Serum omentin, resistin and tumour necrosis factor-α levels in Behcet patients with and without ocular involvement.

PURPOSE: The objective of this study was to evaluate serum omentin, resistin and tumour necrosis factor-α (TNF-α) levels in Behcet disease (BD) patients with and without ocular involvement, as well as control subjects. METHODS: Omentin, resistin and TNF-α levels were assessed in the plasma of 51 BD patients and compared with those of 24 control subjects. RESULTS: The plasma resistin and TNF-α levels were significantly higher in the BD patients than in the control group (p = 0.028 and p = 0.011, respectively), whereas the plasma omentin level was significantly lower in BD patients than in the control group (p = 0.035). In the ocular BD, non-ocular BD and control groups, the omentin levels were 8.9 ± 4.65, 8.6 ± 3.61, and 12.4 ± 6.24 ng/mL; resistin levels were 0.29 ± 0.21, 0.24 ± 0.2 and 0.15 ± 0.45 ng/mL; and TNF-α levels were 25.45 ± 3.65, 24.03 ± 2.49 and 21.93 ± 4.86 ng/mL, respectively. Omentin/resistin and TNF-α/omentin ratios were more significant parameters in the demonstration of the differences in the groups; the former was lower and the latter was higher in the patient groups (p = 0.001 and p = 0.002, respectively). CONCLUSIONS: We demonstrated that the plasma omentin level and omentin/resistin ratio were decreased, whereas the resistin and TNF-α levels and TNF-α/omentin ratio were increased in BD patients. These ratios may be used in the presentation of deviation in the inflammatory and anti-inflammatory balance in BD.

Impact of Collagen Cross-linking on Psychological Distress and Vision and Health-Related Quality of Life in Patients With Keratoconus.

OBJECTIVE: To evaluate the changes in psychological distress level and quality of life (QoL) scores of keratoconus (KC) patients 1 year after corneal collagen cross-linking (CXL). METHODS: Observational cross-sectional study. Thirty-three, consecutive progressive KC patients who received CXL treatment were enrolled in the study. All patients were evaluated before and 1 year after CXL ophthalmologically and psychologically. Main outcome measures were the visual, refractive, and topographic changes and the Beck Depression Inventory, State-Trait Anxiety Inventory (STAI), Short Form-36 (SF-36), and The National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). RESULTS: There were significant improvements in the keratometric readings at flat axis, steep axis, the mean keratometric reading, the corneal astigmatism (Kast), and the maximum keratometric reading. State-Trait Anxiety Inventory-II scores, QoL dimensions, such as physical role difficulty, general health, mental health, ocular pain, near activities, distance activities, peripheral vision, and mental health scores, and the composite score of NEI-VFQ-25, were higher after surgery. There was a positive correlation between the changes observed in Kast and mental health; a negative correlation between the changes in Kast and STAI-II, and a negative correlation between the changes in mental health and STAI-II. Change in STAI-II has significantly predicted the improvement observed in general health. CONCLUSIONS: Our results suggested lower trait anxiety and better vision-related and health-related QoL in KC patients 1 year after successful CXL treatment. Better QoL in these patients seems to be related not only with the visual and refractive results but also improvement observed in trait anxiety.

Approach of Turkish ophthalmologists to micronutrition in age-related macular degeneration.

