The newborn conjunctival flora at the post delivery 24 hours.

PURPOSE: The aim of this study was to investigate the aerobic conjunctival flora of neonates and the effects of delivery type on conjunctival flora development in neonates who were born with normal spontaneous vaginal delivery (SVD) or elective caesarean section (C/S) and who were not given prophylactic antibiotic eye drops after birth. METHODS: This cross-sectional study included 95 healthy newborns. One day after the delivery, conjunctival samples were taken from newborns who were born with normal SVD or elective C/S, and not given prophylactic antibiotic eye drops after birth. Newborns with conjunctival hyperemia and discharge were excluded from study. Samples were plated in blood agar, EMB, and chocolate agar. These cultures were incubated at 37 °C for 24-48 h. Antibiotic sensitivity was evaluated using Kirby-Bauer disc diffusion method. RESULTS: Staphylococcus aureus (S.aureus) growth was observed in 7 (70%) and coagulase negative staphylococcus (CNS) growth in 2 (20%) out of 10 eyes with bacterial growth in 9 culture positive newborns born with C/S. Two S.aureus strains were resistant to methicillin. On the other hand, CNS growth was observed in the conjunctival cultures of 17 out of 19 eyes with bacterial growth in 16 culture positive newborns born with SVD. In 2 eyes with CNS growth, there was also S.aureus growth. The positive cultures for S.aureus were significantly higher in the conjunctival cultures of neonates born with C/S compared to neonates born with SVD, where CNS growth was significantly lower (P = 0.002). All isolates were susceptible to vancomycin, teicoplanin, and gatifloxacin. Two isolates were resistant to methicillin. CONCLUSIONS: In deliveries with C/S, the newborn does not contact the vagina. This may result in changes of bacterial characteristic of the flora. Culture positivity for S.aureus was higher in C/S compared to SVD, which may be important in case neonatal conjunctivitis develops.

Comparison of Retinal Nerve Fiber Layer Thickness in Terms of Birth Weight in Prematurely Born Children.

PURPOSE: To study the potential effects of both prematurity and the sub-groups of low birth weight on thickness of RNFL. METHODS: Prospective case series of 26 preterm school-aged children with low birth weight whose retinal nerve fiber layer analyses with RTVue-100 Fourier-domain optic coherence tomography were performed in 2013 at the Department of Ophthalmology, Erzurum Region Education and Training Hospital. RESULTS: The mean retinal nerve fiber layer thicknesses were 100.6 ± 13.3 microns in extremely low birth weight, 103.9 ± 8.4 microns in very low birth weight, and 104.1 ± 10.8 microns in low birth weight groups. There was no significant difference in RNFL among the groups. CONCLUSIONS: No significant relationship was found between birth weights and retinal nerve fiber layer thickness of preterm children who were appropriate for gestational age.

Association of Birth Parameters With Corneal Thickness in Prematurely Born and Full-Term School-Aged Children.

PURPOSE: The objective of this study was to investigate and compare corneal thicknesses of prematurely born and full-term early school-aged children, who were grouped into birth weight categories according to gestational age. METHODS: This cross-sectional study included 136 school-aged white children. They were grouped as premature (born before 37 weeks of gestation) and full term (born at or after 37 weeks of gestation). These 2 groups were further divided into birth weight groups according to gestational age as small, appropriate, and large for gestational age. Central corneal thickness (CCT) was measured by ultrasound pachymetry. The intraocular pressures of both groups were measured by a Goldmann applanation tonometer. RESULTS: The study included right eyes of 136 children. There were 53 girls and 83 boys whose mean age was 6.5 ± 0.9 years (range: 5-8 yrs). Mean pachymetry of the small for gestational age group (526.8 ± 37.9 µm) in prematurely born children was significantly lower than that of appropriate for gestational age (554.6 ± 34.2 µm) (P = 0.039, mean difference 27.8, 95% confidence interval, 1.1-54.5). When prematurely born and full-term children are compared, the mean pachymetric values of the term children (574.5 ± 37.8 µm) were found to be significantly higher than those of the prematurely born children (545.4 ± 35.6 µm) (P ≤ 0.001). CONCLUSIONS: Birth parameters affect CCT in early school-aged children. Prematurely born, small for gestational age children have lesser CCT. This should be kept in mind at their follow-ups.

