Amblyopia and refractive errors among school-aged children with low socioeconomic status in southeastern Turkey

PURPOSE

To investigate the prevalence of refractive errors and other eye diseases, incidence and types of amblyopia in school-aged children, and their relation to gender, age, parental education, and socioeconomic factors.

METHODS

A total of 21,062 children 6 to 14 years old were screened. The examination included visual acuity measurements and ocular motility evaluation. Autorefraction under cycloplegia and examination of the external eye, anterior segment, media, and fundus were performed.

RESULTS

There were 11,118 females and 9,944 males. The average age was 10.56 ± 3.59 years. When all of the children were evaluated, 3.2% had myopia and 5.9% had hyperopia. Astigmatism 0.50 D or greater was present in 14.3% of children. Myopia was associated with older age, female gender, and higher parental education. Hyperopia was inversely proportional with older age. Spectacles were needed in 4,476 (22.7%) children with refractive errors, and 10.6% of children were unaware of their spectacle needs. Amblyopia was detected in 2.6% of all children. The most common causes of amblyopia were anisometropia (1.2%) and strabismus (0.9%).

CONCLUSION

Visual impairment is a common disorder in school-aged children. Eye health screening programs are beneficial in early detection and proper treatment of refractive errors.

Adherence to treatment in patients with psoriasis vulgaris: Turkish experience

BACKGROUND

Treatment adherence has been an important issue in therapies of chronic diseases such as psoriasis vulgaris. There are a few studies on treatment adherence in psoriasis patients in literature.

OBJECTIVE

The goal of this study is to show treatment adherence and the factors that affect it in psoriasis patients in Turkish population.

METHODS

A total of 109 patients with psoriasis vulgaris were enrolled in an 8-week study. A standard questionnaire was completed by the patients. 'Psoriasis Area and Severity Index' and 'Dermatology life quality index' scores and treatment regimens of patients were recorded. At the end of the 8-week therapy, treatment adherence scores were calculated by using self-reported data given by the patients. The level of satisfaction and reasons for missing treatment were recorded.

RESULTS

One hundred three patients (44 men, 59 women) completed the study. The overall rate of treatment adherence was 75%. Single or divorced patients had a significantly higher mean adherence than married ones. There was a significant correlation between adherence and education level. The average level of satisfaction was 44.3%, and the adherence of satisfied patients was statistically more significant than that of the unsatisfied patients. The major two reasons for non-adherence to the therapy were being busy (25.45%) and fed up (21.81%).

CONCLUSION

In the present study, we found that marital status, education and satisfaction level were important for treatment adherence. We suggest that further studies with different contributing factors consisting of social, cultural and psychological effects may be useful for treatment adherence in psoriasis patients.

Color Doppler Imaging of Ocular Hemodynamic Changes in BehÇet’s Disease

PURPOSE

A prospective evaluation of the ocular blood flow velocity in patients with BehCet's disease was carried out to determine its changes.

METHODS

Subjects were divided into three groups: those with ocular involvement in BehCet's disease (group I), those without ocular involvement in BehCet's disease (group II), and a control group (group III). Twenty-seven eyes in group I and 28 eyes each in groups II and III were investigated. The blood flow in the central retinal artery (CRA), ophthalmic artery (OA), nasal posterior ciliary artery (NPCA), and the temporal posterior ciliary artery (TPCA) was measured using color Doppler ultrasonography (CDU) to determine the peak systolic velocity (PSV), end diastolic velocity (EDV), and resistivity index (RI). The mean blood flow velocity of the central retinal vein (CRV) was also measured. These results were then compared among the three groups of subjects.

RESULTS

The PSV values of CRA in groups I and II were found to be significantly lower than those in the control group ( P < 0.001, P = 0.018, respectively). The PSV values of CRA in group I were found to be significantly lower than those in group II ( P< 0.001). The EDV values of CRA in groups I and II were found to be significantly lower than those in the control group ( P< 0.001, P = 0.034, respectively). The EDV values of CRA in group I were significantly lower than those in group II ( P = 0.041). The PSV values of OA in group I were significantly lower than those in the control group ( P = 0.002). The EDV values of OA in group I were significantly lower than those values in group II or the control group ( P = 0.001 and P = 0.037, respectively). The PSV values of NPCA in group I were significantly lower than those in the control group ( P = 0.007). The PSV values of TPCA in groups I and II were significantly lower than those in the control group ( P< 0.001, P < 0.001, respectively). The EDV values of TPCA in group I were significantly lower than those values in group II or the control group ( P = 0.014 and P = 0.003, respectively). There were no significant differences in the mean blood flow values of the CRV among all three groups ( P > 0.05).

