Lokman Aslan

Retinal fiber layer thickness in children with thalessemia major and iron deficiency anemia.

ABSTRACT Purpose: We aimed to measure peripapillary retinal nerve fiber layer (RNFL) thickness in children with thalassemia major (tha-major), children with iron deficiency anemia (IDA), and children in a healthy control group. Materials and Methods: A total of 47 children with tha-major and 22 children with IDA were selected from two pediatric hematology outpatient clinics as our experimental groups, while 35 healthy children were randomly selected from a primary school to act as a control group. After a complete eye examination was conducted and intraocular pressure measurements were obtained, RNFL measurements were performed using optical coherence tomography, and the information was recorded for statistical analysis. Results: The mean age of the participants was 9.65 ± 4.13 years in the tha-major group, 9.14 ± 2.53 years in the IDA group, and 9.13 ± 3.29 years in the control group, respectively, with no statistically significant difference among the three groups (p > 0.05). Mean peripapillary RNFL thickness was 119.38 ± 35.49 microns in the tha-major group, 184.00 ± 31.14 microns in the IDA group, and 187.73 ± 27.36 microns in the control group. It was significantly thinner in all quadrants in the tha-major group vs. the other two groups (p < 0.01), and in only the inferior quadrant in the IDA group (p < 0.05). Average RNLF thickness correlated positively with mean hemoglobin value (r = 0.488; p < 0.001) and negatively with mean ferritin level (r = −0.544; p < 0.001), but no correlations with mean number of transfusions and mean visual acuity were observed (p > 0.05). Conclusion: The study revealed that peripapillary RNFL is thinner in tha-major in all quadrants and in only the inferior quadrant in IDA. Thinning of the RNLF correlated with hemoglobin value and ferritin level, but not with number of transfusions and visual acuity.

Pain and cooperation in patients having dominant-side or nondominant-side phacoemulsification

Purpose To evaluate the relationship between laterality and perceived pain and cooperation during phacoemulsification under combined topical and intracameral anesthesia. Setting University ophthalmology clinic and eye hospital, Kahramanmaraş, Turkey. Design Cohort study. Methods Seventy‐eight patients with senile cataracts who had ocular surgery were included prospectively. The dominant side was determined with the Edinburg Handedness Inventory. Phacoemulsification and intraocular lens implantation were performed. The surgeon graded the patient’s cooperation from 0 (best) to 3 (worst). The duration of surgery was recorded. Another researcher rated perceived pain from 0 (no pain) to 10 (unbearable pain) using a visual analogue scale (VAS). Pain scores and the degree of cooperation for dominant‐side and nondominant‐side surgery were the primary outcomes. Results Forty‐six patients had surgery in the dominant eye and 32 in the nondominant eye. The 2 groups were similar in age, sex, and severity and type of cataract. The mean VAS score was significantly higher in patients having dominant‐side surgery than in those having nondominant‐side surgery (P<.01). Similarly, the mean cooperation score was significantly poorer in the patients having dominant‐side surgery (P<.05). Visual analogue scores were correlated with patient cooperation (r = 0.890, P<.0001). Conclusion Pain scores were higher in dominant‐side surgery for cataract under topical and intracameral anesthesia, which should be kept in mind when selecting anesthesia and in studies in which pain is scored. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Comparison of Wide Conjunctival Flap and Conjunctival Autografting Techniques in Pterygium Surgery

Pterygium is an abnormal fibrovascular tissue extending on the cornea which is a degenerative and hyperplastic disorder. A stromal overgrowth of fibroblast and blood vessels is accompanied by an inflammatory cell infiltrate and abnormal extracellular matrix accumulation. The surgical excision is the main treatment method of pterygium, but recurrence is the most common postoperative complication. In the present study, we aimed to compare the wide conjunctival flap and the conjunctival autografting techniques in pterygium surgery according to time of operation, safety, and effectiveness. Results showed that the effect of wide conjunctival flap techniques on primary pterygium surgery was found close to the conjunctival autograft techniques. In addition, the flap technique has a shorter surgical time, the surgery does not require extreme experience, feeding of the flap is provided with own vessels since the vascular structure is protected on the upper temporal conjunctival area, reverse placement of the flap is not seen, it needs fewer sutures, so that suture disturbances may reduce, and it is less traumatic than autograft technique during conjunctival transport. Therefore, this technique may be preferred in suitable cases.

The pain experience and cooperation of patients in consecutive cataract surgery.

