Inferior oblique anterior transposition according to a different grading scale for hyperdeviation with inferior oblique overaction.

OBJECTIVE: To define an inferior oblique anterior transposition (IOAT) grading scale in patients with hyperdeviation and inferior oblique overaction (IOOA), which we planned based on the data we obtained in our previous retrospective study. DESIGN: Prospective cohort study. PARTICIPANTS: Thirty-eight patients who underwent graded IOAT. METHODS: The patients were divided into 5 groups according to the amount of hyperdeviation in the primary position (PPHD). The inferior oblique muscle was transposed 2 mm posterior, 1 mm posterior parallel, 1 mm anterior, and 2 mm anterior to the inferior rectus insertion, respectively. Surgical success was defined as success (PPHD ≤3 PD), partial success (PPHD >3 and ≤6 PD), and nonsuccess (PPHD >6 PD). RESULTS: The mean amount of hyperdeviation correction in groups after IOAT was 9.50 ± 0.9 PD (range, 8-10 PD), 12.43 ± 1.5 PD (range, 11-14 PD), 16.67 ± 1.4 PD (range, 15-18 PD), 19.57 ± 1.7 PD (range, 16-21 PD), and 22.57 ± 5.8 PD (range, 14-30 PD), respectively. Surgical success was achieved in 34 patients (89.5%) after surgery, partial success was achieved in 3 patients (7.9%), and nonsuccess was observed in 1 patient (2.6%). All patients in our study had unilateral IOOA preoperatively, and IOOA developed in the contralateral eye of 9 patients (23.7%) during postoperative follow-up. In group 5, 4 patients (57.1%) developed -2 upgaze limitation, but surgery was not required. CONCLUSIONS: A high success rate can be achieved with this grading of IOAT in primary and secondary IOOA cases accompanying hyperdeviation in the primary position.

Impact of serous macular detachment on visual recovery in retinal vein occlusion treatment / O impacto do descolamento macular seroso na recuperação visual no tratamento de oclusões de veias retinianas

ABSTRACT Purpose: The aim of this study was to evaluate the effect of serous macular detachment observed during retinal vein occlusion on treatment results. Methods: A total of 117 eyes from 115 patients who had been treated with intravitreal injections for macular edema secondary to retinal vein occlusion were retrospectively reviewed. Visual acuity, optical coherence tomography, and fundus fluorescein angiography findings were evaluated according to the status of serous macular detachment. Results: In the branch retinal vein occlusion group, a statistically significant increase was detected in the mean visual acuity compared to the baseline value at each visit in the absence of serous macular detachment, whereas the increase in the mean visual acuity was significant only at the 3- and 6-month visits in the presence of serous macular detachment. In the central retinal vein occlusion group, there was an increase in the mean visual acuity compared to the baseline value at every visit in the absence of serous macular detachment, whereas the mean visual acuity decreased compared to the baseline value at every visit except at the 3-month visit in the presence of serous macular detachment. The ellipsoid zone defect was more prominent in the presence of serous macular detachment in eyes with branch retinal vein occlusion, whereas there was no significant difference in the ellipsoid zone in the absence or presence of serous macular detachment in eyes with central retinal vein occlusion. Conclusions: In the group with macular edema due to retinal vein occlusion, the initial mean visual acuity increase observed in the first year was maintained in cases without serous macular detachment but not in those with serous macular detachment. Serous macular detachment could be a negative factor in eyes with retinal vein occlusion.

