Posterior corneal elevation and back difference corneal elevation in diagnosing forme fruste keratoconus in the fellow eyes of unilateral keratoconus patients.

PURPOSE: To evaluate posterior corneal elevation and back difference corneal elevation in patients with keratoconus in 1 eye and forme fruste keratoconus in the fellow eye. SETTING: Kudret Eye Hospital, Ankara, Turkey. DESIGN: Case-control study. METHODS: This study retrospectively reviewed patients with keratoconus in 1 eye and forme fruste keratoconus in the fellow eye and eyes of normal subjects. All subjects were evaluated with a rotating Scheimpflug imaging system (Pentacam), including sagittal and tangential anterior curve analysis, keratometry, and posterior elevation. The back difference elevation values were extrapolated from the difference maps of the Belin-Ambrosió enhanced ectasia display of the Scheimpflug system. The receiver operating characteristic (ROC) curves were analyzed to evaluate the sensitivity and specificity of the parameters. RESULTS: The corneal power, pachymetric progression index, and posterior corneal elevation (posterior elevation and back difference elevation) measurements were statistically significantly higher in eyes with keratoconus or forme fruste keratoconus than in eyes of normal control subjects (P<.05). Using ROC analysis, the area under the curve values of mean keratometry, steepest point on the tangential curve, minimum corneal thickness, pachymetric progression index, Ambrósio's relational thickness, posterior elevation, and back difference elevation to distinguish forme fruste keratoconus from control subjects were 0.51, 0.84, 0.65, 0.81, 0.72, 0.68, and 0.76, respectively. CONCLUSIONS: Back difference elevation was better than posterior elevation in diagnosing forme fruste keratoconus. However, as sole parameters, both had limited sensitivity and specificity to differentiate between forme fruste keratoconus eyes and normal control eyes.

Riboflavin injection into the corneal channel for combined collagen crosslinking and intrastromal corneal ring segment implantation.

PURPOSE: To evaluate the effectiveness of intracorneal riboflavin injection for combined collagen crosslinking (CXL) and intrastromal corneal ring segment (ICRS) implantation. SETTING: Kudret Eye Hospital, Ankara, Turkey. DESIGN: Noncomparative case series. METHODS: Keratoconic eyes had combined ICRS (Intacs) implantation and transepithelial CXL with 20% alcohol application and riboflavin injection into the corneal channel. Outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, sphere, cylinder, and keratotomy (K) readings. RESULTS: The study enrolled 131 eyes (105 patients) with a mean follow-up of 7.07 months ± 4.66 (SD). The mean improvement was 0.26 ± 0.16 logMAR in UDVA and 0.24 ± 0.16 logMAR in CDVA (both P<.05). The mean manifest spherical refraction decreased from -3.87 ± 4.55 diopters (D) to -1.25 ± 2.31 D, the mean manifest cylinder improved from -3.89 ± 1.97 D to -2.27 ± 2.18 D, and the mean K reading improved from 50.50 ± 5.26 D to 46.03 ± 4.51 D (all P<.05). There were no intraoperative or postoperative complications. CONCLUSIONS: Combined ICRS and CXL treatment with intracorneal riboflavin injection was effective in keratoconic eyes. Intracorneal riboflavin injection into the tunnel was safe and may provide more penetration without epithelial removal. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Unilateral exudative retinal detachment as the sole presentation of relapsing acute lymphoblastic leukemia.

Ocular findings are rarely the initial symptom of leukemia, although up to 90% of all leukemia patients have fundus changes during the course of the disease. Herein we report a relapsing acute lymphoblastic leukemia patient with thesole presentation of sudden visual loss and exudative retinal detachment. An 8-year-old boy with acute lymphoblasticleukemia developed sudden visual loss during his first remission period. Bullous retinal detachment with total afferentpupillary defect was observed. Orbital magnetic resonance imaging revealed an intraocular mass lesion; simultaneouslyobtained bone marrow and cerebrospinal fluid samples showed no evidence of leukemic cells. Following local irradiation,and systemic and intrathecal chemotherapy the mass disappeared. Local irradiation, and systemic and intrathecalchemotherapy effectively controlled the isolated ocular relapse of acute lymphoblastic leukemia and eliminated the needfor enucleation.

Phacoemulsification with intravitreal bevacizumab and triamcinolone acetonide injection in diabetic patients with clinically significant macular edema and cataract.

