ISSN: 2459 - 1777 | E-ISSN 2587-0394

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Beyoglu Eye Journal - Beyoglu Eye J: 4 (3)
Volume: 4  Issue: 3 - 2019
ORIGINAL ARTICLE
1.A Real-Life Study: Intravitreal Aflibercept, Ranibizumab and Dexamethasone for Macular Edema Secondary to Branch Retinal Vein Occlusion
Alper Halil Bayat, Selim Bölükbaşı, Burak Erden, Akin Cakir, Şeyma Gülcenur Özturan, Mehmet Tayfur, Mustafa Nuri Elcioglu
doi: 10.14744/bej.2019.18291  Pages 131 - 135
INTRODUCTION: This study aims to compare the efficacy of intravitreal injection of aflibercept (IVA), ranibizumab (IVR) and dexamethasone implant (DEX IMP) for the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO).
METHODS: In this retrospective and comparative study, 57 eyes of 57 patients with ME after BRVO were studied. Patients were diveded into three groups according to treatment regimen as follows: 2 mg IVA (group 1, n=18), 0,5 mg IVR (group 2, n=20) and 0,7 mg Dex imp (group 3, n=19). Group 1 and group 2 were treated with three monthly anti-VEGF treatment followed by pro re nata (PRN) regimen, and group 3 was treated with 0,7 mg dexamethasone dose followed by another injection based on patients' data. Best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP) measurements were noted at baseline, 1, 2, 3 and 6 months.
RESULTS: All groups were similar concerning age, gender, duration of symptoms, initial CMT and BCVA (p>0.05). Mean number of injections were 3,85±0.74 in group 1, 3,85±0,87 in group 2 and 1,75±0,44 in group 3. All the groups decreased CMT and increased BCVA for six months. There was not a statistically significant difference between groups. Concerning side effects, one person in group 1 and 2, four people in group 3 increased IOP, but all of them controlled IOP with anti-glaucomatous drugs. One patient in group 1, two in group 2, four in group three patients had cataract progression.
DISCUSSION AND CONCLUSION: All three drugs have similar results in patients with ME secondary to BRVO at a six-month follow-up. Compared to anti-VEGF drugs, dex imp has side effects as increased IOP and cataract progression, but it has higher BCVA at all months in the treatment of ME after BRVO.

2.Evaluation of Axial Length Changes after Combined Phacovitrectomy for Macula-off Rhegmatogenous Retinal Detachment
Sadık Altan Özal, Rüveyde Garip, Ece Özal, Ayça Küpeli
doi: 10.14744/bej.2019.84856  Pages 136 - 140
INTRODUCTION: To evaluate the reliability of optical biometry for correct intraocular lens (IOL) power calculation in eyes with macula-off rhegmatogenous retinal detachment (RRD) via comparing the axial lengths (AL) measured with optical biometry preoperatively and postoperatively.
METHODS: This retrospective study was conducted with 25 eyes of 25 patients who underwent combined surgery (phacoemulsification and pars plana vitrectomy (PPV)) with the diagnosis of RRD with macular involvement. Best-corrected visual acuity (BCVA), biomicroscopic examination, intraocular pressure measurement and full fundoscopic examination were performed in all patients. Axial length was measured using optical biometry in all patients. The AL measurements were repeated in the postoperative third month in the patients using gas tamponade during vitreoretinal surgery and in the third month after the silicone oil removal in patients using silicone-oil tamponade during vitreoretinal surgery.
RESULTS: The mean age of the patients was 61.60±7.33. Fifteen patients (60%) were female, and 10 (40%) were male. Postoperative BCVA values (0.40±0.28) were significantly higher than the preoperative BCVA values (0.14±0.22) (p<0.05). The preoperative mean value of AL was measured as 24.66±1.90 and the postoperative mean value of AL was 24.67±1.91. There was no statistically significant difference between the measured AL values in the preoperative and postoperative periods (p=0.258).
DISCUSSION AND CONCLUSION: Combined surgery (phacoemulsification and PPV) is a frequently applied method in RRD treatment. The correct AL measurement is important for the removal of refractive errors due to AL measurement in patients with macula-off RRD. Optical biometry provides accurate results in these cases.