RESUMO Objetivo: Avaliar o efeito do descolamento macular seroso observado durante oclusões de veias retinianas nos resultados do tratamento. Métodos: Um total de 117 olhos de 115 pacientes que foram tratados com injeções intravítreas para edema macular secundário à oclusão de veia retiniana foram revistos retrospectivamente. A acuidade visual, tomografia de coerência óptica e os resultados da angiofluoresceinografia foram avaliados de acordo com a presença ou ausência de descolamento macular seroso. Resultados: No grupo com oclusão de um ramo da veia retiniana, foi detectado um aumento estatisticamente significativo na acuidade visual média em comparação com o valor inicial em cada consulta de acompanhamento do descolamento macular seroso, enquanto que o aumento na acuidade visual média só foi significativo nas consultas aos 3 e 6 meses na presença de descolamento macular seroso. No grupo com oclusão da veia central da retina, houve um aumento na acuidade visual média em comparação com a acuidade inicial em cada consulta na ausência de descolamento macular seroso, enquanto a acuidade visual média diminuiu em comparação com a acuidade inicial em todas as consultas, exceto na consulta aos 3 meses. O defeito da zona elipsoide era mais proeminente na presença de descolamento macular seroso nos olhos com oclusão de um ramo da veia retiniana, enquanto que não havia diferença significativa na zona elipsoide com a presença ou ausência de descolamento macular seroso em olhos com oclusão central da veia retiniana. Conclusões: No grupo com edema macular devido à oclusão de veias retinianas, o aumento médio inicial da acuidade visual observado no primeiro ano foi mantido nos casos sem descolamento macular seroso, mas não naqueles com presença de descolamento macular seroso. O descolamento macular seroso pode ser um fator negativo em olhos com oclusão de veias retinianas.

Evaluation of Aerobic Conjunctival Flora in Patients with Demodex Blepharitis

Objective: Demodex species are frequently found in blepharitis cases. This study aimed to compare the conjunctival flora of eyes with Demodex-positive blepharitis and Demodex-negative blepharitis with healthy individuals. Methods: Eyelash epilation was performed to detect Demodex from 44 eyes of 44 patients with chronic blepharitis and 44 eyes of 44 healthy controls and examined under a microscope. A conjunctival swab was taken from the same eye and inoculated on eosin methylene blue agar, Sabouraud dextrose agar, chocolate agar, and 5% sheep blood agar. Aerobic conjunctival flora was evaluated among Demodex-positive blepharitis, Demodex-negative blepharitis and healthy eyes. Results: Demodex spp. was detected in 3 (6.8%) of 44 healthy controls and 24 (54.5%) of 44 patients with blepharitis. The most frequently isolated bacteria in healthy controls were coagulase-negative Staphylococci (CNS) spp. (n=32, 72.7%), Streptococcus spp. (n=16, 36.4%), Corynebacterium spp. (n=13, 29.5%). The most frequently isolated bacteria in Demodex-positive blepharitis were CNS spp. (n=14, 58.3%), Staphylococcus aureus (n=11, 45.8%), Corynebacterium spp. (n=7, 29.2%). In Demodex-negative blepharitis, CNS (n=10, 50.0%), S. aureus (n=10, 50.0%), Corynebacterium spp. (n=5, 25.0%) were most commonly isolated. S. aureus growth was significantly increased in the Demodex negative and positive blepharitis groups compared with the healthy group (p=0.001 and p=0.002, respectively). Although CNS spp. growth decreased in both groups with Demodex-negative and positive blepharitis compared with the healthy group; the decrease was significant only in those with Demodex-negative blepharitis (p=0.045). In terms of other bacterial growth, there was no significant difference between healthy eyes and Demodex positive and negative eyes with blepharitis. Conclusion: We found that Demodex blepharitis has no significant effect on conjunctival flora. Blepharitis itself may be the main factor in changes in the conjunctival flora.

Prediction of Pentacam image after corneal cross-linking by linear interpolation technique and U-NET based 2D regression model.

Keratoconus is a common corneal disease that causes vision loss. In order to prevent the progression of the disease, the corneal cross-linking (CXL) treatment is applied. The follow-up of keratoconus after treatment is essential to predict the course of the disease and possible changes in the treatment. In this paper, a deep learning-based 2D regression method is proposed to predict the postoperative Pentacam map images of CXL-treated patients. New images are obtained by the linear interpolation augmentation method from the Pentacam images obtained before and after the CXL treatment. Augmented images and preoperative Pentacam images are given as input to U-Net-based 2D regression architecture. The output of the regression layer, the last layer of the U-Net architecture, provides a predicted Pentacam image of the later stage of the disease. The similarity of the predicted image in the final layer output to the Pentacam image in the postoperative period is evaluated by image similarity algorithms. As a result of the evaluation, the mean SSIM (The structural similarity index measure), PSNR (peak signal-to-noise ratio), and RMSE (root mean square error) similarity values are calculated as 0.8266, 65.85, and 0.134, respectively. These results show that our method successfully predicts the postoperative images of patients treated with CXL.

Impact of serous macular detachment on visual recovery in retinal vein occlusion treatment.

