Digital analysis of unilateral ptosis repair: external levator advancement vs. Müller's muscle conjunctival resection.

PURPOSE: Evaluation of lid contour and marginal peak point changes to compare outcomes of external levator advancement and Miiller's muscle conjunctival resection surgery in unilateral ptosis. METHODS: We reviewed the charts of unilateral ptosis patients who underwent external levator advancement or Miiller's muscle conjunctival resection. Eyelid contour analysis was conducted on preoperative and 6-month postoperative digital images. This was performed with the multiple margin reflex distances technique, measuring the vertical distance from a line intersecting the center of the pupil to the eyelid margin at 10 positions at 2 mm intervals. The marginal peak point changes were analyzed digitally using the coordinates of the peak point according to the pupil center. Each position's mean distance was compared preoperatively, postoperatively, and with the fellow eyelid. RESULTS: Sixteen patients underwent external levator advancement and 16 patients had Miiller's muscle conjunctival resection. The mean margin reflex distance was improved by both techniques (1.46 vs. 2.43 mm and 1.12 vs. 2.25 mm, p=0.008 and p=0.0001 respectively) and approached that of the fellow eyelid (2.43 vs. 2.88 and 2.25 vs. 2.58 mm, p=0.23 and p=0.19, respectively). However, statistically significant lid margin elevation was limited to between the N6 and T6 points in the external levator advancement group. Whereas, significant elevation was achieved along the whole lid margin in the Miiller's muscle conjunctival resection group. The marginal peak point was shifted slightly laterally in the external levator advancement group (p=0.11). CONCLUSIONS: Both techniques provide effective lid elevation, however, the external levator advancement's effect lessens toward the canthi while Müller's muscle conjunctival resection provides more uniform elevation across the lid margin. The margin reflex distance alone is not sufficient to reflect contour changes.

Digital analysis of unilateral ptosis repair: external levator advancement vs. Müller's muscle conjunctival resection

ABSTRACT Purpose: Evaluation of lid contour and marginal peak point changes to compare outcomes of external levator advancement and Müller's muscle conjunctival resection surgery in unilateral ptosis. Methods: We reviewed the charts of unilateral ptosis patients who underwent external levator advancement or Müller's muscle conjunctival resection. Eyelid contour analysis was conducted on preoperative and 6-month postoperative digital images. This was performed with the multiple margin reflex distances technique, measuring the vertical distance from a line intersecting the center of the pupil to the eyelid margin at 10 positions at 2 mm intervals. The marginal peak point changes were analyzed digitally using the coordinates of the peak point according to the pupil center. Each position's mean distance was compared preoperatively, postoperatively, and with the fellow eyelid. Results: Sixteen patients underwent external levator advancement and 16 patients had Müller's muscle conjunctival resection. The mean margin reflex distance was improved by both techniques (1.46 vs. 2.43 mm and 1.12 vs. 2.25 mm, p=0.008 and p=0.0001 respectively) and approached that of the fellow eyelid (2.43 vs. 2.88 and 2.25 vs. 2.58 mm, p=0.23 and p=0.19, respectively). However, statistically significant lid margin elevation was limited to between the N6 and T6 points in the external levator advancement group. Whereas, significant elevation was achieved along the whole lid margin in the Müller's muscle conjunctival resection group. The marginal peak point was shifted slightly laterally in the external levator advancement group (p=0.11). Conclusions: Both techniques provide effective lid elevation, however, the external levator advancement's effect lessens toward the canthi while Müller's muscle conjunctival resection provides more uniform elevation across the lid margin. The margin reflex distance alone is not sufficient to reflect contour changes.

Short-term Effects of Intravitreal Dexamethasone Implant on Choroidal Structure in Eyes with Refractory Diabetic Macular Edema.