Sociodemographic status of severely disabled and visually impaired elderly people in Turkey.

PURPOSE: To identify the prevalence of ophthalmologic diseases in elderly patients who had been classified as severely disabled and to identify the ophthalmologic conditions leading to visual impairment and blindness. METHODS: The medical records of 2806 patients who had applied to the Health Board of the Erzurum Region Training and Research Hospital between January 2011 and December 2012 were reviewed. One hundred ninety-nine patients aged >64 years who were classified as severely disabled with disability rates of over 50%, and who were unable to care for themselves or to move and/or communicate without help were included in the study. RESULTS: The most frequently seen disabilities were neurological (47.2%) and those resulting from eye diseases (17.1%). The most common ophthalmologic diseases were cataract, glaucoma, and age-related macular degeneration. The mean right and left eye visual acuities were 1.17 ± 1.10 logMAR and 1.13 ± 1.0 logMAR, respectively. Of the 60 patients with ophthalmologic diseases or conditions, 33 were blind (visual acuity worse than 20/400) and 10 were visually impaired (visual acuity worse than 20/70 but better than 20/400). Cataracts were the main cause of blindness. The mean age of the patients who were still being followed up at the time of application to the disability board was significantly lower than that of the others (p =0.015). Seventy-nine percent of the blind patients were from rural areas, and 88% of these had no regular follow-up. Among the blind and visually impaired, significantly more patients from urban areas had social security insurance (SSI) than those from rural areas (p =0.043). Nearly 64% of the blind patients were women. The follow-up rate was significantly lower in women (p =0.025). According to multinomial logistic regression analysis, the visually impaired and blind patients were more likely to have lower follow-up rates than the other types of severely disabled patients (OR: 0.231, 95% Cl: 0.077-0.688, p=0.009). CONCLUSIONS: Blindness gives rise to severe disability, and the most common ophthalmologic diseases that cause severe disabilities in elderly patients are cataract, glaucoma, and age-related macular degeneration. Sociodemographic factors that may affect the accessibility of visually impaired and blind people to health services include their place of residence and gender.

Sociodemographic status of severely disabled and visually impaired elderly people in Turkey / Estado sociodemográfico de pacientes idosos com incapacidades graves e deficiência visual na Turquia

ABSTRACT Purpose: To identify the prevalence of ophthalmologic diseases in elderly patients who had been classified as severely disabled and to identify the ophthalmologic conditions leading to visual impairment and blindness. Methods: The medical records of 2806 patients who had applied to the Health Board of the Erzurum Region Training and Research Hospital between January 2011 and December 2012 were reviewed. One hundred ninety-nine patients aged >64 years who were classified as severely disabled with disability rates of over 50%, and who were unable to care for themselves or to move and/or communicate without help were included in the study. Results: The most frequently seen disabilities were neurological (47.2%) and those resulting from eye diseases (17.1%). The most common ophthalmologic diseases were cataract, glaucoma, and age-related macular degeneration. The mean right and left eye visual acuities were 1.17 ± 1.10 logMAR and 1.13 ± 1.0 logMAR, respectively. Of the 60 patients with ophthalmologic diseases or conditions, 33 were blind (visual acuity worse than 20/400) and 10 were visually impaired (visual acuity worse than 20/70 but better than 20/400). Cataracts were the main cause of blindness. The mean age of the patients who were still being followed up at the time of application to the disability board was significantly lower than that of the others (p =0.015). Seventy-nine percent of the blind patients were from rural areas, and 88% of these had no regular follow-up. Among the blind and visually impaired, significantly more patients from urban areas had social security insurance (SSI) than those from rural areas (p =0.043). Nearly 64% of the blind patients were women. The follow-up rate was significantly lower in women (p =0.025). According to multinomial logistic regression analysis, the visually impaired and blind patients were more likely to have lower follow-up rates than the other types of severely disabled patients (OR: 0.231, 95% Cl: 0.077-0.688, p=0.009). Conclusions: Blindness gives rise to severe disability, and the most common ophthalmologic diseases that cause severe disabilities in elderly patients are cataract, glaucoma, and age-related macular degeneration. Sociodemographic factors that may affect the accessibility of visually impaired and blind people to health services include their place of residence and gender.

