Clinical features, etiological reasons, and treatment results in patients who developed acute acquired nonaccomodative esotropia.

PURPOSE: To evaluate the clinical features, possible etiological reasons, and treatment results in children who developed acute acquired comitant esotropia (AACE) without strabismus in previous years. METHODS: Medical records of the patients who were diagnosed with AACE between July 2017 and June 2021 were retrospectively reviewed. The children with ocular and orbital pathology, hypermetropia > 2.00 diopters, and anisometropia > 1.00 diopters were not included in the study. Possible etiological factors that could cause esotropia, treatment results, motor, and sensory functions were investigated. RESULTS: The mean age at first admission, and the onset of AACE, was 8.8 ± 2.9 (4-13) years of three female (23.1%) and 10 male (76.9%) cases. The causes of AACE were determined to be occlusion of the eye due to corneal foreign body removal in one (7.7%), emotional stress in one case (7.7%), and excessive close work, on computer and smartphone screens in the other 11 cases (84.6%). Orthotropia was achieved in cases who underwent strabismus surgery (n = 10) and in cases using the prism (n = 2); except for one case, all (92.3%) achieved binocular single vision (100 s/arc stereopsis and fusion) after treatment, while there was no binocular single vision in any of the cases before treatment. CONCLUSIONS: Acute acquired comitant esotropia is a rare clinical entity. Successful motor and sensory outcomes can be achieved by strabismus surgery or by prism therapy. It is critical to investigate the patients with AACE in terms of intracranial pathologies, although rarely seen.

Surgical treatment of consecutive exotropia: Comparison of different surgical methods applied to one eye in one session.

PURPOSE: To compare the different surgical methods performed on a single eye in a single session and the factors that affect the success of patients having consecutive exotropia (XT) developed after esotropia surgery. METHODS: The medical data of the patients who underwent surgery for consecutive XT were reviewed retrospectively. Patients with followed of 6 months or more were divided into four groups; patients with medial rectus (MR) advancement (Group 1 = 10), MR advancement and MR resection (Group 2 = 12), MR advancement and lateral rectus (LR) recession (Group 3 = 13), MR advancement, MR resection, and LR recession (Group 4 = 14). Success results and possible risk factors were investigated. RESULTS: Forty-nine patients with consecutive XT (21 female, 28 male) were enrolled in the study. The mean age of overall patients was 22.97 years at surgery for consecutive XT. The groups did not display significant differences in terms of surgery ages, gender, refraction values, visual acuity, amblyopia, inferior oblique overaction, limitation of adduction, surgical success rates, and follow-up time (p > 0.05). Patients of Group 4 had larger preoperative and postoperative deviation, while Group 1 had smaller (p < 0.05). The surgical success rates of Groups 1, 2, 3, 4 were 90%, 75%, 76.9%, and 50%, respectively (p = 0.192). Statistically, no factor was found to be effective in surgical success rates (p > 0.05). CONCLUSION: Surgical treatment of consecutive XT is successful in most of the patients with numerous surgical options performed on a single eye in a single session. Patients, particularly with a high amount of deviation should be warned about the possibility of additional surgery.

Tropicamide and anaphylaxis: A case report.

A 6-month-old boy was brought to the ophthalmology outpatient clinic of our hospital by his parents with the suspicion of esotropia of his left eye. He was able to follow the objects, pupillary light reactions were normal, orthophoric in primary position with corneal light reflex (Hirschberg) test, ductions and versions were normal in all gaze positions. One drop of tropicamide (1%) was instilled in both eyes of the infant for cycloplegic retinoscopy and fundus examinations. After 10 min, anaphylaxis, respiratory and circulatory failure developed. He was immediately examined by the pediatrician, and emergency code was announced. At the 5th min of treatment, he regained consciousness, his respiratory and circulatory symptoms started to improve, and blood pressure returned to normal. In this case report, we aim to point out that tropicamide may rarely lead to life-threatening complications.

Inferior Oblique Overaction: The Results of Myectomy in Cases with a Primary Position Vertical Deviation Less and More Than 20 Prism Diopters.