Objectives: The objective of the study was to evaluate choroidal structural changes after intravitreal dexamethasone implant (IDI) in eyes with diabetic macular edema (DME) refractory to antivascular endothelial growth factor (VEGF) therapy. Methods: Twenty-three eyes of 14 patients with DME refractory to anti-VEGF therapy were included in this retrospective study. Detailed ophthalmological examinations were recorded, and optical coherence tomography images were obtained before and 3 months after IDI. Choroidal images were binarized into the luminal area and total choroidal area. Subfoveal choroidal thickness and choroidal vascularity index (CVI) were calculated. Results: The mean best-corrected visual acuity (BCVA) and central macular thickness (CMT) were improved significantly (from 0.94 to 0.81 LogMAR, p=0.02, and from 464 to 371 µ, p=0.01, respectively) after IDI. There were no significant changes in both SCFT and CVI at the end of the follow-up period (from 446.3 to 428.8 µ, p=0.51 and from 63.1 to 63.7 p=0.35, respectively). Conclusion: IDI in eyes with DME refractory to anti-VEGF therapy improves BCVA and CMT but has no significant effect on SCFT and CVI in the short term.

Comparison of the efficacy of intravitreal Anti-VEGF versus intravitreal dexamethasone implant in treatment resistant diabetic Macular Edema.

PURPOSE: Comparison of the efficacy of monthly anti-VEGF versus dexamethasone (DEX) implant in patients with diabetic macular edema (DME) whose macular edema persists despite three doses of anti-VEGF therapy. MATERIALS AND METHODS: This retrospective study included 94 eyes of 94 patients with central macular thickness (CMT) > 300 µm despite previously receiving three doses of anti-VGEF (aflibercept or ranibizumab) injections between January 2014 and January 2019. The patients were divided into four groups. The first and second groups were the patients who received three more doses of initial anti-VGEF treatment after the initial anti-VGEF treatment. The third and fourth groups were patients switched to intravitreal dexamethasone implants. Patients were followed up every month for six months after the injection. The primary outcome measures were best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) at six months. RESULTS: The mean age of the patients included in the study was 64.64 ± 7; there were 58 men (61.7%) and 36 women (38.3%). There was no statistically significant difference between the groups regarding age, stage of retinopathy, and lens status. When CMT, BCVA, and IOP were assessed among the four groups at the end of the sixth month, no statistical difference between the groups was found. There was no need for medical intervention despite the statistically significant increase in IOP at the end of the sixth month compared to the third month in the dexamethasone implanted groups. In contrast to the decrease in CMT, which was statistically significant in all four groups at the end of the sixth month compared to the third month, the increase in BCVA was not statistically significant in any of the four groups at the end of the sixth month. CONCLUSION: According to the results of our study, there is no superiority between continuing with existing anti-VEGF or switching to a dexamethasone implant after three doses of anti-VEGF.

Evaluation of corneal endothelial cell morphology by specular microscopy in patients with acute anterior uveitis.

PURPOSE: To determine the structure and morphology of corneal endothelial cell layer in patients with acute anterior uveitis. METHODS: Thirty-four eyes of 34 acute anterior uveitis patients and 34 eyes of 34 healthy subjects were included. Mean cell density, coefficient of variation, maximum cell area, minimum cell area, average cell area and hexagonality ratio values were evaluated by non-contact specular microscopy. Parameters recorded in both groups were compared. RESULTS: The mean maximum cell area was 1054,44 ± 251,14 µm2, minimum cell area was 152.29 ± 53.65 µm2 and average cell area was 386.91 ± 41.73 µm2 in acute anterior uveitis group and the mean maximum cell area was 1057.65 ± 261.23 µm2, minimum cell area was 147.26 ± 20.45 µm2 and average cell area was 383.53 ± 43.12 µm2 in the control group. There were no significant differences between the two groups in terms of maximum, minimum and average cell area (respectively, p = 0.080, p = 0.72, p = 0.62, p = 0.67). The mean cell density was 2607.74 ± 277.63 cells/ µm2 in acute anterior uveitis group and 2669.35 ± 265.22 cells/µm2 in the control group. (p = 0.358). In acute anterior uveitis group the mean coefficient of variation was 31.68 ± 8.16, hexagonality ratio was 63.85 ± 11.14 and mean central corneal thickness was 571.47 ± 55.99 µm; in control group the mean coefficient of variation was 25.29 ± 3.00, mean hexagonality ratio was 72.6 ± 4.80% and mean central corneal thickness was 534.82 ± 33.84 µm. Statistically significant differences were seen between the two groups (respectively, P = 0,00, P = 0,00, P = 0.02). CONCLUSION: The mean central corneal thickness and coefficient of variation values were found higher, and the hexagonality ratio was found lower in acute anterior uveitis group. Our findings suggest that intraocular inflammation in anterior chamber negatively affects the endothelial function in patients with acute anterior uveitis.

