The effect of one- and two-rectus muscle strabismus surgery on anterior chamber flare.

PURPOSE: To investigate the effect of the most commonly performed strabismus surgery procedures on the blood-aqueous barrier using laser flare photometry (LFP). METHODS: Patients who underwent unilateral or bilateral strabismus surgery between January 2020 and May 2021 were included. Eyes were grouped according to the number of rectus muscles operated: one rectus muscle procedure (recession) with or without inferior oblique anterization (IOA), ipsilateral two rectus muscle procedure (recession and resection) with or without IOA, and unoperated fellow eyes of patients undergoing unilateral surgery. Anterior chamber flare values were measured by LFP for each eye the day before the surgery and day 1, week 1, and month 1 postoperatively. RESULTS: A total of 66 eyes of 33 patients (21 females) were included. There were 29 eyes in the one-muscle group, 22 in the two-muscle group, and 15 in the fellow-eye group. The mean flare values of the two-muscle group were significantly higher than those of the other groups at postoperative day 1 and week 1 (P = 0.001, for both). The mean postoperative day 1, week 1, and month 1 flare values of the two-muscle group were significantly higher than the mean preoperative flare value. There were no significant differences between pre- and postoperative flare values of the one-muscle or fellow-eye groups (P > 0.05, for both). CONCLUSIONS: In our study cohort, LFP provided evidence of subclinical changes in the blood-aqueous barrier up to the first month postoperatively in otherwise healthy patients undergoing two-muscle surgery compared with those undergoing one-muscle surgery and unoperated fellow eyes.

Relationship between macular intervortex vein anastomosis and optical coherence tomography biomarkers in chronic central serous chorioretinopathy.

BACKGROUNDS: To evaluate the optical coherence tomography (OCT) biomarkers of patients with central serous chorioretinopathy (CSC) according to the presence or absence of direct anatomical relation to intervortex vein anastomosis (IVA) on indocyanine green angiography. METHODS: We reviewed the records of 39 patients with chronic CSC. Patients were categorized in 2 groups: presence of IVA(Group A) or absence of IVA(Group B) in the macular region. Localization of IVA was categorized in 3 areas according to ETDRS grid:inner 1 mm circle (area-1), 1-3 mm middle circle (area-2) and 3-6 mm outer circle (area-3). RESULTS: There were 31 eyes in Group A,21 eyes in Group B. Mean age of the patients was 52.5 ± 11.3years in Group A,47.2 ± 11years in Group B(p<0.001).Mean initial visual acuity (VA) was 0.38±0.38LogMAR in Group A, 0.19±0.21LogMAR in Group B(p<0.001).Mean subfoveal choroidal thickness(SFCT) was 436.3 ± 134.3µ in Group A,480.2 ± 136.6µ in Group B(p<0.001).Localization of IVA in area-1 was correlated with inner choroidal attenuation (ICA) and leakage on IVA(p = 0.011,p = 0.02). Localization of IVA in area-3 was correlated with irregular lesions on RPE(p = 0.042).Smokestack configuration,intraretinal cysts and ICA were correlated with worse initial VA(p<0.001,p = 0.001 and p = 0.04).Shaggy subtype of photoreceptor disruption was associated with better initial VA(p = 0.003). CONCLUSIONS: We detected older age, worse initial VA and thinner SFCT in patients with chronic CSC and macular region IVA(m-IVA). Long term follow-up of patients with and without m-IVA may exhibit the difference in treatment outcomes and development of neovasculopathy.

Characteristics of pediatric open globe injuries in preschool-aged and school-aged children.

OBJECTIVE: To evaluate the characteristics and outcomes of pediatric open globe injuries in preschool- and school-aged children. METHOD: Medical records of 93 children were reviewed. Patients were categorized in 2 groups: preschool-aged group (0-7 years) and school-aged group (8-15 years). Demographic data, characteristics of trauma, Ocular Trauma Score (OTS), and initial and final best-corrected visual acuity (BCVA) were recorded and compared between groups. RESULTS: The preschool-aged group consisted of 54 patients (mean age 4.6 ± 1.8 years), and the school-aged group consisted of 39 patients (mean age 11.5 ± 2.7 years). Most of the injuries were penetrating and caused by nonmetalic sharp objects in both groups. A corneal injury was detected in 45 patients (83.3%) in the preschool-aged group and 29 patients (74.4%) in school-aged group. Localization of the corneal wound was mostly central (46.7%) in the preschool-aged group and peripheral (48.3%) in school-aged group (p = 0.045). Mean corneal wound length was significantly longer in the preschool-aged group (p = 0.018). Most of the cases in the preschool-aged group were OTS group 2 (50%), whereas most of the cases in the school-aged group were OTS group 3 (38.5%). Poor visual outcome was significantly correlated with the following factors in both groups: lower OTS, worse initial BCVA, central corneal wound, longer corneal and total wound length, and presence of lens damage, retinal detachment, and hypotonia (p < 0.05 for all). Poor final BCVA also was significantly correlated with a longer scleral wound in the school-aged group and the presence of vitreous hemorrhage and uveal tissue prolapse in the posterior segment in the preschool-aged group (p < 0.05). CONCLUSIONS: Localization and length of the corneal wound is closely associated with visual outcome in children with open globe injuries. Especially in preschool-aged children, mostly central localization of a corneal wound can be a challenging factor for visual rehabilitation.