PURPOSE: The purpose of this study is to evaluate the results of myectomy in inferior oblique overaction cases with a vertical deviation angle of <20 and ≥20 prism diopters (PD) in the primary position. METHODS: The medical records of cases with inferior oblique overaction that underwent inferior oblique myectomy for ≥6 PD hypertropia in the primary position and >+1 inferior oblique overaction were reviewed. Preoperative and postoperative examination findings and success rates were compared of cases with a deviation angle <20 PD (Group 1) and ≥20 PD (Group 2). RESULTS: The mean age of 35 (58%) female and 25 (42%) men cases of Group 1 (n = 60) were 12.8 ± 9.4 years; the mean age of 25 (58%) female and 18 (42%) male cases of Group 2 (n = 43) were 14.8 years (P = 0.340). The near hypertropia was decreased from 11 to 0.5 PD in Group 1, from 22.1 to 5.1 PD in Group 2 cases (P < 0.001). The distance hypertropia was decreased from 11.3 to 0.5 PD in Group 1 and from 23.3 to 6.1 PD in Group 2 cases (P < 0.001). The mean degree of hypertropia at near and distance was statistically significantly higher both pre- and post-operatively in Group 2 than in Group 1 (P < 0.001), and improved statistically significantly with the initial surgery in both groups (P < 0.001). The rate of the presence of stereopsis of ≥3000 s/arc and fusion, the main criteria of binocular vision (BOV), was not statistically significantly different between the Groups before (P = 0.577) and after the surgery (P = 0.678), but the presence of BOV significantly increased both in Group 1 (P < 0.001) and Group 2 (P = 0.004) postoperatively. The number of cases with surgical success was 57 (95%) and 25 (58%), respectively, in Groups 1 and 2 (P < 0.001). CONCLUSIONS: Myectomy is an effective surgical procedure that can be easily and quickly performed in inferior oblique overaction cases and has high success rates in cases with a small-to-moderate angle of deviation.

The effects of partial and full correction of refractive errors on sensorial and motor outcomes in children with refractive accommodative esotropia.

PURPOSE: To investigate the effects of partial and full correction of refractive errors on sensorial and motor outcomes in children with refractive accommodative esotropia (RAE). METHODS: The records of pediatric cases with full RAE were reviewed; their first and last sensorial and motor findings were evaluated in two groups, classified as partial (Group 1) and full correction (Group 2) of refractive errors. RESULTS: The mean age at first admission was 5.84 ± 3.62 years in Group 1 (n = 35) and 6.35 ± 3.26 years in Group 2 (n = 46) (p = 0.335). Mean change in best corrected visual acuity (BCVA) was 0.24 ± 0.17 logarithm of the minimum angle of resolution (logMAR) in Group 1 and 0.13 ± 0.16 logMAR in Group 2 (p = 0.001). Duration of deviation, baseline refraction and amount of reduced refraction showed significant effects on change in BCVA (p < 0.05). Significant correlation was determined between binocular vision (BOV), duration of deviation and uncorrected baseline amount of deviation (p < 0.05). The baseline BOV rates were significantly high in fully corrected Group 2, and also were found to have increased in Group 1 (p < 0.05). Change in refraction was - 0.09 ± 1.08 and + 0.35 ± 0.76 diopters in Groups 1 and 2, respectively (p = 0.005). Duration of deviation, baseline refraction and the amount of reduced refraction had significant effects on change in refraction (p < 0.05). Change in deviation without refractive correction was - 0.74 ± 7.22 prism diopters in Group 1 and - 3.24 ± 10.41 prism diopters in Group 2 (p = 0.472). Duration of follow-up and uncorrected baseline deviation showed significant effects on change in deviation (p < 0.05). CONCLUSIONS: Although the BOV rates and BCVA were initially high in fully corrected patients, they finally improved significantly in both the fully and partially corrected patients. Full hypermetropic correction may also cause an increase in the refractive error with a possible negative effect on emmetropization. The negative effect of the duration of deviation on BOV and BCVA demonstrates the significance of early treatment in RAE cases.

Causes of low vision and blindness in a Turkish adult population: the Izmir eye study.