Objective vision screening using PlusoptiX for children aged 3-11 years in rural Turkey.

BACKGROUND: This population based cross sectional study was conducted to detect amblyopia risk factors and myopia in a rural district of Northwestern Turkey by using PlusoptiX S12R (Photoscreener PlusoptiX Inc., Nuremberg, Germany). METHODS: Children from 38 rural schools in Caycuma district of Zonguldak Turkey underwent vision screening in their school using PlusoptiX S12 photoscreener. Data were analyzed using the factory default level 5 referral criteria targeting 80% sensitivity and 95% specificity. Referral, unable readings, and positive predictive value (PPV) were reported. RESULTS: Data from 2846 children were analyzed. Mean age was 7.9 years (±0.8) (range 36 months to 11 years). Three hundred ten (11%) were referred of whom 32% were read as 'unable'. 150 children (48% of the referred) received a gold standard examination. Positive predictive value of PlusoptiX was 69%. PPV was 83% when unable readings were excluded. 93 children with amblyopia risk factors were identified. Only 26% (n = 25) had received glasses priorly. 49 children had amblyopia of whom 33 were newly diagnosed. CONCLUSIONS: PlusoptiX showed a reasonable level of positive predictive value in community setting and the device could be a useful tool for vision screening in preschoolers and schoolers. We found most of the amblyogenic refractive errors were underdiagnosed in rural school children leading to a call for action on vision screening.

The role of patient's systemic characteristics and plateletcrit in developing toxic anterior segment syndrome after uneventful phaco surgery: A case-control study.

PURPOSE: To compare the systemic and ocular characteristics and laboratory findings of patients developing toxic anterior segment syndrome (TASS) after uneventful phaco surgery with unaffected subjects undergoing the same surgery in the same session. DESIGN: A retrospective case-control study. METHODS: The study group consisted of 26 eyes of 26 patients who underwent uneventful phaco surgery and who went on to develop TASS, while the control group included 39 subjects who had routine phaco surgery in the same session by the same surgeon. The sterilization stages of reusable instruments, disposable instruments, and compositions were recorded. The preoperative systemic diseases, complete blood count parameters, glycosylated hemoglobin (HbA1c), biochemical parameters, thyroid hormone profiles, and the surgical features were compared between the two groups. RESULTS: Type 2 diabetes mellitus (DM), systemic hypertension (HT), hyperlipidemia, chronic ischaemic heart disease, and chronic renal failure were significantly more common in the TASS group (p < 0.05). Proliferative diabetic retinopathy was also more frequent in the TASS group (p = 0.003). Mean HbA1c% values, white blood cell count, neutrophil/lymphocyte ratio, platelet counts, platelet distribution width, and plateletcrit parameters were significantly higher in the TASS group (p < 0.05). Multivariate logistic regression analysis revealed that a high plateletcrit level (p = 0.001, odds ratio [95% CI]; 22.27 [3.36-147.76]) and systemic HT (p = 0.044, odds ratio [95% CI]; 7.13 [1.05-48.12]) are independently associated with the development of TASS. CONCLUSION: Although TASS may arise as a result of insufficient sterilization of instruments or intraocular solutions, patient factors may also contribute to its development. Systemic vascular disorders such as uncontrolled type 2 DM, systemic hypertension, and hyperlipidemia may increase the risk of TASS after uneventful phaco surgery. Abnormal parameters associated with systemic inflammation, such as higher plateletcrit level, may facilitate the development of TASS. These findings may be a predicting factor of TASS development for uneventful cataract surgeries.

Peripapillary Choroidal Thickness and Retinal Nerve Fiber Layer in Untreated Patients with Obstructive Sleep Apnea-Hypopnea Syndrome: A Case-Control Study.