PURPOSE: The purpose of this study was to evaluate the results of phacoemulsification with intravitreal bevacizumab and triamcinolone acetonide injection in patients with diabetic clinically significant macular edema and cataract. METHODS: The records of 22 diabetic patients, with clinically significant macular edema and cataract who have undergone phacoemulsification with intravitreal injection of 1.25 mg bevacizumab and 2 mg triamcinolone acetonide, were retrospectively evaluated. All patients have undergone focal or modified grid argon laser photocoagulation 1 month after the surgery. All patients were evaluated by spectral OCT/OCT SLO before, 1 month, and 3 months after the surgery. The main parameters were the best-corrected visual acuity (BCVA) and central macular thickness (CMT). Paired samples t-test was used for statistical analysis. RESULTS: The mean initial best-corrected visual acuity was 0.15 ± 0.09 (0.05-0.3), whereas it was 0.6 ± 0.28 (SD) (0.3-0.7), 0.6 ± 0.22 (SD) (0.4-0.7) at 1 month and 3 months after the surgery, respectively. The BCVA levels recorded at 1 month and 3 months after the surgery were significantly higher than the initial BCVA (P = 0.002). The mean initial CMT was 392.2 ± 109.5 µm, whereas it was 295 ± 57.2 µm and 265.5 ± 30.3 µm at 1 month and 3 months after the surgery, respectively. The CMT values recorded at 1 month and 3 months after the surgery were significantly lower than the initial CMT (P < 0.001, P < 0.001). CONCLUSION: Phacoemulsification with intravitreal injection of bevacizumab and triamcinolone acetonide provides a decrease in CMT with a gain in BCVA in diabetic patients with clinically significant macular edema and cataract.

Refractive errors and strabismus in children with laurence-moon-biedl syndrome.

PURPOSE: To describe the ocular and refractive findings in patients with Laurence-Moon-Biedl syndrome. METHODS: Seventeen patients with Laurence-Moon-Biedl syndrome were evaluated retrospectively. All children underwent complete ophthalmologic examination. RESULTS: Of the patients evaluated, 88.2% had an ocular or refractive finding, 58.8% had myopia (degenerative in three cases), 52.9% had astigmatism, 11.7% had an-isometropia, 17.6% had strabismus, 11.7% had retinitis pigmentosa, 5.9% had keratoconus, 5.9% had optic atrophy, and 5.9% had nystagmus. CONCLUSION: Early and regular ophthalmologic assessment is required to prevent visual loss as a result of amblyogenic factors in children with Laurence-Moon-Biedl syndrome.

Central corneal thickness in children with intellectual disability: a controlled study.

PURPOSE: To evaluate the central corneal thickness (CCT) in children with intellectual disability (ID) and to determine the association between ID-related variables and CCT. METHODS: A total of 77 subjects with ID and 38 healthy controls were included in the study. The subjects with ID were subdivided into mild (IQ 50-69; n = 34), moderate (IQ 35-49; n = 30), and severe (IQ <34; n = 13) groups and syndromic (n = 40) versus nonsyndromic (n = 37) distinctions. All children underwent CCT assessment by ultrasound pachymetry, in addition to complete ophthalmologic examination. Analysis of variance, chi test, and linear regression analysis were used for statistical analysis. RESULTS: CCT was significantly higher in the ID group (549.7 +/- 21.4 microm) than that the control group (521.6 +/- 16.9 microm; P < 0.0001). Linear regression analysis revealed that presence of syndromic etiology significantly predicted higher CCT among the individuals with ID (P < 0.0001). CONCLUSIONS: Children with ID have an increased CCT compared with healthy controls. Syndromic etiology is the only variable that predicts higher CCT among the individuals with ID. Although the finding of an increased CCT in children with ID is statistically significant, it is not clinically significant.

Refractive errors and strabismus in children with tuberous sclerosis: a controlled study.

PURPOSE: To evaluate the prevalence of refractive errors and strabismus in children with tuberous sclerosis and in control subjects. METHODS: Twenty-three children with tuberous sclerosis and 151 control subjects were evaluated. All children underwent cycloplegic autorefraction or retinoscopy, slit-lamp biomicroscopy, and dilated fundus examination. Ocular alignment was assessed by the Hirschberg, Krimsky, or prism cover test. RESULTS: The total prevalence of hypermetropia and amblyopia was significantly higher in patients with tuberous sclerosis (P = .035) than in the control subjects (P = .002). CONCLUSION: A high prevalence of hypermetropia seems to be an additional feature of tuberous sclerosis. Early screening for this amblyogenic factor is indicated in patients with tuberous sclerosis.