3.Long-term Results of Ranibizumab, Dexamethasone Implant, and Triamcinolone in Macular Edema due to Branch Retinal Vein Occlusion
Nevin Hande Dikel, Erhan Yumusak, Nesrin Buyuktortop Gokcinar
doi: 10.14744/bej.2019.40412  Pages 141 - 148
INTRODUCTION: The present study aims to compare the long-term efficacy and safety results of intravitreal ranibizumab (RAN), dexamethasone intravitreal implant (DEX) and intravitreal triamcinolone acetonide (IVTA) injections in macular edema due to branch retinal vein occlusion (BRVO).
METHODS: In this retrospective study, one eye each of 43 patients who were treated with intravitreal injections for macular edema secondary to BRVO was recruited into one of the study groups: RAN group (n=17), DEX group (n=16) and IVTA group (n=10). All patients were followed-up for 12 months. Best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT) and intraocular pressure (IOP) at month 1, 3, 6, and 12 were compared with baseline.
RESULTS: The BCVA increased significantly in the RAN and DEX groups at all visits (all p<0.05). BCVA increase in the IVTA group was significant only at month 1 and 6. CMT decreased significantly in all groups at the end of one year of follow-up (p=0.007; p=0.001; p=0.044, respectively). SFCT significantly decreased in all groups at month 1 (all p<0.05). IOP significantly increased in none, 18.8%, 30% of the patients in the RAN, DEX and IVTA groups, respectively. Cataract surgery was performed in none of the patients, 6.3%, and 30% of the patients in the RAN, DEX, and IVTA groups, respectively.
DISCUSSION AND CONCLUSION: BCVA increase was more prominent in both of the RAN and DEX groups than in the IVTA group. DEX may decrease the injection burden; however, ranibizumab may be a safer choice.

4.Objective Accommodation Amplitude Measurements Using a New Autorefractometer Device
Kemal Özülken, Hasan Kızıltoprak
doi: 10.14744/bej.2019.52724  Pages 149 - 155
INTRODUCTION: To measure the value of objective accommodation amplitude (AA) in patients using the new autorefractometer device and to evaluate the effects of age, refraction errors, pupil diameter on objective AA measurements.
METHODS: Three hundred subjects who were divided into five groups according to age were enrolled in this study. AA and pupil diameter were measured three times from both eyes using Tonoref III (NIDEK Co., Ltd.).
RESULTS: The mean AA was 1.6325±0.061 Diopter (D) (0.13-9.11 D). The mean AA values were statistically significantly different between the groups (p=0.000). It was not observed gender effect on AA (p=0.115). Although there was no significant difference between emmetropic and myopic groups, there were significant differences between emmetropic and hyperopic groups and also between myopic and hyperopic groups concerning AA (p=0.000, for both). A statistically significant difference was found for the mean AA between the groups with and without refractive surgery (p=0.028). Correlation analysis revealed that AA is increased as the mean pupil diameter increases (p=0.000, r=0.202) and the mean pupil diameter decreases with increasing age (p=0.000, r=-0.308). When the AA obtained from the patients in group 1 were compared with the AA values obtained by subjective accommodation tests, the AA values obtained by autorefractometer device were found to be correlated with push up, push down and minus lens tests (r=0.577, r=0.682, r=0.427) AA values obtained by autorefractometer device were found to be statistically significantly lower than other subjective tests (p<0.001).
DISCUSSION AND CONCLUSION: The Tonoref III device seems to provide objective AA measurements in presbyopic or non-presbyopic individuals. Age, refractive error, pupil diameter and history of refractive surgery were effective on AA values, while the gender was not effective.

5.Progression Analysis with ABCD Grading System following Corneal Collagen Cross-Linking in Keratoconus
Ayhan Sağlık, Mehmed Uğur Işık
doi: 10.14744/bej.2019.49469  Pages 156 - 162
INTRODUCTION: To evaluate the ABCD grading system used in follow-up of keratoconus progression after the corneal collagen cross-linking (CXL) treatment in different Kmax groups.
METHODS: This study included 57 eyes of 43 patients applied with CXL treatment for progressive keratoconus. All the patients were applied with the standard CXL protocol (Dresden). According to the changes in the Kmax value at the end of 12 months postoperatively (0–1D, 1–2D, >2D), the groups were separated as steepening and flattening. Scheimpflug progression parameters, such as ABCD keratoconus grading systems, were evaluated in six different groups. The Paired Samples t-test was used in the evaluation of parameters with normal distribution and the Wilcoxon test for parameters not showing normal distribution. A value of p<0.05 was accepted as statistically significant.
RESULTS: Mean age of patients was 18.37±3.86 years (11–28 years). According to the ABCD grading system, 0.19 significant regression was determined in grade A (p=0.014) and 0.24 in grade D (p<0.0001). 0.10 progression was seen in grade B (p=0.089), and 0.11 in grade C (p=0.011). In the mean Kmax value 0.25±0.42, D flattening was seen (p=0.137).
DISCUSSION AND CONCLUSION: The anterior corneal surface grade in ABCD system is correlated with Kmax in different groups. However, the posterior corneal surface parameter is not correlated with Kmax in 1-2 D steepening and >2D flattening groups. Although there is an increase in posterior elevation after CXL, despite excessive Kmax flattening, it would be inaccurate to consider this increase as an indicator of topographic progress.

