ISSN: 2459 - 1777 | E-ISSN 2587-0394
Volume : 5 Issue : 3 Year : 2020

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Beyoglu Eye Journal - Beyoglu Eye J: 5 (3)
Volume: 5  Issue: 3 - 2020
1.A Glossary for ‘’Pseudo’’ Conditions in Ophthalmology
Burak Turgut, Sabiha Gungor Kobat
doi: 10.14744/bej.2020.88609  Pages 153 - 162
The term “pseudo’’ refers to ‘’lying, false, fake, simulation, imitation or spurious.’’ In ophthalmological literature, there are many diseases/conditions/signs/phenomena that are considered as “pseudo.” A literature search was conducted on the Medical Subject Headings website, and the keywords that were searched in the title and abstract were as follows: (pseudo-), (fake), (false), (mimicker), (simulator), (masquerade), AND (condition) AND(causes) AND (ophthalmology)OR (eye) OR (ocular) OR (ophthalmic) OR (cornea) OR (retina) OR (strabismus) OR (glaucoma). The search was restricted to English language. The major databases such as PubMed, Medline, Scopus, Google Scholar, OVID, EBSCO, and Cochrane Library were searched or investigated for information. The objective of this review is to summarize common ‘‘pseudo’’ conditions in ophthalmology and their respective common causes. We believe that the knowledge of these pseudo-conditions will provide significant benefits in the differential diagnosis of various ophthalmic disorders.

2.The Effect of Uneventful Phacoemulsification on Intraocular Pressure and Anterior Segment Parameters in Pseudoexfoliation Syndrome
Sevinc Sahin Atik, Seyda Ugurlu, Emine Deniz Egrilmez, Meryem Altın Ekin
doi: 10.14744/bej.2020.08860  Pages 163 - 168
INTRODUCTION: The aim of this study was to evaluate the effects of cataract surgery on anterior segment parameters and intraocular pressure (IOP) in non-glaucomatous pseudoexfoliation syndrome (PXS) eyes.
METHODS: The cohort consisted of 65 patients who were to undergo cataract surgery; the participants were divided into 2 groups: patients with PXS (n=35) and controls without PXS (n=30). A complete ophthalmic examination, measurement of IOP (using an applanation tonometer), and evaluation of anterior segment parameters using a Sirius Scheimpflug/Placido topography device (CSO Italy, Firenze, Italy) were performed on all patients both prior to and 1 month after surgery.
RESULTS: No significant difference was observed between groups in terms of preoperative IOP, pupil diameter, central corneal thickness, anterior chamber depth (ACD), anterior chamber volume (ACV), iridocorneal angle (ICA), or corneal volume (CV) values. A reduction in the postoperative mean IOP value was noted in both groups, with a difference of slightly >2 mmHg in the PXS group (PXS: p=0.000, control: p=0.002). Postoperatively, a statistically significant increase was observed in both groups in the ACD, ICA, ACV, and CV measurements. When comparing the preoperative and postoperative differences of the groups, the only parameter noted to be statistically significantly different was postoperative widening of the ICA. A greater degree of widening was noted in the PXS group (13.83±6.06°) compared with the control group (10.47±6.69°) (p=0.039).
DISCUSSION AND CONCLUSION: IOP values decreased and ACD values increased significantly following phacoemulsification in the PXS and the normal eyes. These findings support results reported in the literature. However, the results related to ICA changes are a new, previously unreported contribution. To more fully comprehend the effects of cataract surgery on patients with PXS in terms of ICA changes, prospective studies with a larger cohort are needed.

