Horner's syndrome secondary to heart surgery in a pediatric patient.

Horner's Syndrome (HS) is a disease characterized by miosis, ptosis, and ipsilateral lack of sweating. It can occur with any injury at the level of the ocular sympathetic system neurons from the hypothalamus to the cervical postganglionic fibers. We present here a case of HS that developed after heart surgery in a 9-year-old boy. Ventricular septal defect, aortic and mitral valves repair, and pacemaker implant procedures were noted in his medical records. Preganglionic HS was diagnosed with bilateral unresponsiveness to a 0.1% adrenaline and positive result in the right eye to 0.5% apraclonidine tests. HS is often related to injuries of the brain stem, upper spinal cord, lung apex tumors and lesions, aortic coarctation, cervical lesions, and carotid lesions have been reported. However, it is rare secondary to heart surgery among the pediatric age group.

Comparative Retinal Vessel Size Study of Intravitreal Ranibizumab and Bevacizumab in Eyes with Neovascular Age-Related Macular Degeneration.

PURPOSE: The aim of this paper was to assess and compare the effects of intravitreal ranibizumab and bevacizumab on retinal vessel diameter in eyes with neovascular age-related macular degeneration (AMD). METHODS: Patients with neovascular AMD who underwent intravitreal injection of either ranibizumab or bevacizumab were included. Noninjected fellow eyes served as a control. The main outcome measures were central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and the artery-vein ratio (AVR). RESULTS: In the ranibizumab group, the mean CRAE value decreased significantly at 1 week and 1 month (p = 0.002). The AVR value decreased significantly at 1 month (p = 0.028). CRVE values did not change at 1 week and 1 month (p = 0.083). In the bevacizumab group, the preinjection CRAE, CRVE, and AVR values did not change through the study period (p = 0.128, p = 0.600, and p = 0.734, respectively). CONCLUSION: These results suggest that intravitreal ranibizumab led to significant retinal arteriolar vasoconstriction in eyes with neovascular AMD.

A case of unusual coexistence of keratoconus and optic disc pit.

PURPOSE: To report a case of unusual coexistence of keratoconus and optic disc pit. METHODS: A 29-year-old male patient followed up because of the left established and right subclinical keratoconus presented with blurred vision on the left eye that occurred within days. In addition to a comprehensive ophthalmic examination, computerized corneal topography (CT), corneal pachymetry, and optical coherence tomography (OCT) examination were performed. RESULTS: The corneal CT showed a mild keratoconus pattern, with a minimum corneal pachymetry of 472 in the right eye and moderate keratoconus pattern with a minimum pachymetry of 435 micron in the left eye. The OCT scans showed the presence of the optic disc pit and related maculopathy. CONCLUSIONS: This is the second report of the coexistence of keratoconus and optic disc pit in the literature. The association of these two entities is therefore less likely to be accidental. Further histopathological studies will be necessary to explain this relationship between two entities.

Ophthalmic findings in acute mercury poisoning in adults: A case series study.

The aim of this study is to report ophthalmic findings of acute mercury poisoning in 48 adults referred to emergency department. Full ophthalmologic examination including the best corrected visual acuity, external eye examination, reaction to light, a slit-lamp examination, funduscopy, intraocular pressure measurements, and visual field (VF) and color vision (CV) tests were performed at the presentation and repeated after 6 months. The parametric values of VF test, the mean deviation (MD), and pattern standard deviation (PSD) were recorded in order to compare patients and the 30 healthy controls. The mean parameter of color confusion index in patients was found to be statistically different than controls (p < 0.01). The MD and PSD in patients were different from controls statistically significant (p < 0.01 and p < 0.01, respectively). There was no correlation between the ocular findings and the urine and blood mercury levels. Methyl mercury, held in the school laboratory for experimental purpose, may be a source of poisoning. In this case series, we showed that acute exposure to mercury had hazardous effect on the visual system, especially CV and VF. We propose that emphasizing the public education on the potential hazards of mercury is crucial for preventive community health.

Differences of the anterior segment parameters in children with down syndrome.