6.Evaluation of Neutrophil-Lymphocyte Ratios, Mean Platelet Volumes, and Platelet-Lymphocyte Ratios in Pterygium
Onur Gökmen, Azer Gökmen
doi: 10.14744/bej.2019.30164  Pages 163 - 167
INTRODUCTION: To assess the neutrophil-to-lymphocyte ratio (NLR), mean platelet volumes (MPV), platelet–lymphocyte ratios (PLR) and other complete blood count parameters (CBC) as indicators of inflammation in patients with pterygium.
METHODS: This study was carried out retrospectively in 111 consecutive pterygium patients and 106 control subjects. Laboratory and clinical parameters were obtained from the patient data management system. NLR and PLR were calculated by dividing neutrophil and platelet count by lymphocyte count.
RESULTS: A significant difference was found in NLR and lymphocyte values between the pterygium and control groups (p<0.05). However, there was no significant difference found in MPV, PLR and other parameters between groups (p>0.05).
DISCUSSION AND CONCLUSION: NLR may have an association with pterygium, which should be investigated at larger subgroups in further studies.

7.Evaluation of the Demographic Features of Eye Loss in Turkey
Korhan Fazıl
doi: 10.14744/bej.2019.47955  Pages 168 - 171
INTRODUCTION: To investigate the causes of eye loss in different age groups and the distribution of age and sex among these patients.
METHODS: The medical records of 816 patients (504 men, 312 women) with eye loss due to different etiologies were evaluated retrospectively for this study. Patients were divided into four age groups (preschool, school, adolescence and adulthood) and causes of eye loss were grouped as follows: trauma, postoperative and other causes (infection, tumor, congenital diseases). Pearson’s Chi-square test was used to compare the causes of eye loss with age sex and the affected side of the patients.
RESULTS: The mean age was 12.6±13.6 (range, 0-76) years. There were 317 patients (38.8%) in group 1, 214 patients (26.2%) in group 2, 107 patients (13.1%) in group 3, and 178 patients (21.8%) in group 4). The most frequent etiologic factor of eye loss among all the patients and individually in each group was trauma (p<0.001). The percentage of trauma tended to increase by age until the age of 20 years. After that, the predominance of other causes of eye loss increased. Fortunately, the overall number of patients with eye loss tended to decrease by age. Traumatic etiologies were more frequently seen in male (68%) population, whereas other causes (infection, tumor and natal diseases) of eye loss were seen more in the female population (57.7%) (p<0.001).
DISCUSSION AND CONCLUSION: The young adult males are more prone to work-related accidents resulting in eye loss. Thus, the preventive measures are very important to reduce the traumatic eye injuries leading to workforce loss.

8.An Alternative Algorithm for Müller Muscle Conjunctival Resection Surgery for Blepharoptosis Management
Gamze Ozturk Karabulut, Korhan Fazıl, Orcun Sonmez, Zehra Karaağaç Günaydın, Kubra Serefoglu Cabuk, Isil Pasaoglu, Muhittin Taskapili
doi: 10.14744/bej.2019.46220  Pages 172 - 178
INTRODUCTION: To evaluate the surgical outcomes of Müller Muscle conjunctival resection surgery performed with an alternative formula.
METHODS: A total of 58 eyes of 58 patients with mild ptosis (≤2 mm) and levator function ≥8 mm who responded to 2.5% phenylephrine were enrolled in this study. Müller muscle conjunctival resection was performed between March 2016-March 2018, and the charts were reviewed retrospectively. Margin-reflex distance 1 was measured before and after five minutes following the instillation of phenylephrine. The amount of excision was 9 mm when the desired elevation was achieved. If the phenylephrine testing resulted in under-correction, 10 mm was resected, and in overcorrection, 8 mm resection was performed. Margin reflex distance and Schirmer test measurements were performed preoperatively and on the first, third and sixth months postoperatively.
RESULTS: The mean increase in margin-reflex distance 1 was statistically significant at the first, third and sixth months postoperatively when compared to preoperative values (p<0.05, Wilcoxon signed ranks test). Postoperative symmetry was achieved in 54 patients (93.1%) after six months. Compared to the preoperative values, changes in Schirmer-1 test results were not statistically significant at each visit after the procedure (p>0.05, Wilcoxon signed ranks test). None of the patients had keratopathy, eyelid contour abnormality, or symblepharon.
DISCUSSION AND CONCLUSION: Müller muscle conjunctival resection is an alternative procedure to external approach in patients with mild ptosis and good levator function. The algorithm used in this study resulted in a high success rate with high predictability.

