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Purpose: To establish whether clinical factors were correlated with deviation control in intermittent exotropia. Methods: This retrospective study included 54 patients with intermittent exotropia. The patient's sex, family history, age at first admission, best corrected visual acuity, refractive errors after cycloplegia, angles of ocular deviation at near and distance, and near, distance, and total deviation control were evaluated. Ocular deviation controls were determined according to the Mayo Clinic's office-based scale. Correlation analysis was performed between the deviation control and the determined clinical factors. Results: Spearman correlation analyses revealed a mild correlation between age with total exotropia control score and age with the control of near exotropia control score (r = 0.320, P =.018 and r = 0.339, P =.012, respectively). The angle of deviation at near showed a significant moderate correlation between total exotropia control score and near exotropia control score (r = 0.523, P <.001 and r = 0.780, P <.001, respectively). The deviation angle at distance showed a mild correlation with distance exotropia control score and total exotropia control score (r = 0.423, P =.001 and r = 0.288, P =.034, respectively). The angle of deviation at distance showed a mild correlation with the angle of deviation at near (r = 0.359, P =.008). The deviation angle at distance was established as an independent factor for predicting total exotropia score (P =.037, P =.015, respectively). Conclusions: The high deviation angle correlates positively with poor deviation control. The distance deviation angle is an independent predictor of total deviation control for the first time in the literature. [J Pediatr Ophthalmol Strabismus. 2022;59(1):53–59.] [ABSTRACT FROM AUTHOR]

Choroidal nodules are common in neurofi bromatosis. Choroidal nodules, which are suggested to be a diagnostic criterion for neurofi bromatosis, can be monitored by near-infrared imaging. Near-infrared imaging is a fast and non-invasive method. This presentation aims to describe choroidal nodules by near-infrared reflectance imaging in a patient with neurofibromatosis type 1 who presented for routine ophthalmology examination. [ABSTRACT FROM AUTHOR]

Background. To evaluate the effects of topical 0.5% ketorolac treatment combined with topical steroids on macular thickness in cases who had uneventful phacoemulsification surgery. Methods. 58 eyes of 58 consecutive cases were included. The mean foveal thickness (MFT), parafoveal thickness (ParaFT), and perifoveal thickness (PeriFT) measurements were performed with optical coherence tomography (RTVue-100, Optovue, Fremont, CA, USA) preoperatively and at postoperative 1 week, 1 month, and 2 months. All cases received topical 0.1% dexamethasone postoperatively. Randomly selected cases additionally received topical 0.5% ketorolac, which started 2 days prior to surgery. Cases who received both topical steroids and ketorolac formed group 1 and subjects who received only topical steroids formed group 2. Results. The increase in mean MFT at the 1st week, 1st month, and 2nd months after surgery in group 1 was significantly lower than group 2 (P=0.008, P≤0.001, and P≤0.001, resp.). In group 1, the increase in mean ParaFT and PeriFT was significantly lower than group 2 at the 1st and 2nd months of the surgery (P<0.05 for all variables). Conclusions. Topical ketorolac combined with steroids is highly efficacious in order to prevent increment in thickness on each part of the macula even after an uneventful phacoemulsification surgery comparing to steroid monotheraphy. [ABSTRACT FROM AUTHOR]

