INTRODUCTION: This study was a comparison of the thickness of the choroid in pediatric patients with attention-deficit hyperactivity disorder (ADHD) and healthy pediatric controls.
METHODS: This study was comparative, cross-sectional, and observational in design. The healthy controls were age- and sex-matched with the members of the ADHD group and had no history of psychosis. Choroidal thickness was determined using spectral-domain optical coherence tomography.
RESULTS: A total of 138 patients were enrolled with a male: female ratio of 54 (69.2%): 24 (30.8%) in the ADHD group and 41 (68.3%): 19 (31.7%) in the control group (p=0.910). The ADHD patients had a mean age of 9.4±1.9 years (range: 6-12 years) and the controls had a mean age of 9.9±2.2 years (range: 6–12 years) (p=0.213). The ADHD group (n=78 eyes tested) had a significantly higher mean choroidal thickness at 1.5 mm (temporal-to-fovea, TTF) measurement than the controls (n=60 eyes tested) (281.12±46.63 μm vs. 264.40±48.61 μm, p=0.042). There were no significant differences in any of the other choroidal thickness measurements (p>0.05).
DISCUSSION AND CONCLUSION: The choroidal thickness measurement (TTF) at 1.5 mm was significantly greater in the ADHD patients. These findings suggest that choroidal thickness alterations may have a potential role in the underlying etiology of ADHD.

INTRODUCTION: This study was an assessment of factors related to the development and maintenance of binocular sensory function after successful alignment of accommodative esotropia (AE).
METHODS: A total of 107 patients aged <12 years with ≥6 months follow-up were included in the study. The variables of age at onset of deviation, duration of deviation before treatment, the amount of uncorrected distance and near deviation, hyperopia, anisometropia, and accommodative convergence to accommodation ratio (AC/A) were evaluated.
RESULTS: The study patients had a mean age of 4.9±2.5 years and a mean length of follow-up of 34.3±28 months. Anisometropia was identified in 26.1% of the participants. Anisometropic patients had a greater degree of hyperopia (mean: 5.02±2.07 D) than the patients without (p>0.05). Amblyopia was seen in 25% of the patients with anisometropia, and in 19% of those without (p<0.05). The binocular visual function of the 2 groups was not significantly different (p>0.05). The age at onset of deviation and the duration of deviation did not affect the final outcome (p>0.05 for all). The degree of initial uncorrected distance deviation had a significant effect on the development of amblyopia, fusion, and contoured stereopsis (p<0.05 for all), while the degree of near deviation without correction had a significant effect only on contoured stereopsis.
DISCUSSION AND CONCLUSION: The degree of uncorrected distance and near deviation had a negative impact on binocular vision and stereopsis in AE. The presence of anisometropia, age at onset of deviation, duration of deviation before treatment, high hyperopia, and high AC/A did not pose a significant risk for impaired binocular function.

INTRODUCTION: The aim of this study was to investigate the effects of iron deficiency anemia on corneal and lenticular densitometry.
METHODS: Thirty-two patients with iron deficiency anemia and 38 healthy participants were enrolled. The Pentacam HR imaging system (Oculus Optikgeräte GmbH, Wetzlar, Germany) was used to record keratometry, corneal densitometry (12-mm corneal diameter), lens densitometry measurements. Endothelial parameters were evaluated using specular microscopy.
RESULTS: The corneal densitometry values in the anterior 0–2 mm and 2–6 mm zone were significantly higher in the iron deficiency anemia group than in the control group (p=0.044 and p=0.021, respectively). There was a statistically significant difference in the mean values of the standard deviation and maximum lens densitometry measurements of the iron deficiency anemia group when compared with the control group (p=0.012 and p=0.011, respectively). There were statistically significant correlations between the anterior 2-6 mm zone corneal densitometry and ferritin, iron, and total iron binding capacity (r=-0.275, r=-0.243, r=0.240, respectively). However, ferritin, iron, and total iron binding capacity showed no significant correlation with the lens densitometry values (p>0.05 for all).
DISCUSSION AND CONCLUSION: Iron deficiency anemia had several effects on corneal and lenticular densitometry measurements. Evaluation of the corneal and lenticular changes at an ophthalmology clinic might be recommended for patients with iron deficiency anemia.

