The effect of hemispheric lesion location on trunk control.

BACKGROUND: Trunk control is the basic component of postural control, and achieving trunk control is a complex process that can be achieved by dynamically building and maintaining neuromuscular function. Lateropulsion, which is also defined as the body falling to one side, is considered an important condition that is frequently encountered after stroke and affects trunk control. It is known that there are differences in the regulation of postural control and trunk control according to hemispheric localization. We had a very specific group of patients and tried to find out the outcomes prospectively in this study. METHODS: The patients were divided into 2 groups those with right hemisphere lesions (Group 1) and those with left hemisphere lesions (Group 2). Comorbidity and cognitive function were evaluated using the Charlson Comorbidity Index (CMI) and Standardized Mini-Mental State Test (SMMSE). Activities of daily living were evaluated using the Turkish version of the Modified Barthel Index (MBI). The Stroke Rehabilitation Assessment of Movement Instrument (STREAM) test was used to assess trunk control and the Brunnstrom (BS) test was used to assess motor functions. RESULTS: There was a significant difference between Groups 1 and 2 in terms of STREAM in lower extremity scores were higher in Group 2 (P < .05). The number of patients in BS lower extremity Stages IV-VI was higher in Group 1 and Group 2 (P < .05). It was determined that upper extremity, lower extremity and Total STREAM scores and BS Hand stage in Group 2 were significantly higher than Group 1 in patients with total middle cerebral artery (MCA) affected(P < .05). CONCLUSION: It was determined that trunk control was more affected in patients with right hemispheric lesions. Additionally, trunk control is significantly affected in patients with total MCA lesions.

The Role of Optic Nerve Diffusion Restriction on Visual Prognosis in Methanol Poisoning.

The aim of this study was to investigate the role of optic nerve diffusion status on cranio-orbital magnetic resonance imaging (MRI) in predicting visual prognosis in cases of methanol intoxication. Diffusion-weighted imaging (DWI) from 16 eyes of eight patients who were admitted to our clinic due to methanol intoxication was analysed retrospectively. The relationship between clinical and laboratory findings, treatment regimen, visual prognosis, and imaging findings was investigated. Diffusion restriction (DR) of the optic nerve on DWI was observed in seven (43%) eyes. Regardless of the clinical and laboratory characteristics and treatment regimen, visual acuity (VA) improved in eyes in which restricted diffusion regressed over the follow-up period. DWI of the optic nerve during the acute phase of methanol poisoning may provide prognostically important data. Improvement of DR during follow-up may be an indicator of an increase in VA.

Wide-Field Fluorescein Angiography in Patients with Idiopathic Acute Anterior Uveitis.

PURPOSE: To elucidate whether wide-field fluorescein angiography (WFFA) can yield additional information in patients with newly diagnosed idiopathic acute anterior uveitis (AAU). METHODS: The WFFA was performed in patients with idiopathic AAU, and the findings were analyzed according to the scoring system by Angiography Scoring for Uveitis Nomenclature. RESULTS: Forty-four eyes of 30 patients (22 eyes of 13 patients in the pediatric group and 22 eyes of 17 patients in the adult group) were studied. The mean age was 12.41 ± 3.92 (range, 5-18) years in the pediatric group and 42.36 ± 32.07 (range, 24-68) years in the adult group. Thirteen eyes (59%) of pediatric patients and 12 eyes (54%) of adult patients showed some evidence of posterior segment activity on the WFFA (p = .764).     Systemic treatment was administered in 53.8% of the pediatric and 5.9% of adult patients, depending on the disease severity. CONCLUSION: Pediatric patients with idiopathic AAU may have subtle posterior segment manifestations more than adult patients, and posterior segment findings may affect the treatment preferences of physicians.

Can trunk control scales differentiate for dependent and independent ambulation in ischemic stroke patients?

