OBJECTIVES: To evaluate visual, refractive, tomographic and aberrometic outcomes of repeat corneal collagen crosslinking (CXL) using Dresden protocol in the management of keratoconus progression at 1-year follow-up.
METHODS: Charts of consecutive progressive keratoconus patients who underwent repeat corneal collagen CXL using Dresden protocol and had at least 1 year follow-up were retrospectively evaluated. Best spectacle-corrected distance visual acuity (CDVA), manifest refraction, slit lamp biomicroscopy, corneal tomography, corneal aberrometry and endothelial cell counts were evaluated before repeat CXL and at postoperative year-1. At postoperative 1-month, corneal demarcation line depth were evaluated using anterior segment optic coherence tomography.
RESULTS: Overall, seven eyes of seven patients with the mean age of 23 (ranged 19 to 27) years were included. The interval between the initial and repeat CXL procedures was 60 (ranged 28 to 89) months. At postoperative month-1, a clear demarcation line could be observed in all patient eyes. The mean demarcation line depth was 250 (ranged 220 to 360) µm. At postoperative month-12, mean CDVA, manifest refraction, topographic indices, and aberrometric outcomes remained stable (p>0.05). Maximum keratometry was reduced more than 1D in two (28.6%) eyes, and remained stable in the remaining five (71.4%) eyes. No significant endothelial cell loss or any other sight-threatening complication was encountered in any patient eye.
DISCUSSION AND CONCLUSION: Repeat corneal CXL seems to be safe and effective in halting keratoconus progression at 1-year follow-up.

OBJECTIVES: To investigate the prevalence of macular pathologies detectable only by optical coherence tomography (OCT) and not suspected on fundoscopic examination before cataract surgery in a large series of Turkish patients and to determine associated risk factors.
METHODS: Medical records of patients who underwent cataract surgery, had normal fundoscopic findings during preoperative evaluation, and underwent macular OCT were retrospectively reviewed for demographic data, ophthalmological findings, and systemic examination results. Patients were divided into normal and abnormal OCT groups according to their macular OCT results. Patients in the abnormal OCT group were further analyzed for the prevalence of OCT-detected occult macular pathologies and associated risk factors.
RESULTS: Data from 1.091 eyes were included in the study. Macular pathology was detected on OCT in 9.2% of patients. Among these patients, 40 (40%) had age-related macular degeneration, 31 (31%) had epiretinal membrane, 11 (11%) had vitreomacular traction, 8 (8%) had lamellar macular hole, 5 (5%) had diabetic macular edema, and 5 (5%) had macular pseudohole. The mean age of patients with occult macular pathology was significantly higher than that of patients with normal OCT findings (p=0.001). 78.0% of patients with retinal pathology were 70 years of age or older. Advanced age was identified as the most important predictor of occult macular pathology (OR: 1.086, p=0.001).
DISCUSSION AND CONCLUSION: Reliance solely on fundoscopic examination would result in approximately 1 in 10 eyes with occult macular pathology being overlooked. OCT screening should be considered prior to cataract surgery, particularly in elderly patients.

OBJECTIVES: The objective of the study was to evaluate the criteria that play a role in the selection of ophthalmic surgeons in the Turkish society and to compare the choices of 662 individuals who are healthcare professionals (Group-1) and 517 non-healthcare professionals (Group-2) as well as different demographic subgroups.
METHODS: A total of 1,179 subjects participated in the online survey between March-June 2024. After collecting demographic data, the subjects were asked to select an eye surgeon among six representative images prepared by the artificial intelligence software with three questions. These three questions first asked for age and gender, then included academic title in the selection. Lastly, age was kept constant.
RESULTS: The mean age of the participants was 44.85±12.94 (18-80) years and the M/F ratio was 0.53. In the first question, the preference for middle-aged male surgeons was the highest with 349 (52.7%) in Group-1 and 215 (41.6%) in Group-2 (p≤0.001). In the second question, the highest preferences were for ‘Associate Professor’ middle-aged male surgeon with 271 (40.9%) in Group-1 and ‘Professor’ older aged male surgeon with 155 (30%) in Group-2 (p≤0.001). In the last question, the highest preferences were ‘Associate Professor’ male surgeon with 205 (31%) in Group-1 and ‘Professor’ male surgeon with 188 (36.4%) in Group-2 (p≤0.001).
DISCUSSION AND CONCLUSION: The selection of ophthalmic surgeon is predominantly male and middle-aged, though this rate was higher in Group-1. It is also evident that academic title has a significant effect on the selection and alters the distribution. This effect is more pronounced in Group-2, among female and below the mean age participants. Although the predominance of male surgeons persists, it was observed that female and above the mean age participants were more inclined to select a female surgeon.

