Clinical Characteristics and Surgical Outcomes of Turkish Patients With Pediatric Glaucoma Who Underwent Glaucoma Surgery in a University Hospital.

PURPOSE: To describe the clinical characteristics and outcomes of a pediatric cohort surgically treated for primary or secondary pediatric glaucoma (PPG/SPG). METHODS: A retrospective chart review was conducted of all patients with pediatric glaucoma who had surgery between 2013 and 2021. Relevant demographic and clinical data were cumulated and analyzed. RESULTS: Forty-two eyes of 29 patients (18 girls and 11 boys) were included: 22 (52.4%) primary congenital glaucoma (PCG), 7 (16.7%) juvenile open-angle glaucoma, and 13 (30.9%) SPG. Mean ages at presentation were 2.57 ± 2.87, 131.96 ± 27.71, and 62.09 ± 65.12 months, respectively. In this study, eyes with PCG presented the earliest, with the highest intraocular pressure (IOP) and thickest central corneal thickness (CCT). The mean number of glaucoma surgeries was 1.48 ± 0.71, with 38.1% of the eyes needing two or more glaucoma surgeries; trabeculectomy was the most frequent glaucoma surgery in this cohort. After surgical intervention, the overall mean IOP dropped from 32.25 ± 12.97 to 18.10 ± 9.23 mm Hg (P < .001). Moreover, the percentage using antiglaucoma medications decreased from 100% to 35.7% at the final visit, as did the number of medications prescribed per eye (2.69 ± 0.92 vs 1.05 ± 1.46, P ≤ .001). Mean best corrected visual acuity (BCVA), in patients who could have their BCVA measured, improved from 0.61 ± 0.61 to 0.53 ± 0.51 logMAR at final follow-up. CONCLUSIONS: Surgical intervention was shown to provide a well-controlled IOP, decrease dependance on glaucoma medications, and improve BCVA in both PPG and SPG. Multiple surgical interventions may be necessary in the treatment of some pediatric patients with glaucoma. Prognostically, thicker CCT was significantly associated with worse IOP control, more glaucoma surgeries, and more antiglaucoma medications at the final visit. Initial BCVA correlated significantly with BCVA at the final visit. [J Pediatr Ophthalmol Strabismus. 2024;61(3):188-197.].

Intraocular foreign body in the anterior chamber angle misdiagnosed as herpetic stromal keratitis.

We report a case of a metallic intraocular foreign body (IOFB) retained in the anterior chamber (AC) angle that was masquerading as herpetic stromal keratitis. A 41-year-old male construction worker was referred to our ophthalmology clinic with the complaint of consistent blurred vision for 3 days in his left eye. He had no history of ocular trauma. The best-corrected visual acuity was found to be 10/10 in the right eye and 8/10 in the left eye. On slit-lamp examination of the anterior segment, the right eye was normal, while the left eye showed unilateral corneal edema and scarring, anterior lens capsule opacification, +2 cells in the AC, and the Seidel test was negative. Fundus examination was normal bilaterally. Despite there not being history of it, we still suspected ocular trauma considering the patient's occupational risk. Consequently, an orbital computed tomography imaging was performed which revealed a metallic-IOFB in the inferior iridocorneal angle. On the second follow-up day, the corneal edema regressed, and a gonioscopic examination of the affected eye was performed, showing a small foreign body embedded in the inferior iridocorneal angle of the AC. Subsequently, the IOFB was surgically removed using Barkan lens, and excellent visual results were achieved. This case emphasizes the importance of considering IOFB in the differential diagnosis of patients with unilateral corneal edema and anterior lens capsule opacification. Fur-thermore, the presence of IOFB should be definitely excluded in patients with occupational risk of ocular trauma even if there is no history of trauma. More awareness about the proper use of eye protection should be raised to circumvent penetrating ocular-trauma.

Metastatic sigmoid adenocarcinoma to the larynx: A case report and updated literature review.

Metastatic laryngeal cancer is a rare entity, usually indicating an advanced disease once discovered. In this report, we are describing a case of a 60-year-old male patient with stage IV colorectal cancer (CRC), who presented to our clinic with dysphonia; further workups showed metastatic CRC.

A new method for quantification of frontal retrusion and complex skull shape in metopic craniosynostosis: a pilot study of a new outcome measure for endoscopic strip craniectomy.

OBJECTIVE: The objective of this study was to propose a new skull outline-based method to objectively quantify complex 3D skull shapes and frontal and supraorbital retrusion in metopic craniosynostosis using 3D photogrammetry. METHODS: A standard section from 3D photogrammetry, which represents the trigonocephalic shape, was used in this study. From the midpoint of the area of this section, half diagonals were calculated to the skull outline at 5° increments in the anterior half of the head. These half diagonals were used to create a sinusoidal curve, and the area under the sinusoidal curve (AUC) was used to represent the mathematical expression of the trigonocephalic head shape. The AUC from 0° to 180° (90° from the midline to each side) was calculated and is referred to as AUC0→180. The AUC from 60° to 120° (30° from the midline to each side) was also calculated and is referred to as AUC60→120. A total of 24 patients who underwent endoscopic strip craniectomy and 13 age- and sex-matched controls were included in the study. The AUC values obtained in patients at different time points and controls were analyzed. RESULTS: The mean preoperative AUC60→120 and AUC0→180 in the patients were significantly lower than those in control individuals. The increase in both AUC60→120 and AUC0→180 values is statistically significant at the discontinuation of helmet therapy and at final follow-up. Receiver operating characteristic curve analysis indicated that AUC60→120 is a more accurate classifier than AUC0→180. CONCLUSIONS: The proposed method objectively quantifies complex head shape and frontal retrusion in patients with metopic craniosynostosis and provides a quantitative measure for follow-up after surgical treatment. It avoids ionizing radiation exposure.

