ISSN: 2459 - 1777 | E-ISSN 2587-0394
Volume : 6 Issue : 1 Year : 2021

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Beyoglu Eye Journal - Beyoglu Eye J: 6 (1)
Volume: 6  Issue: 1 - 2021
EXPERIMENTAL STUDY
1.The Inhibitory Effect of Capparis Ovata Polysaccharides on Cultured Pterygium Fibroblasts
Erkut Küçük, Işıl Aydemir, Kurşad Zor, Oktay Özkan
doi: 10.14744/bej.2021.60352  Pages 1 - 6
INTRODUCTION: Pterygium recurrence after removal surgery is an important problem. Polysaccharides obtained from Capparis species have been shown to possess various biological properties, including anti-tumor activity. This study was an investigation of the effect of Capparis ovata polysaccharides on cultured pterygium fibroblasts and a comparison with the effects of mitomycin C (MMC).
METHODS: Pterygium tissue samples were obtained during excision surgery from 3 patients with primary pterygium, and fibroblasts were isolated. Pterygium fibroblast cultures and L929 cell cultures were treated with different concentrations of MMC and Capparis ovata polysaccharides. Cell proliferation and migration were evaluated.
RESULTS: An MTT assay revealed that cell viability decreased with increasing concentrations of Capparis ovata polysaccharides in both cell types. MMC also inhibited the proliferation of both cell types. A scratch-wound assay indicated that both Capparis ovata polysaccharides and MMC molecules reduced proliferation and migration in the pterygium fibroblasts and L929 cells.
DISCUSSION AND CONCLUSION: The in vitro Capparis ovata polysaccharide inhibition of proliferation and migration of pterygium fibroblasts was similar to that of MMC. The results of this study suggested that Capparis ovata polysaccharides may be a valuable candidate drug to treat pterygium.

ORIGINAL ARTICLE
2.Comparison of Six Methods of Central Corneal Thickness Measurement in Healthy Eyes
Turgay Uçak, Erel İçel, Nurdan Gamze Taşlı, Yücel Karakurt, Hayati Yılmaz, Adem Uğurlu, Mehmet Demir
doi: 10.14744/bej.2021.17894  Pages 7 - 13
INTRODUCTION: Several methods of measuring central corneal thickness (CCT) have been compared, however, the data are still limited and conflicting. The aim of this study was to determine the agreement of CCT measurements performed in healthy eyes using ultrasound pachymetry (USP), non-contact tono/pachymetry, specular microscopy, biometry, Scheimpflug-based corneal topography, and optical coherence tomography (OCT).
METHODS: All of the participants underwent a complete ophthalmological examination. The CCT of all of the eyes included was measured using 6 different methods. The agreement between the methods was analyzed using the mean difference and Bland-Altman analysis based on a 95% limits of agreement.
RESULTS: A total of 64 patients with a mean age of 40.96±14.52 years (range: 20-78 years) were included in the study. The mean CCT value was 552.10±35.65 μm, 550.40±35.55 μm, 554.67±35.49 μm, 545.39±34.21 μm, 546.25±35.49 μm, and 552.64±33.59 μm using USP, non-contact tono/pachymetry, non-contact specular microscopy, biometry, Scheimpflug-based corneal topography, and OCT, respectively. The bias values determined by Bland-Altman plots were -1.70, -2.56, 6.71, 5.85, and -0.53 for tono/pachymetry, specular microscopy, biometry, topography, and OCT, respectively. OCT demonstrated the lowest bias compared to USP. The overall intraclass correlation coefficient was 0.961 (range: 0.945-0.974) with a 95% confidence interval.
DISCUSSION AND CONCLUSION: All of the CCT measurements obtained using non-contact tono/pachymetry, non-contact specular microscopy, biometry, Scheimpflug-based corneal topography, and OCT were consistent with the USP measurements of healthy controls. Larger prospective studies to determine the interchangeability of different methods for CCT measurements in pathological conditions are warranted.

