ISSN: 2459 - 1777 | E-ISSN 2587-0394
Beyoglu Eye Journal - Beyoglu Eye J: 5 (2)
Volume: 5  Issue: 2 - 2020
INVITED REVIEW
1.Importance of Müller Cells
Sabiha Gungor Kobat, Burak Turgut
doi: 10.14744/bej.2020.28290  Pages 59 - 63
Müller cells (MCs) are the most common glial cell found in the human retina. MCs have an important role in architectural and metabolic functions in the retina. Additionally, there has been consideration that MC dysfunction might contribute to the pathogenesis of some retinal diseases, such as proliferative vitreoretinopathy, diabetic retinopathy, macular edema, retinal vein occlusion, macular telangiectasia type 2, age-related macular degeneration, retinal degeneration, hepatic and methanol-induced retinopathy, and glaucoma. This review is a summary of the functions of MCs and a discussion of the importance of these glial cells.

ORIGINAL ARTICLE
2.Effects of Topical Nepafenac and Fluorometholone on Macular Thickness After Posterior Capsulotomy Using Neodymium-doped Yttrium-Aluminum-Garnet Laser
Cemile Ucgul Atilgan, Pinar Kosekahya, Esat Yetkin, Mehtap Caglayan, Yasin Sakir Goker, Selam Yekta Sendul
doi: 10.14744/bej.2020.96158  Pages 64 - 72
INTRODUCTION: The aim of this study was to assess the effects of topical 0.1% nepafenac and 0.1% fluorometholone on macular thickness (MT) after a neodymium: yttrium-aluminum-garnet (Nd: YAG) laser posterior capsulotomy and to compare the findings with those of untreated patients.
METHODS: This prospective study included 75 eyes of 75 patients with posterior capsule opacification. The patients were divided into 3 groups according to the medications administered after a capsulotomy procedure. Group 1 comprised 25 patients who were prescribed 0.1% nepafenac for a week, Group 2 consisted of 25 patients who were prescribed 0.1% fluorometholone for a week, and Group 3 consisted of 25 patients who were not prescribed any medication. A circular-shaped capsulotomy was performed in all cases. MT was measured before the capsulotomy and at the first day, first week, and first month after the procedure using spectral domain-optical coherence tomography and the change values were compared within and between groups.
RESULTS: In Group 1, the superior and nasal parafoveal MT, temporal, and nasal perifoveal MT values at the first month were statistically significantly greater than those observed in the first week (p<0.05 for all values). In Group 2, the superior and nasal parafoveal MT and inferior perifoveal MT measurements in the first month were greater than those recorded the first week (p<0.05 for all values). In Group 3, there was a gradual increase seen in the first day, first week, and first month in the superior and temporal parafoveal MT value (p<0.05 for all). The change value in the parafoveal temporal quadrant was significant between groups, indicating a greater increase in the untreated group compared with the nepafenac and fluorometholone groups (p=0.04).
DISCUSSION AND CONCLUSION: An increase in MT can occur after an Nd: YAG laser posterior capsulotomy. Both topical 0.1% nepafenac and 0.1% fluorometholone can prevent this increase. The 2 drugs were comparable; neither demonstrated apparent superiority to the other.

3.Ocular and Systemic Results of Intravitreal Bevacizumab Injection in Retinopathy of Prematurity Treatment
Sadik Gorkem Cevik, Mediha Tok Cevik, Irfan Perente
doi: 10.14744/bej.2020.46855  Pages 73 - 80
INTRODUCTION: The aim of this study was to evaluate the effectiveness and safety of an intravitreal bevacizumab injection (IVB) in the treatment of retinopathy of prematurity (ROP).
METHODS: The medical records of patients who had received IVB treatment for ROP between January 2014 and October 2018. Anatomical and functional outcomes were evaluated. The Denver II Developmental Screening Test was administered and fluorescein angiography (FA) was performed in some cases.
RESULTS: Thirty-eight eyes of 19 infants were included in the study. An IVB injection was administered to 9 infants with aggressive posterior ROP (APROP) disease (Group 1), 6 infants with any stage ROP with plus disease in zone I (Group 2), and 4 infants with stage 2-3 ROP with plus disease in zone II (Group 3). Complete retinal vascularization was observed in 24 eyes of 12 infants who received a single dose of bevacizumab without any additional treatment. Recurrence of the disease was observed in 12 eyes of 6 infants diagnosed with APROP and laser photocoagulation was performed. FA was performed to 5 IVB patients whose parents approved the procedure. The Denver II Developmental Screening Test was administered to all of the participants, and the test outcomes were consistent with the corrected age of the children, though 2 infants demonstrated a developmental delay in gross motor development tasks. Overall, good anatomical and functional results were obtained.
DISCUSSION AND CONCLUSION: IVB is an effective and relatively safe treatment modality for infants with ROP; however, prospective studies are required to provide more detailed information about systemic side effects.

