Effects of different types of refractive errors on bilateral amblyopia

Objectives: Identifying effects of different types of refractiveerrors on final visual acuity and stereopsis levels inpatients with bilateral amblyopia.Materials and methods: Patients with bilateral amblyopialower than ≥1.5 D anisometropia were included. Thepatients were classified according to the level of sphericalequivalent (0-4 D and >4 D of hypermetropia), the levelof astigmatism (below and above 2D in positive cylinder)and type of composed refractive error [<4 D of hypermetropiaand < 2 D of astigmatism (group I), > 4 D of hypermetropiaand < 2 D of astigmatism (group II), and < 4 Dhypermetropia and > 2 D of astigmatism (group III)]. Initialand final binocular best corrected visual acuities (BCVA)were compared between groups.Results: The initial binocular BCVA levels were significantlylower in patients with > 4 D of hypermetropia(p=0.028), without correction after treatment (p=0.235).The initial binocular BCVA was not different betweenastigmatism groups, but final BCVA levels were significantlylower in 4-6D of astigmatism compared with 2-4D of astigmatism (p=0.001). During comparison of composedrefractive errors, only the initial binocular BCVAwas significantly lower in group I compared to group II(p=0.015). The final binocular BCVA levels were not differentbetween groups I and III (p>0.05).Conclusions: Although the initial BCVA is lower in patientswith higher levels of hypermetropia, the response ofpatients to treatment with glasses is good. The responseof patients with high levels of astigmatism seems to belimited. J Clin Exp Invest 2012; 3(4): 467-471Key words: Amblyopia, isoametropic amblyopia, hypermetropia,refractive amblyopia, visual acuit

Preseptal and orbital cellulitis

ABSTRACT Preseptal cellulitis (PC) is defined as an inflammation of the eyelid and surrounding skin, whereas orbital cellulitis (OC) is an inflammation of the posterior septum of the eyelid affecting the orbit and its contents. Periorbital tissues may become infected as a result of trauma (including insect bites) or primary bacteremia. Orbital cellulitis generally occurs as a complication of sinusitis. The most commonly isolated organisms are Staphylococcus aureus, Streptococcus pneumoniae, S. epidermidis, Haempphilus influenzae, Moraxella catarrhalis and S. pyogenes. The method for the diagnosis of OS and PS is computed tomography. Using effective antibiotics is a mainstay for the treatment of PC and OC. There is an agreement that surgical drainage should be performed in cases of complete ophthalmoplegia or significant visual impairment or large abscesses formation. This infections are also at a greater risk of acute visual loss, cavernous sinus thrombosis, meningitis, cerebritis, endophthalmitis, and brain abscess in children. Early diagnosis and appropriate treatment are crucial to control the infection. Bu enfeksiyonlar çocuklarda akut görme kaybı, kavernöz sinus trombozu, menenjit, serebrit, endoftalmi, beyin absesi gibi komplikasyonlara neden olabilir. Bu nedenle bu enfeksiyonların erken tanınması ve doğru tedavi edilmesi oluşabi-lecek ciddi enfeksiyonların önlenmesi açısından çok önemlidir. Bu yazıda PS ve OS&apos;nin tanı, tedavi, yönetim ve komplikasyonları özetlendi

Comparison of Hybrid Contact Lenses and Rigid Gas-Permeable Contact Lenses in Moderate and Advanced Keratoconus

Objectives:We aimed to compare the clinical results and topographic data of the new generation hybrid contact lens (HCL) and rigid gaspermeable contact lens (RGPCL) in patients with moderate and advanced keratoconus.Materials and Methods:In this prospective study, HCL users comprised group 1 and RGPCL users comprised group 2. Snellen uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and lens-corrected visual acuity (LCVA); manifest spherical-cylindrical values; corneal topography measurements (flat keratometry [K1], vertical keratometry [K2], mean K, maximum K [Kmax], central corneal thickness [CCT], and thinnest corneal thickness [TCT]); and cone location were recorded.Results:The study included 83 eyes of 51 patients in group 1 and 61 eyes of 40 patients in group 2. The groups were similar in age and gender (p>0.05). Mean LCVA (logMAR) was significantly lower than BCVA in both groups (p0.05). There was also no significant difference between the two groups in terms of keratoconus stages, mean Kmax, CCT, TCT, or cone location (p>0.05), while mean UCVA (logMAR) and mean K were higher in group 2 (p<0.05). In both groups, the visual gain with lenses was higher in eyes with central cones, and there was significantly greater visual increase in group 2 (p=0.039).Conclusion:In moderate and advanced keratoconus, HCLs improved vision as much as RGPCLs and both lenses were more effective for central cones. Nevertheless, longer term of follow-up and larger numbers of patients are needed for long term follow-up results of HCL

