Evaluation of the intraocular pressure in obese adolescents.

AIM: The aim of this study was to evaluate the intraocular pressure (IOP) levels of children with normal and high Body Mass Index (BMI) and to find out the potential correlation between glaucoma and obesity. METHODS: Thirty obese and thirty healty children were enrolled in this study. Physical examinations and anthropometric measurements of all patients and controls were performed. Obesity was defined as a BMI exceeding the 95th percentile for the patients according to age and sex. All participants were underwent a complete eye examination. The results of these measurements were considered for statistical analysis. RESULTS: Mean age was 13.5±2.1 years in obese group and 13.3±2.0 years in control group. Mean BMIs were 28.1±3.9 kg/m2 and 19.7±1.2 kg/m2 in obese and control groups, respectively. No significant difference was found in mean IOP levels of both right and left eyes between two groups (P=0.837 and P=0.755, respectively). There was no significant difference in cup/disc ratios of each eyes and mean central corneal thickness of both right and left eyes between obese patients and controls. In visual field analysis, no statistically significant difference in mean false negativeness and mean false positiveness were found between two groups. There were not also any significant correlations in both mean deviation of each eyes (P=0.78 and P=0.94, respectively) and pattern standart deviation of right and left eyes (P=0.89 and P=0.90, respectively) between obese cases and controls. CONCLUSION: In this study, there were no significant difference in IOP measurements, central corneal thicknesses, cup/disc ratios and visual field parameters between obese and normal children. No significant correlation was found between obesity and glaucoma or elevated IOP in children.

Role of OCTA in the prognosis of dry-type AMD.

OBJECTIVE: This study aimed to determine the prognostic value of Optical Coherence Tomography Angiography (OCTA) in dry-type age-related macular degeneration (AMD). PATIENTS AND METHODS: Thirty-five eyes of 25 patients with dry-type AMD were included in the study. All patients underwent a complete ophthalmological examination. First and last foveal avascular zone (FAZ), foveal density (FD), FAZ perimeter, non-flow area (NFA), foveal (F)-parafoveal-perifoveal superficial and deep capillary plexus (SCP-DCP) vessel density (VD) OCTA measurements were recorded. Foveal thickness (FT), macular volume (MV), and choroidal thickness (CT) measurements with enhanced depth imaging (EDI) mode were made with Optical Coherence Tomography (OCT). The relationship of all parameters with the best corrected visual acuity (BCVA-logmar) was evaluated. A p-value <0.05 was considered statistically significant. RESULTS: The mean age of the patients was 73.3±11.8 (45-91) years. There was a statistically significant difference between the first and last BCVA, FT, and FD. While FD and BCVA increased, FT was found to decrease statistically significant (p=0.002, p=0.001, p=0.045, respectively). The correlation of BCVA with other variables at the first and last visit was examined. There was a statistically positive correlation between BCVA and FAZ, FAZ perimeter, and NFA in the first and last measurements. In the second measurement, a statistically negative correlation was found between BCVA and MV, FT, superficial FVD, superficial FT, deep FT, superficial parafoveal VD, superficial parafoveal FT, deep parafoveal FT, deep parafoveal VD, and FD variables. CONCLUSIONS: There are positive and negative correlations between OCTA parameters and BCVA in the SCP-DCP in dry-type AMD. OCTA has prognostic significance in dry AMD.

[Tuberculosis outbreak in 13 people in Saxony-Anhalt: indications of an infection chain by spoligotyping]. / Tuberkulose-Ausbruch bei 13 Personen in Sachsen-Anhalt: Hinweis auf die Infektkette durch Spoligotyping.

