ISSN: 2459 - 1777 | E-ISSN 2587-0394
Beyoglu Eye Journal - Beyoglu Eye J: 5 (1)
Volume: 5  Issue: 1 - 2020
ORIGINAL ARTICLE
1.Results of Callisto Eye System in Toric Intraocular Lens Alignment
Bulent Kose, Sinan Albayrak
doi: 10.14744/bej.2020.86547  Pages 1 - 4
INTRODUCTION: This study was an evaluation of the effectiveness of the Callisto eye image-guided, markerless system (Carl Zeiss Meditec AG, Jena, Germany) in toric intraocular lens (IOL) positioning.
METHODS: The results of a novel, markerless, alignment system used for IOL positioning were analyzed in this retrospective study. Preoperatively, reference image registration was performed with the IOLMaster 700 biometer (Carl Zeiss Meditec AG, Jena, Germany) and transferred to the Callisto eye system, which was used in conjunction with an Opmi Lumera 700 microscope (Carl Zeiss Meditec AG, Jena, Germany). Using the Callisto Z Align technology, a toric IOL was aligned precisely with the steep axis. One day after surgery, the pupil was fully dilated and a thin slit was placed on the marker of the toric IOL and the angle was measured using an axis calculator smartphone application. The degree of the measured angle and the preoperatively determined angle were compared.
RESULTS: Sixty eyes of 46 patients were included. The difference in the absolute angle between the intended and the postoperative (at day 1) axes was a mean of 2.71±1.64°.
DISCUSSION AND CONCLUSION: The Callisto eye image-guided, markerless system successfully provided assistance in precisely positioning the toric IOL.

2.Ultrasound Biomicroscopic Evaluation of Anterior Segment Parameters and Surgical Area Following Trabeculectomy Surgery
Cem Kesim, Nese Alagoz, Banu Solmaz, Cigdem Altan, Berna Basarir, Muhittin Taskapili
doi: 10.14744/bej.2020.14622  Pages 5 - 11
INTRODUCTION: This study used ultrasound biomicroscopy (UBM) imaging to evaluate the anterior segment structure and surgical area of patients with open angle glaucoma following a trabeculectomy procedure.
METHODS: Consecutive patients with primary open angle or pseudoexfoliative glaucoma who underwent a trabeculectomy were included. UBM was used to examine the anatomical parameters of anterior chamber depth, anterior chamber angle, angle opening distance at 500 µm (AOD500), trabecular ciliary process distance (TCPD), iris ciliary process distance, scleral ciliary process angle (SCPA), and ciliary process thickness, as well as the internal ostium opening, ostium-iris distance, and scleral flap dimensions. Bleb morphologies were evaluated qualitatively using the Yamamoto classification and quantitatively according to the presence of drainage from the medial, lateral, and posterior borders.
RESULTS: Twenty-five eyes of 23 patients (4 female, 19 male) were included in the study. The TCPD and SCPA measurements were significantly greater in the postoperative third month (1.04±0.12 mm vs 1.09±0.16 mm, p<0.05; 58.6±3.9° vs 60.8±3.8°, p<0.05, respectively). Cases with a longer ostium-iris distance had a significantly greater AOD500, TCPD, and SCPA (p<0.05). Bleb drainage and morphological classification were correlated (p=0.001).
DISCUSSION AND CONCLUSION: UBM is a sound and efficient method to investigate anterior segment variations and the surgical bleb following a trabeculectomy. TCPD and SCPA values increased after surgery.

3.Outcomes of a Dispersive Ophthalmic Viscosurgical Device
Banu Acar, Żsil Merve Torun, Suphi Acar
doi: 10.14744/bej.2019.09609  Pages 12 - 16
INTRODUCTION: The aim of this study was to evaluate clinical outcomes related to the protection of corneal endothelial cells and the safety of the Bio-Hyalur CS (Biotech Healthcare Group, Luzern, Switzerland) ophthalmic viscosurgical device (OVD) in routine cataract surgery.
METHODS: Patients who had undergone cataract surgery using Bio-Hyalur CS as an OVD and who had at least 3 months of follow-up data were included in the study. Endothelial cell density (ECD) and morphology (hexagonality, area, and coefficient of variation in cell size) as well as intraocular pressure were evaluated during 3 months of follow-up. Intraoperative and postoperative complications were recorded.
RESULTS: Sixty eyes of 44 patients were included in the study. The mean preoperative ECD was 2383.5±288.67 cells/mm2. The mean postoperative ECD was 2186.0±359.65 cells/mm2 and 2149.7±354.49 cells/mm2 at 1- and 3-month visits, respectively. The mean coefficient of variation in cell size was 29.1±5.04% and 30.9±5.79% at preoperative and postoperative 3-month visits, respectively. The mean cell area was 426.1±52.59 µm2 and 476.6±122.26 µm2 at preoperative and postoperative 3-month visits, respectively. No adverse events were reported during the study period.
DISCUSSION AND CONCLUSION: Bio-Hyalur CS provided good endothelial protection and has a favorable safety profile. However, comparative studies with other OVDs are necessary.