PURPOSE: The study was undertaken to investigate whether anterior segment findings are different in children with Down syndrome (DS) to normal children and to focus on its clinical significance. METHODS: A cross-sectional case control study was conducted in a total of 38 children with DS and 42 healthy children. This is the first report in the literature stating that. All subjects underwent ophthalmologic examination including slit-lamp biomicroscopy, cycloplegic refraction, intraocular pressure measurement and Scheimpflug imaging measurement. Customized software for Pentacam was used to analyze structural indices of anterior segment parameters. The mean anterior segment values of right eyes were compared between the groups. RESULTS: The mean anterior chamber parameters of patients with DS and controls were measured respectively: Corneal thickness was 502.31 ± 40.5 and 541.8 ± 37.42 mm (p < 0.001), corneal volume was 56.63 ± 4.5 and 61.02 ± 4.3 mm³ (p < 0.001), corneal radius curvature was 7.41 ± 0.29 and 7.67 ± 0.34 mm (p < 0.001), iridocorneal angle was 39.7 ± 6.2 and 39.5 ± 6.4° (p = 0.944), anterior chamber volume was 181.65 ± 27.38 and 185.77 ± 32.53 m³ (p = 0.528), anterior chamber depth was 3.08 ± 0.24 and 3.02 ± 0.31 mm (p = 447), pupil size was 2.95 ± 0.48 and 3.29 ± 0.45 mm (p < 0.05). CONCLUSION: The majority of the anterior segment parameters were found to be different in children with Down syndrome. While pupil size, corneal thickness, corneal volume and corneal curvature in DS were less than normal, iridocorneal angle, anterior chamber depth and anterior chamber volume were close to controls. The most important parametric differences in children with DS were seen on the cornea.

Ocular findings in children with thalassemia major in Eastern Mediterranean.

AIM: To investigate ophthalmologic findings in children with thalassemia major (TM) and compare the findings with healthy controls. METHODS: In a cross-sectional study, 43 children with thalassemia major from pediatric hematology outpatient clinics from two university hospitals and age/sex matched 47 healthy children were included in the study. After a complete ophthalmic examination, tear function tests including the Schirmer test, fluorescein tear break-up time (BUT), ultrasound pachymetry, and axial length measurement were performed. Obtained data was recorded for statistical analysis and the values of right eyes were compared between groups. RESULTS: The mean best corrected visual acuity was 1.34±0.75 in TM and 1.08±0.28 in controls. It was found lower than 0.1 logMAR unit in 10 (23.2%) children with TM and 2 (4.2%) in controls, and the difference was statistically significant (P<0.05). The mean central corneal thickness was 540±26.95 in children with TM and 536.98±20.45µm in controls (P>0.05). The mean axial length was 22.53±0.50 in TM and 22.57±0.43mm in the control group. The mean Schirmer test score was 19.94±6.91 in TM and 24.22±3.95mm in the control group (P<0.01). The mean BUT score was 9.62±1.28 in TM and 9.73±0.6s in the control group (P>0.05). CONCLUSION: In TM, while corneal thickness, axial length, and BUT are close to controls, the Schirmer scores are less than normal. The study revealed that TM may be affected by the tear function and visual acuity.

Effect of breast feeding on ocular morbidity.

BACKGROUND: To evaluate the effect of human milk on ocular morbidity in infants who did not breast feed during the first 6 months of life. MATERIAL AND METHODS: This retrospective randomized study included 154 subjects who were first or second grade elementary school students, 66-84 month of age. These children were randomly selected from 2080 students during health screenings. All of them were born at term and were normal birth weight. The study was composed of 3 age- and sex-matched groups. Group 1 included 52 subjects who had never been breast fed. Group 2 included 42 subjects who were breast fed and also received additional food (infant formula). Group 3 included 60 subjects who were only breast fed until 6 months old (no formula) except for the first month of life. All subjects underwent a complete ophthalmic examination and any morbidity was recorded. Frequencies of ocular morbidity were compared among the groups by using the chi-squared test. RESULTS: We found significant refractive errors in 12 (23%) subjects in Group 1 (no breast feeding). There was no significant refractive error in Group 2 (breast feeding and formula) and Group 3 (breast feeding only). The difference among the groups was statistically significant (p=0.014, chi-squared test). Allergic conjunctivitis was found in 5 subjects in Group 1, 3 in Group 2, and 2 in Group 3. There was no significant difference among the groups (p=0.395). CONCLUSIONS: Refractive errors were more frequent in Group 1 (no breast feeding) than in Group 2 (breast feeding and formula) or Group 3 (breast feeding only). There is a need to confirm this finding by performing studies with larger sample sizes.

