Clinical and demographic evaluation of Behçet disease among different paediatric age groups.

AIM: The aim of the study is to describe the demographic and clinical features of Behçet disease (BD) in paediatric patients. METHODS: The study included 62 patients who presented to the Department of Ophthalmology at Ankara Education and Research Hospital, Ankara, Turkey and diagnosed as having BD. These patients were placed into three age groups based on the age at the time of BD presentation: group 1, birth to 10 years old; group 2, 11-15 years old; group 3, 16-20 years old. Among these three age groups, the objective was to identify the ocular and extraocular clinical findings and complications of BD, and to uncover the role of gender, if exists, in the aetiology of the disease. RESULTS: The findings indicated that gender played no significant role in the aetiology of BD. In group 1, a family history of BD was more prevalent, and the most common ocular finding was bilateral anterior uveitis. The most frequent form of ocular involvement in groups 2 and 3 was bilateral panuveitis with retinal vasculitis and retinitis. The majority of disease complications were glaucoma, maculopathy and cataract formation. CONCLUSION: Patient age appeared to define the type of ocular involvement in BD. While anterior uveitis was the most frequent ocular finding in BD patients younger than 10 years, panuveitis was the most frequent in patients older than 10 years. As a family history of BD was more frequent among patients younger than 10 years, family screening for BD is considered critical for early and accurate diagnosis of BD, as well as for the control of its complications.

Management of glaucoma in patients with nanophthalmos.

AIMS: In this retrospective study, we aimed to evaluate the results of glaucoma surgery in patients with nanophthalmos. METHODS: Twenty-eight bilateral nanophthalmic patients, of whom 20 patients underwent trabeculectomy+Mitomycin-C (MMC)+inferior sclerotomy between 1996 and 2004, were included in this study. Records of patients with nanophthalmos were reviewed. Intraocular pressure (IOP), glaucoma medications, surgical success, visual acuity and complications were analyzed. RESULTS: The mean IOP was 34.6+/-5.3 mm Hg preoperatively. At the final follow-up visit, the mean IOP dropped to 21.41+/-7.34 mm Hg (P<0.05). The cumulative probability of success was 85% at 1 year, 78.5% at 2 years, 76.9% at 3 years, 70.6% at 4 years and 47% at 5 years after surgery. Visual acuity decreased in 13 (65%) patients but no eye lost vision. Sequels of choroidal detachment (five patients 25%) and retinal folds (four patients 20%) were the most frequent reason for visual decrease. Uveal effusion (10 patients 50%) and cataract formation (seven patients 35%) were major late postoperative complications. CONCLUSIONS: Results indicate that trabeculectomy+MMC+inferior sclerotomy procedure was effective and safe for glaucoma control in patients with nanophthalmos, but uveal effusion is a major problem and cataract surgery is expected in the long run.

Penetration of betaxolol HCL ionic suspension 0.25% and betaxolol HCL solution 0.50% into the aqueous humor.

PURPOSE: To determine the intraocular penetration of topical drops of betaxolol HCl 0.25% suspension and betaxolol HCl 0.50% solution into the aqueous humor. METHODS: Fifteen patients were randomly assigned to receive topical betaxolol HCl 0.25% suspension (n=7) or topical betaxolol HCl 0.50% solution (n=8) the day before cataract surgery. Aqueous samples were collected 2 hours after the administration of the morning dose during cataract surgery. Drug concentrations were determined by high-performance liquid chromatography with fluorescence detection. RESULTS: The mean aqueous humor concentration of topical betaxolol HCl 0.25% suspension was 275.1+/-168.8 micro g/mL (range 570-70 micro g/mL) and the mean aqueous humor concentration of topical betaxolol HCl 0.50% solution was 195.4+/-102.4 micro g/mL (range 334-50 micro g/mL) (p=0.281). CONCLUSIONS: The mean aqueous humor concentration of betaxolol 0.25% suspension was higher than betaxolol 0.50% solution; however, the difference was not statistically significant. With twofold reduced concentration and similar anterior chamber penetration, betaxolol 0.25% suspension could be first choice for Beta 1 selective blocker therapy when considered for patients with glaucoma.

