Investigation of alterations in retrobulbar hemodynamics and their correlation with choroidal thickness after strabismus surgery.

BACKGROUND: To evaluate the changes in retrobulbar circulation after strabismus surgery and to assess the relationship of these changes with choroidal thickness (CT). METHODS: This prospective study included 26 eyes of 26 patients who underwent strabismus surgery and 15 eyes of 15 healthy individuals as control group. The patients who had single horizontal muscle surgery were included in Group 1 (n = 14); and those who had surgery on both horizontal muscles were included in Group 2 (n = 12). Peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI) of ophthalmic artery (OA), posterior ciliary artery (PCA), and central retinal artery (CRA) were measured using Color Doppler Ultrasonography. Subfoveal CT was measured via Optical Coherence Tomography. All measurements were obtained preoperatively, at 1st week and 1st month after surgery. RESULTS: There were no differences regarding preoperative blood flow velocity parameters among the groups. OA RI increased significantly at 1st week and 1st month after surgery in Group 1 and 2 (P = 0.029 and P = 0.045, respectively). There was a significant increase in PCA PSV at 1st week in Group 1 (P = 0.002). There was no difference between the mean preoperative and postoperative CT among the 3 groups. A negative correlation between the percentage changes of CT and CRA EDV was found in Group 2 (P = 0.011). CONCLUSION: Single and double horizontal rectus muscle surgery have a measurable effect on retrobulbar hemodynamics but these changes do not correlate with CT.

Uncommon presentation of Meckel's diverticulum in a child with decompensated hypovolemic shock.

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and may cause serious complications such as intestinal obstruction, gastrointestinal hemorrhage, or inflammation with/without perforation, which can present with non-spe-cific symptoms and signs. We report on the case of a 2.5-year-old boy admitted to our emergency department in poor condition, with compatible signs of decompensated hypovolemic shock. This case finally resulted in intestinal volvulus and internal hernia, a very rare combination of two complications of MD, as determined in the operating room.

The relationship between extremity fractures and visual impairment in childhood: A case-control study.

BACKGROUND: Fractures are common extremity injuries in pediatric orthopedic practice. The aim of this study is to determine the relationship between pediatric extremity fractures and visual impairments. METHODS: Thirty pediatric patients who were admitted to the emergency and orthopedics and traumatology clinic due to an extremity fracture after a fall were included in the study. Following fracture treatment, the patients were evaluated in terms of ocu-lar findings before discharge from the hospital. Thirty age- and sex-matched healthy children who presented to the ophthalmology department for routine care were also recruited as the control group. All participants underwent a comprehensive ophthalmologic examination, including cycloplegic refraction, visual acuity levels, and near stereoacuity measurement. RESULTS: The number of male participants was higher in both groups. There was no significant difference between the groups in terms of age and gender distribution. The most common upper extremity fractures were observed to be distal radius (52%) and distal humerus fractures (28%). The number of patients who had a refractive error that required spectacles was significantly higher in the fracture group (p=0.039). When the visual acuity levels of the better eye were evaluated, the mean visual acuity was significantly lower in the fracture group (p=0.016). The mean stereoacuity was also significantly lower in the study group (<0.001). In the binary logistic regression analysis model, low stereopsis levels were associated with the risk of pediatric extremity fractures (95% CI: 1.056-1.385; p=0.006). CONCLUSION: Our study showed that low-energy pediatric extremity fractures are more common in children with visual im-pairments that require treatment, and low stereopsis is a risk factor for fractures. Consequently, regular eye examinations and early treatment of visual impairments in children may help to prevent fall-related injuries.

Effect of oral citicoline therapy on retinal nerve fiber layer and ganglion cell-inner plexiform layer in patients with primary open angle glaucoma.

AIM: To evaluate the short-term effects of oral citicoline therapy on the retinal nerve fiber layer (RNFL) and the macular ganglion cell-inner plexiform layer (mGCIPL) in patients with primary open angle glaucoma (POAG). METHODS: Fifty-four eyes of 54 patients with POAG glaucoma included in the study. In addition to a topical hypotensive, 250-mg oral citicoline was administered to 27 patients, while 27 patients were assigned as the control group. RNFL and mGCIPL values were measured using optical coherence tomography (OCT) at 1d before treatment and 3mo after the initiation of treatment. At the third month visit, citicoline treatment was discontinued and drug-free control (wash-out) measurements were obtained at the fourth month in citicoline group. RESULTS: The average RNFL thickness was significantly higher at month 3 than the baseline (P=0.038) in citicoline group. However, this improvement partially regressed after a 1-month wash-out period. No statistically significant changes in RNFL were observed in the superior, nasal, temporal and inferior quadrants at months 3 and 4 (P>0.05). The change in the average and inferior quadrant RNFL thickness in the citicoline group at 3mo was significantly greater than the control group (P=0.006 and P=0.014, respectively). There were no significant differences between the groups according to the change in mGCIPL thickness and the superior, nasal and temporal quadrant RNFL thickness (P>0.05). CONCLUSION: With oral citicoline treatment, the loss in the average RNFL is prevented in POAG patients in the short-term. Study data show that citicoline may have a significant impact on slowing glaucoma progression, which could have a potential neuroprotective effect.