4.Evaluation of Central Macula, Retinal Nerve Fiber Layer, and Ganglion Cell Complex Thickness in Congenital Color Vision Deficiency
Ercan Ozsoy, Fatih Celik, Nagehan Can, Elif Yusufoglu, Dogukan Comerter
doi: 10.14744/bej.2020.83703  Pages 81 - 85
INTRODUCTION: This study was designed to evaluate the thickness of the central macula, the retinal nerve fiber layer (RNFL), and the ganglion cell complex (GCC) in individuals with congenital red-green color vision deficiency (CVD) using spectral-domain optical coherence tomography (SD-OCT).
METHODS: This study included 22 males with a red-green CVD (Group 1) and 22 males with normal color vision (Group 2). The Ishihara test was used to determine CVD. SD-OCT was used to evaluate the central macula, RNFL, and GCC measurements of all of the study participants. The quantitative data of the 2 groups were compared. The Kruskal-Wallis test was used for the statistical analysis and a p value <0.05 was considered significant.
RESULTS: The mean central macula thickness observed in Group 1 and 2 was 255.00±25.50 μm and 248.95±24.70 μm, respectively. The mean RNFL thickness of Group 1 and 2 was 110.66±14.70 μm and 109.49±9.90 μm, respectively, and the mean GCC thickness of Group 1 and 2 was 97.70±10.80 μm and 97.56±5.10 μm, respectively. There were no significant differences between the groups in the assessment of the central macula, RNFL, or GCC thickness (p=0.20, p=0.34, p=0.37).
DISCUSSION AND CONCLUSION: The results of this study suggested that congenital red-green CVD does not affect the thickness of the central macula, RNFL, or GCC. To the best of our knowledge, this is the first study to evaluate the thickness of the GCC in individuals with congenital red-green CVD.

5.Static and Dynamic Pupil Characteristics in Myopic Anisometropic Amblyopia
Hasan Kiziltoprak, Kemal Tekin, Esat Yetkin, Mehmet Ali Sekeroglu
doi: 10.14744/bej.2020.08760  Pages 86 - 92
INTRODUCTION: The purpose of this study was to compare static and dynamic pupillometry measurements in patients with myopic anisometropic amblyopia with those of age-matched, healthy subjects.
METHODS: This prospective, cross-sectional study consisted of 29 patients with myopic anisometropic amblyopia and 83 control subjects. While both the amblyopic eye and the fellow eye of patients with myopic anisometropic amblyopia were examined, data were only recorded for the right eye of the subjects in the control group. Static pupillometry measurements determined included the scotopic pupil diameter (PD), mesopic PD, low photopic PD, and high photopic PD. Subsequently, dynamic pupillometry measurements were obtained, including the resting diameter, amplitude of pupil contraction, latency of pupil contraction, duration of pupil contraction, velocity of pupil contraction, latency of pupil dilation, duration of pupil dilation, and velocity of pupil dilation.
RESULTS: In the myopic anisometropia patients, there was a statistically significant difference in the low photopic PD and high photopic PD values of the amblyopic eyes and the corresponding fellow eyes compared with the healthy subjects (p<0.05 for each). These parameters of low photopic PD and high photopic PD were similar between the highly myopic eyes and the fellow eyes. There was no statistically significant difference in the mesopic or scotopic PD values between any of the groups (p>0.05 for each). There were no significant differences in the dynamic pupillometric measurements between the study and control eyes.
DISCUSSION AND CONCLUSION: These results confirm that amblyopia is a binocular disorder. The dynamic pupillary responses were similar in the highly myopic and fellow eyes, indicating that evaluation of relative afferent pupillary defects may not be a useful test to differentiate amblyopic eyes from healthy corresponding eyes.