BACKGROUND: In Germany the number of new tuberculosis incidents continues to decline slightly. Cases of illnesses are often diagnosed late, due to the uncharacteristic course of tuberculosis. The success in environment investigations by health authorities in finding incidents within one infection chain depends on the compliance of patients among other factors. Tuberculosis occurs especially in groups with social disadvantages. In this population segment the identification of contact persons of a patient with infectious tuberculosis presents difficulties. Moreover, identifying the source of infection is frequently not successful. For these reasons, additional infections and sicknesses are caused. The cultural pathogen proof, including type differentiation and resistance testing, continues to be the "gold standard" in tuberculosis diagnostics and is required for the examination of outbreaks. Molecular methods for fine typification of isolated bacterial strains and their subsequent comparison constitute an important tool in the infection epidemiology investigation of incident clustering. OBJECTIVE AND METHOD: The objective of this work is the description of a tuberculosis infection chain in Saxony-Anhalt, which was discovered by means of a molecular biological method. The conservative method represents the environment investigations for the expedient selection of contact persons. The investigations always take 2 directions in the process. On the one hand, it is searched for the still unknown source of infection. On the other hand, persons are to be identified, who have been infected before the diagnosis became known. The diagnostics for contact persons includes besides the lung X-ray checkup exam, the Mendel Mantoux tuberculin skin test (THT), sputum tests and the Interferon Gamma (INF-γ) tests (IGRA). In described case, the molecular biological method of spoliogotyping was employed as additional instrument. Therein, fingerprint maps of the patients' tuberculosis strings were created and compared. Infection chains resulting from the environment investigations were thereby secured. RESULTS: We report on a tuberculosis outbreak in a district of the state of Saxony-Anhalt, which occurred in the time from June 2007 to May 2010. As result of the environment investigations, an infection chain of 13 ill patients (77% ♂, 23% ♀) was identified. In 11 cases the correlation of the infection chain was proven by spoligotyping (9 ♂, 2 ♀). 2 cases (1 ♂, 1 ♀) without verification of the pathogen cannot be attributed on basis of the epidemiological correlations.

Multicenter study of pars plana vitrectomy for optic disc pit maculopathy: MACPIT study.

PurposeTo evaluate surgical intervention with pars plana vitrectomy (PPV) for correction of optic disc pit maculopathy (ODP-M).Patients and methodsRetrospective chart review from 13 centres of 51 eyes of 50 patients with ODP-M who underwent PPV between 2002-2014. Anatomic and final best-corrected visual acuity (BCVA) outcomes were evaluated for all cases with different adjuvant techniques.ResultsThere were 23 males and 27 females with median age 25.5 (6-68) years. Preoperative median foveal thickness was 694.5 (331-1384) µm and improved to 252.5 (153-1405) µm. Median BCVA improved from 20/200 (20/20000 to 20/40) to 20/40 (20/2000 to 20/20) with 20/40 or better in 31 eyes. Complete retinal reattachment was achieved in 44 eyes (86.3%) at 7.1 (5.9) months. The good surgical outcomes were achieved in different adjuvant groups. Median follow-up was 24 (6 to 120) months.ConclusionsThese results confirm the long-term effectiveness of PPV for ODP-M. Prospective studies are needed to determine the effectiveness of any adjuvant technique in improving the success of PPV for ODP-M.

[Meningococcal carriers in high school students and possible risk factors]. / Meningokokken-Trägerstatus von Gymnasiasten und mögliche Risikofaktoren.

From August 2004 to January 2005 a cluster of 7 cases of serogroup B meningococcal disease occurred in the state of Saxony-Anhalt in the town of Sangerhausen and the surrounding area. This led to an investigation of meningococcal carriage in 816 high school students (grades 9 to 13). The students were also asked to fill out a questionnaire regarding possible risk factors for carriage. The goal of the study was the evaluation of a possibly persistently increased risk for further cases in the region. Results of the study were to be used for a comprehensive and targeted education of the public. The percentage of students found harbouring N. meningitidis in the nasopharynx in Sangerhausen (9.0 %) was not elevated compared to that found in the two control regions of Kelbra, County of Sangerhausen (8.2 %) and Jessen, County of Wittenberg (9.9 %). The serogroup B fine type responsible for the cluster (P1.7-2,16:F3-3:PorB3-24) was found only in one student each in Sangerhausen and Kelbra. Thus, there was no evidence of an increased risk for further cases at the time of the study at the end of January, 2005. This may have been due to intensive contact tracing and provision of chemoprophylaxis in Sangerhausen. Visiting a disco or bar and smoking were identified as risk factors for meningococcal carriage. However, these factors were associated with carriage only in boys but not in girls. This may be explained by sex-specific differences in physical interaction with others. Efforts to prevent further cases during clusters of meningococcal disease should consider sex-specific risk behaviour.

Pars plana vitrectomy with pars plana tube implantation in eyes with intractable glaucoma.