BACKGROUND: Data from Turkey show that sense organ diseases were the second leading cause of years lost due to disability in 2015. However, there are no reliable data on either the baseline causative disorders of visual impairment or the burden of these disorders on the population in Izmir region. Izmir is the third most populated city of Turkey with a population of approximately 4.2 million. AIM: The purpose of this study was to define the baseline disorders causing low vision and blindness in accordance with World Health Organization criteria in an adult population in Izmir. METHODS: We evaluated the ophthalmologic reports of 20 790 people in Izmir, Turkey. Age- and sex-specific causes of low vision and blindness were identified. RESULTS: Bilateral low vision and blindness was detected in 347 people, 172 males and 175 females. For those aged 18-50 years, retinal dystrophies (37%), congenital eye anomalies (14%) and myopic degenerations (13%) were the most common causes. For those aged 50+ years, age-related macular degeneration (21%) was the leading cause. Diabetic retinopathy (17%), corneal opacities (14%), cataract (12%) and glaucoma (9%) were also important. Sex was not a significant determinant. CONCLUSION: The specific causes of visual impairment vary greatly with age, however, unavoidable retinal pathologies were the predominant causes at all ages.

Weight reduction for a better visual outcome in idiopathic intracranial hypertension.

PURPOSE: To evaluate the correlation between weight reduction and visual outcome in overweight patients with idiopathic intracranial hypertension. METHODS: Thirty-nine newly diagnosed, overweight (body mass index >25 kg/m2) patients with idiopathic intracranial hypertension were studied retrospectively. All patients underwent medical treatment with acetazolamide, and a weight reduction program was also offered. Patients were grouped according to their compliance with this weight reduction program into the diet-success (Group 1) and diet-failure groups (Group 2). Body mass index, papilledema, visual acuity, and perimetric mean deviation were compared at the end of the 6-month study period. RESULTS: Groups 1 and 2 did not differ regarding the baseline mean body mass index (32.63 ± 5.61, 32.35 ± 5.06 kg/m2), visual acuity (0.080 ± 0.13, 0.130 ± 0.24 logMAR), perimetric mean deviation (-9.978 ± 0.68, -12.86 ± 8.91), or papilledema grade (2.94 ± 0.22, 2.90 ± 0.30), respectively (p>0.05). During the 6 months' follow-up, Group 1 patients, who complied with both medical and diet therapy, improved significantly in all parameters, including body mass index (p<0.001), visual acuity (p=0.001), perimetric mean deviation (p=0.016), and papilledema grade (p<0.001). Conversely, Group 2 patients, who only underwent medical therapy, improved only in papilledema grade (p<0.001). However, coincident development of optic disc pallor was observed in three patients. Further, they also had significant loss in visual acuity (p=0.047) during the study period. CONCLUSION: Weight reduction combined with medical treatment is associated with significantly better improvement in visual acuity, visual field, and papilledema in idiopathic intracranial hypertension patients. Compliance with an efficient diet program should be encouraged in overweight patients with idiopathic intracranial hypertension.

Causes of low vision and blindness in a Turkish adult population: the Izmir eye study

Background: Data from Turkey show that sense organ diseases were the second leading cause of years lost due to disability in 2015. However, there are no reliable data on either the baseline causative disorders of visual impairment or the burden of these disorders on the population in Izmir region. Izmir is the third most populated city of Turkey with a population of approximately 4.2 million. Aim: The purpose of this study was to define the baseline disorders causing low vision and blindness in accordance with World Health Organization criteria in an adult population in Izmir. Methods: We evaluated the ophthalmologic reports of 20 790 people in Izmir, Turkey. Age- and sex-specific causes of low vision and blindness were identified. Results: Bilateral low vision and blindness was detected in 347 people, 172 males and 175 females. For those aged 18–50 years, retinal dystrophies [37%], congenital eye anomalies [14%] and myopic degenerations [13%] were the most common causes. For those aged 50+ years, age-related macular degeneration [21%] was the leading cause. Diabetic retinopathy [17%], corneal opacities [14%], cataract [12%] and glaucoma [9%] were also important. Sex was not a significant determinant. Conclusion: The specific causes of visual impairment vary greatly with age, however, unavoidable retinal pathologies were the predominant causes at all ages