3.Stabilization Period for Central Corneal Thickness, Anterior Chamber Depth, and Iridocorneal Angle Parameters After Deep Anterior Lamellar Keratoplasty in Keratoconus Patients
Gönül Karataş Durusoy, Mehmet Özveren
doi: 10.14744/bej.2021.70894  Pages 14 - 18
INTRODUCTION: The purpose of this study was to assess the stabilization of anatomical outcomes of central corneal thickness (CCT), anterior chamber depth (ACD), and iridocorneal angle (ICA) in keratoconus-affected eyes after deep anterior lamellar keratoplasty (DALK).
METHODS: Keratoconus patients who underwent DALK surgery at Beyoğlu Eye Training and Research Hospital between January 2013 and May 2015 were retrospectively analyzed. Patients with data recorded preoperatively, 1 month postoperatively, and 1, 6, and 12 months post suture removal, including refractive status, best corrected visual acuity (BCVA), CCT, ACD, and ICA parameters were included in the study. The CCT, ACD, and ICA parameters were assessed with anterior segment optical coherence tomography.
RESULTS: A total of 42 eyes of 37 patients with a mean age of 30.5±10.5 years were analyzed. The mean preoperative and post-suture removal 12th-month BCVA was 1.41±0.43 logarithm of minimal angle of resolution (logMAR), and 0.34 ± 0.1 logMAR, respectively (p<0.001). The ACD (11%; p<0.001) and ICA (3%; p=0.009) values significantly increased, whereas the CCT (2%; p=0.008) decreased after suture removal. The ICA and CCT values demonstrated stability 1 month after suture removal, and the ACD was stable 6 months after suture removal.
DISCUSSION AND CONCLUSION: Our study results indicated that the ICA and CCT stabilized 1 month post suture removal and the ACD stabilized 6 months after suture removal. A waiting period of at least 6 months after suture removal is recommended before any post-DALK refractive surgery.

4.Effects of Topical Carbonic Anhydrase Inhibitors on the Olfactory Sense
Fatih Cem Gül, Mete Güler, Sabiha Güngör Kobat, Sertaç Duzer, Öner Sakallıoğlu, Fatih Çelik, Abdulvahap Akyiğit
doi: 10.14744/bej.2021.27676  Pages 19 - 23
INTRODUCTION: The sense of smell plays an important role in daily life. Olfactory impairment can significantly affect an individual’s quality of life. Topical carbonic anhydrase inhibitors are commonly used to treat elevated intraocular pressure (IOP). One potential side effect of these drugs is a loss of the sense of smell. This study is an examination of changes in olfactory function in patients who used dorzolamide and brinzolamide to control IOP after a laser capsulotomy.
METHODS: A total of 60 patients with posterior capsule opacification were included in the study. Sniffin’ Sticks (Burghart Messtechnik GmbH, Wedel, Germany) were used to evaluate patient olfactory sensitivity before starting the topical treatment and after 1 week of treatment.
RESULTS: No statistically significant decrease in olfactory performance was observed in users of either brinzolamide or dorzolamide (p=0.705, p=0.405 respectively).
DISCUSSION AND CONCLUSION: No negative effect on the sense of smell was determined after 7 days of topical application of a carbonic anhydrase enzyme inhibitor to the eye in patients with no previous anosmia.

