Scleral-fixated intraocular lens implantation with "irregular, knotless, zigzag-shaped scleral tunnel suture technique" combined with pars plana vitrectomy or anterior vitrectomy.

PURPOSE: This study aims to introduce a new suture method and report surgical outcomes of patients who underwent scleral-fixated intraocular lens (SF-IOL) implantation combined with either pars plana vitrectomy (PPV) or anterior vitrectomy (AV). METHODS: Twenty-three eyes performed SF-IOL implantation combined with PPV (Group 1), and 34 eyes performed SF-IOL implantation combined with AV (Group 2) were included in the study prospectively. The SF-IOL, either polymethyl methacrylate or foldable IOL, was sutured into the sclera using PC-9 sutures in an irregular, knotless, and zigzag-shaped manner. The scleral tunnel was approximately 12-15 mm long, with at least four sharp edges. Suture tips were trimmed within the scleral tunnel. Postoperative outcomes and complications were evaluated. RESULTS: Both groups showed no complications such as suture tip expulsion, suture reaction, IOL dislocation, or increased intraocular pressure during postoperative visits. Group 1 exhibited a statistically significant improvement in visual acuity compared to preoperative values (P = 0.036 for the 1st month, <0.001 for the 3rd month). Similarly, Group 2 demonstrated a statistically significant improvement in visual acuity compared to the preoperative period (P = 0.001 for the 1st month, <0.001 for the 3rd month). CONCLUSION: The "irregular, knotless, and zigzag-shaped scleral tunnel suture technique" yielded favorable results in terms of IOL stability and visual acuity. This technique can be safely employed in patients undergoing SF-IOL implantation combined with PPV or AV.

Double Flip Technique for Graft Transfer in Autograft Pterygium Surgery.

A 50-year-old man with recurrent pterygium and a 46-year-old woman with primary pterygium underwent surgery using a novel autograft transfer technique that facilitates autograft suturing and ensures correct graft orientation. After removing the pterygium, three edges of the autograft were cut. The autograft was flipped first over the uncut edge and secured to the superior margin of the recipient bed with two sutures. Afterward, the fourth side of the graft was cut and the second flip was done over the sutured edge. Thus, the autograft was in correct surface and side orientation and was sutured to the recipient bed. This simple technique provides both easy transfer and correct orientation of the graft in autograft pterygium surgery.

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.

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)

Optimal timing of capsular tension ring implantation in pseudoexfoliation syndrome / Momento ideal para implante de anel de tensão capsular na síndrome pseudoesfoliativa

ABSTRACT Purpose: The aim of this study was to evaluate the appropriate timing of capsular tension ring implantation in cases of zonular weakness due to pseudoexfoliation syndrome. Methods: This prospective, comparative study was performed at the Ophthalmology Department of Inonu University, Malatya, Turkey. There were 43 patients included in the study. Group 1 (16 patients) had early capsular tension ring implantation, and group 2 (27 patients) had late capsular tension ring implantation. Patients with pseudoexfoliation syndrome who underwent phacoemulsification surgery, posterior chamber intraocular lens implantation, and capsular tension ring implantation were included in the study. Intraoperative complications and difficulties with either capsular tension ring implantation or cortex removal were evaluated in each eye. Results: There was no significant difference between the groups in the difficulty of capsular tension ring implantation (p=0.124). The difficulty of cortex removal differed significantly between the groups (p=0.003). Intraoperative complications were observed in 3 patients in group 1 and 11 patients in group 2; the difference between the groups was not significant (p=0.18). Posterior capsule fluctuations were observed in 8 patients (29.5%) in group 2, which resulted in posterior capsule rupture in 2 patients. Conclusions: Cortex removal is more difficult with early capsular tension ring implantation, and posterior capsule fluctuations may cause problems with late capsular tension ring implantation. The surgeon must consider the risk-to-benefit ratio of early versus late insertion for the optimal timing of capsular tension ring implantation.

