Analysis of retinal nerve fiber layer thickness in anisometropic amblyopia via optic coherence tomography.

OBJECTIVE: To detect retinal nerve fiber layer thickness differences of ambylopic and fellow eyes and ambylopic and control eyes. METHODS: The study comprised a total of 152 eyes recruited from Erzurum Region Training and Research Hospital, Turkey, between January 2018 and May 2018. Anisometropic amblyopia was the only cause of disability (visual acuity ≤ 6/12 and a difference in best-corrected visual acuity (BCVA) between the two eyes of 0.20 logMAR (2 lines on an acuity chart) in amblyopic eyes (n, 74) whereas normal eyes had a best-corrected visual acuity of 6/6 and no morbidities (n, 78). Anisometropic patients were divided into three groups as hyperopic, myopic, and cylindiric. All amblyopic eyes were compared with fellow eye and control group. Retinal nerve fiber layer thickness was analyzed using optic coherence tomography (OCT) (RTVue 100-2, Optovue, Inc. Fremont, CA). RESULTS: The mean age of the patients was 28.64 ± 8.23 years in amblyopia group and 32.23 ± 8.14 years in control group (p, 0.008). Mean best-corrected visual acuity (BCVA) was 0.36 ± 0.23 in amblyopic eyes, 0.96 ± 0.15 in fellow eyes, and 1.00 ± 0 in control group. Mean refractive error was 2.76 ± 7.84 in amblyopic eyes, 0.42 ± 1.34 in fellow eyes, and 0.12 ± 0.27 in control group. Temporal retinal nerve fiber layer thickness (RNFL-T) was 77.27 ± 10.38 µ, 79.31 ± 9.53 µ, and 81.46 ± 9.86 µ respectively in ambylopic group, fellow eyes, and control eyes (p, 0.036). Superior RNFL-T was 136.23 ± 18.52 µ, 131.91 ± 13.80 µ, and 135.56 ± 14.94 µ respectively in ambylopic group, fellow eyes, and control eyes (p, 0.204). Nasal RNFL-T was 87.99 ± 13.05 µ, 82.16 ± 12.33 µ, and 85.50 ± 10.62 µ respectively in ambylopic group, fellow eyes, and control eyes (p, 0.014). Inferior RNFL-T was 144.85 ± 18.39 µ, 140.55 ± 16.92 µ, and 143.47 ± 17.75 µ respectively in ambylopic group, fellow eyes, and control eyes (p, 0.322). There was statistically significant difference in temporal and nasal quadrants and no statistical difference in superior and inferior quadrants. DISCUSSION: The presence of amblyopia seems not to be related with RNFL-T so we could ignore anisometropic amblyopia in patients with disease that could be detected and followed via RNFL thickness. Further and larger scaled studies are needed for certain results.

The Effect of Perioperative Topical Ketorolac 0.5% on Macular Thickness after Uneventful Phacoemulsification.

BACKGROUND: To evaluate the effects of topical 0.5% ketorolac treatment combined with topical steroids on macular thickness in cases who had uneventful phacoemulsification surgery. METHODS: 58 eyes of 58 consecutive cases were included. The mean foveal thickness (MFT), parafoveal thickness (ParaFT), and perifoveal thickness (PeriFT) measurements were performed with optical coherence tomography (RTVue-100, Optovue, Fremont, CA, USA) preoperatively and at postoperative 1 week, 1 month, and 2 months. All cases received topical 0.1% dexamethasone postoperatively. Randomly selected cases additionally received topical 0.5% ketorolac, which started 2 days prior to surgery. Cases who received both topical steroids and ketorolac formed group 1 and subjects who received only topical steroids formed group 2. RESULTS: The increase in mean MFT at the 1st week, 1st month, and 2nd months after surgery in group 1 was significantly lower than group 2 (P = 0.008, P ≤ 0.001, and P ≤ 0.001, resp.). In group 1, the increase in mean ParaFT and PeriFT was significantly lower than group 2 at the 1st and 2nd months of the surgery (P < 0.05 for all variables). CONCLUSIONS: Topical ketorolac combined with steroids is highly efficacious in order to prevent increment in thickness on each part of the macula even after an uneventful phacoemulsification surgery comparing to steroid monotheraphy.

Effect of refractive error on temperament and character properties.

AIM: To determine the effect of refractive error on temperament and character properties using Cloninger's psychobiological model of personality. METHODS: Using the Temperament and Character Inventory (TCI), the temperament and character profiles of 41 participants with refractive errors (17 with myopia, 12 with hyperopia, and 12 with myopic astigmatism) were compared to those of 30 healthy control participants. Here, temperament comprised the traits of novelty seeking, harm-avoidance, and reward dependence, while character comprised traits of self-directedness, cooperativeness, and self-transcendence. RESULTS: Participants with refractive error showed significantly lower scores on purposefulness, cooperativeness, empathy, helpfulness, and compassion (P<0.05, P<0.01, P<0.05, P<0.05, and P<0.01, respectively). CONCLUSION: Refractive error might have a negative influence on some character traits, and different types of refractive error might have different temperament and character properties. These personality traits may be implicated in the onset and/or perpetuation of refractive errors and may be a productive focus for psychotherapy.