Central corneal thickness in children with diabetes.

PURPOSE: To evaluate the central corneal thickness in children with diabetes and to determine the association between diabetes mellitus-related variables and central corneal thickness. METHODS: Fifty-nine patients (mean age: 13.2 years) with diabetes mellitus and 38 controls (mean age: 10.3 years) were compared in terms of central corneal thickness assessed by ultrasound pachymetry. The effects of age, gender, the duration of diabetes mellitus, the mean and current hemoglobin A1C (HbA1C) level, and fasting blood sugar level on central corneal thickness were investigated. Analysis of covariance and multivariate regression analysis were used for statistical analysis. RESULTS: The analysis of covariance with age as the covariant indicated that the diabetes mellitus group had significantly increased central corneal thickness (mean: 576.9+/-41.8 microm) compared with the control group (mean: 521+/-16.6 microm) (P<.0001). A multivariate regression model evaluating the effects of age, gender, duration of diabetes mellitus, fasting blood glucose, and the mean and current HbA1C levels on central corneal thickness was statistically significant (F(4,54)=3.33, P=.016). The results indicated that the current HbA1c value was the only significant predictor for central corneal thickness (B=0.29, t=2.13, P=.038) (B=9.7 microm per 1% HbA1C and B=13.3 microm per 1% HbA1C for right and left eyes, respectively). CONCLUSIONS: Diabetic patients have a significantly increased (approximately 55 microm) central corneal thickness compared with healthy controls. Current HbA1C value, which is the marker of metabolic control of the disease, is the only disease-related variable that predicts a higher central corneal thickness.

Phacoemulsification with intravitreal bevacizumab injection in diabetic patients with macular edema and cataract.

PURPOSE: The purpose of this study was to evaluate the results of phacoemulsification with intravitreal bevacizumab injection in patients with diabetic clinically significant macular edema and cataract. METHODS: The records of 31 patients with diabetic clinically significant macular edema and cataract, which would interfere with macular laser photocoagulation, who have undergone phacoemulsification with intravitreal injection of 1.25 mg bevacizumab were retrospectively evaluated. All patients had undergone focal or modified grid laser photocoagulation 1 month after the surgery. All patients were evaluated by spectral optical coherence tomography/optical coherence tomography SLO before and 1 and 3 months after the surgery beyond complete ophthalmologic examination. The best-corrected visual acuity (BCVA) levels and central macular thickness (CMT) recorded at the first and third months after the surgery were compared with the initial values. Paired samples t test was used for statistical analysis. RESULTS: The mean initial BCVA was 0.10 +/- 0.04 (range, 0.05-0.2). The mean BCVA at the first and third months after the surgery were 0.47 +/- 0.16 (standard deviation) (range, 0.2-0.5) and 0.51 +/- 0.12 (standard deviation) (range, 0.3-0.6), respectively. The BCVA level recorded at the first and third months after the surgery were significantly higher than the initial BCVA (P = 0.004). The mean initial CMT was 387.5 +/- 109.5 microm. The mean CMT at the first and third months after the surgery were 292.7 +/- 57.2 and 275.5 +/- 40.3. The CMT recorded at the first and third months after the surgery were significantly lower than the initial CMT (P < 0.001, P < 0.001). CONCLUSION: Phacoemulsification with intravitreal injection of bevacizumab provides improvement in clinically significant macular edema with a gain in BCVA in patients with diabetes with clinically significant macular edema and cataract.

Cavernous sinus syndrome as the initial presentation of childhood non-hodgkin lymphoma.

A 10-year-old boy with unilateral ophthalmoplegia, ptosis, and proptosis underwent diagnostic examination. Symptoms of headache, nausea, dyspnea, fatigue, weakness, and loss of appetite began 14 days after the onset of ocular manifestations and 7 days before he was examined. Complete blood count showed an increased white blood cell count with 64% blast cells, anemia, and thrombocytopenia. The patient was transferred to a pediatric hematology unit, where he underwent bone marrow aspiration biopsy. Bilateral ocular inflammatory findings and left-sided mild proptosis became evident. He was diagnosed as having B-cell non-Hodgkin lymphoma infiltrating the bilateral cavernous and sphenoid sinuses.