Purpose The aim of this study was to investigate the pain experience and the cooperation of patients during consecutive cataract surgery. Methods In this prospective, randomized study, 60 consecutive adult patients with bilateral senile cataracts were recruited. All operations were performed with clear corneal phacoemulsification (phaco) technique under topical and intracameral anesthesia without sedation. The first surgery was performed in the eye with high-grade cataract. The other eye was operated within 3 months. Every patient was graded using a visual analogue scale (VAS) from 0 (no pain) to 10 (unbearable pain) after the surgery. The cooperation of the patient was graded from 0 (no event) to 3 (marked eye and head movement and lid squeezing) by the surgeon. The VAS scores and cooperation of patients were the main outcome measurements. Results The mean VAS score was 1.50± 0.81 in the first surgery and 2.15±0.79 in the other eye surgery (p<0.001). The patient cooperation score was 1.50±0.81 in the first surgery and 2.18±0.77 in the other eye surgery (p<0.001). The VAS and patient cooperation scores were positively correlated (r=0.633, p<0.001) in the study group. The VAS and patient cooperation scores were similar based on sex and laterality. Conclusions Patients who previously underwent phaco surgery in one eye experience more pain and have worse cooperation during the other eye phaco surgery.

Ocular findings in children with thalassemia major in Eastern Mediterranean.

AIM To investigate ophthalmologic findings in children with thalassemia major (TM) and compare the findings with healthy controls. METHODS In a cross-sectional study, 43 children with thalassemia major from pediatric hematology outpatient clinics from two university hospitals and age/sex matched 47 healthy children were included in the study. After a complete ophthalmic examination, tear function tests including the Schirmer test, fluorescein tear break-up time (BUT), ultrasound pachymetry, and axial length measurement were performed. Obtained data was recorded for statistical analysis and the values of right eyes were compared between groups. RESULTS The mean best corrected visual acuity was 1.34±0.75 in TM and 1.08±0.28 in controls. It was found lower than 0.1 logMAR unit in 10 (23.2%) children with TM and 2 (4.2%) in controls, and the difference was statistically significant (P<0.05). The mean central corneal thickness was 540±26.95 in children with TM and 536.98±20.45µm in controls (P>0.05). The mean axial length was 22.53±0.50 in TM and 22.57±0.43mm in the control group. The mean Schirmer test score was 19.94±6.91 in TM and 24.22±3.95mm in the control group (P<0.01). The mean BUT score was 9.62±1.28 in TM and 9.73±0.6s in the control group (P>0.05). CONCLUSION In TM, while corneal thickness, axial length, and BUT are close to controls, the Schirmer scores are less than normal. The study revealed that TM may be affected by the tear function and visual acuity.

Differences of the Anterior Segment Parameters in Children with Down Syndrome

Abstract Purpose: The study was undertaken to investigate whether anterior segment findings are different in children with Down syndrome (DS) to normal children and to focus on its clinical significance. Methods: A cross-sectional case control study was conducted in a total of 38 children with DS and 42 healthy children. This is the first report in the literature stating that. All subjects underwent ophthalmologic examination including slit-lamp biomicroscopy, cycloplegic refraction, intraocular pressure measurement and Scheimpflug imaging measurement. Customized software for Pentacam was used to analyze structural indices of anterior segment parameters. The mean anterior segment values of right eyes were compared between the groups. Results: The mean anterior chamber parameters of patients with DS and controls were measured respectively: Corneal thickness was 502.31 ± 40.5 and 541.8 ± 37.42 mm (p < 0.001), corneal volume was 56.63 ± 4.5 and 61.02 ± 4.3 mm3 (p < 0.001), corneal radius curvature was 7.41 ± 0.29 and 7.67 ± 0.34 mm (p < 0.001), iridocorneal angle was 39.7 ± 6.2 and 39.5 ± 6.4° (p = 0.944), anterior chamber volume was 181.65 ± 27.38 and 185.77 ± 32.53 mm3 (p = 0.528), anterior chamber depth was 3.08 ± 0.24 and 3.02 ± 0.31 mm (p = 447), pupil size was 2.95 ± 0.48 and 3.29 ± 0.45 mm (p < 0.05). Conclusion: The majority of the anterior segment parameters were found to be different in children with Down syndrome. While pupil size, corneal thickness, corneal volume and corneal curvature in DS were less than normal, iridocorneal angle, anterior chamber depth and anterior chamber volume were close to controls. The most important parametric differences in children with DS were seen on the cornea.

Corneal thickness measured by Scheimpflug imaging in children with Down syndrome.

