Should Ocular Hemorrhage Screening be Conducted in Newborns with Acidosis?

OBJECTIVE: Ocular hemorrhages (OHs) may cause visual disturbances and incidence vary from 18 to 39% in newborns. Precipitated/instrumental delivery and perinatal asphyxia were predefined risk factors. Acidosis can interfere with coagulation and disrupt the pressure of ocular capillaries and put infants with moderate acidosis with or without hypoxic-ischemic encephalopathy at risk for OH. We aimed to evaluate the OH in neonates with fetal acidosis. STUDY DESIGN: Neonates >34 weeks are included if pH < 7.10 and BE < -12 mmol/L within the first hour. Ophthalmologic examinations for retinal (RH), vitreous, and anterior chamber (hyphema) hemorrhage were done within the third day. RH was staged according to Egge's classification. Follow-up of the patients was continued until the age of 2. Clinical characteristics of newborns were analyzed. RESULTS: Sixty-two neonates (38 ± 2.3 weeks, 2,971 ± 612 g) were included. pH = 6.91 ± 0.16, BE = - 17.2 ± 5.3 mmol/L. OH was found in 22 (36.7%) neonates (hyphema n = 2, vitreous n = 2, RH n = 21). Thirty-eight eyes with RH were staged (Stage 3: n = 15 [39.5%]; Stage 2: n =11 [28.9%]; Stage 1: n = 12 [31.6%]). Vaginal delivery (OR: 4.9, 95% CI [1.4-17.8]) and advanced resuscitation at the delivery room (OR: 8.8; 95% CI [1.9-41.7]) were found to increase the risk of RH. CONCLUSION: Approximately one-third of neonates with moderate to severe acidosis exhibited RH when examined on the third day. Contrary to previous studies that reported mild RH in otherwise healthy neonates, our findings revealed that neonates with moderate to severe acidosis predominantly presented with Stage 3 RH. While the higher incidence of RH in vaginally delivered infants is consistent with previous studies, the identification of advanced resuscitation as a risk factor is a new addition to the literature. The findings in our study highlight the importance of retinal examination in neonates with acidosis in the presence of intubation during resuscitation. KEY POINTS: · One-third of neonates with moderate to severe acidosis exhibited RH.. · Stage 3 RH was identified as the most prevalent.. · Advanced resuscitation was identified as an independent risk factor for RH..

Development of myopia in laser-treated ROP infants: prematurity or laser photocoagulation?

PURPOSE: To investigate the relationship between the development of corrected 1-year-old refraction values and risk factors in preterm infants who underwent laser photocoagulation (LPC) therapy for retinopathy of prematurity (ROP). METHODS: The ophthalmic examination findings of preterm neonates who had developed Type I ROP and received LPC therapy were evaluated retrospectively. The association between spherical equivalent (SE) values and clinical findings were analyzed by using multivariable linear regression analysis. RESULTS: The study included 157 eyes of 80 neonates with a mean birth week of 27.1 ± 2.2 weeks (23 to 32 weeks) and a mean birth weight of 995 ± 273 g (565 to 1760 g). The treatments were administered on an average of 36.8 ± 2.7 (32 to 45 weeks) postmenstrual age. LPC treatment was applied bilaterally to 77 of the 80 neonates included in the study, and unilaterally to 3 of them. The mean ± standard deviation of the SE value was 0.31 ± 1.89 diopters (D) (- 8.00 to 4.63 D) according to the results of the 1-year corrected age refraction examination. In univariate analysis, no significant association between GA, BW, and ROP zone and SE value, while the number of laser spots (ß = - 0.27 ± 0.00 D, p = 0.00) and stage 3 ROP (ß = - 0.29 ± 0.37 D, p = 0.00) were significantly associated with the SE value. In multivariable linear regression analysis, a significant association between number of laser spot, stage 3 ROP and SE value (ß = - 0.25 ± 0.00 D, p = 0.01 for number of laser spot, ß = - 0.28 ± 0.36 D, p = 0.00 for stage 3 ROP). CONCLUSION: In conclusion, this study supports that stage of ROP and the number of laser spots count applied in photocoagulation treatment for ROP is significantly correlated with degree of myopia (p < 0.05).