Success of trabeculotomy in patients with congenital glaucoma operated on within 3 months of birth.

AIMS: To determine the efficacy and safety of trabeculotomy in congenital glaucoma patients operated on within first 3 months of birth. METHODS: A total of 36 eyes of 24 patients with congenital glaucoma, who underwent primary trabeculotomy within first 3 months of birth were included. Preoperative and postoperative intraocular pressures (IOP), corneal clarity, diameter, axial length, success rates, and complications were evaluated in this study. RESULTS: The mean follow-up was 38.38+/-11.77 months (range 12-48 months). Mean IOP was 33.16+/-7.28 mmHg (range 23-50 mmHg) preoperatively. At the final follow-up visit, the mean IOP was 21.41+/-7.34 mmHg (range 8-38 mmHg). Pre-and postoperative IOP differences were statistically significant at all examination periods (P<0.001). A12-, 24-, and 36-month success rates were 92, 82, and 74%, respectively. Survival analysis regarding to gender, preoperative corneal diameter and consaguinity were not statistically significant. Only preoperative axial length was a statistically significant parameter (P=0.024) for success. Postoperatively normal corneal clarity was achieved in 29 eyes (80.5%). The main complications were shallow anterior chamber in one (4.2%) eye and detachment of Descement's membrane in two (8.4%) eyes. CONCLUSIONS: Primary trabeculotomy is a safe and effective procedure for congenital glaucoma patients when operated within 3 months of birth. It has a favourable IOP control and a low rate of complications in three year period.

Long-term results of Ahmed glaucoma valve and Molteno implant in neovascular glaucoma.

AIMS: To evaluate the surgical success results of Ahmed glaucoma valve (AGV) and Molteno single-plate implant (MSPI) in cases of neovascular glaucoma (NVG). METHODS: Between May 1997 and May 2002, 38 of 38 NVG patients that underwent implantation of AGV and 27 eyes of 27 NVG patients that underwent MSPI (a total 65 eyes of 65 patients) included to the study. RESULTS: The cumulative probabilities of success were 63.2% at 1 year, 56.2% at 2 years, 43.2% at 3 years, 37.8% at 4 years, and 25.2% at 5 years in AGV group whereas the cumulative probabilities of success were 37.0% at 1 year, 29.6% at 2 years, 29.6% at 3 years, 29.6% at 4 years, and 29.6% at 5 years in MSPI group (P=0.141). Preoperative visual acuity <2/200 (P=0.003), diagnosis of diabetes mellitius (P=0.050), and preoperative IOP>or=35 mmHg (P=0.038) were found to be poor prognostic factors for surgical success. CONCLUSIONS: Both AGV and single plate MSPI were successful for early and intermediate-term of IOP control but in long term both implants were failed to achieve control of IOP in patients with NVG.

Central corneal thickness in primary open angle glaucoma, pseudoexfoliative glaucoma, ocular hypertension, and normal population.

PURPOSE: This study was designed to determine the relationship between central corneal thickness (CCT) and intraocular pressure (IOP) measured by applanation tonometer in glaucomatous, ocular hypertensive, and normal eyes. METHODS: A total of 125 subjects were included in the study. Twenty-six had primary open angle glaucoma (POAG), 25 had pseudoexfoliative glaucoma (PXG), 24 had ocular hypertension (OHT), and 50 of them were normal. IOP values were measured by Goldmann applanation tonometer whereas CCT values were measured by ultrasonic pachymeter. RESULTS: CCT values in the OHT group (595.75+/-22.52 microm) were greater than the CCT values of the POAG group (539.92+/-21.50 microm), the PXG group (526.28+/-31.73 microm), and the normal group (533.96+/-29.25 microm) (p<0.05). Eight patients who were diagnosed with OHT showed IOP values of 21 mm Hg or lower with corrected IOP values according to CCT. CONCLUSIONS: Increased CCT may lead to falsely high values of IOP measured with Goldmann applanation tonometer. In this study, when IOP values of the OHT group were redefined according to the formulae regarding the CCT, the authors noted that one third of them were normal. Determination of the CCT in OHT cases is crucial since it has great impact on IOP values, measured with applanation tonometer, which is the main parameter in the diagnosis and follow-up of glaucoma.

