VISUAL SNOW SYNDROME IN A PEDIATRIC CASE.

INTRODUCTION Visual snow (VS) is a rare condition that is characterized by continuous dynamically flickering dots in the entire visual field that imitate the 'static' or 'snow' of an analogue television set that is not connected to the antenna (1). VS was first described in 3 of 10 migraineurs patients who presented with a spectrum of positive visual symptoms (2). The symptoms of VS can persist for many years. Although VS might be expressed in patients with migraine as visual aura, persistent VS has been accepted as a distinct clinical entity and termed as visual snow syndrome (VSS) independently from migraine. Schankin et al. proposed that the criteria for diagnosis of VSS consisted of visual snow as the main criterion, with some additional criteria (3). A few cases with childhood VSS have been described in literature (4-6). Herein, the case of a teenager was presented to emphasize the importance of differential diagnosis in persistent positive visual phenomena.

Corneal stromal depth of the demarcation line in 'accelerated corneal cross-linking' with different concentrations of riboflavin solutions.

PURPOSE: The aim of this study is to compare the effect of different riboflavin solutions (hypotonic and isotonic) used during accelerated corneal cross-linking (CXL) on the mean depth of the demarcation line (DDL) formed in corneal stroma. METHODS: This prospective, cross-sectional study included 38 eyes of 26 patients. All patients underwent accelerated CXL due to progressive keratoconus. When the corneal epithelium was removed, 17 eyes of 12 patients with corneal thickness < 400 µm were categorized as Group 1, and 21 eyes of 14 patients with corneal thickness > 400 µm as Group 2. Hypotonic riboflavin was applied to Group 1 patients, and isotonic riboflavin to Group 2 patients. Anterior segment optical coherence tomography was performed on all patients by two independent observers at the end of the first and third months. RESULT: Group 1 included 5 male and 7 female patients with an average age of 25.1 ± 8.0 years, whereas Group 2 included 7 male and 7 female patients with an average age of 31.8 ± 10.12 years. At the end of the first month, the mean DDL in Group 1 and Group 2 was 180.32 ± 10.26 and 287.21 ± 15.01 µm, respectively. This difference was statistically significant (p < 0.05). CONCLUSION: Application of different riboflavin solutions was observed to have an effect on measured corneal thickness after saturation and the depth of the demarcation line. The use of hypotonic riboflavin results in swelling of the cornea and more superficial localization of the stromal demarcation line after CXL.

Increased red cell distribution width levels in children with seasonal allergic conjunctivitis.

PURPOSE: Seasonal allergic conjunctivitis (SAC) is an inflammatory disease of the conjunctiva. Red cell distribution width (RDW) is a widely accepted inflammatory marker. We aimed to investigate whether RDW level is associated with the development of SAC in pediatric population. METHODS: The present study consisted of 90 subjects (45 children with SAC and 45 age- and sex-matched healthy children). The demographic findings, complete blood count parameters including RDW and laboratory parameters, were evaluated. RESULTS: The mean RDW levels were significantly higher in children with SAC compared to the control group (14.02 ± 0.82 vs. 13.26 ± 0.64%, respectively, p < 0.001). In receiver operating characteristic analysis, the area under the curve for RDW for predicting SAC was 0.786, and a RDW value of 13.45 or higher predicted SAC with a sensitivity of 75.6% and specificity of 65%. CONCLUSION: Our study suggests that elevated RDW levels are significantly associated with SAC in pediatric population, which may imply a possible role of increased inflammatory status and oxidative stress in the pathogenesis of SAC.

Agenesis of retinal vessels in a newborn with central nervous system developmental abnormality.

A full-term infant with neonatal seizures was diagnosed to have corpus callosum agenesis with congenital agyria. His indirect ophthalmoscopical evaluation revealed bilateral complete absence of retinal vessels with normal optic discs and macula. Bilateral lamellar cataracts developed in the second month of follow-up, and his muscle biopsy was consistent with a mitochondrial disorder. Confirmation by molecular analysis could not be performed since parents did not give their consent for further investigation.