6.Inner Retinal Layer Disease: Multiple Sclerosis
Mehmet Cem Sabaner, Resat Duman, Rahmi Duman, Ersan Cetinkaya, Kenan Yigit, Hayri Demirbas
doi: 10.14744/bej.2020.65982  Pages 93 - 101
INTRODUCTION: This study was an analysis of the retinal layer thickness in multiple sclerosis (MS) patients using spectral-domain optical coherence tomography (SD-OCT).
METHODS: A total of 42 patients diagnosed in the neurology clinic with MS according to the McDonald Criteria and 21 healthy individuals were included in the study and 4 groups were created. The first group comprised 21 eyes of 21 MS patients without eye involvement, the second group was made up of 21 eyes of 21 MS patients with a history of optic neuritis, the third group included the other eye of patients in the second group without a history of optic neuritis, and the fourth group was a control group of 21 eyes of 21 healthy individuals. SD-OCT was used to visualize and measure the retinal layers and the thickness was analyzed using the device software.
RESULTS: The mean age of the patient groups was 35.39±7.52 years, while it was 32.86±2.60 years in the control group. The mean duration of the disease was 9.81±6.65 years with a mean of 4.84±2.38 attacks. The ganglion cell layer (GCL) and the inner plexiform layer (IPL) of all of the patients were thinner compared with the control group in the parafoveal and perifoveal areas. All regions of the retinal nerve fiber layer (RNFL) of patients in the second group were thinner than those of the control group. The RNFL, GCL, and IPL in the central, parafoveal and perifoveal macular rings in group 3 were thinner than the group 1 measurements; however, this difference was not statistically significant. Although the RNFL, GCL, and IPL layer thicknesses were lower in group 2 than group 3, only the difference in the parafoveal GCL thickness was statistically significant.
DISCUSSION AND CONCLUSION: This study demonstrated that MS affects retinal layer thickness, and particularly the inner retinal layers.

7.Serum Vitamin D Level and Body Mass Index in Children with Vernal Keratoconjunctivitis
Gonul Karatas Durusoy, Yalcin Karakucuk, Beril Tulu Aygun, Banu Solmaz
doi: 10.14744/bej.2020.75047  Pages 102 - 107
INTRODUCTION: The purpose of this study was to evaluate the body mass index (BMI) value and serum 25-hydroxyvitamin D [25(OH)D3] level in children with vernal keratoconjunctivitis (VKC).
METHODS: A total of 40 healthy, non-atopic children (control group) and 46 children with VKC (study group) were included in the study. The serum vitamin D [25(OH)D3] levels and BMI values were measured and compared between the 2 groups.
RESULTS: The mean vitamin D level measured in the healthy children (mean: 19.01±5.66 ng/mL, range: 9–33.09 ng/mL) was significantly different from the mean vitamin D level in the VKC-affected children (mean: 14.06±5.02 ng/mL, range 4.37–31 ng/mL) (p<0.001). The mean BMI in the VKC group (17.1±2.5 kg/m2) was significantly higher than the mean BMI of the healthy children (mean: 16.5±2.3 kg/m2; p=0.046). A negative correlation (Spearman’s rho=-0.275; p=0.01) was observed between the vitamin D level and the BMI value.
DISCUSSION AND CONCLUSION: The results indicated that children with VKC had a lower serum vitamin D level and a higher BMI value compared with healthy, age- and sex-matched children.

8.Comparison of Toric Intraocular Lens Alignment Using Image-Guided System and Manual Marking Technique
Bulent Kose, Hakika Erdogan
doi: 10.14744/bej.2020.40427  Pages 108 - 113
INTRODUCTION: The aim of this study was to compare the accuracy of an image-guided system (Callisto eye; Carl Zeiss, Oberkochen, Germany) with the manual marking technique in the positioning of a toric intraocular lens (IOL).

