Objectives: Citicoline is a chemical molecule, and it plays a crucial role in the biosynthesis of cell membranes and has many functions in the human body. This compound, which increases the amount of neurotransmitters, is used in the treatment of various diseases in ophthalmology, neurology, and psychiatry. Its use as a supplement to improve cognitive functions is also widespread. In this review, we aim to shed light on the neuroprotective effects of citicoline and its applications in the field of ophthalmology, based on data obtained from published studies.
Methods: In the literature, the effects of citicoline in various ophthalmological diseases have been mentioned; however, there is no clear consensus regarding its dosage, duration of use, or efficacy due to the limited number of published studies and designs of these studies. Upon reviewing the current studies, we found evidence suggesting that citicoline supplementation may be effective in amblyopia, glaucoma, and non-arteritic ischemic optic neuropathy.
Conclusion: This review aims to evaluate and summarize the current evidence on the neuroprotective effects of citicoline in ophthalmologic diseases. Findings from various clinical studies suggest that it may have a beneficial effect on the treatment of conditions including amblyopia, glaucoma, and non-arteritic ischemic optic neuropathy.

OBJECTIVES: Objectives: To evaluate and compare corneal biomechanical properties and densitometry in healthy individuals and type 2 diabetic patients, with and without non-proliferative diabetic retinopathy (NPDR), and to investigate potential associations with glycemic control.
METHODS: This prospective, observational study included 61 diabetic patients (30 without DR and 31 with NPDR) and 76 healthy controls. Comprehensive ophthalmic examinations were performed for all participants, including Corvis ST for corneal biomechanical assessment and Scheimpflug-based densitometry. Glycated hemoglobin (HbA1c) and blood glucose levels were recorded in the diabetic group. Patients with proliferative DR were excluded to maintain more homogeneous cohorts.
RESULTS: Diabetic patients demonstrated significantly higher stiffness parameters (stress–strain index) and corneal densitometry compared with healthy controls (p<0.001). In subgroup analyses, the tomographic biomechanical index (TBI) was lower among diabetic patients with retinopathy than those without (p=0.036), suggesting an additional impact of retinopathy on corneal biomechanics. Moderate correlations were identified between HbA1c and specific corneal deformation parameters, highlighting the influence of metabolic control on corneal properties. Blood glucose levels exhibited a moderate positive correlation with TBI (p=0.033).
DISCUSSION AND CONCLUSION: Corneal biomechanics and densitometry differ significantly between diabetic patients and healthy controls, with further alterations in those with non-proliferative retinopathy, and these changes may correlate with glycemic control.

OBJECTIVES: This study aimed to evaluate the surgical outcomes and prognosis of patients who underwent Descemet membrane endothelial keratoplasty (DMEK) or penetrating keratoplasty (PK) following Ahmed glaucoma valve (AGV) implantation.
METHODS: Patients who underwent keratoplasty at the cornea department of our hospital between April 2016 and April 2024 were retrospectively reviewed. Patients with a history of prior AGV implantation were included. Surgical success was defined as maintaining graft clarity for a minimum of 6 months post-keratoplasty.
RESULTS: A total of 13 eyes of 13 patients (four women, nine men) with a mean age of 62.0±16.0 years were included. Five patients had a history of multiple glaucoma surgeries prior to AGV implantation. Among the included patients, six had no history of corneal transplantation before AGV implantation, whereas four had previously undergone PK, and two had undergone DMEK. One patient had received two DMEK procedures followed by PK. No tube-related complications, including endothelial touch, were observed. Corneal decompensation developed at a mean of 12.7±10.5 months after AGV implantation, prompting PK in four patients, repeat PK in five patients, and DMEK in four patients. The mean follow-up period after keratoplasty was 21.3±17.3 months. Although the best-corrected visual acuity (BCVA) achieved postoperatively was 1.5 (0.4–2.3) LogMAR at a mean of 13.9±12.3 months, there was no statistically significant difference between pre-operative BCVA (2.3 [1.0–2.3] LogMAR) and final post-operative BCVA (2.3 [0.4–2.7] LogMAR) (p=0.735). Similarly, no significant change was observed in intraocular pressure before and after keratoplasty (p=0.283). A second keratoplasty was recommended in five cases after the initial keratoplasty. At the final follow-up, graft rejection was observed in eight patients, two of whom developed keratitis. The overall surgical success rate was calculated as 23.1%.
DISCUSSION AND CONCLUSION: In patients undergoing keratoplasty for corneal decompensation following AGV implantation, both graft survival and overall surgical outcomes were found to be unfavorable.