3.Evaluating the Effects of Upper Eyelid Blepharoplasty on Tear Film Quality and Intraocular Pressure
İbrahim Cagri Turker, Ceylan Uslu Dogan
doi: 10.14744/bej.2020.81300  Pages 169 - 173
INTRODUCTION: To evaluate tear film quality and intraocular pressure (IOP) changes after upper eyelid blepharoplasty.
METHODS: This retrospective study included 42 eyes of 21 patients who underwent upper eyelid blepharoplasty for dermatochalasis between January 2018 and June 2018 in our clinic. Schirmer’s and tear break-up time (TBUT) values and IOP were measured preoperatively and postoperatively at first day, 1 month, and 3 months in all patients. The ocular surface staining pattern was evaluated according to Oxford scale. Effects of upper eyelid blepharoplasty on tear film quality and IOP were evaluated.
RESULTS: All patients were female and their mean age was 53.28±7.98. The postoperative Schirmer’s test scores at postoperative 3 months were significantly (p<0.01) lower than all previous preoperative measures. Similarly, the postoperative 1-week measurements were significantly (p<0.01) higher than the postoperative 1-month and 3-month measurements. In terms of TBUT, the postoperative 1-week measurement was significantly (p<0.05) higher than the postoperative 1-month measurement and the preoperative value than the postoperative 1-month measurement. There was no significant (p>0.05) difference between the measurements in terms of IOP values. Of the 42 eyes evaluated according to Oxford scale, 28 (66%) had mild symptoms, 10 (23%) had moderate symptoms, and 4 (9%) had marked symptoms. No patient with severe symptoms was detected.
DISCUSSION AND CONCLUSION: Upper eyelid blepharoplasty may have a negative effect on tear film quality in early postoperative period; however, it does not affect IOP at any period. Understanding the effects of surgery performed specifically on ocular surface through larger case series may necessitate ophthalmologic examination for preoperative evaluation and postoperative follow-up of dermatochalasis cases.

4.Subfoveal Choroidal Thickness and Ganglion Cell Complex in Children with Type 1 Diabetes Mellitus Without Diabetic Retinopathy
Alper Halil Bayat, Akin Cakir, Digdem Bezen, Mustafa Nuri Elcioglu
doi: 10.14744/bej.2020.50470  Pages 174 - 177
INTRODUCTION: This study is an analysis of the subfoveal choroidal thickness (SFCT) and ganglion cell complex (GCC) in children who have type 1 diabetes mellitus (T1D) without diabetic retinopathy.
METHODS: In all, 36 right eyes of 36 patients with T1D and 36 right eyes of sex- and age-matched healthy subjects were included in this prospective study. SFCT and GCC measurements were obtained using spectral domain optical coherence tomography (SD-OCT). Correlations between SCFT, GCC and duration of T1D, glycated hemoglobin, and age were also investigated.
RESULTS: The mean SFCT was 342.1±42.3 µm in the T1D group and 354±70.8 µm in the control group (p>0.05). There was no significant difference between the groups in the GCC superior and inferior retina values. The average GCC was thinner in the T1D group (T1D group: 88.11±14.93 µm, control group: 103.39±15.65 µm; p=0.005). The mean central retinal thickness (CRT) was decreased in the T1D group (T1D group: 248.1±16.5 µm, control group: 262.1±18.3 µm; p=0.021).
DISCUSSION AND CONCLUSION: The mean SFCT was not significantly different in diabetic children compared with healthy eyes. The CRT and average GCC thickness were lower in children with T1D. SD-OCT can reveal neurodegenerative changes that may occur before vascular changes in diabetic children.