PURPOSE To measure corneal thickness via the use of a Scheimpflug imaging system (OCULUS Optikgeräte GmbH, Wetzlar, Germany) in children with Down syndrome. METHODS This prospective, nonrandomized, clinical trial included children with Down syndrome and age- and sex-matched healthy controls. All subjects received a complete ophthalmologic examination. Corneal topography measurements were acquired by means of Scheimpflug imaging. Central corneal thickness (CCT), thinnest point of cornea (TP), and corneal volume (CV) were analyzed. RESULTS A total of 27 children with Down syndrome and 37 control subjects were included in the study. In children with Down syndrome, the mean CCT was 494.27 ± 47 μm, the mean TP was 487 ± 49 μm, and the mean CV was 56.2 ± 6. In the controls, the mean CCT was 539.3 ± 40 μm, the mean TP was 538.0 ± 40.8 μm, and the mean CV was 61.3 ± 4. For all 3 parameters, the difference was statistically significant (P < 0.001). In the Down syndrome group, the CCT was <500 μm in 16 subjects (59.2%) and <450 μm in 5 (18.5%). In the control group, the CCT was <500 μm in 14 subjects (37.8%) and <450 μm in 2 (5.4%). CONCLUSIONS In this study, corneal thickness was less in children with Down syndrome than in healthy control subjects. Decreased corneal thickness may be an early sign of a degenerative corneal disease such as keratoconus in children with Down syndrome.

Horner's syndrome following a subtotal thyroidectomy for a benign nodular goitre

We present a case of Horners syndrome occurring as a complication of thyroidectomy. A 42-year-old female patient presented with eyelid drop which developed immediately after thyroidectomy for goitre. Ophthalmic examination revealed eyelid ptosis, miosis and anhidrosis. Preoperative ultrasonography showed multiple isohyperechogenic solid nodules in each lobe, consistent with multinodular goitre. Therefore, the patient underwent subtotal thyroidectomy. The ophthalmic findings did not improve at the end of 6 months follow-up. Similar cases have been reported related to neck tumours or their surgery, mediastinum-located goitre and retropharyngeal abscess surgeries, but not after benign nodular goitre surgery. Several possible mechanisms have been proposed to explain this phenomenon; anatomical variations making the patient susceptible to damage to the sympathetic chain seem to be most likely in our patient.

Topical proparacaine abuse resulting in evisceration

A 72-year-old man was admitted to our clinic because of pain in the right eye. Corneal oedema, peripheral anterior synechiae formation and intraocular lens were determined in the right eye. The left eye was normal except for nuclear sclerosis. Intraocular pressure was 35 mm Hg in the right eye and 14 mm Hg in the left eye. The patient was diagnosed as having bullous keratopathy and glaucoma. He was treated with antiglaucoma drugs and artificial tears as an outpatient. Persistent keratopathy was observed at follow-up, despite adequate therapy. In the detailed anamnesis of the patient, we discovered that he had used a topical anaesthetic instead of the prescribed medicine owing to ocular pain. The patient was still using topical anaesthetic eye drops, despite warnings. Finally, evisceration was performed on his right eye because of corneal melting and perforation.

Preventable visual impairment in children with nonprofound intellectual disability.

Purpose To assess the preventable visual impairment in children with nonprofound intellectual disability (ID). Methods A total of 215 children with IDs (90 Down syndrome [DS], 125 nonprofound ID) and 116 age- and sex-matched healthy subjects were enrolled in this study. All participants underwent ophthalmologic examinations including cycloplegic refraction measurements, ocular movement evaluation, screening for strabismus (Hirschberg, Krimsky, or prism cover test), slit-lamp biomicroscopy, funduscopy, and intraocular pressure measurements. All data were recorded for statistical analysis. Results Ocular findings in decreasing prevalence were as follows: refractive errors 55 (61.1%), strabismus 30 (33.2%), cataract 7 (7.8%), and nystagmus 7 (7.8%) in children with DS; refractive errors 57 (45.6%), strabismus 19 (15.2%), cataract 7 (6.4%), nystagmus 5 (4%), and glaucoma 1 (0.8%) in children with other ID; and refractive errors 13 (11.2%) and strabismus 4 (3.5%) in controls. Cataracts, glaucoma, and nystagmus were not observed in the control group. The most common ophthalmic findings in children with DS compared with other ID and controls were with hyperopia (p<0.03 and p<0.001, respectively) and esotropia (p<0.01 and p<0.01, respectively). Conclusions The pediatric population with ID has a high prevalence of preventable visual impairments, refractive errors, strabismus, and cataracts. The prevalence of strabismus and refractive errors was more frequent in children with DS. The importance of further health screenings including ophthalmic examinations should be utilized to implement appropriate care management and improve quality of life.