Pediatric trauma: Blood product transfusion characteristics in a pediatric emergency department, a single center experience.

AIM: To investigate clinical and laboratory data, management and outcomes of pediatric trauma patients who initially received blood product transfusions. METHODS: Between January 2011-January 2021, traumatic children who underwent blood product transfusions within 24 h of arrival at the emergency department were included. Demographics, clinical and laboratory data, Injury Severity Score (ISS), volume of transfused blood products and crystalloid boluses in 24 h were recorded. Massive transfusion (MT) was defined as transfusion of ≥40 mL/kg of all blood products in 24 h. RESULTS: Among 32 cases, 8 (25.0 %) patients met the MT threshold criterion. Length of pediatric intensive care unit (PICU) stay and mechanical ventilation (MV) were longer for patients who received MT although there was no difference for age, ISS, volume of crystalloid boluses, length of hospital stay, and 30-day mortality between those who received MT or not. Volume of crystalloid boluses was higher in patients who died than those who survived but the volume of blood products was similar for two groups. An APTT value of >37.5 s was identified as a predictor of 30-day mortality (OR = 48.000, 95 % CI: 3.704-621.998, p: 0.003). CONCLUSION: Children who received MT had longer durations of MV and PICU stay than those who did not receive, but there was no significance for ISS, volume of crystalloid boluses, hospital stay, or mortality between two groups. Volume of crystalloid boluses was higher in patients who died than those who survived. An APTT value of >37.5 s can be used to predict 30-day mortality.

A Unique Case of Branch Retinal Artery Occlusion Associated with a Relatively Mild Coronavirus Disease 2019.

Introduction: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of the ongoing coronavirus disease 2019 (COVID-19) pandemic, is associated with inflammatory-induced hypercoagulation leading to multisystemic involvement, including the retina. Case Presentation: We report a unique case of branch retinal artery occlusion that occurred 5 weeks after a relatively mild COVID-19. After excluding all systemic disorders that may have caused retinal artery occlusion and noticing an elevation in the D-dimer level, the case was considered as a late complication of the SARS-CoV-2 infection. Discussion: As branch retinal artery occlusion occurred 5 weeks after COVID-19 in this case, ophthalmologists should keep in mind that late thromboembolic events which can be associated with SARS-CoV-2 infection may occur.

Assessment of central retinal thickness, choroidal thickness, and retinal nerve fiber layer in psoriasis: a spectral-domain optical coherence tomography study.

BACKGROUND: This study aims to evaluate choroidal thickness (CT), retinal thickness, ganglion cell-inner plexiform layer (GCIPL), and retinal nerve fiber layer (RNFL) structures in psoriasis patients using optical coherence tomography (OCT). METHODS: This study included 33 psoriasis patients and 33 healthy individuals. Moreover, psoriasis patients who did not use any systemic anti-inflammatory treatment were evaluated. Retinal and choroidal images of the participants were obtained with spectral-domain OCT. Furthermore, CT was measured in the subfoveal, temporal, and nasal positions at 500-µm intervals to a distance of 1,500 µm from the foveal center. RESULTS: The mean psoriasis area and severity index (PASI) score was 5.70 (range, 2.40-9.00). No significant differences were found in subfoveal (p = 0.659), temporal, and nasal CT values in psoriasis patients compared with the control group (p > 0.05). Similarly, no statistically significant differences were found between the groups in terms of central retinal thickness, macular GCIPL, and RNFL (p > 0.05). Moreover, no significant correlation exists between the duration of psoriasis disease and PASI scores and OCT parameters (p > 0.05). CONCLUSIONS: No significant changes in CT, ganglion cell layer, RNFL, and retinal thickness values were noted in psoriasis patients with mild to moderate mean PASI score.

Psychiatric comorbidity, depression, and anxiety levels and quality of life of the patients with mycosis fungoides.