5.Measurement of Intraocular Pressure with Applanation, Dynamic Contour, and Air-Puff Tonometers: A Comparative Study in Primary Open-Angle Glaucoma and Healthy Cases
Kemal Turgay Ozbilen, M. Selim Kocabora
doi: 10.14744/bej.2020.82713  Pages 178 - 187
INTRODUCTION: This study aimed to investigate and compare the reliability of Goldmann applanation tonometer (GAT), dynamic contour (DCT), and noncontact (NCT) tonometers in intraocular pressure (IOP) measurement and the affecting parameters in healthy subjects and cases with primary open-angle glaucoma (POAG).
METHODS: Left eyes of 64 cases (32 males and 32 females) were selected for this prospective, controlled study. Of these cases, 33 had POAG, and 31 were selected as control. IOP measurement was performed using NCT, DCT, and GAT consecutively for each patient, and then central corneal thickness (CCT) was measured. Ocular pulse amplitude (OPA) and all values were recorded.
RESULTS: The mean age was 53.36±10 years (31–80 years), and CCT was 561±45 μ. IOP was found as 16.39±3.75 mmHg with GAT, 17.89±3.55 mmHg with DCT, and 15.76±3.49 mmHg with NCT. A significant difference was found between DCT with NCT and GAT. Whereas, a positive correlation was found between CCT with all the three methods used, with DCT as the weakest. While the correlation between all the three methods was excellent, the strongest was found to be between DCT and GAT. Thick corneas affected all the three methods, but DCT was the least affected. While DCT tends to measure higher than both GAT and NCT, this difference decreased as the corneal thickness increased. OPA was found to be 2.56±1.04 mmHg; no statistical difference was found between the groups. A correlation was found between OPA and IOP, and OPA was found to be significantly higher in women.
DISCUSSION AND CONCLUSION: DCT is minimally affected by corneal factors, especially in thin corneas, and shows excellent correlation with GAT. This new-generation digital tonometer can be used safely in glaucoma diagnosis and follow-up.

6.Weighted Comparison of the Corneal Topographic Data in Intracapsular versus Ciliary Sulcus Intraocular Lens Implantation during Phacoemulsification Surgery
Mustafa Kalayci, Selim Genc, Kenan Calisir, Abdulkadir Ender, Mehmet Atakan
doi: 10.14744/bej.2020.30301  Pages 188 - 193
INTRODUCTION: This study aimed to evaluate the preoperative and postoperative changes in corneal topography, intraocular pressure (IOP), and visual acuity in patients who developed posterior capsule rupture during phacoemulsification surgery and simultaneously underwent ciliary sulcus intraocular lens (IOL) implantation and in those with intact capsular integrity who simultaneously underwent intracapsular IOL implantation and to compare these changes within and between the two groups.
METHODS: Among the 855 patients, 92 eyes of 69 patients whose corneal topography, IOP, and best-corrected visual acuity (BCVA) were successfully measured were included in the study. Preliminary chamber parameters [horizontal visible iris diameter (HVID), iridocorneal angle, anterior chamber volume (ACV), and anterior chamber depth (ACD)] were measured before and after surgery using a Sirius corneal topography device.
RESULTS: The IOL was implanted in the capsular bag in 58 patients and in the ciliary sulcus between the posterior iris and the capsule in 34 patients. In the sulcus IOL group, both BCVA and IOP measurements statistically significantly increased in the postoperative period compared with the preoperative values (p<0.001). As regards postoperative changes between the intracapsular and sulcus IOL groups, no significant difference was found in the changes in HVID (p=0.584), iridocorneal angle (p=0.282), and ACD (p=0.382), whereas the changes in ACV, IOP, and BCVA were statistically significantly different (p=0.020, p<0.001, and p<0.001, respectively).
DISCUSSION AND CONCLUSION: While the IOP of the sulcus IOL group significantly increased, that of the intracapsular group significantly decreased. Visual acuity increased in both lens implants, but patients with intracapsular lenses had greater improvement in visual acuity; thus, intracapsular IOL implantation was more advantageous than sulcus IOL implantation.

7.Anxiety in Children with Low Vision Secondary to Refractive Errors
Sinan Bekmez, Dilem Eris, Irfan Perente
doi: 10.14744/bej.2020.76993  Pages 194 - 198
INTRODUCTION: This study aimed to evaluate the anxiety status of children with low vision due to refractive errors using a questionnaire survey.
METHODS: Between July and November 2019, the Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire was administered to children with refractive errors (≥3D) and amblyopia who presented to the ophthalmology clinic. Children with low vision were evaluated based on their answers to the SCARED questionnaire.
RESULTS: This study included 38 children (22 girls, 16 boys) with low vision. The average age of the participants was 9.74±2.65 (7–12) years. The average binocular vision was 0.28±0.21 LogMAR. The mean total anxiety score was 21.68±10.55. At least one type of anxiety was detected in 18 (47.4%) children. A positive correlation and statistical significance were found between binocular low vision and anxiety (r=0.63, p<0.001). Boys were more susceptible to anxiety than girls, and a positive moderate correlation and statistical significance were found (r=0.50, p=0.002).
DISCUSSION AND CONCLUSION: Anxiety may develop in children with low vision, and this anxiety more commonly occur in boys than in girls (p=0.002). In addition, psychological disorders can be seen in children with low vision. To better evaluate this connection, large case series studies including visual impairment due to different reasons are needed.