CONCLUSIONS

There are significant reductions in the blood flow values of the orbital arteries in patients with BehCet's disease, and they are more evident in those with ocular involvement. This might be the result of occlusive vasculitis, which is frequently seen in the retinal vessels of patients with BehCet's disease.

Effects of vernal and allergic conjunctivitis on severity of keratoconus

AIM

To demonstrate the effects of two different types of allergic conjunctivitis on severity of keratoconus (KC).

METHODS

We retrospectively reviewed the medical records of 171 KC patients referred between June 2010 and June 2011. The KC patients were divided into 3 groups as KC (group A), KC with vernal keratoconjunctivitis (VKC) (group B) and KC with allergic conjunctivitis (AC) (group C). Main outcome measures were demographic and ocular clinical features including age at presentation, gender, spherical equivalent (SE), best spectacle corrected visual acuity (BCVA), mean keratometric measurement (Km), central corneal thickness (CCT), and intraocular pressure (IOP). Groups were compared in term of study variables.

RESULTS

The median age at presentation was significantly lower in group B (P<0.001). According to the median SE (P=0.003), BCVA (P=0.022), Km (P<0.001), CCT (P=0.015) and Amsler-Krumeich classification (P<0.001), KC was more severe in group B. There was no significant difference in terms of IOP and corrected IOP among the groups (P=0.44), however there were 4 patients who had increased corrected IOP developed after topical corticosteroid use in group B. The differences among the groups persisted even after controlling for age and gender.

CONCLUSION

Our findings demonstrated a more severe KC in VKC patients despite their younger age which suggests evaluation of VKC patients as a separate group in keratoconus disease.

Cardioactive diterpenoids from the roots of Salvia amplexicaulis

Five diterpenoids, three steroids, four triterpenoids and one flavonoid were isolated from the roots of Salvia amplexicaulis Lam. (Lamiaceae). Structures of these compounds were elucidated by spectroscopic analysis. The crude extract and the pure compounds were tested for cardiovascular parameters using Wistar Albino rats. The crude extract, and 7-oxo-abieta-9,12,14-triene, ferruginol, stigmast-4-en-3-one showed a vasodepressor effect.

Bilateral optic disc drusen mimicking papilledema

Background

Optic disc drusen, which are calcified deposits that form anterior to the lamina cribrosa in the optic nerve, may mimic papilledema.

Case Report

We report herein three cases referred to us with suspicion of disc swelling and papilledema. Following ophthalmologic evaluation with B-scan ultrasound, red-free fundus photography, and computed tomography, the diagnosis of papilledema was excluded in all cases and optic disc drusen was diagnosed.

Conclusions

Clinical suspicion of optic disc drusen in cases presenting with swelling of the optic nerve head is important in order to avoid unnecessary interventions and anxiety. The reported cases highlight the commonly encountered clinical presentations and the practical aspects of diagnosis and management of optic disc drusen.

A robust heart sound segmentation algorithm for commonly occurring heart valve diseases

The first step towards detection of valvular heart diseases from heart sound signal (phonocardiogram) is segmentation. A segmentation algorithm provides the location of the first and second heart sounds which in turn helps to locate and analyse the murmur. Established phonocardiogram based segmentation methods use an electrocardiographic (ECG) signal as a continuous auxiliary input in a complex instrumentation setup. This paper proposes an automatic segmentation method that does not require any such auxiliary signal. Compared to other approaches without auxiliary signal, this work extensively utilizes biomedical domain features for reduction of time and computational complexities and is more accurate. The performance of the algorithm is evaluated for nine commonly occurring pathological cases and normal heart sound for various sampling frequencies, recording environments and age group of subjects. The proposed algorithm yields an overall accuracy of 97.47% and is compared with two competing techniques. In addition, the robustness of the algorithm is shown against additive white Gaussian noise contamination at various SNR levels.

