Ophthalmic screening of school children in Ankara.

Ophthalmic screening was done on 23,810 children visited at schools in different regions of Ankara. Children with below normal visual acuity were invited to the outpatient department and had a full routine ocular examination. Thirty-nine nursery and primary schools were selected, ten of them private, eleven average state schools, seven good state schools and eleven village schools. Among the 23,810 children, 3095 (13%) had various pathology; 1516 were girls, 1579 boys. Refractive errors were found in 85% of the children (2630). This equals 11% of the total screened population. Refractive errors were myopia 32%, hypermetropia 21%, astigmatism 47%. Strabismic children were 2.5%, and amblyopia was found in 1.1%. The purpose of the study was to assess the place of an ocular screening program in primary school children and to discuss the differences encountered in different urban areas.

Orbital rhabdomyosarcoma: a twenty-year survey in Turkey.

Orbital rhabdomyosarcoma is the most frequently encountered primary malignant orbital tumor in children. Between 1970 and 1991, 68 primary orbital rhabdomyosarcoma cases were diagnosed and treated in our clinic. Mean age at the time of diagnosis was 8.8 years. Seventy-two percent of the cases were of the embryonal type while 14% had alveolar and 14% had botryoid tumors. Following tissue diagnosis by anterior orbitotomy, radiotherapy and multimodal chemotherapy were instituted promptly. Subtotal exenteration was used in massive orbital involvement and total exenteration in recurrences. Using the Kaplan-Meier method of analysis, the survival rate was 84% at three years and 80% at five years. While morbidity due to the disease itself and treatment complications may still be a problem, the survival rates achieved in the long term are promising.

Neurogenic tumors of the orbit.

Fifty-three patients with neurogenic orbital tumors were diagnosed and treated at our university hospital during the past three decades. There were 16 patients with juvenile pilocytic astrocytomas, 21 patients with meningiomas and 16 with peripheral nerve tumors. Of the 16 peripheral nerve tumor patients, 8 had schwannoma, 4 had neurofibroma, 2 had malignant schwannoma, one had paraganglioma and one had amputation neuroma. Optic nerve tumors were treated via a transfrontal craniotomy if there was no chiasmal involvement. Cases with chiasmal involvement, incomplete resections and recurrences were treated with radiotherapy (5000 cGy). Far advanced cases with progressive proptosis and ocular damage underwent exenteration. Peripheral nerve tumors were treated by local resection. Exenteration was applied when there was an advanced or malignant lesion. Four of the 16 glioma patients and 5 of the 21 meningioma patients died during follow-up. The prognosis for peripheral nerve tumors was generally good, except for malignant schwannomas. Two patients with this malignant tumor died within 2 years after surgery.

Orbital exenteration: a review of 429 cases.

The authors reviewed their experience with 429 cases of orbital exenteration between 1963 and 1993. Apart from the 22 cases operated in concert with other physicians, 407 cases were operated by an ophthalmologist and spontaneous granulation technique was used. Total or eyelid-sacrificing exenteration was carried out for lesions involving the eyelids and for recurrent/infiltrative malignant tumors. Two hundred and thirty-seven cases received total exenteration. The remaining 192 cases were treated with eyelid-sparing or subtotal exenteration. In each case, full exenteration was performed with the removal of the periosteum. Secondary tumors were the most frequent indication for exenterations accounting for 349 (81.3%) cases. Among the secondary tumors, there were 173 eyelid, 104 intraocular, 56 conjunctival tumors, 15 nasopharynx and one maxillary sinus carcinomas. The second leading indication was primary orbital tumors (50 cases, 11.7%). Of the primary orbital tumors, 35 were rhabdomyosarcomas, nine were neurogenic tumors, two were fibrocytic tumors, two were vascular tumors, one was teratoma and one was primary melanocytic tumor. The remaining cases included 16 lacrimal fossa tumors (3.7%), 10 lymphomas (2.3%) and four (1.0%) inflammatory pseudotumors. Squamous cell carcinoma was the single most frequent indication for which exenteration was carried out, accounting for 30.3% of the cases. Spontaneous granulation proved to be a simple technique and produces cosmetically better results for patients not wearing prosthesis.

Contamination in contact lens care systems.

We studied the rate of contamination in the contact lens care systems and conjunctivas of 30 asymptomatic cosmetic soft contact lens wearers. In caring for their lenses, 23 patients used chemical disinfection systems (quaternary ammonium solutions), six patients used hydrogen peroxide, and one used heat. Eighteen patients used unpreserved intravenous saline solution, and only seven patients used commercially prepared preserved saline solutions. Cultures were obtained from lens cases, lens care solutions, and conjunctivas. Contamination was found in 70% of the lens care systems. Fifty-seven percent of the patients had lens case contamination, and 17% had conjunctival contamination. The most frequently isolated bacteria in the lens care systems were Pseudomonas, Staphylococcus epidermidis, and Escherichia coli. We suggest the development of more effective systems for disinfection.