Predictive Factors of Complications and Visual Outcomes after Pediatric Cataract Surgery: A Single Referral Center Study from Türkiye

Objectives

To evaluate the predictive factors of complications and visual acuity outcomes in pediatric cataract patients.

Materials and Methods

This retrospective, observational clinical study included 80 eyes of 50 patients treated for pediatric cataracts between 2010 and 2020. The eyes were divided into Group I (congenital cataracts, n=38) and Group II (developmental cataracts, n=42). Group II was also divided into Group IIA (aphakic, n=21) and Group IIB (pseudophakic, n=21). The effects of the age, laterality, cataract morphology, intraocular lens implantation, preoperative nystagmus/strabismus, and intraoperative anterior hyaloid rupture on complications and final best-corrected visual acuity (BCVA; logMAR) were evaluated.

Results

The median (interquartile range) age and follow-up time were 28 (5-79) months and 60 (29-84) months, respectively. There was a significant difference in mean final BCVA between Group I (0.79±0.46) and Group II (0.57±0.51) (p=0.047); however, no difference was observed between Group IIA and Group IIB (p=0.541). Having congenital cataract (p=0.045), preoperative nystagmus/strabismus (p=0.042), total/mature cataract (p<0.001), and postoperative complications (p=0.07) were significantly associated with final BCVA. However, in multivariate analysis, only total/mature cataract (β: 0.52, p<0.001) and having any complication (β: 0.24, p=0.018) were associated with final BCVA. Congenital cataract and intraoperative anterior hyaloid rupture were the only significant risk factors of postoperative complications on univariate (p=0.027 and p=0.003, respectively) and binary logistic regression analysis (odds ratio [OR]: 2.95 [95% confidence interval: 1.07-8.15], p=0.036 and OR: 4.28 [95% confidence interval: 1.55-11.77], p=0.005, respectively).

Conclusion

Total/mature cataract and the presence of any postoperative complication adversely affected the final BCVA. Having a congenital cataract and intraoperative anterior hyaloid membrane rupture increased the risk of complications.

Mesenchymal stem cells differentiate to retinal ganglion-like cells in rat glaucoma model induced by polystyrene microspheres

AIM

The study aimed to evaluate the differentiation ability of intravitreally injected rat bone marrow-derived mesenchymal stem cells (rBM-MSCs) to retinal ganglion-like cells in a polystyrene microsphere induced rat glaucoma model.

MATERIALS AND METHODS

The glaucoma rat model was generated via intracameral injection of 7 microliter polystyrene microspheres. Green fluorescence protein-labeled (GFP) rBM-MSCs were transplanted intravitreally at or after induction of ocular hypertension (OHT), depending on the groups. By the end of the fourth week, flat-mount retinal dissection was performed, and labeled against Brn3a, CD90, GFAP, CD11b, Vimentin, and localization of GFP positive rBM-MSCs was used for evaluation through immunofluorescence staining and to count differentiated retinal cells by flow cytometry. From 34 male Wistar albino rats, 56 eyes were investigated.

RESULTS

Flow cytometry revealed significantly increased CD90 and Brn3a positive cells in glaucoma induced and with rBM-MSC injected groups compared to control(P = 0.006 and P = 0.003 respectively), sham-operated (P = 0.007 and P < 0.001 respectively), and only rBM-MSCs injected groups (P = 0.002 and P = 0.009 respectively). Immunofluorescence microscopy revealed differentiation of GFP labeled stem cells to various retinal cells, including ganglion-like cells. rBM-MSCs were observable in ganglion cells, inner and outer nuclear retinal layers in rBM-MSCs injected eyes.

CONCLUSION

Intravitreally transplanted rBM-MSCs differentiated into retinal cells, including ganglion-like cells, which successfully created a glaucoma model damaged with polystyrene microspheres. Promisingly, MSCs may have a role in neuro-protection and neuro-regeneration treatment of glaucoma in the future.

Efficacy of different accelerated corneal crosslinking protocols for progressive keratoconus

PURPOSE

To evaluate the efficacy of different accelerated corneal crosslinking (CXL) treatment protocols in patients with progressive keratoconus.

SETTING

Marmara University School of Medicine, Istanbul, Turkey.

DESIGN

Retrospective case series.

METHODS

Patients with progressive keratoconus had 9 mW accelerated CXL (10 minutes; 9 mW/cm²), 30 mW continuous-light accelerated CXL (4 minutes; 30 mW/cm²), or 30 mW pulsed-light accelerated CXL (8 minutes [1 second on/1 second off]; 30 mW/cm²).

