ISSN: 2459 - 1777 | E-ISSN 2587-0394
Volume : 3 Issue : 2 Year : 2022
Beyoglu Eye Journal - Beyoglu Eye J: 3 (2)
Volume: 3  Issue: 2 - 2018
INVITED REVIEW
1.Clinical Findings, Pathogenesis, and Treatment in Non-Infectious Peripheral Ulcerative Keratitis
Banu Acikalin, Yonca Akova, Sezen Akkaya, Murat Garli, Murat Yamic
doi: 10.14744/bej.2018.10820  Pages 43 - 51
Peripheral ulcerative keratitis (PUK) is a group of diseases that manifest with ulceration and/or thinning in the peripheral cornea. Although this group of diseases can occur as a result of infection, most cases are of immunological origin and are associated with autoimmune diseases (AID). The most common form of AID associated with PUK is rheumatoid arthritis (RA). However, PUK may also be seen with other AIDs, such as systemic lupus erythematosus and Wegener’s granulomatosis. There are immunological differences between the peripheral and central cornea that may explain the localization of PUK in the peripheral cornea. For example, the proximity to limbal blood vessels and conjunctival lymphatics is different. Both humoral and cellular immunity play a role in the development of PUK. Although the number of CD8+ T cells did not vary significantly in RA patients, the number of CD4+ T cells was significantly greater. As PUK is very serious, early diagnosis and treatment are very important. Local and systemic corticosteroids, immunosuppressants, biological agents, bandage contact lenses, tissue adhesives, and in some cases, surgical treatment can be applied. Adjacent conjunctival excision, patch lamellar grafts, and keratoplasty are options in surgical treatment. It is very important not to forget the possibility of disease progression despite surgery, and the treatment of underlying disease is crucial. Keratoplasty in PUK cases may not be successful as a result of several factors, such as dry eye and the underlying immunological disease.

ORIGINAL ARTICLE
2.Distinguishing Non-Arteritic Ischemic Optic Neuropathy from optic Neuritis with Serum Vitamin B12, Ferritin and Folic Acid Level
Hande Guclu, Zeynep Banu Doganlar
doi: 10.14744/bej.2018.41736  Pages 52 - 57
INTRODUCTION: The aim of this study was to compare the levels of vitamin B12 (Vit B12), folic acid, serum ferritin, serum iron, and total iron binding capacity (TIBC) in patients with optic neuritis (ON) and non-arteritic ischemic optic neuropathy (NAION). It was hoped to determine whether these simple and inexpensive laboratory measurements are indicative for making a distinction between ON and NAION.
METHODS: In this retrospective study, the data of patients who were diagnosed with ON and NAION between September 2005 and December 2016 were reviewed. In all, 42 patients with NAION, 70 patients with ON, and 76 members of a control group, a total of 188, were enrolled in the study. All of the participants underwent a full ophthalmological examination and complete physical examination, including a detailed medical history and blood count and evaluation of the biochemical parameters, serum ferritin, Vit B12, folic acid, serum iron, and TIBC.
RESULTS: The mean serum ferritin level was 236±458.4 ng/mL for the NAION patients, 32.8±34.6 ng/mL for the ON patients, and 76.1±84.6 ng/mL for the control group. The mean serum Vit B12 level was 478±306.3 pg/mL for the NAION patients, 291.7±136.9 pg/mL for the ON patients, and 417.1±163.4 pg/mL for the control group. The mean serum folic acid level was 11.4±6.3 ng/mL for the NAION patients, 6.6±2.7 ng/mL for the ON patients, and 14.5±5.2 ng/mL for the control group.
DISCUSSION AND CONCLUSION: A higher serum ferritin level was significantly associated with NAION, and lower Vit B12 and folic acid was associated with ON patients. Serum ferritin, Vit B12, and folic acid measurements could be a useful method for distinguishing between NAION and ON before using complicated and invasive methods.

