Huseyin Gursoy

Lenstar versus ultrasound for ocular biometry in a pediatric population.

Purpose. To compare the central corneal thickness (CCT), axial length (AL), anterior chamber depth (ACD), and lens thickness (LT) measured with Lenstar with those obtained with ultrasound pachymetry and A-scan contact ultrasound (ASU) in children. Methods. ODs of 565 school children were included. All measurements were obtained 30 min after instilling 1% tropicamide. For each instrument, three consecutive measurements per each child were performed. Initially, examiner 1 performed measurements with Lenstar to obtain CCT, AL, ACD, and LT. Later, examiner 2 performed measurements with corneal pachymetry to obtain CCT. Finally, ASU was used by examiner 2 to obtain AL, ACD, and LT. Four parameters obtained with Lenstar were compared with those obtained with pachymetry and ASU using Pearson correlation coefficients (r) and Bland-Altman analyses. Result. Lenstar measurements were obtained in 557 of 565 subjects(mean age; 10.48 ± 2.11 years, mean spherical equivalent of the ODs; +0.47 ± 1.18 diopters) whereas ASU and pachymetry could be performed in 530 of 565. Four hundred seventy-nine subjects were statistically assessed after 41 subjects were extracted as outliers from 530 subjects in whom all instruments could be performed. Mean difference between pachymetry and Lenstar was 13.20 ± 13.13 &mgr;m [95% confidence interval (CI): 12.01 to 14.37]. Mean difference between ASU and Lenstar was −0.72 ± 0.35 mm (95% CI: −0.75 to −0.69) for AL, −0.27 ± 0.32 mm (95% CI: −0.30 to −0.24) for ACD, and 0.24 ± 0.28 mm (95% CI: 0.22 to 0.27) for LT. R values were 0.912 (p < 0.001), 0.904 (p < 0.001), 0.487 (p < 0.001), 0.369 (p < 0.001) for CCT, AL, ACD, and LT respectively. Conclusions. AL and ACD were found to be greater with Lenstar, whereas CCT and LT measures were smaller. It is concluded that there was agreement between instruments for CCT and ACD, because the small differences between measures were clinically insignificant. AL and LT values cannot be used interchangeably. If these differences are considered, Lenstar can replace ASU and pachymetry for the majority of children.

Long-term follow-up of bilateral botulinum toxin injections versus bilateral recessions of the medial rectus muscles for treatment of infantile esotropia

PURPOSE To compare long-term outcomes of botulinum toxin A injection with incisional surgery for the management of infantile esotropia. SUBJECTS AND METHODS Medical records of infants <24 months treated for esotropia with either botulinum toxin injection (botulinum group) or bilateral medial rectus muscle recessions (surgery group) were reviewed. Minimum follow-up was 48 months, and patients with accommodative esotropia or inferior oblique muscle overaction were excluded. Success was defined as alignment with 10(Δ) of orthophoria without surgery (botulinum group) or without reoperation (surgery group) and compared by the use of an adjusted odds ratio (aOR). RESULTS The record review identified a total of 51 patients, with 25 in the botulinum group and 26 in the surgery group. Median pretreatment deviation was similar in the botulinum and surgery groups (40(Δ) vs 45(Δ); P = 0.37), but median age at treatment was earlier in the botulinum group (10 vs 12.5 months; P = 0.01). The mean number of injections in successfully treated botulinum group patients was 1.4. The success rate was similar in the botulinum (68%) and surgery (77%) groups (aOR = 0.87, P = 0.87). The median follow-up time was longer in the botulinum group (84 vs 75 months; P = 0.02). Gross stereopsis was demonstrable in 10 of 15 patients in the botulinum group and 9 of 13 in the surgery group (aOR = 3.6, P = 0.46). CONCLUSIONS There was no difference in binocular alignment with botulinum toxin versus surgical treatment. Botulinum toxin injection may be considered a primary treatment for infantile esotropia.

Vision Screening in Children Entering School: Eskisehir, Turkey

Abstract Purpose: To report vision screening results among school children in Eskisehir, Turkey. Methods: Vision screening was performed in 7- to 8-year-old school children in November and December 2011. Best-corrected visual acuity (BCVA) assessment, cover test, and autorefractometer measurement under cycloplegia were performed. Spherical equivalent ≤−0.50 diopters (D) was considered to be myopic, while spherical equivalent >0.75 D was considered to be hypermetropic. Astigmatism was defined as a cylinder power ≥0.75 D. Regression analysis was used to determine the likelihood of having BCVA ≤0.8 Snellen (versus having BCVA >0.8 Snellen) in the presence of independent variables. Results: A total of 709 children were included. The prevalence rates of myopia, hypermetropia, and astigmatism were 22.6%, 10.6%, and 11.0%, respectively. Overall, 145 children (20.4%) needed spectacles, but only 65 of these were wearing them. The prevalence of children who required spectacles for myopia ≤−3.00 D and spectacles for hypermetropia ≥3.00 D were 0.8% and 1.0%, respectively. The prevalence of BCVA ≤ 0.8 Snellen was 56/709 (7.9%). In 39/709 (5.5%) of children, amblyopia was present; strabismus (14/56), isometropia (14/56), and anisometropia (11/56) were the etiologies. Strabismus was diagnosed in 18 children (2.5%). Anisometropia, strabismus, hypermetropia, and astigmatism were associated with BCVA ≤ 0.8 Snellen (odds ratio, OR, 6.32, 39.18, 5.47, 5.17, respectively; p = 0.0001 for all ORs). Conclusions: Myopia and amblyopia rates in Eskisehir were high among school children. The need for a national large-scale vision screening program for children that includes diverse regions of Turkey is apparent.

