Botulinum toxin A for the treatment of strabismus in children with neurological impairment / Toxına botulínica tipo A para o tratamento de estrabısmo em crianças neurologicamente comprometidas

ABSTRACT Purposes: To assess the efficacy of botulinum toxin A injection in the treatment of strabismus in patients with neurological impairment and evaluate the factors associated with treatment success. Methods: The study included 50 patients with strabismus and neurological impairment. In all children, botulinum toxin injection was performed into the appropriate extraocular muscle. The relationship between demographic features, clinical characteristics, and treatment success were analyzed. Results: In the study group, 34 patients had esotropia, and 16 patients had exotropia. As neurological problems, 36 patients had cerebral palsy, and 14 had hydrocephalus. The average follow-up period was 15.3 ± 7.3 months. The mean number of injections was 1.4 ± 0.6. The mean angle of deviation was 42.5 ± 13.2 PD before the treatment, which decreased to 12.8 ± 11.9 PD after the treatment. Successful motor alignment (orthotropia within 10 PD) was achieved in 60% of the patients. Binary logistic regression analysis revealed that esotropic misalignment and shorter duration of strabismus was significantly associated with treatment success in the study group. Patients with esotropia and lower angles of misalignment were more likely to be treated with a single injection. Conclusion: The use of botulinum toxin A for the treatment of strabismus in children with neurological impairment is a good alternative to conventional surgical therapy with a lower risk of overcorrection. The treatment outcome is better in esodeviations and shorter duration of strabismus, implying an advantage of early treatment.

RESUMO Objetivos: Avaliar a eficácia do uso de toxina bo-tulínica tipo A no tratamento do estrabismo em pacientes com comprometimento neurológico e avaliar os fatores associados ao sucesso do tratamento. Métodos: Cinquenta pacientes com estrabismo e comprometimento neurológico foram incluídos no estudo. Em todas as crianças, a toxina botulínica tipo A foi injetada no músculo extraocular apropriado. A relação entre características demográficas, características clínicas e o sucesso do tratamento foram analisadas. Resultados: No grupo de estudo, 34 pacientes tiveram esotropia e 16 pacientes tiveram exotropia, sendo trinta e seis pacientes com paralisia cerebral e 14 pacientes com hidrocefalia. O tempo médio de acompanhamento foi de 15,3 ± 7,3 meses. O número médio de aplicações foi de 1,4 ± 0,6. O ângulo de desvio médio foi de 42,5 ± 13,2 DP antes do tratamento e diminuiu para 12,8 ± 11,9 DP após o tratamento. Alinhamento motor bem sucedido (ortotropia dentro de 10 DP) foi alcançado em 60% dos pacientes. A análise de regressão logística binária revelou que o desalinhamento esotrópico e uma menor duração do estrabismo foram significativamente associados ao sucesso do tratamento no grupo de estudo. Pacientes esotrópicos com ângulos de desalinhamento menores são mais propensos a serem tratados com uma única aplicação. Conclusão: O uso da toxina botulínica tipo A para o tratamento de estrabismo em crianças com comprometimento neurológico é uma boa alternativa para a terapia cirúrgica convencional com menor risco de hipercorreção. O resultado do tratamento é melhor em exodesvios e em pacientes com estrabismo de menor duração, implicando em vantagem para o tratamento precoce.

Botulinum toxin A for the treatment of strabismus in children with neurological impairment.

PURPOSES: To assess the efficacy of botulinum toxin A injection in the treatment of strabismus in patients with neurological impairment and evaluate the factors associated with treatment success. METHODS: The study included 50 patients with strabismus and neurological impairment. In all children, botulinum toxin injection was performed into the appropriate extraocular muscle. The relationship between demographic features, clinical characteristics, and treatment success were analyzed. RESULTS: In the study group, 34 patients had esotropia, and 16 patients had exotropia. As neurological problems, 36 patients had cerebral palsy, and 14 had hydrocephalus. The average follow-up period was 15.3 ± 7.3 months. The mean number of injections was 1.4 ± 0.6. The mean angle of deviation was 42.5 ± 13.2 PD before the treatment, which decreased to 12.8 ± 11.9 PD after the treatment. Successful motor alignment (orthotropia within 10 PD) was achieved in 60% of the patients. Binary logistic regression analysis revealed that esotropic misalignment and shorter duration of strabismus was significantly associated with treatment success in the study group. Patients with esotropia and lower angles of misalignment were more likely to be treated with a single injection. CONCLUSION: The use of botulinum toxin A for the treatment of strabismus in children with neurological impairment is a good alternative to conventional surgical therapy with a lower risk of overcorrection. The treatment outcome is better in esodeviations and shorter duration of strabismus, implying an advantage of early treatment.