RESUMO Objetivo: Identificar a prevalência de doenças oftalmológicas em pacientes idosos que tinham sido considerados como incapacitados graves, e para identificar as condições oftalmológicas que levam à deficiência visual e cegueira. Métodos: Prontuários de 2806 pacientes que tinham solicitado ao conselho de saúde do hospital de treinamento e pesquisa da região de Erzurum entre janeiro de 2011 e dezembro de 2012, foram revistos. Cento e noventa e nove idosos com mais de 64 anos, que foram considerados como incapacitados graves nos quais as taxas de incapacidade são mais de 50% e não são capazes de cuidado próprio e não são capazes de mover-se e/ou comunicar-se sem ajuda, foram incluídos no estudo. Resultados: As deficiências mais frequentemente observados são neurológicas (47,2%) e doenças oculares (17,1%). As doenças oftalmológicas mais frequentemente observadas foram catarata, glaucoma e degeneração macular relacionada à idade. Média de acuidade visual em olho direito e esquerdo foram 1,17 ± 1,10 e 1,13 ± 1,0 logMAR, respectivamente. Dos 60 pacientes, 33 apresentaram cegueira (acuidade visual pior que 20/400), 10 tinham deficiência visual (acuidade visual pior do que 20/70, melhor do que 20/400). A catarata foi a principal causa de cegueira. A idade média dos pacientes com acompanhamento no momento da solicitação ao conselho foi significativamente menor do que os demais (p=0,015). Setenta e nove por cento dos pacientes cegos eram da área rural e 88% deles não tinham acompanhamento regular. Entre cegos e deficientes visuais, a taxa de posse do seguro de segurança social (SSI) foi significativamente maior em pacientes de área urbana (p=0,043). Quase 64% dos pacientes cegos eram mulheres. A taxa de acompanhamento foi significativamente menor nas mulheres (p=0,025). De acordo com a análise de regressão logística multinominal, os pacientes com deficiência e cegos visuais eram mais propensos a ter menor taxa de acompanhamento do que os outros pacientes com deficiência grave (OR: 0,231, 95% Cl: 0,077-0,688, e p=0,009). Conclusões: A cegueira gera incapacitação grave. As doenças oftalmológicas mais frequentemente observadas que causam deficiência grave em pacientes idosos são a catarata, glaucoma e degeneração macular relacionada à idade. O local de residência e o gênero são fatores sociodemográficos que podem ter impacto sobre o acesso à saúde de pessoas com deficiência visual e cegos.

Measurement of Choroidal Thickness Following Caffeine Intake in Healthy Subjects.

PURPOSE: The aim of this study is to investigate the effect of 200 mg caffeine on subfoveal choroidal thickness (CT) in the macular area as measured by enhanced depth imaging optical coherence tomography (EDI-OCT) in healthy subjects. MATERIALS AND METHODS: Fifty healthy individuals (study group) and 50 healthy individuals (control group) were enrolled in study. In the study group, participants received a 200 mg caffeine capsule and the control group consisted of subjects who received plasebo capsule. The subfoveal CT was measured by EDI-OCT before the caffeine intake and at 30 min, 1 h, 2 h, 3 h, 4 h and 6 h following caffeine intake. RESULTS: SFCT after caffeine intake was significantly decreased at 30 min, 1 h, 2 h, 3 h and 4 h compared to the baseline measurement, while the difference between baseline and 6 h was not statistically significant in the study group. There were no significant differences between the baseline and the other measurement times in the control group (p > 0.05). CONCLUSION: The thinning of CT begins about 30 min after the oral ingestion of 200 mg of caffeine and lasts for about four hours.