PURPOSE: To evaluate the knowledge and behaviors of ophthalmologists in Turkey concerning micronutrition support in patients with age related macular degeneration (ARMD). METHODS: This study involved 1,845 ophthalmologists. A scientific poll was sent to all participants by email. The survey covered the following: demographic features, subspecialty knowledge about micronutrition preference for prescribing micronutrition to age related macular degeneration patients, and the reason for this preference. If a participant indicated that he or she prescribed micronutrition, the participant was also asked to indicate the source of the treatment and supplemental treatments. RESULTS: Of 1,845 ophthalmologists, 249 responded to the survey. Of the respondents, 9% (22) never, 43% (107) sometimes, 37% (92) frequently, and 11% (27) always used micronutrition. The most frequent prescribing subgroup was general ophthalmology (22%), followed by the retina-uvea subspecialty (13.9%). The micronutrition prescribing ratio was 54.8% in retina-uvea specialists when the "frequent" and "always" responses were combined. There was no statistically significant difference between subgroups with respect to prescribing micronutrition. Among the ophthalmologists prescribing micronutrition, 57.1% of them did not use the Age-Related Eye Disease Study-1 (AREDS) criteria, and only 31.3% prescribe micronutrition according to AREDS criteria. The results for the general ophthalmologist and retina-uvea specialist subgroups were similar, 56.3% vs 20.2%, and 54.1% vs 36.1%, respectively. Micronutrition was not recommended for the following reasons: expensive (55.4%), low patient expectancy (40%), no effect (30%), and low patient drug compliance (25.4%). Moreover, 55.2% of the clinicians recommended physical activities, dietary changes, and smoking cessation; 7.3% did not recommend these behavioral changes. CONCLUSION: This survey demonstrated that micronutrition preference in age related macular degeneration was low in ophthalmologists in Turkey. Additionally, retina specialists have a lower rate of prescribing micronutrition. Micronutrition support and behavior such as smoking cessation, dietary changes, etc. should be recommended more often to patients with age related macular degeneration.

Etiology and prognosis of penetrating eye injuries in geriatric patients in the Southeastern region of Anatolia Turkey.

BACKGROUND: The purpose of this study was to evaluate the etiologic and prognostic factors of open eye injuries in geriatric patients in the Southeastern region of Anatolia. METHODS: Forty-five geriatric patients who underwent surgery for an open eye injury in our clinic between the years of 2008 and 2012 were evaluated retrospectively. Age, gender, cause and the mechanism of the trauma, visual acuity (VA), and the time between the trauma and the surgery were obtained from files and evaluated. RESULTS: The mean age of the patients was 70.4±8.2 (65-90) years. Thirty-four of the cases were male and 11 were female. The most frequent mechanism of trauma was a wood strike, while the second most common one was injury with a knife. Corneoscleral penetration was the most frequently observed trauma. The mean VA of the patients was 2.26±0.65 at admission, and was 1.53±0.99 logarithm of the minimum angle of resolution at the final evaluation. The most frequent complications of trauma were iris prolapse and hyphema. There was a significant correlation between the first and final VA. CONCLUSION: Penetrating ocular injuries are seen less frequently among geriatric patients, and their prognosis may be worse due to less-efficient wound site healing and differences in scleral rigidity. The most important factor affecting the final VA measurement was the VA of the patient at admission.

Comparison of accelerated and conventional corneal collagen cross-linking for progressive keratoconus.

PURPOSE: To compare outcomes of accelerated and conventional corneal cross-linking (CXL) for progressive keratoconus (KC). MATERIALS AND METHODS: Patients were divided into two groups as the accelerated CXL group and the conventional CXL group. The uncorrected distant visual acuity (UDVA), corrected distant visual acuity (CDVA), refraction and keratometric values were measured preoperatively and postoperatively. The data of the two groups were compared statistically. RESULTS: The mean UDVA and CDVA were better at the six month postoperative when compared with preoperative values in two groups. While change in UDVA and CDVA was statistically significant in the accelerated CXL group (p = 0.035 and p = 0.047, respectively), it did not reach statistical significance in the conventional CXL group (p = 0.184 and p = 0.113, respectively). The decrease in the mean corneal power (Km) and maximum keratometric value (Kmax) were statistically significant in both groups (p = 0.012 and 0.046, respectively in the accelerated CXL group, p = 0.012 and 0.041, respectively, in the conventional CXL group). There was no statistically significant difference in visual and refractive results between the two groups (p > 0.05). CONCLUSIONS: Refractive and visual results of the accelerated CXL method and the conventional CXL method for the treatment of KC in short time period were similar. The accelerated CXL method faster and provide high throughput of the patients.

Intraoperative corneal thickness measurements during corneal collagen cross-linking with isotonic riboflavin solution without dextran in corneal ectasia.