OCT Evaluation of Retinal Parameters in Pediatric Gastritis Patients with Helicobacter Pylori.

OBJECTIVES: The aim of this study was to investigate the effect of Helicobacter pylori (H. pylori) infection on choroidal thickness (CT), retinal nerve fiber layer (RNFL) thickness, and ganglion cell (GCL+IPL) complex thickness in childhood cases of gastritis. METHODS: A total of 104 eyes of 52 children were included in the study. Two groups were created: 54 eyes of 27 H. pylori gastritis cases (Group 1) and 50 eyes of 25 gastritis without H. pylori cases (Group 2), as confirmed by an endoscopic biopsy. The mean subfoveal, submacular, and peripapillary CT, RNFL thickness, and GCL+IPL complex thickness was measured using spectral domain optical coherence tomography. RESULTS: The mean subfoveal CT values were significantly higher in Group 1 compared with Group 2 (p=0.042). The mean submacular CT and peripapillary CT measurements of the eyes in Group 1 was greater than that of Group 2, but the difference was not statistically significant (p>0.05). There was also no statistically significant difference between the GCL+IPL complex or RNFL thickness values of the groups (p>0.05). CONCLUSION: H. pylori is a common gastrointestinal infectious agent with asymptomatic carriers in the population. The role of this agent in ocular pathologies in adult patients has been the subject of many recent studies, but secondary ocular findings in patients with H. pylori gastritis in childhood have not yet been investigated. The results of this study showed that the subfoveal CT value was significantly greater in children with H. pylori gastritis.

Incidence and prognosis of ocular hypertension secondary to viral uveitis.

This retrospective study was designed to estimate the cumulative incidence of glaucoma in viral uveitis. Seventy-six consecutive patients with viral stromal keratouveitis were divided into two groups according to the etiologic agents herpes simplex virus (HSV) keratouveitis (n = 58) and herpes zoster virus (HZV) keratouveitis (n = 18). The groups were evaluated for the incidence and prognosis of ocular hypertension. Etiologic agents were determined with the help of clinical observation supported by the polymerase chain reaction (PCR) of aqueous humor. All patients received oral acyclovir therapy for at least six months and topical prednisolone in tapered doses. There was no significant difference in the recurrences of HSV and varicella zoster virus (VZV) keratouveitis between groups (P = 0.431). The total incidence of secondary glaucoma was 13.1%. Most of the patients responded to antiviral and antiglaucomatous therapy. Trabeculectomy with mitomycin C was performed in only two patients. Secondary glaucoma can be regarded as a frequent complication of viral uveitis. As it has a good prognosis, surgical intervention is rarely required.

Correlation of neutrophyle/lymphocyte ratio and pulmonary parameters with optic coherence tomography findings in stable chronic obstructive pulmonary disease.

INTRODUCTION: To examine the correlation of pulmonary functions and neutrophyle/lymphocyte ratio (NLR) with optic coherence tomography findings in stable chronic obstructive pulmonary disease (COPD). METHODS: Fifty-five COPD (110 eyes) and 48 control cases (96 eyes) were enrolled. COPD patients were grouped as Group 1 (mild-moderate) and Group 2 (severe) according to GOLD classification. Subfoveal choroidal thickness (SFCT), ganglion cell-inner plexiform layer (GCIP) and retinal nerve fiber layer (RNFL) analysis by SD-OCT were performed in follow up. NLR was calculated by blood cell count. RESULTS: Inferior RNFL and average GCIP of COPD were lower than control during the initial and sixth month examination (P = .002, P < .001, respectively). Average RNFL and SFCT were lower in COPD patients in sixth month examination (P = .020, P = .015, respectively). Average, temporal, inferior, nasal RNFL and SFCT in sixth month examination were significantly lower in severe COPD (P < .05 for all), but average GCIP were similar (P = .015). Disease duration, Modified Medical Research Council (mMRC) and attacks/year showed significant negative correlations, whereas forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC) showed significant positive correlations with OCT values. NLR was significantly higher in COPD cases compared to control (P < .001) and had a negative correlation with GCIP values. CONCLUSION: Chronic obstructive pulmonary disease severity is shown to have a negative effect on OCT measurements. SD-OCT can reflect severity of inflammation, and suggested to be used in follow up of COPD cases. NLR may have a role to predict the ganglion cell damage in COPD patients.