Association Between Prognosis of Acute Retinal Necrosis and Retinal Involvement.

Objectives: The aims of this study were to describe the clinical presentation and treatment modalities of acute retinal necrosis (ARN) and to evaluate complications and clinical outcomes according to the extent of retinal involvement at initial presentation. Materials and Methods: The medical records of 52 patients diagnosed with ARN were reviewed and 48 were included in the study. Patients were categorized into two groups according to the extent of retinitis at presentation: retinal involvement of 1-2 quadrants (Group A) or 3-4 quadrants (Group B). Results: The mean age of the 14 women and 34 men at presentation was 51.3±13.6 years (range: 27-78). There were 40 unilateral and 8 bilateral cases. There were 11 eyes (19.6%) in Group A and 45 eyes (80.4%) in Group B. Eleven patients (22.9%) had a history of herpes simplex virus/varicella-zoster virus infection. One patient in Group A and 11 patients in Group B had received local or systemic corticosteroid therapy without concomitant antiviral treatment before referral. The median follow-up period was 29 months (range: 1-209) in Group A and 8.5 months (range: 0.75-209) in Group B. Mean visual acuity (VA) at presentation was 0.42±0.55 LogMAR (range: 0-2.0) in Group A and 1.28±0.95 LogMAR (range: 0-2.9) in Group B (p<0.05). The presence of endothelial keratic precipitates at presentation was significantly different between two groups (p=0.021). Retinal detachment (RD) occurred in 1 eye (9.1%) in Group A and 30 eyes (66.7%) in Group B (p<0.001). Optic disc pallor was seen in 36.4% (4/11) of eyes in Group A and 71.1% (32/45) of eyes in Group B (p=0.033). Other ocular complications were not significantly different between two groups. Mean final visual acuity was 0.29±0.41 LogMAR in Group A and 1.61±0.90 LogMAR in Group B (p<0.05). Conclusion: The extent of retinal involvement at presentation affects visual outcomes and this shows the importance of early diagnosis and early initiation of antiviral treatment.

Effects of Upper Eyelid Surgery on the Ocular Surface and Corneal Topography

Objectives: To evaluate the effect of upper eyelid surgery on ocular surface and corneal topography. Materials and Methods: Patients who underwent upper eyelid blepharoplasty and/or blepharoptosis repair were evaluated prospectively. Tear film break-up time (TBUT), Schirmer tests, corneal staining pattern, Ocular Surface Disease Index questionnaire, corneal topography, and autorefractor parameters were measured preoperatively and at 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively. Results: Thirty-two eyes of 20 patients (9 male, 11 female) were included in the study. The mean age was 44.8±18.9 years (range: 8-74). Patients were divided into the following 3 groups according to the type of surgery performed: upper eyelid blepharoplasty (group 1), upper eyelid blepharoplasty and levator advancement ptosis surgery (group 2), and levator advancement ptosis surgery (group 3). There was a significant decrease in Schirmer test results at 6 months in groups 1 and 2 but no change in group 3. TBUT values were decreased at 1 week in group 3 (p=0.028) and returned to baseline at 1 month. Corneal punctate staining was detected at 1 day and 1 week in all groups. On corneal topography, group 3 showed a significant change in K2 values (0.3 diopters) at 1 month (p=0.006). There was no statistically significant change in autorefractor measurements postoperatively compared to preoperative values (p>0.05). Conclusion: Depending on the type of surgical procedure performed, blepharoptosis repair and upper eyelid blepharoplasty can lead to dry eye of varying severity that may persist at postoperative 6 months.

Interferon Alpha-2a for the Treatment of Cystoid Macular Edema Secondary to Acute Retinal Necrosis.