One-year refractive outcomes after intravitreal bevacizumab versus laser photocoagulation for retinopathy of prematurity.

PURPOSE: To investigate the effects of laser photocoagulation (LPC) and intravitreal bevacizumab (IVB) therapy used in the treatment of retinopathy of prematurity (ROP) on the first age refraction values in our center. METHODS: The preterm infants who received LPC (Group I) and IVB therapy (Group II) for ROP were evaluated, and the refraction results were retrospectively compared. RESULTS: The study included 86 eyes of 45 infants with a mean birth week of 26.5 ± 2.1 weeks and a mean birth weight of 904 ± 223 g. Treatments were administered up to a mean PMA of 36.0 ± 2.4 and 35.3 ± 2.6 weeks in Group I and Group II, respectively. In the follow-up examinations, 1-year spherical, cylindrical, and spherical equivalent (SE) values were 0.1 ± 2.2 D, - 1.2 ± 0.9 D, and - 0.5 ± 2.0 D in Group I and 1.3 ± 1.7 D, - 1.1 ± 0.8 D, and 0.8 ± 1.7 D in Group II, respectively (P = 0.018 for spherical; P = 0.772 for cylindrical, and P = 0.009 for SE). The mean spherical power and SE were significantly higher in Group II for zone II disease (p = 0.005 and p = 0.002). In addition, according to the ROP stage, infants with Stage 3 ROP were found to be significantly more myopic than infants in Stage 2 ROP in Group I (p = 0.03). CONCLUSION: In conclusion, this study supports that even 0.625 mg IVB for ROP causes less myopia compared to LPC. Consistent with the literature, it was observed that the stage and zone of ROP had a significant effect on the development of myopia.

Effect of Topical Anesthesia on Reducing Pain Associated with Mydriatic Eye Drops during Retinopathy of Prematurity Screening.

INTRODUCTION: The study aimed to investigate the effectiveness of topical anesthetic drops in reducing the pain associated with mydriatic eye drops prior to the retinopathy of prematurity (ROP) examination. METHODS: Premature infants who underwent first-time ROP examinations in an outpatient setting were included in this randomized controlled trial. The study group included the infants who were administered topical anesthesia prior to the first mydriatic drops, and the control group included the infants who were given preservative-free artificial tear drops. Pain assessment was performed using the premature infant pain profile (PIPP). RESULTS: A total of 66 infants, 35 in the control group and 31 in the study group, were included in the study. The PIPP scores of the infants during the first, second, and third mydriatic drops were 5.3 ± 2.0; 4.9 ± 1.7; and 4.0 ± 1.8, respectively, in the study group and 5.3 ± 1.7; 5.6 ± 1.8; and 4.6 ± 1.8, respectively, in the control group. No significant difference was found in the scores between the two groups. The PIPP score after the third drop was significantly lower than that after the second drop in the control group, and the PIPP score after the third drop was significantly lower than that obtained after the first and second drops in the study group. DISCUSSION/CONCLUSION: This study showed no significant benefit of the topical anesthetic drop in the prevention of pain associated with mydriatic eye drops. The decrease in the pain response observed in repeated administrations is a novel finding.

Minor dysmorphic features in a patient with papillorenal syndrome: A Case Report.

Papillorenal syndrome, also known as renal coloboma syndrome, is characterised by congenital optic disc anomalies and renal abnormalities. Mutations in the PAX2 gene, which plays a critical role in embryogenesis, cause this syndrome. Other related anomalies are less commonly observed. To our knowledge, this is the first case reported in the literature in which Papillorenal syndrome accompanied various dysmorphic features.

Does the intraocular pressure-lowering effect of prostaglandin analogues continue over the long term?