RESULTS

Of 134 eyes, 34 eyes had conventional CXL, 45 had 9 mW accelerated CXL, 28 had 30 mW continuous-light accelerated CXL (4 minutes, 30 mW/cm²), and 27 eyes had 30 mW pulsed-light accelerated CXL. The uncorrected (UDVA) (P < .001 both) and corrected (CDVA) distance visual acuities increased in with conventional CXL and 9 mW accelerated CXL (P = .001 and P = .002, respectively). With 30 mW continuous accelerated CXL, only CDVA improved (P = .019). With 30 mW pulsed accelerated CXL, UDVA and CDVA did not change significantly (P > .05). With conventional CXL and 9 mW accelerated CXL, all keratometric (K) readings (K1, K2, mean K, maximum K) improved significantly (conventional CXL: P = .014, P = .002, P = .008, and P < .001, respectively; 9 mW accelerated CXL: all P < .001). With 30 mW, no K values changed significantly compared with baseline (all groups P > .05).

CONCLUSION

Although 30 mW accelerated CXL treatment modalities appeared to be effective in stabilizing keratoconus progression, they seemed less effective in achieving topographic improvement.

Quantitative measurement of horizontal strabismus with digital photography

PURPOSE

To develop a method to calculate the gaze angle in photographs and to determine its validity and reliability in real strabismus patients.

METHODS

Photographs of eyes from 15 orthophoric subjects (n = 1,022) with known gaze angle and imaging distance were investigated with the help of a smartphone application developed by the authors. The application provided measurements of the distance from the geometrical center of the cornea to the light reflex (RD) and corneal diameter (CD). The RD/CD ratio of each gaze angle was recorded. To estimate the eyes' gaze angle, an equation to determine the best-fit line for the gaze angle data according to each RD/CD ratio was created. In a second clinical analysis, this equation was applied to photographs of real strabismus patients (n = 72), and the results were compared with measurements taken by a double-masked strabismus specialist. Separately, an equation was created to calculate the imaging distance using the given interpupillary distance.

RESULTS

There was a high correlation between the real and estimated gaze angles (r = 0.990, P < 0.001). The mean error of the estimated gaze angle was found to be 0.03^Δ ± 4.60^Δ. There was a high correlation between the real and estimated imaging distance (r = 0.997, P < 0.001) and a high correlation between the measurements of the application and the specialist (r = 0.966, P < 0.001). The average error was -0.68 ^Δ ± 6.1^Δ, and the reliability was high (Cronbach's α = 0.983).

CONCLUSIONS

The application measured horizontal strabismus in photographs with high reliability.

Sterile corneal infiltrates after corneal collagen cross-linking: evaluation of risk factors

PURPOSE

To evaluate possible risk factors leading to sterile corneal infiltrates following corneal collagen cross-linking (CXL).

METHODS

A total of 588 eyes of 459 patients treated with Epi-off (n = 461) or Epi-on (n = 127) CXL were retrospectively evaluated. Risk factors, including preoperative blepharitis and vernal conjunctivitis, the postoperative use of topical non-steroidal anti-inflammatory drugs (NSAIDs), as well as Kmax and pachymetry measurements, were assessed. In vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) analyses were performed in patients with sterile infiltrates.

RESULTS

Sterile infiltrates developed in 19 cases (3.2%). No patients in the Epi-on group developed sterile infiltrates. The evaluation of acceleration of the CXL procedure as a risk factor revealed no specific difference in the incidence of infiltrates among four different Epi-off groups (3 mW/cm² -30 min, 9 mW/cm² -10 min, 18 mW/cm² -5 min, 30 mW/cm² -4 min procedures; p > 0.05, all). Blepharitis, vernal conjunctivitis, Kmax and pachymetry were not identified as risk factors (p > 0.05). Postoperative use of NSAIDs was a significant contributor (p = 0.007), and it increased the chance of sterile infiltrates 4.09 times (95% CI, 1.463-11.428). In vivo confocal microscopy (IVCM) showed non-specific inflammation with dendritic cells at the epithelium and at Bowman's layer. In AS-OCT, a hyper-reflective band at the level of the anterior stroma to a depth of 100-140 μm was observed.

CONCLUSION

The evaluation of the risk factors such as blepharitis, the use of NSAIDs, vernal conjunctivitis, the duration of CXL procedure and amount of light intensity showed that epithelial damage is possibly the common pathway in the pathogenesis, as no sterile infiltrates in Epi-on CXL occurred, and the postoperative use of NSAIDs increased the risk of developing sterile infiltrates about four times.

