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Objectives: Determining the accuracy of cycloplegic refractive error measurements made with the Spot Vision Screener (SVS, Welch Allyn Inc, Skaneateles Falls, NY, USA) is important for refractive assessment of uncooperative patients during optometric examinations. This study compared cycloplegic refractive errors measured by SVS and tabletop autorefractometer to cycloplegic retinoscopy in children. Materials and Methods: Eighty-eight eyes of 44 subjects were examined in the study. Refractive error measurements were obtained under cycloplegia using retinoscopy, SVS, and Nidek ARK-530 tabletop autorefractometer (ARK-530, Nidek, Japan). Spherical and cylindrical values, spherical equivalents (SE), and Jackson cross-cylinder values at axes of 0° (J0) and 45° (J45) were recorded. Correlations between methods were analyzed using intraclass correlation coefficient (ICC) and Bland-Altman analysis. Results: The mean age was 7 years (range: 6 months-17 years). Sixteen (36%) of the subjects were female and 28 (64%) were male. For SE there was excellent agreement between retinoscopy and SVS (ICC: 0.924) and between retinoscopy and tabletop autorefractometer (ICC: 0.995). While there was a moderate correlation between retinoscopy and SVS for cylindrical values (ICC: 0.686), excellent correlation was detected between retinoscopy and autorefractometer (ICC: 0.966). J0 and J45 crosscylinder power values were not correlated between retinoscopy and SVS (ICC: 0.472) or retinoscopy and tabletop autorefractometer (ICC: 0.442). Retinoscopy was correlated with both SVS and tabletop autorefractometer for all parameters within ±1.96 standard deviations in Bland-Altman analysis. Conclusion: Cycloplegic retinoscopy is the gold standard for refractive error measurement in the pediatric population. However, it requires time and experienced professionals. This study revealed moderate to good agreement between SVS and retinoscopy, with better agreement in spherical errors than cylindrical errors. Although the SVS is intended for screening programs, it may also be useful in the pediatric eye office to estimate spherical refractive error in uncooperative patients.

Traumatic optic neuropathy (TON) is characterized by impaired visual function due to acute damage to the optic nerve injury related to the trauma. The predictive incidence of TON in children and adolescence is 0.7-2.5% after blunt or penetrating head injuries. Orbital trauma is often accompanied by head injury and is the most common cause of unilateral vision loss. Here, we present a case of 11-year-old child who had the complaint of vision loss in the right eye and developed TON after a motor vehicle accident. The intubated patient was admitted to the pediatric intensive care unit after trauma and was operated due to epidural hemorrhage. Visual loss was detected during follow-up and orbital computed tomography revealed multiple fractures in the orbital walls and magnetic resonance imaging showed effusion of the optic nerve sheath and contrast enhancement of the optic nerve. Clinical and imaging findings suggested TON and as there was no indication for surgery, pulse steroid treatment was given for 5 days. With this treatment, the patient's vision loss and clinical findings improved significantly.In conclusion, TON should be considered in patients with a head injury and post-traumatic vision loss. High-dose steroids should be considered in suitable patients.

Objectives:To evaluate the frequency and findings of dry eye associated with ocular graft-versus-host disease (GVHD) in pediatric hematopoietic stem cell transplantation (HSCT) patients.Materials and Methods:Retrospectively the records of pediatric patients with ocular GVHD were evaluated and ophthalmologic examination findings as well as Schirmer test results, tear film break-up time, and corneal staining grades were recorded. In severe dry eye patients topical cyclosporine-A was prescribed and the results were evaluated.Results:GVHD was detected in 51 (23.4%) of 218 HSCT patients, 4 of whom died during follow-up. Thirty (63.8%) of the remaining 47 patients had chronic ocular GVHD and 4 patients with severe dry eye were treated with topical cyclosporine-A with a median follow-up of 12.1 months. Severe dry eye symptoms and findings significantly improved in 2 patients. However, 1 patient had to stop treatment due to side effects.Conclusion:In children, chronic ocular GVHD is a common finding of GVHD after HSCT. Therefore, these patients should be examined periodically for dry eye.

Leber’s hereditary optic neuropathy (LHON) is thought to be a neurovascular disease due to presence of vascular changes in asymptomatic patients. Here we present 2 patients in whom optical coherence tomography angiography (OCTA) imaging demonstrated capillary drop-out areas and decreased radial peripapillary capillary (RPC) density in the quadrants that had thinner retinal nerve fiber layer (RNFL) in OCT images. Progressive decrease in RNFL and RPC density were shown in each patient at month 12 and 30 of follow-up. Following up patients with OCTA imaging in the future will provide insight into the pathogenesis and prognosis of LHON.