3.The Change in Deviation Measurements After Refractive Surgery for Partially Accommodative Strabismus: Early Postoperative Evaluation
Burcin Kepez Yıldız, Mehmet Goksel Ulas, Ebru Demet Aygit, Ceren Gurez, Nilay Kandemir Besek, Yusuf Yildirim, Alper Agca, Korhan Fazil, Birsen Gokyigit, Ahmet Demirok
doi: 10.14744/bej.2018.57060  Pages 58 - 62
INTRODUCTION: The aim of this study was to evaluate the postoperative change in the angle of deviation in patients with partially accommodative esotropia or exotropia who underwent keratorefractive surgery.
METHODS: The records of patients with partially accommodative esotropia or exotropia who underwent keratorefractive surgery (small incision lenticule extraction [SMILE], laser in situ keratomileusis [LASIK]) at Beyoglu Eye Training and Research Hospital between January 2017 and June 2017 were retrospectively reviewed. Preoperative and postoperative third month uncorrected and best corrected visual acuity, the angle of deviation in prism diopters, and titmus stereoacuity measurements were compared. Any preoperative strabismus surgery was also recorded.
RESULTS: A total of 19 eyes of 11 patients with partially accommodative esodeviation or exodeviation who underwent keratorefractive surgery between January 2017 and June 2017 were included in the study. Eight patients had bilateral surgery and 3 patients had unilateral surgery. The mean age of the patients was 24.9±5.78 years. Eight patients (72%) were men and 3 (28%) were women. Four patients had esotropia (36%), 5 had exotropia (45%) and 2 (18%) had exophoria. Five patients (45%) underwent a SMILE procedure and 6 patients underwent femtosecond LASIK surgery. No complications occurred preoperatively or postoperatively. One patient (0.9%) had a history of strabismus surgery before the keratorefractive procedure. No significant difference was detected in the ocular alignment and angle of deviation before and after keratorefractive surgery at postoperative third month.
DISCUSSION AND CONCLUSION: Refractive surgery seems to be ineffective at providing orthophoria for patients with partially accommodative esodeviation or exodeviation.

4.Visual and Refractive Outcomes of Laser In Situ Keratomileusis in Low to High Myopia: Two Years’ Follow-up
Zeynep Kayaarasi Ozturker, Vedat Kaya
doi: 10.14744/bej.2018.26349  Pages 63 - 70
INTRODUCTION: The purpose of this study was to determine the refractive and visual acuity changes in myopic eyes after laser in situ keratomileusis (LASIK) surgery and to evaluate the stability, predictability, efficacy, and safety of the procedure.
METHODS: A total of 199 eyes of 113 patients were evaluated retrospectively at the Beyoğlu Eye Training and Research Hospital in terms of myopia and/or myopic astigmatism correction with LASIK surgery. The cases were classified as low to moderate myopia/myopic astigmatism (-0.50 to -6.00 diopters [D]) (Group 1) and high myopia (-6.25 to -16.00 D) (Group 2). Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), the rate of achieving the planned diopter value, and insufficient and excessive correction were investigated. In all cases, the laser procedure was performed with an LSX (LaserSight, Inc., FL, USA) device, and keratome incisions with a Carrazio-Barraquer or a Moria M2 microkeratome.
RESULTS: The patients were followed up for a median of 18.82±6.06 months. In the group, 52 were male (46.0%), 61 were female (53.9%), and the mean age was 30.5±8.76 years. At the last visit, the mean spherical and cylindrical refractive error in Group 1 regressed from the preoperative values of -3.31±1.54 D and -1.00±1.08 D to -0.17±0.56 D and -0.71±0.57 D, respectively. In Group 2, the mean spherical and cylindrical refractive error regressed from the preoperative values of -8.55±2.26 D and -1.64±3.36 D to -1.53±1.06 D and -0.66±0.71 D, respectively. Preoperative UCVA increased from 0.07±0.46 D to 0.83±0.75 D in Group 1 (p<0.001), and 0.03±0.58 D to 0.43±0.54 D in Group 2 (p<0.001). There was no statistically significant change in the BCVA in either group at the final visit (p>0.05 for each group). Five eyes (10%) in Group 1 and 6 eyes (18%) in Group 2 had a loss of ≥1 line on the Snellen chart with best correction. Four eyes (8%) in Group 1 and 7 eyes (21%) in Group 2 gained ≥1 line on the Snellen chart with best correction.
DISCUSSION AND CONCLUSION: LASIK surgery yielded better results in cases of low to moderate myopia, and had acceptable results in high myopia. Although refractive improvement may be achieved in high myopia, considering the low visual quality obtained and the possibility of regression, the results of high dioptric correction can be variable.

5.Conjunctival Limbal Autograft Implantation in Primary and Recurrent Pterygium
Ali Demircan
doi: 10.14744/bej.2018.35229  Pages 71 - 74
INTRODUCTION: The aim of this study was to evaluate the clinical results and recurrence rate after pterygium excision with a conjunctival limbal autograft in patients with primary and recurrent pterygium.
METHODS: Patients who had primary (Group 1) or recurrent (Group 2) pterygium and who underwent pterygium excision with a conjunctival limbal autograft implantation (with interrupted 10-0 nylon sutures or fibrin glue) were retrospectively reviewed. Only patients with a follow-up of at least 6 months were included. The primary outcome measures were the spherical equivalent (SE) of manifest refraction, uncorrected distance visual acuity, distance corrected visual acuity, topographical astigmatism, and keratometry values measured preoperatively and at 3- and 6-month follow-up visits. Complication and recurrence data were also recorded.
RESULTS: A total of 145 patients were included in the study. There were no statistically significant differences between the groups preoperatively. When all of the cases were evaluated, there was a statistically significant correlation between pterygium length and corneal astigmatism. After surgery, SE, corneal astigmatism, and topographical astigmatism measurements had decreased significantly in both groups when compared with the preoperative values. Postoperative visual acuity, corneal astigmatism, and manifest cylinder values were similar between the groups. There was no recurrence in Group 1. The recurrence rate was 1.75% in Group 2.
DISCUSSION AND CONCLUSION: Pterygium excision with a conjunctival limbal autograft is a safe and effective method for the surgical treatment of primary and recurrent pterygium. The recurrence rate was very low.