Eight-year follow-up of Axenfeld-Rieger syndrome with Turner syndrome.

PURPOSE: To report a case of Turner syndrome associated with iridogoniodysgenesis accompanied by somatic malformations. METHODS: A 29-year-old woman underwent complete ophthalmologic and general examination. Incomplete development of the angle with iris stromal hypoplasia and prominent posterior embryotoxon with iris adhesions were noted. Disc drusen was confirmed by ultrasonography. Visual fields were normal other than bilateral enlargement of blind spot. Intraocular pressure was under 21 mm Hg during 8 years of follow-up without medication. The patient had atrial septal defect, sensorineural hearing loss, polycystic ovaries, hirsutism, glomerulosclerosis, dental anomalies, and low intelligence. A chromosome analysis revealed that she had mosaic Turner syndrome with a 45,X/46,XX karyotype. CONCLUSIONS: Few reported cases in the literature describe the coexistence of Axenfeld-Rieger syndrome and Turner syndrome mosaicism. Somatic and anterior chamber malformations in this patient represent a developmental disorder of the neural crest. General examination and chromosomal analysis are indicated in patients presenting with anterior chamber dysgenesis.

Cataract surgery in patients with Fuchs' heterochromic iridocyclitis.

PURPOSE: To evaluate the results of cataract extraction and posterior chamber intraocular lens (IOL) implantation in patients with Fuchs' heterochromic iridocyclitis (FHI). METHODS: We studied the records of 35 patients with FHI who underwent cataract extraction. Extracapsular cataract extraction (ECCE) was performed by phacoemulsification through a scleral flap in 9 patients and by manual delivery of the nucleus through a corneal section in 26 patients. RESULTS: After a mean follow-up time of 24 (3-60) months, the visual acuity in 21 eyes (60%) was 20/20, and all eyes had 20/40 or better vision. Six eyes with implanted regular PMMA IOL developed a marked anterior uveitis, which was resolved within 3 weeks with topical steroids. Only 1+ or 2+ cellular reaction was observed postoperatively in patients with heparin-coated lens implantation and patients who underwent phacoemulsification. Biomicroscopic evidence of giant cell activity was observed in two patients with heparin-coated IOL and in 11 with regular PMMA IOLs after ECCE (two after phacoemulsification). Four eyes developed intraocular pressure elevation that reverts to normal within 24 weeks with medical therapy. CONCLUSIONS: These results indicate that the surgical outcomes of FHI patients after cataract surgery appear to be better when the phacoemulsification technique is used or when heparin-coated lenses are implanted.

Conjunctival impression cytology and tear-film changes in patients with psoriasis.

PURPOSE: In this study, we evaluated ocular-surface changes and tear-film functions in patients with plaque-type psoriasis. METHODS: This study was performed on two groups. Group I included 100 eyes of 50 subjects with chronic plaque-type psoriasis whose diagnoses were confirmed with skin biopsy. Group II included 100 eyes of 50 healthy volunteers who were in the same age and sex distribution. Ocular-surface changes were evaluated on the cell content of the surface conjunctival epithelium by conjunctival impression cytology and tear-film functions by the Schirmer I test and break-up time (BUT). RESULTS: Of the patients with psoriasis, 50% had a grade 0, 30% had a grade I, and 20% had a grade II conjunctival impression cytology differentiation compared with 95, 3, and 2%, respectively in the control group (p < 0.001). Snake-like appearance of nuclear chromatin in conjunctival epithelial cells was demonstrated in 12% of eyes in group I but in 2% of eyes in group II. The Schirmer's test results showed that average values were 10.1 +/- 5.8 mm in group I and 12.6 +/- 5.5 mm in group II (p > 0.001). The mean break-up time was 7.8 +/- 3.7 s in group I and 12.5 +/- 4.6 s in group II (p < 0.001). CONCLUSIONS: We showed the early conjunctival changes in patients with psoriasis. According to these results, primary etiologic factors may contribute to ocular lesions in psoriasis.

Scleromalacia following trabeculectomy with intraoperative mitomycin C.