OBJECTIVES: To evaluate anatomical and functional changes during follow-up in eyes with glaucoma suspicion.
METHODS: A total of 56 eyes of 28 patients (F/M: 21/7) who were included. Detailed ophthalmologic examination, optic coherence tomography (OCT) and visual field (VF -SITA 24-2 and 10-2) were performed at the initial and 12th month examination. Retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thicknesses, 24-2 VF global indices (MD, PSD), and 10-2 VF superior and inferior hemi-quadrant mean sensitivities (dB) were recorded. The presence of "cluster defect" was noted in both VFs.
RESULTS: The mean age was 56.1±10.8 (34-74) years, mean IOP was 18.2±3.8 mmHg and mean cup/disc ratio (C/D) was 0.4±0.2 at the first visit. There was no significant change in mean IOP and C/D during the follow-up (p=0.655, 0.988, respectively). No significant progression was observed in OCT and VF parameters (p>0.05 for all). At the initial examination, a mild positive correlation was found between total RNFL, GCC and 24-2 MD (r=0.292, 0.316, respectively). At the 12th month, there was a moderate positive correlation between total RNFL and 24-2 MD (r=0.317) and a moderate negative correlation between total RNFL and PSD(r=-0.327). No correlation was observed between 10-2 VF superior/inferior hemi-quadrant mean sensitivity (dB) and inferior/superior RNFL and GCC in both examinations (p>0.05 for all). Cluster defect was present in 35 eyes at initial examination and in 30 eyes at 12th month.
DISCUSSION AND CONCLUSION: There’s not a single parameter that can be used to differentiate glaucoma suspects from early-stage glaucoma. VF, RNFL and GCC should all be evaluated, and longer follow-ups are necessary.

OBJECTIVES: To assess the amplitude of accommodation by autorefractometer in children with bilateral high hyperopia.
METHODS: The records of children with bilateral high hyperopia (+6.00 diopter and above) were investigated. Age, amplitude of accommodation (AA) values and pupil size (PS) changes measured by closed-field autorefractometer (Tonoref III), spherical equivalent (SE), astigmatism, presence of amblyopia, strabismus, and stereopsis were noted. Age-matched emmetropic children were also assessed as control group. Comparisons were statistically performed.
RESULTS: The mean ages of high hyperopia (n=32) and control groups (n=32) were not statistically different (p=0.905). Mean SE values were different in both eyes between groups (p<0.001, p<0.001, right and left eyes, respectively). Mean AA in both eyes were different between groups (p=0.017, p=0.02, right and left eyes, respectively). AA differences between two eyes and pupil size measurements in both eyes (right and left) were not different (p=0.90, p=0.576, p=0.35, respectively). Presence of strabismus and amblyopia were higher in hyperopia group and stereoacuity was better in control group. In hyperopia group, there was statistical difference between patients with and without strabismus regarding to mean AA (p=0.03).
DISCUSSION AND CONCLUSION: Accommodative amplitude, measured by a closed-field autorefractometer (Tonoref III) was lower in bilateral high hyperopic children. AA difference between two eyes and pupil sizes during accommodation were not different between high hyperopic patients and emmetropic controls. High hyperopic patients with strabismus were found to have better accommodative amplitude.