The purpose of the study is to assess the changes in the long-term effects of prostaglandin analogues (PGAs) on intraocular pressure (IOP) reduction in patients with primary open-angle glaucoma (POAG). Data of POAG patients treated with latanoprost (0.005 %), travoprost (0.004 %), or bimatoprost (0.03 %) as the first line treatment for 5 years or more were retrospectively evaluated. Baseline ophthalmic assessment values were recorded together with the IOP at the 6th month, 1st year, and then annually. The 79 patients included 33 (41.8 %) men and 46 (58.2 %) women. There were 34 (43.0 %) patients using latanoprost (0.005 %), 23 (29.1 %) patients using bimatoprost (0.03 %), and 22 (27.8 %) patients using travoprost (0.004 %). There was no difference between the groups in terms of age, gender, or baseline IOP levels. IOP levels at the 6th month were significantly lower than baseline IOP levels in all groups (p < 0.01, Friedman test). The IOP decrease was maintained after the 6th month in all three group with no statistically significant difference compared to the 6th month IOP value (p > 0.05, Friedman test) and no statistically significant difference between the groups during follow-up (Kruskal-Wallis test, p > 0.05). IOP reductions with PGAs were adequate and stable in the 5-year follow-up period with no decrease in effectiveness over time.

Automated detection of type 1 ROP, type 2 ROP and A-ROP based on deep learning.

PURPOSE: To provide automatic detection of Type 1 retinopathy of prematurity (ROP), Type 2 ROP, and A-ROP by deep learning-based analysis of fundus images obtained by clinical examination using convolutional neural networks. MATERIAL AND METHODS: A total of 634 fundus images of 317 premature infants born at 23-34 weeks of gestation were evaluated. After image pre-processing, we obtained a rectangular region (ROI). RegNetY002 was used for algorithm training, and stratified 10-fold cross-validation was applied during training to evaluate and standardize our model. The model's performance was reported as accuracy and specificity and described by the receiver operating characteristic (ROC) curve and area under the curve (AUC). RESULTS: The model achieved 0.98 accuracy and 0.98 specificity in detecting Type 2 ROP versus Type 1 ROP and A-ROP. On the other hand, as a result of the analysis of ROI regions, the model achieved 0.90 accuracy and 0.95 specificity in detecting Stage 2 ROP versus Stage 3 ROP and 0.91 accuracy and 0.92 specificity in detecting A-ROP versus Type 1 ROP. The AUC scores were 0.98 for Type 2 ROP versus Type 1 ROP and A-ROP, 0.85 for Stage 2 ROP versus Stage 3 ROP, and 0.91 for A-ROP versus Type 1 ROP. CONCLUSION: Our study demonstrated that ROP classification by DL-based analysis of fundus images can be distinguished with high accuracy and specificity. Integrating DL-based artificial intelligence algorithms into clinical practice may reduce the workload of ophthalmologists in the future and provide support in decision-making in the management of ROP.

Incidence, Risk Factors and Development of Retinopathy of Prematurity in Mid-Preterm and Late-Preterm Infants.

PURPOSE: To evaluate the incidence, risk factors, and development of retinopathy of prematurity (ROP) in midpreterm and late-preterm infants born at 32 to 36 6/7 weeks of gestational age. METHODS: The ophthalmic examination findings and risk factors of 5,477 preterm infants who underwent ophthalmological examination were evaluated retrospectively. The rates of any stage and severe ROP (requiring treatment) development and treatment options were recorded. The risk factors were analyzed by using logistic regression analysis. RESULTS: A total of 5,477 infants were included in the study, of whom 2,715 (49.57%) were mid-preterm and 2,762 (50.43%) were late-preterm. The rates of any stage and severe ROP were 8.2% (n = 223) and 0.6% (n = 15) in mid-preterm infants, respectively. In late-preterm infants, the rate of any stage ROP was 2.1% (n = 59), and no severe ROP was detected. There was no significant difference in mean birth weight in mid-preterm infants between infants with any stage ROP and severe ROP (P = .104). Of the 15 infants (0.3%) who required treatment, 14 (0.2%) infants had laser photocoagulation, 1 (0.01%) had intravitreal bevacizumab, and 2 (0.03%) had additional therapy (laser photocoagulation and intravitreal bevacizumab). In logistic regression analysis, a significant association was found between treatment requirement and transport from an external center (P < .001, ß = 0.04). CONCLUSIONS: Although ROP development rates decrease as birth weight and gestational age increase, late-preterm infants should be examined for ROP at least once, especially those born in low-income countries because ROP development can still be observed. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].

Predictive value of serum inflammatory markers in retinopathy of prematurity.