6.Deep Anterior Lamellar Keratoplasty Using the Big-Bubble Technique in Keratoconus
Sibel Ahmet, Nilay Kandemir, Alper Agca, Muhittin Taskpili
doi: 10.14744/bej.2018.29292  Pages 75 - 79
INTRODUCTION: The aim of this study was to evaluate the visual outcomes and complications of deep anterior lamellar keratoplasty (DALK) performed using the big-bubble technique in patients with keratoconus.
METHODS: In this case series, 57 eyes of 57 patients with moderate to advanced keratoconus underwent DALK. All of the participants were contact lens-intolerant or had an unacceptable contact lens fitting as a result of advanced keratoconus. DALK was performed using the big-bubble technique. Full thickness donor corneas devoid of Descemet’s membrane were sutured to the recipient bed. Preoperative and postoperative best spectacle-corrected visual acuity (BSCVA), corneal topography, and intra-postoperative complications were evaluated.
RESULTS: The mean age of 40 male (70%) and 17 female (30%) patients who had an average follow-up of 48.84±18.12 months (range: 12–60 months) in this study was 28±11.3 years (range: 7–63 years) at the time of the DALK procedure. The mean BSCVA increased from 1.41±0.44 logMAR to 0.87±0.37 logMAR at the final follow-up (p<0.001). The mean preoperative value of flat (K1) and steep (K2) curvature power was 53.5±8.8 diopters (D) and 60.6 ± 8.5 D, respectively, while the postoperative mean K1 and K2 value was 42.8±1.2 D and 46.06±1.3 D. Microperforation was seen in 6 patients (10.5%) during the suturation as an intraoperative complication. Postoperatively, 8 patients (14%) underwent suture revision and 1 patient (0.2%) underwent amniotic membrane transplantation.
DISCUSSION AND CONCLUSION: DALK using the big-bubble technique appears to be a safe and effective procedure in patients with keratoconus.

7.The Effects of Age on Pupil Diameter at Different Light Amplitudes
Hande Husniye Telek, Hidayet Erdol, Adem Turk
doi: 10.14744/bej.2018.43534  Pages 80 - 85
INTRODUCTION: This study was an evaluation of pupil response at different light amplitudes in healthy individuals in different age groups.
METHODS: A total of 210 eyes of 105 healthy individuals were included in the study. The participants were divided into 4 groups at 15-year age intervals: 15-30, 31-45, 46-60, and over 60 years. The dimensions of the pupil were measured with a pupillometer at 5 different light amplitudes: 0, 1, 10, 100, and 200 cd/m2. The average pupil diameter in the groups was compared and changes in pupil diameter were correlated for each light amplitude according to age.
RESULTS: The mean pupil diameter was 4.96+0.82 mm in males, and 4.95+0.87 mm in females at 0 cd/m2 light amplitude, and 2.44+0.19 mm and 2.40+0.19 mm, respectively, at 200 cd/m2 light amplitude. The differences were not statistically significant (p>0.05). In addition, there was no significant difference in pupil size between the right and left eye at any light amplitude (p>0.05). Pupil diameters were found to be smaller at all light amplitudes with advanced age. There was a negative significant correlation between pupil size and age at all light amplitudes (p<0.05). The correlation was stronger at low light amplitudes.
DISCUSSION AND CONCLUSION: Pupil response to light is influenced by age. This should be taken into consideration when evaluating pupil reaction.

