Arsen Akinci

Posterior corneal elevation and back difference corneal elevation in diagnosing forme fruste keratoconus in the fellow eyes of unilateral keratoconus patients

Purpose To evaluate posterior corneal elevation and back difference corneal elevation in patients with keratoconus in 1 eye and forme fruste keratoconus in the fellow eye. Setting Kudret Eye Hospital, Ankara, Turkey. Design Case‐control study. Methods This study retrospectively reviewed patients with keratoconus in 1 eye and forme fruste keratoconus in the fellow eye and eyes of normal subjects. All subjects were evaluated with a rotating Scheimpflug imaging system (Pentacam), including sagittal and tangential anterior curve analysis, keratometry, and posterior elevation. The back difference elevation values were extrapolated from the difference maps of the Belin‐Ambrosió enhanced ectasia display of the Scheimpflug system. The receiver operating characteristic (ROC) curves were analyzed to evaluate the sensitivity and specificity of the parameters. Results The corneal power, pachymetric progression index, and posterior corneal elevation (posterior elevation and back difference elevation) measurements were statistically significantly higher in eyes with keratoconus or forme fruste keratoconus than in eyes of normal control subjects (P<.05). Using ROC analysis, the area under the curve values of mean keratometry, steepest point on the tangential curve, minimum corneal thickness, pachymetric progression index, Ambrósio’s relational thickness, posterior elevation, and back difference elevation to distinguish forme fruste keratoconus from control subjects were 0.51, 0.84, 0.65, 0.81, 0.72, 0.68, and 0.76, respectively. Conclusions Back difference elevation was better than posterior elevation in diagnosing forme fruste keratoconus. However, as sole parameters, both had limited sensitivity and specificity to differentiate between forme fruste keratoconus eyes and normal control eyes. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Phacoemulsification with intravitreal bevacizumab injection in diabetic patients with macular edema and cataract.

Purpose: The purpose of this study was to evaluate the results of phacoemulsification with intravitreal bevacizumab injection in patients with diabetic clinically significant macular edema and cataract. Methods: The records of 31 patients with diabetic clinically significant macular edema and cataract, which would interfere with macular laser photocoagulation, who have undergone phacoemulsification with intravitreal injection of 1.25 mg bevacizumab were retrospectively evaluated. All patients had undergone focal or modified grid laser photocoagulation 1 month after the surgery. All patients were evaluated by spectral optical coherence tomography/optical coherence tomography SLO before and 1 and 3 months after the surgery beyond complete ophthalmologic examination. The best-corrected visual acuity (BCVA) levels and central macular thickness (CMT) recorded at the first and third months after the surgery were compared with the initial values. Paired samples t test was used for statistical analysis. Results: The mean initial BCVA was 0.10 ± 0.04 (range, 0.05-0.2). The mean BCVA at the first and third months after the surgery were 0.47 ± 0.16 (standard deviation) (range, 0.2-0.5) and 0.51 ± 0.12 (standard deviation) (range, 0.3-0.6), respectively. The BCVA level recorded at the first and third months after the surgery were significantly higher than the initial BCVA (P = 0.004). The mean initial CMT was 387.5 ± 109.5 &mgr;m. The mean CMT at the first and third months after the surgery were 292.7 ± 57.2 and 275.5 ± 40.3. The CMT recorded at the first and third months after the surgery were significantly lower than the initial CMT (P < 0.001, P < 0.001). Conclusion: Phacoemulsification with intravitreal injection of bevacizumab provides improvement in clinically significant macular edema with a gain in BCVA in patients with diabetes with clinically significant macular edema and cataract.

Relationship between intraocular pressure and obesity in children.

PurposeTo establish the relationship between intraocular pressure (IOP) and obesity in children. MethodsSeventy-two obese children (body mass index in the 95th percentile or greater) were compared with 72 age-matched and sex-matched controls (body mass index <95th percentile). Both groups underwent Goldmann applanation tonometry (3 times), blood pressure measurement (3 times), and Hertel exophthalmometry. Paired and unpaired t tests and the Cochran-Mantel-Haenzel statistics were used for statistical analysis. ResultsThe mean IOP between the obese children and controls were significantly different (P<0.0001), even after adjusting for systolic and diastolic blood pressure (P<0.001). Diurnal variation of IOP was higher in obese children (P<0.001). Obese children had higher Hertel values (P<0.001). Sex did not significantly effect IOP in either group (P>0.05). ConclusionsIn addition to its indirect effect on IOP via blood pressure change, obesity is also an independent risk factor for increased IOP.