Mycosis fungoides (MF) is a chronic disease, causing serious morbidities and mortality. This study was designed to measure depression and anxiety levels in MF patients, and quality of life (QoL) assessments and to compare the results with controls. Fifty-two patients with a diagnosis of MF and 52 age and sex matching healthy controls were enrolled in this study. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and the 36-Item Short Form Health Survey (SF-36) were administered to all patients and controls. Mean BAI and BDI scores of the patients with MF were significantly higher than controls. In case of the SF-36, general health perception, emotional, and social functioning scores were significantly lower in MF patients. Depression scores of the patients' were positively correlated with the age of disease onset and negatively correlated with physical functioning scores. Significant negative correlation was detected between eight subscales of the SF-36 and BDI and BAI scores. This study has demonstrated that there is significant impairment of QoL in MF patients MF, with higher anxiety and depression levels, when compared to control group. As the disease progresses, level of depression increases and patients' general health perception deteriorates.

Evaluation of Aqueous Flare Levels Following Intravitreal Ranibizumab Injection for Neovascular Age-related Macular Degeneration.

PURPOSE: To evaluate aqueous flare levels following intravitreal ranibizumab injection for neovascular age-related macular degeneration (AMD). METHODS: In total, 81 eyes of 79 patients who underwent intravitreal ranibizumab injection for neovascular AMD were included. Aqueous flare was evaluated before pupillary dilatation with Kowa FM-600 laser flare meter at baseline, and 1 day, and 1 month after intravitreal administration of ranibizumab 0.5 mg (0.05 mL). RESULTS: The mean anterior chamber flare was 10.7 ± 6.8 (range: 1.5-35.4) ph/ms before the injection, 12.5 ± 8.9 (range: 0.3-43) ph/ms on the first day, and 9.9 ± 5.7 (range: 0.2-28.4) ph/ms in the first month. On the first day, a subtle increasing of flare was observed. However, the difference between the mean aqueous flare levels at baseline and postoperative first day and first month was not statistically different (p>0.05). CONCLUSIONS: No significant short-term intraocular inflammation was noted in these eyes receiving ranibizumab for the treatment of neovascular AMD.

Tick Infestation of Eyelid: Two Case Reports.

Tick infestation of the eyelid is a rare but serious condition that can lead to Crimean-Congo hemorrhagic fever. In this report, we describe two cases who presented with tick infestation of the eyelid. Neither patient developed systemic disease or adverse sequelae after tick extraction. Complete mechanical removal of ticks located on the eyelid with blunt forceps is a safe and effective treatment method.

Health-related quality of life in children operated for pediatric cataracts.

PURPOSE: To evaluate health-related quality of life (HRQOL) in children who had surgery for pediatric cataracts. METHODS: Twenty-five children were divided into 2 groups according to the age at the time of survey (younger than 6 years in group A and 7 years and older in group B). A questionnaire that had 1 part appraising the child's perception and 3 parts evaluating the functional, social, and surgical apprehensions of parents was given to the participants. The questions in the first part were answered by parents in group A (proxy test) and by children in group B (self test). The correlations between the results and patient characteristics were evaluated statistically. RESULTS: Mean (range) score for the first part was 79.5 (58-97) in group A and 70 (56-86) in group B. Functional, social, and surgical scores were 42.5 (0-80), 45 (5-100), and 63 (12.5-100) in group A and 40 (10-90), 70 (40-85), and 75 (25-100) in group B. Functional, social, or surgical scores were not significantly different between groups. Social apprehensions were significantly higher in parents of patients with preoperative strabismus in group B. Functional, social, surgical apprehensions, and children's thoughts were not correlated significantly with age, sex, family history, laterality, associated nystagmus, aphakia or pseudophakia, postoperative optical rehabilitation, or the need for additional surgery in the groups. CONCLUSIONS: Although pediatric cataracts are known to have a great impact on children's life socially and functionally, there was no significant relationship between patient characteristics and HRQOL. The associated preoperative strabismus causes more social concern in the parents.

Anterior uveitis associated with laser epilation of eyebrows.