PURPOSE: To evaluate the relationship between the development of retinopathy of prematurity (ROP) and neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR). MATERIAL AND METHODS: The medical records of 153 preterm infants born before the 34th week of gestation, were retrospectively reviewed. Complete blood cell (CBC) and C-reactive protein (CRP) results measured within the first 24 h of life were recorded. NLR, LMR and PLR were calculated by dividing neutrophil count by lymphocyte count, lymphocyte count by monocyte count, and platelet count by lymphocyte count, respectively. Analysis of possible risk factors related with ROP development was evaluated using logistic regression analysis. Results were compared between infants with and without ROP. RESULTS: A total of 153 infants, of which 64 (41.9%) with ROP and 89 (58.1%) without ROP, were included in the study. While lymphocyte count and LMR were found to be significantly lower in infants with ROP (p = 0.015 and p = 0.044), neutrophil count and NLR were found to be significantly higher (p = 0.021 and p = 0.046, respectively). No significant difference were observed in platelet and monocyte count and PLR (p = 0.808, p = 0.170 and p = 0.075, respectively). Multivariate logistic regression analysis revealed that gestational age, birth weight and NLR were major risk factors for the development of ROP (OR:0.59; p = 0.01, OR:1.00; p = 0.02 and OR: 2.56; p = 0.02, respectively). CONCLUSION: This study supports that, in addition to prematurity, NLR on the first postnatal day has a significant predictive value in ROP.

Retinopathy of Prematurity in Late Preterm Twins with a Birth Weight Discordance: Can it be Predicted by Artificial Intelligence?

Objectives: The objective is to predict the development of retinopathy of prematurity (ROP) in discordant twins using a machine learning approach. Methods: The records of 640 twin pairs born at 32-35 weeks gestational age (GA) with birth weight (BW) discordance were evaluated retrospectively. The infants' gender, GA, postmenstruel age at examination, BW, discordance rate, ROP Stages and Zones, and treatment options were recorded. The variables were used to develop a model to predict the development of ROP. Machine learning models were used for algorithm training and 10-fold cross-validation (CV) was applied for validation. The main measures were reported as sensitivity, specificity, receiver operating characteristic curve, and the area under the curve. Results: A total of 640 twin pairs underwent ophthalmic examination, of which 55 (4.3%) were ROP. The infants' GA was 33.56±1.01 weeks (32-35 weeks) and BW was 1996±335 g (1000-3400 g). The mean discordance rate of the infants was 11.8±9.7% (0.0-53.9%). Using operating points, the Decision Tree algorithm detected ROP prediction with 71% sensitivity and 80% specificity in CV, while the Multi-Layer Perceptron algorithm detected 70% sensitivity and specificity. In addition, the X-Tree and Random Forest algorithms detected ROP prediction with 84% and 80% specificity, respectively. Conclusion: The results of this study support that BW discordance may be effective in the development of ROP in preterm twins and that artificial intelligence models can predict the development of ROP in accordance with clinical findings.

The impact of obesity on ocular hemodynamics and choroidal thickness.

Background: Obesity affects microvascular structures. The effect of obesity on the ocular vascular system can be evaluated by changes in the choroidal thickness (CT) and retrobulbar blood flow (RBF). Objectives: To evaluate the CT and RBF parameters in obese patients with various body mass index (BMI) values and compare these parameters with normal weight, healthy subjects. Design: A prospective study. Methods: The study included 102 eyes of 102 female patients. Patients were divided into three groups according to BMI as group 1 with a BMI of 18.5-24.99 (n = 32), normal weight group; group 2 with a BMI of 30-34.99 (n = 35), as obese class I; and group 3 with a BMI of 35-39.99 (n = 35), as obese class II. The peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index, and pulsatility index values of the central retinal artery (CRA) and ophthalmic artery (OA) were evaluated with color Doppler ultrasonography. CT was measured at the subfoveal area and at 500-µm intervals nasal and temporal to the fovea up to a distance of 1500 µm by using the enhanced depth imaging technique of optical coherence tomography. Intraocular pressure (IOP) was measured with a Goldmann applanation tonometry. Results: There was a significant difference in IOP values within the groups with the highest values in group 3 (17.6 ± 2.1 mmHg) and the lowest in group 1 (12.4 ± 1.7 mmHg). The CT in groups 2 and 3 was found to be statistically significantly lower than that in group 1 at all measurement points (p < 0.001). There was a statistically significant negative correlation between CT at all measurement points and BMI (p < 0.001). The mean CRA PSV, EDV, and OA EDV values were statistically significantly lower in each obese group than those values in group 1 (p < 0.001). The OA PSV values were significantly lower in group 3 (36.5 ± 5.9 cm/s) than those in group 2 (43.8 ± 4 cm/s) and group 1 (44.6 ± 5.2 cm/s) (p < 0.001). Also, significant associations were found between BMI and CRA PSV, CRA EDV, and OA PSV values (p < 0.001). Conclusion: Obesity may predispose to eye pathologies by changing the ocular vascular circulation.