4.Early Ophthalmic Artery Blood Flow Parameter Changes in Patients with Type 1 Diabetes Mellitus
Serdar Ozates, Betul Emine Derinkuyu, Ufuk Elgin, Meliksah Keskin, Nursel Muratoglu Sahin, Zehra Aycan
doi: 10.14744/bej.2020.15238  Pages 17 - 21
INTRODUCTION: The aim of this study was to assess initial changes in blood flow parameters of the ophthalmic artery (OA) in pediatric patients with type 1 diabetes mellitus (DM).
METHODS: Sixty-three subjects were included in this prospective, cross-sectional, observational study. Thirty-one (49.2%) patients with type 1 DM without diabetic retinopathy formed the DM group. The control group comprised 32 (50.8%) healthy subjects. The OA of all of the patients was examined with Doppler ultrasonography. The main outcomes were peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI), and resistivity index (RI) measurements.
RESULTS: The mean age at onset of type 1 DM was 10.7±2.0 years and the mean duration was 11.4±11.0 months. The mean PSV and EDV outcomes in both eyes were significantly higher in the control group than in the DM group, whereas, the mean PI and RI outcomes in both eyes were significantly higher in the DM group (p<0.05). A mean RI of ≥0.75 indicated vascular hemodynamic changes associated with type 1 DM with a sensitivity of 72% and a specificity of 65% (area under the curve: 0.702; p=0.007). A mean PI of ≥1.69 predicted vascular hemodynamic changes associated with type 1 DM with a sensitivity of 79% and a specificity of 71% (area under the curve: 0.742; p=0.001).
DISCUSSION AND CONCLUSION: The results of this study revealed that disturbances in ocular hemodynamics might be present as early as the first year after a type 1 DM diagnosis. Changes in ocular hemodynamic parameters could be used to predict or screen for the development of vascular changes.

5.Long-Term Results in Transcanalicular Laser and External Dacryocystorhinostomy
Halil Ibrahim Yener, Muammer Ozcimen
doi: 10.14744/bej.2019.70299  Pages 22 - 25
INTRODUCTION: This study was an examination of the long-term results of transcanalicular laser (TCL) and external (EX) dacryocystorhinostomy (DCR).
METHODS: Patients who had undergone TCL-DCR or EX-DCR between 2009 and 2013 were invited for long-term follow-up in 2019. All of the patients who responded had an ophthalmic examination and were assessed using lacrimal irrigation. An intranasal evaluation was performed when the irrigation test had non-patent results. TCL procedures were performed with a diode laser (980 nm). Ostium cleansing with a suction unit and a nasal endoscope was performed in the first week. In EX-DCR procedures, an anterior flap was created and tented to the orbicularis oculi muscle. A silicon tube was implanted in both methods and removed at 4-6 months.
RESULTS: A total of 74 EX-DCR patients were assessed. The lacrimal irrigation test was negative in 5 cases. The functional success rate was 93.2% with a follow-up of 8 years. A total of 63 patients who had undergone TCL-DCR were evaluated and the irrigation test was negative in 9 patients. The functional success rate was 85.7% with a follow-up of 7 years. The difference in the success rate was statistically insignificant with a p value of 0.09.
DISCUSSION AND CONCLUSION: The long-term success rates of both EX-DCR and TCL-DCR were high.

6.Tear Film Functions and Dry Eye Symptoms in Young Patients with Pterygium
Erkut Kucuk, Ugur Yilmaz, Kursad Ramazan Zor
doi: 10.14744/bej.2019.18853  Pages 26 - 31
INTRODUCTION: This study was performed to evaluate the Schirmer II test (ST2) results, tear breakup time (TBUT) findings, and Ocular Surface Disease Index (OSDI) scores of pterygium patients under 30 years of age, and to compare the results with pterygium patients aged 30 years and older and healthy controls.
METHODS: Eighty-four eyes of 60 patients who had primary pterygium and were younger than 30 years of age (Group 1), 79 eyes of 53 patients who had primary pterygium and were 30 years of age and older (Group 2), and 64 eyes of 64 healthy controls (Group 3) were included in the study. The results of ST2 and TBUT tests and the OSDI questionnaire scores were recorded and compared.