Refractive errors and strabismus in children with Ddown syndrome: a controlled study.

PURPOSE: To evaluate the prevalence of refractive errors, strabismus, nystagmus, and congenital cataract in children with Down syndrome and control subjects of similar age. METHODS: Seventy-seven children with Down syndrome and 151 control subjects were evaluated for the prevalence of ocular findings. RESULTS: Ocular findings were discovered in 97.4% of children with Down syndrome and 42.4% of control subjects (P < .0001). The point prevalence of nystagmus, strabismus, hypermetropia, astigmatism, and congenital cataract was significantly higher in children with Down syndrome (P < .0001 for the first four categories, and P < .01 for congenital cataract). CONCLUSION: Evaluation, treatment, and regular review of ocular and refractive findings in children with Down syndrome is urgently needed.

Ocular findings in children with chronic renal failure.

PURPOSE: The purpose of this study was to describe the ocular findings in children with chronic renal failure (CRF). MATERIALS AND METHODS: Nineteen children with CRF and 19 age- and sex-matched controls were evaluated. Schirmer and tear film break-up time (TBUT) tests were performed in addition to complete ophthalmologic examination. The presence of dry eye symptoms was noted. Relation between TBUT and Schirmer test results and CRF-related variables such as duration of CRF; dialysis status; and serum calcium, phosphorus, urea, and creatinine levels was evaluated. Student t test and rank correlation test were used for statistical analysis. RESULTS: Dry eye symptoms were detected in 15.8% of children with CRF, against none of the controls (chi(2) = 3.25, P = 0.23). TBUT and Schirmer test results were significantly lower in the study group than in the controls (t = 27.8, P = 0.032 and t = 36.5, P = 0.025, respectively). Within the study group, a negative correlation was found between TBUT and Schirmer test results and the duration of CRF (R = 0.769, Z = 2.234, P < or = 0.022 and R = 0.832, Z = 2.351, P < or = 0.019, respectively). No relation was detected between the TBUT and Schirmer test results and the dialysis status and serum calcium, phosphorus, urea, and creatinine levels in the study group. CONCLUSIONS: The basal tear secretion and tear film stability are lower, and the dry eye symptoms are more common among the children with CRF. The duration of CRF seems to be related with the disturbances in tear secretion and tear film stability.

Refractive errors and ocular findings in children with intellectual disability: a controlled study.

PURPOSE: To evaluate the ocular findings and refractive errors in children with intellectual disability and in controls of average intellectual development of similar socioeconomic backgrounds. METHODS: The study was conducted at Diskapi Children's Hospital in Ankara, Turkey: 724 subjects with intellectual disability and 151 control subjects were evaluated. The subjects with intellectual disability were subdivided into mild (IQ 50-69, n = 490), moderate (IQ 35-49, n = 164), and severe (IQ <34, n = 70) groups, and syndromic (n = 138) versus nonsyndromic (n = 586) disability. All children underwent cycloplegic autorefraction or retinoscopy, slit-lamp biomicroscopy, and dilated fundus examination. Ocular alignment was assessed by Hirschberg, Krimsky, or prism cover test. The main outcome measure was the prevalence of refractive errors and ocular findings. RESULTS: Seventy-seven percent of subjects with intellectual disability, and 42.4% of controls, had ocular findings. The children with intellectual disability had significantly more nystagmus, strabismus, astigmatism, and hypermetropia than controls. Children with syndromic intellectual disability had significantly more nystagmus, strabismus, astigmatism, and hypermetropia than subjects with nonsyndromic intellectual disability. Increasing severity of intellectual disability was related to higher prevalence of nystagmus, strabismus, astigmatism, hypermetropia, and anisometropia. CONCLUSIONS: From a public health perspective, evaluation and treatment of ocular and refractive findings in children with moderate, severe, and syndromic intellectual disability categories is urgently needed and likely to be highly effective in alleviating future health and social care costs, as well as improving the productive lives of individuals with intellectual disability.

Retinopathy in patients with diabetic ophthalmoplegia.