AIMS: Intractable glaucoma is glaucoma resistant to medical therapy and conventional surgical procedures. In this study, a planned surgical technique is discussed for controlling the increased intraocular pressure in selected cases with intractable glaucoma. METHODS: Total pars plana vitrectomy with pars plana tube implantation was performed in 17 eyes of 17 cases with intractable glaucoma. Patients with neovascular glaucoma were not included in this study. The mean age of these patients (seven men, 10 women) was 44.6 (SD 22.1) years and mean follow up period was 30.3 (15.5) months (range 4-71). Drainage implants with a disc were used in 16 cases, whereas, a tube with scleral buckle (Schocket surgery) was preferred in one case. An intraocular pressure below or equal to 20 mm Hg without any adjunctive medication or with only one type of antiglaucomatous drop was considered as an adequate operative outcome. RESULTS: 16 out of 17 eyes maintained adequate pressure control. Only three out of these 16 eyes required prophylactic antiglaucomatous medications. One patient underwent reoperation for pressure control. The most severe complications observed postoperatively were intravitreal haemorrhage (one case), choroidal detachment (one case), implant failure (one case), total retinal detachment (two cases), and corneal endothelial decompensation (five cases). CONCLUSION: Pars plana placement of drainage tube following pars plana vitrectomy should be considered as an alternative method for controlling increased intraocular pressures in selected patients with intractable glaucoma.

Tilt and decentration after primary and secondary transsclerally sutured posterior chamber intraocular lens implantation.

PURPOSE: To evaluate tilt and decentration after primary and secondary implantation of transsclerally sutured posterior chamber intraocular lenses (PC IOLs). SETTING: Dokuz Eylül University Medical School, Department of Ophthalmology, Izmir, Turkey. METHODS: Fifty-six consecutive eyes of 53 patients who had implantation of transsclerally sutured PC IOLs were prospectively included in the study. Intraocular lens tilt and decentration after primary (14 eyes) and secondary (42 eyes) implantation were compared quantitatively using Purkinje images. RESULTS: The mean IOL tilt was 6.09 degrees +/- 3.80 (SD) in all eyes, 5.71 +/- 3.41 degrees in the primary implantation group, and 6.22 +/- 3.94 degrees in the secondary implantation group. The mean IOL decentration was 0.67 +/- 0.43 mm (range 0 to 2.5 mm), 0.59 +/- 0.38 mm, and 0.69 +/- 0.45 mm, respectively. There were no statistically significant differences between the primary and secondary implantation groups in decentration or tilt. Decentration greater than 1.0 mm was present in 7 eyes (16.7%) after secondary implantation and in 1 eye (7.1%) after primary implantation. Tilting of more than 10 degrees was present in 7 eyes (16.7%) and 2 eyes (14.2%), respectively. There were no statistically significant differences between the 2 groups in decentration greater than 1.0 mm (chi square = 0.194, P =.834) or in tilting greater than 10 degrees (chi square = 0.834, P =.659). CONCLUSIONS: Clinically significant IOL tilt or decentration was rare after transscleral implantation. There were no differences in tilt or decentration between primary and secondary implantation.

Improving estimation of corneal refractive power by measuring the posterior curvature of the cornea.

We developed a formula to measure the posterior curvature of the cornea. In our study, real corneal power in 51 eyes was calculated by using anterior and posterior curvatures and corneal thickness. The corneal refractive index was found to be a variable value between 1.3243 and 1.3339 (mean 1.3304 +/- 0.0003).

Prevention of posterior capsule opacification by intraoperative single-dose pharmacologic agents.