Findings of ocular examinations in healthy full-term newborns.

PURPOSE: To assess the anterior and posterior segments of full-term neonates over a 1.5-year period. METHODS: The findings of full-term neonates who underwent ophthalmological examinations between June 2019 and December 2020 were analyzed, and the results were retrospectively recorded. RESULTS: The study comprised 2972 neonates with a mean birth week of 38.7 ± 1.2 weeks and a mean birth weight of 3235 ± 464 g. The neonates were examined on an average of 49.3 ± 18.9 postnatal days. Of the examined neonates, 185 (6.2%) showed abnormal ophthalmological findings, the most prevalent of which were retinal hemorrhage in 2.3% (n=68) and white changes in the peripheral retina in 1.9% (n=55) of the neonates. Cases of optic disc pathologies (n=20), choroidal nevus (n=10), iris-choroidal coloboma (n=5), subconjunctival hemorrhage (n=6), non-specific retinal pigmentary change (n=4), congenital cataract (n=3), posterior synechia (n=3), iris nevus (n=3), corneal opacity (n=1), choroidal coloboma (n=1), iris coloboma (n=1), buphthalmos (n=1), anophthalmos (n=1), microphthalmia (n=1), lid hemangioma (n=1), and vitreous hemorrhage (n=1) collectively accounted for approximately 2% of all neonates. Pathologies that could potentially impair vision, which were detected by ophthalmological examination, accounted for 1.2% of all neonates (n=37). CONCLUSION: The most prevalent finding of the ophthalmological examinations of neonates in the present study was retinal hemorrhage. Ophthalmological examinations of neonates can help in identifying diseases that may affect their vision and are curable or may lead to amblyopia in the long term.

A Shift of the Pupillary Balance Towards the Parasymphathetic System in Migraine Patients with Aura.

Introduction: To analyze the static and dynamic pupillometrics in migraine patients with aura and compare these parameters to those in age- and sex-matched healthy participants. Methods: This cross-sectional study included 34 patients with migraine and 37 healthy participants as a control group. The static pupillometrics consisted of scotopic pupil diameter (PD), mesopic PD, and low and high photopic PD. The dynamic pupillometrics were as follows: the initial diameter, amplitude of pupil contraction, latency of pupil contraction, duration of pupil contraction, velocity of pupil contraction, latency of pupil dilation, duration of pupil dilation, and velocity of pupil dilation. All participants were evaluated during a headache-free period. An automatic quantitative infrared pupillometry system was used to examine the pupillary characteristics of the eyes. Results: The static and dynamic pupillary parameters except the latency of pupil contraction did not significantly differ between the migraine patients during an attack-free period and the healthy participants. The latency of pupil contraction was significantly statistically lower in migraine group than healthy subjects. Also, the scotopic PD differed significantly in the inter-eye comparison within migraine patients (p<0.05). Conclusion: A significant inter-eye difference in scotopic PD values and the lower latency of pupil contraction in migraine patients with aura in the headache-free period might be attributed to a shift of the pupillary balance towards the parasymphathetic system.

Bevacizumab and neurodevelopmental outcomes of preterm infants with retinopathy of prematurity: should we still worry?