Objectives: This study aimed to compare the ability of trunk control scales (TCSs) to distinguish independent ambulation and investigate whether there was a relationship between TCSs and activities of daily living in patients with stroke. Patients and methods: The prospective, cross-sectional study was conducted with a total of 126 patients (52 females, 74 males; mean age: 64.9±10.7 years; range, 40 to 88 years) between August 2018 and January 2020. According to their ability to walk 10 m, the patients were divided into three groups: the nonambulatory group (Group 1, n=31), those who required an assistive device while walking (Group 2, n=35), and those who could walk independently (Group 3, n=60). The Stroke Rehabilitation Assessment of Movement Instrument (STREAM), Postural Assessment Scale for Stroke Patients Scale (PASS), Trunk Impairment Scale, Trunk Recovery Scale, Trunk Control Test, and Modified Barthel Index (MBI) were used to determine the relationship between TCSs and activities of daily living. Results: The median TCS scores differed between the groups; the lowest score was of Group 1, and the highest score was of Group 3 (p

Therapeutic and prognostic features in myasthenia gravis patients followed in a tertiary neuromuscular diseases center in Turkey.

Introduction: In this study, we aim to evaluate the treatment responses and prognostic characteristics of Myasthenia Gravis (MG) patients followed in a tertiary neuromuscular diseases center in Turkey. Methods: One hundred seventy four MG patients (between years 2011 and 2022) in Antalya, Turkey were diagnosed, and evaluated on a classification of MG was based on Myasthenia. Gravis Foundation of America (MGFA) clinical classification. Exclusion of other possible diseases in the differential diagnosis and support by beneficial response to treatment with acetylcholinesterase inhibitors were also taken into consideration. Results: Mean age of participants was 54.86 (SD = 14.856; min-max = 22-84). Ninety (51.7%) were female. MG was more common in women under the age of 65 (58%) and in men over the age of 65 (64%). Generalized MG was seen in 75.3% of the patients. Anti-AChR positivities were detected in 52.3%, Anti-MuSK positivity in 4.6%, and seronegativity in 22.4%. Thymoma was detected in nearly 9.8% and thymectomy was performed in 28.7 percent. Most of the patients (57.5%) were using corticosteroids. Azathioprine was used by 39% and mycophenolate mofetil by 10.3% of patients. Mortality was higher and disease was more severe in late-onset (>50 years) MG patients (especially in the COVID-19 pandemic). Eight patients (four women, four men, mean age 75.5 years) died during follow-up. None of them died due to myasthenic worsening, two died due to malignancy and two due to infection. During the COVID pandemic, 16 patients (9.2%) had COVID infection. Four patients died due to COVID-19 infection, these four patients had serious comorbidities, and three of them were elderly (>75 years). Conclusion: In conclusion, MG is more common in women between the ages of 20-40 and in men over the age of 65. The use of corticosteroids was more common under the age of 50, and the use of non-steroidal immunosuppressant agents was more common over the age of 50. Thymectomy is still an important supportive treatment approach in anti-AChR positive and seronegative generalized patients under 50 years of age. IVIG and plasmapheresis are effective treatments during acute exacerbations and bridging periods of treatments. Specific treatments are needed especially for resistant group of patients.

Dexamethasone intravitreal implant for macular edema and some other rare indications in uveitis.