Short-term variations of optic coherence tomography findings in mild and severe chronic obstructive pulmonary disease.

OBJECTIVE: To evaluate the short-term changes in subfoveal choroidal thickness (SFCT), ganglion cell complex (GCC) analysis, and retinal nerve fiber length (RNFL) of patients with chronic obstructive pulmonary disease (COPD) in a 3-month follow-up. MATERIALS AND METHODS: Forty-eight patients with COPD (96 eyes) and 40 control subjects (80 eyes) were enrolled in our study. COPD patients were grouped according to disease severity as Group 1 (mild-moderate) and Group 2 (advanced). GCC, RNFL, and SFCT analysis by Cirrus SD-OCT were obtained for all eyes, in two consecutive examinations with a 3-month interval. RESULTS: SFCT in Group 2 was lower than Group 1 and control group in the initial and 3rd month examination (p < 0.001, respectively). Inferior RNFL in Group 2 were lower than control group in the initial and 3rd month examination (p = 0.002, p < 0.001, respectively) Temporal RNFL were lower in Group 2 than Group 1 in 3rd month examination (p = 0.009). Average, superior, superotemporal, inferior, and inferonasal GCC analyses of the Group 2 were lower than control group both in the initial and 3rd month examination (p = 0.001, p < 0.001, respectively) SFCT, average, and superior GCC of Group 2 were significantly reduced during the 3-month follow-up (p < 0.001). CONCLUSION: Hypoxia is thought to be the underlying mechanism in COPD, which may influence retinal and choroidal OCT parameters. Decrease in blood flow of optic nerve head, increased vascular resistance, and reduced blood flow in choroid may affect the visual ability in these patients, which should be kept in mind during their follow-up.

Neutrophil-to-lymphocyte ratio in ocular diseases: a systematic review.

AIM: To summarize the results of studies investigating neutrophil-to-lymphocyte ratio (NLR) and to identify the role of NLR in ocular diseases. METHODS: With the aim of identifying the studies related to NLR, a search was conducted on http://www.ncbi.nlm.nih.gov/pubmed by utilizing the key words "neutrophil lymphocyte ratio, ocular diseases, and eye diseases" up to February 2018. All of the original articles were assessed according to date of publications, countries, clinics and topics. Studies about ocular inflammatory diseases were evaluated according to their qualifications, review methods and results. RESULTS: A total of 4473 publications, including original research articles and reviews were screened. The number of publications was shown a regular logarithmic increase over the years. The majority of studies were performed by clinics in Turkey and many of these publications were performed by oncology and cardiology clinics. A total of 75 publications were identified to be about ocular diseases. CONCLUSION: Elevated NLR as a cheap, reproducible, and readily available marker could be used as a diagnostic and/or prognostic marker in ocular diseases.

Incidence and risk factors in secondary glaucomas after blunt and penetrating ocular trauma.

