Risk factor analysis for long-term unfavorable ocular outcomes in children treated for retinopathy of prematurity.

The aim in this study was to report long-term ocular outcomes of neonates treated for retinopathy of prematurity (ROP) and potential risk factors for unfavorable ocular outcomes. The study consisted of neonates treated for ROP between March 1999 and November 2009. Data relating baseline characteristics and late structural, functional and refractive ocular outcomes were recorded. The association between the unfavorable ocular outcomes and ROP-related risk factors was evaluated by regression analysis. Forty-eight children were included for assessment. Average chronological age at the time of followup was 3.11±0.73 years. The rates of unfavorable structural and functional outcomes were 12% and 15.3%, respectively. Ocular deviation was common (27.1%), and mostly esotropic (12/13). A clear myopic tendency was observed (51.2%), and the mean spherical equivalent per eye was -0.72±2.9 diopters. Regression analyses for unfavorable ocular outcomes revealed intraventricular hemorrhage as a core independent risk factor. In conclusion, ROP treatment has shown promising results in both structure and function. Because of the high risk of developing an unfavorable outcome, a more intense follow-up is required in neonates with a history of intraventricular hemorrhage in the neonatal period. Further studies from other centers are needed to develop a national database, which may validate this observation.

Recurrent Alternating Oculomotor Nerve Palsy: An Unusual Presentation of Parasagittal Meningioma.

We present a previously unreported case of 57-year-old man suffering from diplopia. Motility assessment revealed a total right oculomotor nerve palsy that spontaneously resolved in about 10-18 days. Three years later, sudden oculomotor nerve palsy occurred in his left eye and complete resolution with out any treatment was observed after a month. Five years from the second episode there was a further recurrence in the right eye. Magnetic resonance imaging demonstrated a parasagittal meningioma.

Bupivacaine injection for comitant horizontal strabismus: clinical and radiological results.

PURPOSE: To report the outcomes of bupivacaine injection for the treatment of comitant horizontal strabismus and evaluate clinical effectiveness and associated radiological changes. METHODS: This prospective observational clinical study was conducted on 10 patients with comitant horizontal strabismus of up to 40 prism diopters. Ophthalmologic examinations and three-dimensional orbital magnetic resonance imaging were performed pre and post-injection (at first, third, and 12th months). A 4.5 ml of 0.5% bupivacaine was injected into the extraocular muscle under topical anesthesia using an electromyography in all patients. RESULTS: The mean follow-up time at post bupivacaine injection and mean deviation at primary position were was 17 ± 2 months and 21.3 prism diopters, respectively. The mean changes in ocular alignment, enlargement of the cross-sectional area in the injected muscle, and volumetric enlargement were 7.7 PD, 12%, and 17% at the first year post-injection, respectively. No severe or persistent complication was observed. Ptosis and mydriasis were noted post-injection due to the anesthetic effects of bupivacaine but disappeared within 2 h post-injection. CONCLUSIONS: Bupivacaine injection improved eye alignment in small-angle horizontal comitant strabismus, effectively diagnosed with orbital magnetic resonance imaging to evaluate volumetric changes of the extraocular muscles. Further clinical studies with larger numbers of patients should be performed to define optimal dosages, concentration, and application method and dose-response relationship.

Late Surgical Correction of Longstanding Constant Strabismus in Adults: Is Fusion Possible in All Successfully Aligned Patients?

PURPOSE: To determine whether late surgical correction provides fusion in adults who have constant strabismus beginning in early childhood. MATERIALS AND METHODS: This was a prospective study that included 34 consecutive adults with a history of early onset strabismus who had not previously undergone surgery. They were tested with the Bagolini striated glasses (BSG), Worth four-dot (W4D) test, cover test, and four-prism diopter (4-PD) test, preoperatively, and 6 weeks after surgery. RESULTS: The mean age was 23.8 years, 17 patients had esotropia and 17 patients had exotropia. Preoperatively, all patients demonstrated a manifest horizontal deviation ranging from 30∆ to 60∆ and had suppression. At 6 weeks postoperatively, 33 patients had a horizontal manifest deviation of <15∆ (range, 2∆-14∆; median, 6∆), and none were orthotropic as determined by the cover test together with the 4-PD test. All of these 33 patients achieved anomalous retinal correspondence (ARC) with the BSG at near, and 25 (75%) had ARC with the W4D test at near. CONCLUSIONS: Although our study has limited number of patients its findings suggest it is possible to develop ARC after surgery in almost all adult patients with childhood-onset strabismus associated with suppression, and who have not previously been operated upon, if satisfactory alignment is achieved in adulthood.