Purpose: This study was constructed to compare the rate of rehemorrhage in patients with diabetic vitreous hemorrhage (VH) undergoing pars plana vitrectomy (PPV) with versus without preoperative intravitreal bevacizumab (IVB) injection. Methods: It is a retrospective chart review of all patients who had undergone PPV for diabetic VH from January 2008 to January 2011. Patients who had undergone IVB injection before PPV were assigned to Group 1; the others were assigned to Group 2. Postoperative VH was the main outcome. Results: A total of 65 eyes of 60 patients (19 eyes in Group 1 and 46 eyes in Group 2) were examined. Postoperative VH occured in three eyes (15.8%) in Group 1 and in 13 eyes (28.3%) in Group 2, but this was not statistically significant ( p: 0.347). Conclusion: Further studies to evaluate the effect of IVB on postoperative VH are needed. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the outcomes of patients with vitreomacular traction syndrome (VMT) treated with triamcinolone acetonid (TA) assisted 23-gauge (23-G) transconjunctival sutureless vitrectomy. Methods: Restrospective, case series. The medical charts of 13 eyes of 13 consecutive patients with VMT who underwent 23-gauge transconjunctival pars plana vitrectomy were reviewed. All patients had at least six-month follow-up. The main outcome parameters were changes in best corrected visual acuity (BCVA) and central macular thickness (CMT) between the baseline and postoperative follow- up examinations performed at the first, third, and sixth months after the surgery. Results: The mean follow-up period was 7 (range 6-15) months. The mean preoperative BCVA was 1.3±0.4 (logmar). The final BCVA was 0.5±0.3 (logmar) (p = 0.001). The mean CMT was 429±85 µm at baseline, which was significantly reduced to 255±47 µm at the final follow-up visit (p = 0.001). The mean CMT reduction was 174±101 (range: 32-348) µm. No postoperative complications were seen such as endophthalmitis, retinal detachment, hypotony, or glaucoma. Conclusion: Triamcinolone assisted 23-G transconjunctival sutureless vitrectomy is an effective and safe surgical technique in the management of VMT syndrome. Further studies with large case series are needed. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of injection of 1:100,000 dilution adrenalin with sodium bisulfite preservative on the corneal endothelium in phacoemulsification cataract surgery. Methods: This retrospective study comprised 70 patients with age-related cataracts who had undergone phacoemulsification cataract surgery with intraocular lens (IOL) implantation without any surgical complications. In the adrenalin group, patients with intraoperative intracameral adrenalin use were included. The intracameral adrenalin was composed of 1 mL of 1:100,000 dilution adrenalin with sodium bisulfite preservative. The control group included patients who underwent surgery without any intracameral adrenaline use. There were 36 patients in the adrenalin group and 34 patients in the control group. Corneal endothelial density, endothelial cell morphology, and endothelial cell area were measured via specular microscopy both preoperatively and 3 months after surgery. The 2 groups were compared with regard to changes in specular microscopy measurements. Results: The mean (± standard deviation) age was 66.51 ± 8.32 years in the adrenalin group and 67.58 ± 7.83 years in the control group. The difference in age between the 2 groups was not significant (p = .611). The preoperative mean corneal endothelial cell density was 2,270 ± 286 cells/mm2 in the adrenalin group and 2,226 ± 260 cells/mm2 in the control group, and the difference between the 2 groups was not statistically significant (p = .550). In the adrenalin group, the postoperative mean corneal endothelial cell density was 2,191 ± 268 cells/mm2. Although the postoperative mean cell density was lower than the preoperative mean cell density, the difference between the 2 measurements was not statistically significant (p = .117). In the control group, the postoperative mean corneal endothelial cell density was 2,169 ± 272 cells/mm2, and the difference between the preoperative and postoperative measurements was not statistically significant (p = .161). Comparisons of postoperative specular microscopy measurements between the adrenalin and control groups with regard to cell density, cell sizes, and cell shapes showed that there were no statistically significant differences in comparison of all parameters between the 2 groups. Conclusions: Intracameral injection of 1:100,000 dilution adrenalin with sodium bisulfite preservative is not toxic to corneal endothelium. [ABSTRACT FROM AUTHOR]

Purpose: To identify factors which affect mesopic pupil diameter in refractive surgery patients. Setting: This retrospective study was performed at the 1st Ophthalmology Clinic in Ankara Ataturk Training and Research Hospital, Ankara, Turkey. Methods: Medical records of 412 refractive surgery candidates who applied between 2006 and 2008 were reviewed. Detailed ophthalmological examination data were obtained from medical records. Pupil size measurements were performed with a COAS Ocular Wavefront analyzer in mesopic conditions. Relationship between mesopic pupil diameter and age, sex, spherical refractive error (D), magnitude of astigmatism (D), type of astigmatism, spherical equivalent, and average keratometry were analyzed by means of univariate and multivariate regression analyses. Results: Mean mesopic pupil diameter was 6.19 ± 0.88 mm. Mean pupil diameter (mean ± standard deviation) was 5.70 ± 1.01 in hypermetropia, 6.04 ± 0.79 mm in mixed astigmatism, and 6.33 ± 0.82 mm in myopia. The difference in mean mesopic pupil diameters between myopes and hypermetropes was statistically significant ( p = 0.001). However, differences with regard to mean pupil diameters between myopes and mixed astigmatism ( p = 0.660) and between hypermetropes and mixed astigmatism ( p = 0.109) were not significant. Mean pupil diameter was 6.00 ± 0.99 mm in against the rule astigmatism, 5.96 ± 0.84 mm in oblique astigmatism, and 6.27 ± 0.84 mm in with the rule astigmatism. Mean mesopic pupil diameter in with the rule astigmatism group was higher than oblique astigmatism group. Spherical refractive error ( r = -0.213, p = 0.001), cylindrical refractive error (0.197, p = 0.001), and age ( r = −0.341, p = 0.001) showed correlation with pupil diameter. Conclusions: This study showed that age and magnitude of both spherical and cylindrical refractive error are the most determinative factors on mesopic pupil size. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the variations in biomechanical properties of the cornea in rheumatoid arthritis (RA) patients., Methods: A total of 53 RA patients, and 25 healthy individuals (control group) were enrolled. Rheumatoid arthritis patients were classified as in active phase (group 1; n=24) or in remission phase (group 2; n=29). Corneal biomechanical parameters including corneal hysteresis (CH), corneal resistance factor (CRF), corneal compensated intraocular pressure (IOPcc), and Goldmann-correlated IOP (IOPg) were measured with the Reichert Ocular Response Analyzer. Topographical measurements, including central corneal thickness (CCT), anterior chamber depth, iridocorneal angle, and corneal volume were measured using a Sirius corneal topographer., Results: The mean CH was 9.43±1.17 mm Hg in group 1, 9.42±1.84 mm Hg in group 2, and 10.47±1.68 mm Hg in the control group (P=0.03). The mean IOPcc was 17.85±3.2 mm Hg in group 1, 17.95±3.49 mm Hg in group 2, and 15.36±3.11 mm Hg in the control group (P=0.008). The CH showed a significant positive correlation with CRF (P=0.000, r=0.809) and CCT (P=0.000, r=0.461), and a significant negative correlation with IOPcc (P=0.000, r=-0.469)., Conclusions: Decrease in the mean CH measurements indicates that ultrastructural changes in the cornea may occur in the active phase, and these changes persist in the remission period. In addition, IOPcc is significantly affected by the corneal biomechanical properties. In RA patients, it is important to control the corneal parameters and IOP measurements against the irreversible changes on the optic nerve.

