OBJECTIVES: The aim of this study was to investigate the effects of trifocal and monofocal intraocular lens with enhanced depth of focus implantations.
METHODS: Forty patients who had bilateral implantation of the trifocal or monofocal extended depth of focus (EDOF) intraocular lenses after phacoemulsification were included in the study. The pre-operative and post-operative examination findings were analyzed. At the 6th post-operative month, binocular defocus curves, contrast sensitivity measurements, subjective complaints, spectacles independence, and the quality of life questionnaire results of the visual function 14 questionnaire (VF-14) questionnaire were also examined.

RESULTS: While distance and intermediate visual acuities were similar at 6 months postoperatively, near visual acuities were found to be statistically significantly better in the trifocal group. The contrast sensitivity values were found to be statistically better in the EDOF group. In the trifocal group, 25% of the patients had low-intensity and 5% of the patients had moderate-intensity of photopic complaints, respectively, while 10% of the patients in the EDOF group had low-intensity photopic complaints. While spectacles independence could be achieved in all patients in the trifocal group, in the EDOF group, 80% of patients needed spectacles. When examining VF-14 test values without spectacles, it was found that the values of the trifocal group were significantly higher.

DISCUSSION AND CONCLUSION: Trifocal group performed better at near, although far and intermediate vision was comparable between the groups. On the other hand, a higher rate of photic phenomena was observed in the trifocal group.

OBJECTIVES: To reveal the clinical and refractive results of internal fixation surgery in patients who underwent intraocular lens (IOL) fixation.

METHODS: This retrospective study included 40 eyes of 40 patients (FM/M: 20/20) who have been operated for dislocated IOL in Balýkesir University, Faculty of Medicine. The demographic and clinical data were obtained from the files. The demographic data (age, sex, comorbidities, systemic treatment), the cause of IOL dislocation, primary surgery-dislocation duration, best-corrected visual acuity (BCVA) (decimals), objective refraction, spherical equivalent (SE), intraocular pressure (IOP), the status of centration, endothelial cell density (ECD), and complications were recorded. Pre-operative parameters compared with the final visit parameters as post-operative results.

RESULTS: The cause of dislocation was spontaneous in 80% of the patients, and trauma in 20%. The mean duration between cataract surgery and IOL dislocation was 33.2±39.6 months. The mean follow-up time was 19.8±8.3 months. The BCVA was improved from 0.12±0.21 to 0.73±0.33 (p=0.001), and IOP was changed from 17.6±3.2 to 17.9±2.9 mmHg (p=0.672) after surgery. The SE was decreased from 5.52±2.95 to −0.73±1.32 D (p=0.023), and the total astigmatism was decreased from 2.74±2.63 to 1.38±0.75 D (p=0.014) after surgery. ECD was increased from 1740.6±219.8 cell/mm2 to 1724.5±243.0 cell/mm2 (p=0.219). In the final visit, IOL was found centralized in 90% of patients through both miotic and mydriatic pupils. The post-operative complications were intravitreal hemorrhage in 2.5%, corneal edema in 7.5%, and ocular hypertension in 2.5%.

DISCUSSION AND CONCLUSION: Internal IOL fixation is a safe and reliable method in patients with dislocated IOLs, and it can be applied by fixating the dislocated IOL regardless of the haptic type. Post-operative results are acceptable.

OBJECTIVES: To evaluate the visual functions and their correlation with the neurological status in children with cerebral visual impairment (CVI).

METHODS: Case records of children with CVI under 3 years of age at their first visit were reviewed. Children’s visual functions were scored between 0 and 15 based on fixation and following skills. The neuromotor assessment was conducted by the Hammersmith Infant Neurological Examination (HINE) tool.

RESULTS: A total of 233 children with CVI (122 male and 111 female) were identified. The median age was 13 months. The etiologies were hypoxic-ischemic encephalopathy (27.5%), prematurity (23.6%), structural abnormalities (24%), metabolic diseases and genetic syndromes (14.2%), and neuromotor retardation (10.7%). There was no difference in visual function score (VFS) among the etiological groups and the magnetic resonance imaging finding groups (p=0.162, p=0.205, respectively). The VFS values of children without seizures were significantly higher than those with seizures (p=0.003). There was a weak correlation between the HINE ratio and VFS (p<0.001, r=0.341).

DISCUSSION AND CONCLUSION: The visual functions of children with CVI are usually very poor. The visual functions of these children are related to their neurological and motor retardation levels, seizure states, and the presence of additional ocular problems.

OBJECTIVES: In our study, using amsterdam pre-operative anxiety and information scale (APAIS) and visual analog scale anxiety (VASA) analyze the patient’s anxiety level about intraocular injection therapy and assess possible risk factors for these levels of anxiety in relation to the patient’s sociodemographic, disease, and treatment characteristics.