5.The Effect of Long-Term Usage of Single-Agent Antiglaucomatous Drops with Different Preservatives on Cornea Biomechanics
Gözde Aksoy Aydemir, Gülizar Demirok, Ümit Eksioğlu, Mehmet Yakın, Firdevs Örnek
doi: 10.14744/bej.2021.76376  Pages 24 - 30
INTRODUCTION: This study examined the effect of antiglaucomatous drops with different preservatives on corneal biomechanics using the ocular response analyzer (ORA) (Reichert Technologies, Inc., Depew, NY, USA).
METHODS: Patients using antiglaucomatous medical treatment containing a single agent combined with a preservative for at least 1 year who underwent a control examination between January and December 2017 at a glaucoma unit were included in this retrospective study. The patients were divided into 5 groups according to the antiglaucomatous agent and preservative ingredients. Measurements were taken with the ORA and compared with a control group.
RESULTS: A total of 83 eyes treated eyes were included and analyzed. Thirty-three eyes of 33 patients were treated with latanoprost+benzalkonium chloride (BAC), 17 eyes of 17 patients were treated with travoprost+polyquad, 7 eyes of 7 patients were treated with bimatoprost+BAC, 18 eyes of 18 patients were treated with brimonidine+purite, 8 eyes of 8 patients were treated with brimonidine+BAC. A control group of 23 eyes of 23 healthy patients was also assessed for comparison. A significant decrease in corneal hysteresis (CH) and corneal resistance factor (CRF) was seen in the patients using bimatoprost+BAC and brimonidine+BAC when compared with the control group. Evaluation of the bimatoprost+BAC group and the latanoprost+BAC group revealed that the CH and the CRF was significantly lower in the group using bimatoprost+BAC (p<0.01).
DISCUSSION AND CONCLUSION: It has been reported that CH is a more important prognostic marker than central corneal thickness in glaucoma patients. Loss of visual field progresses faster in eyes with a low CH. Both preservatives and the active antiglaucomatous agents in medications can affect CH. Variation in CH in patients using antiglaucomatous drops over a long period is important in both the progression and follow-up of the disease.

6.Evaluation of the Effect of Fasting on Glaucoma Patients
Enes Uyar, Fatih Ulaş, Ümit Doğan, Serdal Çelebi
doi: 10.14744/bej.2020.44366  Pages 31 - 36
INTRODUCTION: The aim of this research was to evaluate the effect of daytime Ramadan fasting and dehydration on intraocular pressure (IOP) and biometric parameters in primary open-angle glaucoma (POAG) patients.
METHODS: This prospective study included 30 eyes of 30 POAG patients who were fasting during Ramadan (Group 1), 40 healthy participants who were fasting (Group 2), and 40 healthy individuals who were not fasting (Group 3). The eyes were evaluated twice a day at approximately 8 am and 4 pm during Ramadan and 1 month after Ramadan.
RESULTS: IOP values at 4 pm were higher in Group 1 than Groups 2 and 3 in Ramadan (p=0.029 and 0.007, respectively). The diurnal reduction in IOP was significantly smaller during fasting in the glaucoma patients compared with Groups 2 and 3 (p=0.012 and 0.007, respectively). Comparisons of biometric parameters revealed less reduction in central corneal thickness (CCT) values from 8 am to 4 pm in glaucoma patients than in Groups 2 and 3 (p<0.05 for all comparisons) during Ramadan and after Ramadan.
DISCUSSION AND CONCLUSION: POAG patients had a higher IOP at 4 pm during the fasting period than was seen following Ramadan. In addition, the diurnal reduction of IOP and CCT was smaller in patients with POAG compared with healthy subjects.

