Decrease of over-elevation in adduction after surgery of medial rectus muscles in partially refractive accommodative esotropia.

SIGNIFICANCE: The course of over-elevation in adduction after strabismus surgery has been evaluated in a small number of research in the literature, we believe our study is the first to report the results in a specific group of esotropia (ET) patients. AIM: To report the course of postoperative over-elevation in adduction in patients who underwent surgery for horizontal deviation on the medial recti in partially accommodative ET. METHODS: The medical charts of patients who had partially accommodative ET with over-elevation in adduction were reviewed retrospectively. A scale from -4 to +4 was used to grade the oblique muscle function. Among these, 17 patients who were operated solely on the horizontal rectus muscles were identified. The primary outcome measure was the degree of improvement in over-elevation in adduction after medial rectus surgery. RESULTS: Nine (52.9%) of the 17 patients (mean age: 5.18 ± 2.24 months) were males and 8 (47.1%) were females. The mean follow-up period was 17.06 ± 15.32 months. Overall, 15 patients (88.2%) achieved surgical success. The mean inferior oblique overaction was found 1.44 ± 0.56 preoperatively and the final postoperative mean inferior oblique overaction was 0.53 ± 0.51 (P = 0.001). Postoperative over-elevation in adduction after 3 months was significantly decreased compared to the preoperative value (P = 0.003, P = 0.001, P = 0.001 at 3rd and 6th months and final visits respectively). CONCLUSION: Over-elevation in adduction accompanying partially refractive accommodative ET seems to regress after medial rectus weakening surgery. This finding should be considered in the presurgical evaluation of these patients.

Sequential tissue plasminogen activator, pneumatic displacement, and anti-VEGF treatment for submacular hemorrhage.

PURPOSE: To report the results of our sequential intravitreal (IV) tissue plasminogen activator (tPA), pneumatic displacement (PD), and IV anti-vascular endothelial growth factor (VEGF) treatment in patients with neovascular age-related macular degeneration (nAMD)-related submacular hemorrhage (SMH). METHODS: A total of 16 eyes of 16 patients with SMH of less than 15 days duration were included in this retrospective pilot study. The tPA was applied on the day of diagnosis, and PD was performed the following day. Patients received 3 consecutive monthly IV injections of ranibizumab starting from 15 days after PD. During the follow-ups, additional ranibizumab treatment was performed if persistent macular or recurrent subretinal or intraretinal fluid hemorrhage was observed. RESULTS: The mean central retinal thickness was 489 ± 92 µm (311-621 µm) at the time of diagnosis, 324 ± 56 µm (209-409 µm) at the first month, 262 ± 48 µm (197-364 µm) at 3 months, 248 ± 40 µm (190-334 µm) at 6 months, and 253 ± 41 µm (192-356 µm) at the last control (p<0.01). The mean best-corrected visual acuity was 2.08 ± 0.79 logMAR (0.7-3.0 logMAR) at baseline, 1.41 ± 0.70 logMAR (0.56-2.50 logMAR) at the first month, 1.21 ± 0.66 logMAR (0.3-2.0 logMAR) at 3 months, 1.14 ± 0.77 logMAR (0.2-2.50 logMAR) at 6 months, and 1.09 ± 0.73 logMAR (0.3-2.50 logMAR) at the last follow-up (p<0.01). CONCLUSIONS: Sequential IV tPA, PD, and IV anti-VEGF treatments for SMH in patients with nAMD is effective. However, further studies are needed to establish the best treatment algorithm for SMH in patients with nAMD.

Retinal and choroidal thicknesses measured with swept-source optical coherence tomography after surgery for idiopathic macular hole.

