ISSN: 2459 - 1777 | E-ISSN 2587-0394
Volume: 4
Issue: 1
Year: 2019
Beyoglu Eye J: 4 (1)
Volume: 4  Issue: 1 - 2019
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INVITED REVIEW
1.Orbital Compartment Syndrome
Burak Turgut, Feyza Calis Karanfil, Fatoş Altun Turgut
doi: 10.14744/bej.2018.70288  Pages 1 - 4
Orbital compartment syndrome (OCS) is a true ophthalmological emergency. It develops as a result of an acute rise in intra-orbital pressure, and if not treated immediately, damage to the optic disc and retina will lead to irreversible vision loss. Thus, immediate diagnosis and management are vital to preserve vision. Presented here is a brief summary of OCS in order to call attention to this condition.

ORIGINAL ARTICLE
2.Balanced Salt Solution-Assisted Intraocular Lens Implantation in Phacoemulsification Surgery: Intraocular Pressure and Endothelial Cell Effects
Erdem Yuksel, Huseyin Baran Ozdemir, Mehmet Ozgur Cubuk
doi: 10.14744/bej.2019.94830  Pages 5 - 10
INTRODUCTION: The purpose of this study was to evaluate the effect of balanced salt solution (BSS)-assisted intraocular lens (IOL) implantation on postoperative intraocular pressure (IOP) and endothelial cells and to compare BSS-assisted IOL implantation with the use of ophthalmic viscosurgical devices during IOL implantation.
METHODS: A total of 52 eyes of 40 patients (25 female, 15 male) with a cataract who underwent phacoemulsification surgery with BSS-assisted (26 eyes) or viscoelastic-assisted IOL implantation (26 eyes) were evaluated. BSS-assisted IOL implantation was performed with the aid of irrigation cannula and BSS without using a viscoelastic substance. Viscoelastic-assisted IOL implantation was performed according to standard procedures to facilitate IOL implantation. IOP measurements and endothelial changes after phacoemulsification surgery, as well as the surgical time were noted and compared. The eyes were also evaluated in terms of cataract density preoperatively and phaco parameters were assessed peroperatively.
RESULTS: The mean age of the patients was 67.5±7.8 years in the BSS-assisted group and 67.8±9.4 years in the viscoelastic group. The mean preoperative IOP and postoperative IOP on day 1, week 1, and month 1 was 14.2±2.3, 14.7±3.1, 13.2±1.5, and 13.8±2.7 mmHg, respectively, for the BSS-assisted group and 14.1±2.9, 19.1±3.4, 13.8±3.1, and 13.2±2.9 mmHg, respectively, for the viscoelastic-assisted IOL implantation group. The IOP increase was significantly greater on the first day in the viscoelastic-assisted IOL implantation group (p=0.007). The surgical time was 12.3±2.1 minutes in the BSS group and 14.6±3.1 minutes in the viscoelastic group (p=0.035). The difference in endothelial changes was not statistically significant between groups (p=0.88).
DISCUSSION AND CONCLUSION: IOL implantation using BSS in phacoemulsification surgery is a reliable technique, and this method has a significantly shorter surgery time and a much smaller postoperative IOP increase. The reduced IOP increase after cataract surgery might be particularly helpful for glaucoma patients.