7.Normative Data of Superficial Retinal Vascular Plexus and the Relationship to Retinal Layers
Mehmed Uğur Işık, Fahrettin Akay, Berkay Akmaz, Yusuf Ziya Güven, İrem Genç Işık
doi: 10.14744/bej.2020.75437  Pages 37 - 42
INTRODUCTION: The aim of this study was to evaluate the relationship between optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) parameters in a healthy population and to detect any changes that occur with age.
METHODS: A total of 100 healthy participants were included in this prospective, observational, and comparative study. The participants were categorized in 4 groups according to age: Group 1: 21-30 years, Group 2: 31-40 years, Group 3: 41-50 years, Group 4: 51-60 years of age. Mean macular thickness, retinal nerve fiber layer (RNFL), ganglion cell inner plexiform layer (GC-IPL), and the choroidal thickness (ChT), vessel density (VD), perfusion density (PD), foveal avascular zone (FAZ), and parapapillary perfusion density parameters were recorded and analyzed.
RESULTS: In comparisons between groups, no significant difference in OCTA parameters was observed. There were inverse correlations between the outer VD, PD, and intraocular pressure (IOP) (r= -0.307, p=0.006 and r= -0.284, p=0.011, respectively). The correlation between parapapillary perfusion density and IOP was close to being significant (r= -0.213, p=0.059). There were significant relationships between OCTA parameters and macular, RNFL, and GC-IPL thickness. No significant relationship between ChT and OCTA parameters was seen.
DISCUSSION AND CONCLUSION: The size and characteristics of superficial VD, PD, parapapillary perfusion density, and FAZ were determined in a population with standardized demographic and ocular clinical features, and the relationship between these parameters and retinal layers was established.

8.Evaluation of Macular Microcirculation in Healthy Children Using Optical Coherence Tomography Angiography
Yalçın Karaküçük, Ayşegül Çömez, Abdullah Beyoğlu, Dilek Yaşa
doi: 10.14744/bej.2020.76588  Pages 43 - 48
INTRODUCTION: This study was designed to evaluate macular perfusion in a healthy pediatric population using optical coherence tomography angiography (OCTA).
METHODS: Fifty-three eyes of 30 healthy children (20 boys and 10 girls) were included in this prospective, cross-sectional study. Age, gender, foveal thickness (FT), superficial foveal avascular zone area (FAZs), deep foveal avascular zone area (FAZd), superficial capillary plexus flow area (SCP), deep capillary plexus flow area (DCP), choriocapillaris flow area (CC), vascular density in the SCP (VDs), vascular density in the DCP (VDd), and subfoveal choroidal thickness (SFCT) were evaluated.
RESULTS: The mean age was 12.0±4.0 years (range: 6-15 years). Gender did not have a statistically significant influence on the FAZs or FAZd. However, there was a positive correlation between the CC and age (r=0.31; p=0.025). The FAZs and FAZd were negatively correlated with the FT (p<0.001). The VDd was positively correlated with the FT (p=0.03) and was negatively correlated with the FAZd (p=0.019).
DISCUSSION AND CONCLUSION: The present study determined normative data of OCTA parameters in healthy children and provides useful insight into the relationship between age, macular microvascular networks, and the FAZ.

9.Preoperative Evaluation of Tractional Retinal Detachment with B–Mode Ultrasonography in Diabetic Vitreous Hemorrhage
Gökhan Demir, Murat Arıcı, Zeynep Alkın
doi: 10.14744/bej.2021.58561  Pages 49 - 53
INTRODUCTION: This study was designed to evaluate the reliability of preoperative ultrasonography (USG) to detect tractional retinal detachment (TRD) in vitreous hemorrhage (VH) due to proliferative diabetic retinopathy.
METHODS: The medical records of patients with VH who underwent A- and B-scan ultrasonography prior to a vitrectomy between November 2016 and May 2017 were reviewed in this retrospective study. All of the patients were assessed using USG before surgery with 4-quadrant transverse and 1-quadrant longitudinal scans whether to determine if the VH was accompanied by TRD. The USG results were compared with the vitrectomy findings.
RESULTS: A total of 111 eyes of 106 patients with VH were evaluated. Twenty-three eyes were excluded from the study due to non-diabetic diagnoses, such as retinal vein-artery occlusion, trauma, intraocular mass, choroidal neovascular membrane, or macroaneurysm. The remaining 88 eyes with diabetic VH were included in the study. Preoperatively, VH alone was observed in 65 eyes (73.8%) and VH accompanied with TRD was determined in 23 eyes (26.2%) using USG. TRD was not found during the operation in 2 eyes (2.2%) diagnosed as VH with TRD by USG (false positive), and in 8 eyes (9.1%), TRD was detected during surgery though VH alone had been recorded based on the USG results (false negative).
DISCUSSION AND CONCLUSION: USG is a reliable diagnostic tool that will provides accurate preoperative information about the presence of TRD in diabetic VH; however, in some cases TRD may go undetected, especially in eyes with peripherally localized or small TRD.