PURPOSE: To compare patients with palsy of the 3rd, 4th or 6th cranial nerve due to diabetes mellitus (DM) with controls matched for age, sex and disease duration in terms of the presence and severity of diabetic retinopathy. PATIENTS AND METHOD: Thirty-three diabetic patients with cranial nerve palsies and 33 age- and sex-matched controls with the same duration of disease were included in this case-control study. Groups were evaluated in terms of the type of DM, presence and level of diabetic retinopathy and coexisting systemic diseases. Outcomes were compared by chi(2) and paired-sample tests. RESULTS: Eleven patients had diabetic retinopathy in the study group. In the control group, 23 patients had diabetic retinopathy. Differences in the presence and severity of diabetic retinopathy between the two groups were found to be statistically significant (p = 0.028 and p = 0.018, respectively). CONCLUSION: Presence and level of diabetic retinopathy are significantly lower in diabetics with cranial nerve palsy than in the age-, sex- and disease-duration-matched controls.

The correlation between headache and refractive errors.

PURPOSE: To compare the prevalence of refractive errors in patients with headache and a control population. METHODS: Three hundred ten patients with headache and 843 controls were retrospectively evaluated. Complete ophthalmologic examination was performed in the headache group. Autorefraction was performed in all participants (with cycloplegia under 10 years of age). Myopia was defined as the spherical equivalent refraction of at least -0.50 D, hyperopia as the spherical equivalent refraction of at least +2.0 D, and astigmatism as the cylinder of at least 1.0 D. Main outcome measures were refractive error, anisometropia, and previous miscorrection of refractive error. Chi-square and Student's t-tests were used for statistical analysis. RESULTS: Total prevalence of refractive errors was higher in the headache group (p = 0.002). The rate of astigmatism was higher in the headache group (p < 0.0001), while that of myopia and hyperopia were similar in both groups (p = 0.74, p = 0.79, respectively). The rates of compound and mixed astigmatism were higher in the headache group (p = 0.026, p < 0.001, respectively). The rates of anisometropia and previous miscorrection of refractive error were higher in the headache group (p < 0.0001 for both). Children with headache have a statistically significant increased risk of total refractive errors (OR = 1.57, 95% CI: 1.18-2.07), anisometropia (OR = 9.59, 95% CI: 5.72-16.1), and miscorrection of refractive error (OR = 9.57, 95% CI: 5.43-16.9). CONCLUSIONS: Compound and mixed types of astigmatism, anisometropia, and miscorrection of refractive error were found more often in patients with headache than in control subjects.

Phacoemulsification in pseudoexfoliation syndrome.

PURPOSE: To compare the incidence of intraoperative and early postoperative complications (IEPC), visual outcomes, and change in intraocular pressure (IOP) between eyes with and without pseudoexfoliation syndrome (PEX) having cataract extraction by phacoemulsification. MATERIAL AND METHOD: 800 eyes with PEX and 1,600 eyes without PEX having cataract extraction by phacoemulsification were included in this retrospective study. Evaluated parameters were incidence of IEPC, visual outcomes and change in IOP. chi2 and Student's t test were used for statistical analysis. RESULTS: There were no significant differences in the incidence of IEPC and visual acuity gain between the two groups (p > 0.05). Rise in IOP in the early postoperative period was significantly higher in the PEX group (p < 0.02). CONCLUSION: Patients with PEX who have phacoemulsification can achieve results similar to patients without PEX. IOP control in the early postoperative period seems to be more important in patients with PEX.

Relationship between intraocular pressure and obesity in children.

PURPOSE: To establish the relationship between intraocular pressure (IOP) and obesity in children. METHODS: Seventy-two obese children (body mass index in the 95th percentile or greater) were compared with 72 age-matched and sex-matched controls (body mass index <95th percentile). Both groups underwent Goldmann applanation tonometry (3 times), blood pressure measurement (3 times), and Hertel exophthalmometry. Paired and unpaired t tests and the Cochran-Mantel-Haenzel statistics were used for statistical analysis. RESULTS: The mean IOP between the obese children and controls were significantly different (P<0.0001), even after adjusting for systolic and diastolic blood pressure (P<0.001). Diurnal variation of IOP was higher in obese children (P<0.001). Obese children had higher Hertel values (P<0.001). Sex did not significantly effect IOP in either group (P>0.05). CONCLUSIONS: In addition to its indirect effect on IOP via blood pressure change, obesity is also an independent risk factor for increased IOP.