3.Clinical Use of Dexamethasone Implants in Resistant Macular Edema Secondary to Branch Retinal Vascular Occlusion Compared with Intravitreal Anti-Vascular Endothelial Growth Factor
Erdem Eris, Irfan Perente, Gurkan Erdogan, Zeynep Seymen, Mehmet Emin Sucu, Abdullah Ozkaya, Ali Demircan, Zeynep Alkin, Ahmet Demirok, Ozgur Artunay
doi: 10.14744/bej.2019.63835  Pages 11 - 16
INTRODUCTION: Branch retinal vein occlusion (BRVO) is the second most common type of retinal vascular disorder. Both inflammation and increased vascular endothelial growth factor (VEGF) levels play important roles in the pathogenesis of macular edema (ME) secondary to BRVO. The aim of this study was to compare the efficacy of 0.7-mg intravitreal dexamethasone implants with continued anti-VEGF treatment in patients with ME secondary to BRVO who were poor responders to at least 6 previous anti-VEGF injections.
METHODS: Patients exhibiting an insufficient response to at least 6 ranibizumab treatments and who subsequently underwent a dexamethasone implant were included Group 1. Patients who were at risk for cataract or glaucoma continued treatment with the same drug and were defined as Group 2. The best corrected visual acuity (BCVA) and central macular thickness (CMT) changes at month 2, 4, and 6 were measured.
RESULTS: Ninety eyes were evaluated. In Group 1, the mean baseline BCVA of 0.71±0.75 logarithm of the minimum angle of resolution (logMAR) improved to 0.53±0.62 logMAR at month 2 (p<.001), 0.67±0.72 logMAR at month 4 (p=0.325), and 1.03±0.83 logMAR at month 6 (p=.001). In Group 2, the mean baseline BCVA was 0.73±0.83 logMAR, and improved to 0.68±0.83 logMAR at month 2 (p=0.12), 0.698±0.81 logMAR at month 4 (p=0.270), and 0.76±0.80 at month 6 (p=0.546). The baseline CMT in each group was 588±176 μm and 545±165 μm, respectively (p=0.248). The mean CMT of Group 1 changed from a baseline measurement of 588±176 μm to 308±132 μm at month 2 (p<.001), 450±195 μm at month 4 (p<.001), and 510±190 μm at month 6 (p<.001). The mean CMT of Group 2 changed from a baseline value of 545±165 μm to 486±162 μm at month 2 (p<.001), 516±168 μm at month 4 (p<.001), and 528±171 μm at month 6 (p=0.037).
DISCUSSION AND CONCLUSION: Dexamethasone implants were a more effective treatment for patients with BRVO-related resistant ME than ranibizumab at month 2. However, this positive effect seems to decline rapidly in the long term.

4.Refractive Results and Endothelial Cell Density After Eyecryl Phakic Intraocular Lens Implantation
Ufuk Urdem, Alper Agca
doi: 10.14744/bej.2019.52824  Pages 17 - 22
INTRODUCTION: This study was an examination of the refractive results and complications encountered with implantation of the Eyecryl phakic intraocular lens (IOL) (Biotech Vision Care, Luzern, Switzerland).
METHODS: IOL recipients with a follow-up period of at least 2 years were included the study. Uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively), central endothelial cell density (ECD), and procedure-related complication data were recorded.
RESULTS: The study included 52 eyes from 26 patients. The efficacy index (postoperative UDVA/preoperative CDVA) was 1.32±1.09 in the first year and 1.39±1.03 in the second year. The safety index (postoperative CDVA/preoperative CDVA) was 1.69±1.16 at the last follow-up. None of the patients lost 2 or more lines of CDVA. The mean ECD loss was –4.51±9.69% at 1 year (p=0.005). There was no statistically significant ECD loss between the 1- and 2-year follow-up visits (p=0.794).
DISCUSSION AND CONCLUSION: The results of Eyecryl phakic IOL implantation were favorable in terms of efficacy and safety.