UNLABELLED: Abstract Objective: To monitor the changes in corneal thickness during the corneal collagen cross-linking procedure by using isotonic riboflavin solution without dextran in ectatic corneal diseases. MATERIALS AND METHODS: The corneal thickness measurements were obtained before epithelial removal, after epithelial removal, following the instillation of isotonic riboflavin solution without dextran for 30 min, and after 10 min of ultraviolet A irradiation. RESULTS: Eleven eyes of eleven patients with progressive keratoconus (n = 10) and iatrogenic corneal ectasia (n = 1) were included in this study. The mean thinnest pachymetric measurements were 391.82 ± 30.34 µm (320-434 µm) after de-epithelialization of the cornea, 435 ± 21.17 µm (402-472 µm) following 30 min instillation of isotonic riboflavin solution without dextran and 431.73 ± 20.64 µm (387-461 µm) following 10 min of ultraviolet A irradiation to the cornea. CONCLUSION: Performing corneal cross-linking procedure with isotonic riboflavin solution without dextran might not induce corneal thinning but a little swelling throughout the procedure.

Accelerated corneal collagen cross-linking for progressive keratoconus.

PURPOSE: To evaluate the efficacy of accelerated corneal cross-linking (CXL) procedure for progressive keratoconus. MATERIALS AND METHODS: Twenty-three eyes of 23 patients undergone accelerated CXL procedure were evaluated preoperatively and postoperatively at 1st, 3rd and 6th month for uncorrected distant visual acuity (UDVA), best corrected distant visual acuity (CDVA), spherical error, cylindrical error, spherical equivalent (SE), keratometric values and thinnest corneal thickness (TCT) values with corneal topography by Scheimpflug camera and endothelial cell density (ECD). RESULTS: The mean UDVA was improved from 0.97 ± 0.41 logarithm of minimal angle of resolution (logMAR) to 0.76 ± 0.45 logMAR at the 6th month after CXL (p = 0.332). The mean CDVA was improved from 0.49 ± 0.30 logMAR to 0.34 ± 0.22 logMAR at the 6th month after CXL (p = 0.026). The mean sphere was decreased from -4.47 ± 4.1 diopter (D) to -3.79 ± 3.86 D and the mean cylinder was decreased from -5.60 ± 2.2 D to -4.55 ± 1.98 D and the mean SE was decreased from -7.22 ± 4.48 D to -6.36 ± 4.34 D at the 6th month after CXL (p = 0.128, p = 0.002 and p = 0.045, respectively). Flat keratometry, steep keratometry, mean keratometry and maximum keratometry were significantly reduced at the 6th month after CXL (p = 0.025, p < 0.001, p = 0.004 and p = 0.03, respectively). TCT and ECD were not changed significantly the 6th month after CXL (p = 0.135 and p = 0.082, respectively). CONCLUSION: Accelerated CXL procedure was effective to stabilize progression of keratoconus with significant reduction in topographic keratometric values and significant increase in CDVA in 6 months.

Transient corneal endothelial changes following accelerated collagen cross-linking for the treatment of progressive keratoconus.

PURPOSE: To evaluate the corneal endothelial changes following accelerated collagen cross-linking (CXL) for the treatment of progressive keratoconus. METHODS: Thirty-six consecutive progressive keratoconus patients who received accelerated CXL treatment were enrolled in the study. Following de-epithelization, isoosmolar 0.1% riboflavin solution without dextran was instilled every 3 min throughout the 30 min of soaking time before the 5 min of 18 mW/cm(2) UVA irradiation and every 2 min during the UVA irradiation. Corneal specular microscopy was performed on both treated and fellow eyes of each patient preoperatively, in the first week, and in the first, third and sixth month postoperatively. RESULTS: There were significant differences in endothelial cell density (ECD), percentages of hexagonality (6A) and coefficient of variation of endothelial cell area (CV) in the first week and first month postoperatively in the treated eyes when compared to their preoperative values and also to the first week and first month ECD, 6A and CV values of the non-operative eyes. ECD returned to the preoperative values at sixth month whereas 6A and CV returned to the preoperative values at third month. CONCLUSION: Our results suggested that there may be transient changes in human corneal endothelium following accelerated UVA/riboflavin CXL. Resolution of these changes during the follow-up may indicate a safe recovery. However, the treatment guidelines for accelerated CXL including irradiance level and soaking time should be clearly established to minimize the toxic effects of the treatment.

Topical and subconjunctival ranibizumab (lucentis) for corneal neovascularization in experimental rat model.