In the present study, 110 eyes of 81 patients with uveitis who underwent intravitreal dexamethasone implant (IDI) injection and had a follow-up of at least 6 months between January, 2012 and September, 2022, were retrospectively analyzed. A total of 298 IDI injections were administered (mean, 2.71±2.37; range, 1-12). The mean age of the patients was 49.44±16.67 years (range, 15-86 years). The mean follow-up time after the first IDI was 34.31±26.53 months (range, 6-115 months). In total, 77 (95.1%) patients had non-infectious uveitis, while 4 patients (4.9%) received IDI for uveitic macular edema in association with infectious uveitis (1 patient with acute retinal necrosis and 3 patients with systemic tuberculosis). IDI was injected under the umbrella of intravitreal ganciclovir injection in the patient with healed acute retinal necrosis for the associated pseudophakic cystoid macular edema. A total of 6 patients (7.4%) received IDI prior to phacoemulsification surgery to control the possible post-operative macular edema. In addition, 3 patients (3.7%) with Vogt-Koyanagi-Harada disease received bilateral IDI as the systemic therapy could not be administered due to side-effects of the systemic treatment. In total, 1 patient (1.2%) with idiopathic retinal vasculitis, aneurysms and neuroretinitis was treated with IDI injections in both eyes in addition to systemic therapy to reduce the ongoing inflammation. Of note, two eyes (1.8%) received simultaneous single IDI and anti-vascular endothelial growth factor administration for the treatment of unilateral extrafoveal macular neovascularization (one with active serpiginous choroiditis and one with sympathetic ophthalmia). IDI was administered for the treatment of uveitic macular edema in 68 patients (83.9%). Best-corrected visual acuity improved from 0.69±0.64 to 0.60±0.76 logMAR at the final visit (P=0.008). Baseline mean central macular thickness (CMT) was 499.74±229.60 µm (range, 187-1,187 µm) and the mean final CMT was 296.60±152.02 µm (range, 126-848 µm). Intraocular pressure elevation requiring topical antiglaucomatous eye drops occurred in 28 eyes (25.5%). During the follow-up period, bilateral glaucoma surgery was required in 1 patient (1.2%) and 25 of 65 phakic eyes (38.4%) underwent phacoemulsification. Retinal detachment occurred in one eye (0.9%), endophthalmitis in one eye (0.9%), and transient intravitreal hemorrhage occurred in three eyes (2.7%) after the IDI injections. On the whole, the present study demonstrates that although IDI is mostly employed in non-infectious uveitic eyes with macular edema, it can also be administered in cases with systemic therapy intolerance, pseudophakic macular edema prophylaxis, and with great caution, in selected cases involving infectious uveitis and macular edema.

Is the clinical course of non-arteritic ischemic optic neuropathy associated with oxidative damage and the dynamics of the antioxidant response?

PURPOSE: Oxidative stress is known to be a decisive factor in the wide etiopathogenesis of optic neuropathy. This study aimed to comprehensively evaluate the interaction of optic neuropathy's clinical course with systemic oxidative damage and antioxidant response dynamics in a large series. METHODS: This case-controlled clinical study included 33 non-arteritic anterior ischemic optic neuropathy (NAION) patients and 32 healthy individuals. Extensive systemic oxidation profiles were statistically compared between the two groups, and correlations between the clinical and biochemical data in the study group were analyzed. RESULTS: Vitamin E and malondialdehyde (MDA) levels were significantly higher in the study group. Significant correlations were observed in the analyses between clinical findings and oxidative stress parameters. Correlations between vitamin E and intraocular pressure (IOP), between B12 and cup-to-disk ratio (c/d), between antioxidant glutathione and superoxide dismutase (SOD) enzyme systems, and between uric acid (UA) and age were found to be very significant. As significant correlations were found in either clinical and biochemical data or in oxidative stress parameters, correlations between vitamin E and cholesterol, MDA were found to be very significant. CONCLUSIONS: This study not only supplies significant information regarding oxidative damage and antioxidant response in NAION, but also points out the specific interactions of neuromodulators, like vitamin E, in intracellular signaling pathways and regulation mechanisms. A better reading of these connections may help improve diagnosis, follow-ups and treatment criteria and strategies.

Evaluation of the corneal biomechanical properties and corneal thickness in patients with Graves' orbitopathy.