The effect of platelet-rich fibrin on wound healing following strabismus surgery.

PURPOSE: To investigate the effect of platelet-rich fibrin (PRF) on post-operative wound healing following strabismus surgery in a rabbit model. METHODS: Nine New Zealand white rabbits were involved in the study. One of these nine rabbits was kept in control without having any operation. Both eyes of eight rabbits underwent superior rectus muscle (SRM) resection. After resection of SRM, PRF was applied to SRM of the right eyes. In the left eye, SRM was not wrapped with PRF and served as a control. The rabbits were sacrificed and enucleated 6 weeks after the surgery. Inflammation and vascular proliferation were assessed by staining with haematoxylin-eosin. Scar and fibrosis were examined by the Masson trichrome staining. Immunohistochemical staining was performed for a vascular endothelial growth factor (VEGF) and alpha-smooth muscle actin (α-SMA). RESULTS: There was no significant difference in terms of inflammation (p = 0.535), vascularization (p = 0.602), and fibrosis (p = 0.745) between the eyes. Immunohistochemical staining for VEGF demonstrated no significant difference (p = 0.745). However, significant staining for α-SMA was detected in PRF-treated eyes compared with control eyes (p = 0.037). CONCLUSION: Consistent with the hypothesis that PRF facilitates wound healing as a biocatalyst, there was only a significant difference for α-SMA related to myofibroblast activity which is important for wound remodelling. Future comprehensive studies are needed to extend these results.

Use of Botulinum Toxin A in the Treatment of Intermittent Exotropia: Factors Affecting Treatment Outcome.

PURPOSE: To evaluate the efficiency of botulinum toxin A (BTA) injection in the treatment of intermittent exotropia (IXT) and determine factors affecting treatment outcome. MATERIALS AND METHODS: A total of 74 patients diagnosed with any type of IXT were included in the study. BTA injection was administered into both lateral rectus muscles. Gender, refractive error, age, pre- and post-injection measurements of ocular deviation, age at the time of the first BTA injection, number of injections, duration of misalignment, age at the onset of misalignment, presence of amblyopia, presence of anisometropia, preterm birth history, type of delivery, presence of any neurological disorder, follow-up period, postoperative ptosis, and vertical deviation were recorded. The final angle of deviation was used in the statistical analysis. Successful motor alignment was defined as a deviation of ≤10 prism diopters (PD) at distance. The relationship of all factors with treatment success was analyzed using the binary logistic regression analysis. RESULTS: A total of 74 patients, 40 female and 34 male, were included in the study. All the patients were followed up for six to 53 months after the first BTA injection, and the mean follow-up was 16.1 ± 11.1 months. Before the first BTA injection of the patients, the mean amount of deviation was measured as 25.7 ± 14.2 (range, 0-60) PD at near and 37.1 ± 10.9 (range, 16-65) PD at distance. According to the most recent examination of the patients, the mean amount of deviation was 10.6 ± 9.8 (range, 0-45) PD at near and 16.4 ± 10.2 (range, 0-45) PD at distance. There was a statistically significant difference between the first and last examinations of the patients in relation to the amount of deviations measured at both near and distance (p < .001). Successful motor alignment (orthotropia within 10 PD for exodeviation) was achieved in 42 patients (56.7%). Thesuccess of treatment increased with the decreased amount of deviation at distance before the BTA injection. CONCLUSIONS: In patients with IXT, BTA injection into the lateral rectus muscles is an effective procedure, which is also less invasive and taking shorter time than surgery, and it can be considered as an alternative treatment option in those with small-medium angle IXT.