PURPOSE: To evaluate the changes in retinal nerve fiber layer thickness (RNFLT), ganglion cell layer thickness (GCLT), retinal thickness (RT), and subfoveal choroidal thickness (SFCT) in eyes that received pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for idiopathic macular hole (IMH) and to compare these data with data from fellow eyes and healthy controls. METHODS: This cross-sectional study included 49 subjects. Eighteen eyes that underwent surgery for IMH, 18 fellow eyes, and 31 eyes of the healthy controls were designated as group 1, group 2, and group 3, respectively. The RNFLT, GCLT, RT, and SFCT were measured by using the swept-source optical coherence tomography (SS-OCT) device at last postoperative visit. RESULTS: The RNFLT was significantly lower in group 1 than group 2 and group 3 (p<0.05). The GCLT was significantly reduced in all sectors in group 1 as compared to group 2 and group 3 (p<0.05). The RT was found to be significantly lower (except in central field) in group 1 than group 2 and group 3 (p<0.05). The SFCT was significantly decreased in group 1 as compared to group 2 and group 3 (p<0.05). CONCLUSIONS: A reduction in the RNFLT, GCLT, RT, and SFCT was observed following PPV with ILM peeling for IMH detected by SS-OCT.

Evaluation of the acute changes in objective accommodation, pupil size and ocular wavefront aberrations after cigarette smoking.

CONTEXT: The acute effects of cigarette smoking on pupil size and ocular wavefront aberrations (OWA) have been previously documented. The accommodation status of the eye is well known to be related to ocular aberrations. No previous study has evaluated the impact of cigarette smoking on the accommodation status of the eye. This study presents intriguing findings regarding the changes in objective accommodation of the eye after cigarette smoking. OBJECTIVE: To evaluate the acute changes in objective accommodation and OWA after cigarette smoking. MATERIALS AND METHODS: A total of 34 otherwise healthy cigarette smoker participants were included in this prospective study. All subjects smoked a single cigarette containing 1 mg nicotine. Measurements of pupil size, OWA and objective accommodation were done before and after smoking. A Wavefront Aberrometer device (Irx3, Imagine Eyes, Orsay, France) was used for the measurements. RESULTS: The mean age of the participants was 36.6 ± 10.3 years (range 21-51 years). Pupil size did not significantly differ before (mean 5.72 ± 1.21 mm) and after smoking (mean 5.68 ± 1.14 mm) (p = 0.62). However, a significant decrease was observed in total spherical aberration (TSA) of the eye after smoking (p = 0.01). There was an increase in objective accommodation after smoking at each accommodative stimulus (range 0-5). This increment was significant at 2 D (p = 0.02) and 3 D (p = 0.03) of stimulus. DISCUSSION AND CONCLUSIONS: The TSA of the eye significantly decreases after smoking. Cigarette smoking also causes a significant increase in objective accommodation at 2 D and 3 D of stimulus.

Supraciliary contraction segments: a new method for the treatment of presbyopia.

BACKGROUND AND OBJECTIVE: To evaluate the safety and effectiveness of supraciliary contraction segment implants (SCSIs) for the treatment of presbyopia. MATERIALS AND METHODS: This prospective, non-comparative study comprised 10 eyes from five phakic and emmetropic 50-year-old subjects. Preoperative and postoperative near and distance visual acuity, topography, axial length, pachymetry, and intraocular pressure were analyzed. A 5.32-mm long and 0.85-mm thick piece of polymethyl methacrylat (PMMA) and a 5.32-mm long or 0.55-mm thick dried hydrophilic SCSI were placed within the scleral tunnels that were created 2 mm away from the limbus. The 500-550 m deep tunnels were parallel to the limbus and four segments were implanted per eye. The SCSIs were entirely placed at a depth of approximately 85% in the sclera. RESULTS: The uncorrected distance visual acuity was similar before and after the surgery (0.00 logMAR). The monocular mean uncorrected near visual acuity (UNVA) was 0.5 ± 0.0 before surgery, 0.12 ± 0.10 logMAR at 1 month after surgery, 0.16 ± 0.18 logMAR at 3 months after surgery, and 0.29 ± 0.16 logMAR at the 18-month follow-up. CONCLUSION: Despite obtaining satisfactory results at 6 months after the surgery, a follow-up of the SCSI intervention at 18 months revealed a regression of the early post-op UNVA improvement caused by a progressive outward movement of SCSIs.