Information, attitude, and behavior toward organ transplantation and donation among health workers in the eastern Black Sea region of Turkey

AIM

We sought to evaluate the information, attitude, and behaviors toward organ donation among health workers in the eastern Black Sea region of Turkey.

METHOD

This descriptive study was performed between December 2008 and November 2009. It involved 1,545 health personnel in 8 state hospitals in the eastern Black Sea region of Turkey, excluding the university hospitals in the towns of Trabzon, Rize, Gümüşhane, and Giresun. Educational seminars regarding organ transplantation and donation were arranged for the hospitals in the study. Questionnaires on the subject distributed to the participants were collected before the seminars began. They contained questions about occupation, gender, age, previous organ donation, whether the person would consider donating if they had not already volunteered (if not, the reasons why), whether any relatives had volunteered to donate organs, whether anyone close to them had volunteered to donate organs, whether they would donate organs in the event of a relative's death, and what they might think if they were to require an organ transplant. Following the seminars, participants were given the opportunity to obtain organ donation cards from a stand on site. Data were analyzed using the chi-square test.

RESULTS

Eighty-one participants (5.2%), including 46 women (5.2%) and 35 men (5.3%), had previously officially volunteered to donate organs (P = .875). One hundred thirty-seven health personnel were willing to donate organs by visiting the donation stand after the seminars. The main reasons for participants who had not volunteered to donate organs failing to do so were lack of information about donation and procedures (28.4%), lack of interest in the subject (23.2%), and Islamic religious beliefs and/or traditions (19.6%). One hundred eighty health personnel (11.7%) had family members or relatives who had volunteered to donate organs. Asked whether they would donate that person's organs in the event of the death of a relative, 93 doctors (67.6%), 225 nonphysician health personnel (41.1%), and 345 other participants (43.1%) stated that they would not (P < .0005).

CONCLUSIONS

Health workers play a key role to overcome the difficulties encountered regarding organ donation. This study showed the need for constant effective education seminars to enhance knowledge and sensitivity on the part of health workers.

Use of adjunctive mitomycin C in external dacryocystorhinostomy surgery compared with surgery alone in patients with nasolacrimal duct obstruction: A prospective, double-masked, randomized, controlled trial

BACKGROUND

The most common cause for the failure of external dacryocystorhinostomy (DCR) surgery is the formation of granulation tissue at the osteotomy site or common canaliculus.

OBJECTIVES

The aims of this study were to assess the efficacy of intraoperative adjunctive mitomycin C (MMC) treatment in external DCR surgery and to compare this procedure with the standard DCR procedure alone in the long term (1 year).

METHODS

In this prospective, double-masked, randomized, controlled trial, patients with primary acquired nasolacrimal duct obstruction were randomized (using a random number table) into 2 groups based on surgical procedure. In the MMC group, intraoperative adjunctive MMC 0.2 mg/mL was applied to the osteotomy site for 30 minutes. The control group underwent standard DCR procedure only. The results of the DCR surgeries were assessed using objective findings (eg, cessation of excessive tearing via nasolacrimal duct irrigation and the improvement in height of tear meniscus) and subjective symptoms (asking patients to describe the degree of tearing improvement). Both the patients and the researchers who were assessing the study outcomes were masked to treatment group.

RESULTS

One hundred eyes of 100 Turkish patients were assessed and equally randomized to the MMC (27 women, 23 men; mean [SD] age, 47.0 [7.6] years) and control (26 women, 24 men; mean age, 46.6 [8.8] years) groups. The follow-up period was not significantly different between the MMC and the control groups (13.1 [1.1] vs 13.2 [1.4] months). Significantly more eyes in the MMC group than the control group remained symptom-free throughout the 1-year follow-up period (45/50 [90%] vs 33/50 [66%]; P=0.005). Significantly more patients in the control group than the MMC group had an improvement in symptoms at the 1-year follow-up (8/50 [16%] vs 2/50 [4%] eyes; P=0.005). Based on the patency of the drainage system, the success rate was significantly greater in the MMC group than the control group (48/50 [96%] vs 42/50 [84%]; P=0.005). Based on nasolacrimal duct irrigation, significantly fewer patients in the MMC group than the control group had an enclosed naso-lacrimal duct (2/50 [4%] vs 8/50 [16%]). No adverse effects (eg, abnormal nasal bleeding, mucosal necrosis, infection) or any other surgical adverse events were observed.