PURPOSE: To compare the effectiveness of the topical and subconjunctival (SC) ranibizumab treatment in experimental corneal neovascularization (NV) model in rats. METHODS: A model of NV was generated by cauterizing right corneas of 30 Sprague-Dawley rats with silver nitrate. The animals were separated into five groups randomly. first group (control group) received topical artificial tear drops two times daily while second and third groups received topical ranibizumab four times daily at concentrations of 5 mg/mL and 10 mg/mL, respectively. Forth and fifth groups were given 0.5 mg/0.05 mL and 1 mg/0.1 mL of SC ranibizumab in the 1st, 3rd and 7th days. The measurements (percentage of NV area and number of vessels) from digital photographs of the corneas were determined and analyzed using analysis software (ImageJ, v1.38). The animals were sacrificed on the 10th day and their corneas were subjected to hemotoxylin-eosin histopathological staining and antisera against CD34 and von-Willebrand factor to evaluate microvascular structures immunohistochemically. RESULTS: The percentage of the corneal NV area and number of vessels in all treatment groups was found to be significantly lower than the control group. There was no significant difference in relation to the percentage of NV area and number of vessels in the treatment groups. Score of the corneal edema was determined to be significantly less in the groups that undertook treatment. Number of vessels and inflammatory cells were significantly lower in the histological and immunohistochemical sections in the treated groups than in the control group. In all treatment groups, fibroblast intensity was significantly lower than the control group (p = 0.005). CONCLUSION: Topical or SC administration of ranibizumab seems to be a promising and effective medication in the treatment of corneal NV. Further research is recommended to assess the potential side effects and effective dose.

Congenital bilateral upper eyelid eversion: report of a case.

Congenital bilateral upper eyelid eversion is a rare condition and the definite cause is not known. It is often seen in Black babies or babies with Down's syndrome. With early diagnosis and appropriate treatment, the condition can be managed without surgery. We report a case of congenital upper eyelid eversion in an otherwise healthy Caucasian neonate, born by normal vaginal delivery. The case responded well to conservative treatment, including eyelid repositioning, lubricants, antibiotic ointment, and eyelid patching.

Mean platelet volume in ocular Behçet's disease.

OBJECTIVE: To determine whether mean platelet volume (MPV) is an indicator of disease severity in ocular Behçet's Disease (BD). MATERIALS AND METHODS: The study population was 30 newly diagnosed ocular BD patients who presented with active uveitis. These patients had no past history of smoking, drug use, or systemic diseases including diabetes mellitus, hypertension, cardiovascular disease, and renal disease. A control group consisting of 34 healthy individuals was included for comparison. MPV measurements were performed serially upon presentation with active uveitis and at one and three month thereafter in BD group whereas only at presentation in the controls. RESULTS: Upon presentation with active uveitis, the mean MPV levels were 7.88 ± 1.14 femtoliters (fL) for BD group. During the posttreatment follow-up period at first and third months, BD patients demonstrated a mean MPV level of 7.71 ± 1.12 fL and 7.65 ± 1.04 fL, respectively. The mean MPV value of control group, was 8.39 ± 0.66 fL at presentation. Fluctuations in MPV values were not significant in the BD group, while there was a significant difference between the initial measurements of the BD and control groups. CONCLUSION: MPV measurement in ocular BD is not a predictive laboratory test to determine the clinical improvement in early stages following classical immunosuppressive treatment.

Evaluation of cystoid macular edema using optical coherence tomography and fundus autofluorescence after uncomplicated phacoemulsification surgery.

Aim. To investigate the utility of fundus autofluorescence (FAF) and optical coherence tomography (OCT) in the evaluation of cystoid macular edema (CME) following cataract surgery. Materials and Methods. Forty eyes of 29 patients undergone phacoemulsification, with posterior chamber intraocular lens implantation surgery. Central macular thickness (CMT) of the patients was evaluated using OCT and FAF preoperatively and postoperative 1st, 30th, 60th, 90th, and 180th days. Results. CME was detected in three eyes (7.5%) of two patients using OCT. Hyperautofluorescence (HAF) was detected in two of these three eyes and resolved with treatment. In the remaining 37 eyes without CME, there was a significant increase in visual acuity when compared to preoperative values (P = 0.008) Mean macular thicknesses (MMT) of the eyes without CME were 174 ± 20 µ m preoperatively and 179 ± 22 µ m at day 1, 178 ± 19 µ m at 1st month, and 168 ± 10 µ m at 6th month postoperatively. In the eyes with CME, the MMTs, measured with OCT were 189 ± 23 µ m preoperatively and 432 ± 361 on day 1, 343 ± 123 µ m at 1st month, 345 ± 196 at 2nd month, and 200 ± 36 µ m at 6th month postoperatively. Conclusion. We found a moderate increase in CMT in the first 3 months postoperatively, in the eyes without CME which did not cause visual disturbances. FAF is a noninvasive, rapid method for the evaluation and follow-up of CME following cataract surgery.