PURPOSE: To determine whether an intraoperative single dose of dexamethasone, diclofenac, ethylenediaminetetraacetic acid (EDTA), a combination of EDTA and RGD peptide (arginine-glycin-aspartic acid sequence), or mitomycin-C (MMC) is a pharmacological means of preventing or reducing the development of posterior capsule opacification (PCO). SETTING: Department of Ophthalmology, Celal Bayar University, School of Medicine, Manisa, and Department of Pathology, Dokur Eylül University, School of Medicine, Izmir, Turkey. METHODS: Fifty-four rabbits were randomly divided into 6 groups. Dexamethasone (4 mg/cc), diclofenac (2.5 mg/cc), EDTA (8 mg/cc), a combination of EDTA and RGD peptide (2.5 mg/cc), or MMC (0.04 mg/cc) was given, 0.1 cc by hydrodissection and 0.9 cc into the capsular bag after phacoemulsification. The sixth group served as a control group. After 3 months, the PCO was graded clinically and the proliferation of lens epithelial cells (LECs) was evaluated histologically. RESULTS: The drugs were significantly effective in preventing PCO compared with the control (P <.005). Dexamethasone had a weaker effect than the other drugs. In histological analysis, although monolayer LECs in the dexamethasone and diclofenac groups were observed, there was no proliferative activity on the posterior capsules in the EDTA, EDTA+RGD, and MMC groups in contrast to the multilayer cells in the control. CONCLUSIONS: Intraoperative single-dose application of EDTA, EDTA+RGD peptide combination, and MMC significantly prevented the development of PCO in rabbit eyes. Diclofenac was less effective but also reduced PCO. Although dexamethasone did not prevent the proliferation of LECs, it decreased PCO clinically.

Management of free floating iris cysts in the anterior chamber: a case report.

PURPOSE: To present a case with free iris cysts in the anterior chamber and its management with YAG laser. CASE REPORT: A 14-year-old boy presenting with the complaint of seeing a small ball-like moving mass in his left eye. RESULTS: Slit-lamp examination revealed a pair of free-floating iris cysts located inferiorly in the anterior chamber. After YAG laser application both the cysts collapsed. CONCLUSIONS: This is the first report of a case with multiple free iris cysts in the anterior chamber. Considering the possibility of endothelial damage in the long-term, it is worth noting the favorable response to YAG laser treatment.

Unilateral Purtscher-like retinopathy after weight-lifting.

PURPOSE: To report a case of Purtscher-like retinopathy after weightlifting. METHODS: A 17-year-old man presented with a sudden visual loss in his left eye after weightlifting two weeks ago. Fundus examination of the left eye showed cotton-wool spots and scattered retinal hemorrhages in the posterior pole. Fluorescein angiography and indocyanine green angiography with a scanning laser ophthalmoscope were performed. RESULTS: Angiography showed hypofluorescent areas adjacent to the optic disc and in the posterior pole and partial filling insufficiency in the inferior and inferotemporal branch retinal veins. Complete venous filling was noted in late phases of angiography. CONCLUSIONS: The pathogenesis of weightlifting suggests the Purtscher-like changes as a result of Valsalva maneuver in our case. To our knowledge, this is the first reported case of Purtscher-like retinopathy associated with weightlifting.

Bilateral duplication of the optic canals.

During an autopsy survey of 369 human skulls, one with bilateral (0.27%) and one with unilateral (0.27%) duplication of the optic canal were reported. The anatomical findings in case of this rare anomaly are presented.

Somatostatin receptors in the orbits.

In-111 pentetreotide has been recommended for the detection of somatostatin receptor (SSR) positive tumors. Sites with increased numbers of activated lymphocytes may also show In-111 pentetreotide with Graves' ophthalmopathy (GO) compared to various other orbital disorders. Five patients with GO, three patients with necrotizing scleritis, and two patients with orbital pseudotumor were imaged at 4 hours, 24 hours, and 48 hours after injection of In-111 pentetreotide. Although planar images did not show considerable uptake, SPECT slices showed marked and persistent uptake in the orbits unilaterally in one patient, and bilaterally in three patients with GO. There was no significant correlation between the In-111 pentetreotide activity and the degree of opthalmopathy determined by Werner's classification. Pseudotumors also showed positive uptake. Early uptake was present in one patient with necrotizing scleritis because of Wegener's granulomatosis, and was completely diminished at 24 hours. Octreotide treatment in three patients with GO did not cause any clinical improvement. Although the presence of SSR, either on the infiltrated lymphocytes or on fibroblasts, implies that octreotide treatment for GO can be considered, the results are not encouraging. Nonspecific binding might be present when uptake patterns of orbits and persistence of activity during octreotide treatment are considered.

Thallium-201 uptake in the orbits.

Thallium-201 uptake patterns in the orbits are not widely known. Diffuse, bilateral orbital localization of TI-201 chloride may be an incidental finding because of orbital muscle or other soft tissue uptake. Differences in orbital blood flow and soft tissue mass may be the cause of the varying uptake intensities in most cases. Focal uptakes, even when bilateral, may indicate specific pathology and should be investigated. Sample cases are presented.