PURPOSE: The aim of this study was to evaluate the effect of serous macular detachment observed during retinal vein occlusion on treatment results. METHODS: A total of 117 eyes from 115 patients who had been treated with intravitreal injections for macular edema secondary to retinal vein occlusion were retrospectively reviewed. Visual acuity, optical coherence tomography, and fundus fluorescein angiography findings were evaluated according to the status of serous macular detachment. RESULTS: In the branch retinal vein occlusion group, a statistically significant increase was detected in the mean visual acuity compared to the baseline value at each visit in the absence of serous macular detachment, whereas the increase in the mean visual acuity was significant only at the 3- and 6-month visits in the presence of serous macular detachment. In the central retinal vein occlusion group, there was an increase in the mean visual acuity compared to the baseline value at every visit in the absence of serous macular detachment, whereas the mean visual acuity decreased compared to the baseline value at every visit except at the 3-month visit in the presence of serous macular detachment. The ellipsoid zone defect was more prominent in the presence of serous macular detachment in eyes with branch retinal vein occlusion, whereas there was no significant difference in the ellipsoid zone in the absence or presence of serous macular detachment in eyes with central retinal vein occlusion. CONCLUSIONS: In the group with macular edema due to retinal vein occlusion, the initial mean visual acuity increase observed in the first year was maintained in cases without serous macular detachment but not in those with serous macular detachment. Serous macular detachment could be a negative factor in eyes with retinal vein occlusion.

An Algorithm Recommendation to Detect Specific Pathology of the Lacrimal Sac.

ABSTRACT: We aimed to recommend an efficient algorithm to detect the presence of specific pathologies of the lacrimal sac (LS). The charts of 296 patients who had undergone LS biopsy were reviewed retrospectively. The age, gender, history, examination and radiological findings, sac appearance, and pathology results of the patients were recorded. The power of our data to predict the presence of potential specific pathology was identified by regression analysis. After the causality evaluation of the statistical results, an algorithm was created to differentiate specific LS pathologies from chronic dacryocystitis. Our algorithm was mainly formed by deciding on radiological examination and biopsy according to the risk scoring created by the examination findings. A specific LS pathology was observed in 11 (3.7%) patients. When we applied the recommended algorithm to cases with a suspicion of specific pathology and/or found to have a specific pathology, 36.4% of the patients would not require radiological examination and 29.6% of them would not require a biopsy. On the other hand, 80% of the frozen biopsies had been conducted on cases without a specific pathology. Managing the cases according to our algorithm would mean that frozen biopsy would be recommended in only 1 (12.5%) case without a specific pathology. Besides, the detection of cases with a specific pathology would not be prevented and the necessary diagnostic procedures would continue to be performed. Specific LS pathologies can be detected adequately, whereas decreasing unnecessary examinations and procedures in cases without a specific pathology by using our algorithm.

Screening for Combination Cancer Therapies With Dynamic Fuzzy Modeling and Multi-Objective Optimization.

Combination therapies proved to be a valuable strategy in the fight against cancer, thanks to their increased efficacy in inducing tumor cell death and in reducing tumor growth, metastatic potential, and the risk of developing drug resistance. The identification of effective combinations of drug targets generally relies on costly and time consuming processes based on in vitro experiments. Here, we present a novel computational approach that, by integrating dynamic fuzzy modeling with multi-objective optimization, allows to efficiently identify novel combination cancer therapies, with a relevant saving in working time and costs. We tested this approach on a model of oncogenic K-ras cancer cells characterized by a marked Warburg effect. The computational approach was validated by its capability in finding out therapies already known in the literature for this type of cancer cell. More importantly, our results show that this method can suggest potential therapies consisting in a small number of molecular targets. In the model of oncogenic K-ras cancer cells, for instance, we identified combination of up to three targets, which affect different cellular pathways that are crucial for cancer proliferation and survival.

Correlation between intraocular pressure obtained with water drinking test versus modified diurnal tension curve measurement in pseudoexfoliation glaucoma.