Secondary glaucoma after pediatric cataract surgery.

AIM: To determine the incidence and risk factors of secondary glaucoma after pediatric cataract surgery. METHODS: Two hundred and forty nine eyes of 148 patients underwent cataract surgery without intraocular lens (IOL) implantation (group 1), and 220 eyes of 129 patients underwent cataract surgery with IOL implantation (group 2) retrospectively, were evaluated between 2000 and 2011. The outcome measure was the presence or absence of post-cataract surgery glaucoma, defined as an intraocular pressure (IOP) ≥26mmHg, as measured on at least two occasions along with corneal or optic nerve changes. RESULTS: The mean follow-up periods of group 1 and 2 were (60.86±30.95) months (12-123 months) and (62.11±31.29) months (14-115 months) respectively. In group 1, 12 eyes of 8 patients (4.8%) developed glaucoma. None of the patients developed glaucoma after surgery in group 2. The mean age of the patients at the cataract surgery was (2.58±0.90) months (1 month-4 months) and the average period for glaucoma development after surgery was (9.50±4.33) months (4-16 months) in group 1. Three of the 12 glaucomatous eyes were controlled with antiglaucomatous medication and 9 eyes underwent trabeculectomy+mitomycin C surgery. One patient underwent a second trabeculectomy + mitomycin C operation for both of his eyes. CONCLUSION: The incidence of glaucoma after pediatric cataract surgery is very low in patients in whom IOL is implanted. The aphakic eyes after pediatric cataract surgery are at an increased risk for glaucoma development particularly if they underwent surgery before 4 months of age.

Intravitreal bevacizumab monotherapy for retinopathy of prematurity.

BACKGROUND: The aim of this study was to evaluate the treatment outcomes of intravitreal bevacizumab (IVB) injections, used as a monotherapy in type 1 retinopathy of prematurity (ROP). METHODS: A retrospective chart review was performed for 17 type 1 ROP patients (34 eyes), who had IVB injection between July 2011 and June 2012. Birthweight, gestational age at birth, stage and location of ROP, IVB injection time, time of complete retinal vascularization, and additional treatments if needed, were noted. A total of 0.625 mg (0.025 mL) bevacizumab was injected intravitreally. RESULTS: Thirty eyes of 17 patients with type 1 ROP enrolled in the study were treated with IVB injection. Of them seven had aggressive posterior-ROP, six had stage 2 ROP, and four had stage 3 ROP. The mean gestational age was 28.44 weeks (range, 26-31 weeks); and the mean birthweight was 1151.88 g (range, 600-1600 g). The mean age for IVB injection was 35.47 weeks. The mean full retinal vascularization time was 136.6 ± 26.6 days. The mean follow-up time was 285.3 ± 70 days. ROP was regressed and retinal vascularization was completed in all cases except one eye, which had threshold disease. CONCLUSION: IVB injection, used as a monotherapy, is an effective treatment approach in patients with type 1 ROP. Timely treatment of stage 2 and early stage 3 ROP in which disease progression was observed, prevents vitreoretinal membrane formation in posterior disease. Further studies need to be performed to determine the safety of IVB injection.

Effects of hyperbaric oxygen on crystalline lens and retina in nicotine-exposed rats.