CONCLUSIONS

In the management of these patients with primary acquired nasolacrimal duct obstruction, adjunctive intraoperative MMC application with standard DCR surgery had a significantly higher success rate than did standard DCR surgery alone. Further large, double-masked, randomized studies are needed to confirm these findings.

Posterior chamber lens implantation with scleral fixation in children with traumatic cataract

PURPOSE

To evaluate the outcomes of posterior chamber lens implantation with scleral fixation (SF-PCIOL) in children with traumatic cataract.

METHODS

Twenty-four eyes of 24 cases were included. All patients had corneal or corneoscleral lacerations that were primarily repaired. Traumatic cataract subsequently developed and SF-PCIOL was performed due to insufficient posterior capsule support.

RESULTS

The average age of the patients was 5.8 years (range: 4 to 10 years). All cases had SF-PCIOL implanted via internal route using triangular double scleral flaps made of 9-0 polypropylene after a complete anterior vitrectomy. Average follow-up was 14.6 ± 4.3 months (range: 11 to 18 months). Visual acuity was increased at the last visit in 23 (96%) patients. Common postoperative complications were fibrinous reaction in 6 (25%) patients, transient intraocular pressure increase in 4 (17%) patients, membrane formation requiring removal in 1 (4%) patient, transient intraocular hemorrhage as vitreous hemorrhage in 1 (4%) patient, and retinal detachment in 1 (4%) patient after the postoperative second month.

CONCLUSION

SF-PCIOL is an effective and reliable method in patients with pediatric traumatic cataract who had insufficient posterior capsule support.

Comparison of central corneal thickness measurements with a rotating scheimpflug camera, a specular microscope, optical low-coherence reflectometry, and ultrasound pachymetry in keratoconic eyes

OBJECTIVE

To compare central corneal thickness (CCT) measurements with a rotating Scheimpflug camera (RSC), noncontact specular microscopy (SM), optical low-coherence reflectometry (OLCR), and ultrasonic pachymetry (UP) in keratoconus (KC) patients.

METHOD

In this prospective study, four CCT measurements taken with an RSC, SM, OLCR, and UP were compared in 81 eyes of 44 consecutive KC patients. The KC patients were divided into four subgroups according to Amsler-Krumeich's KC classification.

RESULTS

The RSC and UP measurements of the CCT were not statistically significant in all the groups. Comparison of the SM vs. the OLCR measurements yielded statistically significant differences in all the KC patients and in all KC stages. In all the KC patients, RSC and OLCR showed a high correlation coefficient factor (r = 0.87, p = 0.000).

CONCLUSION

CCT measurements with RSC are comparable to those achieved with UP. Compared with the other devices, according to SM measurements, the central cornea is thicker in all keratoconic eyes and in all KC grades, and it is thinner according to OLCR. RSC, UP, SM, and OLCR should not be used interchangeably in keratoconic eyes.

Outcomes of revision external dacryocystorhinostomy and nasal intubation by bicanalicular silicone tubing under endonasal endoscopic guidance

AIM

To evaluate the long-term treatment outcomes in patients who underwent revision of external dacryocystorhinostomy (DCR) and nasal intubation by bicanalicular silicone tubing (BSTI) under endonasal endoscopic guidance.

METHODS

Data from 28 patients with recurrent dacryocystitis were retrospectively reviewed. Revision external DCR and bicanalicular nasal intubation by silicone tubing under endonasal endoscopic guidance was performed in 28 eyes of 28 patients. The patients were evaluated with respect to the reason of recurrence, time to recurrence, time to revision, duration of follow-up and surgical success.

RESULTS

Endoscopic endonasal examination detected an osteotomy-side obstruction by the excessive granulation tissue in 24 patients (86%), nasal septal deviation in three patients (10%) and nasal polyp in one patient (4%). Recurrence occurred after a mean duration of 5.3±3.7 months following the first operation. The mean time between the first DCR operation and the revision DCR was 11.5 ± 9.3 months. After a mean follow-up of 14.9±7.8 months, the rate of anatomic success alone was 85% (24/28); the rate of subjective success was 78% (22/28).