A 58-year-old man admitted to our opthalmology department with the complaint of branch retinal vein occlusion. He was treated with intravitreal Ozurdex in the right eye. Two days after the injection, the patient presented with ocular pain and the visual acuity was hand movement. A diagnosis of endophthalmitis was made. We performed emergent pars plana vitrectomy (PPV) and the implant was removed from the vitreous cavity using a retinal forceps. A combination of vancomycin 1.0 mg and amikacin 0.4 mg was injected intravitreally. However, because of the blurring in the vitreus one week after the procedure, phacoemulsification and a repeat PPV was performed. Five days after the last procedure the signs and symptoms of endophthalmitis were resolved. Our case demonstrated that endophthalmitis could develop after intravitreal implantation of Ozurdex. Surgical removal of the implant and immediate vitrectomy seems to be a useful treatment option in these cases.

A 50 year-old male patient was referred to our clinic due to a floating mass in the right eye. The uncorrected visual aquity was 10 / 10 in both eyes.The patient did not have any systemic disorder and trauma history. His ophthalmological examination revealed an unremarkable anterior segment with no signs of inflammation. Indirect opthalmoscopy and posterior segment biomicroscopy performed with 90D lens was unremarkable in the left eye, while in the right eye a single oval cyst was identified floating freely in the vitreous. The cyst was partially masking the underlying retinal vasculature. B-scan ultrasound revealed an echo-free, round-shaped cyst that was free from surrounding vitreous strands or retina localised at the posterior vitreous. Fluorescein angiography (FA) ruled out the presence of intra and overlying vascularisation of the cyst. Indeed, FA showed a clear-edged hypofluorescence due to a pre-retinal masking effect. The indirect hemaglutinin tests of the patient for ecinococcus and cysticercosis were negative. Eosinophilia was not detected in the preripheral blood smear. Based on these findings the patient was diagnosed as primary vitreal cyst. The presented case was mild symptomatic so the patient was decided to be followed up without any treatment.

Aim: To study the relationship between corneal white-to-white (WTW) distance and mesopic pupil diameter., Methods: This study is composed of 30 cases that underwent photorefractive keratotomy (PRK). Pupil size measurements were performed with Schwind ORK wavefront analyzer in mesopic conditions. WTW distance was measured with a measuring caliper. Also, A-scan ultrasound examination was performed in all patients. The relationship among the mesopic pupil diameter and age, sex, axial length, lens thickness, anterior chamber depth(ACD), horizontal WTW distance, vertical WTW distance, spherical equivalent, and average keratometry were analyzed with univariate and multivariate regression analysis., Results: Mean pupil diameter was (6.39±0.80)mm (range: 3.70mm-7.73mm). Horizontal WTW distance measurements were between 11.00mm and 12.50mm and mean horizontal WTW distance was (11.79±0.43)mm. On the other hand, vertical WTW distances ranged between 10.00mm and 13.00mm, and their mean was (11.42±0.72)mm. Bivariate correlation between pupil diameter and other variables showed that the axial length, ACD, spherical equivalent, and horizontal WTW distance had a moderate correlation with mesopic pupil diameter. Multiple regression analysis revealed that spherical equivalent and horizontal WTW distances were significantly associated with mesopic pupil diameter (R=0.598, R(2)=0.358 P=0.02)., Conclusion: This study shows that mesopic pupil diameter is closely related to horizontal WTW distance. These two factors must be taken in consideration together in preoperative ablation zone planning.