OBJECTIVE: To determine histopathological changes on crystalline lens and retina of rats after subcutaneous injection of nicotine and to examine the effects of hyperbaric oxygen (HBO) on these changes related to nicotine exposure. METHODS: Twenty-eight female Sprague-Dawley rats were enrolled in the study and the rats were divided into four equal sized groups randomly (Group N: the rats exposed only to nicotine, group HB: the rats received only HBO, group N+HB: the rats that underwent to nicotine injection and subsequently received HBO, group C: the control group that neither exposed to nicotine nor received HBO). The rats were sacrificed by decapitation method and all were enucleated immediately after scarification. Tissue samples from crystalline lens, lens capsule, and the retina from the right eyes of the rats were examined by light microscopy. RESULTS: While the histological appearances of the retina and the lens was similar in group HB, group N+HB, and the control group; group N showed some pathological changes like decrement in the retinal ganglion cell density, atrophy of the retinal nerve fiber layer, congestion of the vessels in the optic nerve head, thinning of the internal plexiform layer, thinning of the lens capsule, and transformation of the anterior subcapsular epithelium into squamous epithelia. DISCUSSION: Subcutaneous injection of nicotine was found to be related with some pathological changes in the retina and lens of the Sprague-Dawley rats. However HBO caused no significant negative effect. Furthermore, the histopathological changes related to nicotine exposure in the lens and retina of the rats recovered by the application of HBO.

Effect of low molecular weight heparin (enoxaparin) on congenital cataract surgery.

AIM: To assess the efficacy of intracameral enoxaparin (a low-molecular-weight heparin) infusion, in variable doses on postoperative inflammatory response in congenital cataract surgery. METHODS: It is a prospective, randomized controlled trial. Eighty eyes of 53 children with congenital cataract were enrolled in this study. Every eye had primary posterior capsulorrhexis and intraocular lens (IOL) implantation after lens aspiration. The eyes were divided into 4 equal groups. In group 1 balanced salt solution (BSS) without enoxaparin was used as an irrigation solution. Whereas in group 2, 3 and 4, 40mg, 20mg and 10mg enoxaparin in 500mL BSS was used respectively. The inflammatory response in the anterior chamber was compared among the groups with slit-lamp biomicroscopy. RESULTS: The mean follow-up period was (17.75±3.95) months in group 1, (18.00±5.15) months in group 2, (19.20±5.47) months in group 3 and (18.65±5.16) months in group 4. Mean number of inflammatory cells in the anterior chamber in group 1 was significantly higher than that of group 2, 3, 4 (P<0.001). There was fibrin formation in the anterior chambers of 3 eyes in group 1 and one eye in group 4. There was synechiae formation in 3 eyes of group 1 and one eye of group 4. There was no significant difference among the groups by means of fibrin or synechiae formation (P>0.05). There were IOL precipitates in 4 eyes of group 1 and 2 eyes of group 4. IOL precipitate formation was significantly higher in group 1 than that of group 2 and 3 in which there was no IOL precipitate (P=0.048). There was IOL subluxation in only one eye of group 1, 3 and 4 while no subluxation was observed in group 2 (P>0.05). There was no statistically significant difference detected about IOL subluxation occurance in all 4 groups (P>0.05). CONCLUSION: Complications of cataract surgery in congenital cataract patients associated with postoperative inflammatory response found to be decreased with the use of enoxaparin in intraocular infusion solutions. Furthermore according to our results the anti-inflammatory effect of enoxaparin was dose dependant.

The effects of Nd:YAG laser posterior capsulotomy on macular thickness, intraocular pressure, and visual acuity.

BACKGROUND AND OBJECTIVE: To evaluate how different energy levels of Nd:YAG laser posterior capsulotomy affect best-corrected visual acuity (BCVA), intraocular pressure (IOP), and macular thickness of patients with posterior capsule opacification. PATIENTS AND METHODS: Thirty eyes of 30 patients with posterior capsule opacification following phacoemulsification were enrolled in the study. Patients were classified according to total energy used during Nd:YAG laser capsulotomy (≤ 80 mJ = group I, > 80 mJ = group II). RESULTS: Mean total energy levels were 58 ± 18 mJ (range: 14 to 80 mJ) in group I and 117 ± 36 mJ (range: 84 to 200 mJ) in group II. BCVA at 1 week preoperatively and 1 and 3 months postoperatively was significantly better compared to preoperative BCVA in both groups (P < .001). In group I, IOP increased 1 week postoperatively (P = .007) and declined to preoperative levels at 1 month. In group II, IOP increased 1 week postoperatively (P = .001) and did not return to preoperative levels during 3 months of follow-up (P = .04). Both groups had increased macular thickness compared to preoperative levels, but group II measurements were significantly higher 1 week and 1 month postoperatively compared to group I (P = .004 and .03, respectively). CONCLUSION: Increased IOP and macular thickness are inevitable after Nd:YAG laser capsulotomy, but the severity and duration are less when a total energy level less than 80 mJ is used.