AIM: Bevacizumab may affect preterm infants' ongoing organogenesis with its antiangiogenic effects. We aimed to compare neurodevelopmental outcomes (NDO) of preterm infants treated for retinopathy of prematurity (ROP) with laser photocoagulation (LP), intravitreal bevacizumab (IVB) or both treatments, and to find out the effects of IVB on NDO. METHODS: Medical records of preterm infants with ROP treatment and evaluation for NDO were retrospectively collected between 1 January 2017 and 31 June 2019. Primary outcome was Bayley Scales of Infant and Toddler Development 3rd Edition (Bayley-III) scores including cognitive, language, and motor scores. Secondary outcomes were neurodevelopmental impairments (NDIs) classified as the presence of any of cerebral palsy (CP), sensorineural/mixed hearing loss, visual impairment, and developmental delay with any Bayley-III score <85. Severe NDI (sNDI) was defined as presence of any of CP with a Gross Motor Function Classification Scale of 3, 4, or 5, requirement for hearing aids or cochlear implants, bilateral visual impairment or severe developmental delay with any Bayley-III score <70. RESULTS: LP, IVB, and IVB + LP groups included 32, 12, and 10 patients, respectively. Patent ductus arteriosus treatment rates were as 68.7, 75, and 90% in groups, respectively (p<.05 between LP and IVB + LP groups). Grades 3 and 4 intraventricular hemorrhage (IVH) was lower in LP group than IVB group (9.4% vs. 33.4%, p<.05) while IVB + LP group had no grades 3 and 4 IVH. Other neonatal characteristics were similar (p > .05). CP was in 50%, 28%, and 0% of LP, IVB, and IVB + LP groups (p<.05). There was no difference in median Bayley-III cognitive, language, and motor scores between groups (p > .05). Moderate and severe developmental delays were similar between groups (p > .05) whereas IVB group had more moderate cognitive delay; and more severe cognitive, language, and motor delay. NDI rate was not different (59.3%, 50%, and 40% in groups, p > .05). sNDI was highest in IVB group but not statistically significant (31.2, 41.7, and 10% in groups, p > .05). Multiple logistic regression analysis showed that ROP treatment type and grades 3 and 4 IVH did not have any significant effect on NDO (p > .05). Odds of NDI was not effected by ROP treatment type (p > .05). CONCLUSIONS: Patients treated with bevacizumab should be carefully monitored for neurodevelopmental problems, although the frequency of grades 3 and 4 IVH in the bevacizumab group is thought to contribute to higher rates of sNDI and Bayley-III score <70.

Accuracy of Photorefraction and Wavefront-Based Autorefraction in Children Under 3 Years of Age.

OBJECTIVES: This study was designed to assess the accuracy of photorefraction and wavefront-based autorefraction in children under 3 years of age. METHODS: A cross-sectional study was performed with children who had no ocular abnormalities other than a refractive error and were less than 3 years old. Spot Vision Screener (Welch Allyn Inc., Skaneateles Falls, NY, USA) was used for photorefraction and SureSight Vision Screener (Welch Allyn, Skaneateles Falls, NY) was used for autorefraction. The measurements were performed with both devices before and after cycloplegia. The results were compared with those obtained using cycloplegic retinoscopy. The assessments were performed in terms of spherical equivalent (SE) values and Jackson cross-cylinder power values (J0 and J45). RESULTS: A total of 305 children with a mean age of 15.1±10.4 months were included. The mean SE values measured with the Spot Vision and SureSight before cycloplegia were 0.43±0.75 D and 0.90±0.86 D, respectively. Following cycloplegia, the mean SE values were 1.80±1.25 D and 1.55±1.40 D, respectively. The mean SE value obtained with cycloplegic retinoscopy was 1.53±1.34 D. The mean SE values measured with both devices prior to cycloplegia were significantly lower than that measured with cycloplegic retinoscopy (p<0.001). No significant difference was observed between the cycloplegic SE values obtained with SureSight and retinoscopy (p=0.66). Spot Vision yielded significantly higher cycloplegic SE values compared with cycloplegic retinoscopy (p<0.001). CONCLUSION: Both devices underestimated SE values in comparison with cycloplegic retinoscopy in children under 3 years of age. Wavefront-based autorefraction performed with cycloplegia may be an alternative to cycloplegic retinoscopy, but needs confirmation.

Evaluation of Infectious Uveitis at a Tertiary Referral Center in Turkey: A 31-year Retrospective Study.