Optic disc drusen (ODD) is an important clinical entity that is sometimes misdiagnosed as papilledema because of elevated and blurred disc margins. A 17-year-old male who presented with headaches underwent detailed ophthalmological examination as well as colored fundus photography, B-scan ultrasonography (USG), fundus autofluorescence (FAF), optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), and visual field testing. His visual acuity was 10/10 in both eyes. Fundus examination revealed bilateral blurred and elevated optic disc margins. Diagnosis of bilateral ODD was confirmed with B-scan USG. FAF imaging revealed hyperautofluorescent areas on both optic discs. Optic nerve head OCT scans showed elevated irregular disc borders and thinning of the retinal nerve fiber layer in both eyes. On visual field testing, loss of the nasal visual field was detected in the left eye. OCTA imaging showed focal capillary dropout, especially in the nasal peripapillary area, in both eyes and reduced peripapillary and macular vessel density. In this case report, we evaluated the clinical findings and the structural features of bilateral ODD with multimodal imaging modalities including OCTA.

Optical coherence tomography angiography (OCTA) is a non-invasive alternative method used in the diagnosis and follow-up of acute branch retinal artery occlusion to show changes secondary to ischemia. We report a case with acute branch retinal artery occlusion. A 52-year-old man presented with a complaint of sudden-onset visual loss in the right lower quadrant of the left eye for the previous three days. Best-corrected visual acuity was 0.4 temporally. Inferonasal visual field deficit was detected with confrontation. Pupillary light reactions were normal in both eyes and there was no relative afferent pupillary defect. Dilated fundus examination revealed retinal lesion suggesting superior temporal branch retinal artery occlusion. He was treated with dextran 40 and pentoxifylline. Follow-up fundus fluorescein angiography could not performed because of chronic renal failure; OCTA demonstrated superficial and deep capillary non-perfusion areas and telangiectases in areas corresponding to the artery occlusion.

Objectives: To evaluate the risk factors for strabismus in patients with anisometropia by comparing degree of anisometropia, depth of amblyopia, and binocular visual function in anisometropic patients with and without strabismus. Materials and Methods: Sixty-five anisometropic patients older than 5 years with amblyopia in one eye who were followed in the Ankara University Faculty of Medicine, Department of Ophthalmology, Pediatric Ophthalmology and Strabismus Unit between May 2009 and April 2010 were included in this study. There were 27 cases of strabismus. The depth of amblyopia, degree of anisometropia, and binocular visual function were assessed in anisometropic cases with and without strabismus. Results: The 65 patients with anisometropia were divided into two groups: 27 patients with strabismus (group 1) and 38 patients without (group 2). Depth of amblyopia was greater in patients with strabismus compared to those without (p=0.006). In patients with strabismus, there was no correlation between angle of deviation and depth of amblyopia (p=0.453). In anisometropic amblyopia patients without strabismus, there was a positive correlation between depth of anisometropia and depth of amblyopia (p=0.35, Pearson’s correlation coefficient=0.343). Comparison in terms of anisometropia showed that patients with strabismus had significantly larger spherical difference between the two eyes than in patients without strabismus (p=0.000, Mann-Whitney U test). There was no significant difference in terms of cylindrical values (p=0.146, Mann-Whitney U test). There was no statistically significant difference in the presence of fusion between anisometropic patients with and without strabismus. Conclusion: The risk of developing strabismus increased as degree of anisometropia increased in anisometropic cases. In addition, depth of amblyopia was greater in anisometropic patients with strabismus.

Television (TV) falls cause serious morbidity and mortality in children. Head trauma is frequently seen, and cranial nerve palsies ( 6th and 7th nerves are more frequently affected) are associated with head trauma. Strabismus surgery can be performed in cases not resolving with conservative treatment, however, the delay in treatment related to associated traumas and systemic problems may result in amblyopia. There is no previous report in the literature about ocular findings accompanied by body and head trauma in children after television falls. In order to share our experience, we retrospectively evaluated the records of three patients that were admitted to our clinic with the history of TV-related injuries. The visual acuities of patients, anterior segment and fundus findings as well as the characteristics of the television (tube or LCD, size of the screen, height of the easel) were recorded. (Turk J Ophthalmol 2013; 43: 451-4)