PURPOSE: To evaluate peripapillary choroidal thickness (PPCT), central macular choroidal thickness (CMCT), and retinal nerve fiber layer (RNFL) thickness in untreated patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: This prospective, randomized, and comparative study was conducted in a university ophthalmology clinic. 106 eyes of 106 patients with OSAHS and 44 eyes of 44 healthy individuals were evaluated in this study. Only right eyes were evaluated. The patients with OSAHS were divided into three groups as mild (group 1), moderate (group 2), and severe (group 3) according to apnea-hypopnea index. The PPCT, CMCT, and RNFL measurements were performed by using spectral domain optical coherence tomography with enhanced depth imaging technique. The main parameters assessed were PPCT-Temporal, PPCT-Superior, PPCT-Nasal, PPCT-Inferior quadrants, CMCT, and RNFL thicknesses. RESULTS: The PPCT of all quadrants was significantly thicker in the control group compared with the moderate and severe subgroups of OSAHS (p < 0.05). The PPCT-Superior and PPCT-Temporal were significantly thinner in the mild subgroup compared with the control group (p = 0.003 and p = 0.028, respectively). There was no difference between the control and mild groups regarding the RNFL thicknesses except nasal RNFL and inferotemporal RNFL which are thinner in the mild group. The RNFL thicknesses of all quadrants were significantly thicker in the control group compared with moderate and severe subgroups (p < 0.05). The CMCT was significantly thicker in the control group compared with all subgroups of OSAHS (p < 0.05). CONCLUSIONS: In OSAHS patients, PPCT, CMCT, and RNFL were significantly thinner compared with the control group. These results may explain why OSAHS patients are prone to normotensive glaucoma.

The Effect of Dexamethasone Intravitreal Implant on Retinal Nerve Fiber Layer in Patients Diagnosed with Branch Retinal Vein Occlusion.

PURPOSE: To evaluate the effect of a single dose of intravitreal dexamethasone (DEX) implant on retinal nerve fiber layer (RNFL) thickness in patients with branch retinal vein occlusion (BRVO) in a 6-month period. MATERIALS AND METHODS: This retrospective observational study included the patients with BRVO who received intravitreal DEX implant and whose assessment included the baseline RNFL thickness measurements. The data of 26 eyes of 24 patients were retrospectively analyzed. Spectral domain optic coherence tomography was used to measure peripapillary RNFL thickness in six regional subfields. Intraocular pressure (IOP) values at each visit were recorded. The data of single dose DEX implant during 6 months were assessed. RESULTS: The mean preoperative and postoperative 6th month nasal RNFL values were 85.4 ± 23.0 µm and 82.1 ± 17.6 µm, respectively, and the difference between the measurements was not statistically significant (p = 0.372). There was a slight decrease in the mean RNFL values postoperatively compared to the baseline values in all quadrants except supero-temporal quadrant; however, none of them reached statistically significant level (p > 0.05). The mean IOP values before and 6 months after implantation were 15.7 ± 2.9 mmHg and 16.5 ± 4.2 mmHg, respectively. The difference between the 6th month IOP values and baseline IOP values was not statistically significant (p = 0.236). CONCLUSION: Intravitreal DEX implant seems to have no adverse effect on RNFL thickness in BRVO patients in a 6-month period.

Tear function and ocular surface after Muller muscle-conjunctival resection.

Muller muscle-conjunctival resection (MCR) is a surgical technique to correct mild and moderate ptosis. In this study, tear function tests and ocular surface are evaluated in patients who underwent unilateral surgery. Sixteen patients with normal preoperative tear function who underwent unilateral MCR were evaluated prospectively. The fellow eyes of the patients were taken as the control group. A dry eye assessment questionnaire, Schirmer testing, tear film break-up time, fluorescein stain, Rose-Bengal stain, and conjunctival impression cytology were used to assess the tear film functions and ocular surface changes in the operated and non-operated eyes. There was no statistically significant difference in the tear function tests and goblet cell densities between the operated and non-operated eyes. The results indicate that an MCR procedure has no apparent effect on tear function tests and goblet cell density in patients with normal preoperative tear function.

Simultaneous Bilateral Non-Arteritic Anterior Ischaemic Optic Neuropathy and Unilateral Central Retinal Artery Occlusion after Hip Prosthesis Surgery.