PURPOSE: To evaluate the corneal biomechanical properties and central corneal thickness in patients with Graves' orbitopathy (GO). METHOD: A total of 132 eyes of 66 patients with GO and 108 eyes of 54 healthy subjects were enrolled. Eyes with GO were classified as high score clinical activity score (CAS, ≥ 3) (Group 1, n = 64) and low CAS score (< 3) (Group 2, n = 68). Corneal biomechanical parameters [corneal hysteresis (CH), corneal resistance factor (CRF)], Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated IOP (IOPcc) levels were measured with Ocular Response Analyzer (ORA, Reichert Ophthalmic Instruments, Buffalo, NY) and compared between the groups. RESULTS: The mean CH values were found as 9.6 ± 1 mmHg in Group 1, 10.2 ± 0.9 mmHg in Group 2, and 11.4 ± 1.7 mmHg in the Control Group (p < 0.001). In post hoc analysis the mean CH was significantly lower in Group 1 than Group 2 and Control Group (Group 1-Group 2, p < 0.001; Group 1-Control Group, p < 0.001). The mean CRF was found as 10.5 ± 2.1 in Group 1, 10.4 ± 2.2 in Group 2, and 10.43 ± 2.0 in the Control group. There was no statistically significant difference between the groups in CRF measurements (p = 0.959). The mean IOPcc values were found as 17.1 ± 3.6 mmHg in Group 1, 15.8 ± 4.0 mmHg in Group 2 and 15.2 ± 4.1 mmHg in the Control Group. The IOPcc and IOPg measurements between all groups were statistically significant (p = 0.009, p = 0.027, respectively). CONCLUSIONS: Corneal biomechanical measurements were different in the GO patients with varying CAS scores compared to healthy individuals.

Optic neuritis in CD59 deficiency: an extremely rare presentation.

BACKGROUND: CD59 is the principal cell inhibitor of complement membrane attack on cells. Stroke, peripheral neuropathy, and recurrent central nervous system attacks have been reported in patients with inherited CD59 deficiency. In this paper, we report a patient with CD59 deficiency associated with two attacks of demyelinating peripheral neuropathy and the third attack as an isolated optic neuritis. CASE: An 8-month-old girl whose sibling died at 12th month of age with recurrent weakness episodes responsive to intravenous immune globulin treatment, presented with weakness in legs and poor sucking. Weakness episodes with neurogenic electromyography suggested CD59 deficiency. Immunophenotypic analysis with flow cytometry showed CD59 deficiency. Sanger sequencing of CD59 gene revealed a homozygous c146delA (p.Asp49Valfs*32) mutation. First two attacks were treated with intravenous immunoglobulin therapy without any sequalae. Third attack was an isolated optic neuritis which could not be explained by any other entity. The patient had no response to intravenous immunoglobulin but benefited from pulse steroid therapy. Eculizumab was started every two weeks in order to prevent possible advanced attacks and to reduce their severity. CONCLUSION: Although it is a rarely reported disease, better recognition of CD59 deficiency by pediatric neurologists is necessary because it is curable. In addition to different presentations reported, optic neuritis may also be a manifestation of CD59 deficiency.

Accidentally diagnosed ocular abnormalities identified during close screening for retinopathy of prematurity.

PURPOSE: To report the variety of ocular findings which have been identified serendipitously during the screening for retinopathy of prematurity (ROP) in a tertiary referral center during seven-year period. METHODS: The charts of 1568 preterm infants who screened for ROP were reviewed retrospectively. Any ocular lesion except for ROP were noted. All infants had undergone routine ocular examination of the external eye, pupillary light reflex, anterior and posterior segment. Wide-angle digital retinal image acquisition system for any vitreoretinal pathology requiring a close follow-up had been utilized. RESULTS: Abnormal ocular findings other than ROP were diagnosed in 296 infants (19.2%). Tunica vasculosa lentis was the most common finding (25%) followed by vitreous or retinal hemorrhages (17.2%) and retinal white lesions (16.6%). Retina was the most frequently involved anatomic site. Other frequent ocular findings included optic disc cupping, congenital cataract, optic nerve hypoplasia, choroidal nevus, persistent fetal vasculature, lid hemangioma, and tilted disc. However, life-threatening pathologies such as lipemia retinalis and even retinoblastoma were also diagnosed. CONCLUSION: A duly ophthalmologic examination is mandatory in premature infants for ROP screening. During such examinations, ophthalmologists must be aware of coexisting ocular findings; which could be sight-threatening or even life-threatening.

Autoimmune encephalitis and paraneoplastic syndromes in Turkey: a multi-centre study.