PURPOSE: To report the results of interferon (IFN) α-2a treatment in patients with cystoid macular edema (CME) secondary to acute retinal necrosis (ARN). METHODS: We reviewed the records of seven patients (eight eyes) who received IFNα-2a for post-ARN CME. The initial dose of IFNα-2a was 3 MIU/day and it could be tapered down to 3 MIU twice a week. Efficacy was assessed by central macular thickness (CMT) on spectral-domain optical coherence tomography and visual acuity. RESULTS: Age range of seven patients (four men, three women) was 36-74 years. Mean CMT decreased from 477.9 ± 167.5 µm to 367.3 ± 120.5 µm at first week, and vision improved up to five lines in five eyes. CME relapsed after cessation of IFNα-2a in all and improved following reinstitution of treatment. Treatment was discontinued in one patient because of depression. Three patients electively discontinued treatment due to poor tolerability or lack of functional improvement. CONCLUSION: IFNα-2a is an effective therapeutic option for post-ARN CME, though side effects such as fatigue, elevated liver enzymes, neutropenia, and depression may limit tolerability. Lower initial doses may be a better tolerated.

Patterns of cytomegalovirus retinitis at a tertiary referral center in Turkey.

PURPOSE: To analyze predisposing conditions in Turkish patients with CMV retinitis and to compare HIV-positive and HIV-negative patients. METHODS: We reviewed medical charts and ocular images of 41 patients with CMV retinitis diagnosed between 1996 and 2019. RESULTS: Eleven patients (27%) had HIV infection and 30 were immunocompromised from diverse causes. Initial visual acuity, type, zone, and extent of CMV retinitis, and response to anti-CMV treatment were not significantly different between the two groups. Vitreous haze and panretinal occlusive vasculopathy were the presenting features only in non-HIV patients, seen in 34% and 16% of eyes, respectively. Although not statistically significant, recurrent CMV retinitis was more common in non-HIV patients (17.4% vs. 4.3%/eye-year) and immune recovery uveitis was more common in HIV patients (43% vs. 26%/eye-year). Visual outcomes were similar. Final visual acuity of 1 logMAR or worse was significantly associated with the recurrence of CMV retinitis (odds ratio 9.67; p = 0.01) and also with the occurrence of immune recovery uveitis (odds ratio 4.31; p = 0.058). CONCLUSIONS: Diverse immunocompromising conditions are more commonly associated with CMV retinitis than HIV infection in Turkish patients. Intraocular inflammation was more commonly associated with active retinitis in non-HIV patients and immune recovery uveitis was more common in HIV patients.

The ocular surface side effects of an anti-psychotic drug, clozapine.

PURPOSE: The purpose of this study is to investigate the effects of long-term clozapine usage on tear film stability and corneal topographic parameters. MATERIAL AND METHODS: The study was conducted between March 2014 and November 2014. Thirty patients who were diagnosed of schizophrenia and have been under clozapine treatment for 2.73 ± 0.73 years (range 2-4 years) were involved in this study (group 1). Thirty healthy subjects (group 2) who have statistically similar demographic features compared with the group 1, were involved as a control group. Full ophthalmologic examination with biomicroscopy and indirect ophthalmoscopy was applied. Corneal topographic parameters were measured using the Pentacam HR and Schirmer test was done. Statistical analysis of the subjects was evaluated by using SPSS (for Windows version 16.0; SPSS Inc., Chicago, IL) program. RESULTS: K1 value was measured as 43.39 ± 0.17 D (43-43.50 D) and K2 value was measured as 43.39 ± 0.06 D (43.30-43.50 D) in groups 1 and 2, respectively. In groups 1 and 2, K2 values were noted as 43.86 ± 0.27 D (43.50-44.50 D) and 43.72 ± 0.18 D (43.50-44.00 D), respectively. Central corneal thickness was found to be 523.93 ± 15.66 µm (495-554 µm) and 550.13 ± 1.03 µm (520-580 µm) in groups 1 and 2, respectively. Corneal apex thickness was 525.86 ± 15.75 µm (497-556 µm) in group 1 and 551.60 ± 14.99 µm (521-581 µm) in group 2. The corneal thickness of thinnest location was 520.93 ± 15.60 µm (492-551 µm) and 548.06 ± 15.17 µm (518-578 µm) in groups 1 and 2, respectively. Corneal volume was determined as 58.13 ± 3.46 mm(3) (52-64 mm(3)) in group 1 and 60.73 ± 3.76 mm(3) (54-66 mm(3)) in group 2. The Schirmer test showed thickness of 3.33 ± 0.72 mm (2-4 mm) and 13.60 ± 1.59 mm (11-16 mm) in groups 1 and 2, respectively. The mean fluorescein break-up time was 5.40 ± 1.50 s (3-8 s) and 12.46 ± 1.40 s (10-14 s) in groups 1 and 2, respectively. There was a statistically significant difference in the Schirmer test, fluorescein break-up time, central corneal thickness, corneal apex, and the thinnest corneal location thickness between the two groups. CONCLUSION: Clozapine may induce dry eye syndrome and thus may lead to morphological alterations in corneal parameters through its anticholinergic and antidopaminergic activities. Because of these corneal alterations, one should be aware of evaluating patients having diseases like glaucoma or preoperative selection of corneal refractive surgery candidates.