RESUMO Objetivo: Avaliar o momento apropriado para implante de anel de tensão capsular em casos de fraqueza zonular devida à síndrome pseudoesfoliativa. Métodos: Este foi um estudo prospectivo e comparativo realizado no Departamento de Oftalmologia da Universidade İnönü. Foram incluídos 43 pacientes, sendo 16 no grupo 1 e 27 no grupo 2. O grupo 1 era composto de pacientes que se submeteram ao implante precoce do anel de tensão capsular, enquanto no grupo 2 os pacientes tiveram implante tardio. Foram incluídos pacientes com síndrome pseudoesfoliativa submetidos à cirurgia de facoemulsificação e ao implante de lente intraocular na câmara posterior e anel de tensão capsular. Em cada olho, foram avaliadas as complicações intraoperatórias e as dificuldades tanto com a implantação do anel de tensão capsular quanto com a remoção do córtex. Resultados: Não houve diferença significativa entre os grupos quanto à dificuldade de implante do anel de tensão capsular (p=0,124). Ao se comparar as remoções do córtex, observou-se diferença significativa entre os grupos (p=0,003). Complicações intraoperatórias foram observadas em 3 pacientes do grupo 1 e 11 pacientes do grupo 2; porém, não houve diferença significativa entre os grupos (p=0,18). No grupo 2, observaram-se flutuações da cápsula posterior em 8 pacientes (29,5%), com ruptura da cápsula posterior em dois deles. Conclusões: A remoção do córtex é mais difícil no implante precoce do anel de tensão capsular e flutuações da cápsula posterior podem causar problemas no implante tardio do anel de tensão capsular. O cirurgião deve ponderar a relação risco/benefício do implante precoce e tardio ao avaliar o momento ideal para implante de anel de tensão capsular.

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.

Optimal timing of capsular tension ring implantation in pseudoexfoliation syndrome.

PURPOSE: The aim of this study was to evaluate the appropriate timing of capsular tension ring implantation in cases of zonular weakness due to pseudoexfoliation syndrome. METHODS: This prospective, comparative study was performed at the Ophthalmology Department of Inonu University, Malatya, Turkey. There were 43 patients included in the study. Group 1 (16 patients) had early capsular tension ring implantation, and group 2 (27 patients) had late capsular tension ring implantation. Patients with pseudoexfoliation syndrome who underwent phacoemulsification surgery, posterior chamber intraocular lens implantation, and capsular tension ring implantation were included in the study. Intraoperative complications and difficulties with either capsular tension ring implantation or cortex removal were evaluated in each eye. RESULTS: There was no significant difference between the groups in the difficulty of capsular tension ring implantation (p=0.124). The difficulty of cortex removal differed significantly between the groups (p=0.003). Intraoperative complications were observed in 3 patients in group 1 and 11 patients in group 2; the difference between the groups was not significant (p=0.18). Posterior capsule fluctuations were observed in 8 patients (29.5%) in group 2, which resulted in posterior capsule rupture in 2 patients. CONCLUSIONS: Cortex removal is more difficult with early capsular tension ring implantation, and posterior capsule fluctuations may cause problems with late capsular tension ring implantation. The surgeon must consider the risk-to-benefit ratio of early versus late insertion for the optimal timing of capsular tension ring implantation.

Aripiprazole-induced transient myopia.

This study aims to present a case of transient myopia due to aripiprazole used in the treatment of depression. A 21-year-old female who was being treated for depression with 15 mg/day Aripiprazole during two months. She normally used -3.75 D glasses. She was admitted to our outpatient clinic with sudden onset blurring of vision in both eyes despite using glasses for about three days. Using of aripiprazole was observed in the patient's history. She was found to have myopia of -6.0 diopters in both eyes with measurement of otorefractometer; her visual acuity was 6/10 in both eyes with her glasses. The other eye examination findings of the patient were normal. The drug was discontinued, and the patient was followed. One mount later on examination, the patient's visual acuity increased to 10/10 in both eyes. Following the first day of the Alx values measured were 0.3 mm longer than one month after the measurement; the minimal difference between the other anterior segment findings were recorded. Although the specific mechanisms that cause acute myopia has not been fully revealed, it can be ciliary spasm, ciliary bodies effusion, peripheral uveal effusion and effects of ocular serotonergic intraneural fibers. We believe that it would be important for clinicians. They should keep in mind these conditions when prescribing aripiprazole and need to inform patients about the side effects related to the eye.