Adie-Holmes syndrome associated with COVID-19 infection: A case report.

With increasing experience, it has been suggested that the SARS-CoV-2 virus has a neurotropic effect. Here, we present a case of a tonic pupil who developed after COVID-19 infection. A 36-year-old woman presented with progressive photophobia and blurred vision. On neurological examination, loss of deep tendon reflexes accompanying a tonic pupil was detected and brain MR imaging was normal. With this case, we aimed to describe a rare pattern of neurological involvement caused by the possible SARS-CoV-2 virus.

Evaluation of amblyopic eyes with optical coherence tomography angiography and electrophysiological tests.

Purpose: To investigate the structural and functional changes of the retina and optic nerve in amblyopia. Methods: Eighteen patients with unilateral anisometropic amblyopia and 27 age-matched healthy controls were involved in this study. All patients underwent optical coherence tomography angiography (OCTA), pattern visual evoked potential (pVEP), and flash electroretinogram (fERG). Results: There was no statistically significant difference in terms of the foveal avascular zone (FAZ), perifoveal superficial density, whole superficial density, parafoveal deep density, perifoveal deep density among the eyes (P > 0 0.05). Significant differences were found only in superficial capillary plexus (SCP) vessel density in whole (P = 0.029) and parafoveal (P = 0.008) image. In electrophysiological tests, while VEP latencies of the amblyopic eyes increased compared to nonamblyopic eyes and controls (P = 0.027), VEP amplitudes decreased in amblyopic and nonamblyopic eyes compared to controls (P = 0.01), amplitudes of the rod (P = 0.027) and cones (P < 0.001) also decreased in amblyopic eyes compared to nonamblyopic and healthy eyes. When we assessed the correlation between the parameters of OCTA and electrophysiological test, only a significant correlation was found between parafoveal SCP vessel density and VEP amplitudes (r = 0.341). Conclusion: We found a significant decrease only in SCP vessel density of the OCTA parameters in amblyopic eyes compared to healthy eyes. We detected a significant relationship between parafoveal SCP vessel density and VEP parameters, which might be associated with the underlying pathophysiology of the amblyopia.

Evaluation of retinal alterations in Parkinson disease and tremor diseases.

Optical coherence tomography (OCT) has been suggested as a method for detection of retinal alterations in neurodegenerative diseases. The usefulness of OCT as a diagnostic tool to differentiate Parkinson's disease (PD) from other tremor diseases, remains unknown. We aimed to evaluate morphological changes of the retina in patients with PD, essential tremor (ET), essential tremor-Parkinson's disease (ET-PD) using OCT. Forty-two eyes of 21 patients with PD, 24 eyes of 12 patients with ET, 24 eyes of 12 patients with ET-PD and 44 eyes of 22 age-matched healthy controls were included in the study. All participants underwent detailed neurological and ophthalmological examination. Measurements in all quadrants of macula and retinal nerve fiber layer (RNFL) thickness using OCT were recorded. There was no significant difference among the groups regarding age, sex. The average RNFL thickness was thinner in PD patients than that of ET (p = 0.032). The RNFL thickness in superior quadrant was lower in PD group compared with the ET and control group (p = 0.001, p = 0.016). Significant differences were observed in most of the macular thickness parameters excluding foveolar and foveal thickness (p = 0.865, 0.394). Correlations were found among several OCT parameters and disease duration or severity in all patient groups (p > 0.05). Retinal alterations were found in PD patients compared to ET. However, no significant retinal changes were detected by OCT in patients with ET and ET-PD compared to controls. According to our data, retinal assessments by OCT do not seem to be satisfactory for differentiation of these disorders.

Protective effect of pomegranate juice on retinal oxidative stress in streptozotocin-induced diabetic rats.