METHODS: A total of 80 eyes of 80 patients who underwent cataract surgery with a monofocal, single-piece, hydrophobic, biconvex, toric, aspheric IOL (Acrysof IQ SN6AT, Alcon Laboratories, Inc., Fort Worth, TX, USA) implantation were included. Before surgery, all of the patients underwent a complete eye examination that included evaluation of uncorrected (UCVA) and corrected distance visual acuity (CDVA), spherical equivalent (SE), astigmatic refraction (AR), keratometry, biometry, as well as meridian registration with the IOLMaster 700 (Carl Zeiss, Oberkochen, Germany), slit lamp examination, intraocular pressure measurement, and dilated retinal examination. The diopter of the toric IOL was calculated with an online calculator (Alcon, Fort Worth, TX, USA). At 3 months post surgery, the UCVA, CDVA, SE, and residual astigmatism were recorded, and the pupils of all of the patients were fully dilated to determine the toric IOL marker positions.
RESULTS: Group 1, the Callisto eye system group, comprised 45 eyes, and Group 2, the manual marking technique group, was composed of 35 eyes. The preoperative values of both groups were statistically similar in terms of the SE, corneal cylinder, axial length, logMAR UDVA, and logMAR CDVA. At postoperative 3 months, there were no significant differences between the 2 groups in the logMAR UDVA, logMAR CDVA, degree of misalignment of toric IOL, or mean deviation from target-induced astigmatism values. The mean deviation degree from the intended axis was 2.04±1.84 in the Callisto eye system group (Group 1) and 3.24±2.64 in the manual marking technique group (Group 2). However, this difference did not have any effect on the logMAR UDVA.
DISCUSSION AND CONCLUSION: The image-guided markerless system was found to be as effective as manual marking in the positioning of toric IOLs.

9.Evaluation of Demographic Features of Eyelid Lesions
Korhan Fazil, Safak Karslioglu, Muslime Akbaba, Ibrahim Bulent Buttanri, Didem Serin, Gamze Ozturk Karabulut, Damla Bektasoglu
doi: 10.14744/bej.2020.53824  Pages 114 - 117
INTRODUCTION: This study was an evaluation of demographic and histopathologic features of eyelid lesions.
METHODS: The medical records of 261 patients (296 eyelid lesions) who attended a single clinic between 1997 and 2011 were examined retrospectively. The incidence of benign and malignant lesions, the pathological classification, and age and sex data were investigated.
RESULTS: A total of 204 benign lesions (68.9%) and 92 malignant neoplasms (31.1%) were found. Among these, the most frequently seen types of benign neoplasms were xanthelasma (28.4%), papilloma (14.7%), chalazion (8.8%), nevus (6.4%), moll cyst (5.9%), and capillary hemangioma (4.9%). The most frequently seen malignant neoplasms were basal cell carcinoma (72.8%), squamous cell carcinoma (13%), and sebaceous gland carcinoma (5.4%). The study group was made up of 149 (57%) female patients and 112 (43%) male patients. The majority of benign lesions were seen in women, whereas malignant neoplasms were observed more often in male patients. The mean age of patients with benign lesions and malignant neoplasms was 38.1±21.7 and 62.7±15.3 years, respectively. Benign lesions involved the upper eyelid more frequently than the lower, while malignant lesions were seen more frequently in the lower eyelid, with the exception of sebaceous gland carcinoma.
DISCUSSION AND CONCLUSION: The majority of eyelid lesions were benign and malignant neoplasms were seen more frequently in the older population. Basal cell carcinoma was the most common malignant eyelid tumor. The most common site of malignant tumor origin was the lower eyelid, with the exception of sebaceous gland carcinoma.

10.Evaluation of the Long-term Effect of Ethambutol Usage on the Retinal Nerve Fiber Layer Using Spectral-Domain Optical Coherence Tomography
Gul Varan, Leyla Hazar, Ahmet Sahin
doi: 10.14744/bej.2020.96658  Pages 118 - 121
INTRODUCTION: The aim of this study was to use spectral-domain optical coherence tomography (SD-OCT) to evaluate the long-term effect of ethambutol on the optic nerve fiber layer.
METHODS: Twenty eyes of 10 patients who had been treated with ethambutol for tuberculosis were retrospectively evaluated. Retinal nerve fiber layer (RNFL) analyses performed initially and about 2 years after the end of treatment were included in the study. Data of visual acuity, fundus examination, other diseases, and drug use history of all of the participants were evaluated. Color vision was tested with the Ishihara Color Test. Superior, inferior, nasal, and temporal quadrant RNFL parameters were evaluated using SD-OCT.
RESULTS: The mean age of the 10 patients was 38.77±14.86 years. There were 6 males and 4 females in the group. The mean length of follow-up was 4.44±1.94 months (range: 2-8 months). The mean RNFL result of the analysis performed 2 years after discontinuation of ethambutol treatment was superior RNFL: 122.45±18.64 µ, inferior RNFL: 131.40±13.31 µ, temporal RNFL: 71.60±8.53 µ, and nasal RNFL: 81.70±9.73 µ. There was significant thinning in the temporal quadrant (p<0.05).
DISCUSSION AND CONCLUSION: Long-term use of ethambutol caused thinning in the RNFL. SD-OCT is useful in the follow-up of these patients.