9.Choroidal Thickness and its Correlations with Ocular Parameters in Primary Open-angle Glaucoma
Bunyamin Kutluksaman, Guliz Fatma Yavas, Sibel Inan, Mustafa Dogan, Umit Ubeyt Inan
doi: 10.14744/bej.2019.86570  Pages 179 - 189
INTRODUCTION: To evaluate the relationships between macular choroidal thickness (mCT) and ocular parameters, such as optic nerve head (ONH) and multifocal electroretinogram (mf-ERG) parameters, in cases with primary open-angle glaucoma (POAG).
METHODS: This controlled and prospective clinical trial included 49 patients with POAG diagnosed for the fırst time and 47 healthy participants. Macular CTs, ONH and mf-ERG parameters were measured, and the examination findings were recorded at baseline and follow-ups.
RESULTS: In the POAG group, the mean mCT was 254.92±37.65 μm at baseline, and it was 235.6±38.48 μm at 3-month and was 237.55±37.27 μm at 6-month. In the glaucoma group, there was a significant decrease in the first three months despite the treatment, but no significant change was observed in the next three months. In the healthy group, the mean mCTs were 287.78±26.77 μm, 285.48±25.58 μm and 285.02±27.44 μm at baseline, at 3-month and at 6-month, respectively. No significant change was observed in the control group throughout the process. However, the mean mCT values in the glaucoma group were significantly thinner in all controls compared to the healthy group (p<0.05). Furthermore, significant correlations were found between CT and some ONH, as well as mf-ERG parameters.
DISCUSSION AND CONCLUSION: The choroid can play an important role in the pathogenesis of glaucoma. Significant correlations in parameters support this relationship. We have observed that the glaucomatous effect initiated first in the inferior quadrant of ONH.

10.The Effects of Trabeculectomy on Ocular Pulse Amplitude in Patients with Glaucoma
Yalcin Karakucuk
doi: 10.14744/bej.2019.61687  Pages 190 - 195
INTRODUCTION: This study aimed to investigate whether trabeculectomy and its intraocular pressure (IOP)-lowering effect have an effect on ocular pulse amplitude (OPA) in glaucoma patients.
METHODS: Thirty-five consecutive patients with glaucoma (70 eyes) who had undergone unilateral first-time trabeculectomy between April and November 2012 were enrolled in this retrospective study. Patients with intraoperative or postoperative complications were excluded from this study. The eye that underwent trabeculectomy was considered the study eye; the fellow eye was used as the control eye. OPA and IOP were measured by Pascal dynamic contour tonometry (DCT), IOP was measured by Goldmann applanation tonometry (GAT), and systolic and diastolic blood pressure and heart rate were measured before and one month after trabeculectomy. The change in the pre- and postoperative values was compared between the two eyes.
RESULTS: The study sample included 17 male and 18 female patients with a mean age of 60.83±13.46 years. The mean preoperative GAT, DCT and OPA values in the study eyes were 24.97±8.26, 31.23±10.55 and 4.22±1.77 mmHg, respectively. One month after trabeculectomy, the GAT, DCT and OPA values were 12.83±4.35, 20.28±7.34 and 2.96±1.66 mmHg, respectively. There was a significant decrease in OPA after filtration surgery in the study eyes (p<0.001), but not in the control eyes (p>0.05). Changes in OPA were positively correlated with changes in IOP (p<0.05), and a significant association was found between OPA and IOP, and as measured by DCT (Regression coefficient = 0.093 [0.041–0.145]) and GAT (Regression coefficient = 0.093 [0.013–0.173]).
DISCUSSION AND CONCLUSION: There was a significant decrease in OPA in the eyes that underwent trabeculectomy, and the change in OPA after surgery was significantly different in the study eyes in comparison to the change in OPA in the control eyes. The OPA changes were strongly correlated with the IOP changes in the study eyes.