Surgical Management of Primary Inferior Oblique Muscle Overaction: A Subgroup-Specific Surgical Approach.

OBJECTIVES: The aim of this research was to assess the surgical results of recession and myectomy procedures in a subgroup of patients who had primary inferior oblique muscle overaction. METHODS: The records of 94 patients who had been treated due to primary inferior oblique muscle overaction were retrospectively analyzed. The patients were classified into 2 groups according to the severity of the inferior oblique hyperfunction. Recession was performed for patients with a low grade (+1 or +2) inferior oblique hyperfunction, and patients with high grade (+3 or +4) hyperfunction underwent myectomy surgery. Patients demonstrating a horizontal misalignment underwent conventional horizontal muscle surgery along with an inferior oblique weakening procedure. RESULTS: A total of 134 eyes fulfilled the inclusion criteria. Recession was performed in 95 eyes and myectomy in 39. Surgical success was obtained in 96.8% of the eyes that underwent recession and 97.4% of the eyes that underwent myectomy. Residual inferior oblique hyperfunction was observed in 3 eyes after recession and in 1 eye after myectomy. After surgery, about one-quarter of the patients with unilateral inferior oblique overaction subsequently developed a contralateral inferior oblique overaction. CONCLUSION: The results of this study demonstrated that both recession and myectomy procedures are effective for treating primary inferior oblique hyperfunction with minimal complications when applied in the appropriate patient.

Estimation of angle kappa and pupil barycentre configuration in myopic tilted disc syndrome.

BACKGROUND: To evaluate the angle kappa and pupil barycentre configuration in patients with myopic tilted disc syndrome (TDS). METHODS: Thirty-five eyes of 35 patients with TDS were included in the study. Thirty-five eyes of 35 age- and sex-matched healthy subjects were enrolled in the control group. All measurements were performed with the Lenstar LS 900. Angle kappa was calculated according to Pythagorean theorem using the x and y co-ordinates of the pupil centre. Pupil dx and pupil dy values (pupil dx: x co-ordinate of pupil centre relative to corneal apex, pupil dy: y co-ordinate of pupil centre relative to corneal apex) were used to evaluate the pupil barycentre configuration. Central corneal thickness, white to white (cornea diameter), pupil diameter, anterior chamber depth, lens thickness, and axial length were also measured. RESULTS: The calculated mean angle kappa distance was 0.27 ± 0.15 mm in the TDS group and 0.29 ± 0.23 mm in the control group (p = 0.42). The mean pupil dx was -0.01 ± 0.24 mm in the TDS group and -0.17 ± 0.14 mm in the control group (p = 0.006). The mean pupil dy was -0.02 ± 0.13 mm in the TDS group and -0.05 ± 0.22 mm in the control group (p = 0.65). CONCLUSIONS: The pupil barycentre in TDS cases was statistically significantly closer to the corneal vertex on the horizontal plane compared to the control group. However, there was no statistically significant differences in terms of angle kappa and pupil dy values between the groups. According to our results, refractive surgery can be performed safely with respect to complications related to decentration of ablation zone and decentration of multifocal intraocular lenses in these groups of patients.

Effect of Fasting on Contrast Sensitivity in Healthy Males.

PURPOSE: To evaluate the effect of fasting on contrast sensitivity (CS) in healthy male individuals during the month of Ramadan. METHODS: This study included 45 healthy male individuals, aged between 20 and 40 years, working in the same environment. Functional acuity contrast testing (F.A.C.T) was performed using the Optec 6500 vision testing system. Measurements taken during a state of satiety one week before Ramadan were compared with those taken a minimum of 12 hours after the start of fasting in the first and fourth weeks of Ramadan. RESULTS: Contrast sensitivity (CS) was increased at the spatial frequency of three cycles per degree (cpd) at the end of the first week of Ramadan in comparison to the CS measured before Ramadan ( P = 0.03). The mean CS values were increased at the spatial frequencies of 3 and 12 cpd at the end of the last week of Ramadan in comparison to the mean values measured before Ramadan ( P = 0.01 for both). CONCLUSION: Although we found statistically significant increases in CS at certain frequencies, we can conclude that Ramadan fasting has no negative effects on CS.