11.Histopathological Evaluation of Pterygium Patients with Type 2 Diabetes Mellitus
Ozgur Erogul, Leyla Eryigit Erogul, Nilay Sen Korkmaz, Fatih Celik, Mustafa Dogan, Hamidu Hamisi Gobeka
doi: 10.14744/bej.2020.43434  Pages 122 - 128
INTRODUCTION: The aim of this study was to histopathologically compare patients with and without diabetes mellitus who underwent pterygium excision.
METHODS: In this retrospective case-control study, 60 patients with a history of pterygium excision were divided into 2 groups: those with DM and those without DM. Histopathological findings (squamous metaplasia, dysplasia, inflammation, fibrinoid changes, and vascularization) were compared.
RESULTS: The mean age of the 60 patients (females, 54.5%) included in the study was 58.6±12.8 years. The mean age was 53.7±13.7 years in the patients with DM and 63.6±9.6 years in the patients without DM. There were no significant differences in the excised pterygium tissues in terms of squamous metaplasia, dysplasia, fibrinoid changes, inflammation, or vascularization.
DISCUSSION AND CONCLUSION: There was no histopathological difference in the pterygium tissue in patients with DM.

12.Results of Intravitreal Anti-VEGF Injection in Choroidal Neovascularization Caused by Pathologies Other Than Age-Related Macular Degeneration
Mehmet Ozveren
doi: 10.14744/bej.2020.30316  Pages 129 - 134
INTRODUCTION: The aim of this retrospective study was to evaluate the efficacy of the intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents to treat choroidal neovascularization (CNV) caused by a pathology other than exudative type age-related macular degeneration (AMD).
METHODS: This was a retrospective study of 43 treatment naive eyes of 35 patients who had been diagnosed with CNV caused by a pathology other than exudative- type AMD and who underwent intravitreal injection of anti-VEGF agents. Primary and secondary outcome measures were the best corrected visual acuity (BCVA) and the central macular thickness (CMT).
RESULTS: The mean patient age was 44.6±13.1 years. The mean number of injections was 3.3±1.8. The mean logarithm of minimal angle of resolution BCVA at baseline and the 12th month follow-up was 0.89±0.50 and 0.73±0.57, respectively (p=0.120). In all, 44.2% of the eyes gained ≥15 letters of BCVA, whereas 14% lost ≥15 letters of BCVA. The mean CMT at baseline and the 12th month follow-up was 381±121 and 311±73 microns, respectively (p=0.001).
DISCUSSION AND CONCLUSION: Stabilized functional and improved anatomic outcomes following intravitreal anti-VEGF agent injection for CNV unrelated to AMD were seen at the 12th month of follow-up.

13.Evaluation of Clinical Findings, Optical Coherence Tomography, Fundus Fluorescein Angiography, and Indocyanine Green Angiography Imaging in Patients with Polypoidal Choroidal Vasculopathy
Ruveyde Garip, Dilek Yasa, Abdullah Ozkaya
doi: 10.14744/bej.2020.08379  Pages 135 - 141
INTRODUCTION: The aim of this study was to describe clinical findings as well as spectral-domain optical coherence tomography (SD-OCT), fundus fluorescein angiography (FA), and indocyanine green angiography (ICGA) findings of polypoidal choroidal vasculopathy (PCV).
METHODS: This retrospective, observational case series included 144 eyes of 103 patients who were diagnosed with PCV between January 2014 and August 2016. Best corrected visual acuity, 90-diopter lens slit-lamp fundus biomicroscopy examination findings, color fundus photography, SD-OCT, FA, and ICGA findings were evaluated at the time of diagnosis.
RESULTS: Sixty-six patients (93 eyes, 64.1%) were male and 37 (51 eyes, 35.9%) were female. Sixty-two (60.2%) patients had unilateral involvement. The most common SD-OCT finding was retinal pigment epithelial detachment (PED). Red-orange subretinal lesions were seen in 20 eyes (13.9%). There was a single polyp in 21 (14.6%) eyes, and more than 1 polyp in 123 (85.4%) eyes observed with ICGA imaging. The polyps were located in the peripapillary area in 10 (6.9%) eyes, the macular area in 91 (63.2%) eyes, and the extramacular area in 1 (0.7%) eye. A significant branching vascular network was seen in the ICGA images of 112 (77.8%) eyes.
DISCUSSION AND CONCLUSION: In this study, the majority of patients were male, with unilateral macular polyps. A serous PED and an exudative pattern were the most common clinical manifestations. SD-OCT showed specific findings for PCV, but ICGA was the most useful test for diagnosis.