Non-arteritic anterior ischaemic optic neuropathy (NAION) results from the ischaemia of the anterior part of the optic nerve. Postoperative NAION is especially related to spinal surgeries, cardiovascular surgeries, and head-neck surgical procedures. This paper reports a rare case with simultaneous bilateral NAION and unilateral central retinal artery occlusion after hip prosthesis surgery. A 63-year-old woman had sudden visual loss in both eyes after hip prosthesis surgery. Fundus examination revealed bilateral optic disc oedema and macular paleness, and dot-blot haemorrhage around the optic disc suggesting central retinal artery occlusion in the left eye. Sudden simultaneous loss of vision may appear after non-ocular surgical procedures. In this case, anaemia due to excessive blood loss and prolonged hypotension during hip prosthesis surgery was the probable cause of anterior ischaemic optic neuropathy and unilateral central retinal artery occlusion.

Impact of intelligent phacoemulsification software on torsional phacoemulsification surgery.

BACKGROUND: The purpose of this study was to compare phacoemulsification energy parameters during torsional phacoemulsification with or without the use of intelligent phacoemulsification (IP) software. METHODS: One hundred and twenty-eight eyes with nuclear grades ranging from 1 to 5 were enrolled in this randomized prospective study. Operated eyes were divided into two groups, ie, those operated on using IP software (Group 1, n = 67) and those operated on without IP software (Group 2, n = 61). The two groups were compared in terms of ultrasound energy level, ultrasound energy time, aspiration time, and amount of fluid used during surgery. RESULTS: Operated eyes were further grouped according to soft (grade 1 and 2, n = 37), medium (grade 3, n = 46), and hard (grade 4 and 5, n = 31) nuclear densities. Both the study and the control groups were similar in distribution of nuclear density (P > 0.05). Cumulative dissipated energy was measured as 14.06 ± 9.92 in Group 1 and 14.22 ± 10.99 in Group 2 (P = 0.92). Total ultrasound time was 49 seconds in Group 1 and 52 seconds in Group 2 (P = 0.58). Although the torsional amplitude used was similar (P = 0.86) when IP was either on (71%) or off (68.4%), aspiration time was found to be 4 minutes 17 seconds in Group 1 (P = 0.86) and 5 minutes and 17 seconds in Group 2 (P = 0.007). Total fluid used was measured as 91 cc (P = 0.86) in Group 1 and 109 cc (P = 0.02) in Group 2. CONCLUSION: The new IP software did not cause a difference in ultrasound energy levels. However, the new software was found to be advantageous in regards to fluid use and aspiration time.

[Eye injuries at a tertiary health center in the west Black Sea region, Turkey]. / Bati karadeniz bölgesinde uçüncü basamak bir saglik merkezindeki göz yaralanmalari.

BACKGROUND: We aimed to investigate the clinical aspects and visual prognosis in eye injury and to constitute data in the west Black Sea region in Turkey for national statistics. METHODS: A retrospective analysis of 281 eye trauma cases admitted to the Emergency Department of Zonguldak Karaelmas University Hospital between 2005 and 2010 was performed. RESULTS: A majority of eye injuries (42.7%) affected individuals aged 30 to 50 years. The most frequent cause of injury in the rural areas was wooden objects. The most frequent cause of injury in males aged 30 to 50 years was work-site injuries. Corneal-scleral lacerations were found to be the most serious injuries with regard to initial and final visual acuities. CONCLUSION: Eye injuries are still the most common and preventable cause of blindness. Simple precautions and public education might prevent this health problem, which causes economic and labor force loss and psychological problems. One of the basic precautions would be raising public awareness on wearing a seat belt inside the car and protective eyeglasses at the work site and while working in rural areas.

Incidence and risk factors for retinopathy of prematurity in the West Black Sea region, Turkey.

The objective of this study was to determine the incidence, risk factors and severity of retinopathy of prematurity (ROP) and to establish screening criteria for our region. Data on 330 infants with gestational age at birth < or = 34 weeks were analyzed retrospectively for a ROP diagnosis and risk factors. Infants with type 1 ROP were treated with argon laser photocoagulation. ROP was detected in 106 of 330 infants; 18 infants had type 1 ROP and were treated. Two infants with ROP that progressed to stage 4 disease required surgery. No treatment was needed in infants born after 32 weeks of gestation. Respiratory distress syndrome and low gestational age were the most important risk factors for type 1 ROP. In the West Black Sea region of Turkey, screening all premature infants with a gestational age < or = 32 weeks or a birth weight < or = 1900 g appears to be appropriate.