Extraocular muscle imbalance after scleral buckling.

Postoperative muscle imbalance was prospectively evaluated in 44 patients who underwent conventional scleral buckling operations. Strabismus was present in 27 of 44 patients (61%). Heterotropia resolved spontaneously during the first six postoperative months in nine of 27 patients (33%). Diplopia persisted in six patients (13.6%) and limitation of ductions occurred in 22 of 44 patients (50%). The risk of developing postoperative strabismus was 2.5 times longer if an implant was placed under a rectus muscle. Otherwise, presence, degree, and direction of the duction deficits did not correlate with placement of a local implant under the corresponding rectus muscles or their antagonists. Reoperation, preoperative detachment of macula and size of the local implant were not statistically correlated with extraocular muscle imbalance. We believe that decrease in postoperative swelling and increase in visual acuity that allows phoria adaptation are the main causes of spontaneous resolution.

Preserved human amniotic membrane transplantation in the treatment of primary pterygium.

BACKGROUND AND OBJECTIVE: To assess the outcome of simple excision with preserved human amniotic membrane transplantation in the treatment of primary pterygium. PATIENTS AND METHODS: A total of 59 eyes with primary pterygium underwent surgical excision. In Group 1, 28 eyes were treated with simple excision and preserved human amniotic membrane transplantation. In Group 2, 31 eyes were treated with bare sclera excision. These two groups were compared in recurrence, final appearance of the operation site, and complications. Patients were followed for at least 10 months. RESULTS: During a mean follow up of 14.9 months, we observed 3 (10.7%) recurrences in Group 1 and 20 (38.7%) recurrences in Group 2 (P:0.03). In Group 1, 20 (71.4%) eyes and 14 (45.2%) eyes in Group 2 had a satisfactory final operation site appearance (P:0.041). No serious complication was observed in both groups. CONCLUSION: Simple excision and preserved human amniotic membrane transplantation appears to be a safe and effective way of treating primary pterygium because of the lack of serious complications and a relatively low rate of recurrence.

Magnetic resonance imaging in the evaluation of eyes treated with silicone oil.

BACKGROUND AND OBJECTIVE: To evaluate the sensitivity of magnetic resonance imaging (MRI) in detecting retinal detachment (RD) in eyes filled with silicone oil, and to determine the MRI characteristics of silicone oil in vivo. PATIENTS AND METHODS: Seven eyes of seven patients with RD and eight eyes of eight patients without RD after silicone oil surgery were included in the study. All of the patients had clear media. MRI was performed in these patients. The results of ophthalmic examinations were compared with MRI findings. RESULTS: MRI detected six of the seven detached retinas. The multiplanar imaging capability of MRI helped in showing the RDs in various locations. The chemical shift artifact exaggerated the retinal thickness and made the detached retina visible. Fat suppressed images showed the silicone oil-corneal contact clearly. CONCLUSION: MRI is an effective technique for demonstrating RD in eyes filled with silicone oil and can be used successfully in eyes with opaque media.

Retinal breaks and rhegmatogenous retinal detachment in association with branch retinal vein occlusion.

BACKGROUND AND OBJECTIVE: To report the incidence and clinical characteristics of retinal breaks and/or rhegmatogenous retinal detachment (RRD) in patients with branch retinal vein occlusion (BRVO). PATIENTS AND METHODS: We reviewed the clinical records of 230 eyes of 214 patients with BRVO and identified eyes with retinal breaks and/or RRD. Patients had at least 6 months of follow-up. RESULTS: Seven of 230 eyes (3%) had retinal breaks and 3 eyes (1.3%) had RRD. One of the eyes with RRD had subclinical retinal detachment. All 7 eyes had ischemic disease documented by fluorescein angiography. Two of 7 eyes had concurrent retinal neovascularization. Four eyes with breaks, but without RRD, and the eye with subclinical RRD were managed by argon green laser. Two eyes with RRD were managed successfully with scleral buckling surgery and postoperative supplemental argon green laser. The mean follow-up period was 14.8 +/- 8.3 months. CONCLUSIONS: Patients with BRVO should be monitored closely for possible retinal break formation and RRD development.