OBJECTIVES: The objectives are to compare axial length (AL) measurements obtained using swept-source optical biometers and contact A-scan ultrasonography (USG) in eyes with mature cataract, and to evaluate inter-device agreement and acquisition success rates.
METHODS: This retrospective cross-sectional study included eyes with clinically defined mature cataract. AL measurements were obtained using two swept-source optical devices (Tomey - OA and Heidelberg Anterion) and contact A-scan USG (Tomey UD-800), all performed on the same day by a single examiner. Inter-device comparisons, Bland–Altman agreement analyses, and intraclass correlation coefficients (ICC) were calculated. Optical measurement failure rates were recorded.
RESULTS: AL measurements were successfully obtained with both optical biometers in 50 eyes. AL values showed strong agreement between the Tomey - OA OA-2000 and Anterion, with no significant inter-device difference. In contrast, contact A-scan USG yielded significantly shorter AL measurements compared with both optical devices (mean difference approximately 0.26–0.30 mm). Optical biometry failed to obtain AL measurements in approximately one-third of eyes with mature cataract. Inter-method reliability for AL was high (ICC >0.90).
DISCUSSION AND CONCLUSION: Swept-source optical biometers provide consistent and interchangeable AL measurements in eyes with mature cataract when measurements are obtainable. However, optical acquisition failure remains common in advanced cataracts, highlighting the continued clinical relevance of A-scan USG. The systematic tendency of contact ultrasound to produce shorter AL measurements should be considered during intraocular lens power calculation.

OBJECTIVES: The study aimed to evaluate the occurrence and intensity of positive and negative dysphotopsias in patients with different intraocular lens (IOL) positions – vertical, horizontal, superonasal, and inferonasal – and to determine whether IOL position correlates positive or negative dysphotopsias.
METHODS: This prospective cohort study included 80 patients, divided into four equal groups based on IOL positioning. Each group received a monofocal hydrophobic acrylic IOL during ultrasound phacoemulsification cataract surgery. Patients with horizontally placed IOL served as the control group. In each group, there were twenty participants. Clinical assessments, including visual acuity and biometry measurements, were recorded preoperatively and 1 month postoperatively. Post-surgery, patients completed a questionnaire evaluating the presence and severity of dysphotopsias.
RESULTS: Positive dysphotopsia was reported by 26.3% of patients, with no significant difference among the groups (Fisher’s exact test, p=0.63). Negative dysphotopsia appeared in 11.3% of patients, significantly more frequent in those with superonasal and inferonasal IOL positions (Fisher’s exact test, p=0.01). Regarding the IOL location, there was no discernible difference in the severity of positive (Kruskal–Wallis test, p=0.33) and negative (Kruskal–Wallis test, p=0.23) dysphotopsias among patients who were experiencing them. Postoperatively, all patients demonstrated improved visual acuity, anterior chamber depth, and axial length measurements.
DISCUSSION AND CONCLUSION: The study found a significant association between IOL position and the incidence of negative dysphotopsia, especially with inferonasal and superonasal placements. However, the IOL position did not influence the intensity of either positive or negative dysphotopsia. This implies that post-surgery negative dysphotopsia perception is influenced by lens location. Patient satisfaction remained high, though negative dysphotopsia intensity negatively correlated with satisfaction scores.

OBJECTIVES: The aim of the study was to evaluate the incidence of senile macular degeneration (SMD) in patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEG).
METHODS: The medical files of 2600 patients with glaucoma were analyzed. In this study, 168 patients (90 females and 78 males) with POAG and PEG were included. Patients diagnosed with POAG and PEG with SMD were also recorded. SMD was classified in two categories: Wet type and dry type. Lens status was classified as pseudophakic and phakic. Glaucoma severity was classified according to the Hodapp-Parrish-Anderson criteria. All patients underwent complete ophthalmologic examinations.
RESULTS: Ninety (53.57%) patients were female, and 78 (46.43%) were male. The mean age was 63±8.4 years for women and 66.5±7.8 years for men. Sixty-six (73.3%) of women and 60 (76.9%) of men had POAG, 24 (26.7%) of women and 18 (23.1%) of men had PEG. 18 (20.0%) right and 25 (27.8%) left eyes of women and 30 (38.5%) right and 24 (30.8%) left eyes of men were pseudophakic, 72 (80.0%) right and 65 (72.2%) left eyes of women and 48 (61.5%) right and 54 (69.2%) left eyes of men were phakic. SMD was observed in 10 patients (5.95%); four women and five men had dry-type SMD, while one man had wet-type SMD.
DISCUSSION AND CONCLUSION: In our study, when gender, age, severity of glaucoma, pseudophakic and phakic status of the lens were evaluated in patients with the association of glaucoma and SMD, these variables had no statistically significant effect on the association of glaucoma and SMD.

