Osman Melih Ceylan

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.

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.

Preoperative detection of posterior capsule tear with ultrasound biomicroscopy in traumatic cataract

UNLABELLED We report ultrasound biomicroscopy (UBM) evaluation of a paintball-related traumatic cataract with a posterior capsule tear. Slitlamp examination revealed anterior and posterior subcapsular cataracts with a suspicious tiny posterior capsule tear within the larger area of posterior bulging. Ultrasound biomicroscopy (35 MHz) confirmed the presence of a sub-1.0 mm posterior capsule tear, which was clearly observed intraoperatively and postoperatively. This is the first report illustrating the high performance of 35 MHz UBM in detecting a sub-1.0 mm posterior capsule tear. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.

Evaluation of essential and toxic trace elements in pseudoexfoliation syndrome and pseudoexfoliation glaucoma.

Pseudoexfoliation syndrome (PEX), an age-related disorder of the eye, is associated with significant ophthalmic morbidity and can lead to pseudoexfoliation glaucoma (PEG). The etiology of this disorder has not been clearly understood. Trace elements have been suggested to have roles in the pathogenesis of several disorders. This study aimed to determine whether trace element levels have a role in the development of PEX and/or PEG. Levels of zinc (Zn), copper (Cu), selenium (Se), manganese (Mn), chromium (Cr), cobalt (Co), molybdenum (Mo), nickel (Ni), vanadium (V), arsenic (As), aluminum (Al), mercury (Hg), cadmium (Cd), and strontium (Sr) were determined in serum samples of 32 cases of PEX, 30 cases of PEG, and 32 control subjects using inductively coupled plasma–mass spectrometry. Mn, Mo, and Hg concentrations were found to be significantly increased in patients with PEX. Logistic regression revealed Mn and Hg as the strongest determinants of PEX and Mo as the strongest determinant of PEG in the studied Turkish subjects. Levels of Mn, Cr, Co, Mo, Al, Hg, Sr, Ni, V, and As were determined for the first time in these ophthalmological disorders. Increased levels of serum Mn, Mo, and Hg suggest a possible role of these elements in the pathobiology of PEX.

Imaging late capsular block syndrome: Ultrasound biomicroscopy versus Scheimpflug camera

UNLABELLED We describe 2 patients with late capsular block syndrome whose anterior chamber morphology was evaluated with ultrasound biomicroscopy and Scheimpflug imaging before and after neodymium:YAG laser capsulotomy. Pretreatment ultrasound biomicroscopy examination showed significant capsular bag distension in both patients. Scheimpflug imaging failed to capture the posterior capsule displaced far behind the intraocular lens. Automatic anterior chamber depth measurements were incorrect with Scheimpflug imaging in 1 patient. Ultrasound biomicroscopy seems to be superior to Scheimpflug imaging in eyes with extremely distended capsular bags. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.

Comparison of Oculus Pentacam and Stratus optical coherence tomography for measurement of central corneal thickness.

Purpose: Measurement of central corneal thickness (CCT) plays an essential role in the diagnosis and treatment of many ocular diseases. In this study, we aimed to compare the CCT measurements obtained using the Scheimpflug system (Pentacam; Oculus, Inc) with a retinal optical coherence tomography device (Stratus OCT; Carl Zeiss Meditec, Inc) to examine healthy corneas. Methods: CCT measurements of 80 eyes belonging to 40 male patients (mean age: 24.48 ± 6.01 years) were evaluated with the Pentacam and the Stratus OCT. The relationship between the CCT values obtained with these 2 devices was examined with a Pearson correlation analysis, a paired t test, and a Bland-Altman analysis. Results: The average CCT value obtained with Pentacam was 546.11 ± 34.15 μm and that obtained with Stratus OCT was 567.76 ± 35.02 μm. Although the average difference between the devices was 21.65 ± 8.59 μm (P < 0.0001), the measurements obtained with both devices were significantly correlated (r = 0.969, P < 0.0001). In Bland-Altman analysis, there was a high consistency between measurements obtained with either Pentacam or Stratus OCT devices. Conclusions: Corneal thickness measurements differ depending on the device used. Corneal thicknesses that have been calculated with Pentacam were lower than the values obtained with Stratus OCT. Both devices used for CCT measurement are easily applied, noninvasive, and effective. However, the devices are not interchangeable. Stratus OCT is not optimal for CCT measurement because of the important limitations of using manual measurements, but it can be used if other measurement devices designed for the purpose are not available.

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.

Bilateral Symmetrical Subepidermal Calcified Nodules of the Eyelids

Abstract A subepidermal calcified nodule is an uncommon variant of calcinosis cutis and only a limited number of cases have been reported about the eyelid nodules in the literature. A 20-year-old male was referred to our department with symmetrical nodules on both upper eyelids enlarging over 3 years. Both nodules were removed by excisional biopsy. After the histopathologic evaluation, the diagnosis was subepidermal calcified nodule. He had a complete recovery with no recurrence and acceptable aesthetic appearance. As a rare entity, subepidermal calcified nodule should be thought in differential diagnosis of eyelid nodular lesions and symmetrical appearance may be seen.

Effects of 1% cyclopentolate hydrochloride on anterior segment parameters obtained with Pentacam in young adults

PURPOSE To investigate the effects of topically applied 1% cyclopentolate hydrochloride on anterior segment parameters obtained with a Pentacam rotating Scheimpflug camera in healthy young adults. METHODS Anterior segment analyses of 25 eyes from 25 young adults (Group 1), before and after 45 min of 1% cyclopentolate hydrochloride application, were performed. For a control group (cycloplegia-free, Group 2), 24 eyes of 24 age- and sex-matched healthy cases were evaluated twice at 45 min intervals. The results obtained from the groups were compared statistically. RESULTS The mean ages of the groups were 23.04 ± 3.42 (range, 18-29) and 22.4 ± 2.05 (range, 18-27) years for Groups 1 and 2, respectively (p=0.259). In Group 1, measurements between the two analyses were significantly different for the values of anterior chamber depth (ACD), anterior chamber angle (ACA), and anterior chamber volume (ACV) (p<0.05), whereas no statistical difference was found for the central corneal thickness (CCT) and keratometry (K1, K2) measurements. In Group 2, none of these parameters were statistically different between the two analyses. CONCLUSIONS Topically applied 1% cyclopentolate hydrochloride caused an increase in the ACD and ACV values, and a decrease in the ACA value. However, it had no significant effect on the CCT and keratometry measurements. It is important to consider these effects when using the Pentacam device on young adults with cycloplegia and when applying it for various reasons.