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      Evaluation of Anterior Segment's Structures in Tilted Disc Syndrome

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          Abstract

          Purpose. To evaluate anterior segment's structures by Pentacam in patients with tilted disc syndrome (TDS). Methods. Group 1 included forty-six eyes of forty-six patients who have the TDS. Group 2 including forty-six eyes of forty-six cases was the control group which was equal to the study group in age, gender, and refraction. A complete ophthalmic examination was performed in both groups. All cases were evaluated by Pentacam. The axial length (AL) of eyes was measured by ultrasound. Quantitative data obtained from these measurements were compared between two groups. Results. There was no statistically significant difference for age, gender, axial length, and spherical equivalent measurements between two groups ( p = 0.625, p = 0.830, p = 0.234, and p = 0.850). There was a statistically significant difference for central corneal thickness (CCT), corneal volume (CV), anterior chamber angle (ACA), and pupil size measurements between two groups ( p = 0.001, p = 0.0001, p = 0.003, and p = 0.001). Also, there was no statistically significant difference for anterior chamber depth (ACD), anterior chamber volume (ACV), and lens thickness (LT) measurements between two groups ( p = 0.130, p = 0.910, and p = 0.057). Conclusion. We determined that CCT was thinner, CV was less, and ACA was narrower in patients with TDS. There are some changes in the anterior segment of the eyes with tilted disc.

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          Most cited references20

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          Population prevalence of tilted optic disks and the relationship of this sign to refractive error.

          To assess the prevalence of tilted disks and its association with refractive error and visual field defects. Population-based cohort study. The Blue Mountains Eye Study examined urban Australians aged 49 years or older between 1992-1994. Of 4,433 eligible participants, 3,654 (82.4%) participated. The eye examination included logMAR visual acuity, standardized refraction, cover testing, stereoscopic optic disk photography, and Humphrey automated perimetry. Inferior or nasal optic disk tilting was graded from stereoscopic photographs. Of 3,583 participants with gradable photographs, inferior or nasal optic disk tilting was observed in 77 eyes of 56 participants (1.6%). The prevalence of tilted disks increased from 0.4% in eyes with astigmatism or= 5.0 diopters. The mean astigmatic error was 2.2 diopters in eyes with tilted disks compared with 0.7 diopters in eyes with normal disk appearance, P <.001. Myopia was present in 66.2% of eyes with tilted disks compared with 12.4% of eyes with a normal disk appearance, P <.001. The most common associated features were astigmatism (93.5%), pallor, and tessellation of the adjacent chorioretinal tissues (74.0%), situs inversus of the retinal vessels (70.1%), beta-peripapillary atrophy (64.9%), strabismus (30.4%), visual field defects (19.4%), posterior staphyloma (18.2%), inferonasal pigmentary accumulation (9.1%), and chorioretinal atrophy (5.2%). Superotemporal (33.3%) and superior (25.0%) visual field defects were most frequent. A tilted disk appearance was not a rare finding in our study population and was strongly associated with astigmatism and higher levels of spherical refractive error, particularly myopia. The tilted disk and its associated visual field defect should be distinguished from other sinister causes.
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            Anterior chamber measurements using Pentacam rotating Scheimpflug camera.

            To investigate the mean values and standard deviations according to age, reliability, and correlation between different parameters of anterior chamber measurements using the Pentacam rotating Scheimpflug camera. Heidelberg IOL and Refractive Surgery Research Group, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. This prospective clinical study comprised 76 healthy volunteers (mean age 46.6 years +/- 16.8 [SD]). Three consecutive measurements were made of only 1 eye and anterior chamber depth (ACD), mean and minimum anterior chamber angle (ACA), and anterior chamber volume (ACV) were evaluated. Mean ACD was 2.93 +/- 0.36 mm, mean ACA was 34.81 +/- 5.05 degrees, minimum ACA was 29.99 +/- 5.53 degrees, and mean ACV was 160.3 +/- 36.81 mm3. Increasing age was associated with reduced ACD and ACV; however, mean and minimum ACAs were lowest in patients aged 40 to 59 years. Excellent correlation was found between ACD and ACV (R = 0.92). Anterior chamber depth and mean ACA correlated only moderately (R = 0.65). The correlation coefficient between ACD and minimum ACA was smaller (R = 0.58). There was no correlation between ACV and ACA (R = 0.37). Minor standard deviations were noted (ACD 0.02 +/- 0.02 mm, mean ACA 1.12 +/- 0.94 degrees, minimum ACA 2.04 +/- 2.67 degrees, and ACV 2.48 +/- 1.65 mm3). Using the Pentacam, it was possible to examine different parameters of the anterior chamber within a short period and with good reliability. The evaluation of the ACA in different positions can help to classify the potential risk for angle-closure glaucoma.
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              Congenital anomalies of the optic disc.

              Although anomalies affecting the optic nerve head are usually clinically innocuous, they can sometimes cause significant symptoms and lead to visual loss. It is important to be able to recognize even the relatively benign lesions in order to differentiate them from other more threatening lesions or disease processes which they may clinically resemble. An awareness of the clinical appearance of disc anomalies is especially important in the differential diagnosis of optic nerve glaucomatous changes. Some anomalies cause various types of visual field loss which, if the actual disc lesion is not recognized, may lead to unnecessary neurologic evaluation or even to intracranial surgery. The optic nerve changes in acquired myopia and in the congenital tilted disc syndrome should be clearly defined and differentiated: high (pathologic) myopia may be highly progressive with many dangerous secondary sequelae, while the latter anomaly is stationary. Finally, there is a group of conditions, collectively termed "elevated anomalies of the disc," which must be considered in the differential diagnosis of papilledema and potentially dangerous intraocular tumors, particularly retinoblastoma. This review provides a clinicopathologic correlation comparing the characteristics of the normal optic disc to those of the most important congenital anomalies of the disc.
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                Author and article information

                Journal
                J Ophthalmol
                J Ophthalmol
                JOPH
                Journal of Ophthalmology
                Hindawi Publishing Corporation
                2090-004X
                2090-0058
                2016
                25 August 2016
                : 2016
                : 5185207
                Affiliations
                1Haseki Research and Training Hospital, Department of Ophthalmology, Istanbul, Turkey
                2Inonu University School of Medicine, Department of Ophthalmology, Malatya, Turkey
                Author notes

                Academic Editor: Edward Manche

                Author information
                http://orcid.org/0000-0003-1752-6810
                Article
                10.1155/2016/5185207
                5014945
                a9ae5ee8-28cc-47fb-8257-62c86f2e8520
                Copyright © 2016 Ercan Ozsoy et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 June 2016
                : 26 July 2016
                : 3 August 2016
                Categories
                Research Article

                Ophthalmology & Optometry
                Ophthalmology & Optometry

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