Contexte : En Turquie, les données montrent que les maladies des organes des sens représentaient la deuxième cause d'années de vie perdues en raison d'une incapacité en 2015. Cependant, il n'existe de données fiables ni sur les troubles de base à l'origine de la déficience visuelle, ni sur la charge de ces troubles dans la population de la région d'Izmir. Izmir constitue la troisième ville la plus peuplée de Turquie, avec une population d'environ 4,2 millions d'habitants. Objectif : La présente étude avait pour objectif de définir les troubles de base à l'origine d'une faible vision et de la cécité dans une population adulte d'Izmir, selon les critères de l'Organisation mondiale de la Santé. Méthodes : Nous avons évalué les rapports ophtalmologiques de 20 790 personnes à Izmir [Turquie]. Les causes de la faible vision et de la cécité liées à l'âge et au sexe ont été identifiées. Résultats : Une faible vision et une cécité bilatérales ont été détectées chez 347 personnes, dont 172 hommes et 175 femmes. Pour les sujets âgés de 18 à 50 ans, les dystrophies rétiniennes [37 %], les anomalies oculaires congénitales [14 %] et la dégénérescence myopique [13 %] constituaient les causes les plus courantes. Pour ceux âgés de plus de 50 ans, la dégénérescence maculaire [21 %] liée à l'âge était la cause principale. La rétinopathie diabétique [17 %], les opacités cornéennes [14 %], la cataracte [12 %] et le glaucome [9 %] étaient aussi des causes importantes. Le sexe ne constituait pas un déterminant significatif. Conclusion : Les causes spécifiques de la déficience visuelle varient grandement en fonction de l'âge ; néanmoins, les pathologies rétiniennes non évitables étaient les causes prédominantes à tout âge

الخلفية: أسفرت الحرب الدائرة في سوريا عن كثير من التغييرات في الحياة الاجتماعية والاقتصادية للسوريين. ولم توث للعلاقة بين سلوك التدخين والحرب. الهدف: تحديد مدى انتشار تدخين السجائر بين الطلاب الجامعيين خلال الأزمة في دمشق، الجمهورية العربية السورية ، وأثر الحرب على سلوك التدخين. في المرحلة الجامعية من جميع السنوات الدراسية والكليات طالبا1027فل الأسماء على الإنترنت لما مجموعه ْ مغمقطعياطرق البحث: أجرينا مسحا في جامعة دمشق. أن % بالنسبة لتدخين الشيشة (الأرجيلة). وتبين 30.4% بالنسبة لتدخين السجائر، و24.73 النتائج: بلغ المستوى العام لانتشار تدخين التبغ مستوى انتشار تدخين السجائر أعلى بكثير بين الرجال وطلاب غير المهن الطبية والطلاب المغتربين عن أسرهم. ولم تظهر أي اختلافات كبيرة في لمكان نشأتهم (ريفيين مقابل حضريين)، وسنة الدراسة، وتغيير محل الإقامة بسبب الحرب.مستوى انتشار تدخين السجائر عند مقارنة الطلاب وفقا منذ% من المدخنين بزيادة عدد السجائر التي يستهلكونها يوميا53.1، وأفادنة يومياّ ارتباط الحرب بزيادة كبيرة في متوسط عدد السجائر المدخ وتبين خاصة من جانب السلطات المعنية بالصحة وجهودافي مناطق النزاع وقد تتطلب اهتماماإضافياصحيااندلاع الحرب. وتمثل زيادة التدخين شاغلا العمومية. من جانب السلطات المعنية خاصةوجهودافي مناطق النزاع وقد تتطلب اهتماماإضافياصحياالاستنتاجات: تمثل زيادة معدلات التدخين شاغلا بالصحة العامة

Weight reduction for a better visual outcome in idiopathic intracranial hypertension / Redução de peso para a melhora do resultado visual na hipertensão intracraniana idiopática