PURPOSE: This retrospective study was designed to evaluate the risk factors for the development of posttraumatic glaucoma after ocular trauma. METHODS: Data were obtained from the records of 102 patients (105 eyes) that experienced blunt or penetrating ocular trauma and presented to our center between January 1987 and April 2006. Logistic regression was used to evaluate the association between the baseline structural and functional ocular characteristics and posttraumatic glaucoma. Odds ratios with 95% confidence intervals (CI) were obtained. RESULTS: Need for glaucoma surgery was independently associated with hyphema (odds ratio: 0.279; 95% CI: 0.085-0.916), corneal injury (odds ratio: 12.143; 95% CI: 2.029-72.66), presence of optic atrophy (odds ratio: 8.000; 95% CI: 1.615-39.636), visual acuity <20/200 (odds ratio: 50.00; 95% CI: 10.183-245.501), and a history of penetrating ocular trauma (odds ratio: 10.00; 95% CI: 2.819-38.635). Corneal (odds ratio: 1.113; 95% CI: 1.022-1.213) and vitreal injuries (odds ratio: 10.410; 95% CI: 1.232-87.97) were found to be statistically significant factors for the development of early glaucoma. CONCLUSIONS: This study found several independent predictive factors that were significantly associated with the need for glaucoma surgery in cases of posttraumatic glaucoma, including hyphema, corneal injury, presence of optic atrophy, visual acuity <20/200, and a history of penetrating ocular trauma. Additionally, some factors were found to affect the development of early glaucoma after ocular trauma, such as corneal and vitreal injury.

The Relationship between Neutrophil-to-lymphocyte Ratio and Age-related Macular Degeneration.

PURPOSE: To investigate the possible associations of neutrophil-to-lymphocyte ratio (NLR) and high sensitivity C-reactive protein (hs-CRP) level with age-related macular degeneration (ARMD). METHODS: Patients were divided to three groups of 40 patients with non-neovascular ARMD (group 1), 40 patients with neovascular ARMD (group 2), and 40 healthy control subjects (group 3). The neutrophil and lymphocyte counts were evaluated using an ABX Pentra DF120/USA biochemical analyzer, and hs-CRP levels were measured using a Beckman Coulter Immage 800. The NLR was measured by dividing neutrophil count by lymphocyte count. RESULTS: The patients in group 2 were older and more often diabetic than the patients in groups 1 and 3 (p < 0.001 and p < 0.001, respectively). The NLR level was 1.65 ± 0.71 in group 1, 1.98 ± 0.84 in group 2, and 1.46 ± 0.44 in group 3. The hs-CRP value was 1.98 ± 0.251 mg/L in group 1, 3.242 ± 0.211 mg/L in group 2, and 1.145 ± 0.193 mg/L in group 3. Both NLR and hs-CRP values were significantly higher in group 2 compared to group 3 (p = 0.002 and p = 0.002, respectively). In multivariate analysis, NLR remained an independent predictor of neovascular ARMD (odds ratio, 3.882; 95% confidence interval, 1.574 to 9.576; p = 0.003) together with age (p < 0.001), diabetes mellitus (p = 0.041), and hs-CRP (p = 0.018). CONCLUSIONS: Our study suggests that increased NLR value is independently associated with neovascular ARMD.

Impact of oral contraceptive pills on central corneal thickness in young women.

OBJECTIVES: Hormonal changes during oral contraceptive pill (OCP) use may affect central corneal thickness (CCT) values. We aimed to evaluate the impact of OCP use on CCT values in healthy young women. MATERIALS AND METHODS: Fifty women subjects who use OCP for contraception (Group 1) and forty control subjects (Group 2) who do not use OCP were included in this prospective study. None of the patients had any history of systemic or ocular diseases. The CCT values measured by ultrasonic pachymeter (Nidek US-4000 Echoscan, Japan) and the intraocular pressure (IOP) values were measured by noncontact tonometer (Reichert 7 CR Corneal Response Technology, USA) at the time of admission to our clinic. The demographic findings and body mass index (BMI) scores of participants were also recorded. RESULTS: The mean ages were 32.8 ± 5.6 for OCP + patients (Group 1) and 31.3 ± 6.9 for OCP-patients (Group 2) (P = 0.28). The mean CCT values were significantly higher in Group 1 when compared to that of the Group 2 (540.9 ± 30.4 µm and 519.6 ± 35.6 µm, respectively) (P = 0.003). The mean IOP value was 14.3 ± 2.5 mmHg in Group 1 and 14.4 ± 2.7 mmHg in Group 2 (P = 0.96). The mean BMI scores were 24.4 ± 5.8 kg/m2 in Group 1 and 24.6 ± 3.5 kg/m2 in Group 2 (P = 0.83). CONCLUSION: Our findings revealed that CCT values were significantly higher in patients with OCP use. Ophthalmologists should be aware of potential elevated CCT levels in these patients.