PURPOSE: To report the development of scleromalacia in pediatric age as a complication of trabeculectomy with the adjunctive use of intra-operative mitomycin C. PATIENTS: Reported are 2 patients who developed scleromalacia following trabeculectomy combined with intra-operative 0.4 mg/ml mitomycin C application for 5 minutes for refractory glaucoma in aphakic bullous keratopathy and penetrating keratoplasty. RESULTS: Scleromalacia localised in the surgical area developed in 2 young patients. Scleromalacia remained stable in both patients after 6 and 24 months follow-ups. CONCLUSIONS: It is suggested that this procedure be done more selectively, especially in young patients, with a shorter application time and using a lower concentration.

The results of trabeculectomy with and without mitomycin C in young patients.

The results of primary trabeculectomy with and without mitomycin C (MMC) were evaluated in young glaucoma patients. The patients, 15-40 years of age, were divided into two main groups and two subgroups. In group IA, primary Cairns type trabeculectomy was performed in 24 eyes of 24 patients with juvenile glaucoma; in group IB, trabeculectomy + MMC 0.4 mg/ml in 3 min was done in 20 eyes of 20 patients with juvenile glaucoma; in group IIA, primary trabeculectomy was performed in 20 eyes of 20 patients with developmental glaucoma, and in group IIB, trabeculectomy + MMC 0.4 mg/ml in 3 min was performed in 16 eyes of 16 patients with developmental glaucoma. The success rate of the surgery was 75% in group IA, 90% in group IB, 50% in group IIA, and 75% in group IIB. There was no statistically significant difference among the groups in terms of success rates of trabeculectomies (p > 0.05).

Comparison of the anti-inflammatory effects of diclofenac and flurbiprofen eye drops after cataract extraction.

PURPOSE: A clinical double-blind study was performed in patients who had undergone extracapsular cataract extraction and intraocular lens implantation (ECCE+IOL) to compare the anti-inflammatory effects of diclofenac sodium 0.1% and flurbiprofen 0.03% eye drops. METHODS: The diclofenac group included 21 eyes of 21 patients and the flurbiprofen group included 22 eyes of 22 patients. The parameters compared were pachymetry of the cornea, corneal surface changes, intraocular pressure (IOP) and the degree of inflammation of the anterior chamber at one, three and six weeks after cataract surgery. RESULTS: There was no statistically significant difference between the two treatment groups in corneal pachymetry, corneal surface changes, IOP and the anterior chamber inflammation (p>0.05). CONCLUSION: Both drugs were well tolerated and may be safely used to reduce inflammation for cataract surgery.

Fuchs' heterochromic uveitis associated with retinitis pigmentosa.

We report a case of bilateral retinitis pigmentosa simplex (RP) with a combination of unilateral Fuchs' heterochromic uveitis (FHU). Both of these entities are quite rare syndromes and coexistence of these entities in one patient is rarer than can be expected. Even though this rare coexistence came together in one patient, we found no hereditary factors to presume that both traits segregate independently.

The SRKII formula in the calculation of intraocular lens power.

This study compares the predictive accuracy of the SRKII formula for groups with average axial length and long eyes. 344 eyes which underwent cataract extraction with implantation of a posterior-chamber intraocular lens were included in the survey; 246 eyes had an average axial length (22.0-24.49 mm), and 98 eyes had an axial length of more than 24.50 mm. Mean absolute errors were 0.26+/-0.68 dpt in the first group and 1.16+/-1.78 dpt in the second group. 94.3% of the average eyes were within 1.0 dpt of the expected refraction, 98.8% within 2.0 dpt, whereas in the long-eye group 58.2% were within 1.0 dpt and 84.7% within 2.0 dpt. The results show that the SRKII formula performed credibly in average-length eyes; in the long eyes the ratio of large refractive deviations was greater than that of the other group.

Phacoemulsification with and without trabeculectomy in patients with glaucoma.

