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Purpose: To investigate the ocular motility disturbances, optic nerve changes, and refractive errors in children with or without surgically treated hydrocephalus., Methods: This retrospective study included 63 subjects diagnosed with hydrocephalus between 2007 and 2019 at the Baskent University Hospital. Full orthoptic and ophthalmic examination and brain magnetic resonance imaging were performed in all subjects., Results: The mean age of patients was 68.4±27.6 months, and the mean follow-up time was 21.3±5.2 months. Twenty-one (51.2%) patients had esotropia (ET), and 14 (34.1%) had exotropia (XT). Of the patients with ET, 9 (14.2%) had a sixth nerve palsy. Four patients (6.3%) had a fourth nerve palsy, and 1 had a superior rectus palsy. Eleven patients had manifest, and 2 latent, nystagmus. Thirteen (20.6%) patients had optic disc abnormalities. The mean BCVA was 0.4±0.2 (0.05-1.0) in the right eye and 0.5±0.2 (0.1-1.0) in the left eye. Of the 19 (30.1%) patients who had a significant refractive error, 9 (47.3%) had hyperopia. Thirty-six (57.1%) patients had ventriculoperitoneal shunt surgery, and 11 (30.5%) of them had shunt revision due to occlusion. Ocular motility disorders were found to be significantly more common in patients who underwent single shunt surgery and shunt revision than those who had no surgical procedure (P=0.041and P=0.032, respectively)., Conclusion: The evaluation of ocular motility disorders and visual dysfunction in hydrocephalic children can be a source of valuable information when diagnosing and following the disease., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Objectives: To investigate the prevalence of strabismus in families of a proband with accommodative, partial accommodative, or infantile esotropia, and to evaluate the mode of inheritance and the role of consanguineous marriages in this prevalence., Materials and Methods: Families of probands with comitant strabismus were invited to participate in the study. The family members of 139 subjects with accommodative, 55 with partial accommodative, and 21 with infantile esotropia agreed to participate. Detailed family trees were constructed. The first- and second-degree relatives were invited for a complete ophthalmological examination, and 518 individuals from 168 families were evaluated. The role of consanguinity, the presence of tropia, phoria (≥8 PD), microtropia, and hypermetropia (≥3.00 D) among first- and second-degree relatives were analyzed., Results: A non-Mendelian pattern was found in 49 families (23%), an autosomal dominant pattern in 39 families (18%), and an autosomal recessive pattern in 6 families (3%). The prevalence of consanguineous marriages among parents of probands was 18.1%, 22.6%, and 14.3% in the accommodative, partial accommodative, and infantile esotropia groups, respectively (p=0.652). The prevalence of strabismus in first-degree relatives was 58.9%, 45.5%, and 38.1%, respectively (p=0.07). The prevalence of microtropia in probands' siblings was significantly higher in the accommodative esotropia group (p=0.034)., Conclusion: Sporadic cases and non-Mendelian inheritance were more frequent than autosomal recessive inheritance. Autosomal recessive inheritance was found not to be frequent in consanguineous marriages. The prevalence of strabismus and microtropia was significantly higher in families of esotropia cases than in the general population.

Aim: To evaluate the efficacy and safety of suramin, genistein and collagen matrix for the prevention of inflammation, the reduction of fibrosis and the delay in adjustment after strabismus surgery on a rabbit model., Methods: By using an adjustable suture technique, a recession of the superior rectus muscle (SRM) was made in 36 eyes of 18 rabbits. Three study groups were created using genistein, suramin and collagen matrix (n = 6 per group). Two control groups utilized dimethyl sulphoxide (DMSO) (n = 6) and balanced salt solution (n = 12). The adjustments and measurements were made on days 2, 7, 14. After enucleation was done on day 21, the degree of inflammation was evaluated quantitatively in histopathological sections and immunohistochemical investigations were performed for tissue expression of cytoplasmic vascular endothelial growth factor (VEGF), MAC 387, TGF-β and bFGF., Results: The adhesions between conjunctiva and SRM were significantly less in the collagen matrix and suramin groups (p = 0.002) and adhesions between the sclera and SRM were considerably reduced in the genistein and DMSO groups (p = 0.006) on day 7. Force exerted for adjustment was significantly less in the collagen matrix and suramin groups on day 14 (p = 0.006). Expression of b-FGF was significantly lower in the conjunctival epithelium in the suramin and genistein groups (p = 0.0001 for both). TGF-β was significantly lower (p = 0.001) in the suramin group and VEGF expression was totally absent. MAC 387 expression was lower in the genistein and suramin groups (p = 0.0001)., Conclusion: Suramin, genistein and collagen matrix successfully reduce adhesions, and facilitate adjustment following recession surgery. Both suramin and genistein effectively suppress growth factor expression, while collagen matrix offers the longest time interval for adjustability after strabismus surgery.