Success of hydrocone (TORIS-K) soft contact lens for keratoconus and traumatic keratopathy.

OBJECTIVE: To present success of Toris-K contact lenses in keratoconus and traumatic keratopathy with irregular corneal surface. METHODS: Toris-K contact lenses were used to treat 7 eyes of 4 patients with traumatic keratopathy (Case 1) or keratoconus (Case 2, Case 3, and Case 4). All cases had a complete eye examination before the contact lens application. The case with traumatic keratopathy was a 32-year-old male who had corneal penetrating injury due to hobnail strike 23 months ago. The other 3 keratoconus cases were females at the age of 14, 16 and 22 years old. They had high myopia and irregular astigmatism due to keratoconus. All patients refused using rigid gas permeable contact lens because of intolerance. Toris-K contact lenses were fitted on all eyes. All patients were followed-up for 28 months with a complete ophthalmic examination and corneal topography every two months. RESULTS: Improvement of BCVA of the cases was remarkable. All cases were comfortable with their Toris-K contact lenses for 28 months. There was no significant distortion on the lenses during follow-up period. CONCLUSION: Toris-K lenses may be an effective alternative treatment option for the patients with keratoconus and traumatic keratopathy, especially who cannot tolerate rigid gas permeable contact lenses.

Association of birth parameters with refractive status in a sample of caucasian children aged 4-17 years.

Purpose. To investigate the association of birth parameters with refractive status in different age groups of Caucasian children. Materials and Methods. This cross-sectional study included 564 eyes of 282 children aged 4 to 17 years. All children underwent complete ophthalmologic examination. The children were divided into three groups according to their refractive status (emmetropia,myopia, and hyperopia), ages (4-7, 8-9, 10-12, and 13-17), and appropriateness for gestational age, respectively. Results. The mean age of the children was 9.2 ± 2.8 (age range 4-17 years). The mean spheric equivalent was +0.3 ± 1.7 (range: (-10.0)-(+10.0) diopters). The mean birth weight and gestational age were 2681.1 ± 930.8 grams (750-5000 grams) and 37.2 ± 3.7 weeks (25-42 weeks). According to multinominal logistic regression analysis, children with myopia were more likely to have higher birth weights than emmetropic children (OR: 1.0, 95% CI: 1.000-1.001, and P = 0.028). The hypermetropes were found to be significantly small for gestational age between 13 and 17 years of age. Conclusion. Birth weight and appropriateness for gestational age as birth parameters may have an impact on development of all types of refractive errors. The hypermetropic children tended to be small for gestational age.

Is ciliary muscle affected in migraine patients with aura and without aura?

BACKGROUND: The aim of this study was to compare spherical equivalents (SE) and spherical equivalents with cycloplegic (CSE) values of migraine patients with and without visual aura, with those patients without migraine complaints. MATERIAL/METHODS: We included patients over the age of 18 years, who had 20/20 uncorrected vision, and who did not have ocular pathology in their examination. The patients were divided into 3 groups: Group 1: 86 eyes of 43 migraine patients without aura, Group 2: 38 eyes of 19 migraine patients with aura, and Group 3: 60 eyes of 30 patients without migraine. Spherical equivalents and spherical equivalents with cycloplegic from the auto-refractometrical values of the patients were compared. RESULTS: The mean age of the migraine and control patients was 34.2±8.3 and 33.6±10.8 years, respectively. Forty-three (69%) of 62 migraine patients had migraine without aura and 19 (31%) had migraine with aura. The right and left eyes of the patients were evaluated together and a significant correlation was found between the groups. To evaluate the impact of cycloplegia in patients, SE and CSE values were obtained and differences between these values were evaluated. It was found that the change in Group 2 patients was significantly lower than the change in Group 3 patients (p=0.024). CONCLUSIONS: We found that the cycloplegic spherical equivalents values of our patients with aura were lower than control patients. We need further studies to reveal whether migraine with aura is the trigger or the result of those attacks.