Collagen Cross-linking in Keratoconus Patients with Thin Corneas: Short-Term Results

Pur po se: To study the effectiveness and safety of corneal collagen cross-linking with hypoosmolar riboflavin solution applied to keratoconus patients with thin corneas. Ma te ri al and Met hod: In this retrospective study, medical records of keratoconus patients planned for cross-linking surgery and having thinnest corneal thickness (TCT) less than 400 μm after corneal epithelial removal were reviewed. There were 12 patients and 16 eyes in the study cohort. After the epithelium was removed, hypoosmolar solution was applied for 30 minutes and pachymetric measurements were taken. If corneal thickness became more than 400 μm, the cross-linking procedure was started; if not, hypoosmolar solution was continued until corneal thickness reached 400 μm. Maximum keratometry values (K Max), pachymetric measurements, uncorrected distance visual acuities (UDVA), and corrected distance visual acuities (CDVA) were recorded. Comparison between preoperative measurements and measurements taken in sixth postoperative month were performed. Re sults: The mean TCT was 422.75±26.98 μm preoperatively (max: 450, min: 360). The mean TCT was reduced to 373.63±22.41 μm after epithelium was removed (max: 398, min: 325). There was a statistically significant difference between preoperative K max (62.62±5.09) and postoperative K max (61.55±5.80), (p=0.03). On the other hand, the difference between preoperative-postoperative UDVA (p=0.29) and preoperative-postoperative CDVA was not significant (p=058). There were no cases with significant corneal opacity or with any other complication. Dis cus si on: Corneal collagen cross-linking with hypoosmolar riboflavin solution in keratoconus patients with thin corneas is an effective procedure and can be considered as safe regarding preservation of visual acuities and absence of significant corneal opacity. (Turk J Ophthalmol 2012; 42: 316-2

Investigation of the Pupil Diameter Differences in Anisometropic Amblyopia

Pur po se: To study pupil diameter differences between amblyopic and fellow eyes in anisometropic amblyopia. Ma te ri al and Met hod: This study was carried out from medical records of 412 candidates for refractive surgery with excimer laser. 69 patients (21 males and 48 females) with anisometropic amblyopia were enrolled in this study. Mean age of subjects was 33.07±9.07 years. Pupil size measurements were performed with an ocular wavefront analyzer. Amblyopic eyes and fellow eyes were compared with regard to pupil diameter, spherical refractive error, magnitude of astigmatism, spherical equivalent, and best-corrected visual acuity on Snellen chart. Also, correlation analyses were performed to determine correlation coefficients and their significance between selected variables. Re sults: Mean pupil diameter was 5.95±0.90 mm in amblyopic eyes and 6.15±0.90 mm in fellow eyes. Difference in mean pupil diameter between amblyopic and fellow eyes was statistically significant (p=0.01). Mean spherical refractive error (-2.96±6.21 D), mean astigmatic refractive error (-2.87±1.80 D), mean BCVA (0.44±0.19), and mean spherical equivalent (-4.40 ±2.92 D) in amblyopic eyes were statistically different from the values in fellow eyes (p=0.01). In addition, the analyses showed that the correlations between the magnitude of anisocoria and anisometropia, and between the magnitude of anisocoria and the depth of amblyopia were statistically insignificant. Dis cus si on: This study shows a relationship between anisocoria and amblyopia. The existence of such relationship helps both to diagnose amblyopia earlier and to unveil some hidden process in the pathophysiology of amblyopia. (Turk J Ophthalmol 2013; 43: 45-50

Aarskog syndrome associated with hypermetropia and toe anomaly

No Abstrac

The Effect of Cross-Linking Treatment on Conus Curvature and Higher Order Corneal Aberrations in Keratoconus