Use of topical anesthetic and non-medical alternatives in welding workers regarding ophthalmic problems.

PURPOSE: Welding workers' ophthalmic problems resulting from their professions are frequently observed in ophthalmic emergencies and can cause severe visual impairment. We aimed to investigate the use of topical anesthetic and non-medical alternatives of this population regarding ophthalmic problems in this study. MATERIALS AND METHODS: The study included 204 welding workers randomly selected from a population of 1852 people who had at least one-year experience as a welding worker and who were members of a chamber of welding workers. Data were collected at face to face interviews with a questionnaire composed of questions about ophthalmic problems caused by their profession and about how they eliminated these problems. Obtained data were analyzed with SPSS. RESULTS: Of 204 workers, 38.7% preferred non-medical alternatives including application of potatoes (22%), dressing with tea (17%), rinsing with cold water (3.4%) and closing eyes (2%). 30.5% of the participants used topical anesthetics (72% commercial and 28% prepared in pharmacies). There was a significant relation between use of non-medical methods and topical anesthetics, and workers' education, duration of work experience and receiving training from their seniors (p < 0.05). CONCLUSION: Use of non-medical methods and topical anesthetics by welding workers was found to be associated with low-education levels and insufficient knowledge about ophthalmologic problems due their professions and their treatment. They should be provided with appropriate training for the issue and precautions should be taken to prevent people from buying drugs without a prescription.

Pain and cooperation in patients having dominant-side or nondominant-side phacoemulsification.

PURPOSE: To evaluate the relationship between laterality and perceived pain and cooperation during phacoemulsification under combined topical and intracameral anesthesia. SETTING: University ophthalmology clinic and eye hospital, Kahramanmaras, Turkey. DESIGN: Cohort study. METHODS: Seventy-eight patients with senile cataracts who had ocular surgery were included prospectively. The dominant side was determined with the Edinburg Handedness Inventory. Phacoemulsification and intraocular lens implantation were performed. The surgeon graded the patient's cooperation from 0 (best) to 3 (worst). The duration of surgery was recorded. Another researcher rated perceived pain from 0 (no pain) to 10 (unbearable pain) using a visual analogue scale (VAS). Pain scores and the degree of cooperation for dominant-side and nondominant-side surgery were the primary outcomes. RESULTS: Forty-six patients had surgery in the dominant eye and 32 in the nondominant eye. The 2 groups were similar in age, sex, and severity and type of cataract. The mean VAS score was significantly higher in patients having dominant-side surgery than in those having nondominant-side surgery (P<.01). Similarly, the mean cooperation score was significantly poorer in the patients having dominant-side surgery (P<.05). Visual analogue scores were correlated with patient cooperation (r = 0.890, P<.0001). CONCLUSION: Pain scores were higher in dominant-side surgery for cataract under topical and intracameral anesthesia, which should be kept in mind when selecting anesthesia and in studies in which pain is scored. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Retinal fiber layer thickness in children with thalessemia major and iron deficiency anemia.