PURPOSE: The aim of this paper was to study the correlation and agreement between the intraocular pressure (IOP) peak value and fluctuations detected with the modified diurnal tension curve (mDTC) and the water drinking test (WDT) in pseudoexfoliation glaucoma (XFG) patients. METHODS: This prospective observational study enrolled 42 eyes of 42 XFG patients. The IOPs were measured at 2-h intervals from 8 am to 4 pm with a Goldmann applanation tonometer by a single observer to establish the mDTC. The WDT was then performed between 4 and 5 pm on the same day and the IOP was measured 4 times at 15-min intervals after water ingestion. The IOPpeak, IOPmean, IO min, and IOPfluctuation were measured with both the mDTC and WDT. The paired sample t test, Spearman's correlation coefficient and Bland-Altman plots were used for statistical analysis. RESULTS: The mean age of the 42 patients consisting of 24 females and 18 males was 66.9 ± 6.8 years, and the mean central corneal thickness was 517.7 ± 29.1 µm. The mean values with the mDTC and WDT measurements were 15.05 ± 2.75 mmHg and 17.17 ± 3.25 mmHg (p ≤ 0.0001, r = 0.884) for IOPmean, 16.76 ± 3.45 mmHg and 18.92 ± 3.94 mmHg (p ≤ 0.0001, r=0.787) for IOPpeak, and 13.61 ± 2.56 mmHg and 15.11 ± 2.84 mmHg (p ≤ 0.0001, r=0.824) for IOPmin, respectively, and a positive correlation was present between these values. CONCLUSION: There was a positive correlation between the peak, minimum, and mean IOP values determined using the mDTC and WDT in treated XFG patients. WDT can be used as an alternative in the assessment of the IOP in these patients as a more practical method.

Brown syndrome: clinical features and results of superior oblique tenotomy / Síndrome de Brown: quadro clínico e resultados da tenectomia do oblíquo superior

ABSTRACT Purpose: This study was conducted to further define the specific clinical characteristics of patients with Brown syndrome and evaluate the outcomes of superior oblique tenotomy in its surgical management. Methods: A retrospective analysis of the medical charts of 45 patients with Brown syndrome was performed, which revealed that 11 patients underwent superior oblique tenotomy due to abnormal head posture and/or hypotropia and 1 patient underwent bilateral superior oblique tendon elongation with a silicone band due to abnormal head posture. In the last patient, silicone bands were removed at the postoperative 3rd month due to the lack of improvement in the abnormal head posture and the limitation of elevation in adduction. Simultaneous horizontal rectus muscle surgery was performed in four patients. Results: There was a predominance of female gender, right eye, congenital form, unilaterality, A-pattern, and an abnormal head posture type with a combination of chin up and head tilting. Bilateral form was observed only in female patients. Amblyopia was detected in two patients. Among patients aged >5 years, 40% had reduced stereopsis. Abnormal head posture was found in 60% of patients. More than half of them were diagnosed with a vertical and/or horizontal deviation. Tenotomy procedure eliminated the abnormal head posture in all patients and significantly improved the mean limitation of elevation in adduction and hypotropia (p=0.001, p=0.012). Two patients developed inferior oblique overaction in the operated eye. There was complete spontaneous resolution in two patients. Conclusions: The clinical features of patients with Brown syndrome in our study are considerably consistent with those of previous reports. The present study demonstrated the effectiveness of superior oblique tenotomy with less overcorrection in the surgical treatment of Brown syndrome.(AU)

RESUMO Objetivo: Definir mais detalhadamente as características clínicas específicas de pacientes com síndrome de Brown e avaliar os resultados da tenectomia do músculo oblíquo superior no manejo cirúrgico da síndrome de Brown. Métodos: Prontuários de 45 pacientes com síndrome de Brown foram analisados retrospectivamente. Onze pacientes submetidos à tenectomia do músculo oblíquo superior devido a postura anormal da cabeça ou a hipotropia e um paciente submetido ao alongamento bilateral do tendão do oblíquo superior com uma faixa de silicone devido a postura anormal da cabeça. Neste último paciente, a faixa de silicone foi removida no terceiro mês pós-operatório devido à ausência de melhora na postura anormal da cabeça e à limitação da elevação em adução. Quatro pacientes submeteram-se simultaneamente à cirurgia do músculo reto horizontal. Resultados: Houve predominância de sexo feminino, olho direito, forma congênita, acometimento unilateral, padrão em "A" e um tipo de postura anormal da cabeça combinando queixo elevado e inclinação da cabeça. A forma bilateral foi vista apenas em pacientes do sexo feminino. Foi constatada ambliopia em 2 pacientes. Dentre os pacientes acima de 5 anos de idade, 40% tinham estereopsia reduzida. Postura anormal da cabeça estava presente em 60% dos pacientes. Mais da metade dos pacientes foi diagnosticada com um desvio vertical, horizontal ou ambos. O procedimento de tenectomia eliminou a postura anormal da cabeça em todos os pacientes e melhorou significativamente a limitação média da elevação em adução e a hipotropia (p=0,001 e p=0,012). Dois pacientes desenvolveram hiperação do músculo oblíquo inferior no olho operado. Resolução completa ocorreu espontaneamente em 2 pacientes. Conclusões: O quadro clínico dos pacientes com síndrome de Brown no nosso estudo é bastante consistente com os relatos iniciais na literatura. Este estudo mostrou a eficácia da tenectomia do oblíquo superior, com menor hipercorreção no tratamento cirúrgico da síndrome de Brown.(AU)