OBJECTIVES: To detect the difference in internal hyperreflectivity of macular cystoid spaces in diabetic retinopathy (DR), exudative (wet) age-related macular degeneration (wet AMD), branch retinal vein occlusion (BRVO).
METHODS: The medical records of the consecutive patients who were followed up from Prof. Dr. Cemil Taşcıoğlu City Hospital, from 01 April 2023 to 01 June 2023, in the retina department, have been included in this study. The mean gray value (GV) and max-min GV parameters of the cystoid spaces which were detected in the spectral domain optical co-herence tomography (OCT) scans, were measured by using the ImageJ program (National Institutes of Health, Bethesda, Maryland, USA). The established diagnosis, baseline best corrected visual acuities (BCVA), OCT biomarkers such as serous macular detachment, hard exudate, hyperreflective foci and central macular thicknesses were also noted. The parameters were compared to each other regarding the different pathologies.
RESULTS: The mean-max GV of cystoid spaces and the mean-max GV of cystoid/vitreous ratio were found to be highest in the DR, followed by BRVO, and lowest in wet AMD (p<0.001 and p<0.001; respectively). Correlation analyses revealed a positive correlation between OCT biomarkers and intracystic hyperreflectivity (ICH) (p<0.001, respectively). Besides, the max GV cystoid/vitreous ratio is positively correlated with the BCVA (p<0.046; p=0.04, respectively).
DISCUSSION AND CONCLUSION: This pilot study investigates ICH in macular edema of various etiologies. The ICH was highest in the DR group, followed by the BRVO group, and lowest in the AMD group. It has been observed that there is a high correlation between ICH and OCT biomarkers. Findings support the hypothesis that ICH may reflect underlying inflammatory pro-cesses and contribute to individualized treatment approaches in retinal vascular pathologies.

OBJECTIVES: To evaluate the risk factors associated with consecutive esotropia, as well as the changes in deviation angle and the prevalence of esotropia in patients who underwent surgery for exotropia.
METHODS: The records of patients with basic-type exotropia who underwent either bilateral lateral rectus recession (symmetric surgery) or unilateral lateral rectus recession combined with medial rectus resection (asymmetric surgery), and who were followed for at least one year, were retrospectively reviewed. Preoperative, early postoperative, and late postoperative findings were analyzed for both groups: symmetric surgery (Group 1) and asymmetric surgery (Group 2). Consecutive esotropia was defined as ≥5 prism diopters of esotropia at either distance or near fixation.
RESULTS: Of the 114 patients included, 52 (46%) were female and 62 (54%) were male. The mean age at surgery was 20.42 years in Group 1 and 15.59 years in Group 2 (p>0.05). Group 2 had significantly lower visual acuity, stereopsis, and fusion rates, and higher rates of amblyopia and anisometropia compared to Group 1. At the final follow-up examination, the deviation angles decreased significantly in both groups (p<0.001), and the prevalence of consecutive esotropia reduced from 17% to 7% in Group 1 and from 30% to 19% in Group 2 (p=0.031). While stereopsis did not significantly improve postoperatively in Group 1, increased significantly in Group 2 (p=0.031). Fusion improved significantly in both groups (p<0.001). Refractive error, anisometropia, preoperative and early postoperative deviation angles, and the extent of surgery were identified as significant risk factors for consecutive esotropia (p<0.05).
DISCUSSION AND CONCLUSION: Although initial overcorrection following exotropia surgery tends to decrease over time, patients with high preoperative and early postoperative deviation angles, high refractive errors, anisometropia, and greater surgical amounts should be carefully monitored for the development of consecutive esotropia.

OBJECTIVES: To compare the iris vessel density results before and after rectus plication, a vessel-sparing procedure, and resection/recession surgery using a non-invasive method, optical coherence tomography angiography (OCT-A).
METHODS: This single-center, prospective observational study was held in Beyoglu Eye Research and Training Hospital. Ten patients were included in the study after excluding patients with systemic or ocular diseases, nystagmus or fixation loss. The anterior segment module of the OCT-A was utilized, and the eye-tracking feature was disabled to obtain the highest image quality. OCT-A imaging was performed one day before or on the day of the surgery and within three days after surgery.
RESULTS: Ten patients (8 females) were included in the study. Five had esotropia, meanwhile 5 had exotropia. Two patients received muscle plication in one eye, and the other three received one rectus plication and antagonist recession on the same eye. Preoperative and postoperative images were analyzed both qualitatively and quantitatively with device software and ImageJ. The vessel density near the plicated rectus decreased less after surgery. The mean preoperative and postoperative vessel densities were 53.68% and 49.62% in the plication group (p>0.05). However, they were 60.19% preoperatively and 54.26% postoperatively in the resection/recession group (p=0.043).
DISCUSSION AND CONCLUSION: In this study, OCT-A was utilized for the first time to evaluate the qualitative and objective quantitative changes in iris vessel density after rectus plication and recession/resection surgeries. The quantitative comparisons demonstrated that the iris vessel density decreased less after vessel-sparing surgery. Iris OCT-A shows promise for evaluating changes in iris vessel density.