ABSTRACT Purpose: To evaluate the correlation between weight reduction and visual outcome in overweight patients with idiopathic intracranial hypertension. Methods: Thirty-nine newly diagnosed, overweight (body mass index >25 kg/m2) patients with idiopathic intracranial hypertension were studied retrospectively. All patients underwent medical treatment with acetazolamide, and a weight reduction program was also offered. Patients were grouped according to their compliance with this weight reduction program into the diet-success (Group 1) and diet-failure groups (Group 2). Body mass index, papilledema, visual acuity, and perimetric mean deviation were compared at the end of the 6-month study period. Results: Groups 1 and 2 did not differ regarding the baseline mean body mass index (32.63 ± 5.61, 32.35 ± 5.06 kg/m2), visual acuity (0.080 ± 0.13, 0.130 ± 0.24 logMAR), perimetric mean deviation (-9.978 ± 0.68, -12.86 ± 8.91), or papilledema grade (2.94 ± 0.22, 2.90 ± 0.30), respectively (p>0.05). During the 6 months' follow-up, Group 1 patients, who complied with both medical and diet therapy, improved significantly in all parameters, including body mass index (p<0.001), visual acuity (p=0.001), perimetric mean deviation (p=0.016), and papilledema grade (p<0.001). Conversely, Group 2 patients, who only underwent medical therapy, improved only in papilledema grade (p<0.001). However, coincident development of optic disc pallor was observed in three patients. Further, they also had significant loss in visual acuity (p=0.047) during the study period. Conclusion: Weight reduction combined with medical treatment is associated with significantly better improvement in visual acuity, visual field, and papilledema in idiopathic intracranial hypertension patients. Compliance with an efficient diet program should be encouraged in overweight patients with idiopathic intracranial hypertension.

RESUMO Objetivo: Avaliar a correlação entre a redução de peso e o resultado visual em pacientes com hipertensão intracraniana idiopática e sobrepeso. Métodos: Trinta e nove pacientes, recém-diagnosticados com hipertensão intracraniana idiopática e sobrepeso (índice de massa corporal >25 kg/m2), foram estudados retrospectivamente. Todos os pacientes foram submetidos a tratamento médico com acetazolamida e receberam um programa para redução de peso. Os pacientes foram classificados de acordo com o cumprimento do programa de redução de peso em: sucesso da dieta (Grupo 1) e falha da dieta (Grupo 2). Os índices de massa corporal, a papiledema, a acuidade visual e desvios médios perimétricos foram comparados no final de 6 meses. Resultados: Os grupos não apresentaram diferenças em relação às médias da linha de base de índice de massa corporal (32,63 ± 5,61/32,35 ± 5,06 kg/m2), acuidade visual (0,080 ± 0,13/0,130 ± 0,24 logMAR), desvios médios perimétricos (-9,978 ± 0,68/-12,86 ± 8,91) e níveis de papiledema (2,94 ± 0,22/2,90 ± 0,30) (p>0,05). Durante o período de acompanhamento de 6 meses, os pacientes do grupo 1, que obedeceram as terapias médicas e dietéticas, melhoraram significativamente em todos os parâmetros, incluindo o índice de massa corporal (p<0,001), a acuidade visual (p=0,001), o desvio médio perimétrico (p=0,016) e o nível de papiledema (p<0,001). Por outro lado, os pacientes do grupo 2, que receberam apenas terapia médica, apresentaram melhoras somente no nível de papiledema (p<0,001). No entanto, observou-se o desenvolvimento coincidente de palidez de disco óptico em três pacientes. Além disso, esses pacientes também apresentaram perda significativa de acuidade visual (p=0,047) durante o período de estudo. Conclusão: A redução de peso combinada ao tratamento médico está associada à melhora significativa das acuidades visuais, dos campos visuais e de papiledema em pacientes com hipertensão intracraniana idiopática. O cumprimento de programas de dietas eficientes deve ser encorajado em pacientes obesos com hipertensão intracraniana idiopática.

Risk factors affecting the visual outcome in patients with indirect traumatic optic neuropathy.