RESULTS: Group 1 had lower TBUT values compared to Group 2 and the control group (p= 0.03 and p<0.001, respectively). Group 1 had lower ST2 values than the control group (p<0.001). There was no significant difference in the ST2 results between Group 1 and Group 2 (p=0.08). Group 1 had higher OSDI scores than the control group (p=0.003). There was no significant difference in the OSDI scores between Group 1 and Group 2 (p=0.7).
DISCUSSION AND CONCLUSION: The results indicated that young patients with pterygium had lower ST2 results, lower TBUT values, and higher OSDI scores compared to the control group, and lower TBUT values compared to older patients with pterygium. Tear film abnormality may be a factor in the pterygium pathogenesis, especially in young patients, and may increase the vulnerability of the ocular surface of young people to environmental factors, leading to pterygium formation.

7.Keratopigmentation: Is it a Miracle or an Adventure?
Melisa Zisan Karslioglu, Ayse Yildiz Tas, Cem Kesim, Afsun Sahin, Orkun Muftuoglu
doi: 10.14744/bej.2020.76476  Pages 32 - 37
INTRODUCTION: This study is an analysis of the cosmetic and functional results of patients who underwent keratopigmentation (KTP).
METHODS: Sixteen eyes of 16 patients, 7 females (43.75%) and 9 males (56.25%) were included in the study. Intrastromal and superficial manual KTP were performed under general anesthesia. Patients with no light perception or with only light perception but total corneal opacification, prosthetic contact lens intolerance, or unwillingness to use a contact lens were studied. The main outcomes were postoperative patient’s satisfaction, cosmetic results, pigment stabilization and surgical complications. A grading system (0-5 points) was used to assess patient satisfaction and the cosmetic results.
RESULTS: The mean age of the patients was 30.5±12.06 years (range: 16-53 years). Black pigment was used in 10 patients (62.5%), a brownish color in 5 patients (31.25%) and a greenish, yellow, blue, and black color pigmentation was used for 1 patient (6.25%). The mean follow-up was 29.31±15.45 months (range: 8-52 months). In 2 of 16 patients, mild to moderate pigment loss was seen 12 months after the surgery and superficial KTP was repeated. Minimal pigment loss was seen in 5 patients, but the cosmetic results were satisfactory and no secondary surgical procedure was required. Pigment leakage underneath the conjunctiva was seen in only 1 patient. Otherwise, there were no complications associated with keratopigmentation. The postoperative mean patient satisfaction score was 4.18±0.75 points (range: 3-5 points).
DISCUSSION AND CONCLUSION: KTP is a safe surgical procedure that is easy to learn and perform, does not require expensive materials, and avoids more extensive and invasive reconstructive ocular procedures. Corneal KTP may have a great impact on future ophthalmic surgical practice from both therapeutic and cosmetic perspectives.

8.Surgical Management of Primary Inferior Oblique Muscle Overaction: A Subgroup-Specific Surgical Approach
Ercan Ozsoy, Abuzer Gunduz, Emrah Özturk, Cem Cankaya
doi: 10.14744/bej.2020.81904  Pages 38 - 42
INTRODUCTION: The aim of this research was to assess the surgical results of recession and myectomy procedures in a subgroup of patients who had primary inferior oblique muscle overaction.
METHODS: The records of 94 patients who had been treated due to primary inferior oblique muscle overaction were retrospectively analyzed. The patients were classified into 2 groups according to the severity of the inferior oblique hyperfunction. Recession was performed for patients with a low grade (+1 or +2) inferior oblique hyperfunction, and patients with high grade (+3 or +4) hyperfunction underwent myectomy surgery. Patients demonstrating a horizontal misalignment underwent conventional horizontal muscle surgery along with an inferior oblique weakening procedure.
RESULTS: A total of 134 eyes fulfilled the inclusion criteria. Recession was performed in 95 eyes and myectomy in 39. Surgical success was obtained in 96.8% of the eyes that underwent recession and 97.4% of the eyes that underwent myectomy. Residual inferior oblique hyperfunction was observed in 3 eyes after recession and in 1 eye after myectomy. After surgery, about one-quarter of the patients with unilateral inferior oblique overaction subsequently developed a contralateral inferior oblique overaction.
DISCUSSION AND CONCLUSION: The results of this study demonstrated that both recession and myectomy procedures are effective for treating primary inferior oblique hyperfunction with minimal complications when applied in the appropriate patient.

