Preseptal and Orbital Cellulitis: Analysis of Clinical, Laboratory and Imaging Findings of 123 Pediatric Cases From Turkey.

BACKGROUND: We aimed to compare the clinical and laboratory characteristics and imaging methods of patients diagnosed with preseptal cellulitis and orbital cellulitis in the pediatric age group. METHODS: The study was designed retrospectively, and the medical records of all patients who were hospitalized with the diagnosis of preseptal cellulitis and orbital cellulitis were reviewed. The findings of preseptal cellulitis and orbital cellulitis groups were compared. The risk factors for the development of orbital involvement were analyzed. RESULTS: A total of 123 patients were included, 90.2% with preseptal cellulitis and 9.8% with cellulitis. The male gender ratio was 60.2%, and the mean age was 72 ± 43 months. While all patients had eyelid swelling and redness, 20.3% had fever. Ocular involvement was 51.2% in the right eye and 4.9% in both eyes. The most common predisposing factor was rhinosinusitis (56.1%). Radiologic imaging (computed tomography/magnetic resonance imaging) was performed in 83.7% of the patients. Subperiostal abscess was detected in 7 cases (5.6%) in which three of the cases were managed surgically and four were treated with medically. The levels of C-reactive protein were significantly higher in patients with orbital involvement (P = 0.033), but there was no difference between the presence of fever, leukocyte and platelet values. CONCLUSIONS: Rhinosinusitis was the most common predisposing factor in the development of preseptal cellulitis and orbital cellulitis. Orbital involvement was present in 9.8% of the patients. It was determined that high C-reactive protein value could be used to predict orbital involvement.

Is optical coherence tomography angiography a useful tool in the screening of hydroxychloroquine retinopathy?

PURPOSE: To detect the early changes in retinal vasculature via optical coherence tomography angiography (OCTA) by comparing the quantitative OCTA parameters in the group of patients who were using hydroxychloroquine (HCQ) or not. METHODS: This was a cross-sectional, comparative, and observational study. The patients who were newly or previously prescribed HCQ for an autoimmune disease were included. OCTA imaging was performed via OCT RT XR Avanti with AngioVue software (Optivue Inc, Freemont, CA). The study group had two groups: a control group (patients newly diagnosed and who were not taking any medication) and a treatment group (patients who were receiving HCQ treatment). The main outcome measure was OCTA parameters. RESULTS: A total of 102 eyes of 102 patients were included. There were 70 patients in the treatment group and 32 patients in the control group. All of the vascular density values were similar between the control and treatment groups (p > 0.05 for all). However, the superficial whole thickness, superficial parafoveal thickness, superficial perifoveal thickness, deep whole thickness, deep parafoveal thickness, and deep perifoveal thickness were thinner in the treatment group than the control group (p < 0.05 for all). CONCLUSION: Vascular density parameters did not differ between the control and treatment groups. However, the retinal thickness values were lower in the treatment group.

Blood-aqueous barrier deterioration following retained metallic corneal foreign body: A laser flare photometric study.

BACKGROUND: This study aims to use laser flare photometry to evaluate flare changes in patients following corneal damage from a metallic foreign body (FB). METHODS: Foreign body injured eyes and the healthy fellow eyes of 54 consecutive patients were studied in this comparative, observational, cross-sectional study. Flare levels were analyzed according to demographics, history of previous exposures, foreign body location, and foreign body penetration into the injured cornea. RESULTS: The mean flare value was significantly higher for the eyes with corneal foreign body injury compared to the fellow-control eyes (11.35±14.17 ph/ms and 6.30±3.81 ph/ms, respectively) (p=0.014). The mean flare values were significantly lower in eyes with a history of more than one previous corneal foreign body removal flare values than in other eyes (p=0.029). CONCLUSION: Flare is increased by corneal foreign body exposure. However, eyes that experience multiple previous corneal foreign body exposures may show relatively low flare, probably due to corneal desensitization.

Foveal avascular zone and vessel density in children with attention deficit hyperactivity disorder.