Inferior Oblique Muscle Overaction: Clinical Features and Surgical Management.

PURPOSE: To further define the clinical features of patients with inferior oblique muscle overaction (IOOA) and evaluate the surgical results in a subgroup of these patients. METHODS: The medical records of 173 patients who underwent inferior oblique muscle (IO) weakening surgery due to primary or secondary IOOA were retrospectively reviewed. The patients were assigned a surgical group based on severity of IOOA and presence of dissociated vertical deviation (DVD) or hypertropia. Patients with +1 or +2 IOOA underwent recession, patients with +3 or +4 IOOA underwent myectomy, and patients with any grade of IOOA and DVD or hypertropia underwent anterior transposition (AT) surgery. RESULTS: A total of 286 eyes of 173 patients who underwent surgery due to IOOA were included in the study. IOOA was accompanied by esotropia, exotropia, abnormal head posture (AHP), pattern strabismus, convergence insufficiency, DVD, facial asymmetry, and nystagmus. The most common comorbid disorder was esotropia. The recession was used in 173 eyes, myectomy in 64, and AT in 49. Surgical success was obtained in 96.0% of eyes that underwent recession, in 98.4% of eyes that underwent myectomy, and in 93.9% of eyes that underwent AT. In the follow-up, IOOA occurred in the fellow eye in 36.1% of patients who underwent unilateral surgery. CONCLUSIONS: This study is a comprehensive report on the concomitants of the IOOA. Also, it showed that all of the three surgical procedures including recession, myectomy, and AT are effective in the surgical management of IOOA when performed in select patient groups.

Familial association of keratoconus and granular corneal dystrophy: The familial case series.

OBJECTIVE: The aim of the present study was to evaluate the coexistence of bilateral keratoconus and granular corneal dystrophy (GCD) in the members of a family. METHODS: A total of 22 patients were examined in four generations of the family tree in this family screening study. Visual acuity test, biomicroscopic examination, and fundus examination were performed in all patients. The diagnosis of granular dystrophy was based on biomicroscopic examination findings. Corneal topography was performed on the patients diagnosed with granular dystrophy and other family members aged >5 years with normal examination findings. Corneal photographs were obtained from all patients with granular dystrophy except one case. RESULTS: Keratoconus or subclinical keratoconus was detected in seven cases. In addition, GCD type 1 was found in six of the seven cases. All patients diagnosed with keratoconus and granular dystrophy were females. On the other hand, there was no ophthalmologic problem in the men of the family tree. Although an autosomal dominant inheritance was found, the onset of the disease only in women suggests that there may be a variant expression. CONCLUSION: The present study showed an association of GCD and keratoconus in four generations of a family. More research is required to further explain this association.

Measurement of Contrast Sensitivity in Patients with Behçet's Disease without Ocular Involvement.

PURPOSE: To evaluate contrast sensitivity in patients with Behçet's disease (BD) without ocular involvement. METHODS: The study group was composed of 47 BD patients (20 to 50 years of age) who did not have ocular involvement. The control group was composed of 47 normal volunteers who were similar to the study group in terms of age and gender. No participants in this study had any ocular or systemic pathologies except for BD. The contrast sensitivity measurements were performed using the Functional Acuity Contrast Test under photopic conditions, and the results were compared between the two groups. RESULTS: The mean age of the BD patients and control subjects was 34.5 ± 9.7 and 33.2 ± 7.6 years, respectively. The mean disease duration of the BD patients was 5.5 ± 6.4 years. There was a statistically significant decrease at five spatial frequencies (A, 1.5; B, 3; C, 6; D, 2; and E, 18 cycles per degree) in patients with BD compared with control subjects (p < 0.001, p = 0.004, p = 0.002, p < 0.001, and p = 0.001, respectively). CONCLUSIONS: The contrast sensitivity of BD patients without ocular involvement was lower than that of the control group. Further studies seem mandatory to confirm our results.