METHODS: Three hundred sixty-nine patients who received intravitreal ranibizumab, aflibercept, bevacizumab, and dexamethasone implants were included in the study. To measure the level of anxiety, APAIS questionnaire and VASA were used. APAIS and VASA were evaluated according to age, sex, indication for the injection, injection drug, previous injection numbers, and lens status in the study eye.

RESULTS: About 15.4% of the patients participating in the study had VASA ≥6. The APAIS anxiety component score of 43.9% of the patients was found to be ≥11. Total information requests were found to be ≥5 in 48.7% of the patients. There was a significant negative correlation between VASA, APAIS, and patient age (spearman r=−0.25, p=0.004, r=−0.22, p=0.001). A significant negative correlation was found between the number of previous injections and anxiety levels measured by VASA (spearman r=−0.35, p=0.02), as well as between the number of previous injections and APAIS scores (anxiety levels and total information request) (spearman r=−0.32, p=0.03). There was a no significant difference between VASA, APAIS, and patient sex (p<0.05). A higher level of anxiety measured by VASA and APAIS has been shown in patients who have not had cataract surgery before, compared to those who have undergone cataract surgery (p<0.05).
DISCUSSION AND CONCLUSION: The study underscores the importance of improving patient information and conducting further research to alleviate stress levels.

OBJECTIVES: The objective of the study was to present different clinical presentations, clinical and histopathological features, and treatment outcomes of intraorbital lymphoma.

METHODS: Medical records of 18 eyes of 17 patients with histopathologically proven diagnoses of intraorbital lymphoma at Dokuz Eylül University Ophthalmology Department, between 2007 and 2022, were reviewed retrospectively. The age, gender, location, laterality, stage, type of involvement, histopathological features, systemic involvement, recurrence, time from initial symptoms to diagnosis, follow-up time, and survival times were recorded. Visual acuities at the time of diagnosis and following treatment were evaluated.

RESULTS: The mean age of the patients was 63±19.11 (range: 15–79, median age 65). The most common presenting findings were periorbital swelling, conjunctival mass, and ptosis. Periorbital region involvement was present in 10 of 17 cases (58.8%) and conjunctival involvement was present in 7 cases (41.2%). Biopsy samples were taken from all cases. Non-Hodgkin lymphoma was the most common type of lymphoma, whereas the most common histopatholog-ical diagnoses were marginal zone lymphoma and diffuse large B-cell lymphoma. One case was diagnosed with mature T-cell lymphoma. Nine cases had bone marrow involvement. While two cases refused treatment, two cases were not treated due to age and comorbid diseases. Nine cases received chemotherapy, two cases received radiotherapy (RT), 1 case received chemotherapy and RT, and one case received antibiotherapy treatment. In one case with proptosis and exposure keratitis, lateral canthatomy, temporary tarsorrhaphy, and aggressive topical treatment resulted in complete epithelialization of the cornea.

DISCUSSION AND CONCLUSION: Orbital lymphoma is a painless and slowly progressive clinical picture that requires high clinical suspicion because it is a common tumor of the orbit. Although clinical symptoms and findings vary according to the intraorbital location of lymphoma, patients should be examined for systemic involvement and followed up in a multidisciplinary manner.

OBJECTIVES: In this study, we aimed to investigate the factors affecting spontaneous recovery in cases of acute binocular diplopia.

METHODS: A total of 224 patients presenting with acute binocular diplopia within 7 days were included in this study. The age, gender, etiology, and radiological findings of the cases were retrospectively examined and noted. The status of diplopia in the 6th month was noted.

RESULTS: The most commonly identified causes were presumed microvascular (28%), cerebrovascular (14%), and autoimmune-inflammatory (14%) in origin. Spontaneous recovery in diplopia was observed in 153 cases (68.3%) at 6 months. While the recovery rate was high in the presumed microvascular and idiopathic groups, it was low in the neoplastic group. Cranial nerve palsy was detected in 132 patients (58.9%). The most common were 6th, 3rd, and 4th nerve palsies, respectively. No difference was found in terms of spontaneous recovery at 6 months among cranial nerve palsies (p=0.952). The spontaneous recovery rate was found to be significantly higher in patients without radiological imaging findings (p<0.001).
DISCUSSION AND CONCLUSION: It is important for the physician to predict whether diplopia will resolve spontaneously. While the underlying etiology and neuronal damage are crucial factors, radiological imaging findings of the patients can also provide valuable insights.