INTRODUCTION: This study evaluated the serum irisin level of patients with age-related macular degeneration (ARMD) and compared it with that of healthy individuals.
METHODS: The serum irisin level of 15 healthy controls (Group 1) and 15 dry ARMD patients (Group 2) and 15 wet ARMD patients (Group 3) were measured using the enzyme-linked immunosorbent assay (ELISA) method and compared.
RESULTS: There was no statistically significant difference between the groups in terms of age or gender (p>0.05). The mean serum irisin levels of Group 1, Group 2, and Group 3 were 25.81±24.04 ng/mL, 22.93±19.05 ng/mL, and 12.38±8.16 ng/mL, respectively. Although the mean irisin level in the wet ARMD patients was lower than that of the control and dry ARMD groups, there was no statistically significant difference between the groups (p>0.05).
DISCUSSION AND CONCLUSION: The results suggest that the serum irisin level in ARMD patients is not different from that of healthy individuals. Studies of larger groups that examine the irisin level in the vitreous and neovascular membranes will further elucidate any role in the pathogenesis of ARMD.

INTRODUCTION: To evaluate the effect of topical cyclosporine A (CsA) (Restasis, Abbvie, Lake Bluff, IL, USA) on recurrence rates and tear metrics after pterygium excision and limbal-conjunctival autografting (LCUA) technique in patients with primary pterygium.
METHODS: A total of 60 eyes of 60 patients with primary pterygium who underwent pterygium excision and the LCUA technique were evaluated prospectively. Among them, 30 eyes of 30 patients were treated with topical CsA (Restasis) for 6 months postoperatively (Group 1). The remainder of the patients were assigned to Group 2. The follow-up period was 12 months for each group. The primary outcome measures were a comparison of Schirmer I test and fluorescein tear break-up time (FTBUT) results, the recurrence rate, and postoperative complications.
RESULTS: There were no significant differences in age (mean age of Group 1 and 2 was 55.0±9.7 years and 56.3±8.9 years, respectively) or sex between groups (p>0.05). Farmers were the largest group of patients (40.0%). Recurrence of pterygium was observed in 5 (16.6%) eyes in Group 1 and 8 (26.6%) eyes in Group 2. The recurrence rate was not statistically significant between groups (p=0.35). The complication rate was significantly lower in Group 1 compared with that of Group 2 (p=0.02). The average increase in Schirmer I and FTBUT values was significantly higher in Group 1 than in Group 2 (p<0.05).
DISCUSSION AND CONCLUSION: The use of topical CsA did not demonstrate any significant improvement in the recurrence rate of pterygium following LCUA surgery.

INTRODUCTION: The aim of this study was to investigate the effect of chalazion excision on corneal aberrations and corneal densitometry.
METHODS: Thirty-six patients with a chalazion in 1 eyelid and 40 healthy subjects were included in the study. Corneal aberration parameters of total root mean square (RMS), RMS high-order aberration (HOA), horizontal trefoil, oblique trefoil, horizontal coma, vertical coma, and spherical aberration values were measured using Scheimpflug corneal topography (Pentacam HR; Oculus Optikgeräte GmbH, Wetzler, Germany). Corneal densitometry values measured from 4 regions of the cornea (0–2, 2–6, 6–10, and 10–12 mm) and 4 corneal depths (anterior, central, posterior, and total) were recorded. Preoperative measurements of the patients (Group 1), postoperative first-month measurements (Group 2), and control group (Group 3) measurements were compared.
RESULTS: The total RMS measurement was 1.64±0.48 μm in Group 1, 1.35±0.32 μm in Group 2, and 1.17±0.38 μm in Group 3 (Group 1–2: p=0.007, Group 1–3: p<0.001, Group 2-3: p=0.173). The mean spherical aberration value was 0.183±0.057 μm in Group 1, 0.157±0.048 μm in Group 2, and 0.144±0.050 μm in Group 3 (Group 1–2: p=0.104, Group 1-3: p=0.004, Group 2–3: p=0.781). The total corneal densitometric measurement was 15.95±1.80 gray scale units (GSU) in Group 1, 14.76±1.76 GSU in Group 2, and 14.33±1.49 GSU in Group 3 (Group 1–2: p=0.01, Group 1–3: p<0.001, Group 2–3: p=0.804).
DISCUSSION AND CONCLUSION: It was observed that some corneal aberration and corneal densitometry values were higher in patients with a chalazion compared with those of healthy individuals, and there was a decrease in corneal aberration and densitometry values after surgical excision.