9.The Efficacy of Single-Dose Intravitreal Dexamethasone Implant for Diabetic Macular Edema Refractory to Anti-VEGF Therapy: Real-Life Results
Mert Simsek, Mehmet Citirik, Serdar Ozates, Kemal Tekin, Dilara Ozkoyuncu
doi: 10.14744/bej.2020.06977  Pages 43 - 48
INTRODUCTION: To investigate the efficacy, safety, and side effect profiles of a single-dose intravitreal dexamethasone implant (IDI, Ozurdex) in patients with diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor (VEGF) therapy.
METHODS: This study included 101 eyes of 78 diabetic patients with DME that remained persistent despite administering at least six doses of anti-VEGF therapy. The patients were evaluated at baseline and were followed up monthly until the sixth month after the IDI injection. The primary outcomes were central foveal thickness (CFT) and best-corrected visual acuity (BCVA).
RESULTS: The mean number of anti-VEGF injection administered to patients was 6.50±0.33. One month after the last injection, the response to treatment was evaluated. IDI injection was performed approximately 1.14±0.08 months after the last anti-VEGF injection. After the IDI injection, BCVA value increased (p<0.001) and CFT value decreased (p<0.001). The peak effect of the IDI was observed in the second month after the injection. CFT values increased and BCVA values decreased from the beginning of the fourth month after the IDI injection. The recurrence rate of CFT elevation in the sixth-month follow-up was 57.4%. Moreover, we observed that high pre-injection CFT values were correlated with a high post-injection recurrence rate of CFT elevation (p<0.001).
DISCUSSION AND CONCLUSION: These findings suggest that the IDI injection significantly improves BCVA and CFT values in patients with DME refractory to anti-VEGF therapy. However, recurrence of CFT elevation may occur in >50% patients in the sixth month after the first injection.

CASE REPORT
10.Sterile Corneal Infiltrate Management After Corneal Crosslinking in Pediatric Keratoconus
Ayhan Saglik, Mehmed Ugur Isik
doi: 10.14744/bej.2020.65707  Pages 49 - 52
A 6-year-old female was admitted to the ophthalmology department with a preliminary diagnosis of keratoconus. An accelerated cross-linking (CXL) protocol (9 mW/cm2 in 10 minutes) was performed on the right eye. On postoperative day 2, a slit-lamp examination revealed 2 corneal infiltrates with grade 3 haze. Since there was no growth in the cultivated cultures and no response to topical antibiotic treatment, the infiltrates were considered to be sterile, and topical 1% prednisolone drops were applied hourly. Despite topical steroid treatment of 1% prednisolone on postoperative day 5, no significant improvement was observed in the patient's symptoms and slit-lamp findings. Therefore, systemic 1 mg/kg prednisolone (total dose, 15 mg) was added to the treatment on postoperative day 5. One day after initiating the systemic steroid treatment, the infiltrates had shrunk, and the patient's complaints decreased. In patients with keratoconus who are under 10 years of age, the addition of a potent steroid regimen to the treatment may be essential in cases with suspected infiltrates after CXL treatment.

11.Acanthamoeba Keratitis Associated with Scleral Contact Lens Use in a Keratoconus Patient
Mehmet Ozgur Cubuk, Kadriye Dogruman Al, Selma Usluca, Kamil Bilgihan
doi: 10.14744/bej.2019.99609  Pages 53 - 56
To the best of our knowledge, this is the second reported case of Acanthamoeba keratitis (AK) as a result of scleral lens use and the first case of AK associated with Maxim scleral lens use (Accu-Lens, Inc., Lakewood, CO, USA). A 22-year-old male scleral lens user presented at the department of ophthalmology at Gazi University Hospital complaining of painful corneal opacities and erosion in the cornea of right eye. A real-time polymerase chain reaction assay (Primerdesign, Southampton, UK) was performed, and Acanthamoeba spp. DNA was amplified on the corneal specimen. A topical antimicrobial treatment was prescribed, and the symptoms had improved significantly at the 2-week follow-up. Contact lens wearers always run the risk of developing AK, even with gas-permeable scleral contact lenses. Therefore, AK must be considered as an important differential diagnosis in patients who use scleral contact lenses.

12.Aripiprazole-Induced Acute Transient Bilateral Myopia: A Case Report
Yunus Bulgu, Selim Genc
doi: 10.14744/bej.2020.71677  Pages 57 - 58
Aripiprazole is an atypical, antipsychotic drug used for the treatment of schizophrenia, depression, bipolar disorder, and obsessive-compulsive disorder in adults. There are a few reports in the literature of ocular side effects of aripiprazole, such as transient myopia, diplopia, and acute angle closure. This report describes the case of a 34-year-old female patient who was referred to the clinic with painless blurred vision in both eyes. She had been diagnosed with major depression and had been using aripiprazole for a month. She experienced blurred vision after the first week of drug therapy. The uncorrected visual acuity (UCVA) was 4/10 in both eyes using a standard Snellen chart. She had a refractive error of -2.00 diopters and the best corrected visual acuity was 10/10 in both eyes. The ocular examination results were normal other than the refractive error. The patient was diagnosed with aripiprazole-induced, acute transient myopia. The UCVA was 10/10 in both eyes at the 2-week follow-up following termination of the aripiprazole therapy. It is important to be prepared to recognize aripiprazole-induced, acute transient myopia in patients complaining about blurred vision.

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