To report a case of refractory ligneous conjunctivitis (LC) in which topical allogeneic serum eye drops from a relative with proven serum plasminogen activity were effective.
A 12-year-old male complained of intractable swelling and hardness of all eyelids, with woody discharge. He had been followed up with similar complaints since he was 1 year old. Until his teenage years, his membranes were relatively mild and non-progressive with topical cyclosporine (0.05%), artificial tears (single dose), antihistamines, antibiotics, and prednisolone acetate during active periods. His symptoms have been aggravated by impending corneal epithelial erosions due to thick ligneous membranes under the upper eyelids for the last year. Since commercial plasminogen eye drops were unavailable, allogeneic serum eye drops were prepared from a plasminogen-rich relative of the patient after obtaining informed consent.
The patient’s and his 1st° relatives’ plasma plasminogen activities were determined by chromogenic assay, and only his mother’s brother had a plasma plasminogen activity of 98%. Therefore, allogeneic serum eye drops were prepared from his plasma and given qid in addition to topical cyclosporine bid and artificial tears qid. Inflammatory pseudomembranes regressed with a dramatic resolution of the swelling and redness of the upper eyelids. No new conjunctivitis attacks were encountered during the last year.
Plasminogen-rich allogeneic serum seems reasonable when there is no access to commercially available plasminogen eye drops for patients with intractable LC.

We report a neurofibromatosis type 1 (NF-1) patient with pulsating enophthalmos as the first symptom. A 25-year-old female presented to us with posterior displacement of the left eye and a headache. The patient had enophthalmos with pulsations. A slit lamp examination revealed bilateral Lisch nodules and a computed tomography scan of the orbit demonstrated aplasia of the greater wing of the sphenoid bone on the left. The patient had café-au-lait macules, a history of scoliosis, and splenectomy operations. Genetic counseling confirmed the diagnosis of NF-1. NF-1 is a multisystemic, autosomal dominant genetic disease with cutaneous, neurologic, cardiovascular, and ophthalmologic manifestations. Dysfunction of tumor suppressor gene NF-1 is the main cause. Therefore, periodic screening for tumor development is required. Since NF-1 has several neuro-ophthalmological findings, ophthalmologists can play a significant role in its diagnosis and management.

Möbius syndrome (MBS) is a rare congenital disorder characterized by facial and abducens palsy which is usually bilateral and may involve multiple cranial nerves. Additional features, such as craniofacial anomalies, tongue malformations, and limb defects, may also be present. The etiology of this syndrome is not well established but the ischemic necrosis of the brainstem leading to hypoplasia of the cranial nerve nuclei is the supposed to be most likely one. MBS leads to a large angle esotropia along with bilateral limitation of abduction with delayed diagnosis, which is very challenging to correct with a single procedure. There are only a few reports illustrating the surgical outcome of strabismus in MBS. In this case report, we describe an unusual case of unilateral MBS who presented with large esotropia since childhood and was managed by two-stage strabismus surgery, including unilateral medial rectus (MR) muscle recession followed by vertical recti transposition. The final primary position alignment was satisfactory. Therefore, MR muscle recession alone is an effective first procedure of choice for mild-to-moderate esotropia in patients with MBS, whereas severe cases may further require the transposition of vertical recti. As it is a congenital condition, early surgical intervention may prevent amblyopia and provide an opportunity for the development of binocular single vision. Hence, prompt diagnosis and early surgical intervention are of utmost importance in these cases.

Horner’s syndrome, caused by supraclavicular nerve block, is a rare case. It is mostly expected after interscalene nerve block, caused by anatomic reasons. Horner’s syndrome results from neuronal paralysis of the post-ganglionic cervical sympathetic chain. For anatomic reasons, interscalene nerve block is very common but very uncommon in the case of supraclavicular nerve block. Horner’s syndrome results from the paralysis of the ipsilateral sympathetic cervical chain. One common cause is interscalene nerve block. This effect occurs frequently due to anatomical proximity – the brachial plexus nerves in the interscalene region are situated very close to the sympathetic cervical chain. When a local anesthetic is injected near the interscalene nerves, it can spread to surrounding tissues, including the sympathetic chain. In contrast, with a supraclavicular nerve block, this effect is extremely rare. The rarity is due to the anatomical distance between the supraclavicular nerves and the cervical sympathetic chain, as well as the presence of a thick fascial layer surrounding the supraclavicular nerves, which prevents the spread of local anesthetic to the upper tissues.
In this case, the unusual effect of supraclavicular nerve block was revealed as a Horner’s syndrome soon after injection of local anesthetic. There are a few reasons explaining this outcome. In one case, an anatomic-short neck can cause rapid distribution of local anesthetic through surrounding tissues. Another reason might be fat tissue, as local anesthetics are fat-soluble agents, and rapid injection of local anesthetics can be a reason for the upward distribution of medication. This case is important to understand what might be expected, even in cases when it is unusual, and inform the patient in ad-vance to avoid any incomprehension after an operation.