CONCLUSION

Revision external DCR and bicanalicular nasal intubation by silicone tubing under endonasal endoscopic guidance can be recommended in patients with recurrent dacryocystitis as a surgical approach that achieves satisfactory objective and subjective success rates.

Two cases of Goldenhar syndrome

We describe two boys with Goldenhar syndrome. The 8-year-old boy had an epibulbar dermoid in his left eye, type 1 Duane syndrome, bilateral preauricular appendages, and an interauricular septal defect. The 10-year-old boy had an epibulbar dermoid in his right eye, appendages in the right preauricular region, and sensorineural hearing loss.

Residual symptoms after surgery for unilateral congenital superior oblique palsy

PURPOSE

To establish the surgical results and residual symptoms in 48 cases with unilateral congenital superior oblique muscle palsy that had surgical intervention to the vertical muscles alone.

METHODS

Myectomy and concomitant disinsertion of the inferior oblique (IO) muscle was performed in 38 cases and myectomy and concomitant IO disinsertion and recession of the superior rectus muscle in the ipsilateral eye was performed in 10 cases. The preoperative and postoperative vertical deviation values and surgical results were compared.

RESULTS

Of the patients who had myectomy and concomitant IO disinsertion, 74% achieved an "excellent" result, 21% a "good" result, and 5% a "poor" result postoperatively. The difference in deviation between preoperative and postoperative values was statistically significant (P < .001). Of the patients who had myectomy and concomitant inferior oblique disinsertion and ipsilateral superior rectus recession, 50% achieved an "excellent" result, 20% a "good" result, and 30% a "poor" result postoperatively. The difference in deviation between preoperative and postoperative values was statistically significant (P < .001).

CONCLUSION

Both procedures are effective and successful in patients with superior oblique muscle palsy, but a secondary surgery may be required.

DSP implementation of a heart valve disorder detection system from a phonocardiogram signal

Auscultation, the technique of listening to heart sounds, remains a primary detection tool for diagnosing heart valve disorders. Other techniques, e.g. electrocardiography, ultrasound, etc, are accurate as well as informative; but expensive. With major advancement in the speed of computers, heart sound signals can be processed with ease by memory efficient digital signal processing and pattern recognition algorithms. This paper presents a digital signal processor (DSP) implementation of such a technique by using new threshold criteria. The proposed work can detect whether a heart sound recording belongs to a person suffering from valvular heart disease or not by giving 'diseased' or 'not diseased' decisions. The algorithm is tested for nine commonly occurring pathological problems and normal heart sound. The robustness of the algorithm is also checked against synthetically injected additive white Gaussian noise (AWGN) with different SNR levels. It is found to give an accuracy of 96.67% up to SNR values of 15 dB and 93.33% up to SNR values of 5 dB.

A Comparison of Latanoprost Monotherapy With a Combination Therapy of Timolol/Dorzolamide in Patients With Primary Open-Angle Glaucoma

We compared latanoprost monotherapy therapy with timolol/ dorzolamide in patients with primary open-angle glaucoma to evaluate the effects on intraocular pressure (IOP) and occurrence of adverse events. IOP and topical side effects were evaluated at the beginning, first, and third months. Mean IOP was decreased at the third month. The most common side effect was hyperemia (43.6%). We concluded that latanoprost reduces IOP better than fixed combination and its topical side effects are tolerable.

Spontaneous Fracture of an Implanted Posterior Chamber Intraocular Lens

Purpose

Spontaneous fracture of an intraocular lens (IOL) haptic is a rare complication of cataract surgery. The authors report a case of spontaneous fracture of an implanted posterior chamber IOL.

Case

Five years ago, a 12-year-old patient underwent linear lens extraction, posterior capsulotomy, and anterior vitrectomy due to traumatic cataract and received a polymethyl methacrylate (PMMA) biconvex posterior chamber IOL implanted in ciliary sulcus. Five years later, IOL optic was found in anterior chamber with its haptics broken from the optic-haptic junction.