Ophthalmic Manifestations in Children With Congenital Hypothyroidism.

PURPOSE: To evaluate the frequencies of ophthalmic abnormalities in children with congenital hypothyroidism. METHODS: A total of 121 patients with a history of congenital hypothyroidism, aged 1 to 216 months, were included in the study. The initial ophthalmological examinations and demographic data of patients who were examined between April 2013 and April 2015 were retrospectively reviewed. Accompanying systemic abnormalities were also noted. RESULTS: Ophthalmic pathology was determined in 40.4% (49 of 121) of patients with congenital hypothyroidism, of which 79.5% (39 of 49) had significant refractive errors and 32.6% (16 of 49) had strabismus. Systemic abnormalities were observed in 74.3% (90 of 121) of the children, among which 47.1% (57 of 121) were congenital heart defects and 38.0% (46 of 121) were neurologic abnormalities. A high prevalence of Down syndrome (17.3%; 21 of 121) and atopic dermatitis (8.2%; 10 of 121) was detected among patients with congenital hypothyroidism. CONCLUSIONS: In addition to many associated systemic abnormalities, ophthalmic pathologies may also occur in children with congenital hypothyroidism. Thus, routine ophthalmological examination is recommended for these children, starting from the time of initial diagnosis.

Comparative Clinical Outcomes of Pediatric Patients Presenting With Eyelid Nodules of Idiopathic Facial Aseptic Granuloma, Hordeola, and Chalazia.

PURPOSE: To present the clinical features of the eyelid nodules observed in a newly determined dermatologic disorder, idiopathic facial aseptic granuloma (IFAG), and to compare them with children having acute hordeolum and chalazion. METHODS: Duration of the lesion, localization, presence of coexisting facial nodules, management strategies, and response time to topical/oral antibiotics were retrospectively reviewed in 50 children with IFAG, acute hordeolum, or chalazion. RESULTS: Fourteen children with one or more IFAG nodules on their eyelids, 28 children with one or more acute hordeolum, and 8 children with one or more chalazion were examined. Children with IFAG on their eyelids and face presented earlier than children with acute hordeolum (P = .006). The duration of this lesion was similar among patients with IFAG on their eyelids and acute hordeolum (P = .53). Duration of the lesion and treatment response time were shorter in children with IFAG on their eyelids and face (P = .004) than in those with IFAG on their eyelids (P = .013). The lesions of patients with chalazion had a longer duration compared to those with IFAG on their eyelids (P = .005), IFAG on their eyelids and face (P < .001), and acute hordeolum (P = .04). Twenty patients with acute hordeolum recovered after topical antibiotics and had a similar treatment response time to those with IFAG on their eyelids and face (P = .06) and those with IFAG on their eyelids (P = .16). CONCLUSIONS: IFAG should be considered in the differential diagnosis of painless eyelid nodules in children. Because IFAG on the eyelids has many overlapping features with hordeola/chalazia, its differentiation may be difficult in the absence of accompanying facial granulomas. Chronic subepidermal eyelid nodules resembling skin abscess should alert clinicians for IFAG. Because IFAG responds well to oral clarithromycin, unnecessary surgical interventions should be avoided in these cases. [J Pediatr Ophthalmol Strabismus. 2016;53(4):206-211.].

A Rare Cause of Retinal Artery Occlusion in Severe Hypernatremic Dehydration in Newborns.

Neonatal hypernatremia is an important electrolyte disorder that may have serious complications. It may be a rare and underdiagnosed cause of venous and arterial thrombosis, leading to severe brain damage by cerebral edema and intracranial hemorrhage. Here, the authors present a case of bilateral central retinal artery occlusion in a newborn with severe hypernatremic dehydration who is found to be normal in terms of other causes of retinal arterial thromboembolization. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:482-485.].

