 6 (ANOVA; P = 0.021 and = 0.040, respectively). However, the difference in dilated PD was not significant (day 0 7.8 +/- 0.6 mm, day 28 7.7 +/- 0.7 mm, and month 6 7.6 +/- 0.6 mm, P = 0.379). In the alfuzosin group, PD did not differ significantly from the baseline except for the scotopic measurements, which decreased from 5.6 +/- 0.6 mm at day 0 to 5.5 +/- 0.6 mm at day 28 and 5.2 +/- 0.8 mm at month 6 (P = 0.004). Compared to baseline values, small but statistically significant decreases were detected in mesopic and scotopic illumination in patients treated with tamsulosin and in scotopic PD in patients treated with alfuzosin. The clinical significance of these differences needs further evaluation.