PURPOSE: To evaluate the etiology and possible prognostic factors affecting the visual outcome in patients with indirect traumatic optic neuropathy (TON). METHODS: The records of patients with indirect TON were reviewed and compared the results of treatment with high doses of corticosteroids (Group 1) and simple observation without treatment (Group 2). RESULTS: The mean age at the time of injury was 34.7 ± 11.4 (18-58) years in Group 1 and 37.5 ± 17.7 (8-73) years in Group 2 (p = 0.513). The mean value for the first referral of the patient to the ophthalmology clinic following trauma was 2.4 ± 2.4 (1-10) days in Group 1 and 16.7 ± 13.9 (1-30) days in Group 2 (p = 0.004). The most common causes of trauma were road traffic collision (57.1 and 68%) in the Group 1 and 2, respectively (p = 0.606). The mean initial visual acuity was 0.03 ± 0.07 (0.00-0.30) in Group 1 and 0.17 ± 0.21 (0.00-0.80) decimal in Group 2 patients (p = 0.001). The mean visual acuity at the final follow-up was 0.21 ± 0.35 (0.00-1.00) and 0.46 ± 0.42 (0.00-1.00) in Group 1 and Group 2, respectively, indicating better initial and final visual acuity values in Group 2 (p = 0.022), and also a statistically significant recovery of visual acuity between initial and final values in both groups (p < 0.05). The most important determinant of the final visual acuity was initial visual acuity (p < 0.001; 95.0% CI: 0.792-2.096). CONCLUSIONS: Our study demonstrated that road traffic collision is the leading cause of indirect traumatic optic neuropathy, and the best predictor of final visual acuity outcome is the initial visual acuity.

Primary and Secondary Intraocular Lens Implantations in Children With Pediatric Cataract: Visual Acuity and Strabismus at the Age of 2 Years and Older.

PURPOSE: To compare the visual outcomes of primary and secondary intraocular lens (IOL) implantations and to identify the risk factors for the development of strabismus in patients with pediatric cataract. METHODS: The records of the pediatric patients who had undergone cataract surgery between January 1999 and November 2014 were reviewed retrospectively. The results of the cases with cataract extraction with primary IOL implantation (primary group) and cases with secondary IOL implantation (secondary group) were compared and the risk factors for the development of strabismus were investigated. RESULTS: This study included 220 eyes of 148 patients who had surgery for pediatric cataract. The mean age of the patients was 6.84 ± 3.45 years (range: 2 to 17 years) for the primary group at the time of cataract extraction and primary posterior chamber IOL implantation and 8.92 ± 5.12 years (range: 2 to 18 years) for the secondary group at the time of secondary IOL implantation (P = .118). Strabismus developed in 28 patients (23.73%) in the primary group and 9 patients (30%) in the secondary group (P = .702). At the last postoperative examination, Snellen visual acuity was 0.44 and 0.28 for the primary and secondary groups, respectively (P = .013). There was a negative relationship between visual acuity and the development of strabismus (P = .048), whereas there was a positive relationship between the follow-up period and the development of strabismus (P = .008). CONCLUSIONS: Optic rehabilitation of the pediatric cataract is an important factor in the development of strabismus. These cases should be monitored closely. [J Pediatr Ophthalmol Strabismus. 2017;54(2):97-102.].

Development of Strabismus in Children Initially Diagnosed with Pseudostrabismus.

PURPOSE: To evaluate the incidence of strabismus in children initially diagnosed with pseudostrabismus and to identify risk factors for the development of strabismus. METHODS: The medical records of patients who were diagnosed with pseudostrabismus at initial examinations in outpatient clinic were reviewed retrospectively. Follow-up examinations were made at the strabismus department. Age at first examination, gender, family and developmental history, ophthalmic and orthoptic findings including orbit, and eyelid pathologies were investigated. RESULTS: Sixty-five patients with the diagnosis of pseudostrabismus were identified; 2 patients (3.1%) had pseudoexotropia, and 63 patients (96.9%) had pseudoesotropia. The mean age at the initial exam was 29.26±26.68 months (range; 4-120 months). Epicanthal skin folds (n=35), flat broad nasal bridge (n=17), blepharophimosis syndrome (n=1), hypertelorism (n=1), telecanthus (n=1), and multiple pathologies (n=10) were the reasons for pseudostrabismus. Six patients (9.2%) had clinically significant hypermetropia. Anisometropia and amblyopia were detected in 1 (1.5%) and 3 patients (4.6%), respectively, at the initial examination. The mean follow-up period was 25.2±23.28 months (range; 1-154 months). During the follow-up period, true strabismus was detected in 8 cases (12%); of these, 5 cases had non-refractive esotropia, 2 cases had refractive accommodative esotropia, and 1 case had exotropia. Binocular single vision was not developed following amblyopia therapy and refractive correction in esotropic cases. Binocular single vision and best corrected visual acuity were statistically significant risk factors for the development of strabismus (P=0.001). CONCLUSION: The pseudostrabismic children with subnormal binocular single vision or low visual acuity require follow-up for the risk of development of true strabismus.