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.

Duane Retraction Syndrome: Clinical Features and a Case Group-Specific Surgical Approach.

PURPOSE: To describe the clinical features of patients with Duane retraction syndrome (DRS) and evaluate the outcomes of surgical approaches based on the characteristics of each patient. METHODS: The records of 38 Caucasian subjects with DRS were retrospectively reviewed. The patients were classified as type I, II, or III based on the Huber Classification. Ten patients underwent unilateral medial rectus (MR) recession due to abnormal head posture (AHP) and/or esotropia. Four patients underwent Y-splitting and recession of the lateral rectus (LR) with MR recession due to AHP and/or esotropia, upshoot, and globe retraction. RESULTS: There was a preponderance of unilaterality, female gender, left eye, type I, orthotropia, upshoot, and low refractive error. All patients demonstrated globe retraction and fissure narrowing. AHP was only present in unilateral cases. Nine patients had amblyopia. More than half of the patients over 5 years of age had decreased stereopsis. MR recession decreased AHP to less than 8° in all patients. Y-splitting and recession of the LR eliminated upshoot in all four patients. One patient who underwent an 8-mm MR recession demonstrated -2 adduction limitation. CONCLUSIONS: The DRS patients in our study demonstrated features that are consistent with previous reports in the literature. This study emphasizes the need to consider disease classification in the surgical management of DRS patients.

Corneal endothelial changes in patients with vitamin D deficiency.

Purpose: The purpose of this study is to evaluate the effect of vitamin D deficiency on corneal endothelial layer using specular microscopy. Methods: Fifty-eight eyes of 58 patients whose vitamin D level was below 15 ng/ml and who had no ocular pathology were included in the study (Group 1). Forty eyes of 40 age-and sex-matched subjects were enrolled as control group (Group 2). Corneal endothelial cell density (CD), coefficient of variation (CV), hexagonal cell ratio (HEX), and central corneal thickness (CCT) were measured using specular microscopy (Konan Medical Inc., Nishinomiya, Japan). The obtained data were compared between the groups. Results: There was no significant difference between the groups in terms of age and gender (P = 0.344, P = 0.399, respectively). The mean CD value was 2772.79 ± 202.21 cells/mm2 in Group 1 and 2954.97 ± 116.89 cells/mm2 in Group 2 (P = 0.001). The mean CV value was 30.31 ± 3.65 in Group 1 and 28.20 ± 2.71 in Group 2 (P = 0.003). The mean HEX value was 46.56 ± 6.32 in Group 1 and 51.07 ± 5.28 in Group 2 (P = 0.001). The mean CCT value was 555.87 ± 36.90 µ in group 1 and 549.0 ± 37.39 µ in Group 2 (P = 0.96). Conclusion: Vitamin D deficiency may affect the corneal endothelial layer. Patients with vitamin D deficiency should be evaluated for endothelial parameters in particular before an intraocular surgery. Further studies are needed to confirm our results.

Corneal Endothelial Changes in Behçet's Patients with Inactive Ocular Involvement.

PURPOSE: The purpose of this article is to evaluate alterations in the corneal endothelial layer in Behçet's disease (BD) with inactive ocular involvement using specular microscopy. MATERIALS AND METHODS: Thirty-three eyes of 33 BD patients who had at least one anterior segment involvement and no active inflammation in the last 3 months were included in the study (group 1). Twenty-seven of the 33 BD patients had an anterior uveitis attack and six of them had a panuveitis (both anterior and posterior involvement) attack. Thirty-three eyes of 33 age- and sex-matched healthy subjects were enrolled in the control group (group 2). Corneal endothelial cell density (CD), coefficient of variation (CV), hexagonal cell ratio (HEX), and central corneal thickness (CCT) were measured using specular microscopy (Konan Medical, Nishinomiya, Japan), and the results were compared between groups. RESULTS: The mean CD was 2739 ± 164.18 cells/mm2 in group 1 and 2922 ± 107.60 cells/mm2 in group 2 (p = 0.001). The mean CV was 32.9 ± 4.76 in group 1 and 28.5 ± 3.06 in group 2 (p = 0.001). The mean HEX was 44.7 ± 6.51 in group 1 and 49.7 ± 6.10 in group 2 (p = 0.019). The mean CCT was 545.75 ± 40.89 µ in group 1 and 545.66 ± 30.09 µ in group 2 (p > 0.05). CONCLUSIONS: Ocular attacks in our BD patients may have caused permanent changes in the corneal endothelial layer. However, these changes did not lead to corneal decompensation, but further studies are necessary to confirm these results.