Refractive Errors and Strabismus in Children With Down Syndrome: A Controlled Study

PURPOSE To evaluate the prevalence of refractive errors, strabismus, nystagmus, and congenital cataract in children with Down syndrome and control subjects of similar age. METHODS Seventy-seven children with Down syndrome and 151 control subjects were evaluated for the prevalence of ocular findings. RESULTS Ocular findings were discovered in 97.4% of children with Down syndrome and 42.4% of control subjects (P < .0001). The point prevalence of nystagmus, strabismus, hypermetropia, astigmatism, and congenital cataract was significantly higher in children with Down syndrome (P < .0001 for the first four categories, and P < .01 for congenital cataract). CONCLUSION Evaluation, treatment, and regular review of ocular and refractive findings in children with Down syndrome is urgently needed.

Refractive errors and ocular findings in children with intellectual disability: A controlled study

PURPOSE To evaluate the ocular findings and refractive errors in children with intellectual disability and in controls of average intellectual development of similar socioeconomic backgrounds. METHODS The study was conducted at Diskapi Childrens Hospital in Ankara, Turkey: 724 subjects with intellectual disability and 151 control subjects were evaluated. The subjects with intellectual disability were subdivided into mild (IQ 50-69, n = 490), moderate (IQ 35-49, n = 164), and severe (IQ <34, n = 70) groups, and syndromic (n = 138) versus nonsyndromic (n = 586) disability. All children underwent cycloplegic autorefraction or retinoscopy, slit-lamp biomicroscopy, and dilated fundus examination. Ocular alignment was assessed by Hirschberg, Krimsky, or prism cover test. The main outcome measure was the prevalence of refractive errors and ocular findings. RESULTS Seventy-seven percent of subjects with intellectual disability, and 42.4% of controls, had ocular findings. The children with intellectual disability had significantly more nystagmus, strabismus, astigmatism, and hypermetropia than controls. Children with syndromic intellectual disability had significantly more nystagmus, strabismus, astigmatism, and hypermetropia than subjects with nonsyndromic intellectual disability. Increasing severity of intellectual disability was related to higher prevalence of nystagmus, strabismus, astigmatism, hypermetropia, and anisometropia. CONCLUSIONS From a public health perspective, evaluation and treatment of ocular and refractive findings in children with moderate, severe, and syndromic intellectual disability categories is urgently needed and likely to be highly effective in alleviating future health and social care costs, as well as improving the productive lives of individuals with intellectual disability.

The correlation between headache and refractive errors

PURPOSE To compare the prevalence of refractive errors in patients with headache and a control population. METHODS Three hundred ten patients with headache and 843 controls were retrospectively evaluated. Complete ophthalmologic examination was performed in the headache group. Autorefraction was performed in all participants (with cycloplegia under 10 years of age). Myopia was defined as the spherical equivalent refraction of at least -0.50 D, hyperopia as the spherical equivalent refraction of at least +2.0 D, and astigmatism as the cylinder of at least 1.0 D. Main outcome measures were refractive error, anisometropia, and previous miscorrection of refractive error. Chi-square and Students t-tests were used for statistical analysis. RESULTS Total prevalence of refractive errors was higher in the headache group (p = 0.002). The rate of astigmatism was higher in the headache group (p < 0.0001), while that of myopia and hyperopia were similar in both groups (p = 0.74, p = 0.79, respectively). The rates of compound and mixed astigmatism were higher in the headache group (p = 0.026, p < 0.001, respectively). The rates of anisometropia and previous miscorrection of refractive error were higher in the headache group (p < 0.0001 for both). Children with headache have a statistically significant increased risk of total refractive errors (OR = 1.57, 95% CI: 1.18-2.07), anisometropia (OR = 9.59, 95% CI: 5.72-16.1), and miscorrection of refractive error (OR = 9.57, 95% CI: 5.43-16.9). CONCLUSIONS Compound and mixed types of astigmatism, anisometropia, and miscorrection of refractive error were found more often in patients with headache than in control subjects.

Phacoemulsification in Pseudoexfoliation Syndrome

Purpose: To compare the incidence of intraoperative and early postoperative complications (IEPC), visual outcomes, and change in intraocular pressure (IOP) between eyes with and without pseudoexfoliation syndrome (PEX) having cataract extraction by phacoemulsification. Material and Method: 800 eyes with PEX and 1,600 eyes without PEX having cataract extraction by phacoemulsification were included in this retrospective study. Evaluated parameters were incidence of IEPC, visual outcomes and change in IOP. χ2 and Student’s t test were used for statistical analysis. Results: There were no significant differences in the incidence of IEPC and visual acuity gain between the two groups (p > 0.05). Rise in IOP in the early postoperative period was significantly higher in the PEX group (p < 0.02). Conclusion: Patients with PEX who have phacoemulsification can achieve results similar to patients without PEX. IOP control in the early postoperative period seems to be more important in patients with PEX.