BACKGROUND AND OBJECTIVE: This retrospective study was performed to determine the postoperative intraocular pressure (IOP) control in patients with glaucoma who underwent phacoemulsification with and without trabeculectomy. PATIENTS AND METHODS: Thirty-five eyes underwent phacoemulsification, and 21 eyes underwent combined surgery. The minimum postoperative follow-up for both groups was 6 months. RESULTS: The average IOP decreased from 19.7 +/- 4.6 mm Hg preoperatively to 16.3 +/- 3.1 mm Hg in the phacoemulsification group, and from 21.2 +/- 5.9 mm Hg to 14.4 +/- 3.3 mm Hg in the combined group at 6 months (statistically not significant). There was no statistically significant difference between the groups in terms of visual acuity improvement or the number of glaucoma medications. CONCLUSION: Cataract surgery, with phacoemulsification alone and combined with trabeculectomy, induces a statistically and clinically significant reduction of IOP in patients with glaucoma.

Autosomal recessive nanophthalmos.

Nanophthalmos is a rare congenital ocular malformation which is generally recognized at middle age when serious complications have already developed. In this report 7 early diagnosed nanophthalmic cases are presented and diagnostic criteria, complications, inheritance and various modalities of treatment are discussed.

Calculation of intraocular lens power with the SRK II formula for axial high myopia.

AIM: The SRK II formula has been widely used for intraocular lens (IOL) power calculations. The predictability of this formula is evaluated in axial myopic patients. METHODS: Planned extracapsular cataract extraction and posterior chamber IOL implantation (PECCE + IOL) were performed on 98 eyes of 98 patients with axial length > 24.5 mm. Cases had no preoperative complications and postoperative visual acuity was at least 0.5 (Snellen). Corneal refractive power and axial length were measured preoperatively and emmetropic IOL power calculations were made using the SRK II formula. Long-term (mean 4.7 months) visual acuities and refractions were noted postoperatively. RESULTS: The absolute refractive error was < 1.00 Diopters (D) in 57 eyes (58.2%) and < 2.00 D in 83 eyes (84.7%). The mean absolute error of the SRK II formula in axial myopia was 1.16 D +/- 0.78 SD. CONCLUSIONS: The SRK II formula is not very accurate in axial myopic patients.

Treatment of glaucoma in young nanophthalmic patients.

PURPOSE: To evaluate the criteria of diagnosis and management of secondary glaucoma in young nanophthalmic patients. METHODS: Considering the anatomic features and clinical characteristics, 22 eyes of 11 patients were identified as bilateral nanophthalmos. Intraocular pressures (IOP) were checked with Goldmann applanation or Keeler pulse-air 2000 tonometer, and Nd-Yag laser was used for iridotomies. Prophylactic V-shaped unsutured sclerectomies over the pars plana were combined with trabeculectomy, and Mitomycin C (MMC) in 0.2 mg/ml concentration was applied. RESULTS: Among 22 eyes of bilateral nanophthalmic patients 8 eyes had secondary angle-closure glaucoma. Laser iridotomies were performed in 6 eyes. Laser iridotomy and supplemental medical therapy were sufficient in 4 out of 6 eyes. Mean IOP dropped from 26.4 to 14.5 mmHg in these patients. Due to continuous increase of IOP in the other patients, they underwent trabeculectomy with V-shaped sclerostomy and intraoperative MMC application. Mean IOP dropped from 39.3 mmHg to 19.3 mmHg. Postoperative uveal effusion on other major complications were not observed. Mean age of these patients was 14.6 years during treatment. CONCLUSION: Management of glaucoma in nanophthalmus is complicated. Initial treatment is medical. If it is insufficient, laser iridotomies and V-shaped sclerostomies with filtration surgery can be performed at any age.

Effects of antiglaucoma drugs on ocular surface.

Topical medications have a very important role in chronic glaucoma treatment. Long-term use of these medications can cause significant changes on ocular surfaces. In this study, the ocular surfaces of 20 control subjects (group I), 20 primary open-angle glaucoma patients (group II) treated (mean 21.20 +/- 1.32 months) with 0.50% timolol maleate, and 20 primary open-angle glaucoma patients (group III) treated (mean 21.70 +/- 1.34 months) with 0.50% timolol maleate + 1% dipivefrin hydrochloride were evaluated. Studied parameters included Schirmer's test, tear break-up time, conjunctiva impression cytology and goblet cell density. These results suggest that long-term applications of topical anti glaucoma medications damage the ocular surface.