PURPOSE: To compare the retinal and choroidal microvasculature quantitatively via optical coherence angiography (OCTA) in children with attention deficit hyperactivity disorder (ADHD) who were under methylphenidate (MFD) treatment or newly diagnosed as ADHD and were not taking any medication. METHODS: This was a cross-sectional, comparative, and observational study. The children who were between 6 and 17 years old and previously diagnosed as ADHD and were under MFD treatment or who were newly diagnosed as ADHD were included in the study. Optical coherence tomography angiography imaging was performed via OCT RT XR Avanti with AngioVue software (Optivue Inc, Freemont, CA). The main outcome measure of the study was OCTA parameters of the children with ADHD. RESULTS: A total of 186 eyes of 186 patients were included in the study. There were 80 eyes in the control group (newly diagnosed) and 106 eyes in the treatment group (under MFD treatment). The mean duration of methylphenidate use in the treatment group was 33.9 ± 20.1 months (between 6 and 84 months). The choriocapillary flow area (p = 0.03), superficial parafoveal thickness (p = 0.01), and deep parafoveal thickness (p = 0.01) were statistically greater in the treatment group than the control group. CONCLUSION: Most of the important OCTA parameters especially foveal avascular zone (FAZ) area and FAZ perimeter were similar in the two groups. There was a significant difference between the two groups in parafoveal thickness values which might point to a slight effect of MFD on retinal circulation.

Early Results with a New Posterior Chamber Phakic Intraocular Lens in Patients with High Myopia.

PURPOSE: To report clinical results of a foldable, hydrophilic acrylic, single-piece, injectable, posterior chamber phakic intraocular lens (pIOL). MATERIAL AND METHODS: Medical records of patients who underwent posterior chamber phakic IOL (Eyecryl Phakic IOL, Biotech Vision Care, Ahmedabad, India) implantation for surgical correction of myopia were retrospectively reviewed. Only patients with at least a one-year follow-up were included. Manifest refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), endothelial cell density (ECD), and pIOL vault were analyzed at 1, 3, 6, and 12 months after surgery. Complications observed during and after surgery were also recorded. RESULTS: The study included 58 eyes of 29 patients. Mean patient age was 32 ± 7 years. Spherical equivalent of manifest refraction was -13.41 ± 3.23 D preoperatively and -0.44 ± 0.55 D postoperatively. Preoperative CDVA was 0.29 ± 0.71 logMAR. Postoperative UDVA and CDVA were 0.21 ± 0.66 and 0.15 ± 0.69 logMAR, respectively, at the 12-month visit. At the 12-month visit, the efficacy index was 1.20 and the safety index was 1.39. Mean ECD was 2713 ± 339 cells/mm2 at the preoperative visit and 2608 ± 362 cells/mm2 at the 12-month visit (3.9% loss, p < 0.001). ECD loss from 3 months to 12 months was not statistically significant. No significant cataract formation, significant endothelial cell loss, glaucoma, uveitis, or any other vision-threatening complication was observed. CONCLUSION: Based on postoperative experience, we have found that Eyecryl Phakic IOL is safe and effective for treating high myopia.

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.

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.

The morpho-functional evaluation of retina in amblyopia.

PURPOSE: To investigate the morphological or functional differences of retina in amblyopia. MATERIALS AND METHODS: Forty-one patients with unilateral strabismic, anisometropic or combined amblyopia were included in the study. A control group was composed of 16 normal children. All participants were tested with optical coherence tomography (OCT) and pattern electroretinography (PERG). The findings from amblyopic and nonamblyopic eyes were compared among the amblyopic groups. Also, amblyopic and nonamblyopic eyes were compared with the healthy control eyes. RESULTS: No significant difference was found in OCT parameters for amblyopic and nonamblyopic eyes among the amblyopic groups (p > 0.05). In the combined and anisometropic groups, ganglion cell complex (GCC) was found to be significantly increased in both amblyopic and nonamblyopic eyes compared to the control group (p < 0.05). In strabismic amblyopia, significant reduction in GCC thickness and increase in foveal thickness were found, compared to nonamblyopic eyes (p = 0.019, p = 0.08). There were no significant differences in PERG amplitude and latency between the amblyopic and the nonamblyopic eyes in amblyopic groups (p > 0.05). PERG amplitude in amblyopic eyes was found to be significantly decreased compared with that in normal eyes (p < 0.05). When the nonamblyopic eyes were compared with the control group, only the anisometropic amblyopia group demonstrated significant reduction in amplitude and prolongation in latency (p = 0.002, p = 0.026). CONCLUSION: We found no significant differences in morphological and functional measures among amblyopic groups. However, we detected significant differences in the retinal function and morphology of both amblyopic and nonamblyopic eyes compared with healthy control eyes.

