ABSTRACT: To investigate the development of dissociated vertical deviation (DVD) in infantile esotropia and its relationship with the infant's age and the surgical intervention technique.
The medical records of the patients that were diagnosed with infantile esotropia and followed-up in the Strabismus Department of our clinic (Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey) were reviewed retrospectively. The patients' ages at the time of admission, risk factors, ophthalmological examinations before and after treatment, and treatment mode were recorded and compared.
DVD was found to develop in approximately one-half of the cases (47.9%) at an average age of 3.2 years (20 months-5.5 years) regardless of the type of treatment. DVD developed in 80.5% of cases that had no surgery and in 37.5% of cases who were surgically treated. On comparison according to age, DVD was seen in 24.1% of the cases that were treated between ages 6 months and 2 years and in 52% of the cases that were treated after age 2 years. The difference was found to be statistically significant (p<0.01). On comparison according to the surgical technique, DVD developed in 34.8% of the cases who had undergone bimedial rectus recession and in 38% of the cases with unilateral recession and resection. This difference was not statistically significant (p>0.05).
In the treatment of infantile esotropia, early surgical intervention to obtain binocularity and prevent amblyopia is associated with a reduced incidence of the development of DVD. It is concluded that the incidence of the development DVD increases if surgery is not performed, if performed at a later age, or if additional muscle surgery is needed during follow-up due to undercorrection.
The British journal of ophthalmology 06/2010; 94(6):740-2. · 2.92 Impact Factor
ABSTRACT: To determine the changes in retinal nerve fiber layer thickness in subjects with high hyperopia and anisometropic amblyopia.
Retinal nerve fiber layer thickness was measured with scanning laser polarimetry and confocal scanning laser tomography in subjects with hyperopia (n=18) with a mean age of 16.6 +/-3.1 years and anisometropic amblyopia (n=14) with a mean age of 17.4 +/-3.8 years. A control group consisted of 25 healthy emmetropic subjects with a mean age of 25.7 +/-11.8 years. In all subjects 3 measurements with 2 different techniques were obtained and the average values for each parameter were analyzed and compared between the groups.
Heidelberg Retinal Tomography revealed a smaller disc area and cup/disc ratio (C/D) in the hyperopic and amblyopic subjects in comparison to the control group, however there was no statistically significant difference between the hyperopia and amblyopia groups. Increased nerve fiber layer thickness in these groups had no statistical significance. There was also no statistically significant difference in various parameters in the measurements taken with scanning laser polarimetry.
Refractive errors may change the quantitative assessment of optic nerve head topography and retinal nerve fiber layer thickness. There is no associated nerve fiber layer changes in anisometropic amblyopic subjects in comparison to the control group and the subjects with high hyperopia.
Binocular vision & strabismus quarterly 02/2005; 20(1):33-7.
ABSTRACT: To compare binocular functions in amblyopic and non-amblyopic anisometropes and to investigate the possible associated factors for amblyopia development such as type of refractive error and initial age of refractive error correction.
Prospectively anisometropic subjects with (n=42) and without amblyopia (n=33) were included in the study. Full ophthalmological examination including binocularity and motility was performed.
There was no statistically significant difference between the ages at the time of initial refractive error correction (P =0.946). All of the anisometropes (100%) had fusion with Worth 4-dot test and Bagolini glasses. However 81% of amblyopic subjects had fusion with Worth 4 dot test and 88.1% had normal response with Bagolini glasses. Median stereopsis was 60 sec of arc in anisometropic subjects and 400 sec of arc in amblyopes.
Our data support that, binocular functions are well developed in anisometropes without amblyopia and initial age at correction of refractive error has no primary effect on development of amblyopia.
Indian Journal of Ophthalmology 59(3):215-6. · 1.02 Impact Factor
ABSTRACT: To investigate the process of emmetropization in anisometropic amblyopic subjects during childhood and to determine the effects of spectacle use only and patching.
Retrospectively, the records of patients who were diagnosed as anisometropic amblyopes were reviewed and 132 subjects who were between the ages of 5 to 8 at the time of diagnosis, with minimum follow-up of 3 years, were included in the study. Full ophthalmological examination was performed in every subjects and the information from every visit was retrieved for evaluation. Patients were divided into two groups according to the treatment they applied: patching and spectacle alone.
The emmetropization process was similar to normal subjects after 3 years of follow-up, with a change of -0.71 D from the baseline spheric retinoscopy measurement in the spectacle group and -0.53 D in patching group (p > 0.809). Patching and spectacle use did not change the decrease in hypermetropia. Astigmatism and anisometropia scores did not show any difference in two groups in the 3-year follow-up period.
The emmetropization process is similar to normal population in anisometropic subjects and spectacle use and patching therapy have no effects on this process. The anisometropia score does not change with patching and stays relatively the same during the follow-up in childhood.
ABSTRACT: To evaluate the efficiency of amniotic membrane in prevention of adhesion formation after strabismus surgery.
A prospective, controlled study was conducted on 20 eyes of 10 pigmented rabbits. After disinsertion of the superior rectus muscle, under the muscle insertion area to induce adhesion formation, a partial-thickness 4 x 4 mm sclerectomy was performed in both eyes. In the right eyes, a piece of appropriate size human amniotic membrane was sutured on the sclerectomy site. As the control group, left eyes were operated with a similar procedure but without amniotic membrane transplantation. After 2 months, both eyes were enucleated to perform histopathologic examination.
There was no adhesion between the sclera and muscle in the amniotic membrane group; however, there were various degrees of adhesions in the control group (p=0.004). Fibrosis in rectus muscle was present in 40% of the specimens in the amniotic membrane group and 90% in the control group with a higher grade (p=0.023). The mean number of inflammatory cells was significantly higher in the amniotic membrane group (p=0.005).
According to our results, amniotic membrane has antifibrotic effect but no anti-inflammatory effect in rabbit eyes due to possible xenograft reaction to human tissues. It is effective in prevention of adhesion formation with possible physical barrier action.
European journal of ophthalmology 19(6):899-904. · 0.96 Impact Factor