Are most sixth nerve palsies really paralytic?

BACKGROUND: Etiology and date of palsy are two important parameters that affect the treatment protocol of sixth nerve palsies. This study evaluated the treatment protocols and outcomes of treatment in sixth nerve palsies. METHODS: Thirty-four patients who had sixth nerve palsy were included. Botulinum toxin A (BTX) injection was performed on patients with acute sixth nerve palsy and paresis (BTX group), whereas chronic cases received only horizontal surgery (surgery group). All patients in the BTX group received a BTX injection into the ipsilateral medial rectus muscle. Patients in the surgery group underwent either ipsilateral medial rectus recession or recession combined with lateral rectus resection without the transposition procedure. RESULTS: Fifteen patients were treated with a BTX injection to the medial rectus muscle. One patient underwent ipsilateral medial rectus muscle recession and 6 patients received both medial rectus recession and lateral rectus resection in the same session. Measurement of esotropia was 24.9 prism diopters (PD) (range: 18 to 35 PD) before treatment in the BTX group. The recovery rate was 86.6% (13 of 15) without any residual deviation. In the surgery group, the mean preoperative deviation was 35.1 PD (range: 14 to 75 PD), which decreased to mean 2.57 PD (range: 0 to 10 PD) postoperatively. The achievement of orthotropia rate was 85.7%. CONCLUSION: BTX injection was found to be an effective treatment because it prevented medial rectus contraction in acute sixth nerve palsies. Correction of deviation with the recession of contracted medial rectus muscles and resection of lateral rectus muscles without the need of transposition in chronic sixth nerve palsy testified that most sixth nerve palsies involve partial paralysis rather than complete paralysis.

Effects of intracameral use of adrenalin solution with preservative on corneal endothelium.

OBJECTIVE: To evaluate the effects of injection of 1:100,000 dilution adrenalin with sodium bisulfite preservative on the corneal endothelium in phacoemulsification cataract surgery. METHODS: This retrospective study comprised 70 patients with age-related cataracts who had undergone phacoemulsification cataract surgery with intraocular lens (IOL) implantation without any surgical complications. In the adrenalin group, patients with intraoperative intracameral adrenalin use were included. The intracameral adrenalin was composed of 1 mL of 1:100,000 dilution adrenalin with sodium bisulfite preservative. The control group included patients who underwent surgery without any intracameral adrenaline use. There were 36 patients in the adrenalin group and 34 patients in the control group. Corneal endothelial density, endothelial cell morphology, and endothelial cell area were measured via specular microscopy both preoperatively and 3 months after surgery. The 2 groups were compared with regard to changes in specular microscopy measurements. RESULTS: The mean (+/- standard deviation) age was 66.51 +/- 8.32 years in the adrenalin group and 67.58 +/- 7.83 years in the control group. The difference in age between the 2 groups was not significant (p = .611). The preoperative mean corneal endothelial cell density was 2,270 +/- 286 cells/mm(2) in the adrenalin group and 2,226 +/- 260 cells/mm(2) in the control group, and the difference between the 2 groups was not statistically significant (p = .550). In the adrenalin group, the postoperative mean corneal endothelial cell density was 2,191 +/- 268 cells/mm(2). Although the postoperative mean cell density was lower than the preoperative mean cell density, the difference between the 2 measurements was not statistically significant (p = .117). In the control group, the postoperative mean corneal endothelial cell density was 2,169 +/- 272 cells/mm(2), and the difference between the preoperative and postoperative measurements was not statistically significant (p = .161). Comparisons of postoperative specular microscopy measurements between the adrenalin and control groups with regard to cell density, cell sizes, and cell shapes showed that there were no statistically significant differences in comparison of all parameters between the 2 groups. CONCLUSIONS: Intracameral injection of 1:100,000 dilution adrenalin with sodium bisulfite preservative is not toxic to corneal endothelium.

Capsule contraction syndrome in Behcet's disease.

We reported the case of a 39-year-old patient with inactive Behcet's syndrome developed capsule contraction syndrome after uneventful phacoemulsification and a foldable intraocular lens implantation. Two weeks after the operation, the patient was accepted to hospital with severe decrease of visual acuity (VA) on the operated eye. Capsule opening area had been reduced considerably by fibrotic tissue, which evaluated with full dilated pupil. Since capsule contraction syndrome (CCS) had been diagnosed in very early stage and which structure was not severely thick, the fibrotic band was treated successfully, 360 degree circular shape, by neodymium YAG (Nd:YAG) laser. Capsule opening area was remained stable during follow up period of one month. But a significant reocclusion was developed that need surgical reopening 3 months after initial operation. Continuous curvilinier capsulorhexis (CCC) may be recurred again after a successful treatment in patient with uveitis like Behcet's disease.