OBJECTIVES: To quantify short-timescale refractive recovery after a standardized smartphone near task and timed distance-viewing breaks aligned with the 20-20-20 paradigm, and to determine how much of the accommodative/near work-induced transient myopia (NITM) recovery occurs within the earliest seconds of a break.
METHODS: In this cross-sectional, 58 students symptomatic for digital eye strain (Computer Vision Syndrome Questionnaire score ≥ 6) completed a 20-minute continuous reading task on smartphone. Objective refractive error was recorded with an open-field autorefractor at baseline, immediately post-task, and after distance-viewing breaks of 20 seconds, 1 minute, and 2 minutes (≥6 m fixation; no near work permitted).
RESULTS: The mean age of participants was 20.85±1.43 years. At baseline near fixation, mean sphere and SE were −2.08±0.45 and−2.38±0.46 D, respectively. Immediately after 20 minutes of reading, a myopic shift was evident (sphere −2.12±0.50 D; SE −2.47±0.46 D). During distance breaks, refractive measures recovered toward baseline in a biphasic pattern: A significant early recovery within 20 seconds (sphere P=0.007; SE P=0.005), followed by smaller improvements from 20 to 60 seconds (sphere P=0.266; SE P=0.034) and from 60 to 120 seconds (sphere P=0.415; SE P=0.270). Cylinder remained stable across conditions (≈ −0.6 D; P=0.136), whereas sphere and SE varied significantly across near and break intervals (both P<0.001).
DISCUSSION AND CONCLUSION: After a 20-minute smartphone near task, the largest component of refractive recovery occurs within the first 20 seconds of distance fixation, with diminishing returns up to 2 minutes. This objective kinetics support the refocusing premise of the 20-20-20 approach and indicate that incorporating more frequent distance-viewing breaks can capture most accommodative/NITM recovery (20–2 min–20).

OBJECTIVES: Plus disease, which can be diagnosed during clinical ophthalmoscopic examinations, is the most important feature in determining retinopathy of prematurity (ROP) requiring treatment. In the current study, we aimed to automatic diagnose and predict plus disease based on deep learning (DL) from retinal images of infants with ROP.
METHODS: 600 retinal images from infants screened for ROP were evaluated. Each image was classified as normal, pre-plus and plus disease. After image pre-processing, the images were distributed into groups equal to the number of normal eye images and were used for training DL algorithms such as EfficientNetB7, InceptionResNetV2 and VGG16. The algorithms were trained with 10-fold cross-validation, and results are reported as sensitivity, specificity, accuracy, receiver operating characteristic (ROC) curve, and area under the curve (AUC).
RESULTS: Of the 600 retinal images included, 258 images obtained after pre-processing were graded as 86 (33.3%) normal, 86 (33.3%) as pre-plus disease, and 86 (33.3%) as plus disease. For plus versus no-plus disease diagnosis, among the algorithms, InceptionResNetV2 achieved 0.90 sensitivity, 0.92 specificity, and 0.91 accuracy. Area under the ROC curve was 0.91. For detection of pre-plus disease or worse versus normal, the algorithm achieved 0.81 sensitivity, 0.97 specificity, and 0.88 accuracy.
DISCUSSION AND CONCLUSION: Our results showed that DL algorithms can automatically diagnose plus disease in ROP with high sensitivity, high specificity, and high accuracy.

OBJECTIVES: To evaluate the age-related etiological spectrum and visual outcomes of patients presenting with spontaneous vitreous hemorrhage (VH) at a tertiary eye emergency department.
METHODS: This single-center retrospective cohort study reviewed the medical records of 55,107 patients who presented to a tertiary referral hospital between January 2018 and December 2024. A total of 804 eyes of 804 patients with a first episode of spontaneous vitreous hemorrhage and at least 12 months of follow-up were included. Etiology was determined by clinical examination, imaging methods, and diagnostic pars plana vitrectomy (PPV) when required. Patients were categorized into pediatric (<18 years), adult (18–65 years), and elderly (>65 years) groups. Best-corrected visual acuity (BCVA) at presentation and at 12-month follow-up was analyzed. Visual outcomes were compared between the early (≤3 months) and delayed (>3 months) vitrectomy groups.
RESULTS: The incidence of spontaneous VH among emergency presentations was 1.46%. Male patients constituted 60.57% of the cohort. Retinopathy of prematurity was the most common etiology in pediatric patients, whereas proliferative diabetic retinopathy predominated in the adult and elderly groups. Mean BCVA improved from 1.54±0.63 logMAR at presentation to 0.38±0.39 logMAR at 12 months (p<0.001). Significant visual improvement was observed in all age groups (p<0.001). Diagnostic PPV was performed in 27% of eyes. Visual gain was greater in the early vitrectomy group than in the delayed vitrectomy group (0.58±0.25 vs 0.44±0.31 logMAR; p=0.02).
DISCUSSION AND CONCLUSION: The etiological spectrum of spontaneous VH varies according to age. Significant visual improvement can be achieved with appropriate medical and surgical treatment. Early PPV in selected cases may provide superior visual recovery compared with delayed intervention.