Clinical Features and Surgical Results in Harada-Ito Surgery Patients.

Symptomatic excyclotorsion is an important clinical problem, especially in acquired superior oblique muscle palsy. Excyclotorsion can disrupt the fusion and cause torsional diplopia. Harada-Ito surgery (HI) is a widely used method for treating excyclotorsions. This method relieves the torsional diplopia by increasing the effect of the incyclotorsion. In this study, we aimed to report the clinical features of patients with torsional diplopia due to acquired trochlear nerve palsy and the results of HI surgery in these patients.

A study on the validity and reliability of the Amblyopia andStrabismus Questionnaire (A&SQ) in Turkish.

BACKGROUND/AIM: This study aims to evaluate the reliability and validity of the Amblyopia and Strabismus Questionnaire (AandSQ) that is translated into Turkish. MATERIALS AND METHODS: This is a methodological study. A total of 149 patients took part in the survey research between December 2012 and June 2014 in an university hospital, and 37 were retested. Cronbach's alpha coefficient was used for the questionnaire's reliability analysis. RESULTS: Cronbach's alpha coefficients for the subscales of fear of losing the better eye, distance estimation, visual disorientation, double vision, and social contact and appearance were found to be 0.80, 0.88, 0.95, 0.80, and 0.81, respectively. Five factors determined by the exploratory factor analysis explained 69.87% of the total variance. CONCLUSION: The Turkish version of the AandSQ is found as a reliable and valid scale for analyzing Turkish society. The AandSQ might be helpful for measuring quality of life in patients with strabismus.

Long-term motor and sensory outcomes after surgery for infantile esotropia.

BACKGROUND/AIM: Infantile esotropia (ET), entitled as congenital ET, is defined as an alternating, cross-fixational ET that occurs within the first 6 months of life. The aim of this study was to determine the long-term motor and sensory outcomes after surgical correction of patients with infantile ET. METHODS: Medical records of 108 consecutive children who had bimedial rectus recession (BMR) initially for ET were reviewed retrospectively. The patients were divided into 3 groups: the group I, surgery before one-year old; the group II, surgery between one and two-year old; the group III, surgery after two-year old. RESULTS: No significant differences were determined among the groups for preoperative mean angle of deviation and refractive error (p > 0.05, for both). Development rate of dissociated vertical deviation (DVD) was greater (40%) in the group I, and the relationship between the rate of DVD and the timing of the initial surgery was statistically significant (p = 0.03). Risk for additional surgery was significantly greater in patients with a younger mean age at initial surgery (p = 0.01). Although measurable stereopsis rate was higher in the group I (35%, 32.4%, 27.8%, respectively) the difference among the groups was insignificant (p = 0.80). CONCLUSION: Patients with ET have limited potential of high grade stereoacuity despite the early alignment of eyes. Early surgery also has potential effects for the development of both inferior oblique overaction and DVD earlier.

Abducens Palsy Due to Cerebral Venous Sinus Thrombosis in a Patient with Heart Failure.

Cerebral venous sinus thrombosis has a wide spectrum of presentation. The clinical manifestation depends on the location of the thrombus, its rate of progression, and the extent of venous collateralization. In this case report, we present the findings of cerebral venous sinus thrombosis presenting with abducens palsy and papilloedema in a patient with heart failure, an unusual etiology for cerebral venous sinus thrombosis.

Consecutive exotropia: risk factor analysis and management outcomes.

PURPOSE: To report the frequency of risk factors and outcomes of consecutive exotropia (XT) following bimedial rectus recession (BMR) for the treatment of childhood esotropia (ET). METHODS: Ninety-eight patients with ET, who underwent only BMR between 1996 and 2007, were included in this study. Predictors of the development of consecutive XT and treatment outcomes were compared between groups (group 1, cases with consecutive XT; group 2, cases without consecutive XT). RESULTS: Mean follow-up time after BMR surgery was 7.23 ± 3.62 years. There was no significant difference between the groups in terms of age, preoperative angle of near deviation, follow-up time, or refraction for both eyes (p>0.05 for all). The differences regarding preoperative angle of distance deviation (p = 0.009), presence of inferior oblique overaction (p = 0.023), amount of BMR (p = 0.028), and postoperative adduction limitation (p<0.0001) between the groups were statistically significant. However, only preoperative angle of distance deviation and presence of postoperative adduction limitation were independent risk factors for the development of consecutive XT (p = 0.043, p = 0.007, respectively). CONCLUSIONS: Postoperative adduction limitation should alert physicians to the increased risk of developing consecutive XT in the long-term follow-up after BMR for the treatment of childhood ET.