INTRODUCTION: Gold weight implantation in the upper eyelid is a frequently performed treatment for paralytic lagophthalmos to prevent corneal exposure. A margin reflex distance of -1 and -2 (MRD1, MRD2), the palpebral fissure height (PFH), and the vertical lagophthalmos (LV) are 1 dimensional (1D) measurements used in follow-up. Because the exposure area is 2-dimensional (2D), this study was designed to investigate the results using both 1D and 2D analysis
METHODS: Ten patients who underwent pretarsal suborbicularis oculi gold weight implantation were included in the study. Photographs were taken with a digital camera and the images were analyzed using ImageJ software (US National Institutes of Health, Bethesda, MD, USA). The lagophthalmos area (LA) and ocular surface area (OSA) were measured in 2D in addition to the MRD1, MRD2, PFH, LV. Preoperative and postoperative values were compared using the Wilcoxon signed-rank test. Associations between parameters were evaluated using Spearman's correlation analysis.
RESULTS: The mean age of the patients (7 male, 3 female) was 39.6±16.4 years (range: 14–60 years). The mean implant weight was 1.46 g (0.8–1.6 g). There were significant reductions in the MRD1, MRD2, PFH, OSA, LV, and LA values after surgery (p<0.05). The weight of the gold implant had a strong correlation with the PFH, OSA, MRD1, and MRD2, but not the LV or LA, preoperatively. The OSA was strongly correlated with the MRD1, PFH, and the implant weight, but not the MRD2. The LA was strongly correlated with the LV, preoperatively. In the postoperative period, the OSA was strongly correlated with the PFH and the MRD2 but not the MRD1, while the LA was strongly correlated with the LV, MRD1, and the PFH.
DISCUSSION AND CONCLUSION: It is easy to obtain 2D measurements using digital image analysis software, and they proved to be accurate and correlated strongly with 1D measurements. The OSA and LA measurements were significantly lower following upper eyelid gold weight implantation. The PFH and LV were compatible with the OSA and LA, preoperatively.

INTRODUCTION: This study was designed to evaluate the effects of corneal collagen cross-linking (CXL) on topographic parameters, visual acuity, and corneal high-order aberrations according to the preoperative cone location in keratoconus.
METHODS: This retrospective study assessed patients with keratoconus who underwent CXL between March 2016 and February 2019. Patients with a history of corneal surgery, corneal hydrops, corneal scar tissue, delayed epithelial healing, and a corneal thickness of <400 μm were excluded. The included eyes were divided into 2 groups according to the preoperative cone location: maximum K in the central 3-mm optical zone (group 1) or the central 3-mm to 5-mm optical zone (group 2). The preoperative and postoperative 24-month, best-corrected visual acuity (BCVA), intraocular pressure, K max, symmetry index front, corneal thickness, and high order aberration findings were recorded.
RESULTS: The study included 67 eyes of 67 patients with keratoconus: 39 in group 1, and 28 in group 2. There were statistically significant differences between the groups in the preoperative BCVA values (p=0.04). There was no significant difference between the preoperative and postoperative mean K max between the 2 groups (p=0.08). The mean difference in corneal thickness between preoperative and postoperative measurements was significantly lower in group 2 than in group 1 (p=0.03). The preoperative and postoperative mean spherical aberration was significantly higher in group 1 than in group 2 (p=0.001 and p=0.005, respectively).
DISCUSSION AND CONCLUSION: The preoperative cone location in keratoconus may affect CXL outcomes. At the end of the second year, CXL was found to have a similar efficacy on visual acuity and keratometry parameters in the central and paracentral cone groups, and the recovery in terms of a spherical aberration among high-order aberrations after CXL in the central cone group was better than that of the paracentral cone group.

INTRODUCTION: This study was designed to assess the monocyte-to-high-density lipoprotein (HDL) ratio (MHR) as a possible marker of systemic inflammation in patients with branch retinal vein occlusion (BRVO).
METHODS: A study group of 62 patients with BRVO and a control group of 60 age-matched, healthy individuals were enrolled in the study. The blood lipid profile, hematology profile, and C-reactive protein (CRP) level were measured. The MHR was calculated as the ratio of the monocyte count to the HDL level, and the neutrophil-to-lymphocyte ratio (NLR) was calculated as the ratio of the neutrophil count to the lymphocyte count.
RESULTS: In patients with BRVO versus controls, the mean MHR was 14.1±5.1 vs 12.2±4.3 (p=.032), the mean NLR was 1.99±0.69 vs 2.01±0.86 (p=.889), and the mean CRP level was 3.44±2.53 mg/L vs 2.81±1.57 mg/L (p=.102). The area under the receiver operating characteristic curve for the MHR and the NLR was 0.621 and 0.519, respectively. The sensitivity and specificity of the MHR and the NLR to predict BRVO was 51% and 73% vs 79% and 35%, respectively.
DISCUSSION AND CONCLUSION: The MHR values were higher in patients with BRVO compared with those of the control group. BRVO seems to be associated with systemic inflammation.