Unilateral Optic Neuropathy and Acute Angle-Closure Glaucoma following Snake Envenomation.

Purpose. We aimed to describe a unique case in which a patient developed unilateral optic neuritis and angle-closure glaucoma as a result of snake envenomation. Case Report. Approximately 18 hours after envenomation, a 67-year-old female patient described visual impairment and severe pain in her left eye (LE). The patient's best corrected visual acuity was 10/10 in the RE and hand motion in the LE. Cranial magnetic resonance imaging showed signs of neuropathy in the left optic nerve. In the LE, corneal haziness, closure of the iridocorneal angle, and mild mydriasis were observed and pupillary light reflex was absent. Intraocular pressure was 25 mmHg and 57 mmHg in the RE and LE, respectively. The patient was diagnosed with acute angle-closure glaucoma in the LE. Optic neuropathy was treated with intravenous pulse methylprednisolone. Left intraocular pressure was within normal range starting on the fourth day. One month after the incident, there was no sign of optic neuropathy; relative afferent pupillary defect and optic nerve swelling disappeared. Conclusions. Patients with severe headache and visual loss after snake envenomation must be carefully examined for possible optic neuropathy and angle-closure glaucoma. Early diagnosis and treatment of these cases are necessary to prevent permanent damage to optic nerves.

Acquired capillary hemangioma of the eyelid in a 49-year-old woman from Turkey.

A 49-year-old woman developed a dark brown nodular mass in the lower eyelid. The lesion had grown fast for 2 months and then had remained stable in size. Excisional biopsy was performed. Histopathological examination of an excisional biopsy specimen pointed to proliferative vessels lined by increased endothelial cells without nuclear atypism. The nodular mass evaluated as a capillary hemangioma.

Success of ranibizumab in central serous chorioretinopathy resistant to bevacizumab.

PURPOSE: To present effectiveness of intravitreal ranibizumab (IVR) injection for central serous chorioretinopathy (CSC), resistant to intravitreal bevacizumab (IVB) injection. METHODS: Files of the patients who had the diagnosis of CSC between 2005 and 2013 were reviewed retrospectively. Eighty-five eyes of 81 patients' files have been investigated. Ten eyes of 10 patients that were resistant to IVB, with no history of photodynamic therapy, were included in to this study. Demographic details, best-corrected visual acuity (BCVA), and central macular thickness (CMT) were studied to analyze the effectiveness of IVR. RESULTS: The mean age of the patients was 38.8 years (SD=4.7 years). The mean follow-up time after first IVR injection was 7.9 months (SD=1.5 months). The mean number of IVB and IVR injections was 2.0 (SD=0.7) and 1.3 (SD=0.4), respectively. The mean CMT before IVR injection was 392.4 µm (SD=66.3) and decreased to 194.1 µm (SD=9.3, P<0.001) at the last visit. The mean BCVA before IVR injection was 0.50 logMAR (SD=0.23) and improved to 0.05 logMAR (SD=0.06, P<0.001) at the last visit. In all cases after IVR injection, the subretinal fluid almost resolved completely, and leakage disappeared in fundus fluorescein angiography. CONCLUSION: Ranibizumab might be a promising option for the patients with CSC, resistant to bevacizumab in acute or early chronic stage.

Unilateral cataract and vitreoretinopathy in a case with klippel-trenaunay syndrome.