BACKGROUND: Autoimmune encephalitis (AIE) and paraneoplastic syndromes (PNS) are both rare groups of neurological diseases that are difficult to diagnose. AIM: We aimed to determine the common and distinct aspects of these two aetiologies of encephalitis as well as the characteristics of our patient group. METHODS: We respectively analysed the records of the patients including symptoms, demographic features, neurological examination, cranial-magnetic-resonance-imaging (MRI), electroencephalography (EEG) findings, cerebrospinal fluid results (CSF) findings. Autoimmune/paraneoplastic autoantibodies in blood and/or CSF were all documented. RESULTS: Forty-six patients fulfilled the diagnostic criteria. Thirty-eight of them were diagnosed with AIE, and 8 of them were diagnosed with PNS. The PNS group had higher nonconvulsive status epilepticus than the AIE (2/8 vs 0/38; p=0.027). PNS patients were diagnosed with a malignancy in their follow-ups more than those in the AIE group [4/38 vs 8/8] (p<0.001). When the symptoms of antibody-positive and negative patients were compared in the AIE group, the rates of consciousness/memory problems (13/15 vs 11/23; p=0.020) and speech impairment (8/15 vs 2/23; p=0.004) were significantly higher in patients without antibodies (n: 15) than in antibody-positive patients (n: 23). In antibody-negative groups, the rates of memory problems in neurological examination (13/15 vs 12/23 p=0.028) and temporal findings on electroencephalography were more prominent than antibody-positive groups (1/23 vs 5/15; p=0.027). The number of patients with cerebellar signs was higher in antibody-positive patients (6/23 vs 0/15; p=0.038). CONCLUSION: Although the positivity of autoantibodies is critical in the diagnosis of AIE and PNS, even minor differences in clinical and laboratory findings of patients are helpful in the diagnosis, especially in the autoantibody-negative patients. Comparing the data with other population studies has shown that several inherited and environmental factors may contribute to the pathophysiology of AIE and PNS, as well as clinical and laboratory differences.

Adult Spinal Primary Leptomeningeal Medulloblastoma Presenting as Pseudotumour Cerebri Syndrome.

A previously well 34-year-old man presented with severe pseudotumour cerebri. Imaging showed that he had a cauda equina tumour which proved to be a medulloblastoma. There was no tumour mass in the posterior fossa so we assume that this was a primary leptomeningeal medulloblastoma. In patients with somewhat atypical pseudotumour, spinal imaging should always be considered.

Effects of lumbar lordosis increment on gait deteriorations in ambulant boys with Duchenne Muscular Dystrophy: A cross-sectional study.

BACKGROUND: Increment of lumbar lordosis, a frequent spinal finding in Duchenne Muscular Dystrophy (DMD), is a compensatory mechanism secondary to muscle weakness. However, excessive lumbar lordosis may change the position of the center of mass, and lead to balance and walking difficulties. OBJECTIVE: To study the relationship between factors that may influence ambulatory function in boys with DMD and to investigate the effects of lumbar lordosis increment on gait and balance perturbations. METHODS: Twenty-one ambulant patients with DMD and 10 healthy boys were included. Lumbar lordosis and thoracic kyphosis angles, dynamic and static balance tests, ambulatory function, muscle strength, and disease severity were assessed. Usage of steroids and orthotic devices were recorded. Scoliosis was assessed on radiographs. Receiver operator characteristic curves were formed and area under curve (AUC) measurements were performed to assess the ability of the tests to discriminate ambulatory status and optimal cut-off values were established according to the Youden index. RESULTS: The amount of lumbar lordosis correlated strongly and negatively with quality of ambulation (r = -0.710) and moderately with performance on balance tests. The strength of both upper limbs and lower limbs muscles were not associated with any of the variables. According to the AUC analysis, patients with a lumbar lordosis higher than 36° had worse scores on gait and dynamic balance tests. CONCLUSION: Ambulation and dynamic balance are negatively affected by the increment of lumbar lordosis with a cut-off point of 36°in boys with DMD.

CyberKnife Stereotactic Radiotherapy in Secondary Vasoproliferative Tumor of the Retina.