Comparison of limbal-conjunctival autograft and intraoperative 0.02% mitomycin-C for treatment of primary pterygium.

PURPOSE: To compare the outcomes of use of intraoperative 0.02% mitomycin-C (MMC) and limbal-conjunctival autograft (LCAG) for treatment of primary pterygia. MATERIAL AND METHOD: One hundred and twelve eyes of eighty patients with primary pterygia were randomly treated either by intraoperative 0.02% MMC for 5 min or LCAG. Recurrence (defined as fibrovascular tissue invading the cornea >1.5 mm) and complications were evaluated. RESULTS: Fifty-two eyes were included in the MMC group and sixty in the LCAG group. Recurrence occurred in three eyes (5.76%) in the MMC group and in two eyes (3.33%) in the LCAG group. This difference between recurrence in the two groups was not statistically significant (P > 0.05). Incidence of complications such as conjunctival cysts, symblephara, conjunctival hyperemia, and subconjunctival hemorrhage was similar in both groups (P > 0.05) whereas corneal epithelial defects (CED), irritation, lacrimation, and photophobia were more common in the MMC group (P < 0.05). CONCLUSION: Simple excision then intraoperative use of 0.02% (MMC) for 5 min or LCAG are similarly successful in the treatment of primary pterygia. Some complications, for example irritation, lacrimation, photophobia, and CED are more common when simple excision is followed by MMC.

Keratoconjunctivitis sicca in juvenile rheumatoid arthritis.

PURPOSE: To compare the symptoms, signs, and results of objective tests for keratoconjunctivitis sicca (KCS) in patients with juvenile rheumatoid arthritis (JRA) and controls. METHODS: Sixty-four patients with JRA and 64 age- and sex-matched controls were compared in terms of symptoms, signs, and results of objective tests for KCS. Relation between tear film breakup time (TBUT), Schirmer test results, and JRA-related variables such as age of onset, duration, and type of JRA; presence of antinuclear antibodies (ANAs); and history of uveitis were evaluated. Analysis of variance, multivariate regression analysis, Kruskall-Wallis, Student t tests, and chi tests were used for statistical analysis. RESULTS: Twelve and a half percent of patients with JRA complained of dry eye symptoms compared with 1.5% of the controls (P = 0.031). Dry eye signs were detected in 10.9% of patients with JRA compared with 1.5% of controls (P = 0.038). TBUT and Schirmer test results were lower in the JRA group than in controls (P = 0.032 and P = 0.029, respectively). Seven patients (10.9%) had definite and 1 (1.5%) had probable diagnosis of KCS in the JRA group compared with no children in the control group (P = 0.034). Within the JRA group, Schirmer test and TBUT results were significantly lower in male patients and ones with longer duration of disease. CONCLUSIONS: The prevalence of symptoms, signs, and definite diagnosis of KCS is higher and basal tear secretion and tear film stability are lower in children with JRA than in controls. Among children with JRA, male sex and longer duration of disease are independent risk factors for having decreased basal tear secretion and tear film stability.

Does blunt ocular trauma induce corneal astigmatism?

PURPOSE: To determine the effect of blunt ocular trauma on refractive astigmatism. METHODS: Eighty-six eyes of 86 patients with known previous refractive status exposed to blunt ocular trauma were included in the study. Trauma-induced astigmatism (TIA) was calculated using vector analysis. In eyes with TIA, central corneal thickness was assessed by ultrasound pachymetry, and corneal topographies were obtained. Anterior-chamber angles were examined by Goldmann 3-mirror lens to find microhemorrhages, scarring, or recession. Patients were followed up between 8 and 12 months (average, 9.2 months). RESULTS: In 18 eyes (21%), TIA was detected. Six (7%) of these eyes had lenticular astigmatism caused by traumatic lens subluxation. In the remaining 12 eyes (14%), corneal topography showed regular astigmatic patterns, which were symmetrical in 3 eyes and asymmetric in the remaining 9. The etiologic factor was a game marble in 6 eyes and a stone in the remaining 6. The mean central corneal thickness was 535.75 microm (range, 498-570 microm) in these 12 eyes. In 9 of these 12 eyes, recession or scarring in the anterior-chamber angle was detected at 1 edge of the steepest axis. CONCLUSIONS: Blunt trauma can induce astigmatism. Hard and small objects are more likely to induce astigmatism.