EXPERIMENTAL STUDY
11.Treatment of Corneal Alkali Burn with Chestnut Honey, Royal Jelly, and Chestnut Honey-Royal Jelly Mixture
Kursat Atalay, Kubra Serefoglu Cabuk, Ahmet Kırgız, Aysel Kara Caglar
doi: 10.14744/bej.2019.29290  Pages 196 - 201
INTRODUCTION: The alkaline burn of the cornea usually results in a decreased vision with opacification. In this study, we investigated the potential role of endemic chestnut honey (CH) and royal jelly on corneal healing after an alkaline burn.
METHODS: We created an alkaline burn on the center of the corneas of four groups of Wistar rats by applying round filter paper soaked with 1 N NaOH for 30 seconds. The animals were treated with RJ, CH, RJ-CH combination and Na-Hyaluronate (Na-HA) eye drops. We performed a serial evaluation with anterior segment photography on the first, 7th, and 14th days of the experiment. Pathologic examination conducted with hematoxylin and eosin stains and immunostaining for SMA and α4β1 integrin. We evaluated the corneal healing process with a scoring system, which was estimating the degree of corneal edema, the size of the corneal ulcer, and limbal hyperemia.
RESULTS: There was no statistically significant difference between groups on the first, 7th, and 14th days concerning the healing scores (p=0.88, p=0.06, p=0.80, respectively). However, there were significantly better scores in the repeated measures of CH (p=0.012) and RJ-CH (p=0.00) groups. The RJ group and Na-HA group did not show a significant difference in repeated measures (p=0.19 and p=0.10, respectively). The α4β1 integrin levels on immunostaining showed a significant difference among groups on the 14th day (p=0.002).
DISCUSSION AND CONCLUSION: We found better corneal healing after treatment with the RJ-CH containing eye drops concerning corneal healing sore and α4β1 integrin staining.

CASE REPORT
12.Dural Carotid-cavernous Fistula Mimicking Thyroid Orbitopathy
Aysel Pelit, Mehmet Serdar Dervişoğulları, Çağatay Andiç, Veli Nusret Özdemir
doi: 10.14744/bej.2019.77487  Pages 202 - 205
In this study, we aim to present a case with dural carotid-cavernous fistula mimicking thyroid orbitopathy. The differential diagnosis of red-eye is very complex, and the caregiver should distinguish between all diagnoses.

13.Performing Corneal Collagen Cross-linking after Radial Keratotomy in a Patient with Keratoconus: Case Report
Mehmet Ozgur Cubuk, Kamil Bilgihan
doi: 10.14744/bej.2019.79653  Pages 206 - 209
To present a case with progressive keratoconus after treated with radial keratotomy (RK) and was undergone corneal collagen cross-linking (CXL) for preventing the progress of keratectasia.
A progressive keratoconus case who was previously treated with RK was undergone corneal collagen cross-linking (CXL) in her left eye for preventing the progress of keratectasia. After the CXL procedure performed at another clinic, best-corrected visual acuity (BCVA) of her left eye decreased from 0.9 to 0.6 Snellen lines in an 8-months follow-up. Pre CXL maximum keratometric power (P-Kmax) was also increased from 52.1 to 57.16 Diopter (D) in the eight months after CXL.
Applying CXL on the keratoconic patient previously treated with RK should be questioned.

14.Bacterial Conjunctivitis Accompanying Spontaneous Subconjunctival Abscess
Saadet Gültekin Irgat, Fatih Ozcura
doi: 10.14744/bej.2019.72691  Pages 210 - 212
Subconjunctival abscess is a rare form of ocular infections. Subconjunctival abscesses often develop in the eyes with previous surgery or trauma. It is extremely rare in patients without surgery or trauma. In this study, we aimed to present a rare case of subconjunctival abscesses associated with spontaneous bacterial conjunctivitis. The patient was admitted to the hospital with complaints of redness, swelling and burning in two eyes. He said he used antibiotic drops for about a week, but his complaints did not decline. A subconjunctival abscess was detected in the right eye. There was no history of previous ocular surgery and trauma. Abscess drainage and subconjunctival antibiotic injection were performed. Oral and topical antibiotics were prescribed. There was no growth in culture. The third week was a complete recovery. In conclusion, spontaneous subconjunctival abscess formation should be considered in the differential diagnosis in unhealed eyes after bacterial conjunctivitis.

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