Purpose: To evaluate surgical outcomes of Müller muscle conjunctival resection surgery for reoperation of residual ptosis after external levator advancement in patients with aponeurotic ptosis. Methods: A total of 23 eyes of 23 patients who had undergone Müller muscle conjunctival resection for residual ptosis between January 2016 and July 2018 were reviewed retrospectively. Margin reflex distance (MRD), interlid crease, and show distance measurements were performed with a ruler in millimeters during the office examination, and the photographs of patients were taken before the procedure and on the 10th day, at the first, third, and sixth months after the procedure. The successful outcome was described as MRD1 between 3 and 5 mm, interlid MRD1 difference ≤1 mm, interlid crease difference ≤2 mm, interlid show difference ≤2 mm, and the presence of symmetrical lid contour. Results: The mean increases in MRD1 were statistically significant at the first, third, and sixth months postoperatively when compared with preoperative values both before external levator advancement and before Müller muscle conjunctival resection (p = 0.000). There was statistically significant decrease in interlid MRD1 difference, interlid crease difference, and interlid show difference relative to preoperative values. Interlid crease and show difference within the range of successful outcome criteria were achieved in all patients. However, interlid MRD1 difference exceeded 1 mm in only 1 patient who had overcorrection. Conclusions: In patients who have residual ptosis without contour abnormality following external levator advancement, and positive response to phenylephrine testing, Müller muscle conjunctival resection is an effective approach.

Purpose:The purpose of this study is to compare the thickness and depth measurements of the lamina cribrosa (LC) obtained using a swept-source optical coherence tomography (SS-OCT) device in idiopathic intracranial hypertension (IIH) patients and healthy subjects.Methods:This retrospective, cross-sectional observational study included 16 eyes with IIH and 20 control eyes. The LC measurements with serial horizontal B scans of the optic nerve head were obtained using SS-OCT (Topcon 3D DRI OCT Triton). The anterior lamina surface (ALS) depth, posterior lamina surface (PLS) depth, and LC thickness measurements were evaluated.Results:In patients with IIH, the mean ALS depth was 225.00 ± 58.57 μm and the mean PLS depth was 449.75 ± 63.50 μm. In the IIH control group, the corresponding values were 359.40 ± 105.38 and 570.10 ± 99.41 μm (P < 0.05). The difference in LC thickness between the IIH and control subjects was not statistically significant.Conclusion:LC can be evaluated using an SS-OCT device. LC was displaced anteriorly in patients with IIH compared with normal controls. The assessment of LC level with SS-OCT in IIH cases is a valuable and reproducible adjunctive imaging method in terms of diagnosis and follow-up.

We report an unusual case of hydroxychloroquine (HCQ) toxicity after only 2 months of starting the treatment. A 42-year-old woman presented with visual impairment. Her visual acuity was 20/20 in the right eye and 20/25 in the left eye. Ophthalmologic examination revealed a bull's eye pattern in both eyes which was more prominent in the left eye. She had received HCQ therapy (400 mg/day) for 1 month, and had been taking 200 mg/day for 1 month for the treatment of rheumatoid arthritis. HCQ macular toxicity is rarely seen in short-term use, before 5 years, and to our knowledge, there is only one other case reported in the literature.

Purpose: The aim of this study is to evaluate the variability of central retinal thickness asymmetry in healthy Caucasian adults with the posterior pole asymmetry analysis to serve as a reference. Methods: In total, 404 eyes of 202 subjects who aged between 18 and 80 years, who had no ocular pathology, were included in this cross-sectional observational study. Retinal thickness maps with posterior pole asymmetry analysis mode were taken with the optical coherence tomography (SPECTRALIS SD-OCT; Heidelberg Engineering). Superior and inferior hemifields were divided into five zones resembling to the strategy in Glaucoma Hemifield Test. Mean retinal thickness in each of the five zones was compared with the thickness of the corresponding zone in each eye (paired-samples t-test), and differences in retinal thickness (DRT1–5) and ganglion cell layer thickness between reciprocal locations were measured. Differences in retinal thickness values of two eyes of each subject were also compared (independent-samples t-test). Results: The intra-eye asymmetry was statistically significant in zones 4 and 5. The highest mean intraocular differences in retinal thickness were 5.8 µm (zone 5) in all eyes, 5.8 µm (zone 5) in the right eyes, and 5.9 µm (zones 4 and 5) in the left eyes. The only statistically significant interocular local differences in retinal thickness asymmetries were found in zone 3. The intraocular asymmetry in retinal thickness was found to be the lowest in zone 1. The differences of ganglion cell layer thickness (GCLTs) were not statistically significant. Conclusion: There were statistically significant physiological inter-eye asymmetry in zone 3 and intra-eye asymmetries in zones 4 and 5. These measurements must be considered during screening for glaucoma with posterior pole asymmetry analysis in the Caucasian population.