5.Effects of Common Thrombophilia Factor Mutations in Central Retinal Vein Occlusion
Muhammer Ozgur Cevik, Sadik Gorkem Cevik
doi: 10.14744/bej.2018.25733  Pages 23 - 27
INTRODUCTION: Central retinal vein occlusion (CRVO) is a severe eye disease that impairs vision. Although numerous systemic conditions have been reported to be a contributor, its exact pathophysiology has not yet been resolved. The purpose of this study was to study the role of some common thrombophilic polymorphisms in CRVO patients.
METHODS: A total of 33 CRVO patients (25 non-ischemic CRVO and 8 ischemic CRVO) and 30 controls were recruited. Factor V Leiden (G1691A), prothrombin (Factor II G20210A), MTHFR (C677T), MTHFR (A1298C), and PAI-1 5G/4G polymorphisms in venous blood DNA samples were examined, as well as the presence of hypertension, diabetes mellitus, glaucoma, smoking, and history of thrombosis.
RESULTS: It was determined that MTHFR C677T polymorphisms, either in heterozygous or homozygous form, might be a risk factor for CRVO and systemic thrombosis. No differences were detected between the CRVO and control groups in terms of diabetes mellitus (p=0.058>0.05), hypertension (p=0.3>0.05), smoking (p=0.923>0.05), glaucoma (p=0.06>0.05) or use of anticoagulant drugs (p=0.4>0.05). Analysis of patient history revealed a statistically significant difference regarding a thrombotic event in the medical history of the CRVO group (p=0.001<0.05; n=4) versus the control group. The ischemic CRVO group had a significantly higher incidence of diabetes mellitus (p=0.002<0.05) and hypertension (p=0.031<0.05) than the non-ischemic CRVO group.
DISCUSSION AND CONCLUSION: The MTHFR C677T mutation appears to be a risk factor for CRVO but factor V Leiden (G1691A), prothrombin (Factor II G20210A), MTHFR (A1298C), and PAI-1 5G/4G mutations were not determined to be specifically related to CRVO in this study. The presence of diabetes mellitus and hypertension was significant in the ischemic CRVO group. Further studies with larger sample sizes should be conducted.

6.Duane Retraction Syndrome and Accompanying Ocular Abnormalities
Murat Kocamaz, Ebru Demet Aygıt, Aslı İnal, Osman Bulut Ocak, Uğur Çiçek, Birsen Gokyigit
doi: 10.14744/bej.2019.36854  Pages 28 - 31
INTRODUCTION: Duane retraction syndrome (DRS) is a congenital syndrome characterized by limitation in adduction and/or abduction eye movements and narrowing of the palpebral fissure in adduction, and may include globe retraction, upshoot or downshoot. Several systemic abnormalities, syndromes, and additional ocular findings can accompany DRS. This study is an evaluation of eye findings in patients with DRS.
METHODS: The records of 632 patients with DRS who were followed up between 1995 and 2016 were reviewed retrospectively. Patients with a follow-up of less than 6 months and patients with a history of eye/cranial trauma or injury were not included in the study. Before the patients were examined, a detailed anamnesis was obtained. Details of the medical records, including additional systemic diseases, were recorded.
RESULTS: The average of follow-up time was 45 months (min-max: 6-128 months). There were 255 male and 377 female patients. A total of 34 patients (5.4%) had additional ocular abnormalities. The most frequently observed ocular pathologies associated with DRS were congenital ptosis (n=6, 0.94%) and coloboma of the iris (n=4, 0.63%).
DISCUSSION AND CONCLUSION: Most cases of DRS are observed as isolated. However, various ocular and systemic abnormalities and syndromes are associated with DRS. In particular, synkinetic syndromes may frequently be seen alongside DRS. Therefore, a complete ocular examination and anamnesis are crucial in cases with DRS.