A 16-year-old boy with X-linked retinoschisis was examined for the visual decline on his left eye. Upon examination, a vasopermeable elevated mass lesion was determined at the lower temporal retinal periphery associated with surrounding arc-like hard exudates which is consistent with a vasoactive proliferative tumor of the retina. After discussing the therapeutic options with the patient and his parents, 3 successive dexamethasone implants 6 months apart were administered. As no satisfactory regression was noticed, CyberKnife stereotactic radiosurgery (SRS) was performed. Regression of the exudative tumor was obtained in follow-up examinations at 12 and 24 months after the SRS session and the thickness of the lesion was markedly reduced.

Unilateral Purtscher-like retinopathy as the presenting feature of a case with spontaneous carotid artery dissection.

Carotid artery dissection should be considered in the differential diagnosis when a clinician faces with a case presenting with a unilateral Purtscher-like retinopathy.

Patients with cerebrotendinous xanthomatosis diagnosed with diverse multisystem involvement.

Cerebrotendinous xanthomatosis (CTX) is a lipid storage disease caused by deficiency of sterol 27-hydroxylase enzyme encoded by CYP27A1 gene. This multicenter, cross-sectional descriptive study aimed to document clinical characteristics of CTX patients of different ages, clinical presentations of early-diagnosed patients, and responses to short-term chenodeoxycholic acid (CDCA) treatment. Seven of 11 CTX patients were diagnosed in childhood. Three patients (27%) had neonatal cholestasis, seven (63%) patients had a history of frequent watery defecation started in infantile period, and eight (72.7%) patients had juvenile cataract. Four patients in the adult age group had pyramidal signs and parkinsonism symptoms. The mean Mignarri score at diagnosis was significantly lower in the pediatric patients (267.8 ± 51.4) than in the adult patients (450.0 ± 64.0, p = 0.001). No significant difference was determined between pediatric patients and adult patients regarding plasma cholestanol concentration at diagnosis (p = 0.482). The frequency of defecation decreased with treatment in six children, who had diarrhea at admission. Compared to pretreatment values, patients' body weight and standardized body mass index significantly increased at the 12th month of treatment. In conclusion, Mignarri scores are lower in the pediatric patients than in adult patients since the most determinative signs of the CTX disease are not apparent yet in the childhood. The disease is frequently overlooked in routine practice as the disease presents itself with different clinical combinations both in adults and in children. CTX is potentially a treatable disease; thereby, enhanced awareness is critically important for early diagnosis particularly in children.

Complete blood count parameters to predict retinopathy of prematurity: when to evaluate and what do they tell us?

PURPOSE: To evaluate the relationship of novel inflammatory markers neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with retinopathy of prematurity (ROP) development and requirement for laser photocoagulation (LP) treatment. METHODS: The charts of infants screened for ROP were reviewed retrospectively, and 120 newborns who had complete blood count (CBC) data in the first 24 hours after delivery (early period) and between 35 and 37th gestational weeks (late period) were included. Study population consisted of 34 infants who required LP for ROP treatment, 52 newborns with ROP that regressed without treatment, and 34 controls who did not developed any ROP stages. Demographics, etiological factors and CBC data including NLR and PLR values were noted. Risk factors for ROP development and treatment requirement were investigated using logistic regression analyses. RESULTS: Significantly lower NLR was found in ROP cases compared to non-ROP group during late period (p = 0.003), while there was no difference in NLR during early period (p = 0.298). No significant difference was observed in PLR during both early and late periods (p = 0.230 and p = 0.349, respectively). Multivariate analysis revealed daily weight gain as major risk factor for ROP development (p = 0.001; OR: 0.870, 95% CI: 0.799-0.947), and hyperbilirubinemia as an independent risk factor for LP requirement (p = 0.045; OR: 0.204, 95% CI: 0.043-0.966). CONCLUSION: NLR or PLR does not appear to be predictive risk factors for treatment requirement in cases with ROP. CBC values during first 24 h of life may be misleading; therefore, a late period CBC is recommended to evaluate prognostic factors for ROP development.

Intraocular Lens Opacification Following Silicone Oil Endotamponade.