INTRODUCTION: The aim of this study was to compare the refractive results and safety of Artiflex (Ophtec BV, Groningen, Netherlands) and Eyecryl (BioTech Healthcare GmbH, Luzern, Switzerland) phakic intraocular lenses (pIOL).
METHODS: The medical records of patients who underwent implantation of Artiflex or Eyecryl pIOL were retrospectively reviewed. Patients with a follow-up of 3 years were included in the study. Manifest refractive error, uncorrected and corrected visual acuity, intraocular pressure (IOP) and central endothelial cell density (ECD) data were evaluated preoperatively and at 1 and 3 years after surgery.
RESULTS: In all 79 eyes (Artiflex group: 35 eyes; Eyecryl group: 44 eyes) were included in the study. The preoperative spherical equivalent (SE) of manifest refractive error was -11.53±3.46 in the Artiflex group and -13.08±3.01 in the Eyecryl group. Three years after the operation, the efficacy index was 1.06±0.55 and 1.15±0.85 in the Artiflex and Eyecryl groups, respectively. The safety index was in 1.32±0.49 and 1.46±0.95 the Artiflex and Eyecryl groups, respectively. The SE refractive error, efficacy index, safety index UDVA, CDVA, IOP, and ECD were not significantly different between groups during follow-up.
DISCUSSION AND CONCLUSION: Both the Artiflex and Eyecryl foldable pIOLs were found to be safe and effective up to 3 years after implantation. Prospective longitudinal studies are needed to assess and compare the rate of cataract formation.

INTRODUCTION: The goal of this study was to evaluate surgical techniques and outcomes in patients with Brown’s syndrome.
METHODS: A retrospective review was conducted of patients who underwent surgery of the superior oblique (SO) muscle between 2003 and 2011 at a referral center.
RESULTS: In all, 190 patients (111 female and 79 male) with an age range of 4-50 years were included in the study. The right eye was affected in 98 patients, and the left eye in 92 patients. Abnormal head posture (AHP), ocular movement (OM), and hypotropia were assessed. The greatest improvement of AHP was seen following an SO temporal tenotomy (91%). Patients with a -4 limitation achieved full OM after a SO temporal tenotomy.
DISCUSSION AND CONCLUSION: Temporal tenotomy provided the best improvement in limitation of elevation in adduction.

INTRODUCTION: This is a retrospective, comparative evaluation of the short-term efficacy and safety of intravitreal ranibizumab (IVR) and IVR combined with posterior subtenon triamcinolone acetonide (STA) in the treatment of diabetic macular oedema (DME).
METHODS: A total of 79 pseudophakic eyes of 57 patients with DME who underwent IVR injection treatment were examined retrospectively. All of the patients were treatment-naive. In the study group (STA+IVR), consisting of 30 eyes of 39 patients, the STA and IVR were administered in the first treatment session simultaneously, followed by 2 consecutive monthly IVR injections. In the control group (IVR only) comprised 40 eyes of 27 patients, 3 consecutive monthly IVR injections were administered. Patients with serous retinal detachment (SRD) according to optical coherence tomography images were identified in both groups for subgroup analyses. The primary outcome measures were changes in central macular thickness (CMT), best corrected visual acuity (BCVA), and the intraocular pressure (IOP) at 1, 2, and 3 months post-injection.
RESULTS: There was no statistically significant difference between the demographic characteristics of the patients’ baseline BCVA and CMT measurements (p>0.05). For the IVR group, the mean pre-treatment CMT and BCVA was 421.20±89.10 μm and 0.42±0.24 logMAR, respectively. After the third injection, the mean was 308.12±59.07 μm and 0.20±0.12 logMAR, respectively. The combined treatment group baseline measurements were 454.50±122.52 μm and 0.54±0.29 logMAR, respectively. After the third injection, the mean was 294.22±50.33 μm and 0.27±0.21 logMAR, respectively. The decrease was statistically significant for both groups (p=0.001). Comparison of the CMT within groups revealed a statistically significant difference in favor of the combined group after the second injection (p=0.017). There was no statistically significant difference in the BCVA gains between groups (p>0.05). Patients with SRD were evaluated as a subgroup, and at the first month, the mean gain in CMT was -71.63±57.98 μm in the control group and -123.61±93.46 μm in the study group (p=0.048). The required anti-glaucomatous treatment was statistically significant in the combined group (p=0.008).
DISCUSSION AND CONCLUSION: Both treatments provided improvement in BCVA and CMT and can be considered functional and anatomically effective treatment options for DME.