Glaucoma after Penetrating Keratoplasty: Incidence, Risk Factors, and Management

Purpose. To report the incidence and risk factors for postkeratoplasty glaucoma (PKG), as well as its management. Subjects and Methods. 122 eyes, (43% with pseudophakic and aphakic bullous keratopathy (PABK)) which underwent penetrating keratoplasty (PK), were analyzed. Results. The rate of PKG development was 34% within 39 months of follow-up. PABK, corneal perforations, keratitis, and previous high intraocular pressure (PHIOP) were high risk factors for PKG. Glaucoma was controlled medically in 62% of PKG cases. Surgery (Ex-PRESS shunt in 63%) and diode laser cyclophotocoagulation were applied in others (38%). The rate of postoperative complications and graft survival was similar in eyes with and without PKG. Conclusion. PHIOP, preoperative diagnoses other than keratoconus, and corneal dystrophies were highly associated with PKG. Ex-PRESS shunts were effective in refractory PKG. If glaucoma is controlled, it is possible to obtain similar rates of graft survival and postoperative complications in eyes with and without PKG.

Reproducibility of ocular biometry with a new noncontact optical low-coherence reflectometer in children.

Purpose TO evaluate the reproducibility of Lenstar in the pediatric population. Methods Three consecutive measurements per eye by 2 ophthalmologists with a total of 6 measurements per eye were performed using Lenstar. Axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), and corneal curvatures (K1 and K2) were measured for right and left eyes in 154 school-age children. Right and left eyes were analyzed separately. Each optical parameter obtained by 2 examiners was compared by paired samples t test. Intraobserver and interobserver correlation coefficients (r) were calculated for each variable. Significance was attributed when p<0.05. Results Measurements could be performed in 152 of the children included. The mean measurements were not different statistically except for left AL (23.22±0.81 vs 23.21 ±0.82 mm; p=0.014), left CCT (548.5±32.3 vs 548.0±32.7 μm; p=0.013), and right ACD (3.19±0.25 vs 3.19±0.25 mm; p=0.033). Intraobserver r values were all above 0.957 except for left LT (r=0.786) for examiner 2. Interobserver r values were all above 0.979. Conclusions Although statistical significance was obtained in some variables, they were clinically negligible. The intraobserver and interobserver relation coefficients were very high for all optical parameters including the r value for left LT for examiner 2 (r=0.786). Lenstar is a highly reproducible, user independent, and tolerable instrument for ocular biometry in the pediatric population, with no anesthesia or discomfort.

Vision, Retinal Thickness, and Foveal Avascular Zone Size After Intravitreal Bevacizumab for Diabetic Macular Edema

IntroductionTo investigate three monthly intravitreal bevacizumab (IVB) injections effects in chronic diabetic macular edema (DME).MethodsA prospective, noncomparative study in which inclusion criteria were; DME with central macular thickness (CMT) of at least 250 μm, and no treatment for diabetic retinopathy (DR) within 4 months before the first injection. All eyes received three monthly 1.25 mg IVB injections. CMT by optical coherence tomography, visual acuity (VA), foveal avascular zone (FAZ) greatest linear dimension (GLD), and area of FAZ by fundus fluorescein angiography were documented initially and 1 month after last injection. Outcomes (P < 0.05 were significant) and correlations (r values) were analyzed.ResultsA total of 29 eyes of 29 patients (group 1, 19 female, 10 male), aged 60.7 ± 6.6 years were analyzed. The patients were split into two groups; group 2 included 15 mild-to-moderate nonproliferative DR, and group 3 included 14 more-severe DR. VA gain was significant in all groups (P < 0.05). Mean CMT decrease was approximately 46, 36, and 55 μm in groups 1, 2, and 3, respectively (P < 0.05 only in group 1). A 0.045-mm2 increase in FAZ area was obtained in group 1 (P < 0.05). In group 2, an increase in GLD and area of FAZ was 0.048 mm and 0.058 mm2, respectively (P < 0.05), whereas in group 3, FAZ enlargement was nonsignificant. VA and CMT were significantly correlated (r values = 0.5−0.6), except for the final VA-final CMT in group 2. FAZ dimensions and other parameters (VA and CMT) were noncorrelated.ConclusionAccording to the authors’ short-term results, three monthly IVB injections can be used for chronic DME regardless of VA, CMT, or FAZ dimensions, despite the FAZ enlargement encountered, especially in cases with milder DR.