INTRODUCTION[|]This study was designed to compare optic nerve head (ONH) parameters and corneal biomechanical properties of healthy and glaucomatous macrodiscs.[¤]METHODS[|]This cross-sectional study included total of 234 eyes, of which 92 served as normal controls, 92 had healthy macrodiscs, and 50 had glaucomatous macrodiscs. Measurement of ONH parameters in all p¬atients was performed using optic coherence tomography (OCT). Corneal hysteresis (CH) was measured in each patient using Ocular Response Analyzer (ORA; Reichert, Inc., Depew, NY, USA). Central corneal thickness (CCT) was determined by ultrasonic pachymetry. All OCT and ORA parameters of healthy and glaucomatous macrodiscs were compared.[¤]RESULTS[|]Optic disc area of healthy macrodiscs and glaucomatous macrodiscs was similar, and larger than observed in control group (p=0.70, p=0.0001, respectively). Rim area was significantly thinner in glaucoma group than healthy macrodisc group or control group. (p=0.0001, p=0.022, respectively) Mean cup area of glaucomatous discs was larger than healthy macrodiscs (p=0.001). Cup/disc (C/D) area ratio, and horizontal and vertical C/D ratios were higher in glaucoma group than healthy macrodisc group (p=0.002, p=0.002, p=0.018, respectively) ORA analyses revealed that CH of glaucoma patients was lower than that of healthy macrodisc or control group (p=0.048, p=0.035, respectively), whereas, mean CH of macrodisc group was similar to that of control group (p=0.988). Mean CCT of macrodisc group was higher than that observed in control or glaucoma patients (p=0.015, p=0.045).[¤]DISCUSSION AND CONCLUSION[|] It was concluded that OCT analyses can help differentiate healthy macrodiscs from glaucomatous discs. CH and corneal thickness measurements of healthy macrodiscs are greater than those of glaucomatous optic discs.[¤]

DOI:10.14744/bej.2017.21931 Beyoglu Eye J 2017; 1: 3–8 Original Article Ebru Onmez et al., Corneal biomechanical properties of physiological macrodiscs 4 physiologically related to optic disc size (8–10). As large optic nerve heads (ONHs) have large cups, they can be misdiagnosed and treated as glaucoma. Therefore, differentiation of ONH parameters between normal-sized discs and macrodiscs is extremely important for differential diagnosis of healthy macrodisc from glaucomatous optic neuropathy. Our previous study revealed that macrodiscs have larger cup area, horizontal and vertical C/D ratio, and C/D ratio compared with normal-sized discs using optical coherence tomography (OCT). Moreover, RNFL thicknesses, rim area, and visual field (VF) indices (mean deviation [MD], pattern standard deviation [PSD]) of macrodiscs were similar to those of normal eyes (11). The aim of this study was to assess whether biomechanical properties of corneal tissue of the eye in healthy patients with macrodics are different from those of glaucoma patients with macrodiscs.

INTRODUCTION[|]The aim of the present study was to compare intraocular pressure (IOP) level as measured with Goldmann applanation tonometry (GAT) and Icare rebound tonometry (RBT; Icare Finland Oy, Vantaa, Finland) in patients with varied central corneal thickness (CCT). [¤]METHODS[|]Total of 138 eyes of 138 consecutive patients from glaucoma department were studied. Ultrasound pachymeter was used to measure CCT in all cases and patients were divided into 3 groups according to CCT. Group 1 comprised patients with thin CCT (<520 μ), Group 2 was made up of patients with normal CCT (520-570 μ), and patients with thick CCT (>570 μ) composed Group 3. IOP was measured with RBT, which uses average of 6 readings, followed by GAT. Measurements of groups were compared.[¤]RESULTS[|]Mean age of patients was 59.4+-10.9 years. Mean CCT value was 494.9+-15.9 μ in Group 1 (n=40), 549.1+-16.3 μ in Group 2 (n=52), and 604.0+-22.2 μ in Group 3 (n=46). Mean IOP measurement obtained by GAT and RBT was 13.2+-4.0 and 13.8+-3.9 mmHg, respectively, in Group 1 (p=0.013), 16.9+-3.2 and 16.8+-3.1 mmHg in Group 2 (p=0.745), and 18.1+-3.4 and 18.4+-3.8 mmHg in Group 3 (p=0.359). Mean difference in IOP for entire study group between GAT and RBT was -0.21+-1.7 mmHg (p=0.15). This difference was statistically significant only in Group 1 (p=0.013). Positive correlation was found between CCT and measurement via both GAT and RBT (p<0.01). There was no correlation between CCT and difference in IOP obtained by RBT and GAT.[¤]DISCUSSION AND CONCLUSION[|]Icare RBT demonstrated agreement with Goldmann applanation tonometry, except in thin corneas.[¤]

PURPOSE:To evaluate and compare optic nerve head parameters and retinal nerve fiber layer (RNFL) thickness between large discs and normal-sized vital discs using Stratus optical coherence tomography (OCT). METHODS:A total of 293 healthy eyes (145 with macrodisc and 148 with normal-sized disc) were enrolled in the study. After a complete ophthalmic evaluation, measurement of optic nerve head parameters and RNFL thickness using OCT was performed in all subjects. Optic disc areas larger than 2.80 mm were accepted as macrodiscs. All OCT parameters were compared between normal-sized discs and macrodiscs. RESULTS:Participants' mean age was 46.5±10.6 years (range, 13 to 74 y). Average optic disc areas were 2.19±0.29 and 3.02±0.29 mm in the normal and the macrodisc groups, respectively. The optic disc area (P<0.0001), the cup area (P<0.0001), the horizontal cup disc ratio (P<0.0001), the vertical cup disc ratio (P<0.0001), and the cup disc area ratio (P<0.0001) were found to be significantly different in the macrodisc group and the control group. Rim areas (P=0.57) and RNFL thicknesses (inferior, superior, and mean) were found to be similar in both groups (P=0.75, 0.65, 0.85, respectively). CONCLUSIONS:A macrodisc may have a macrocup and should not be misdiagnosed as glaucoma. The present study showed that macrodiscs are identical to normal-sized discs in terms of rim area and RNFL thickness. We suggest that these 2 OCT parameters can help to differentiate a healthy macrodisc from a glaucomatous optic disc.