AIM: To investigate the effect of pomegranate juice (PJ) intake on overall oxidation status in retinas of diabetic rats. METHODS: Twenty-seven rats were divided into four groups as control (CO), diabetic (DM), control treated with PJ (CO-PJ), and diabetic treated with PJ (DM-PJ).The retina tissues were used to determine 8-hydroxy-2'-deoxyguanosine (8OHdG), malondialdehyde (MDA), reduced glutathione (GSH) levels, and the enzyme activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px). RESULTS: The levels of 8OHdG and MDA were significantly increased in the retina of DM group compared to CO group (P=0.001, P<0.001 respectively). Both 8OHdG and MDA levels were decreased in PJ-DM group compared to DM group (P=0.004, P<0.001 respectively). The activities of antioxidant enzymes GSH, SOD, and GDH-Px were significantly decreased in the retina of DM group compared to CO group (P≤0.01). GSH and GSH-Px activities were higher in PJ-DM group compared with DM group (P=0.010, P=0.042, respectively) but SOD activity was not statistically different (P=0.938). CONCLUSION: PJ intake is found to be effective in decreasing oxidative end products, and in increasing the activities of antioxidant enzymes in diabetic retinas of rats, which suggests it may be effective against oxidative stress in diabetic retinas.

Evaluation of inner retinal layers with optic coherence tomography in vigabatrin-exposed patients.

In order to reveal the underlying retinal pathology leading to dysfunction in vigabatrin-exposed patients, we aimed to evaluate the inner retinal layers encompassing ganglion cell complex (GCC) layer and inner plexiform layer with new generation optic coherence tomography (OCT). Fourteen patients with epilepsy and exposure to vigabatrin and 12 clinically normal individuals, constituting the control group, were included. Retinal images were obtained using spectral-domain OCT (Optovue RTVue Fourier domain). Nasal and superior quadrants of retinal nerve fiber layer (RNFL) were found to be significantly lower in the patient group compared to the controls (p < 0.01). No significant difference was shown in the thickness of GCC layer (p > 0.05). Foveal thickness was significantly higher in the patient group (p: 0.006), but no significant difference was found in perifoveal and parafoveal regions between groups (p > 0.05). The thickness of RNFL was found to be lower in vigabatrin-exposed patients without any reduction in GCC layer in the macular region. However, foveal thickness was found to be significantly higher compared to perifoveal and parafoveal macular regions in vigabatrin-exposed patients. In conclusion, OCT revealed reduced thickness of RNFL without any reduction in ganglion cell layer in our study. The objective quantitative assessment of OCT is a practical noninvasive method and it can have role in future monitoring of these patients.

Botulinum toxin as an adjunct to monocular recession-resection surgery for large-angle sensory strabismus.

PURPOSE: To evaluate the result of using intraoperative botulinum toxin A (BTA) as an adjunct to monocular recession-resection surgery in the management of large-angle sensory strabismus. METHODS: The medical records of patients diagnosed with sensory strabismus with constant large-angle strabismus were reviewed retrospectively to identify those who underwent monocular recession-resection surgery combined with 5 units of BTA injection into the recessed muscle of the nonfixating eye. Surgical outcome was considered successful if the final deviation was within the range of 0Δ-10Δ. RESULTS: A total of 13 patients (mean age, 31.04 ± 18.5 years) were included, 8 with exotropia and 5 with esotropia. The mean follow-up period was 52.77 ± 10.9 months. The mean preoperative deviation was 66Δ ± 16Δ in the esodeviation group and 56Δ ± 5Δ in the exodeviation group. The final postoperative mean deviation was 6Δ ± 7Δ in the esodeviation group and 6Δ ± 8Δ in the exodeviation group. There were 7 patients (87.5%) with final deviation of ≤10Δ in the exodeviaton group and 4 (80%) in the esodeviation group. CONCLUSIONS: Adjunctive usage of BTA with conventional surgery appears to enhance surgical outcomes by increasing the amount of expected correction. The combined use of BTA with monocular recession-resection rectus muscle surgery may be a good alternative in the treatment of large-angle sensory strabismus with the advantage of less risk of potential complications compared to supramaximal surgery or surgery in the "good" eye.

Development of Strabismus in Children Initially Diagnosed with Pseudostrabismus.