BACKGROUND: The objective of the study is to report a case of unilateral anterior uveitis after laser hair removal of the eyebrows with an alexandrite laser. FINDINGS: A 36-year-old female presented with painful red eye and photophobia in her left eye 2 days after receiving alexandrite (755 nm) laser epilation of both eyebrows. Visual acuity was 20/20 in both eyes. Right eye examination was normal. Left eye examination showed conjunctival injection, 2+ cells in the anterior chamber, and local posterior synechiae. Intraocular pressure and fundus examination were normal in both eyes. Topical steroids and cycloplegic drops were prescribed. Three days after the initiation of topical treatment, there was a reduction in anterior chamber cells to 1+, but posterior synechiae was enhanced. One week after, there were 0.5+ cells in the anterior chamber and no further enlargement of posterior synechiae. At the 2-month follow-up, uncorrected visual acuity remained 20/20 in both eyes. Slit-lamp biomicroscopy of the right eye was normal. Intraocular pressure and fundus examination were still normal in both eyes. Although anterior chamber of the left eye was clear, posterior synechiae persisted. We are still following the patient. CONCLUSION: Laser hair removal of the eyebrows can lead to ocular damage and should be avoided.

Serum vitronectin levels in patients with Behçet's disease.

BACKGROUND/AIMS: To determine serum vitronectin levels in Behçet patients with and without ocular involvement, and to evaluate the relationship between vitronectin concentrations and clinical manifestations of Behçet's disease (BD). METHODS: Sixty-five patients with BD and 21 control subjects were included. All patients were queried for the clinical manifestations of BD. Serum vitronectin concentrations were determined by using in vitro enzyme immunoassay kits. RESULTS: Serum vitronectin levels between the patients and the control subjects were not different. There was no statistically significant difference between vitronectin levels in Behçet patients with and without ocular involvement. No correlation was found between vitronectin concentrations and clinical manifestations. CONCLUSION: This is the first study evaluating vitronectin levels in Behçet patients. Further studies involving larger numbers of subjects would be useful to improve our understanding of the functions of vitronectin in BD.

Results of interferon alpha-2a therapy in patients with Behcet's disease.

PURPOSE: Corticosteroids, the main treatment option in acute attacks of ocular Behcet's disease (BD), are ineffective in preventing recurrent inflammation. Even combined therapy with systemic corticosteroids and azathioprine, cyclosporine, chlorambucil, or cyclophosphamide may be ineffective in controlling the disease in severe cases. We report our clinical experience with the efficacy and tolerability of interferon alpha-2a (IFN-α-2a) monotherapy in patients with Behcet uveitis refractory to conventional immunosuppressive agents. METHODS: We retrospectively analyzed the medical records of 12 Turkish Behcet patients who had been treated with IFN-α-2a between February 2009 and October 2011 because of severe uveitis refractory to traditional immunosuppressants. IFN-α-2a was initially administered at 4.5×10(6) IU/day subcutaneously; then, the dosage was tapered gradually depending on the clinical response. Previous immunosuppressive drugs such as systemic corticosteroids, azathioprine, and cyclosporine were stopped 1 day before the initiation of IFN-α-2a treatment. RESULTS: The mean duration of IFN-α-2a use was 13.3 months (range: 3-28 months). Eighty-three percent of patients with ocular BD achieved partial or complete response. Best-corrected visual acuity improved or remained stable in all of patients. All patients experienced flu like symptoms responding to oral acetaminophen, hair loss was also developed in 7 of them (58%), and psoriatic skin rash was seen in 3 patients (25%) during treatment with IFN-α-2a. No other side effects were observed. CONCLUSIONS: IFN-α-2a treatment is effective in Behcet uveitis refractory to traditional treatment regimens and provides significant improvement in visual prognosis.

[Comparison of microscopy and EIA in the diagnosis of Giardia intestinalis in stool specimens.]. / Giardiasisin tanisinda Enzym Immun Assay (EIA) ve direkt inceleme yöntemlerinin karsilastirilmasi

In this study; we compared the direct microscopic method and EIA test in the investigation of the stools of patients with gastrointestinal symptoms who presented at clinics. A total of 188 stool specimens collected from clinics were investigated by direct microscopy using native-Lugol preparations. Giardia cysts and/or trophozoites were observed in 141 specimens. There were no Giardia cysts and/or trophozoites or any other intestinal parasites detected in the other 47 stool specimens. The RIDASCREENR EIA kit procedure was applied in all specimens. Out of 141 specimens positive with direct microscopy, 136 specimens were positive with the EIA test and 5 specimens, negative. Parasites were not found in 47 stool specimens with direct microscopy. Of these, 38 specimens were negative with the EIA test and 9 specimens, positive. When the patient and control groups were compared, a significant difference was observed between the two methods (p < 0.05). The sensitivity and specificity of the EIA method that was used to determine the antigenic properties of G. intestinalis in stools were 96.4% and 80.8%, respectively.