The course of corneal and intraocular pressure changes during pregnancy.

OBJECTIVE: To determine concurrent changes in corneal thickness, intraocular pressure (IOP), and corneal topography measurements during normal pregnancy. DESIGN: Prospective cohort study. PARTICIPANTS: We studied 50 eyes from 25 healthy women whose ages ranged from 21 to 35 years and who were first seen during the 10th week of pregnancy. METHODS: Measurements included IOP (noncontact tonometry); corneal thickness (ultrasound pachymetry); and corneal topography (TMS 2N, TOMEY, Nagoya, Japan). Changes in IOP, central corneal thickness (CCT), and corneal power were calculated at 4 time periods: first trimester, second trimester, third trimester, and 3 months postpartum. RESULTS: The mean IOPs in the second and third trimesters of pregnancy were found to be lower than those in the first trimester and at 3 months postpartum (p = 0.001). The mean CCT in the second and third trimester of pregnancy was measured to be higher than in the first trimester and at 3 months postpartum (p < 0.001). Both IOP and CCT returned to first-trimester levels following delivery. In the third trimester, a 3.1% increase in CCT was associated with a 9.5 % decrease in IOP. Topographic measurements did not show statistically significant changes throughout the trimesters or after pregnancy. CONCLUSIONS: An increase in CCT was accompanied by a decrease in IOP in the second and third trimesters. Physiologic changes occurring in CCT and IOP should be considered in the management of glaucoma during pregnancy.

Posterior scleritis presenting with angle closure glaucoma.

PURPOSE: To report a case of posterior scleritis associated with angle closure glaucoma and transient myopia. METHODS: A previously healthy 29-year-old male was referred for YAG laser iridotomy to treat angle closure glaucoma. He was suffering from severe pain and vision loss in his right eye. Findings on examination were hyperemia, proptosis, and myopia measuring approximately 6 diopters. Diagnosis of posterior scleritis was made due to presence of choroidal thickening, sub-Tenon effusion and the classical "T" sign observed on orbital ultrasonography. RESULTS: Treatment was initiated using oral prednisolone. After 8 days, the patient's symptoms regressed and visual acuity returned to 20/20. CONCLUSIONS: Posterior scleritis is an often misdiagnosed eye disease. Pain is the main symptom and may be accompanied by decrease in visual acuity. Early diagnosis and treatment is important to avoid permanent visual loss.

Effects of a new hemostatic agent Ankaferd Blood Stopper(®)on the intraocular tissues in rat model.

PURPOSE: To investigate the histopathological changes due to administration of Ankaferd Blood Stopper(®) (ABS) into intraocular tissues by an anterior chamber and intravitreal injections. METHODS: Twenty Wistar albino rats were divided into four equal groups. Group 1 was injected 0.01 mL ABS into anterior chamber. Group 2 was injected intravitreal 0.02 mL ABS. Groups 3 and 4, which were used as controls, were injected into the anterior chamber and intravitreal 0.01 mL and 0.02 mL balanced salt solution (BSS), respectively. At 2, 5, 10, 15 and 20 days after injection, the eyes were examined under an operating microscope and were subsequently enucleated for histopathological examination. RESULTS: Ophthalmic examination of the rats prior to enucleation revealed ocular complications ranging from conjunctival hyperemia to corneal perforation in group 1 and increased conjunctival hyperemia and discharge in group 2. No physical and histopathological anomalies were detected in groups 3 and 4. All eyes in group 1 showed mixed type inflammatory cell reaction, foreign-body reaction, stromal congestion, disintegration of the collagen fibers and loss of the epithelium of the posterior wall in the iris and ciliary body were observed histopathologically. All eyes in group 2 showed disintegration and separation of the retina, brown pigment accumulation and mixed type inflammatory cell reaction. CONCLUSION: Our results indicate that the commercially available form of ABS solution exerts a toxic effect on intraocular tissues. We consider that the intraocular use of different concentrations, rather than multiple time point of ABS should be investigated.

Validation of plusoptiX S04 photoscreener as a vision screening tool in children with intellectual disability.