BACKGROUND AND OBJECTIVE: To report cases with intraocular lens (IOL) opacification following silicone oil (SO) endotamponade. PATIENTS AND METHODS: Medical charts of 32 eyes with IOL opacification were evaluated retrospectively. All eyes had rhegmatogenous retinal detachment and had a history of previous hydrophilic acrylic IOL implantation. All patients underwent vitrectomy with SO endotamponade. Clinical features of all cases and the results of histochemical evaluation of explanted IOLs were reported. RESULTS: The mean duration of SO endotamponade was 4.6 ± 2.0 months. The mean follow-up was 67.0 ± 23.5 months. The interval between phacoemulsification surgery and IOL opacification was 27.4 ± 18.3 months. With the exception of two eyes, all IOL opacification was detected during the follow-up period after SO removal. IOL exchange was performed in 12 eyes (37.5%). Histochemical analysis revealed significant calcification mostly on the surface of explanted IOL optics. CONCLUSION: Vitreoretinal surgeons should be aware of that some hydrophilic IOLs may have the potential of opacification following SO endotamponade. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:37-43.].

Optic nerve sheath decompression saves sight in severe papilloedema: results from 81 eyes in 56 patients with pseudotumor cerebri.

PURPOSE: To report the outcome of optic nerve sheath decompression (ONSD) for papilloedema in a teaching hospital in western Turkey. METHODS: The charts of 56 patients who had ONSD surgery between April 2007 and September 2019 were collated; and a total of 81 operated and 31 fellow eyes were included. Pre- and postoperative ophthalmologic examination including best-corrected visual acuity (BCVA), colour vision (CV), visual field (VF) analysis, fundoscopic examination and demographic and medical characteristics of the patients were noted and outcomes after surgery were investigated. RESULTS: Of all study eyes, 49 (43.7%) eyes had BCVA 0.2 or less and 62 (55.3%) eyes had mean deviation (MD) below - 20.0 dB. 62 (55.3%) eyes had Frisen grade 4 or 5 papilloedema. Almost half of the eyes had severe vision loss. After ONSD, BCVA, CV and MD in both operated and fellow non-operated eyes improved significantly (p < 0.001, p = 0.009 and p < 0.001 for operated, p < 0.001, p = 0.007 and p < 0.001 for fellow eyes, respectively). Earlier surgery and higher cerebrospinal fluid opening pressure were related to better outcomes. None of the patients had major operative complications. CONCLUSION: Optic nerve sheath decompression can safely improve vision not only of the operated but also of the non-operated eye, even in cases with severe vision loss from severe bilateral papilloedema. Regardless of initial VA and VF, patients may benefit from ONSD; the earlier it is done the more likely the better outcome.

A small incision technique for repairing involutional lower eyelid entropion.

PURPOSE: The objective of this paper is to describe and review our experience with Goldberg's small incision technique for use with involutional entropion. METHODS: Retrospective consecutive interventional case series with validated late surgical outcomes were reported. All involutional entropion cases with horizontal laxity of less than 8 mm were repaired with a small incision technique. Retractors were separated from the tarsus by blunt dissection made from three 4 mm horizontal incisions. Three 6-0 double-armed polyglactin sutures were used to tighten retractors and the orbicularis oculi muscle. The sutures were removed 3 weeks postoperatively or earlier if overcorrection continued during the first week of the postoperative period. Data were obtained for a postoperative follow-up period of at least 24 months. RESULTS: A total of thirty-seven lower eyelids from thirty-one patients with involutional entropion were included in the study. Primary operations were performed on 31 eyelids and reoperations on six eyelids. The mean follow-up time was 40 ± 11 months. Thirty-six (97.3%) of the eyelids had no recurrence. As overcorrection was seen postoperatively in ten eyelids (27%), a number of sutures had to be removed earlier than planned. The ectropion eventually resolved, and no recurrence was seen during follow-up in these patients. CONCLUSIONS: In our practice, the small incision technique has been highly effective in involutional entropion repair, with minimal complications. Although this approach does not directly address lateral canthal tendon laxity, the procedure has the advantages of being easy to learn and also that it can be combined with other procedures for tendon laxity.