Halil Ibrahim Altinsoy

Evaluation of the Nerve Fiber Layer and Macula in the Eyes of Healthy Children Using Spectral-Domain Optical Coherence Tomography

PURPOSE To determine the normative values of the peripapillary retinal nerve fiber layer (RNFL), macular thickness, and macular volume in healthy children using spectral-domain optical coherence tomography (SD-OCT) and analyze the correlation of such values with age, refraction error, and biometric measurements. DESIGN Observational case series. METHODS This institutional study involved 107 eyes from 107 healthy pediatric patients (54 female, 53 male) with ages between 6 and 16 years. After the biometric measurements and refractive error values (in spherical equivalent) of the cases were obtained, the peripapillary RNFL, macular thickness, and macular volume values were calculated using the Spectralis OCT device. RESULTS Among the study group, with an average age of 10.46 ± 2.94 years, the average axial length (AL) was 23.33 ± 0.89 mm; the average spherical equivalent (SE) value was -0.27 ± 0.99 diopter. The average peripapillary RNFL thickness was 106.45 ± 9.41 μm; the average macular thickness was 326.44 ± 14.17 μm; and the average macular volume was 0.257 ± 0.011 mm(3). The aforementioned OCT measurements were not significantly correlated with age, SE, or AL values (P > .05 for all). CONCLUSIONS This study reports SD-OCT findings among healthy pediatric cases. SD-OCT can be reliably used for pediatric patients because of its short exposure time and high degree of image resolution.

Assessment of central and peripheral fusion and near and distance stereoacuity in intermittent exotropic patients before and after strabismus surgery

PURPOSE To determine whether central fusion and distance stereoacuity are useful as objective measures in assessing the need for and success of surgery for intermittent exotropia (X[T]). METHODS A prospective, institutional, clinical trial was conducted of 26 consecutive patients with X(T) who were undergoing strabismus surgery in whom fusion (central and peripheral) and stereoacuity (at near and distance) were assessed preoperatively and postoperatively, as well as in 112 normal subjects. To obtain accurate measurements with sensory tests, the lower age was limited to 5 years for inclusion. A successful surgical alignment was defined as an exotropia of 10 prism diopters or less at 6 m. Sensory and motor outcome measures were determined 1 year after surgery. RESULTS The successful surgical alignment rate was 69%. All patients with X(T) demonstrated peripheral fusion, whereas 35% demonstrated central suppression preoperatively and postoperatively. Central fusion was not predictive of surgical outcome (P = .078); however, there was a trend toward less surgical success in patients with central suppression. Patients with X(T) exhibited good near stereoacuity before and after surgery. Distance stereoacuity in patients with X(T) preoperatively was significantly diminished compared with normal subjects (P < .001) and was improved in 58% postoperatively. Patients who achieved successful surgical alignment had a greater likelihood of demonstrating distance stereoacuity improvement postoperatively than patients who failed to achieve successful surgical alignment (P = .003). Patients with central suppression were unlikely to improve their distance stereoacuity postoperatively (P = .014). CONCLUSIONS Successful surgery may improve distance stereoacuity. Better distance stereoacuity and central fusion are frequently associated with better surgical success in X(T).

Management of diplopia in patients with blowout fractures.

Purpose: To report the management outcomes of diplopia in patients with blowout fracture. Materials and Methods: Data for 39 patients with diplopia due to orbital blowout fracture were analyzed retrospectively. The inferior wall alone was involved in 22 (56.4%) patients, medial wall alone was involved in 14 (35.8%) patients, and the medial and inferior walls were involved in three (7.6%) patients. Each fracture was reconstructed with a Medpore® implant. Strabismus surgery or prism correction was performed in required patients for the management of persistent diplopia. Mean postoperative follow up was 6.5 months. Results: Twenty-three (58.9%) patients with diplopia underwent surgical repair of blowout fracture. Diplopia was eliminated in 17 (73.9%) patients following orbital wall surgery. Of the 23 patients, three (7.6%) patients required prism glasses and another three (7.6%) patients required strabismus surgery for persistent diplopia. In four (10.2%) patients, strabismus surgery was performed without fracture repair. Twelve patients (30.7%) with negative forced duction test results were followed up without surgery. Conclusions: In our study, diplopia resolved in 30.7% of patients without surgery and 69.2% of patients with diplopia required surgical intervention. Primary gaze diplopia was eliminated in 73.9% of patients through orbital wall repair. The most frequently employed secondary surgery was adjustable inferior rectus recession and <17.8% of patients required additional strabismus surgery.

Combination of Laser Photocoagulation and Intravitreal Bevacizumab in Aggressive Posterior Retinopathy of Prematurity.

The response to combined laser photocoagulation and a single intravitreal injection of 0.75 mg bevacizumab to each eye on separate days in two patients with aggressive, posterior retinopathy of prematurity (ROP) is described. Combined treatment resulted in regression of zone-1 disease in Case 1, which had no retinal detachment. However, no significant regression or unfavorable anatomic response was observed in the second case with retinal detachment. Although the combination of laser photocoagulation and intravitreal bevacizumab injection seems to be well tolerated, inducing prompt regression of agressive zone-1 ROP without retinal detachment, further controlled studies with long-term follow-up are necessary for their use in the treatment of ROP with for potentially dangerous growth factor inhibitors in premature babies.