Topiramate and accommodation: Does topiramate cause accommodative dysfunction?

OBJECTIVE

To investigate the accommodation function in topiramate users.

DESIGN

Case-control clinical study.

PARTICIPANTS

The participants included 16 controls and 22 patients using 100 mg/kg topiramate who were diagnosed with migraine according to the International Classification of Headache Disorders, second edition criteria.

METHODS

One-minute dynamic measurements of refraction with accommodation stimuli of 0 D, 2 D, 2.5 D, 3 D, 4 D, and 5 D were obtained using the open field refractometer WAM-5500 in.

RESULTS

In most of the accommodation stimuli ranges (0 D, 2.5 D, 3 D, and 5 D), topiramate users had a significantly higher accommodative lag compared with controls (p = 0.028, p = 0.014, p = 0.011, and p = 0.011, respectively). The most important causes of accommodative lag were found to be accommodation stimulus and inclusion in the topiramate group (p < 0.001, R² = 0.32, 95% CI 0.22-0.37 and 0.42-0.91, respectively). Multivariate linear regression analysis revealed that the 2 most important predictors of accommodative lag were accommodation stimulus and age (p < 0.001, r = 0.51, 95% CI 0.31-0.32 and 0.67-0.69, respectively) CONCLUSIONS: Even after adjustment for age, accommodative lag is greater across several accommodative stimulus levels in patients using topiramate, which may be related to visual symptoms in topiramate users.

Comparison of Intraocular Pressure Measurements in Healthy Pediatric Patients using Three Types of Tonometers

Objectives:

This study aimed to compare intraocular pressure (IOP) measurements in healthy pediatric patients using three types of tonometers.

Materials and Methods:

Seventy-eight eyes of 78 patients under the age of 18 who underwent a routine ophthalmologic examination were included in the study. IOP was measured using Tono-Pen (TP) tonometry, Goldmann applanation tonometry (GAT), and non-contact tonometry (NCT), consecutively. IOP was adjusted based on central corneal thickness (CCT). Patients with any ocular disorders other than a limited refractive error were excluded from the study.

Results:

The study consisted of 46 girls and 32 boys. The mean age was 12.6±2.7 (range: 5-17) years. The mean CCT was 559.3±35.3 µm. The mean refractive error was -0.50±1.70. The mean level of visual acuity was 0.98±0.1 (range: 0.3-1.0) using the Snellen chart. Significant differences were found between the measurement results of each of the three tonometric methods. Mean IOP was 12.1±2.2 mmHg for TP, 15.7±2.5 mmHg for GAT, and 17.1±3.1 mmHg for NCT. The correlations between measurement methods revealed that the highest correlation was between NCT and GAT (p<0.001, r=0.670). The second highest correlation was between NCT and TP (p<0.001, r=0.477). The lowest correlation was between GAT and TP (p<0.001, r=0.403). A positive correlation was found between CCT and each IOP measurement method.

Conclusion:

In pediatric patients, TP and NCT measurements were found to be positively correlated with GAT measurements. Because TP measurements were lower than GAT measurements and NCT measurements were higher than GAT measurements, patient follow-ups, treatment strategies, and surgery plans must be organized taking these differences into consideration.

Retinal Electrophysiological Effects of Intravitreal Bone Marrow Derived Mesenchymal Stem Cells in Streptozotocin Induced Diabetic Rats

Diabetic retinopathy is the most common cause of legal blindness in developed countries at middle age adults. In this study diabetes was induced by streptozotocin (STZ) in male Wistar albino rats. After 3 months of diabetes, rights eye were injected intravitreally with green fluorescein protein (GFP) labelled bone marrow derived stem cells (BMSC) and left eyes with balanced salt solution (Sham). Animals were grouped as Baseline (n = 51), Diabetic (n = 45), Diabetic+BMSC (n = 45 eyes), Diabetic+Sham (n = 45 eyes), Healthy+BMSC (n = 6 eyes), Healthy+Sham (n = 6 eyes). Immunohistology analysis showed an increased retinal gliosis in the Diabetic group, compared to Baseline group, which was assessed with GFAP and vimentin expression. In the immunofluorescence analysis BMSC were observed to integrate mostly into the inner retina and expressing GFP. Diabetic group had prominently lower oscillatory potential wave amplitudes than the Baseline group. Three weeks after intravitreal injection Diabetic+BMSC group had significantly better amplitudes than the Diabetic+Sham group. Taken together intravitreal BMSC were thought to improve visual function.