PURPOSE: To evaluate the incidence of strabismus in children initially diagnosed with pseudostrabismus and to identify risk factors for the development of strabismus. METHODS: The medical records of patients who were diagnosed with pseudostrabismus at initial examinations in outpatient clinic were reviewed retrospectively. Follow-up examinations were made at the strabismus department. Age at first examination, gender, family and developmental history, ophthalmic and orthoptic findings including orbit, and eyelid pathologies were investigated. RESULTS: Sixty-five patients with the diagnosis of pseudostrabismus were identified; 2 patients (3.1%) had pseudoexotropia, and 63 patients (96.9%) had pseudoesotropia. The mean age at the initial exam was 29.26±26.68 months (range; 4-120 months). Epicanthal skin folds (n=35), flat broad nasal bridge (n=17), blepharophimosis syndrome (n=1), hypertelorism (n=1), telecanthus (n=1), and multiple pathologies (n=10) were the reasons for pseudostrabismus. Six patients (9.2%) had clinically significant hypermetropia. Anisometropia and amblyopia were detected in 1 (1.5%) and 3 patients (4.6%), respectively, at the initial examination. The mean follow-up period was 25.2±23.28 months (range; 1-154 months). During the follow-up period, true strabismus was detected in 8 cases (12%); of these, 5 cases had non-refractive esotropia, 2 cases had refractive accommodative esotropia, and 1 case had exotropia. Binocular single vision was not developed following amblyopia therapy and refractive correction in esotropic cases. Binocular single vision and best corrected visual acuity were statistically significant risk factors for the development of strabismus (P=0.001). CONCLUSION: The pseudostrabismic children with subnormal binocular single vision or low visual acuity require follow-up for the risk of development of true strabismus.

Imaging Methods in the Diagnosis of Optic Disc Drusen.

Optic disc drusen (ODD) are benign congenital anomalies of the optic nerve characterized by calcified hyaline bodies. While superficial drusen can be diagnosed easily during fundus examination, detecting buried drusen requires the use of additional imaging methods such as B-scan ultrasonography (USG), fundus fluorescein angiography (FFA), computed tomography (CT) and fundus autofluorescence (FAF). ODD can be detected by USG with the presentation of highly reflective round structures. ODD appear as hyperautofluorescent areas on FAF and bright spots on CT scans. FFA can be helpful in differentiating ODD from true optic disc edema. Optic disc edema shows early hyperfluorescence due to diffuse leakage whereas ODD presents as well-defined hyperfluorescence in the late phase. In recent years, it has been reported that optical coherence tomography (OCT) examination has allowed more detailed evaluation of ODD and yielded useful findings for the differentiation of optic disc edema from ODD. In this review, the role of OCT in the diagnosis of ODD is discussed.

The Course of the Changes in Anterior Chamber Parameters After Laser Peripheral Iridotomy: Follow-up for 6 Months With a Scheimpflug-Placido Disc Topographer.

PURPOSE: To evaluate the course of the changes in anterior chamber (AC) parameters using a Scheimpflug-Placido disc topographer before and through 6 months after laser peripheral iridotomy (LPI). MATERIALS AND METHODS: A total of 109 eyes of 56 consecutive patients classified as primary angle closure suspect (PACS), primary angle closure (PAC), and primary angle closure glaucoma (PACG) were included in this prospective, interventional, observational case series. Anterior chamber volume (ACV), central anterior chamber depth (CACD), and anterior chamber angle (ACA) were measured by Scheimpflug photography preoperatively and at 1, 3, and 6 months after LPI. With respect to the parameters above, alterations in the measurements were assessed to determine whether the effects induced by LPI on AC morphology persisted with time. RESULTS: At 1 month after LPI, mean ACV, CACD, and ACA increased significantly in all groups (P<0.05). However, in eyes with PACG, significant reductions at 3 months in ACA [0.00 (-1.00 to 0.00) degrees, median (Md) [quartile 1 (Q1) to quartile 3 (Q3)], P=0.032] and at 6 months in ACV [-1.00 (-2.25 to 1.00) µL, P=0.043) and CACD (-0.01 (-0.02 to 0.00) mm, P=0.006) were shown. On analysis of all eyes together, a weak correlation was found between axial length and the change in CACD (r=0.266, P=0.007). Eyes with ACA≤25 degrees widened by 6.6±2.8 degrees versus 4.9±2.4 degrees in eyes with ACA>25 degrees at 1 month after the procedure (P=0.002). CONCLUSIONS: Scheimpflug-Placido disc topographer detected significant changes in the AC parameters after LPI in all groups. However, compared with PACS and PAC, the PACG showed significant alterations in the AC parameters through 6 months.