OBJECTIVES: To compare anatomical and functional outcomes in patients with diabetic macular edema who exhibited a suboptimal response to intravitreal anti-VEGF therapy and underwent early (<6 months) versus late (≥6 months) switch to an intravitreal dexamethasone implant.
METHODS: This retrospective comparative study included 141 eyes of 141 patients with diabetic macular edema. Patients received at least three consecutive anti-VEGF injections without adequate anatomical or functional response and were subsequently switched to a dexamethasone implant. Patients were divided into two groups: early switch (<6 months) and late switch (≥6 months). Best-corrected visual acuity, central macular thickness, optical coherence tomography biomarkers, intraocular pressure, lens status, number of injections, and complications were analyzed.
RESULTS: Of 141 patients (79 females, 62 males; mean age 65.3±8.9 years), 49 were in the early switch group and 92 were in the late switch group. At baseline, best-corrected visual acuity was marginally better in the late switch group (p=0.049), while baseline central subfield thickness was comparable (p=0.35). After switching, both groups showed a significant reduction in central subfield thickness (p<0.01), with no difference between the groups (p=0.58). Best-corrected visual acuity improved significantly in both groups; however, visual gain was greater in the early switch group (p=0.038). The mean number of total intravitreal injections was significantly higher in the late switch group (p<0.01). Mean intraocular pressure increased from 16.3 to 18.0 mmHg in both groups (p<0.01), with no intergroup difference. Thirty-one patients required cataract surgery during follow-up, without correlation with switch timing. Optical coherence tomography bio-markers revealed that patients with ellipsoid zone disruption had poorer BCVA outcomes, while those with subfoveal serous detachment exhibited greater central subfield thickness reduction (p<0.05).
DISCUSSION AND CONCLUSION: Early switch from anti-VEGF to a dexamethasone implant in refractory diabetic macular edema provides superior functional outcomes and reduces treatment burden compared with late switch, despite similar anatomical improvements.

OBJECTIVES: To compare the efficacy and safety of intravitreal triamcinolone acetonide (IVTA) monotherapy versus combined intravitreal triamcinolone acetonide and bevacizumab (IVTA+IVB) therapy in the treatment of macular edema secondary to branch retinal vein occlusion (BRVO).
METHODS: In this retrospective study, 66 eyes of 65 patients with BRVO-related macular edema were evaluated. Patients were divided into two groups: IVTA monotherapy (n=37) and IVTA+IVB combination therapy (n=29). Central macular thickness (CMT), best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were measured at baseline, week 1, and months 1, 3, and 6 after injection.
RESULTS: Both groups demonstrated significant improvements in BCVA and reductions in CMT compared with baseline (p<0.001), with no statistically significant differences between the groups at any follow-up time point. IOP was significantly elevated in the IVTA group at several time points (p<0.05), while the combination group showed stable IOP levels. New-onset glaucoma developed in 8 patients in the IVTA group and only 1 patient in the combination group. No serious ocular complications occurred in either group.
DISCUSSION AND CONCLUSION: Both treatment regimens provided comparable anatomical and visual improvements; however, combination therapy was associated with a more favorable safety profile. Although the use of IVTA has declined in contemporary clinical practice in favor of intravitreal dexamethasone implants, this study suggests that IVTA alone or in combination may still offer a viable and cost-effective alternative in regions where access to current therapies is limited or in low-resource settings.