CASE REPORT
14.Isolated Superior Ophthalmic Vein Thrombosis Associated with Orbital Cellulitis: Case Report
Zeynep Ozer Ozcan, Alper Mete
doi: 10.14744/bej.2020.37450  Pages 142 - 145
Superior ophthalmic vein thrombosis (SOVT) is a rare clinical entity that may be associated with sino-orbital disease. The clinical presentation of SOVT may include signs of venous congestion, such as unilateral ptosis, chemosis, ophthalmoplegia, and eyelid swelling, with or without fundus findings. This case report describes a case of SOVT associated with orbital cellulitis diagnosed with magnetic resonance imaging and treated using anticoagulant therapy, antibiotherapy, and a corticosteroid. In the presence of orbital cellulitis, clinicians should always keep the possibility of SOVT in mind, as it may result in mortality and visual loss if not diagnosed early and given appropriate treatment without delay.

15.Valsalva Maculopathy Associated with a Sudden, Forceful Shout
Bengi Ece Kurtul, Ahmet Elbeyli, Sait Coskun Ozcan
doi: 10.14744/bej.2020.16878  Pages 146 - 148
Valsalva maculopathy (VM) induced by the Valsalva maneuver may cause a sudden, painless, and dramatic loss of vision in healthy individuals due to a premacular location of the hemorrhage and rupture of retinal capillaries. The prognosis is generally good. The hemorrhage usually clears spontaneously without any treatment. Presently described are clinical findings from a case evaluated as VM resulting from a sudden, forceful shout during a quarrel. A 43-year-old female was admitted to the clinic with a 1-day history of sudden, painless loss of vision in the right eye after sudden, strong shout during an argument. There was no history of trauma or any systemic disease. On examination, the visual acuity was finger count at 1 meter in her right eye, and a central subhyaloid and subinternal limiting membrane premacular hemorrhage was noted. Her intraocular pressure values were 14 mmHg in the right eye and 13 mmHg in the left eye. Her blood pressure measurement was 130/80 mmHg. At 1 month, her vision had improved to 20/25 (LogMAR 0.10) and there was resolution of the hemorrhage without treatment. Although VM is considered to be rare, the events and activities with which it is associated are relatively common in daily life. A sudden, forceful shout and Valsalva stress can lead to dangerous, sudden vision loss due to a premacular hemorrhage.

16.Xerophthalmia: Findings from the Eye Lead to Diagnosis of a Fatal Intestinal Disease
Beril Tulu Aygun, Burcin Kepez Yildiz, Deniz Ogutmen Koc, Yusuf Yildirim
doi: 10.14744/bej.2020.93063  Pages 149 - 152
Vitamin A has an essential role in the maintenance of corneal and conjunctival epithelization, as well as photoreceptor transduction in the retina. A deficiency of vitamin A causes keratinization of the surface epithelium, and night blindness is often the first symptom. This report describes a case of chronic intestinal pseudo-obstruction (CIPO), a rare and potentially fatal disease, diagnosed following detection of a vitamin A deficiency in an ophthalmological examination. A 25-year-old female patient presented with a 3-month history of dryness, a burning sensation, and decreased vision, especially at night, in both eyes. She appeared cachectic and ill, and reported having lost 10 kg in the previous year. An ophthalmological examination revealed conjunctival and corneal keratinization in addition to punctate keratopathy with xerosis in both eyes, which raised the suspicion of a vitamin A deficiency. Her serum vitamin A level confirmed the diagnosis, and she was referred to the gastroenterology clinic, where she was diagnosed with CIPO and treated with parenteral multivitamin supplementation. A vitamin A deficiency should be suspected in patients with malnourishment and xerosis. Rapid diagnosis and treatment can be life-saving in cases with a severe underlying pathology.

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