OBJECTIVES: To evaluate the surgical outcomes of blepharoptosis in patients with no light perception (NLP) who used prostheses and to assess eyelid symmetry and functional improvement following appropriate surgical management.
METHODS: This retrospective study included 15 patients with prosthesis-related ptosis treated between 2020 and 2024. Demographic characteristics, prosthesis type and duration of use, type of ptosis, preoperative levator function, and surgical technique were recorded. Margin reflex distance 1 (MRD-1) was measured preoperatively and at postoperative 1 week, 1 month, 3 months and 6 months, using standardized digital photographs. Eyelid symmetry, complications, and need for revision surgery were evaluated. Repeated measurements were analyzed using the Friedman test with Wilcoxon signed-rank post hoc comparisons.
RESULTS: The mean age was 40.13±17.41 years (range 15–70 years); 10 patients were female and 5 were male. The mean preoperative levator function was 11.80±3.52. Regarding the underlying causes of eye loss/prosthesis use, 9 (60.0%) were due to trauma, 1 (6.7%) was due to infection, 2 (13.3%) were due to glaucoma, and 3 (20.0%) were due to other causes. 12 patients had evisceration, and 3 patients used a prosthesis over a phthisis bulbi eye. 13 patients underwent Müller Muscle-Conjunctival Resection (MMCR) and 2 patients underwent levator surgery. MRD-1 increased significantly from 1.20±0.94 mm preoperatively to 3.27±0.70 mm at 6 months. Further analysis to determine the source of the difference revealed statistically significant differences between preoperative MRD-1 and postoperative MRD1 at 1 week, 1 month, 3 months, and 6 months. The Friedman test showed a significant improvement over time (p<0.001). Technique comparisons were exploratory due to the small levator subgroup. No significant difference was found between the duration of eye prosthesis use and preoperative MRD-1 (p=0.761).
DISCUSSION AND CONCLUSION: MRD-1 improved from 1.20±0.94 mm preoperatively to 3.27±0.70 mm at 6 months, and eyelid symmetry (≤1 mm) was achieved in 86.6% of patients, demonstrating that ptosis of the upper eyelid in ocular prosthesis patients can be effectively corrected with appropriately selected surgical techniques based on levator function.

Epithelioid sarcoma is a rare type of tumor that primarily affects young men and accounts for less than 1% of all soft tissue sarcomas. In this case, a patient diagnosed with epithelioid sarcoma and systemic metastases presented with complaints of decreased vision and eye pain. Examination revealed a mass lesion involving the conjunctiva, iris and lens, accompanied by conjunctival hyperemia, corneal edema and hyphema. Ocular metastasis was suspected, and samples were obtained through excisional biopsy of the conjunctival nodule and aspiration of fluid from the anterior chamber. Pathological examination confirmed that the conjunctival nodule represented an ocular metastasis of epithelioid sarcoma. Although there are reported cases of primary orbital epithelioid sarcoma, we present this report because it demonstrates a unique example of extra-orbital primary disease with subsequent ocular metastasis.

To report a case of long-standing occupational ocular argyrosis with histopathological confirmation during cataract surgery. A 57-year-old male silver worker with a 16-year history of ocular argyrosis and progressive visual deterioration underwent comprehensive ophthalmological examination and phacoemulsification with intraocular lens implantation. The anterior lens capsule obtained during capsulorhexis was submitted for histopathological examination. Clinical examination revealed bilateral diffuse corneal deposits, periocular pigmentation, and characteristic findings consistent with chronic silver deposition patterns. The right eye demonstrated a mature cataract with complete cortical opacity. Phacoemulsification was performed successfully without complications. Histopathological analysis confirmed characteristic silver deposits within the capsular matrix, providing a definitive diagnosis of ocular argyrosis. Postoperative visual acuity improved from hand motion to 0.9. This case demonstrates successful cataract surgery outcomes in a patient with long-standing occupational ocular argyrosis. Histopathological examination of surgical specimens provides invaluable diagnostic confirmation and demonstrates the systemic nature of silver deposition. The case emphasizes the importance of long-term monitoring in patients with occupational silver exposure and confirms that cataract surgery can be performed safely with excellent visual outcomes in patients with concurrent ocular argyrosis.