Amniotic membrane in the management of strabismus reoperations.

PURPOSE: To reduce postoperative scar formation and to improve duction using amniotic membrane (AM) in strabismus reoperations. METHODS: A prospective study of interventional case series comprised of 14 patients with restrictive strabismus. Objective clinical findings (visual acuity, angle of deviations and degree of duction deficits) were recorded in both the pre- and post-operative periods. Strabismus surgery included the excision of adhesions and scar tissue, repositioning of extraocular muscles (according to the degree of deviations) and placement of two sheets, one between muscle and tenon and the other between muscle and sclera. Conjunctival recession with covering of the bare sclera using AM was also performed. RESULTS: The mean preoperative deviation of the patients was 34.3 prism diopters (PD) and mean post-operative deviation was 4.6 PD. The mean pre-operative duction deficit of the patients was 1.7; mean post-operative duction deficit was 0.2. Postoperatively all patients improved in relation to deviation and duction. Less than 8 PD deviations with no duction deficits were achieved in 12 (86 %) of the patients. CONCLUSIONS: Amniotic membrane placement around the extraocular muscle improves the duction and decreases the residual angle of deviations by inhibiting postoperative scar formation.

Tear nitric oxide levels in Behçet's disease.

The aim of this study was to evaluate the tear nitric oxide (NO) level in patients with Behçet's disease and to compare it with that in healthy subjects. MATERIAL AND METHODS. The subjects were divided into 3 groups: the active disease, inactive disease, and control groups. NO concentrations were determined by a nitrate/nitrite colorimetric assay kit and measured spectrophotometrically at 540 nm. RESULTS. The tear nitrate/nitrite levels were 0.06 nmol/µL (SD, 0.05) in the active disease group, 0.05 nmol/µL (SD, 0.05) in the inactive disease group, and 0.02 nmol/µL (SD, 0.01) in the control group. The tear nitrate/nitrite levels of both active and inactive groups were higher than those of the control group (P=0.001 and P=0.047, respectively), but there was no significant difference between the active and inactive groups. CONCLUSION. Our results demonstrated that the tear NO levels were elevated in the patients with Behçet's disease. We imply that a better understanding of NO function in the pathogenesis of Behçet uveitis is necessary to develop new therapies based on the inhibitors of NO synthases.

An immunohistochemical analysis of the neuroprotective effects of memantine, hyperbaric oxygen therapy, and brimonidine after acute ischemia reperfusion injury.

PURPOSE: This study applies treatment methods to rat retinas subjected to acute ischemia reperfusion injury and compares the efficacy of memantine, hyperbaric oxygen (HBO) therapy, and brimonidine by histopathological examination. METHODS: Thirty adult Wistar albino rats were divided into five groups after retinal ischemia was induced by elevating the intraocular pressure to 120 mmHg. The groups were as follows: group 1: control; group 2: acute retinal ischemia (ARI) model but without treatment group; group 3: memantine (MEM) treatment group; group 4: HBO therapy group; and group 5: brimonidine treatment (BRI) group. In the control group, right eyes were cannulated with a 30-gauge needle and removed without causing any intraocular pressure change. The ARI group was an acute retinal ischemia model, but without treatment. In the MEM group, animals were given a unique dose of intravenous 25 mg/kg memantine by the tail vein route after inducing ARI. In the HBO group, at 2 h following ARI, HBO treatment was applied for nine days. In the BRI group, a 0.15% brimonidine tartrate eye drop treatment was applied twice a day (BID) for seven days before ARI. Twenty-one days after establishing ischemia reperfusion, the right eyes were enucleated after the cardiac gluteraldehyde perfusion method, and then submitted to histological evaluation. RESULTS: On average, the total retinal ganglion cell number was 239.93 ± 8.60 in the control group, 125.14 ± 7.18 in the ARI group, 215.89 ± 8.36 in the MEM group, 208.69 ± 2.05 in the HBO group, and 172.27 ± 8.16 in the BRI group. Mean apoptotic indexes in the groups were 1.1 ± 0.35%, 57.71 ± 0.58%, 23.57 ± 1.73%, 15.63 ± 0.58%, and 29.37 ± 2.55%, respectively. CONCLUSIONS: The present study shows that memantine, HBO, and brimonidine therapies were effective in reducing the damage induced by acute ischemia reperfusion in the rat retina. Our study suggests that these treatments had beneficial effects due to neuroprotection, and therefore may be applied in clinical practice.