OBJECTIVES: The aim of this study was to examine the demographic and clinical characteristics of patients with infectious uveitis over time. METHODS: The records of a total of 2032 patients treated for uveitis were retrospectively analyzed and 369 eyes of 324 patients diagnosed with infectious uveitis were included in the study. The patients were divided into 2 groups according to the date of presentation. The first group comprised patients seen between January 1988 and August 2009, and patients who presented between September 2009 and April 2019 were classified in the second group. RESULTS: The prevalence of infectious uveitis was 15.1% in the first group and 16.8% in the second group. A statistically significant decrease was observed in the number of toxoplasmosis patients in the second group (p=0.031). There was no significant difference in the number of patients with herpetic anterior uveitis (HAU) (p=0.215). A significant increase was recorded in the number of patients with tuberculosis and acute retinal necrosis (ARN) (p=0.006 and p=0.041, respectively). While there were no patients diagnosed with cytomegalovirus (CMV) anterior uveitis in the first group, 19 patients were diagnosed with the disorder in the second group. There was a decrease in the rate of legal blindness among the patients who were treated in the second period compared with the first period; however, this difference was not statistically significant (p=0.069). CONCLUSION: Toxoplasmosis and HAU were the 2 most common causes of infectious uveitis. The incidence of CMV anterior uveitis, tuberculosis-related uveitis, and ARN increased over the period studied.

Should parents be present during screening examinations for retinopathy of prematurity?

Purpose: To investigate whether parents should be present during screening examinations for retinopathy of prematurity (ROP) by investigating the anxiety levels of parents using two different approaches. Methods: This cross-sectional and two-center study was carried out with the parents at the time of the first ROP screening examination of their premature infants. At one center, the parents accompanied the infants during the ROP examination (Group 1), and in the other center, they did not (Group 2). Anxiety levels were assessed with the State-Trait Anxiety Inventory (STAI), which consists of the State Anxiety (STAI-S) and Trait Anxiety (STAI-T) subscales and a visual analog scale (VAS). Results: A total of 147 parents of 127 infants were included in the study. STAI-T and -S levels were 40.5 ± 8 and 37.9 ± 7.5, respectively, in Group 1 and 39.6 ± 8.1 and 39.4 ± 9.1 in Group 2 before the examination. There were no statistically significant differences in terms of these values between the two groups (P > 0.05). The state anxiety levels increased by an average of 1.7 ± 8 in Group 1 and reached 39.6 ± 10.1 after the examination. In Group 2, these levels decreased by an average of - 2.7 ± 7.5 points to a score of 36.4 ± 10.3. This difference was found to be statistically significant (P = 0.001). A similar pattern was observed in the evaluation of the VAS data. Conclusion: As a preliminary opinion, it may be more appropriate for parents to not participate in screening examinations, but single-center controlled studies are required to confirm the results.

Comparison of photoscreening and autorefractive screening for the detection of amblyopia risk factors in children under 3 years of age.

PURPOSE: To evaluate the effectiveness of photoscreening and autorefractive screening for the detection of amblyopia risk factors (ARFs) in a cohort of preterm and term-born children <3 years of age. METHODS: In this cross-sectional study, the Spot Vision photoscreener and the SureSight autorefractor were used to screen participants. The diagnostic and predictive values of the devices in detecting ARF based on American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 2013 referral criteria was calculated using manufacturer criteria, the VIP 90 (90% specificity) and VIP 94 (94% specificity) criteria from the Vision in Preschool (VIP) study, and criteria recommended by Rowatt and colleagues. Results were evaluated using receiver operating characteristic (ROC) curves. RESULTS: A total of 368 patients (mean age, 14.4 ± 10.4 months) were included. The ARF rate was 25% according to the 2013 AAPOS criteria. The highest specificity and positive predictive values (PPV) were obtained with Spot Vision manufacturer criteria (specificity, 0.91; PPV, 0.69). SureSight manufacturer criteria showed very low specificity and PPV values (specificity, 0.43; PPV, 0.35) and a high false positive rate (57%). The highest specificity and PPV values for SureSight were obtained with the Rowatt criteria (specificity, 0.86; PPV, 0.62). CONCLUSIONS: In our study cohort, photoscreening with the Spot Vision manufacturer criteria seemed sufficient for vision screening in the 0-3 years age group, with high specificity values. The Rowatt criteria may increase performance of the SureSight in this age group.