10.Accuracy of Photorefraction and Wavefront-Based Autorefraction in Children Under 3 Years of Age
Caner Kara, İkbal Seza Petriçli
doi: 10.14744/bej.2021.09825  Pages 54 - 61
INTRODUCTION: This study was designed to assess the accuracy of photorefraction and wavefront-based autorefraction in children under 3 years of age.
METHODS: A cross-sectional study was performed with children who had no ocular abnormalities other than a refractive error and were less than 3 years old. Spot Vision Screener (Welch Allyn Inc., Skaneateles Falls, NY, USA) was used for photorefraction and SureSight Vision Screener (Welch Allyn, Skaneateles Falls, NY) was used for autorefraction. The measurements were performed with both devices before and after cycloplegia. The results were compared with those obtained using cycloplegic retinoscopy. The assessments were performed in terms of spherical equivalent (SE) values and Jackson cross-cylinder power values ( J0 and J45).
RESULTS: A total of 305 children with a mean age of 15.1±10.4 months were included. The mean SE values measured with the Spot Vision and SureSight before cycloplegia were 0.43±0.75 D and 0.90±0.86 D, respectively. Following cycloplegia, the mean SE values were 1.80±1.25 D and 1.55±1.40 D, respectively. The mean SE value obtained with cycloplegic retinoscopy was 1.53±1.34 D. The mean SE values measured with both devices prior to cycloplegia were significantly lower than that measured with cycloplegic retinoscopy (p<0.001). No significant difference was observed between the cycloplegic SE values obtained with SureSight and retinoscopy (p=0.66). Spot Vision yielded significantly higher cycloplegic SE values compared with cycloplegic retinoscopy (p<0.001).
DISCUSSION AND CONCLUSION: Both devices underestimated SE values in comparison with cycloplegic retinoscopy in children under 3 years of age. Wavefront-based autorefraction performed with cycloplegia may be an alternative to cycloplegic retinoscopy, but needs confirmation.

SURGICAL TECHNIQUE
11.New Scleral Fixation Technique for Subluxated Posterior Chamber Intraocular Lens
Uğur Ünsal, Berkay Akmaz
doi: 10.14744/bej.2021.97659  Pages 62 - 65
Objectives: This study describes a new scleral fixation technique to treat a subluxated intraocular lens (IOL).

Methods: Four eyes of 4 patients were treated for a subluxated IOL with the described technique at Batigoz Eye Hospital. Demographic data, IOL type, and follow-up details were recorded, including the length of follow-up, postoperative refraction error, and complications.

Results: The study included 2 female and 2 male patients. The median age was 54 years (range: 45-66 years). The mean duration of follow-up was 8 months (range: 5-13 months). Two of the subluxated IOLs were a monoblock subluxation of the IOL and the capsular tension ring, 2 were a 3-piece IOL. Follow-up examinations revealed no astigmatism >1.50 D. An anterior vitrectomy was performed in 1 patient who had preoperatively prolapsed vitreous in the anterior chamber. No complication was observed throughout the follow-up.

Conclusion: This new scleral fixation technique facilitates fixation of a dislocated IOL. Compared with previous methods, this technique provides fixation of the subluxated IOL to the sclera with a less invasive procedure and less intraocular manipulation.