8.Effects of Intravitreal Injection of Ranibizumab and Aflibercept on Corneal Endothelium and Central Corneal Thickness
Mehmet Coskun
doi: 10.14744/bej.2018.03521  Pages 86 - 90
INTRODUCTION: This study was an evaluation of intravitreal injections of ranibizumab (IVR) and aflibercept (IVA) administered to the corneal endothelium.
METHODS: Thirty eyes of 30 patients made up the IVR injection group and 30 eyes of another 30 patients were recruited as the IVA injection group. Specular microscopy results before the injection, on the 1st, 7th, and 30th days were examined. Central corneal thickness (CCT), endothelial cell density (CD), coefficient of variation (CV), and hexagonality (HEX) values were recorded.
RESULTS: No difference was seen between the groups with respect to gender (p=0.057). No significant difference was seen in CCT measurements in the IVR or the IVA group (p=0.08, p=0.16, respectively). Nor was a significant difference seen in the IVR group in terms of CD (p=0.85); however, a statistically significant difference was detected in the IVA group (p=0.03). Furthermore, no significant difference was seen in the IVR or the IVA group with regard to CV (p=0.12, p=0.17, respectively), and no significant difference was seen in the IVA group with respect to HEX values between measurements intervals (p>0.05); however, a significant difference was found in the IVR group (p=0.02).
DISCUSSION AND CONCLUSION: Neither IVR nor IVA affected the CCT or CV values. The CD did not change significantly in the IVR group, whereas in the IVA group, the CD values of the first day after the injection were high, although they had returned to normal on the 30th day. In the IVR group, a statistically significant difference was seen in terms of the HEX values.

9.Evaluation of Surgical Outcomes, Patient Satisfaction, and Potential Complications after Blepharoplasty
Sezen Akkaya
doi: 10.14744/bej.2018.08208  Pages 91 - 95
INTRODUCTION: This study is an evaluation of the surgical outcomes, patient satisfaction, and potential complications following blepharoplasty surgery.
METHODS: A total of 128 patients who underwent blepharoplasty surgery between 2015 and 2017 were included in this study. A postoperative lid crease difference of at least 1 mm was considered asymmetrical. Pre- and postoperative tear break-up time (TBUT) was evaluated. All of the patients were asked to complete a satisfaction assessment form prepared by the authors. The scar tissue that developed along the incision line was evaluated and graded by a single observer.
RESULTS: The mean age of the patients was 62.70±9.73 years, and all of the patients were monitored for a period of least 6 months. In combination with blepharoplasty, 17 patients underwent eyebrow surgery, 6 underwent lower eyelid surgery, and 4 underwent levator surgery. Lid crease asymmetry of 1 mm was determined in 8 patients, and a 2-mm asymmetry was identified in 2 patients, although the pre- and postoperative TBUT was not significantly different (p≥0.05). A total of 107 (83.59%) patients reported a very high level of satisfaction at the postoperative sixth month, 15 (11.71%) patients reported a high level of satisfactıon, and 6 (4.68%) reported a moderate level of satisfaction. In the postoperative sixth month, 87 (67.97%) patients had no scar tissue at the incision line, while 36 (28.13%) patients had noticeable scar tissue upon close inspection, and 5 (3.91%) patients had apparent scar tissue. None of the patients developed serious complications, such as severe hematoma, lagophthalmos, or wound separation.
DISCUSSION AND CONCLUSION: In the present study, the patients generally expressed long-term satisfaction with the results of blepharoplasty surgery for dermatochalasis. A comprehensive preoperative assessment, and combining surgeries when necessary and appropriate, ensures a high rate of success in blepharoplasty procedures.

CASE REPORT
10.Anterior Chamber Dislocation of Ozurdex Implant: A Case Report
Elif Ertan, Rahmi Duman, Resat Duman, Mustafa Dogan
doi: 10.14744/bej.2018.91885  Pages 96 - 98
Anterior chamber dislocation of an Ozurdex (Allergan plc, Dublin, Ireland) implant from the vitreous cavity is unusual. The risk factors for dexamethasone implant migration into the anterior chamber include a defective posterior lens capsule, aphakia, and a prior history of pars plana vitrectomy. Presently described is a case of corneal toxicity occurring after the migration of a dexamethasone implant into the anterior chamber.

11.Persistent Subretinal Fluid: Wait or Treat?
Ertugrul Tan Yassa, Berker Bakbak
doi: 10.14744/bej.2018.86580  Pages 99 - 100
Persistent subretinal fluid (SRF) may occur even after successful surgery for rhegmatogenous retinal detachment (RRD). In most cases, persistent SRF resolves spontaneously within a year, but persistent SRF may cause poor central vision, photoreceptor damage, and the irreversible loss of visual function. Therefore, a variety of interventions have been developed to manage persistent SRF, including the prophylactic use of steroids. As far as we know, an intravitreal steroid injection has never been used in the treatment of persistent SR. This report is a description of steroid treatment used in the case of a 46-year-old male patient with SRF persisting for 15 months after pars plana vitrectomy surgery for the treatment of macula-off RRD. A single-dose intravitreal triamcinolone acetonide (IVTA) injection (4 mg/0.1 mL) was administered; however, no improvement was seen in the lesions. It was concluded that an IVTA injection should be used in a limited fashion in patients with persistent SRF.

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