INTRODUCTION: The aim of this study was to examine the efficacy and the shortfalls of the Birmingham Eye Trauma Terminology classification system for ocular trauma in predicting the visual outcome.
METHODS: The records of 256 eyes of 246 patients with a diagnosis of mechanical ocular trauma admitted to the Osman Gazi University Hospital ophthalmology department between 1995 and 2000 were retrospectively reviewed. The zone, type, grade, and pupil status of the injuries were determined according to the Birmingham classification system. Injuries with a good prognosis were defined as injuries that resulted in vision of equal to or better than counting fingers at 1 meter. Fischer’s exact test was used to determine the statistical significance of relationships between the final visual acuity and the initial clinical findings.
RESULTS: Open eye injuries restricted to zone I, those with no afferent pupillary defect, and those graded as 3 or better or classed as type B were significantly associated with a better visual outcome (p<0.05). Open eye injuries that extended to zone III, had an afferent pupillary defect, or were graded as 4 or worse were significantly associated with a poorer visual outcome (p<0.05). Closed eye injuries classified as type B or grade 4 were significantly associated with a poor visual outcome (p<0.05).
DISCUSSION AND CONCLUSION: The Birmingham classification system for mechanical ocular trauma offers a standardized method for both open and closed eye injuries, however, adding subclasses to type C (injuries with foreign body involvement) could enhance the classification method and help to understand the influence of foreign body properties and sizes on the outcome.

INTRODUCTION: This study evaluated the anatomical and functional results of 23-G transconjunctival sutureless vitrectomy (TSV) in diabetic retinopathy (DR) patients with a variety of vitreoretinal diseases.
METHODS: Consecutive patients who underwent 23-G TSV for complications of DR were evaluated retrospectively. The primary outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), and intraoperative and postoperative complications.
RESULTS: A total of 42 eyes of 41 patients were included and followed up for a mean of 15.64±10.0 months. The mean patient age was 59.33±7.4 years. Indications for surgery were nonclearing vitreous hemorrhage (VH) (n=10), tractional retinal detachment (TRD) (n=8), TRD+VH (n=12), epiretinal membrane (n=5), diabetic macular edema (n=3), submacular hemorrhage (n=2), macular hole (n=1), or vitreomacular traction (n=1). There was a significant improvement in the BCVA at the postoperative first and third months, and at the last visit compared with the preoperative value (p<0.001). There was no significant change in the mean IOP measured on the postoperative first day, first week, first month, third month, or the last visit (p>0.05). In the postoperative period, the VH resolved spontaneously in 9 eyes. Repeat 23 G vitrectomy was performed in 6 eyes: 4 with recurrent retinal detachment and 2 with VH.
DISCUSSION AND CONCLUSION: The results indicate that 23-G TSV is an effective technique for vitreoretinal disease in patients with DR.

A bony fracture in the orbital floor, the most common site, can lead to tissue herniation, enophthalmos, hypoglobus, or strabismic diplopia. Several surgical approaches for repair have been described in the literature. This report is a description of an illustrative case and a brief summary of the literature related to the transconjunctival approach to orbital floor fracture repair as performed by ophthalmologists. A 19-year old female patient had fallen from a 5-meter-high fence and sustained panfacial fractures, including both orbits and the surrounding sinuses. An acute repair was performed by a maxillofacial team to stabilize the facial structure. Following neurosurgical stabilization, she was referred to ophthalmology with pronounced hypoglobus and enophthalmos, diplopia, relative afferent pupillary defect, and a slightly pale right optic nerve head. Surgery was performed under general anesthesia using the transconjunctival approach and an alloplastic implant. This approach was effective, providing excellent exposure while reducing the risks of lower eyelid retraction and surgical scars associated with the transcutaneous approach.