Purpose. We present a case with Klippel-Trenaunay (KT) syndrome that had unilateral mature cataract and vitreoretinopathy. Case Report. A 17-year-old boy with KT syndrome presented to the clinic of ophthalmology for low vision in the right eye. His best corrected visual acuity (BCVA) was hand motion in the right eye and 20/20 in the left eye. Anterior segment examination revealed mature cataract in the right. During the physical examination, port-wine stains were noted over right side of his face, ankle, and toes. He had asymmetric face and his head was larger on the right side. Leg lengths were symmetrical, although he had skin hypertrophy. Cranial magnetic resonance imaging studies showed cortical atrophy discordant to his age, asymmetric vascular dilatations in the right hemisphere, hypertrophy in the right periorbital soft tissue, and choroidal plexus. The patient received an uncomplicated cataract surgery. His BCVA in the right eye improved to 20/200 after the surgery. After removing cataractous lens, we were able to examine the fundus that revealed severe vitreoretinopathy and choroidal hemangioma. Conclusion. This case emphasizes the importance of prompt ophthalmic examination in patients with KT syndrome.

The effects of topical antiglaucoma drugs as monotherapy on the ocular surface: a prospective study.

Purpose. The aim was to compare the effects of antiglaucoma eye drops on the tear functions and ocular surface. Method. Eighty-five eyes of 43 patients with glaucoma were included into this randomized prospective study. Timolol without preservative (1), timolol with benzododecinium bromide (2), latanoprost (3), bimatoprost (4), travoprost with benzalkonium chloride (5), and brimonidine with purite (6) were given to 6 groups. Schirmer I, tear film breakup time (TBUT), staining scores, and impression cytology samples were evaluated before and during 12-month-follow-up period. Results. At the end of 12 months, there was no detected change in Schirmer I and TBUT tests indicating dry eye. Corneal staining scores were higher in groups 1 and 2, while conjunctival staining scores were higher in group 6. Goblet cell count decreased in groups 1 and 5 in superior and inferior, group 2 in superior, and groups 3 and 6 in inferior conjunctiva. Squamous metaplasia grades showed a significant increase in groups 1 and 2 at 3rd, 6th, and 12th month controls (P < 0.05). Conclusion. We observed nonserious impact on tear functions and ocular surface with antiglaucoma monotherapy. Beta blockers induced more damage on the ocular surface suggesting the role of the dosing and active substances beside preservatives.

Unilateral morning glory optic disc anomaly in a case with Down syndrome.

BACKGROUND: This case is unique because it is the first reported case of Down syndrome with morning glory optic disc anomaly in literature. CASE PRESENTATION: A 15-year-old girl with features of Down syndrome presented to the Clinic of Ophthalmology for a regular ophthalmologic examination. Her best corrected visual acuity was 20/50 in the right eye and 20/20 in the left eye. The fundus examination revealed findings compatible with unilateral morning glory optic disc anomaly in the right eye. The patient underwent a complete ophthalmologic and systemic evaluation to explore possible associated findings. CONCLUSION: This case report emphasizes the importance of ophthalmic screening-examinations in Down children to rule out any vision relevant pathology.

Central retinal artery occlusion in association with fibromuscular dysplasia.

A 14 year-old female, whose chief complaint was severe vision loss in the right eye for 2 days, presented to the Clinic of Ophthalmology of Fatih Sultan Mehmet Education and Research Hospital. The patient had been attending follow-up visits for 4 years, following a diagnosis of fibromuscular dysplasia by the Clinic of Pediatrics. The patient underwent a complete ophthalmo-logic, angiographic, hematologic, and systemic evaluation. Fundus fluorescein angiography was performed immediately, because of the cherry-red spot sign in the macula of the right eye. Fundus fluorescein angiography revealed evidence of marked stasis of the retinal arterial circulation in the right eye. Best corrected visual acuity was 20/400 in the right eye and 20/20 in the left eye.