Sema Arvas

Consecutive Exotropia following Strabismus Surgery

We investigated the clinical factors affecting the development of consecutive exotropia following esotropia surgery. The development period of consecutive exotropia, amblyopia and limitation of adduction were evaluated in 89 patients with primary esotropia that changed to consecutive exotropia after surgery. In the presence of deep amblyopia, consecutive exotropia developed earlier. When two horizontal muscles were operated, limitation of adduction was more frequent in symmetrical rather than asymmetrical surgical procedure. Since consecutive exotropia may develop many years after esotropia surgery, a long-term follow-up period in patients without consecutive exotropia in the early postoperative period is advised.

Indocyanine Green Angiographic Findings in Young Patients with Grönblad-Strandberg Syndrome

Purpose: The objective of the present investigation was to define the indocyanine green (ICG) angiographic features of angioid streaks (AS) in young patients with Grönblad-Strandberg syndrome and to compare them with findings on fluorescein angiography (FA) and red-free photographs. Methods: Complete ophthalmological examination, red-free photography, FA and ICG angiography were performed on 6 patients, 4 women and 2 men, ranging in age from 21 to 33 years, with Grönblad-Strandberg syndrome. Results: ICG angiography showed AS in the form of hypofluorescent lines with numerous associated hyperfluorescent foci. The AS were more clearly visualized and were seen to be more numerous and larger by ICG angiography. Choroidal neovascularization (CNV) and macular involvement had become bilateral in all of the cases. ICG angiography allowed precise localization of CNV in some cases, but it was not much superior to FA in the determination of CNV and the visualization of ‘peau d’orange’. Conclusions: ICG angiography provides some information different from FA in the evaluation of AS, but usually neovascular complications and peau d’orange appearance could be seen more clearly in the red-free photographs and FA. The hypofluorescent AS pattern was significantly observed in young patients with Grönblad-Strandberg syndrome.

Diode laser photocoagulation posterior to the ridge in severe stage 3+ threshold retinopathy of prematurity

Abstract Purpose: To evaluate the results of diode laser photocoagulation (DLP) of the retina posterior to the ridge in eyes with severe Zone II, Stage 3+ threshold retinopathy of prematurity (ROP). Method: DLP was applied posterior to the fibrovascular ridge for advanced Zone II, Stage 3+ threshold ROP patients, either as the primary treatment combined with DLP of the avascular retina (group 1), or as a secondary treatment in eyes that had previously undergone DLP of the avascular retina (group 2). Statistical analysis was performed using SPSS software trail version 16.0. Values are presented as mean ± SD. Results: A total of 50 eyes of 29 premature infants were treated (14 [48%] male, 15 [52%] female). The mean gestational age was 29.5 ± 2.2 weeks (range: 26–34 weeks). The mean birth weight was 1259 0.72 ± 409.15 g (range: 500–2050 g). The mean gestational age for DLP of the avascular region anterior to the ridge and DLP posterior to the ridge was 37 ± 3 weeks and 38 ± 3 weeks, respectively. The mean follow-up was 26 ± 5 weeks (18–38 weeks). In 48 eyes, the tractional fibrovascular ridge had regressed. Transient retinal hemorrhage was the most common complication. Three eyes exhibited optic-disc dragging; two eyes progressed to Stage 4a ROP; two eyes presented with macular traction, without any detachment; and one eye developed a vitreous hemorrhage, which resolved spontaneously. There were no statistically significant differences between complicated and uncomplicated eyes regarding gestational age, birth weight and applied laser spot numbers (p > 0.05 for all, Mann–Whitney U test). Conclusion: DLP, posterior to the ridge as an additive treatment in the management of severe Zone II, Stage 3+ threshold ROP patients, is safe and effective; this approach could be used as either the primary treatment, or as the follow-up to failed laser treatment of the avascular retina to halt the progression of the disease.

The association between serum homocysteine levels and retinopathy of prematurity.

Objective: To evaluate the relationship between serum total homocysteine levels and retinopathy of prematurity (ROP). Methods: This prospective case-control study involved premature infants diagnosed with ROP 4 weeks after birth (cases); controls were premature infants not developing ROP during follow-up. Fasting serum total homocysteine concentrations were determined in all participants 4 weeks after birth, using high performance liquid chromatography. Results: A total of 45 and 35 infants were included in the case and control groups, respectively. The mean ± SD (range) serum total homocysteine levels were 10.36 ± 1.72 μmol/l (7.45 - 14.84) in infants with ROP and 8.41 ± 2.12 μmol/l (5.56 - 13.90) in controls. This difference was statistically significant. Mean ± SD total homocysteine levels were higher in infants with more severe ROP (11.45 ± 1.76 μmol/l) compared with mild ROP (9.92 ± 1.56 μmol/l). Conclusions: Elevated serum total homocysteine levels are associated with the development of ROP in premature infants. Further studies with larger patient populations are required, to improve understanding of the relationship between homocysteine and ROP development.

Optical Coherence Tomographic Findings in Susac Syndrome

Purpose: To report optical coherence tomographic (OCT) findings in Susac syndrome. Methods: A 15-year-old girl who had symptoms of deafness and encephalopathy was referred with a provisional diagnosis of Susac syndrome. Funduscopy revealed cotton wool spots and ischaemic cloudy swelling of the retina. Results: OCT taken from the abnormal retinal area showed increased reflectivity of the inner retinal layers and decreased reflectivity from the outer retinal layers and the retinal pigment epithelium due to shadowing. Neither intraretinal nor subretinal fluid were observed on the OCT imaging. OCT findings were compatible with the accepted view that the retinal pathology in Susac syndrome is due to arteriolar occlusion. Conclusion: OCT may be used as a complementary diagnostic method to fluorescein angiography in Susac syndrome.