Comparison of the simultaneous conjunctiva and oropharynx-nasopharynx swab results in patients applying to the SARS-CoV-2 outpatient clinic for the first time.

The aim is to comparatively evaluate the results of simultaneous conjunctiva and oropharynx-nasopharynx (ONP) swabs in patients who had presented to the outpatient department with a suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). An ONP sample was obtained following bilateral conjunctiva swabs in 85 subjects with a contact history or symptoms but unknown SARS-CoV-2 status and with no ocular symptoms or findings. The results were evaluated according to the patient's symptoms and how the swab was taken. The conjunctiva swab was positive in 29 (34.1%) cases and the ONP swab in 20 (23.5%) cases. Both methods produced positive results in 11 (14.1%) cases. The mean cycle threshold (Ct ) value was 30.15 ± 3.41 in symptomatic cases and 33.62 ± 1.76 in asymptomatic cases (p = .008). The mean Ct value was 24.37 ± 3.48 when only the ONP swab was positive and 31.22 ± 1.99 when only the conjunctiva swab was positive. In cases that were positive by both methods, the mean Ct value was 25.21 ± 4.94 for the ONP swab and 30.29 ± 5.05 for the conjunctiva swab. We found higher SARS-CoV-2 detection rates with the conjunctiva swab than the ONP swab in cases with unknown SARS-CoV-2 status in the early period. In addition, the conjunctival viral load seemed to be higher in symptomatic cases than in asymptomatic cases. We, therefore, believe a conjunctiva swab could be an alternative method to detect SARS-CoV-2 at the time of the first presentation to the outpatient department.

Brown syndrome: clinical features and results of superior oblique tenotomy.

PURPOSE: This study was conducted to further define the specific clinical characteristics of patients with Brown syndrome and evaluate the outcomes of superior oblique tenotomy in its surgical management. METHODS: A retrospective analysis of the medical charts of 45 patients with Brown syndrome was performed, which revealed that 11 patients underwent superior oblique tenotomy due to abnormal head posture and/or hypotropia and 1 patient underwent bilateral superior oblique tendon elongation with a silicone band due to abnormal head posture. In the last patient, silicone bands were removed at the postoperative 3rd month due to the lack of improvement in the abnormal head posture and the limitation of elevation in adduction. Simultaneous horizontal rectus muscle surgery was performed in four patients. RESULTS: There was a predominance of female gender, right eye, congenital form, unilaterality, A-pattern, and an abnormal head posture type with a combination of chin up and head tilting. Bilateral form was observed only in female patients. Amblyopia was detected in two patients. Among patients aged >5 years, 40% had reduced stereopsis. Abnormal head posture was found in 60% of patients. More than half of them were diagnosed with a vertical and/or horizontal deviation. Tenotomy procedure eliminated the abnormal head posture in all patients and significantly improved the mean limitation of elevation in adduction and hypotropia (p=0.001, p=0.012). Two patients developed inferior oblique overaction in the operated eye. There was complete spontaneous resolution in two patients. CONCLUSIONS: The clinical features of patients with Brown syndrome in our study are considerably consistent with those of previous reports. The present study demonstrated the effectiveness of superior oblique tenotomy with less overcorrection in the surgical treatment of Brown syndrome.

Computed Tomography Diagnostic Abilities for Open-Globe Injuries in Pediatric Versus Adult Patients.