Objectives: To study the effect of corneal collagen cross-linking on conus curvature and corneal aberrations in keratoconus. Materials and Methods: The medical records of thirty-seven eyes of 32 progressive keratoconus patients (17 male, 15 female, mean age: 22.13±4.64 years) who had undergone corneal cross-linking were evaluated retrospectively. The change in refractive errors, visual acuity on Snellen charts, average keratometry, conus curvature, and corneal aberrations calculated at 6.00 mm pupil size throughout the follow-up time were compared with paired t-test. The correlation of the change in best-corrected visual acuity and in uncorrected visual acuity with the change of the parameters which had statistically significant difference at 18 months was studied with Pearson’s correlation analysis. Results: The best-corrected visual acuity, uncorrected visual acuity, spherical and cylindrical error, average keratometry, conus curvature, vertical coma, total corneal aberrations, total higher order aberrations had statistically significant difference at 18 postoperative months (p=0.001). Spherical aberration (p=0.95) and horizontal coma (p=0.78) did not show statistically significant difference at the end of follow-up. The change in uncorrected visual acuity correlated with change in conus curvature (r=-0.420, p=0.01) and change in cylindrical refraction (r=0.453, p=0.005) at 18 months. The change in best-corrected visual acuity correlated with change in total corneal aberrations (r=-0.490, p=0.002), vertical coma (r=0.408, p=0.01), average keratometry (r=-0.386, p=0.02), conus curvature (r=-0.381, p=0.02), and total higher order aberrations (r=-0.326, p=0.05) at 18 months. Conclusion: Corneal collagen cross-linking treatment applied to progressive keratoconus cases induces significant decrease in conus curvature, in total corneal aberrations, and in higher order aberrations, especially in vertical coma, and leads to a prominent visual acuity increase eventually. (Turk J Ophthalmol 2014; 44: 184-9

Aarskog syndrome associated with hypermetropia and toe anomaly

Aarskog syndrome is characterised by a disproportionately short stature and facial, skeletal and urogenital anomalies ('shawl' scrotum and cryptorchidism). Ophthalmic findings include a slight downward slant to the palpebral fissures, hypertelorism, blepharoptosis, strabismus, ophthalmoplegia, hypermetropic astigmatism and a large cornea, Findings on the extremities include joint hyperextensibility, short and broad hands, interdigital webbing, a short fifth finger, clinodactyly and broad feet with bulbous toes. We report on a 7 1/2-year-old boy with typical findings of Aarskog syndrome, hypermetropia and bilateral proximal implantation of the fifth toes. These associated abnormalities have hitherto never been described, to our knowledge

Orthokeratologic Lens Applications in the Correction of Low to Moderate Myopia

Purpose: To evaluate the efficacy and safety of orthokeratology in patients with low and medium myopia. Material and Method: Twenty six eyes of 6 male and 7 female patients were evaluated prospectively. The mean spherical equivalent was -3.87±1.35 D (-7 - -2.25) in 26 eyes. Individual semi-rigid, gas-permeable night Gelflex lenses (Australia) were performed based on keratometry values, ambient pupil, mesopic pupil, and autorefractometry values providing best-corrected visual acuity (BCVA). In all cases, uncorrected and best-corrected visual acuity, refraction, keratometry, corneal topography, slit lamp and intraocular pressure measurements were evaluated on first day, at first week, and at first, third and sixth months. Results: While the mean uncorrected visual acuity (UCVA) before orthokeratology (Ortho-K) was 1.08±0.24 (0.4-1.3) logMAR, first week after Ortho-K, it was 0.24±0.27 (0-1) logMAR. The BCVA was 0.01±0.07 (0-0.4) logMAR prior and first week after Ortho-K. First week after Ortho-K, it was 0.22 logMAR at right and 1 logMAR at left. While the average UCVA of our cases at first month was 0.11±0.19 (0-0.8) logMAR, the average BCVA at first month was 0.018±0.08 (0-0.4) logMAR. No ophthalmological complications were noted. Discussion: Ortho-K is a safe and effective method for correction of low and moderate myopia in patients who do not prefer surgery and do not wish to wear glasses or contact lenses during the day. (Turk J Ophthalmol 2013; 43: 317-20