A Rare Cause of Hearing Loss: Susac Syndrome.

Susac's syndrome is a rare autoimmune disease, which is characterized by microangiopathic changes that affects the brain, retina, and cochlea. It is mainly characterized by asymptomatic cerebral infarctions, low-and mid-frequency sensorineural hearing loss, and bilateral distal retinal artery occlusions. Otolaryngologists should be familiar with Susac's syndrome because hearing loss may be the initial presenting symptom. The recommended treatment options vary from antithrombotic to immunomodulatory drugs. Although in its early stage, remission from the disease or self-limiting clinical course may be observed. Residual disabilities such as blindness, deafness, and dementia may also be presented in its late stages. Awareness of the condition and suspicion in selected patients will provide early diagnosis and treatment, which are both important to prevent the development of severe sequelae.

Chronic Meningitis Complicating Intracranial Hypertension in Neurobrucellosis: A Case Report.

In neurobrucellosis, even though meningitis is encountered frequently, chronic intracranial hypertension is a rare manifestation. Early diagnosis and treatment is very important for the prevention of permanent visual loss secondary to poststasis optic atrophy in these cases. We report a case that presented with permanent visual loss secondary to intracranial hypertension in neurobrucellosis. Our goal is to draw attention to the consideration of neurobrucellosis in cases with papilla stasis, even in the absence of neurological findings in endemic areas.

Rehabilitation outcomes of children with cerebral palsy.

[Purpose] To evaluate the results of Bobath-based rehabilitation performed at a pediatric cerebral palsy (CP) inpatient clinic. [Subjects and Methods] The study subjects were 28 children with CP who were inpatients at a pediatric service. Inclusion criteria were: being an inpatient of our hospital aged 2-12 with a diagnosis of CP; having one permanent primary caregiver; and the caregiver having no medical or psychotic problems. All of the patients received Bobath treatment for 1 hour per day, 5 days a week. The locomotor system, neurologic and orthopedic examination, Gross Motor Function Measure (GMFM) of the patients, and Short Form-36 (SF-36) of permanent caregivers were evaluated at the time of admission to hospital, discharge from hospital, and at 1 and 3 months after discharge. [Results] Post-admission scores of GMFM at discharge, and 1 and 3 months later showed significant increase. Social function and emotional role subscores of SF-36 had increased significantly at discharge. [Conclusion] Bobath treatment is promising and randomized controlled further studies are needed for rehabilitation technics.

Nonarteritic anterior ischemic optic neuropathy as the presenting manifestation of primary antiphospholipid syndrome.

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by vascular thrombosis or pregnancy morbidity. Ocular involvement in APS includes a broad spectrum of manifestations involving anterior and posterior segment or the presence of neuroophthalmologic features. Nonarteritic anterior ischemic optic neuropathy (NAION) is a very rare finding, and in this report a case having NAION as the prevailing sign of APS is presented. A middle-aged women who presented with visual disturbances in her left eye (LE) and turned out to have the diagnosis of primary APS with the help of rheumatological investigations is discussed. She was treated with oral steroids for NAION in her LE. With systemic and rheumatological work-up, primary APS was diagnosed, and hydroxychloroquine, coumadin, and aspirin were started, after which she remained stable under control. Due to the important diagnostic and therapeutic implications of APS, it should be considered in the differential diagnosis of NAION, particularly when the etiology is uncertain.

Structural and functional comparison of the persistent and resolved amblyopia.