OBJECTIVES: This study evaluated the clinical utility of a multimodal large language model-based artificial intelligence (AI) model in predicting postoperative visual outcomes following full-thickness macular hole (FTMH) surgery using the inverted internal limiting membrane (ILM) flap technique.
METHODS: A retrospective analysis was conducted on 45 patients who underwent pars plana vitrectomy for FTMH at a tertiary eye care center between January 2021 and December 2023. Preoperative optical coherence tomography (OCT) images, demographic data, and clinical parameters were analyzed using the AI model to predict best-corrected visual acuity (BCVA) at four postoperative time points. The predicted BCVA values were then compared with actual clinical outcomes.
RESULTS: Preoperatively, the mean AI-predicted BCVA was 1.13±0.20 logMAR compared with the actual value of 1.24±0.33 logMAR (p=0.192). At 6 months, the predicted BCVA was 0.65±0.20 logMAR versus the actual value of 0.67±0.25 logMAR (p=0.528), and at 12 months, it was 0.47±0.17 logMAR versus 0.55±0.27 logMAR (p=0.155). However, at 7 days postoperatively, the model significantly overestimated visual impairment, predicting 1.37±0.28 logMAR versus the actual value of 1.07±0.33 logMAR (p<0.001). Spearman correlation analysis showed the strongest association between AI-predicted and actual BCVA at 6 months (r s=0.5885, p<0.001), with a moderate correlation at 12 months (r s=0.4156, p=0.005), a weak correlation preoperatively (r s=0.3029, p=0.043), and no significant correlation at 7 days (r s=0.1949, p=0.199).
DISCUSSION AND CONCLUSION: These findings demonstrate the model’s potential as a supportive tool for visual outcome prediction after FTMH surgery. The AI platform showed clinically relevant predictive performance for preoperative and later postoperative visual outcomes after FTMH surgery, particularly at 6 and 12 months, but was less reliable in the early postoperative period.

Although sinonasal adenoid cystic carcinoma (ACC) mainly originates from the salivary glands and lacrimal gland, approximately 10–25% of cases may arise from the sinonasal cavity and paranasal sinuses. Orbital involvement typically occurs due to local spread. Only a few cases of isolated orbital ACC without another primary focus have been documented. This report aims to describe a case of sinonasal ACC presenting as a retroorbital mass, raise awareness of this tumour and its rare presentation among both ophthalmologists and otolaryngologists, and provide brief information on its treatment. A 74-year-old female who presented to an external centre with progressive periorbital oedema, congestion, proptosis, and exotropia in her right eye for approximately 4 months was referred with a right retrobulbar mass. During the initial examination, the best-corrected visual acuity was 0.05 in the right eye (OD) and 0.8 in the left eye (OS). There was no significant pathology in the anterior or posterior segments. Eye movements were normal in the OS and moderately restricted in the OD, particularly in upgaze. She reported no otorhinolaryngological complaints, and her examination was normal except for a polyp-like lesion extending from the middle to the inferior meatus. Maxillofacial and orbital magnetic resonance imaging revealed a mostly homogeneous malignant soft tissue lesion extending from the retro-orbital area to the orbital apex, ethmoid cells, and nasal cavity. The patient underwent tumour excision via an inferior transconjunctival approach and endoscopic sinus surgery. Both nasal and intraorbital surgical excision specimens were consistent with ACC on histopathological examination.

We report two cases of late capsular bag distension syndrome (LCBDS), which is a rare but significant complication following cataract surgery and often presents with blurred vision years after intraocular lens (IOL) implantation. Case 1: An 80-year-old male presented with a one-year history of progressive blurred vision in the right eye. His history included uneventful phacoemulsification and multifocal IOL implantation eight years earlier. Examination revealed dense, turbid fluid behind the IOL. Scheimpflug imaging and anterior segment optical coherence tomography (AS-OCT) detected hyperintense signals between the IOL and posterior capsule. Nd: YAG laser posterior capsulotomy was performed, resulting in complete resolution of the fluid and recovery of 20/20 vision. Case 2: A 60-year-old hypertensive female reported progressive blurred vision in the right eye for nine months. Ten years earlier, she had undergone uncomplicated cataract surgery. AS-OCT and Scheimpflug imaging demonstrated fluid accumulation posterior to the IOL. Nd: YAG capsulotomy led to complete symptom resolution and restoration of 20/20 vision at the one-week follow-up. This report is among the few in the literature to demonstrate how multimodal imaging, particularly AS-OCT and Scheimpflug imaging, can distinctly differentiate late capsular bag distension syndrome from posterior capsule opacification, enabling accurate diagnosis and appropriate management.