PURPOSE: Intellectual disability (ID) is a major public health issue, affecting more than 1% of children worldwide. Pediatric vision screening using standard eye charts may be challenging for children with ID, who may benefit from a quick noninvasive vision screening tool. This study evaluated the accuracy of plusoptiX S04 (Plusoptix Gmbh, Nuremberg, Germany) in detecting amblyopia risk factors in children with ID. METHODS: Children diagnosed with ID according to age-appropriate psychological tests were examined consecutively. Vision screening was performed using the plusoptiX S04 prior to complete ophthalmological examination, including cycloplegic refraction. Pass/refer screening results was compared with findings of ophthalmological examination. Amblyogenic risk factors were defined according to American Association for Pediatric Ophthalmology and Strabismus referral criteria. RESULTS: A total of 182 infants and children were examined. Only 3% of children were uncooperative for screening. Ophthalmological examination detected amblyogenic risk factors in 32% of patients. The sensitivity of plusoptiX S04 was 95% (95% CI, 85.6%-98.9%), and specificity was 50% (95% CI, 40.8%-59.1%). The positive predictive value was 47% (95% CI, 37.7%-56.4%) and the negative predictive value was 95.4% (95% CI, 87.1%-99.1%). CONCLUSIONS: High sensitivity and negative predictive values suggest that the plusoptiX S04 will detect most children with ID who have amblyogenic risk factors, but one-half of all children referred will have no risk factors.

Effects of the folk medicinal plant extract Ankaferd Blood Stopper® on the ocular surface.

PURPOSE: To investigate the effects of Ankaferd Blood Stopper(®) (ABS) on the ocular surface. METHODS: Twenty adult male Wistar albino rats, weighing 390-530 g, were used in this prospective, controlled trial. One drop of ABS and one drop of balanced salt solution (BSS) were instilled into the lower conjunctival sac of the right and left eyes, respectively. After the rats were anesthetized, the ocular surface was evaluated based on the Draize criteria, and fluorescein tests were performed at 1, 2, 4, 18, 24, and 48 h. Subsequently, the rats were killed and all eyes were enucleated for histopathological examination. RESULTS: The outcome of the Draize and fluorescein tests revealed that ABS caused more irritation of the ocular surface than BSS (P < 0.001). The highest mean ABS score was 4.9 for the Draize test and 0.4 for the fluorescein test, and ABS was considered to be a slight irritant. Histopathological examinations of the cornea and the conjunctiva revealed no significant difference between the eyes instilled with BSS and those instilled with ABS. CONCLUSIONS: ABS is a hemostatic drug that exerts a slight toxic effect on the ocular surface. Given its ease of use and antibacterial activity, as well as its efficiency in stopping bleeding, the use of ABS during ocular surgery should be further investigated in experimental and clinical studies.

Comparing techniques for pterygium surgery.

PURPOSE: To compare various techniques of pterygium surgery including bare sclera, intraoperative mitomycin C application, conjunctival flap reconstruction, and conjunctival autografting technique. METHODS: This study is designed to compare 4 currently used techniques in order to determine the complication and recurrence rates after pterygium exision. Included in the study were 77 eyes from 60 patients. Bare sclera technique was used to treat 21 primary pterygia;mitomycin C was used to treat 20 (16 primary, 4 recurrent) pterygia;18 (17 primary, 1 recurrent) pterygia were treated by conjuntival flap reconstruction;and 18 (9 primary, 9 recurrent) pterygia were treated by conjunctival autografting technique. All patients who underwent surgery were followed up for between 6 months and 2 years. RESULTS: Eight recurrences (38.09%) were observed in the bare sclera group whereas there were 5 (25%) recurrences in the mitomycin C group. In the conjunctival flap reconstruction group, 6 (33.33%) recurrences were detected. In the conjunctival autografting group, 3 recurrences were observed. There were no major complications threatening visual ability in the surgical patients. CONCLUSION: A comparison of the groups demonstrated that the recurrence rate was highest in the bare sclera group, and lowest in conjunctival autografting and mitomycin C treatment groups respectively. Although the conjunctival autografting technique is a more difficult and time consuming technique than the others, cosmetic and surgical results were found to be superior. We advise conjunctival autografting for the treatment of pterygium in view of the high recurrence rates of other techniques, and the possible complications of mitomycin C treatment for benign disease.