PURPOSE: To assess structural or functional differences of the retina among subjects with persistent and resolved amblyopia. METHODS: Fourteen eyes with persistent amblyopia that did not reach normal visual acuity (VA) levels (≤0.1 LogMAR) despite amblyopia treatment, 18 eyes with resolved amblyopia, and 16 eyes of 16 normal subjects were included. All subjects underwent optical coherence tomography (OCT), pattern visual evoked potential (PVEP), and pattern electroretinography (PERG) evaluation. RESULTS: There was no significant difference in foveal thickness, foveal volume, macular volume, ganglion cell layer thickness, and total and sectorial retinal nerve fiber layer measurements among three groups (p > 0.05). Foveolar thickness was significantly increased in both resolved and persistent amblyopia groups compared with the control group (p = 0.031). However, there was no difference between amblyopic groups (p = 0.98). Although, in the PVEP study, N75 implicit time was found significantly prolonged in both amblyopia groups (p = 0.046), there were no significant differences in P100 implicit time and amplitude among the groups (p > 0.05). PERG amplitude of the persistent group was significantly lower than that of the control group (p = 0.003). There were no significant differences in P50, N95 implicit times among groups (p > 0.05). CONCLUSIONS: In our study, the only significant difference between persistent and resolved amblyopia groups was the initial VA. Neither OCT nor electrophysiological examinations were found to be useful in order to explain why some cases were resistant to the treatment for amblyopia.

Effects of levodopa on retina in Parkinson disease.

PURPOSE: To evaluate the effects of levodopa on retina, we assessed retina with optical coherence tomography (OCT) in Parkinson disease (PD). METHODS: Thirty-five patients with PD (17 with levodopa monotherapy, 18 untreated) and 11 healthy controls were included in this cross-sectional study. Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn & Yahr (H&Y) staging scale were used for the evaluation of disease severity. All retinal scans were performed using OCT. RESULTS: Total UPDRS and motor subscores were lower in untreated patients compared to patients with treated PD (p = 0.013, p = 0.033, respectively). There was no significant difference in the range of H&Y stages between the untreated and treated PD groups (p = 0.342). The average retinal nerve fiber layer thickness of the untreated (106.76 ± 10.55 µm) and treated (104.62 ± 8.23 µm) patients with PD were significantly thinner than those of controls (115.60 ± 9.11 µm) (p<0.005). However, there was no significant difference between the untreated and patients with treated PD (p = 0.780). No significant difference in mean values of average thickness of ganglion cell complex layer was observed among controls, patients with untreated PD, and patients with treated PD (p = 0.304). CONCLUSIONS: Although the disease in patients with treated PD was more severe than in the untreated group, no significant difference in the thickness of retina was found between the 2 groups. Therefore, we thought that levodopa might have a protective effect on retina in patients with PD.

Assessment of structural and functional visual outcomes in relapsing remitting multiple sclerosis with visual evoked potentials and optical coherence tomography.

The purpose of this study is to consider the clinical utility of optical coherence tomography (OCT) and find a correlation with VEP. Effects of different disease modifying treatments (DMT) were further evaluated by measuring OCT parameters and whether a correlation exists between the RNFL thickness, disease duration and expanded disability status scale (EDSS) were also assessed. 13 patients were on interferon beta-1a (IFN), 14 patients were receiving glatiramer acetate (GA), 19 patients were not being treated with any DMT and 21 healthy controls were included the study. During OCT examination, retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness was found to be lower in all MS groups but macular volume (MV) was lower only in GA group than controls. Although, P100 latencies were longer than controls in all MS groups, there was no statistically significant difference between IFN and w/o DMT groups. Patients with ON history, P100 latencies were found significantly longer than those without ON. VEP amplitudes were found lower with ON history patients than those without ON, however this was not statistically significant. EDSS strongly correlated with P100 latency, RNLF, GCC but no correlation was observed with VEP amplitude and MV. Our results show that RNFL, GCC and MV were all decreased in MS patients with or without DMT comparing to controls and it is more prominent in eyes with ON. Further follow-up studies are warranted to understand the pathophysiology of CNS axonal degeneration and involvement of optic nerves.