OBJECTIVES: The aim of this study was to compare the role of computed tomography (CT) in the diagnosis of open-globe trauma and intraocular foreign body (IOFB) in pediatric and adult age groups. METHODS: Medical records of cases with open-globe trauma at Inonu University Hospital's Ophthalmology Emergency Service were retrospectively evaluated. Preoperative orbital CT images of the cases obtained at emergency services and their clinical and/or surgical findings were compared in pediatric and adult groups. RESULTS: We included 47 eyes of 47 cases aged 18 years and below (pediatric group) and 85 eyes of 82 cases over 18 years (adult group). The mean ± SD age was 10.80 ± 5.11 years (range, 2-18 years) in the pediatric group and 46.34 ± 19.01 years (range, 19-82 years) in the adult group. Computed tomography images revealed 21.7% of the cases with corneal lacerations, 55.5% with scleral lacerations, and 91.6% with corneoscleral lacerations in the pediatric group, whereas the respective numbers were 48.4%, 66.6%, and 61.9% in the adult group. The detection rates of corneal penetrations and vitreous hemorrhage with CT were significantly lower in the pediatric group than in the adult group (P < 0.05). The CT scans diagnosed 66.6% of the pediatric cases and 90% of the adult cases with an IOFB. CONCLUSIONS: Corneal lacerations and IOFBs can be missed, especially in the pediatric group, because the eye is smaller in adults. Pediatric patients with a history of ocular trauma should undergo an examination under general anesthesia followed by surgical exploration if necessary.

Effect of inferior oblique anterior transposition in correcting vertical hyperdeviation in primary position.

OBJECTIVE: To evaluate the effect of inferior oblique anterior transposition (IOAT) on improvement of vertical hyperdeviation in primary position. METHODS: This study was a retrospective review and included 35 eyes of 33 patients (18 males and 15 females). Patients with dissociated vertical deviation were not included in the study. Preoperative and postoperative average follow-up was 11.46 ± 11.73 and 11.43 ± 9.73 months, respectively. The eyes were divided into 5 groups according to the amount of transposition. Inferior oblique muscle was transpositioned 2 mm posterior to the inferior rectus insertion in group 1; 1 mm posterior to the inferior rectus insertion in group 2; parallel to the inferior rectus insertion in group 3; 1 mm anterior to the inferior rectus insertion in group 4; and 2 mm anterior to the inferior rectus insertion in group 5. RESULTS: The mean preoperative and postoperative vertical hyperdeviation were 16.52 ± 5.54 and 0.97 ± 2.34 prism diopters (PD), respectively. The mean preoperative vertical hyperdeviation in group 1, group 2, group 3, group 4, and group 5 was 11.0 ± 4.24, 12.88 ± 4.26, 16.63 ±3.50, 19.83 ± 2.71, and 25.5 ± 3.00 PD, respectively. Postoperatively, improvement in vertical hyperdeviation in group 1, group 2, group 3, group 4, and group 5 was 11.0 ± 4.24, 11.63 ± 3.20, 15.46 ± 3.19, 18.17 ± 2.23, and 25.5 ± 3.00 PD, respectively. The vertical hyperdeviation had improved 100% in group 1; 90.2% in group 2; 92.9% in group 3; 91.59% in group 4; and 100% in group 5. CONCLUSION: IOAT surgery planned according to hyperdeviation amount has effective and predictable results in correcting vertical hyperdeviation in primary position.

Bifid mandibular condyle: a case report.

A case of left bifid mandibular condyle (BMC) is reported in a 36-year-old female. The patient had a history of trauma in childhood. From the radiological examination, the left condyle was seen to have two anterioposteriorly situated heads. BMC is an extremely rare condition, where the condyle is duplicated or lobulated. The literature on BMC is reviewed, and possible cause of trauma and consequences of the anomaly are discussed.

[Pneumosinus dilatans]. / Pnömosinüs dilatans.

Pneumosinus dilatans is a localized abnormal dilatation of paranasal sinuses which contains only air and is covered with normal epithelium. We presented the X-ray, CT and MRI findings of three cases with pneumosinus dilatans secondary to arachnoid cyst and meningioma. When evaluating the patients with long-lasting symptoms, pneumosinus dilatans should be considered.