A conventional strabismus surgical approach for lost medial rectus muscles.

We present 3 cases of successful conventional strabismus surgery to retrieve lost medial rectus (MR) muscles. In all cases the lost MR muscle was retrieved and re-attached to the intended scleral point. Two patients had residual exotropia, while the third case was orthophoric after surgery. The retrieval of lost MR muscle using conventional strabismus surgery technique can be successfully achieved if the lost MR muscle is recognized early and the re-operation is performed by an experienced surgeon.

Frequency, risk factors and outcomes of retinopathy of prematurity in a tertiary care hospital in Turkey.

The aim was to report outcomes of retinopathy of prematurity (ROP) screening conducted between March 1999 and March 2012 in a retrospective manner before October 2005 (Group 1) and prospective manner thereafter (Group 2). Data of the neonates with either a gestational age of 34 weeks or less or with a birth weight of less than 1501 g were analyzed to elucidate the frequency of ROP, ROP-related risk factors and population characteristics. Of the 640 neonates, 240 (37.5%) had any stage of ROP. Gestational age ≤32 weeks, birth weight <1500 g, oxygen therapy, respiratory distress syndrome, and sepsis were found as independent determinants for any stage of ROP. Gestational age ≤28 weeks, mechanical ventilation, intraventricular hemorrhage, and outborn infant status were found as independent determinants for treatmentrequiring severe ROP (8.6%). Frequency of ROP did not seem to follow a decreasing trend; however, neonates in Group 2 were more immature and sicker. Therefore, check-backs seem to be necessary to follow the dynamic nature of ROP.

Evaluation of the nerve fiber layer and macula in the eyes of healthy children using spectral-domain optical coherence tomography.

PURPOSE: To determine the normative values of the peripapillary retinal nerve fiber layer (RNFL), macular thickness, and macular volume in healthy children using spectral-domain optical coherence tomography (SD-OCT) and analyze the correlation of such values with age, refraction error, and biometric measurements. DESIGN: Observational case series. METHODS: This institutional study involved 107 eyes from 107 healthy pediatric patients (54 female, 53 male) with ages between 6 and 16 years. After the biometric measurements and refractive error values (in spherical equivalent) of the cases were obtained, the peripapillary RNFL, macular thickness, and macular volume values were calculated using the Spectralis OCT device. RESULTS: Among the study group, with an average age of 10.46 ± 2.94 years, the average axial length (AL) was 23.33 ± 0.89 mm; the average spherical equivalent (SE) value was -0.27 ± 0.99 diopter. The average peripapillary RNFL thickness was 106.45 ± 9.41 µm; the average macular thickness was 326.44 ± 14.17 µm; and the average macular volume was 0.257 ± 0.011 mm(3). The aforementioned OCT measurements were not significantly correlated with age, SE, or AL values (P > .05 for all). CONCLUSIONS: This study reports SD-OCT findings among healthy pediatric cases. SD-OCT can be reliably used for pediatric patients because of its short exposure time and high degree of image resolution.

Management of diplopia in patients with blowout fractures.

PURPOSE: To report the management outcomes of diplopia in patients with blowout fracture. MATERIALS AND METHODS: Data for 39 patients with diplopia due to orbital blowout fracture were analyzed retrospectively. The inferior wall alone was involved in 22 (56.4%) patients, medial wall alone was involved in 14 (35.8%) patients, and the medial and inferior walls were involved in three (7.6%) patients. Each fracture was reconstructed with a Medpore® implant. Strabismus surgery or prism correction was performed in required patients for the management of persistent diplopia. Mean postoperative follow up was 6.5 months. RESULTS: Twenty-three (58.9%) patients with diplopia underwent surgical repair of blowout fracture. Diplopia was eliminated in 17 (73.9%) patients following orbital wall surgery. Of the 23 patients, three (7.6%) patients required prism glasses and another three (7.6%) patients required strabismus surgery for persistent diplopia. In four (10.2%) patients, strabismus surgery was performed without fracture repair. Twelve patients (30.7%) with negative forced duction test results were followed up without surgery. CONCLUSIONS: In our study, diplopia resolved in 30.7% of patients without surgery and 69.2% of patients with diplopia required surgical intervention. Primary gaze diplopia was eliminated in 73.9% of patients through orbital wall repair. The most frequently employed secondary surgery was adjustable inferior rectus recession and <17.8% of patients required additional strabismus surgery.