Purpose: We aimed to compare the demographic features, visual acuities before and after treatment, amblyopia and strabismus degrees and binocular visual functions in cases with anisometropic, strabismic and/or anisometropic amblyopia. Material and Method: The study included 50 anisometropic, 50 strabismic and 50 anisometropic and strabismic cases that were followed up with the diagnosis of amblyopia, in our clinic, between January 2007 - September 2010. Amblyopia criteria was defined as the best corrected visual acuity of ≤0.8 and at least 2 lines difference between the visual acuities of two eyes. Anisometropia was defined as ≥1D difference in the spherical and cylindrical value between two eyes. Results: The groups were statistically similar in means of age and sex distribution. Visual acuities in amblyopic eyes before and after treatment were also statistically similar. There were no significant difference between 3 groups in means of compliance to occlusion therapy. In anisometropic cases, anisometropic spherical values were found to have position correlation with amblyopia degree. In hypermetropic and myopic cases, a strong correlation was shown between anisometropia and amblyopia, especially in hypermetropic cases, amblyopia degree increased as the anisometropia increased. In all strabismus cases, a positive correlation between strabismus and amblyopia degrees was shown even though it was statistically insignificant. In strabismic cases, esotropia was significantly higher than exotropia. In anisometropia group, stereopsis and fusion was found to be preserved better in comparison to the strabismic cases. It was concluded that deviation had a more profound effect on binocular function loss than anisometropia. Discussion: We recommend to follow the hypermetropic anisometropic cases and especially cases with high degree strabismus and esotropia more closely. And also we emphasize that strabismus affects binocular function loss more than anisometropia, even though the anisometropic cases had higher degree of amblyopia they had a better prognosis than the strabismus cases. (Turk J Ophthalmol 2013; 43: 326-34)

Pur po se: To evaluate the quality of life (QOL) in children who had undergone surgery for pediatric cataract. Ma te ri al and Met hod: Twenty-five children were included in the study and were divided into two group according to age (group 1 - patients younger than 6 years and group 2 - patients older than 7 years). A questionnaire was given to the patients and their parents to assess the QQL. The questionnaire had 4 parts evaluating the functional, social and surgical apprehensions of the parents and a part appraising the child’s thought. This last part was answered by parents in group 1 and by children in group 2. The correlations between the questionnaire results and patient characteristics were assessed statistically. Re sults: The mean age was 3.5±1.6 (1.5-6) years in group 1 and 9.9±2.6 (7-15) years in group 2. Functional, social or surgical scores were 42.5 (0-80), 45 (5-100) and 63 (12.5-100) in group 1 and 40 (10-90), 70 (40-85) and 75 (25-100) in group 2, respectively. Functional, social or surgical scores were not significantly different between the groups. Social apprehensions were significantly higher in the parents of patients with preoperative strabismus in group 2 (Mann-Whitney U test, p=0.05). Dis cus si on: Pediatric cataracts have a great impact on children’s life socially and functionally. Depending on the age at surgery, the visual acuity of the patients may vary, but the associated preoperative strabismus causes more social concern in the parents. (Turk J Ophthalmol 2013; 43: 156-60)

The clinical characteristics, pathogenesis, and treatment of traumatic and toxic neuropathies are given in this manuscript. (Turk J Ophthalmol 2013; 43: 118-23)

Objectives: The aim of this study was to identify the causes of visual impairment in children attending schools for students with visual impairment and to identify children suitable for treatment and rehabilitation. Materials and Methods: All students were examined in our department by a pediatric ophthalmologist and an ophthalmologist experienced in low vision and visual rehabilitation. The children’s medical histories were recorded. All children underwent ophthalmological examination including visual acuity measurement, anterior segment and dilated fundus evaluation, retinoscopy with cycloplegia, and intraocular pressure measurement. The causes of visual impairment were grouped as avoidable and unavoidable. Children with residual visual acuity better than 20/1250 were included in the low vision rehabilitation programme. Results: A total of 120 patients were evaluated and 79.2% were legally blind (visual acuity less than 0.05), 18.4% had low vision (visual acuity between 0.05 and 0.3), and 0.8% had normal vision (>0.3). The main causes of visual impairment were retinal dystrophies (24.2%) and retinopathy of prematurity (17.5%). Of all diseases related to visual impairment, 27.6% were avoidable. Improvement in visual acuity was achieved with low vision aids in 57.5% of all patients. Conclusion: The incidence of visual impairment due to avoidable causes can be decreased by ophthalmic screening. Treatment of these children in the early stages of visual development can improve visual acuity. Even in cases with delayed diagnosis, low vision aids are important for visual and neurobehavioral development, and these programmes may improve quality of life and education in these children.

Optic nerve avulsion is a rare pathology with poor prognosis usually seen after blunt trauma. The optic nerve is separated from the sclera by indirect forces due to the relatively weak structure of the lamina cribrosa area. Here we describe an 11-year-old boy who experienced optic nerve avulsion and retinal detachment after penetrating ocular trauma.