Anterior segment parameters and eyelids in systemic sclerosis.

To evaluate main numerical parameters of anterior segment and the effects of eyelid skin changes on these parameters in patients with systemic sclerosis (SSc). Thirty-four patients with SSc and 34 healthy individuals were enrolled. Besides full eye examination, anterior segment measurements including anterior chamber depth (ACD), anterior chamber volume, anterior chamber angle width, central corneal thickness, pupil size, corneal volume and keratometry were obtained using a Sirius Scheimpflug/Placido photography-based topography system. Eyelid thickness was evaluated using the scala of the modified Rodnan skin score and the patients were subgrouped with respect to these scores to evaluate the effect of eyelid thickening on the anterior segment parameters. Age and sex distributions of the groups were similar (p > 0.05). SSc patients had steeper and thinner corneas, smaller corneal volumes, narrower, shallower and smaller anterior segments but only the mean ACD value of right eyes was found significantly less than those of the controls (p = 0.047). The mean ACD values of SSc subgroup patients with moderate to severe eyelid thickening (50 %) had lower ACD measurements compared to those of control group. (p = 0.043 for the right eyes, p = 0.070 for the left eyes). However, SSc subgroup patients with none to mild eyelid thickening (50 %) had similar anterior segment parameters with control subjects (p > 0.05). Anterior chamber parameters of the SSc patients could show significant differences. These differences occur parallel to the eyelid changes but not secondary to it.

Visual findings as primary manifestations in patients with intracranial tumors.

AIM: To evaluate the visual findings as primary manifestations in patients with intracranial tumors. METHODS: The medical charts of the patients with intracranial tumors who initially admitted to the Neuro-ophthalmology and Strabismus Department with ocular complaints between August 1999 and December 2012 were reviewed retrospectively. The detailed clinical history and the findings of neuro-ophthalmologic examination were recorded. Ocular symptoms and signs, the types and locations of intracranial tumors, and the duration of symptoms before the diagnosis were evaluated. RESULTS: The mean age of 11 women (61.1%) and 7 men (38.9%) was 42.2±11.0 (range 20-66y) at the time of intracranial tumor diagnosis. Initial symptoms were transient visual obscurations, visual loss or visual field defect in 16 cases (88.9%), and diplopia in 2 cases (11.1%). Neuro-ophthalmologic examination revealed normal optic discs in both eyes of 6 patients (33.3%), paleness, atrophy or edema of optic disc in 12 patients (66.7%), and sixth cranial nerve palsy in 2 patients (11.1%). Visual acuity ranged between normal vision and loss of light perception. Cranial imaging demonstrated craniopharyngioma (n=1), plasmacytoma (n=1), meningioma (n=6; olfactory groove and tuberculum sellae, pontocerebellar angle, anterior cranial fossa, frontal vertex, suprasellar region), and pituitary macroadenoma (n=10). The mean duration between the onset of visual disturbances and the diagnosis of intracranial tumor was 9.8±18mo (range 3d-6y). CONCLUSION: The ophthalmologist is frequently the first physician to encounter a patient with clinical manifestations of intracranial tumors that may cause neurological and ocular complications. Neuro-ophthalmologic findings should be carefully evaluated to avoid a delay in the diagnosis of intracranial tumors.