Discussion

The broken haptic was examined with scanning electron microscopy. The fracture site of the haptic was on the optic-haptic junction. The fractured surface had a regular appearance.

Conclusions

To our knowledge, this is the fourth report of spontaneous fracture of an implanted posterior chamber IOL.

The relationship between pneumatized middle turbinate and the anterior ethmoid roof dimensions: a radiologic study

The development of pneumatized middle turbinate may affect anterior ethmoid roof formation. The aim of this study was to investigate the relationship between the pneumatized middle turbinate and the dimensions of the anterior skull base structures using computed tomography scans. The coronal reconstructed images of the computed tomography scans were evaluated retrospectively. The lateral and medial ethmoid roof points, the width of the cribriform plate (CP), and the anterior ethmoid roof were identified at the first coronal cut, which was determined by the infraorbital nerve. The pneumatized middle turbinates were measured on the axial, vertical, and sagittal planes. The images of 101 patients were evaluated. The mean axial diameters of the pneumatized middle turbinate on the right and left sides were between 6.93 and 4.95 mm, respectively. The correlation between the axial diameters of the pneumatized middle turbinate and the width of the anterior ethmoid roof (termed AER width) was significant for both sides and gender (p < 0.05). There was a higher correlation on the right side where the pneumatized middle turbinate was observed more frequently (r = 0.357). The relationship between CP width and the diameters of the pneumatized middle turbinate was not significant (p > 0.05) for both sides. Iatrogenic lesions of the skull base occur predominantly in the lateral lamella of the CP. The risk of this complication may decrease with increasing of the AER width. Pneumatized middle turbinate may cause an increase in the width of the anterior ethmoid roof and provide more reliable endoscopic intervention of the anterior skull base and frontal sinus.

Evaluation of intracameral injection of ranibizumab and bevacizumab on the corneal endothelium by scanning electron microscopy

PURPOSE

To evaluate the effects of intracameral injection of ranibizumab and bevacizumab on the corneal endothelium by scanning electron microscopy (SEM).

METHODS

Twenty-eight female rabbits were randomly divided into four equal groups. Rabbits in groups 1 and 2 underwent intracameral injection of 1 mg/0.1 mL and 0.5 mg/0.05 mL ranibizumab, respectively; group 3 was injected with 1.25 mg/0.05 mL bevacizumab. All three groups were injected with a balanced salt solution (BSS) into the anterior chamber of the left (fellow) eye. None of the rabbits in group 4 underwent an injection. Corneal thickness and intraocular pressure were measured before the injections, on the first day, and in the first month after injection. The rabbits were sacrificed and corneal tissues were excised in the first month after injection. Specular microscopy was used for the corneal endothelial cell count. Endothelial cell density was assessed and comparisons drawn between the groups and the control. Micrographs were recorded for SEM examination. The structure of the corneal endothelial cells, the junctional area of the cell membrane, the distribution of microvillus, and the cell morphology of the eyes that underwent intracameral injection of vascular endothelial growth factor (VEGF), BSS, and the control group were compared.

RESULTS

Corneal thickness and intraocular pressure were not significantly different between the groups that underwent anti-VEGF or BSS injection and the control group on the first day and in the first month of injection. The corneal endothelial cell count was significantly diminished in all three groups; predominantly in group 1 and 2 (P<0.05). The SEM examination revealed normal corneal endothelial histology in group 3 and the control group. Eyes in group 1 exhibited indistinctness of corneal endothelial cell borders, microvillus loss in the luminal surface, excessive blebbing, and disintegration of intercellular junctions. In group 2, the cell structure of the corneal endothelium and intercellular junctions were normal. However, a relative reduction was observed in the microvillus density of endothelial cells. Although eyes in group 3 were morphologically similar to fellow eyes and the control group, disarrangement in endothelial cell borders was evident.

CONCLUSION

The SEM examination pointed out deterioration in endothelial cell morphology after intracameral injection of 1 and 0.5 mg ranizumab. However, the effects of intracameral bevacizumab injection on corneal endothelial cells were similar to those found in fellow eyes and the control group. Further large-scale studies that examine the cellular changes by transmission electron microscopy are required to support the results of the present study that evaluates the structural changes in endothelial cells by SEM.