CASE REPORT
12.Maculopathy, Fundus Changes and Anterior Lenticonus in Alport Syndrome
Mirko Ratkovic, Ajla Pidro, Aida Pidro
doi: 10.14744/bej.2021.60783  Pages 66 - 69
Alport syndrome is a rare basement membrane disorder that may include ocular manifestations: dot-and-fleck retinopathy, anterior lenticonus, posterior polymorphous corneal dystrophy, or temporal macular thinning. It is primarily an X-linked inheritance condition (85%). This case report describes a 51-year-old male patient with Alport syndrome who was diagnosed due to ocular manifestations that were subsequently linked with a history of renal failure and bilateral sensorineural hearing loss. The diagnostic tools used were biomicroscopy, ultrasound, corneal topography, endothelial microscope analysis, macula optical coherence tomography, and fundus photography. Clear lens extraction was performed and improved his visual acuity. Further genetic analysis revealed a mutation in the COL4A5 gene on the X chromosome. Ocular manifestations can help determine the right diagnosis and help in multisystemic disease assessment. In cases of Alport syndrome, a nephrologist should be informed about the potential development of a specific antiglomerular basement membrane antibody that may lead to graft rejection. The patient's close relatives should also be examined.

13.Giant Papilla Prolapse from the Upper Tarsal Conjunctiva in a 3-year-old Child: A Case Presentation and a Brief Literature Review
Bengi Ece Kurtul, Süleyman Koca
doi: 10.14744/bej.2021.65807  Pages 70 - 73
Giant papillae (1.0 mm or greater in diameter) on the upper tarsal conjunctiva are one of the most common findings in cases of vernal keratoconjunctivitis (VKC). Presently described is the case of a 3-year-old female with a unilateral giant papilla formation prolabing from the medial side of the upper tarsal conjunctiva toward the ocular surface in the left eye. A brief review of the recent literature concerning the etiology, associated risk factors, surgical options, and management of patients with giant papillae is also discussed. A significant reduction in the size of the papilla was observed after a week of medical treatment with a topical steroid and antiallergic eye drops. To the best of our knowledge, this case demonstrates the first time that a giant papilla appeared in the form of a prolapsed mass extending from the tarsal conjunctiva in a child with VKC. Ophthalmologists should keep in mind that a giant papilla can look like another form of conjunctival mass, and should not rush to excise or biopsy, as it may respond to medical treatment.

14.Voriconazole Treatment for Fungal Chorioretinitis After Obesity Surgery
Fatma Savur, Havva Kaldırım, Kürşat Atalay
doi: 10.14744/bej.2020.70883  Pages 74 - 78
Presently described is a case of fungal septicemia diagnosed based on a fundus examination and successfully treated with voriconazole. A 48-year-old woman who had undergone sleeve gastrectomy 20 days prior due to obesity was referred to the ophthalmology clinic for blurred vision in the right eye. The initial examination indicated visual acuity of only light perception in the right eye and 0.00 logMAR in the left eye. Anterior segment examination and light reaction results were normal in both eyes. The vitreous was clear. A central, hemorrhagic, hypopigmented lesion 1/3 optic disc diameter in size, was located in the right fovea, bulging from the retina. There were 3 or 4 small hypopigmented lesions in both peripheral retinas. The examination findings and patient history suggested fungal chorioretinitis. The patient was treated with intravenous voriconazole at a maintenance dose of 200 mg 2 times a day following a loading dose of 6 mg/kg 2 times a day for 48 hours according to the recommendation of the infectious diseases clinic. Multimodal imaging using fundus photography, fluorescein angiography, and spectral domain optical coherence tomography was performed throughout treatment. The patient's daily follow-up revealed no deterioration and improvement was seen on the third day. Endogenous fungal chorioretinitis is a rare infection, but it remains important in ophthalmology due to the high potential to cause severe visual loss and the limited diagnosis and treatment options. Patients who are susceptible to fungemia and have a recurrent fever may be referred to an ophthalmologist. Many clinical tests may have negative results but a careful fundoscopic examination can determine signs of fungemia-related chorioretinitis.

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