Modified endoscopic strip craniectomy technique for sagittal craniosynostosis: provides comparable results and avoids bony defects.

PURPOSE: This study describes a modified technique addressing bony defects and incomplete ossification after endoscopic strip craniectomy (ESC) for SC followed by postoperative helmet therapy (PHT). The study aims to delineate quantitative and qualitative outcomes of this modified ESC technique followed by PHT and discern the optimal duration of PHT following ESC. A secondary aim is to address the effects of the technique on bony defects. METHODS: Patients undergoing ESC followed by PHT between 2017 and 2021 were included. Patient sex, age at surgery, duration of surgery, red blood cell transfusion, length of hospital stay, PHT duration, cephalic index (CI) at multiple time points, and bony defect information were collected. Descriptive and correlative analysis was done. RESULTS: Thirty-one patients (25 male, 6 female) were operated in study period. Mean age at surgery was 12.81 weeks, mean duration of surgery was 57.50 min, average transfused RBC volume was 32 cc, mean length of hospital stay was 1.84 days, mean PHT duration was 33.16 weeks, and mean follow-up time was 63.42 weeks. Mean preoperative CI was 70.6, and mean CI at the end of PHT was significantly higher, being 77.1. Maximum improvement in CI (CImax) took place at week 22.97. PHT duration did not have a correlation with CI at last follow up. There were no bony defects. CONCLUSION: Modified ESC technique is effective in successful correction of sagittal craniosynostosis. CImax already takes place, while PHT is continuing, but there is no certain time point for dishelmeting. The technique avoided bony defects and incomplete ossification.

The benefit of trans-attic endoscopic control of ossicular prosthesis after cholesteatoma surgery.

OBJECTIVE: To show the efficiency of using transmastoid atticotomy (TMA) endoscopy on the outcome of ossiculoplasty in patients with cholesteatoma. TMA is often performed as part of the surgical management of patients with middle ear cholesteatoma extending to the epitympanum. TMA can also be used as an access for endoscopic view to confirm the right alignment and stability of the ossicular prosthesis because the reconstruction of the tympanic membrane will obscure the visualization of the prosthesis. METHODS: A retrospective study was done at a tertiary referral institute, including 133 ears with cholesteatoma that underwent canal wall-up tympanomastoidectomy (CWU) with ossicular reconstruction using titanium prosthesis between August 2013 and August 2015. Post packing of the ear canal and position, stability, and axis of the prosthesis were checked using endoscope positioned in the attic through TMA. A postoperative pure-tone average air-bone gap (ABG) of 20 dB or less was considered as a successful hearing result. Results are compared with historical control groups. RESULTS: Of the 133 ears, 88 patients underwent reconstruction with partial ossicular replacement prosthesis (PORP), whereas the rest (45 patients) had total ossicular replacement prosthesis (TORP). A postoperative ABG ≤ 20 dB was obtained in 77.4% of all the patients (79.5% for PORP; 73.3% for TORP). CONCLUSION: Endoscopic assessment of the ossicular prosthesis via the attic, after repositioning of the tympanomeatal flap and packing the ear canal, decreases the risk of immediate ossiculoplasty failure and improves the functional outcome after ossicular chain reconstruction in cholesteatoma surgery. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:2754-2759, 2019.

Tympanoplasty in adhesive otitis media: A descriptive study.

OBJECTIVES/HYPOTHESIS: There is no consensus among clinicians regarding the best treatment strategy for adhesive otitis media (AdOM). It is common practice to only intervene in the presence of recurrent infections or significant conductive hearing loss. In an attempt to provide evidence regarding the efficacy and safety of surgical intervention, we have analyzed the long-term outcome of tympanoplasty for AdOM . STUDY DESIGN: Prospective study. METHODS: From January 2013 to April 2014, 57 patients with AdOM (60 ears) who fit our criteria for tympanoplasty were recruited and underwent tympanoplasty using tragal cartilage combined with transtympanic ventilation tube and cortical mastoidectomy. Otorrhea control, graft uptake, hearing level changes, and complications were evaluated within a 3-year period of follow-up. RESULTS: Otorrhea was controlled in 94% of the ears. Tympanic membrane healing was achieved in all ears except one ear, which had myringitis. Overall there was significant improvement in hearing. Whereas the mean preoperative air-bone gap (ABG) was 30.4 ± 4.0 dB, postoperative mean ABG was 8.6 ± 6.9 dB at 1 year. Closure of ABG to within 20 dB was achieved in 46 ears (83.6%). One ear showed a drop in bone conduction level by 25 dB. No iatrogenic cholesteatoma was detected in any of the cases. CONCLUSION: This study demonstrated that tympanoplasty has favorable outcomes in AdOM . Risks of iatrogenic sensorineural hearing loss or cholesteatoma formation are negligible. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:2804-2810, 2016.

Oropharyngeal trauma mimicking a first branchial cleft anomaly.

We present a unique and challenging case of a remnant foreign body that presented to us in a child disguised as a strongly suspected congenital branchial cleft anomaly. This case entailed oropharyngeal trauma, with a delayed presentation as a retroauricular cyst accompanied by otorrhea that mimicked the classic presentation of an infected first branchial cleft anomaly. During surgical excision of the presumed branchial anomaly, a large wooden stick was found in the tract. The diagnostic and therapeutic obstacles in the management of such cases are highlighted. In addition to exploring the existing literature, we retrospectively analyzed a plausible explanation of the findings of this case. Laryngoscope, 126:E224-E226, 2016.