7.HandyRef-K: Comparison of the Latest Handheld Auto Refracto-keratometer with Retinomax and Plusoptix in Patients Younger than Three Years of Age
Zeynep Seymen, Esra Vural, Erdem Eris, Asli Vural, Tülin Öğreden, Önder Aslan, Ali Riza Cenk Celebi, Irfan Perente
doi: 10.14744/bej.2018.20591  Pages 32 - 37
INTRODUCTION: The purpose of the study was to compare the refractive error measurements of pediatric patients performed with a Plusoptix A09 photorefractor (PO; Plusoptix AG, Nuremberg, Germany), a Retinomax K-plus 3 (RTX; Right Group, Tokyo, Japan), and the new handheld auto refracto-keratometer, the Nidek HandyRef-K (HDY; Nidek SA, Créteil, France), and to evaluate the intermethods agreement.
METHODS: A total of 194 eyes of 194 children were included in the study. All of the children underwent refraction measurement with the PO before cycloplegia and 2 autorefractors were used after cycloplegia: the RTX and the HDY.
RESULTS: The mean age of the patients was 16.65±10.04 months (range: 3-34 months). There were no statistically significant differences between the spherical values (SV) or cylindrical axis values (CAV) measured with the PO (SV: 1.61±1.79 diopters [D]; CAV: 94.25±72.47 D), the RTX (SV: 1.91±2.06 D; CAV: 94.3±73.44 D), and the HDY (SV: 1.89±2.04 D; CAV: 93.55±73.71 D) (p>0.05).There was a statistically significant difference in the cylindrical values (CV) assessed with the RTX (CV: -0.97±0.75 D) and the HDY (CV: -1.11±0.76 D) (p=0.003) and the HDY and the PO (CV: -0.92±0.68 D)(p=0.002), while there was no statistically significant difference between the values determined with the RTX and the PO (p>0.05). Statistically significant differences were demonstrated for spherical equivalent values (SEV) obtained with the RTX (SEV: 1.43±1.97 D) and the PO (SEV: 1.15±1.74 D) (p=0.02), and the HDY (SEV: 1.34±1.95 D) and the PO (p=0.03), but no significant difference was found between the RTX and the HDY values (p>0.05).
DISCUSSION AND CONCLUSION: No significant difference was found between the SEV measured by the RTX and the HDY, but the PO was significantly less hyperopic than the RTX and the HDY. The CV measured by HDY was higher than that of other devices. These devices can be used for screening in crowded pediatric ophthalmology clinics and may be an easier way of measuring refractive errors in children younger than 3 years of age, but high SEV and CV results should serve as an alert to physicians. It should also be kept in mind that cycloplegic retinoscopy is still the gold standard and these alternative methods can only be used for screening. The prescription of eyeglasses should not be made without cycloplegic retinoscopy.

8.Investigating Estrogen and Progesterone Receptors in the Lacrimal Sacs of Individuals With and Without Chronic Dacryocystitis
Hakan Baybora, Hasan Hüseyin Uysal, Orhan Baykal, Yunus Karabela
doi: 10.14744/bej.2019.35744  Pages 38 - 41
INTRODUCTION: Chronic dacryocystitis is usually seen in middle-aged or older women, suggesting that decreased estrogen and progesterone serum levels may be a causative factor in the disease pathology. However, the occurrence of the disease in premenopausal females and males suggests that there may be more to the explanation than the level of female sex hormones. The purpose of the present study was to investigate estrogen and progesterone receptor positivity in the lacrimal sacs of individuals with and without chronic dacryocystitis.
METHODS: The study group included 50 female and 20 male patients diagnosed with chronic dacryocystitis. Lacrimal sac samples were taken during a dacryocystorhinostomy. The control group comprised 29 cadavers with no evidence of lacrimal system pathology in the health records. The samples were obtained transconjunctivally. Lacrimal sac samples from both groups were stained with the estrogen and progesterone receptor protein antigen. Fisher's exact test and a chi-square test were used to compare the receptor positivity results of premenopausal and postmenopausal women, and samples of those with dacryocystitis and cadaver sacs without the disease.
RESULTS: In the control group, estrogen receptor positivity was observed in the samples of 2 premenopausal females. In the study group, estrogen receptor positivity was seen in 4 premenopausal females. There was no significant difference in estrogen receptor positivity between the premenopausal and postmenopausal female groups (p=0.41). A similar result was not established between the premenopausal and postmenopausal females in case group (p=0.056). No comparison was made of the progesterone receptor because only 1 example of progesterone receptor positivity was found in a premenopausal female in the dacryocystitis group.
DISCUSSION AND CONCLUSION: Estrogen receptor positivity did not seem to be a factor in chronic dacryocystitis physiopathology.