What is the role of partial middle turbinectomy in endocanalicular laser-assisted endonasal dacryocystorhinostomy?

Background This study was designed to compare outcomes of endocanalicular laser-assisted endonasal dacryocystorhinostomy (DCR) with and without partial anterior middle turbinectomy. Methods A prospective randomized comparative study was conducted on 91 subjects with primary acquired nasolacrimal duct obstruction, undergoing endocanalicular (ECL) procedures. Group 1 was composed of 44 (7 bilateral) patients undergoing ECL diode laser-assisted endonasal DCR without partial anterior middle turbinectomy and group 2 was composed of 47 (7 bilateral) patients undergoing partial anterior middle turbinectomy and ECL diode laser-assisted endonasal DCR. Follow-up period was 11.0 (6.0–14.5 months) months for group 1 and 9.2 (5.0–14.2 months) months for group 2. Functional success was defined as absence of epiphora and anatomic success was defined as ability to irrigate the lacrimal system. Anatomic and functional success at the 1st week, 3rd month, and final postoperative examinations of two groups were compared using chi-square tests. Results Final anatomic successes were 39/51 (76%) cases for group 1 and 51/54 (94%) cases for group 2. Final functional successes were 36/51 (%71) patients in group 1 and 48/54 (88%) patients in group 2. Group 2 had higher success at the final examination and the difference was statistically significant. Conclusion We recommend partial anterior middle turbinectomy in all laser ECL laser-assisted endonasal DCR, but further studies with larger sample sizes are needed to strengthen our hypothesis.

Tissue Adhesives as an Alternative for Conjunctival Closure in Strabismus Surgeries

Purpose: Comparison of conjunctival closure with fibrin glue and conventional closure in strabismus surgeries. Methods: Twenty-nine patients undergoing strabismus surgery were studied. Group 1 included twelve cases in whom Tisseel was used for closure and group 2 included seventeen cases in whom 7/0 Vicryl was used. Severity of redness, watering, pain, and discomfort in opening eyes were evaluated postoperatively. Results: In the first hour, severe pain was experienced in both groups without statistical significance; but in group 1, pain was less severe in the 12th and 24th hour (P<.0001). After the first hour severity of watering was less in group 1 (P<.0001). Discomfort in opening eyes was detected in fifteen patients in group 2 in the first 12 hours where only one case with fibrin glue had discomfort. In the second week, no differences in severity of complaints were seen. Conclusions: Conjunctival closure with Tisseel following strabismus surgery might be an alternative to suturing.

Intravitreal Bevacizumab Following Laser Therapy for Severe Retinopathy of Prematurity

Trial of intravitreal bevacizumab injection in 7 eyes of 4 infants with continued retinopathy of prematurity progression despite previous laser therapy was reported. Six of the eyes benefited from the therapy. Intravitreal bevacizumab injection may be an alternative therapy in progressive stage 3 retinopathy of prematurity despite laser photocoagulation.

The effects of mild-to-severe retinopathy of prematurity on the development of refractive errors and strabismus.

Abstract Purpose: To investigate the effects of mild-to-severe retinopathy of prematurity (ROP) on refractive state and the incidence of strabismus. Materials and methods: Infants born ≤32 weeks of gestation were prospectively evaluated. Inclusion criteria were a follow-up of at least 6 months and at least stage 1 ROP. Group 1 included stage 1 ROP cases. Cases with stage 2 or 3 ROP without indication for treatment formed the second group. Group 3 included cases who received treatment for ROP. Logistic regression, adjusted for birth weight and gestational age, and multiple comparison tests were used to compare outcomes among groups. Results: The mean follow-up time was 20.9 ± 6.6 months. In the first (n = 21), second (n = 22), and third groups (n = 23), the right spherical equivalents (SE) were 1.17 ± 1.33, −0.18 ± 3.09, and −1.08 ± 4.05 diopters, and the left SEs were 1.23 ± 1.34, −0.09 ± 3.24, and −1.46 ± 4.02 diopters, respectively (p = 0.026 for right SE and 0.008 for left SE). The incidences of anisometropia were 3/21, 4/22, and 11/23 in the first, second, and third groups, respectively (adjusted odds ratios [aOR] for group 3 vs 1 = 5.39, aOR for group 3 vs 2 = 4.06). Strabismus developed in 7/21, 6/22, and 10/23 in groups one, two, and three, respectively (aOR for group 3 vs 1 = 2.06, aOR for group 3 vs 2 = 2.27). Eighteen of these were esotropias. Conclusions: Refractive errors and strabismus were associated with mild-to-severe ROP. Esotropia was the most frequent type of strabismus.