Background and Objective: To determine important factors causing decentration after laser-assisted subepithelial keratectomy (LASEK)., Patients and Methods: A total of 223 cases (446 eyes) were evaluated after LASEK using corneal topography to determine the amount of decentration. Decentration and pupillary offset values and their components on the nasal, temporal, superior, and inferior axes were analyzed with the t test and the two-way repeated measures analysis of variance test in patients with myopia or hypermetropia. Correlation analysis between the amount of decentration and the possible determinative variables (age, gender, spherical refractive error, magnitude of astigmatism, spherical equivalent, average keratometry, mesopic pupil diameter, decentration, and pupillary offset) were performed., Results: Although decentration up to 0.99 mm was observed, mean decentration was 0.26 ± 0.16 mm. Alternatively, pupillary offset values were higher and the mean pupillary offset was 0.28 ± 0.16 mm. In myopia, mean total decentration was significantly less than hyperopia (P = .001). The inferior component of decentration was higher than the other locations in both myopia and hypermetropia. The nasal component of pupillary offset was highest among others. When all cases were included in the analysis, Pearson correlation analysis showed a statistically significant correlation between decentration and presence of hyperopia (r = 0.162 and P =.001) and amount of pupillary offset (r = 0.296 and P = .001)., Conclusion: Mean decentration was higher in hyperopia than in myopia. Most of the decentration may be attributed to inferior decentration. Pupillary offset values were the factor most significantly correlated to the amount of decentration in all cases., (Copyright 2010, SLACK Incorporated.)

Purpose: To report a case of sixth nerve palsy after intravitreal bevacuzimab injection., Methods: After intravitreal bevacizumab injection in a 64-year-old man, the patient admitted to our clinic with the complaint of diplopia. A complete ophthalmologic examination was done to clear the symptomatology of patient., Results: Examination of ductions revealed marked limitation of abduction of the right eye and full ductions of the left eye, consistent with right lateral rectus paralysis., Conclusions: Although intravitreal bevacizumab injections are generally well tolerated, it is possible that some serious systemic adverse events may occur. For this reason, patients must be closely monitored following these injections.

Objective: To evaluate the effect of long-term application of bimatoprost and latanoprost on the anterior chamber depth of primary open-angle glaucoma patients., Methods: The anterior chamber depth (ACD) and axial length (AL) of patients using prostaglandin analogues for open-angle glaucoma (group I) and an age- and gender-adjusted control group (group II) were measured by ultrasonography. Patients using bimatoprost and those using latanoprost were also compared in terms of ACD and AL., Results: The mean ACD of group I (27 eyes of 27 subjects) was significantly lower than that of group II (30 eyes of 30 subjects) (p = .012). Similarly, the ratio of ACD to AL was significantly lower in group I compared with group II (p = .001). The ACDs of patients using bimatoprost or latanoprost and the control group were not significantly different by Kruskal-Wallis test (p = .056), but the differences of these 3 groups in ACD/AL ratios were significant (p = .004). When the Mann Whitney U test was used for pairwise comparison, there was a significant difference between the control group and the patients using latanoprost or bimatoprost in terms of the ACD/AL ratio (p = .008 for each). There was no difference between the patients using latanoprost and those using bimatoprost in terms of the ACD/AL ratio (p = .4)., Conclusion: The ACD of patients on prolonged therapy with prostaglandin analogues seems to be lower than than that of the control group. However, prospective long-term studies on large number of subjects are needed to evaluate the effect of each type of prostaglandin on ocular structures.

Purpose: We aimed to evaluate the dynamic function of iris muscle in asymmetric pseudoexfoliation patients by videonystagmography., Methods: 15 patients with asymmetric pseudoexfoliation and 15 control subjects were included. The function of iris muscle was assessed by the pupillometry test of the videonystagmography by calculating the percent of change in pupillary diameter in unit time during fixation to an accommodative target, light reaction, convergence, and divergence., Results: There were significant differences between groups in the reaction during fixation (p: 0.01), in light reaction (p: 0.014), and in divergence-induced mydriasis (p: 0.003). In all of these, the difference between control eyes and pseudoexfoliative eyes of patients with PXS was significant., Conclusions: Pupillometry seems to be a promising noninvasive method to detect the clinical signs of PXS and may be useful for an accurate diagnosis.

We compared the effectiveness of fixed conventional strabismus surgery (CSG) with a one-stage intraoperative adjustable suture technique in 88 patients undergoing strabismus surgery (ASG) either with fixed conventional (38) or intraoperative adjustable suture (50) technique. The mean correction of deviation with both near-fixation and distant-fixation for the ASG and CSG were not different. One-stage intraoperative adjustable suture technique is safe and effective method for strabismus surgery for cooperative patients.