8.Effectiveness of Selective Laser Trabeculoplasty as Initial or Adjunctive Treatment for Primary Open-Angle Glaucoma
Halil Ibrahim Yener, Muammer Ozcimen
doi: 10.14744/bej.2020.85866  Pages 199 - 204
INTRODUCTION: The aim of this study was to evaluate the effectiveness of selective laser trabeculoplasty (SLT) at lowering intraocular pressure (IOP) as initial or adjunctive treatment in patients with primary open-angle glaucoma (POAG).
METHODS: This was a prospective, comparative study. A total of 162 eyes of 81 patients with bilateral POAG were evaluated. The patients were categorized into 2 groups. SLT was performed as an adjunctive treatment in 42 POAG patients (Group 1, 84 eyes) and as initial treatment in 39 POAG patients (Group 2, 78 eyes).
RESULTS: The mean baseline IOP and post-SLT IOP for the entire study group was 23.3±4.8 mm Hg and 14.6±2.7 mm Hg, respectively. The mean percentage reduction of IOP post-SLT at the final visit was 34.5% in Group 1 and 40.5% in Group 2. The number of medications used in the Group 1 before SLT was 2.11±0.88 (range: 1-4), while after SLT, medication use decreased to 0.9 ±0.15 (range: 0-3). The mean length of follow-up was 49.85±8.2 weeks (range: 24-78 weeks).
DISCUSSION AND CONCLUSION: SLT can be used effectively as a primary or an adjunctive therapy for the treatment of POAG. It was also effective at reducing the quantity of medications used. The reduction in IOP was similar in the primary and adjunctive group for up to 1 year of follow-up.

9.A Series of Civilian Ocular Injuries from the Civil War in Syria
Ahmet Elbeyli, Bengi Ece Kurtul
doi: 10.14744/bej.2020.58661  Pages 205 - 208
INTRODUCTION: This study aimed to evaluate the demographic and clinical features of eye injury cases in the Syrian Civil War.

METHODS: A total of 224 eyes of 212 Syrian patients who were referred urgently to Hatay Mustafa Kemal University Faculty of Medicine Department of Ophthalmology between January 2011 and December 2018 were evaluated retrospectively. Types of trauma and clinical findings were analyzed.

RESULTS: Patients were predominantly male (n=194, 91.5%). The mean age was 29.50±10.76 (range 1–74) years. A total of 30 (14.15%) patients were <18 years old. Most eye traumas (n=177, 79.0%) were open globe injuries, and the remaining 21.0% (n=47) were closed globe injuries. Intraocular foreign body was detected in 106 (47.32%) eyes. Primary repair was performed in 74.10% (n=166) of the cases, and evisceration was performed in 4.46% (n=10).

DISCUSSION AND CONCLUSION: Our study indicated that war conditions can cause serious eye injuries in civilians. These conditions often cause vision and eye loss in adults and children. In addition, all units carrying and treating patient should be strongly coordinated to minimize vision, time, and economic losses.

10.Comparative Analysis of Pupil Diameters in Light and Dark Conditions After Instillation of 0.15% Brimonidine Drops in Eyes With and Without Pseudoexfoliation Syndrome
Sercan Cate, Çağlar Bektaş, Burak Turgut
doi: 10.14744/bej.2020.52244  Pages 209 - 213
INTRODUCTION: This study aimed to compare pupil diameters in light and dark conditions after instillation of 0.15% brimonidine drops in eyes with and without pseudoexfoliation syndrome (PES).
METHODS: Forty eyes of 40 patients in whom 0.15% brimonidine drops were instilled to their right eyes between March 2019 and June 2019 were analyzed in this study. Study groups included 20 subjects without PES (group 1) and 20 patients with PES (group 2). Pupil diameters before and 30 and 90 min after brimonidine application were recorded and analyzed.