Is being small for gestational age a risk factor for strabismus and refractive errors at 3 years of age?

BACKGROUND: Visual problems, cerebral visual impairment, refractive errors and strabismus are commonly found in preterm infants in long-term follow-ups. The aim of this study was to determine the factors that lead to the development of amblyogenic risk factors, such as high refractive errors, anisometropia and strabismus, in the long-term evaluation of preterm infants. METHODS: We retrospectively evaluated children who were screened for retinopathy of prematurity (ROP) and who had a 3rd year ophthalmologic examination. The impacts of sex, gestational age (GA), birth weight (BW), BW for GA, being small for gestational age (SGA), being appropriate for gestational age (AGA), multiple pregnancies and the results of ROP screening on refractive errors and the development of strabismus were evaluated by logistic regression analysis. The SGA and AGA groups were compared in terms of refractive errors and presence of strabismus. RESULTS: Six hundred and eight children, including 317 (52.1%) males and 291 (47.9%) females, were included in the study. The mean GA was 31 ± 3 weeks (24-36), and the mean BW was 1505 ± 435 g (600-2460). The number of SGA-born children was 101 (16.6%). Manifest deviation was detected in 42 (5.6%) children, and optical correction was required in 101 (16.6%) children. Being an SGA infant and multiple pregnancies were risk factors for refractive errors requiring optical correction, and hyperopia (≥3.00 D) was found to be a risk factor for the development of strabismus in the multivariate regression analysis. Additionally, the SGA group was at high risk for strabismus, hyperopia, high astigmatism and the need for optical correction. CONCLUSIONS: We concluded that SGA seems to be associated with an increased risk of strabismus and a high refractive error. It should be taken into consideration during follow-up examinations of SGA infants.

Relationships between corneal biomechanics and the structural and functional parameters of glaucoma damage.

PURPOSE: To investigate the relationships between (i) thickness of the retinal nerve fiber layer, optic nerve head topography, and visual field parameters and (ii) corneal biomechanical properties in normal controls and patients with ocular hypertension and primary open-angle glaucoma. METHODS: This observational, cross-sectional study included 68 eyes with primary open-angle glaucoma, 99 eyes with ocular hypertension and 133 control eyes. Corneal biomechanical properties, optic nerve head topographic features, retinal nerve fiber layer thickness, and visual fields were assessed in all cases. Corneal biomechanical properties, retinal nerve fiber layer thicknesses, and optic nerve head topographic features were compared among the groups. The associations between structural and functional measures of glaucomatous damage and corneal biomechanical factors were also evaluated. RESULTS: Significantly lower corneal hysteresis and corneal resistance factor values were observed in the primary open-angle glaucoma and ocular hypertension groups as compared with the control group, but there were no significant differences between the primary open-angle glaucoma and ocular hypertension groups. In the ocular hypertension group, no associations were observed between the corneal hysteresis and corneal resistance factor with values and the structural and functional parameters. In the primary open-angle glaucoma group, positive correlations were observed between the corneal hysteresis values and the global retinal nerve fiber layer thickness (p<0.01, r=0.27), mean retinal nerve fiber layer thickness (p<0.01, r=0.33), and mean deviation (p<0.01, r=0.26), and negative correlations were observed between the corneal resistance factor values, and the cup area (p<0.01, r=-0.39), cup-to-disk ratio (p=0.02, r=-0.28), linear cup-to-disk ratio (p=0.02, r=-0.28), and cup shape (p=0.03, r=-0.26). In the control group, weak correlations were detected between the corneal hysteresis and the cup area (p=0.03, r=0.19), cup-to-disk ratio (p=0.01, r=0.21), and linear cup-to-disk ratio (p=0.01, r=0.22). CONCLUSIONS: Distinct correlations were identified between the corneal hysteresis and corneal resistance factor values and the functional and structural parameters in the primary open-angle glaucoma and control groups. Corneal hysteresis and corneal resistance factor may have different roles in the pathophysiology of glaucoma.