Combination of Laser Photocoagulation and Intravitreal Bevacizumab in Aggressive Posterior Retinopathy of Prematurity.

The response to combined laser photocoagulation and a single intravitreal injection of 0.75 mg bevacizumab to each eye on separate days in two patients with aggressive, posterior retinopathy of prematurity (ROP) is described. Combined treatment resulted in regression of zone-1 disease in Case 1, which had no retinal detachment. However, no significant regression or unfavorable anatomic response was observed in the second case with retinal detachment. Although the combination of laser photocoagulation and intravitreal bevacizumab injection seems to be well tolerated, inducing prompt regression of agressive zone-1 ROP without retinal detachment, further controlled studies with long-term follow-up are necessary for their use in the treatment of ROP with for potentially dangerous growth factor inhibitors in premature babies.

An analysis of neonatal risk factors associated with the development of ophthalmologic problems at infancy and early childhood: a study of premature infants born at or before 32 weeks of gestation.

BACKGROUND: To determine the frequency of ophthalmologic problems and the risk factors that affect the occurrence of these problems in premature newborns with a gestational age of 32 weeks or less. METHODS: Premature newborns observed at a neonatal intensive care unit between January 2002 and March 2006 were included. A control visit including an ophthalmologic examination was performed at 10 months of age or later. Primary ocular morbidities were studied, and the association between these parameters and prenatal, perinatal, and neonatal characteristics were evaluated. RESULTS: A total of 169 premature newborns were included in the study, and they were examined at a mean age of 25.85 ± 11.79 months (range: 10 to 42 months). There was complete vision loss (blindness) in 1 (0.6%) case, strabismus in 15 (8.9%) cases, and refractive errors in 10 (5.9%) cases. Twenty (77%) cases with any abnormality and 50 (35%) cases with a normal examination at follow-up had a history of retinopathy of prematurity (ROP) at any stage during the neonatal period (P = .001). Short gestational age (P = .018), low birth weight (P = .002), and the presence of ROP requiring retinal surgery during the neonatal period (P = .007) were determined to be significant risk factors for the development of vision loss, strabismus, and refractive errors. CONCLUSION: Neonates with a gestational age of 32 weeks or less, especially those younger than 30 weeks, should not only be screened for ROP in the neonatal period, but should also have regular follow-up examinations to check for the development of other ophthalmologic problems during infancy and early childhood.

Congenital absence of salivary and lacrimal glands accompanied by growth and development retardation.

Congenital absence or hypoplasia of some or all major salivary or lacrimal glands, nasolacrimal ducts, and puncta is a rare autosomal dominant disorder. Phenotypical expression may show great variability, and the diagnosis may be difficult. Only a few cases have been reported in the literature. This report describes a patient who has all of the essential features suggestive of aplasia of the lacrimal and salivary glands, as well as retardation of growth and development. Although the characteristic features of aplasia of the lacrimal and salivary glands have been described, an association with development and growth retardation has not been reported in the literature.

Duane's retraction syndrome: its sensory features.

PURPOSE: To investigate binocularity in Duane's retraction syndrome (DRS) and to evaluate whether or not there is a relationship between the sensory and clinical features of the syndrome. METHODS: Clinical and sensory findings of 29 patients with DRS were recorded. Binocularity was tested with the Bagolini glasses (BG), Worth four-dot (W4D), TNO and the stereo-fly plate of the Titmus test. RESULTS: Twenty-four (83%) patients showed fusion with the BG at near and 23 (79%) had fusion at distance. With the W4D, 23 (79%) patients had fusion at near and 19 (65%) had fusion at distance. Seven (24%) patients demonstrated normal stereoacuity, 15 (52%) had reduced stereoacuity and the remaining seven (24%) patients had no measurable stereoacuity. In patients without stereoacuity, amblyopia (p < 0.001), type 2 and 3 DRS (p = 0.031) and exotropia (p = 0.003) in primary position were more common than in those with reduced or with normal stereoacuity. Restriction of ocular ductions was also more severe in patients without stereoacuity than in those with reduced or normal stereoacuity (p = 0.019, p = 0.016). Patients with type 2 and 3 DRS were significantly more likely to have amblyopia (p = 0.037), large-angle heterotropia (p = 0.005) in primary position, upshoot or downshoot (p = 0.010) than those with type 1 DRS. CONCLUSIONS: Although approximately 75% of DRS patients had fusion and measurable stereoacuity, only 25% demonstrated normal binocularity. This report provides new data on the relationship of sensory features to most of the clinical findings of this syndrome. Sensory features, as well as most clinical features of the syndrome, are better in patients with type 1 DRS.