CASE REPORT
9.Topiramate-Induced Acute Myopia, Diplopia, and Photosensitivity: A Case Report
Murat Kocamaz, Onur Karadag
doi: 10.14744/bej.2019.07379  Pages 42 - 45
Topiramate is primarily used as an antiepileptic drug. It has also demonstrated effectiveness in migraine prophylaxis, depression, trigeminal neuralgia, bipolar disorders, and idiopathic intracranial hypertension. The drug has a large number of potential ocular side effects, such as acute-onset angle closure glaucoma (ACG), acute myopia, nystagmus, diplopia, photosensitivity, suprachoroidal effusions, peri-orbital edema, and blepharospasm. Presently described is the case of a 24-year-old woman presenting with a sudden loss of vision in both eyes. Her medical history revealed that the patient had initiated topiramate use 12 days earlier. The uncorrected visual acuity was 20/400 in both eyes and the best corrected visual acuity was determined to be 20/25 in the right eye with -5.50 spherical refractive correction and 20/20 in the left eye with -6.25 spherical refractive correction. On the second day of examination, diplopia developed. The patient's clinical condition was considered to be related to the drug and topiramate was discontinued immediately. The clinical findings of the patient subsequently improved rapidly without treatment. On the fifth day of examination, her autorefractometry measurements were +0.25 -0.25 α 121° in her right eye and +0.25 in her left eye and her uncorrected visual acuity was 20/20 in both eyes with normal bilateral anterior chamber depth. She had no vision complaint or diplopia but she began to experience photosensitivity, which persisted for 4 months before regressing completely. When ophthalmologists encounter acute myopia and acute-onset ACG, especially in young patients, they should keep the use of topiramate in mind.

10.Conjunctival Limbal Autograft Combined with Amniotic Membrane Transplantation to Treat a Moderate Chemical Eye Injury
Cem Cankaya
doi: 10.14744/bej.2019.57966  Pages 46 - 50
A 25-year-old male patient presented at the clinic with chemical trauma to the left eye. His visual acuity according to Snellen chart measurement was 0.05/10 in the left eye and 10/10 in the right eye. On slit lamp examination, conjunctival hyperemia and limbal ischemia were observed between the 1 o’clock and 6 o’clock hours (approximately 5 clock hours). The cornea was edematous in this area, and a corneal epithelial defect adjacent to the limbal ischemia area was present. The anterior chamber, iris, and lens were normal; the fundus could not be concurrently evaluated. Conjunctivalization and excessive neovascularization were observed in the limbal ischemic area at the end of the fourth week of medical treatment. Visual acuity in the left eye was 0.3 and the epithelial defect had healed. At the end of the sixth week, a conjunctival limbal autograft (CLAU) combined with amniotic membrane (AM) transplantation surgery was performed. Subsequently, the corneal neovascularization was noted to have completely vanished in the ischemic area where the CLAU and AM transplantation were performed. Visual acuity improved to 0.7 and the symptoms of the patient decreased.

11.Hypotony Maculopathy After Trabeculectomy in a Patient With GAPO Syndrome
Selim Genç, Emre Güler, Hanefi Cakir, Osman Şalkacı, Fehim Esen
doi: 10.14744/bej.2019.83007  Pages 51 - 53
This report describes a case of hypotony maculopathy developing in a patient with GAPO syndrome following a trabeculectomy with mitomycin C (MMC). A 42-year-old man with a diagnosis of GAPO syndrome underwent a trabeculectomy with an MMC application of 0.4 mg/mL for 1 minute. Intraocular pressure was measured at 6 to 8 mmHg during the first weeks after the surgery. A fundus examination then revealed macular choroidal folds, retinal vascular tortuosity, and swelling in the optic nerve. At postoperative 1 month, additional suturing of a bleb was performed; however, the hypotony continued. Postoperative hypotony should be taken into account in patients with GAPO syndrome due to a defective fibrosis process following a trabeculectomy.



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