RESULTS: In group 1, the mean pupil diameters before brimonidine drop instillation were 4.8±1.2 mm and 5.8±1.2 mm in light and dark conditions, respectively, while those in group 2 were 4.4±1.2 mm and 4.9±1.3 mm, respectively. At 30 min after brimonidine drop instillation, the pupil diameters in light and dark conditions were 4.3±1.1 mm and 5.3±1.0 mm in group 1 and 4.1±1.1 mm and 4.5±1 mm in group 2, respectively. In group 1, the mean pupil diameters at 90 min were 4.2±1.1 mm and 5.1±1.1 mm in light and dark, respectively, and in group 2, they were 4.0±1.1 mm and 4.4±1.2 mm, respectively. In the dark, the pupil diameters before drop instillation were significantly smaller in group 2 than in group 1 (p≤0.05). A significant difference was found between the groups with respect to the measurements in the dark at 30 min (p≤0.05). When the differences at 30 and 90 min and the initial pupil diameters in light condition were compared between the groups, the change in the pupil diameter at 30 min was statistically significant (p≤0.05). At 90 min, differences in both light and dark measurements were statistically significant (p≤0.05).

DISCUSSION AND CONCLUSION: Brimonidine causes significant miosis in eyes with PES compared with eyes without PES. Brimonidine may have positive effects on spherical aberrations, glares, and halos. However, inadequate pupillary dilation may make it more difficult to perform cataract surgery and may further increase the complication rate.

11.Assessment of Plasma Thiol-disulfide Balance in Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma
Tamer Takmaz, Derya Yaman, Nilay Yuksel, Mücella Arıkan Yorgun, Almila Şenat, Özcan Erel
doi: 10.14744/bej.2020.41275  Pages 214 - 218
INTRODUCTION: The thiol-disulfide balance is very important in cellular events such as apoptosis and oxidative stress. This study is a comparison of plasma thiol-disulfide homeostasis in patients with pseudoexfoliation syndrome (PEXS) and pseudoexfoliation glaucoma (PEXG).
METHODS: Thirty-one patients with PEXS, 43 patients with PEXG, and 38 healthy controls were included in this prospective study. The plasma level of native thiol and disulfide were measured using a spectrophotometric assay and the native thiol/disulfide ratio was analyzed
RESULTS: The demographic characteristics of the 3 groups were similar (p>0.05). Statistically significant differences were observed in the plasma disulfide levels (21.6±7.3 µmol/L vs. 17.4±6.8 µmol/L) and the native thiol/disulfide ratio (22.9±9.1 vs. 29.9±14.7) between the PEXG group and the controls (p=0.03, p=0.02, respectively).
DISCUSSION AND CONCLUSION: Significant differences in the plasma levels of disulfide and the native thiol/disulfide ratio in PEXG patients indicated a breakdown of the thiol-disulfide circuits.

12.Carvacrol Protects Against Paclitaxel-Induced Retinal and Optic Nerve Cytotoxicity: A Histopathological Study
Emine Çinici, Nilay Dilekmen, Zerrin Kutlu, Büşra Dinçer, Özkan Çinici, Hilal Balta, İlknur Çalık
doi: 10.14744/bej.2020.63825  Pages 219 - 222
INTRODUCTION: Carvacrol (CV) is a phenolic monoterpenoid found in the essential oil of a number of aromatic plants and herbs. The present study was an investigation of the potential protective effect of CV against paclitaxel (PTX)-induced retinal and optic nerve cytotoxicity in rats.
METHODS: A total of 18 adult male Wistar albino rats (250-400g) were randomized into 3 equal groups comprising 6 animals each. Group 1 (control group) received intraperitoneal (IP) saline solution (0.5 mL/200 g) weekly for 4 weeks. Group 2 received an IP dose of PTX (5 mg/kg), and Group 3 received CV (25 mg/kg) 30 minutes after an IP dose of PTX (5 mg/kg) weekly for 4 weeks. At the conclusion of the experimental period, the retinal and optic nerve tissues of the subjects were evaluated histopathologically.

