A. Osman Saatci

Ocular findings in 55 patients with Down's syndrome

Fifty-five patients with Downs syndrome were examined to evaluate the characteristics and frequency of ocular findings. Of these patients, 29 (52.7%) were hypermetropes, 7 (12.7%) were emmetropes, and 7 (12.7%) were myopes; astigmatism of more than 3.00 diopters was present in 7(12.7%) patients. Strabismus was observed in 12 (21.8%) patients. All but one of these 12 patients also had esotropia. Congenital nasolacrimal duct obstruction was present in 12 subjects (21.8%). Blepharitis was found in 19 (34.5%) cases. Nystagmus occurred in 7 (12.7%) patients. Brushfield spots were detected in only 20 (36.3%) of the patients and were more common in light-colored irides. Lens opacities were diagnosed in 11 (20%) patients, and two underwent successful cataract surgery. On fundus examination, an increased number of retinal vessels crossing the optic nerve head was detected in 21 (38.1%) cases. One of the patients had a retinal detachment. Significant but correctable ocular problems are present in patients with Downs syndrome and may interfere with the quality of life of the patient and with binocular vision. Surgical intervention may be needed for strabismus and for cataracts.

Intravitreal triamcinolone acetonide injection for acute non-arteritic anterior ischaemic optic neuropathy*

Non‐arteritic anterior ischaemic optic neuropathy is the most common optic neuropathy of the elderly, characterised by unilateral, sudden, painless visual loss. No effective treatment has been proven to reverse or limit the course of this disease. We evaluated the role of intravitreal triamcinolone acetonide injection in eyes with non‐arteritic anterior ischaemic optic neuropathy (NAION). Four eyes of four patients with acute NAION received a single intravitreal injection of triamcinolone acetonide (4 mg). The time between visual loss and intravitreal injection varied between four and 10 days. Mean age of patients was 57.25 years (range, 44 to 77 years). All patients experienced some visual gain. No complications related to the injection were observed during the following three months. Intravitreal triamcinolone injection may offer help in limiting the damage in this small group of patients with a relatively short history of visual loss due to NAION.

Ocular and systemic findings associated with optic disc colobomas

PURPOSE To determine the ocular and systemic anomalies associated with optic disc colobomas. PATIENTS AND METHODS The records of patients with a diagnosis of isolated optic disc coloboma and chorioretinal coloboma with optic disc involvement were retrospectively reviewed. RESULTS Fifteen patients were included in the study. Of the 30 eyes, the optic disc and choroid were involved in 18, an isolated disc coloboma was present in 5, a normal optic disc was present in 4, and the optic disc could not be identified because of extreme microphthalmia in 1. Of the optic discs outside the fundus colobomas, 1 had an abnormal shape and 1 had optic atrophy and hypoplasia. Eight patients had bilateral but asymmetric involvement of the optic nerve with the coloboma. Fourteen eyes of 9 patients were microphthalmic. Nine eyes of 6 patients had microcornea. One patient had a nonrhegmatogenous retinal detachment at the time of diagnosis. One eye had a retrobulbar cyst with microphthalmia. Eight (53%) of the patients had sensory strabismus. Two patients had unilateral cortical lens opacities. Associated systemic findings were present in 6 (40%) of the 15 patients. CONCLUSIONS Optic disc colobomas have a wide variety of presentations. Poor visual acuity was observed mostly in eyes with macular involvement and microphthalmia.

Magnetic resonance imaging characteristics of posterior scleritis mimicking choroidal mass.

We present imaging findings in a case of posterior scleritis, which may mimic tumoral mass lesion resulting in unnecessary enucleation. Magnetic resonance imaging was remarkable for a subretinal mass hypointense on T2 and hyperintense on T1 weighted images. A peripheral rim of hypointensity was noteworthy, suggestive of sclerouveal thickening. There was an ill-defined area of increased T2 signal intensity adjacent to globe at the site of nodular lesion implying an inflammatory process. A linear contrast enhancement was seen within the bulbus oculi which may represent detached retina by exudation or displaced retina due to thickened sclera and choroidal layers. The CSF space around the optic nerve was enlarged.

Macular hole formation in Bietti's crystalline retinopathy: A case report

Three years after the initial diagnosis, a 21-year-old healthy man with Biettis crystalline retinopathy developed unilateral stage 4 macular hole with surrounding macular detachment. The mechanism of macular hole formation, which may or may not be a feature of Biettis crystalline dystrophy, is not clear.