An Analysis of Neonatal Risk Factors Associated With the Development of Ophthalmologic Problems at Infancy and Early Childhood: A Study of Premature Infants Born at or Before 32 Weeks of Gestation

BACKGROUND To determine the frequency of ophthalmologic problems and the risk factors that affect the occurrence of these problems in premature newborns with a gestational age of 32 weeks or less. METHODS Premature newborns observed at a neonatal intensive care unit between January 2002 and March 2006 were included. A control visit including an ophthalmologic examination was performed at 10 months of age or later. Primary ocular morbidities were studied, and the association between these parameters and prenatal, perinatal, and neonatal characteristics were evaluated. RESULTS A total of 169 premature newborns were included in the study, and they were examined at a mean age of 25.85 ± 11.79 months (range: 10 to 42 months). There was complete vision loss (blindness) in 1 (0.6%) case, strabismus in 15 (8.9%) cases, and refractive errors in 10 (5.9%) cases. Twenty (77%) cases with any abnormality and 50 (35%) cases with a normal examination at follow-up had a history of retinopathy of prematurity (ROP) at any stage during the neonatal period (P = .001). Short gestational age (P = .018), low birth weight (P = .002), and the presence of ROP requiring retinal surgery during the neonatal period (P = .007) were determined to be significant risk factors for the development of vision loss, strabismus, and refractive errors. CONCLUSION Neonates with a gestational age of 32 weeks or less, especially those younger than 30 weeks, should not only be screened for ROP in the neonatal period, but should also have regular follow-up examinations to check for the development of other ophthalmologic problems during infancy and early childhood.

Consecutive exotropia: risk factor analysis and management outcomes.

Purpose: To report the frequency of risk factors and outcomes of consecutive exotropia (XT) following bimedial rectus recession (BMR) for the treatment of childhood esotropia (ET). Methods: Ninety-eight patients with ET, who underwent only BMR between 1996 and 2007, were included in this study. Predictors of the development of consecutive XT and treatment outcomes were compared between groups (group 1, cases with consecutive XT; group 2, cases without consecutive XT). Results: Mean follow-up time after BMR surgery was 7.23 ± 3.62 years. There was no significant difference between the groups in terms of age, preoperative angle of near deviation, follow-up time, or refraction for both eyes (p>0.05 for all). The differences regarding preoperative angle of distance deviation (p = 0.009), presence of inferior oblique overaction (p = 0.023), amount of BMR (p = 0.028), and postoperative adduction limitation (p<0.0001) between the groups were statistically significant. However, only preoperative angle of distance deviation and presence of postoperative adduction limitation were independent risk factors for the development of consecutive XT (p = 0.043, p = 0.007, respectively). Conclusions: Postoperative adduction limitation should alert physicians to the increased risk of developing consecutive XT in the long-term follow-up after BMR for the treatment of childhood ET.

Recurrent Alternating Oculomotor Nerve Palsy: An Unusual Presentation of Parasagittal Meningioma

Abstract We present a previously unreported case of 57-year-old man suffering from diplopia. Motility assessment revealed a total right oculomotor nerve palsy that spontaneously resolved in about 10–18 days. Three years later, sudden oculomotor nerve palsy occurred in his left eye and complete resolution with out any treatment was observed after a month. Five years from the second episode there was a further recurrence in the right eye. Magnetic resonance imaging demonstrated a parasagittal meningioma.

Relapsing Devic's disease in a child.

Neuromyelitis optica (NMO) also named Devics disease is an acute demyelinating disorder that primarily affects the spinal cord and optic nerves. NMO can occur rarely in children but pediatric NMO cases need specific consideration owing to possible poor visual and motor outcome. In this case report, a NMO case of a 10-year-old girl with bilateral optic neuritis, cerebral, and spinal cord involvement is presented.

Intracranial meningiomas and neurofibromatosis type 2

Dear Editor, We read with great interest the study by Aboukais et al. [1] describing the characteristics of intracranial meningiomas and neurofibromatosis type 2 (NF 2). On the basis of our experience, there is another important point that should be mentioned. Meningiomas are slow-growing tumors, and they are mostly asymptomatic for a patient’s entire life. Meningiomas occur in about half of NF 2 patients, and they are often multiple [4]. Barrett et al. [2] and Prasad et al. [5] reported that recurrent third nerve palsy could be the presenting feature of NF 2. We reported a similar case of a 57-year-old man with recurrent alternating oculomotor nerve palsy secondary to a parasagittal meningioma [3]. It is possible that these high-grade meningiomas related to NF 2 can cause a form of neuromyotonia or meningioma-associated mediators may trigger an inflammatory reaction combined with vasculopathy leading to oculomotor neuropathy. We recommend that all NF2 patients should be investigated to diagnose a possible oculomotor nerve disorder secondary to meningioma in the follow-up period.

Congenital Absence of Salivary and Lacrimal Glands Accompanied by Growth and Development Retardation

Congenital absence or hypoplasia of some or all major salivary or lacrimal glands, nasolacrimal ducts, and puncta is a rare autosomal dominant disorder. Phenotypical expression may show great variability, and the diagnosis may be difficult. Only a few cases have been reported in the literature. This report describes a patient who has all of the essential features suggestive of aplasia of the lacrimal and salivary glands, as well as retardation of growth and development. Although the characteristic features of aplasia of the lacrimal and salivary glands have been described, an association with development and growth retardation has not been reported in the literature.