Transepithelial versus epithelium-off crosslinking in adults with progressive keratoconus

PURPOSE

To compare the efficacy of epithelium-off corneal collagen crosslinking (CXL) with transepithelial CXL in patients with progressive keratoconus.

SETTING

Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey.

DESIGN

Retrospective cohort study.

METHODS

Eyes that had transepithelial CXL were compared with eyes treated with epithelium-off CXL. All patients with a follow-up of 18 months were evaluated for uncorrected (UDVA) and corrected (CDVA) distance visual acuities, corneal topography, aberrometry, and pachymetry (Pentacam).

RESULTS

The mean patient age was 22.8 years ± 4.7 (SD) (range 18 to 31 years) in the transepithelial group (30 eyes) and 23.7 ± 3.9 years (range 18 to 30 years) in the epithelium-off group (30 eyes). The mean UDVA and CDVA significantly improved in both groups (P < .001). There was no significant difference in the CDVA gain between the 2 groups. In the epithelium-off group, significant improvements occurred in spherical error (P = .002), spherical equivalent (P = .004), maximum keratometry (K), flat K (P = .036), and steep K (P < .001). The reductions in flat K, steep K, and maximum K were greater in the epithelium-off group (P = .004 for flat K; P < .001 for steep K and maximum K). In the transepithelial group, significant improvements occurred in the cylindrical error (P = .009) and in the index of surface variance and index of surface asymmetry (both P < .001).

CONCLUSION

Although transepithelial CXL seemed to have reduced effectiveness in inducing improvement in topographic indices, its effect on visual acuity is likely to be similar to that of epithelium-off CXL.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Neurodegeneration in ocular and central nervous systems: optical coherence tomography study in normal-tension glaucoma and Alzheimer disease

BACKGROUND/AIM

To evaluate, in vivo, the optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) in patients with normal-tension glaucoma (NTG) and those with Alzheimer disease (AD) in comparison with healthy subjects.

MATERIALS AND METHODS

This cross-sectional study included 18 patients with NTG, 20 with AD, and 20 control subjects. An ophthalmologic examination and OCT scans of both eyes were performed in all patients.

RESULTS

There was a significant reduction in peripapillary RNFL thickness and macular GCC thickness and a significant increase in the global loss volume (GLV) rate in both the NTG and AD patients when compared to the control subjects (P = 0.004, P = 0.006, P < 0.001, respectively). The statistical evaluation showed no difference in any RNFL or GCC parameters between the AD and NTG groups (P > 0.05). There was a negative correlation between disease duration and average RNFL and GCC thicknesses (r = -0.350, P = 0.027 and r = -0.471, P = 0.002, respectively) and a positive correlation between duration and GLV (r = 0.427, P = 0.006) in the AD group.

CONCLUSION

The average RNFL thickness, GCC thickness, and GLV rates may help in the diagnosis of AD as an additional examination and may provide some important clues about the duration of the disease.

Age-related macular degeneration and Alzheimer disease

This review highlight the similarities in the pathogenesis between Alzheimer disease and age-related macular degeneration. All studies published between 1990 and 2014 were reviewed to identify the common pathological pathways. Alzheimer disease and age-related macular degeneration share common features such as vitronectin and amyloid-β accumulation, increased oxidative stress, and apolipoprotein and complement activation pathways, which are reviewed as histologic and immunologic common features.

The relationship of age when motor alignment is achieved and the subsequent development of stereopsis in infantile esotropia

PURPOSE

To determine the oldest age beyond which the chance of developing stereopsis is not possible even with excellent motor alignment in patients with infantile esotropia.

METHODS

The medical records of children with infantile esotropia who underwent a single operation and had alignment within 10(Δ) of orthotropia at all follow-up examinations were retrospectively reviewed. Patients were assessed for stereopsis after the age of 48 months.

RESULTS

A total of 38 children were included. There was a statistically significant inverse correlation between age at surgery and final stereopsis (r = 0.494, P = 0.002). There was a significant difference at mean age at surgery between patients having stereopsis better than 1000 arcsec and those having no stereopsis (P = 0.002). Post hoc power analysis revealed a value of 85%. Receiver operating characteristic curve analysis revealed that the optimum cut-off value of the age at surgery for predicting stereopsis was 16 months (Youden index = 0.474; area under ROC curve, 0.784; 95% CI: 0.62-0.90; P = 0.0002).

CONCLUSIONS

Surgery for infantile esotropia is most likely to result in measureable stereopsis if patient age at alignment is not more than 16 months.