RESULTS: All of the retinal specimens in Group 1 (control) were histopathologically normal. In Group 2 (PTX), all of the eyes (6/6) revealed increased retinal vascularity and rosette-like structures in the outer nuclear layer, and in Group 3 (PTX-CV), all of the eyes (6/6) demonstrated normal retinal vascularity and the absence of rosette-like structures. All of the optic nerve specimens in Group 1 (control) were histopathologically normal. In Group 2 (PTX), all of the eyes (6/6) demonstrated severe vacuolization and a decreased number of astrocytes and oligodendrocytes in the optic nerve specimens, while 3 eyes (3/6) showed marked single cell necrosis. None of the eyes in Group 3 (PTX-CV) demonstrated either vacuolization or a reduction in the number of astrocytes and oligodendrocytes. No remarkable single cell necrosis was observed in the optic nerve specimens of Group 3 (PTX-CV).

DISCUSSION AND CONCLUSION: The histopathological findings indicated that CV played a protective role against PTX-induced cytotoxicity. CV might be a promising resource to counteract oxidative stress-based cytotoxicity in the field of retinal and optic nerve disorders.

13.Combined Intracapsular Lens Removal and Scleral Fixation of Intraocular Lenses Through the Same Scleral Tunnel in Cases with Severely Dislocated Lenses
Selim Genç, Amber Şenel Kükner, Özum Yücel, Sariye Taşkoparan, Fehim Esen
doi: 10.14744/bej.2020.18199  Pages 223 - 227
INTRODUCTION: The management of severely dislocated lenses floating in the anterior vitreous is challenging. This study describes the clinical outcome of a surgical approach with intracapsular lens extraction (ICCE) and implantation of a scleral-fixated posterior chamber intraocular lens (SF-IOL) at the same surgical session.

METHODS: Records of patients who had severely dislocated lenses were retrospectively reviewed. All included patients had undergone ICCE, followed by implantation of an SF-IOL during the same surgical session through the same scleral tunnel placed 1.5 mm posterior to the limbus. Clinical characteristics of the patients were collected, and surgical videos were watched again to review intraoperative complications.

RESULTS: Thirty eyes of 30 patients (mean age, 68±11.1 years, 23 male, 7 female) were included in the study. Twenty-five patients had a history of blunt trauma, and five patients had pseudoexfoliation syndrome. The best-corrected visual acuity of the patient improved significantly after the procedure (p=0.001). The intraocular pressure of the patients remained unchanged (p=0.38). Three patients developed mild IOL dislocation that did not require any intervention. A patient developed transient hypotony, and another developed mild vitreous hemorrhage. These complications improved spontaneously without the need for further intervention.

DISCUSSION AND CONCLUSION: Simultaneous removal of dislocated lens and SF-IOL implantation through the same scleral tunnel was a safe and effective procedure for patients with severely dislocated IOLs.