Combined central retinal artery and vein occlusion in a child with systemic non-Hodgkin's lymphoma

Purpose: To report on a case of systemic non-Hodgkins lymphoma and unilateral combined central retinal artery and vein occlusion. Method: We examined a 14-year-old boy who experienced a sudden unilateral visual loss five months after the initial diagnosis of systemic non-Hodgkins lymphoma. Result: Visual loss was due to combined central retinal artery and vein occlusion in association with tumoral optic nerve involvement. Conclusion: Alhough very rare systemic non-Hodgkins lymphoma may present with central retinal artery and vein occlusion prior to overt central nervous system involvement.

Axial length and hyperopia in eyes with retinal vein occlusions.

We performed a prospective study in order to elucidate thepredisposing role of axial length and hyperopia in retinal veinocclusions. The study group comprised 39 patients with unilateralcentral retinal vein occlusion (CRVO), 50 patients with unilateralbranch retinal vein occlusion (BRVO), 13 patients with unilateralhemispheric retinal vein occlusion (HRVO) and 45 controleyes.The axial length of affected eyes was compared to fellow eyesand control eyes in each subgroup of patients with retinal veinocclusion. No statistical difference was noted for any of thesubgroups (p > 0.05). Hyperopia was detected in 12 of 39 eyes(31%) with CRVO, 14 of 50 eyes (28%) with BRVO, 4 of 13 eyes(31%) with HRVO and 15 of 45 eyes (33%) in the control group.No statistically significant difference was discovered (p> 0.05).In the light of our study, we believe that axial length andhyperopia may not be risk factors in retinal vein occlusions, incontrast to common belief.

Choroidal detachment associated with direct spontaneous carotid-cavernous sinus fistula

A case of spontaneously occurring direct carotid-cavernous fistula complicated by choroidal detachment is presented. After thrombosis of the superior ophthalmic vein, paradoxical worsening of the clinical manifestations, recurrence of the choroidal detachment and subsequent resolution of symptoms were observed. We concluded that carotid-cavernous fistula should be kept in mind in the etiological evaluation of choroidal detachment.

Indocyanine green angiography in Biettils crystalline retinopathy

Abstract Background: To our knowledge, the indocyanine green (ICG) angiographic features of Biettis crystalline retinopathy have been described in a single case only. We report the ICG angiographic findings in four patients with Biettis crystalline retinopathy and compare them with the fluorescein angiographic findings. Methods: Review of the records of four patients with Biettis crystalline retinopathy, three of whom were from a single consanguineous family. Fluorescein and ICG angiography were performed with the Heidelberg scanning laser ophthalmoscope. Results: The ICG angiographic findings varied according to the stage of the disease. In the early stages no retinal pigment epithelium (RPE) alterations or choriocapillaris loss were noted. In advanced cases there was extensive chorioretinal atrophy. Most notably, intraretinal crystals did not exhibit fluorescence/cyanescence and had no masking effect on fluorescein or ICG angiography. In all cases angiography showed hypofluorescent/hypocyanescent dots, most likely corresponding to RPE alterations adjacent to atrophic areas. Interpretation: ICG angiography does not give additional information in Biettis crystalline retinopathy and probably is not superior to fluorescein angiography. However, it delineates the atrophic areas slightly better than does fluorescein angiography.

Adherence of triamcinolone acetonide to various intraocular lens materials

PURPOSE: To determine the adherence of triamcinolone acetonide to various intraocular lens (IOL) materials. SETTING: Department of Ophthalmology, Dokuz Eylül University, İzmir, Turkey. METHODS: Four IOLs of 4 materials (single‐piece poly(methyl methacrylate) [PMMA], 3‐piece foldable silicone, 3‐piece hydrophobic acrylic, and single‐piece hydrophilic acrylic) were first immersed in triamcinolone acetonide (40 mg/mL) for 15 minutes and then bathed in a balanced salt solution for another 15 minutes. Afterward, each lens optic was examined under light microscopy and digital images were obtained with a digital color video camera. The percentage of optic area covered with triamcinolone acetonide was determined by image analysis. RESULTS: Mean triamcinolone coverage was 7.62% ± 4.06% (SD) for PMMA IOLs (range 1.97% to 11.43%), 9.09% ± 4.60% for silicone IOLs (range 4.70% to 15.32%), 8.75 ± 7.20% for hydrophobic acrylic IOLs (range 1.31% to 16.86%), and 23.16 ± 8.53% for hydrophilic acrylic IOLs (range 15.02% to 35.12%). Adherence of triamcinolone acetonide to hydrophilic acrylic lenses was statistically significant when compared with other IOL materials. CONCLUSION: Intraoperative triamcinolone injection may obscure visualization intraoperatively and postoperatively, especially in eyes with hydrophilic acrylic lenses, because triamcinolone acetonide seems to have a tendency to adhere to hydrophilic acrylic lenses in vitro.