PURPOSE: We aimed to measure peripapillary retinal nerve fiber layer (RNFL) thickness in children with thalassemia major (tha-major), children with iron deficiency anemia (IDA), and children in a healthy control group. MATERIALS AND METHODS: A total of 47 children with tha-major and 22 children with IDA were selected from two pediatric hematology outpatient clinics as our experimental groups, while 35 healthy children were randomly selected from a primary school to act as a control group. After a complete eye examination was conducted and intraocular pressure measurements were obtained, RNFL measurements were performed using optical coherence tomography, and the information was recorded for statistical analysis. RESULTS: The mean age of the participants was 9.65 ± 4.13 years in the tha-major group, 9.14 ± 2.53 years in the IDA group, and 9.13 ± 3.29 years in the control group, respectively, with no statistically significant difference among the three groups (p > 0.05). Mean peripapillary RNFL thickness was 119.38 ± 35.49 microns in the tha-major group, 184.00 ± 31.14 microns in the IDA group, and 187.73 ± 27.36 microns in the control group. It was significantly thinner in all quadrants in the tha-major group vs. the other two groups (p < 0.01), and in only the inferior quadrant in the IDA group (p < 0.05). Average RNLF thickness correlated positively with mean hemoglobin value (r = 0.488; p < 0.001) and negatively with mean ferritin level (r = -0.544; p < 0.001), but no correlations with mean number of transfusions and mean visual acuity were observed (p > 0.05). CONCLUSION: The study revealed that peripapillary RNFL is thinner in tha-major in all quadrants and in only the inferior quadrant in IDA. Thinning of the RNLF correlated with hemoglobin value and ferritin level, but not with number of transfusions and visual acuity.

Laterality does not affect the depth perception, but interpupillary distance.

In this study, which investigates the relationship between the levels of stereopsis with eye and hand dominance or interpupillary distance, 120 healthy young volunteers were investigated. Eye dominance was determined by modified Miles technique following a complete eye examination. Handedness was assessed with the Edinburgh handedness inventory. Interpupillary distance was measured with millimetric ruler. Stereoacuity was measured in both contour (Titmus test) and random dot (TNO test) stereograms. The stereopsis scores were evaluated in terms of hand or eye dominance. The correlation between stereopsis score and interpupillary distance was assessed. Main outcome measures were stereopsis scores according to hand and eye dominance. As a result, right- and left-handed individuals showed no differences in terms of stereopsis. No differences were found in stereopsis scores between right- and left-eye dominant people. There was a correlation between interpupillary distance and the depth of stereopsis (r = -0.248, P < 0.05). Contrary to the expectation, the left and right dominant individuals did not differ in levels of stereopsis. Interpupillary distance has a positive effect on stereopsis.

Horner's syndrome following a subtotal thyroidectomy for a benign nodular goitre.

We present a case of Horner's syndrome occurring as a complication of thyroidectomy. A 42-year-old female patient presented with eyelid drop which developed immediately after thyroidectomy for goitre. Ophthalmic examination revealed eyelid ptosis, miosis and anhidrosis. Preoperative ultrasonography showed multiple isohyperechogenic solid nodules in each lobe, consistent with multinodular goitre. Therefore, the patient underwent subtotal thyroidectomy. The ophthalmic findings did not improve at the end of 6 months follow-up. Similar cases have been reported related to neck tumours or their surgery, mediastinum-located goitre and retropharyngeal abscess surgeries, but not after benign nodular goitre surgery. Several possible mechanisms have been proposed to explain this phenomenon; anatomical variations making the patient susceptible to damage to the sympathetic chain seem to be most likely in our patient.

Preventable visual impairment in children with nonprofound intellectual disability.

PURPOSE: To assess the preventable visual impairment in children with nonprofound intellectual disability (ID). 
 METHODS: A total of 215 children with IDs (90 Down syndrome [DS], 125 nonprofound ID) and 116 age- and sex-matched healthy subjects were enrolled in this study. All participants underwent ophthalmologic examinations including cycloplegic refraction measurements, ocular movement evaluation, screening for strabismus (Hirschberg, Krimsky, or prism cover test), slit-lamp biomicroscopy, funduscopy, and intraocular pressure measurements. All data were recorded for statistical analysis.
 RESULTS: Ocular findings in decreasing prevalence were as follows: refractive errors 55 (61.1%), strabismus 30 (33.2%), cataract 7 (7.8%), and nystagmus 7 (7.8%) in children with DS; refractive errors 57 (45.6%), strabismus 19 (15.2%), cataract 7 (6.4%), nystagmus 5 (4%), and glaucoma 1 (0.8%) in children with other ID; and refractive errors 13 (11.2%) and strabismus 4 (3.5%) in controls. Cataracts, glaucoma, and nystagmus were not observed in the control group. The most common ophthalmic findings in children with DS compared with other ID and controls were with hyperopia (p<0.03 and p<0.001, respectively) and esotropia (p<0.01 and p<0.01, respectively).
 CONCLUSION: The pediatric population with ID has a high prevalence of preventable visual impairments, refractive errors, strabismus, and cataracts. The prevalence of strabismus and refractive errors was more frequent in children with DS. The importance of further health screenings including ophthalmic examinations should be utilized to implement appropriate care management and improve quality of life.