Myositic type of idiopathic orbital pseudotumor in a 4-year-old child: a case report.

Idiopathic orbital pseudotumor is a benign, noninfectious, and nonneoplastic disease with unknown cause. It is the third most common orbital disease after thyroid orbitopathy and lymphoproliferative disorder. Idiopathic orbital pseudotumor is extremely rare in pediatric age group and may cause real diagnostic problems. This paper describes a 4-year-old girl who presented with sudden ptosis in the right eye and swollen eyelid. She recovered completely with high-dose steroid therapy. We report clinical and magnetic resonance imaging findings of orbital myositis, which is a rare subtype of idiopathic orbital pseudotumor in children and needs to be differentiated from other orbital disease especially malignancy.

The effect of I-gel ™ airway on intraocular pressure in pediatric patients who received sevoflurane or desflurane during strabismus surgery.

OBJECTIVES: The aim of this study was to investigate the effect of I-gel(TM) laryngeal mask airway on intraocular pressure (IOP) in children with strabismus undergoing balanced anesthesia with sevoflurane or desflurane. METHODS: Forty-seven children, ASA physical status I, were scheduled for elective strabismus surgery. Patients were randomly assigned to one of the two inhalation anesthetic groups. Sevoflurane group comprised of 27 children, and desflurane group comprised of 20 children. Anesthesia was induced and maintained with sevoflurane or desflurane. No muscle relaxant was used. IOPs were measured before anesthesia, at 2 and 5 min after insertion of I-gel(TM) and after removal of I-gel(TM) . IOP measurements were obtained by Tonopen(®). RESULTS: Intraocular pressure significantly decreased 2 min after insertion of I-gel(TM) in both sevoflurane and desflurane groups (P < 0.001). Measurements 5 min after I-gel(TM) insertion were also significantly lower than those of before insertion in both groups (P < 0.01). However, no significant differences were found between the preoperative measurement and the measurement after removal of I-gel(TM) within two groups (P = 0.072 and P = 0.547, respectively). No significant differences were found in all IOP measurements between sevoflurane and desflurane groups. CONCLUSION: Insertion of I-gel(TM) laryngeal mask airway with giving sevoflurane or desflurane inhalation anesthetics seemed not to cause any increase in IOPs in pediatric ophthalmic surgery.

Toxic anterior segment syndrome subsequent to pediatric cataract surgery.

OBJECTIVE: The aim of this study was to investigate possible risk factors and treatment outcomes for the development of toxic anterior segment syndrome (TASS) subsequent to pediatric cataract surgery. MATERIALS AND METHODS: Totally 893 eyes of 534 patients who underwent pediatric cataract surgery were evaluated retrospectively from the point of TASS development between 2006 and 2011. TASS was observed in 19 eyes of 13 patients. Properties of surgical materials used for these patients, postoperative symptoms and their initiation time, therapeutic approaches and results were evaluated. RESULTS: Lens aspiration, posterior capsulotomy and anterior vitrectomy was performed for 480 eyes and TASS developed in 12 eyes. However, TASS was observed in seven eyes of 413 eyes that underwent lens aspiration, posterior capsulotomy, anterior vitrectomy and intraocular lens (IOL) implantation. The factors that may cause TASS were evaluated. Materials used in surgery (intraocular irrigation fluids, viscoelastic materials, intracameral medications etc.) were the same, in all cases. But in all TASS cases, it has been noticed that ethylene oxide-sterilized vitrectomy packs were used for anterior vitrectomy. After the abolition of use of this material, we didn't see new TASS cases. Clinical improvement was achieved by treatment with 0.1% dexamethasone, 0.3% ofloxasin and 5% NaCl in 18 eyes with TASS at mean duration of 6.4 ± 4.7 (range, 2-16) weeks. Penetrating keratoplasty was performed to one eye of a patient with bilateral TASS due to unresponsiveness to medical management. CONCLUSION: Use of ethylene oxide-sterilized vitrectomy packs in pediatric cataract surgery is an important risk factor for the development of TASS. Although the majority of the patients with TASS after pediatric cataract surgery recover with medical therapy, a few cases may need penetrating keratoplasty due to irreversible corneal decompensation.