Variability of serum oxidative stress biomarkers relative to biochemical data and clinical parameters of glaucoma patients.

PURPOSE: The importance of oxidative stress in both the formation and the course of glaucoma has been known. Among the antioxidants, vitamin E possesses the specific effects and regulatory mechanisms of a neurohormone. The serum oxidant/antioxidant profile is reportedly altered in ocular pathologies. In this study, we analyzed the effect of the clinical parameters of glaucoma and biochemical data on antioxidants and serum oxidative stress markers as oxidation degradation products. METHODS: In this multicenter case control study, control and patient groups consisted of 31 healthy individuals and 160 glaucoma patients with no known additional abnormalities, respectively. We analyzed the oxidation degradation products malonyl dialdehyde (MDA), advanced oxidation protein products (AOPP), antioxidants, vitamins E and A, Serine (Ser), superoxide dismutase (SOD), glutathione peroxidase (Gpx), transferrine (TF), and total antioxidant capacity (TADA). All of these parameters and their relationships with serum cholesterol, glucose, protein, albumin, triglyceride levels, age, gender, visual acuities, intraocular pressure (IOP), c/d ratio, gonioscopic findings, medications, presence of pseudoexfoliation (px), central visual field and Optical Coherence Tomography (OCT) data, pachymetry, and Laplace values, were evaluated individually. Statistical comparisons were performed among them, and with the control group as well. RESULTS: TADA, AOPP, SOD, and Gpx were found to be decreased, and MDA, Ser, TF, vitamins A and E increased in the patient group. All data, excluding AOPP, varied significantly. Vitamin E was the most consistent parameter. CONCLUSIONS: In this study, the association between glaucoma and lipid oxidation was shown on a systematic basis, and the significance of vitamin E as a neuroprotective agent has been revealed once more.

Evaluation of extraocular muscles in the edematous phase of Graves ophthalmopathy on contrast-enhanced fat-suppressed magnetic resonance imaging.

OBJECTIVE: Extraocular muscles (EOMs) reveal characteristic contrast-enhancement patterns on magnetic resonance (MR) imaging due to their rich vascular supply. The objective of this study was to evaluate contrast-enhancement patterns of EOMs in patients with edematous phase of Graves ophthalmopathy (GO) using contrast-enhanced fat-suppressed MR imaging in comparison with normal volunteers. METHODS: EOMs of 15 patients with edematous phase of GO and those of 15 normal volunteers were evaluated using coronal T1-weighted MR images with fat suppression before and after intravenous administration of gadolinium. The image sequence was a fast spin-echo with chemical shift selective fat saturation. The degree of contrast enhancement for EOMs and temporal muscles (TMs) was assessed via a 4-step grading system and by 2 reviewers. RESULTS: There were statistically significant differences for the degrees of contrast enhancement in all EOMs between the patients with GO and normal volunteers. The degrees of contrast enhancement for all EOMs were significantly decreased in patients with edematous phase of GO. CONCLUSIONS: The microcirculation within the EOMs tends to be impaired during the progress of disease, and the MR imaging pattern gives a semiquantitative measurement of the microcirculatory impairment of the EOMs during the edematous phase of the disease.