Topical proparacaine abuse resulting in evisceration.

A 72-year-old man was admitted to our clinic because of pain in the right eye. Corneal oedema, peripheral anterior synechiae formation and intraocular lens were determined in the right eye. The left eye was normal except for nuclear sclerosis. Intraocular pressure was 35 mm Hg in the right eye and 14 mm Hg in the left eye. The patient was diagnosed as having bullous keratopathy and glaucoma. He was treated with antiglaucoma drugs and artificial tears as an outpatient. Persistent keratopathy was observed at follow-up, despite adequate therapy. In the detailed anamnesis of the patient, we discovered that he had used a topical anaesthetic instead of the prescribed medicine owing to ocular pain. The patient was still using topical anaesthetic eye drops, despite warnings. Finally, evisceration was performed on his right eye because of corneal melting and perforation.

Corneal thickness measured by Scheimpflug imaging in children with Down syndrome.

PURPOSE: To measure corneal thickness via the use of a Scheimpflug imaging system (OCULUS Optikgeräte GmbH, Wetzlar, Germany) in children with Down syndrome. METHODS: This prospective, nonrandomized, clinical trial included children with Down syndrome and age- and sex-matched healthy controls. All subjects received a complete ophthalmologic examination. Corneal topography measurements were acquired by means of Scheimpflug imaging. Central corneal thickness (CCT), thinnest point of cornea (TP), and corneal volume (CV) were analyzed. RESULTS: A total of 27 children with Down syndrome and 37 control subjects were included in the study. In children with Down syndrome, the mean CCT was 494.27 ± 47 µm, the mean TP was 487 ± 49 µm, and the mean CV was 56.2 ± 6. In the controls, the mean CCT was 539.3 ± 40 µm, the mean TP was 538.0 ± 40.8 µm, and the mean CV was 61.3 ± 4. For all 3 parameters, the difference was statistically significant (P < 0.001). In the Down syndrome group, the CCT was <500 µm in 16 subjects (59.2%) and <450 µm in 5 (18.5%). In the control group, the CCT was <500 µm in 14 subjects (37.8%) and <450 µm in 2 (5.4%). CONCLUSIONS: In this study, corneal thickness was less in children with Down syndrome than in healthy control subjects. Decreased corneal thickness may be an early sign of a degenerative corneal disease such as keratoconus in children with Down syndrome.

Lens capsule-related problems in patients undergoing phacoemulsification surgery.

PURPOSE: This study aimed to compare lens capsule-related problems in mature versus non-mature senile cataracts in patients undergoing phacoemulsification surgery. METHODS: A total of 295 patients with senile cataract were divided into two groups according to lens maturation: 105 patients with mature senile cataract comprised Group 1 (study group) and the remaining 190 with non-mature senile cataract comprised Group 2 (control group). Prior to surgery, ophthalmological examination was undertaken. Patients' best-corrected visual acuity and intraocular pressure were measured and a slit-lamp examination and funduscopy performed. All examination data were recorded and any capsule-related problems during surgery were also recorded. Patient files were reviewed retrospectively and compared between groups. Fisher's exact test was used in the statistical analysis. RESULTS: In Group 1, the capsule-related problems found were: inability to complete capsulorhexis (seven eyes [6.6%]), posterior capsular perforation (three eyes [2.8%]), and conversion to extracapsular surgery (one eye [0.9%]). A posterior capsular perforation was seen in one eye (1%) in the control group. An intraocular lens was inserted into the sulcus in six eyes (5.7%) and one anterior chamber (0.9%) in Group 1 and into the sulcus in one eye (0.5%) of Group 2. The lens was inserted into the capsular bag in all other patients. CONCLUSION: Delaying surgery in patients with cataracts creates a high risk for capsule-related surgical complications. Although capsule dyes make capsulorhexis easier, capsulorhexis is the most problematic phase of phacoemulsification in mature cataracts.