14.Evaluation of Posterior Ocular Structures in Patients with Isolated Iris Coloboma
Serkan Akkaya
doi: 10.14744/bej.2020.72621  Pages 228 - 233
INTRODUCTION: To measure lamina cribrosa thickness (LCT), lamina cribrosa depth (LCD) and subfoveal choroidal thickness (SFCT) by imaging posterior ocular structures in pediatric cases with isolated unilateral iris coloboma and to determine the differences as compared with healthy contralateral eyes of these cases (fellow eyes) and healthy control eyes.
METHODS: This cross-sectional, comparative prospective study included seven children (age range, 9-17 years) with unilateral isolated iris coloboma. The healthy contralateral eyes of these cases formed the fellow group. An age-matched (age range 8-17 years) control group (n = 9) including children with both eyes having either normal or corrected-to-normal visual acuity was formed. A detailed ophthalmic examination was performed. The posterior ocular segments were evaluated using spectral domain-optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI) technique.
RESULTS: The SFCT was 372.0 ± 48.8 µm, 375.3 ± 44.0 µm, and 386.5 ± 71.8 µm, respectively and the LCD was 362.4 ± 68.3 µm, 354.4 ± 47.1 µm, and 350.7 ± 38.1 µm, respectively, in the coloboma, fellow, and control eyes. There was no difference between the groups regarding SFCT and LCD. The mean LCT was significantly thinner in the coloboma eyes (200.2 ± 9.5 µm) than in the fellow (238.8 ± 26.7 µm; p = 0.023) and control eyes (240.0 ± 12.9 µm; p < 0.001). The LCT showed no significant correlation with age, axial length or spherical equivalent.
DISCUSSION AND CONCLUSION: Better visual prognosis is expected in isolated iris coloboma. Nevertheless, detailed examinations using new technologies such as SD-OCT may reveal some structural changes. Longitudinal studies are required to understand if a thinner LCT in coloboma eyes is associated with any future problems.

15.Unilateral Painful Red Eye with Corneal Cysts Assessed with Corneal Confocal Microscopy: A Case Mimicking Acanthamoeba Keratitis
Aysun Sanal Doğan, Canan Gürdal, Emrah Utku Kabataş, Naciye Kabataş, Osman Çelikay
doi: 10.14744/bej.2020.47965  Pages 234 - 237
A 28-year-old woman with a history of trauma to her right eye 2 months prior reported experiencing a stinging sensation and tearing in the morning since the injury occurred and the need to occasionally use an eye patch. Three days before presentation she had been prescribed a therapeutic contact lens (CL) with the diagnosis of a corneal epithelial defect. She described significant pain despite the CL. There was a corneal lesion with haze at the base surrounded by corneal edema. Corneal confocal images revealed hyperreflective cystic lesions that suggested Acanthamoeba keratitis (AK). However, the lesion healed within 10 days and the results of cultures taken before the initiation of treatment proved to be negative. The history of trauma and CL wear, the presence of severe pain, corneal findings, and the confocal microscopy detection of cysts led to a suspicion of AK in a differential diagnosis, but the final diagnosis was recurrent epithelial erosion based on the negative culture results, quick response to treatment, and the possibility of similar confocal findings in a healing epithelium. Since AK may cause loss of vision, suspicion should require that samples be obtained for microbiological study and close follow-up of the clinical course until a final diagnosis can be achieved.

16.Amniotic Membrane Transplantation for Spontaneous Corneal Perforation in a Case of Rheumatoid Arthritis
Uğur Acar
doi: 10.14744/bej.2020.40327  Pages 238 - 241
This report describes a case of spontaneous corneal perforation in a patient with rheumatoid arthritis (RA) and highlights the efficacy of treatment with amniotic membrane transplantation (AMT). A 58-year-old African-American woman with RA presented with complaints of redness and blurred vision in the right eye. Spontaneous corneal perforation and iris prolapse were determined in the paracentral corneal region of the right eye. Two-layer AMT surgery was performed. The anterior chamber began to improve 2 weeks after the AMT. Treatment for RA was scheduled with the rheumatology department.

17.Sequential Presentation of Superior and Inferior Branch Retinal Artery Occlusion in the Same Eye
Berrak Şekeryapan Gediz, Mehmet Ali Şekeroğlu
doi: 10.14744/bej.2020.20982  Pages 242 - 245
Branch retinal artery occlusion (BRAO) accounts for approximately 40% of retinal artery obstructive disease. The visual prognosis is relatively good, with the exception of recurrent BRAO. Recurrent BRAO may be idiopathic or associated with conditions such as systemic vasculitides, blood dyscrasias, floppy mitral valve syndrome, or Susac syndrome. This report describes a patient who presented with an inferior BRAO without any indication of systemic disease. There was a history of a superior BRAO in the same eye. Patients with a BRAO are at significant risk for future cardiovascular and cerebrovascular events and these patients should be referred to a neurologist and a cardiologist immediately after diagnosis.

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