Long term results of accelerated corneal collagen cross-linking in pediatric keratoconus.

PURPOSE: To evaluate the long term visual, refractive, and corneal tomographic outcomes of epithelium-off accelerated corneal collagen cross-linking (ACXL) in the management of pediatric keratoconus (KC). METHODS: This retrospective study included patients under 18 years old with progressive KC who underwent ACXL between 2012 and 2019 at Dicle University Hospital. Complete ophthalmic examination was performed including uncorrected distance visual acuity (UDVA), best spectacle-corrected distance visual acuity (CDVA), manifest refraction, and corneal tomography. Evaluations were performed preoperatively and at 6 months intervals postoperatively. RESULTS: Forty-nine eyes of 49 patients were included in the study. The mean age of patients at the time of ACXL was 14.2 ± 1.8 (range: 9.5-17.3) years. Mean follow up was 4.61 ± 1.90 (range: 2.0-8.1) years. The mean LogMAR UDVA improved from 0.94 ± 0.41 to 0.81 ± 0.43, 0.69 ± 0.41, and 0.67 ± 0.33 after 1, 3, and 5 years respectively (p = 0.001). The mean LogMAR CDVA improved from 0.58 ± 0.36 to 0.46 ± 0.31, 0.34 ± 0.23, and 0.39 ± 0.27 after 1, 3, and 5 years respectively (p = 0.015). The mean refractive cylinder improved significantly from 6.01 ± 2.07 diopters (D) to 5.46 ± 1.87, 5.38 ± 2.18, and 5.02 ± 2.31 D after 1, 3, and 5 years respectively (p = 0.005). As compared to preoperative values, steep keratometry and maximum keratometry were not significantly different (p = 0.805 and 0.448, respectively) following ACXL, while flat keratometry significantly improved after ACXL (p = 0.012). Although central corneal thicknesses decreased significantly (p = 0.029), the decrease in thinnest corneal thickness was not statistically significant (p = 0.205). CONCLUSION: Epithelium-off ACXL seems to be effective for halting KC progression with long term clinical benefits in pediatric patients.

Effect of fasting on diurnal fluctuation of parafoveal and peripapillary vessel density and related oculodynamic and haemodynamic parameters.

PURPOSE: To investigate the effects of Ramadan fasting on diurnal superficial-deep parafoveal vessel density (pfVD) and nerve head (NH)-radial peripapillary capillary (RPC) peripapillary vessel density (ppVD) using optical coherence tomography angiography (OCTA), as well as other related oculodynamic and haemodynamic parameters, and to compare these findings with those in the nonfasting period in healthy individuals. METHODS: A total of 105 healthy individuals, 42 women and 63 men, were included in this prospective study. OCTA was used to examine the superficial-deep pfVD and NH-RPC ppVD. In the third week of Ramadan, OCTA readings were obtained twice daily at 08:00 and 16:00 hour (h) under fasting conditions and compared with nonfasting values 2 weeks after Ramadan. Both intraocular pressure (IOP) and blood pressure values were assessed accordingly. RESULTS: The mean age (23-51) of individuals was 34.37 ±â€¯7.04 years. In comparison with the 08:00 -h values, the 16:00 -h IOPs, superficial-deep pfVDs and RPC ppVDs were substantially reduced both during the fasting and nonfasting periods (P = 0.001, P = 0.009, P = 0.006, P = 0.006, P = 0.004, P = 0.004, P = 0.41, P = 0.032 and P = 0.021). No differences were found in the diurnal change of superficial-deep pfVDs, NH-RPC ppVDs, IOPs and mean ocular perfusion pressures (MOPPs) between the fasting and nonfasting periods, whereas the same was not true for mean arterial blood pressures (MABPs) (P = 0.049). CONCLUSIONS: The parafoveal and peripapillary VDs (except for NHpp-VD) and IOPs were found to have decreased significantly throughout the day both in fasting and nonfasting periods. Our study confirms the diurnal changes in the IOPs, MOPPs, superficial-deep pfVDs and NH-RPC ppVDs under dehydration and normal terms.

Approach of Family Physicians to Pediatric Eye Screening in Diyarbakir

Objectives: In Turkey, preventive medicine services are the responsibility of family physicians and vision screening is a key component of this responsibility. In this study, we aimed to investigate the approach of family physicians to vision screening in infants and children. Materials and Methods: Data were collected using a 16-item questionnaire administered to 100 family physicians working in the center and provinces of Diyarbakir. Results: The results indicated that 88 (88%) physicians declared knowing what the red reflex test was, while 12 physicians declared that they had never heard of it. Only 16 (16%) physicians performed the test routinely and 36 (36%) physicians performed it only in suspicious cases. Ten (10%) physicians indicated that they did not refer the patients to an ophthalmologist even though they did not perform the red reflex test. Moreover, 5 (5%) physicians did not have an ophthalmoscope and 12 (12%) physicians reported not knowing how to use an ophthalmoscope. Forty (40%) of the physicians measured preschool visual acuity at least once. Sixty-six (66%) physicians referred younger children who could not express their vision problems to an ophthalmologist. Four (4%) physicians declared that they would delay surgery in children with strabismus until they were old enough for surgery. Ninety-three (93%) physicians suggested that educational seminars about vision screening would be beneficial. Conclusion: Educational seminars about vision screening may have favorable outcomes. The medical devices in family medicine centers should be improved. Vision screening can be added to the negative performance-based compensation system in order to increase physicians' attention to vision screening. To implement detailed eye screening programs like those in developed countries, an infrastructure should be established for this screening program.