Rapid Development of Corneal Hydrops in a Septic Infant who Received Diode Laser for Aggressive Posterior Retinopathy of Prematurity.

A premature baby who was hospitalized with the diagnosis of sepsis was treated with diode laser photocoagulation for aggressive posterior retinopathy of prematurity. Diffuse corneal ectasia and corneal hydrops developed in the right eye, and hyphema and corneal hydrops developed on the left eye on postoperative day 12. The patient died because of cardiovascular collapse and hemodynamic instability. Sepsis may be a contributory factor to the clinical susceptibility of the patient for the postoperative corneal effects of the laser. This situation has not been previously reported in the literature.

Serum neutrophil-to-lymphocyte ratio in retinopathy of prematurity.

PURPOSE: To evaluate the relationship between serum neutrophil-to-lymphocyte ratio (NLR) and development of retinopathy of prematurity (ROP). METHODS: Infants with a gestational age of ≤32 week were screened for ROP. Complete blood cell, high-sensitivity C-reactive protein, and interleukin 6 levels of subjects were measured within the first 24 hours of life. The NLR was calculated by dividing neutrophil count by lymphocyte count. The association between other risk factors and the development of ROP were analyzed using univariate analysis and multivariate logistic regression analysis. RESULTS: A total of 100 infants were included: 80 with ROP and 20 without ROP. The NLR values differed significantly between the ROP group (median, 0.67; interquartile range, 0.38-1.09) and non-ROP group (median, 0.32; interquartile range, 0.22-0.79; P = 0.02). The lymphocyte count in the ROP group (4.01 ± 1.89) compared to that of the non-ROP group (5.69 ± 2.16) was significantly lower (P = 0.001). In multivariate analysis, lymphocyte count remained an independent predictor of ROP (OR = 0.599; 95% CI, 0.430-0.836; P = 0.003). CONCLUSIONS: The NLR seems not to be an independent predictor of development of ROP. Lymphocyte count is inversely associated with ROP.

Ophthalmological Findings of Turkish Children With Muscular Dystrophies.

PURPOSE: To present the results of ophthalmological examinations in children with muscular dystrophies and highlight the importance of their ophthalmological evaluation. METHODS: Retrospective analysis of the ophthalmological examination records in 74 children with a type of muscular dystrophy, examined between January 2011 and January 2015, was performed. RESULTS: The most common type of muscular dystrophy observed in our patients was Duchenne muscular dystrophy (67.5%), followed by Becker muscular dystrophy (9.4%), myotonic dystrophy (8%), limb-girdle muscular dystrophy (6.7%), merosin-negative muscular dystrophy (4%), and Ullrich muscular dystrophy (4%). Ten cases of Duchenne muscular dystrophy had both macular and retinal pigmentary changes (20%) and 9 had abnormal electroretinographies with decreased photopic and scotopic responses. Ptosis was the most common finding (83.3%). No abnormalities of light reflexes, pupil size, or saccadic and smooth pursuit movements were seen among cases with myotonic dystrophy. CONCLUSIONS: Ophthalmological problems are commonly seen in children with muscular dystrophies. Simple ophthalmological screening and early intervention can improve their communication skills by way of increasing their visual talents.

Initial Ophthalmic Findings in Turkish Children with Autism Spectrum Disorder.

Children with autism spectrum disorders (ASD) frequently have ophthalmologic disorders. Due to poor cooperation with ophthalmological examination, ocular abnormalities in such children may be overlooked. We retrospectively studied the records of 324 patients diagnosed as ASD that underwent ophthalmological examination between January 2011 and November 2014 at Dr. Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey. Ophthalmic pathology was noted in 26.9% of patients with ASD, of which 22% had significant refractive errors and 8.6% had strabismus. Comprehensive eye examination by a pediatric ophthalmologist is recommended for all children diagnosed as ASD.