The influence of corneal collagen cross-linking on anterior chamber in keratoconus.

AIMS: This study aimed to evaluate the effect of the corneal changes following corneal cross-linking (CXL) on the anterior chamber in keratoconus patients. MATERIALS AND METHODS: Forty-five eyes of 32 patients who had been diagnosed with progressive keratoconus and had undergone CXL were included in this retrospective study. The thinnest corneal thickness of the progressive keratoconus patients included in the study was >400 µ. The preoperative (T0), postoperative 6th month (T1), and postoperative 1st year (T2) anterior chamber volume (ACV), anterior chamber angle (ACA), and anterior chamber depth (ACD) scheimpflug imaging values were obtained for each eye. RESULTS: The mean T0 ACV value was 182.79 ± 36.68 mmwhile the T1 value was 201.25 ± 41.73 mm3 and the T2 value was 208.40 ± 42.69 mm3 with a statistically significant difference between the periods (P = 0.001). The mean T0 ACA value was 38.64° ±5.85°, increasing to 41.45° ±4.83° in the T1 and 42.10° ± 4.84° in the T2. The T0 value was significantly lower than the post-CXL values (P = 0.003). The mean ACD value was 3.73 ± 0.29 mm at the T0 and 3.82 ± 0.38 mm at the T1 and 3.84 ± 0.36 mm at the T2. The pre-CXL values were significantly lower than the post-CXL values (P = 0.001). CONCLUSIONS: The improvement of corneal parameters by CXL in keratoconus patients can have a positive effect on anterior chamber parameters as well. This effect becomes marked at the postoperative first 6-month evaluation.

The Influence of Corneal Collagen Crosslinking on Conjunctival Flora.

PURPOSE: To investigate the influence of corneal collagen crosslinking (CXL) on conjunctival flora. MATERIALS AND METHODS: Included in this study were 42 patients, all of whom were treated with CXL for progressive keratoconus (KC). Conjunctival swab samples were collected under operating-room conditions immediately before and immediately after the procedure. Samples were quickly immersed in Amies Transport Medium (ATM), transferred to the microbiology laboratory, diluted, and inoculated into three areas each of blood agar, chocolate agar, eosin methylene blue (EMB) agar, and Saboraud-Dextrose agar plates. Inoculated plates were incubated at 35°C for 24-48 h. Preliminary species identification of isolated bacterial colonies was based on catalase and oxidase tests, Gram staining, and colony morphology. Definitive identification of isolates was made with Vitek-II fully automated identification kits. RESULTS: Cultures were positive in 24 (57.1%) preoperative and 10 (23.8%) postoperative samples (p ˂ 0.05). Microorganisms isolated from preoperative conjunctival samples included coagulase-negative Staphylococcus (CNS) spp. in 23 (54.8%) samples, S. aureus in three (7.1%), Moraxella spp. in two (4.8%), Streptococcus spp. in three (7.1%), Corynebacterium spp, in one (2.4%), Micrococcus spp. in one (2.4%), and Candida spp. in one (2.4%). Microorganisms isolated from postoperative conjunctival samples included CNS spp. in nine (21.4%) samples, S. aureus in one (2.4%), Corynebacterium spp. in two (4.8%), and Acinetobacter spp. in one (2.4%). CONCLUSIONS: CXL appears to have a significant impact on conjunctiva flora.