Background: Extraocular muscles may be recessed using implants as spacer material. Silicone retinal band is an example of a spacer used to elongate the superior oblique (SO) tendon in Brown's syndrome and SO overaction; however, complications such as extrusion, scarring and restriction due to the implant have been reported. The purpose of our study was to evaluate and compare fibroblastic and inflammatory reactions to different alloplast materials in a rabbit model., Method: Twenty-three rabbit eyes underwent superior rectus (SR) expander surgery, and 9 eyes SR recession surgery. SR expander surgery was performed using either silicone retinal band (240 style; 6 eyes), polytetrafluoroethylene (Gore-Tex; 10 eyes) or porous polyethylene (Medpor; 7 eyes). Twenty eyes were enucleated at 4 weeks and 12 eyes at 8 weeks and examined by light microscopy. The expression of basic fibroblast growth factor (bFGF) was evaluated by immunohistochemical analysis., Results: All alloplast materials induced more inflammatory response compared to control eyes (p < 0.05). Medpor induced a markedly stronger inflammatory response than silicone and Gore-Tex (p < 0.05). Gore-Tex and silicone induced similar inflammatory responses. Gore-Tex implants yielded a slightly higher bFGF expression than silicone or Medpor implants (p = 0.07)., Conclusion: Polytetrafluoroethylene (Gore-Tex) was found to be similar to silicone in its biocompatibility when used as spacer material in extraocular muscle tendon expander surgery. The high bFGF expression observed in Gore-Tex-implanted eyes suggests porous polymers may promote tissue ingrowth into the implant., ((c) 2010 S. Karger AG, Basel.)

Purpose: To investigate hemodynamic changes after strabismus surgery using color Doppler imaging (CDI)., Method: Group 1 patients (n = 13) underwent surgery on a single horizontal rectus muscle, and group 2 (n = 13) underwent surgery on both horizontal rectus muscles. Subjects with no systemic or ophthalmologic disorders were selected as controls (n = 16). In group 1 and group 2, CDI of the ophthalmic artery (OA), the central retinal artery (CRA), and the nasal and temporal posterior ciliary arteries (PCAs) was performed before surgical correction and on postoperative days 1 and 7. For each vessel, peak systolic (V(max)), end diastolic (V(min)), and mean (V(mean)) blood flow velocities were measured, in addition to the resistivity index (RI) and pulsatility index (PI)., Results: V(max) in the OA on postoperative day 1 was higher in group 2 than in group 1 (P =.004). V(min) in the OA on postoperative day 1 was significantly higher in group 2 than in the controls (P =.001) and group 1 (P =.001). For group 2, comparison of the OA preoperative findings to the findings on postoperative day 1 showed that V(min) (P =.003) and V(mean) (P =.02) increased significantly, and the RI (P =.01) and PI (P =.006) decreased significantly. These significant differences were not observed on day 7 (P >.05)., Conclusion: Surgery on both horizontal rectus muscles in an eye causes hemodynamic changes in the OA in the early postoperative period.

Purpose: The success of any specific occlusion regimen is limited by the level of concordance, which is difficult to measure accurately in patching treatment. The aim of this study was to investigate prospectively the concordance rate of a group of children with strabismic and/or anisometropic amblyopia using a schematic diary based on completing 'smiley' images, filled in by the child under parental supervision, and to assess the effect of correlates such as initial visual acuity, age, and total and daily occlusion time on concordance., Methods: We recruited 51 amblyopic children aged 13 months to 12 years (mean 6.57 +/- 2.82). The median duration of treatment was 16 weeks. Non-concordance was defined as occluding less than 75% of the prescribed time and was analyzed using a concordance index calculated from occlusion time recorded in the diary/prescribed occlusion time., Results: Of the 51 patients followed prospectively, 12 (23.5%) failed to return their diaries (Group 1); 27 (52.9%) complied with occlusion (Group 2); and 12 (23.5%) failed to comply with occlusion completely (Group 3). The total proportion of non-concordance was 47.1% (Group 1 + Group 3). Concordance was not significantly related to initial visual acuity (r = -0.22, p = 0.19), patient age (F = 1.0787, p = 0.349) or total occlusion time (X2 = 2.779, p = 0.249), but the number of daily occlusion hours showed significant difference in Group 1 (X2 = 15.894, p = 0.000). When the three groups were compared for change in visual acuity, a significant difference was found between group 1 and group 2 (X2 = 6.125, p = 0.047)., Conclusion: The substantial proportion of non-concordance in our study suggests that, although useful for recording purposes, parental diaries may not be stimulating enough to increase the overall level of concordance. Therefore, other forms of monitoring need to be explored.