Keratoconjunctivitis sicca in juvenile rheumatoid arthritis.

Purpose: To compare the symptoms, signs, and results of objective tests for keratoconjunctivitis sicca (KCS) in patients with juvenile rheumatoid arthritis (JRA) and controls. Methods: Sixty-four patients with JRA and 64 age- and sex-matched controls were compared in terms of symptoms, signs, and results of objective tests for KCS. Relation between tear film breakup time (TBUT), Schirmer test results, and JRA-related variables such as age of onset, duration, and type of JRA; presence of antinuclear antibodies (ANAs); and history of uveitis were evaluated. Analysis of variance, multivariate regression analysis, Kruskall-Wallis, Student t tests, and χ2 tests were used for statistical analysis. Results: Twelve and a half percent of patients with JRA complained of dry eye symptoms compared with 1.5% of the controls (P = 0.031). Dry eye signs were detected in 10.9% of patients with JRA compared with 1.5% of controls (P = 0.038). TBUT and Schirmer test results were lower in the JRA group than in controls (P = 0.032 and P = 0.029, respectively). Seven patients (10.9%) had definite and 1 (1.5%) had probable diagnosis of KCS in the JRA group compared with no children in the control group (P = 0.034). Within the JRA group, Schirmer test and TBUT results were significantly lower in male patients and ones with longer duration of disease. Conclusions: The prevalence of symptoms, signs, and definite diagnosis of KCS is higher and basal tear secretion and tear film stability are lower in children with JRA than in controls. Among children with JRA, male sex and longer duration of disease are independent risk factors for having decreased basal tear secretion and tear film stability.

Ocular findings in children with chronic renal failure.

Purpose: The purpose of this study was to describe the ocular findings in children with chronic renal failure (CRF). Materials and Methods: Nineteen children with CRF and 19 age- and sex-matched controls were evaluated. Schirmer and tear film break-up time (TBUT) tests were performed in addition to complete ophthalmologic examination. The presence of dry eye symptoms was noted. Relation between TBUT and Schirmer test results and CRF-related variables such as duration of CRF; dialysis status; and serum calcium, phosphorus, urea, and creatinine levels was evaluated. Student t test and rank correlation test were used for statistical analysis. Results: Dry eye symptoms were detected in 15.8% of children with CRF, against none of the controls (χ2 = 3.25, P = 0.23). TBUT and Schirmer test results were significantly lower in the study group than in the controls (t = 27.8, P = 0.032 and t = 36.5, P = 0.025, respectively). Within the study group, a negative correlation was found between TBUT and Schirmer test results and the duration of CRF (R = 0.769, Z = 2.234, P ≤ 0.022 and R = 0.832, Z = 2.351, P ≤ 0.019, respectively). No relation was detected between the TBUT and Schirmer test results and the dialysis status and serum calcium, phosphorus, urea, and creatinine levels in the study group. Conclusions: The basal tear secretion and tear film stability are lower, and the dry eye symptoms are more common among the children with CRF. The duration of CRF seems to be related with the disturbances in tear secretion and tear film stability.

Refractive errors in neurofibromatosis type 1 and type 2

Objective: To document the prevalence of refractive errors in patients with neurofibromatosis type 1 (NF1) and type 2 (NF2) and to compare it with that of age- and sex-matched controls. Methods: 82 patients with NF1, 21 patients with NF2 and 103 age- and sex-matched controls were evaluated in this prospective observational case–control study. Cycloplegic autorefraction and dilated fundus examination were performed. Myopia was defined as the spherical equivalent refraction of at least −0.50 diopters (D), hyperopia as the spherical equivalent refraction of at least 2.0 D and astigmatism as the cylinder of at least 1.0 D. Main outcome measures were refractive error, IQ, years of education, height, weight and body mass index (BMI). Results: The prevalence of myopia was 23.1% in patients with NF1, 23.8% in patients with NF2 and 16.5% in age- and sex-matched controls. These differences were significant (p<0.03, p<0.03), and adjusting for intelligence, education, height, weight and BMI increased the significance of this finding (p<0.001, p<0.001). The prevalences of astigmatism and hyperopia were similar in both groups. Conclusion: A high prevalence of myopia seems to be an additional feature of NF1 and NF2.