ISSN: 2459 - 1777 | E-ISSN 2587-0394
Volume : 6 Issue : 2 Year : 2021

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Beyoglu Eye Journal - Beyoglu Eye J: 6 (2)
Volume: 6  Issue: 2 - 2021
ORIGINAL ARTICLE
1.Conjunctival Impression Cytology and Tear Function in Patients with Keratoconus
Deniz Özarslan Özcan, Sait Coşkun Özcan, Didar Gürsoy
doi: 10.14744/bej.2021.83584  Pages 79 - 83
INTRODUCTION: The aim of this study was to evaluate the ocular surface alterations of conjunctival cytological changes and tear function in patients with keratoconus.
METHODS: A total of 98 eyes with keratoconus and 68 eyes of age- and sex- matched healthy subjects were included in this prospective study. Ophthalmological evaluations, including Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), ocular surface staining (OSS), Schirmer test, and conjunctival impression cytology (CIC), were performed.
RESULTS: The mean participant age was 23.4±5.3 years in the keratoconus group and 24.9±6.0 years in the control group. In the keratoconus group, the mean OSDI and OSS scores were statistically significantly higher than those of the controls, and the Schirmer and TBUT results were statistically significantly lower (all p<0.001). The severity of keratoconus was positively correlated with the CIC grade (r=0.292; p=0.004).
DISCUSSION AND CONCLUSION: Keratoconus results in deterioration of the ocular surface, including CIC and tear function parameters. The grade of keratoconus appears to be associated with conjunctival cytologic changes.

2.Effects of Intravitreal Injection on Ocular Surface and Anterior Segment Parameters
Hafize Gökben Ulutaş, Neslihan Parmak Yener
doi: 10.14744/bej.2021.65487  Pages 84 - 89
INTRODUCTION: This study was designed to investigate the long-term effects of intravitreal anti-vascular endothelial growth factor (VEGF) injections on ocular surface and anterior segment parameters. A comparison was performed of the treated eye and the fellow healthy eye.
METHODS: The study group included patients who had received at least 3 intravitreal injections of anti-VEGF agents (bevacizumab, ranibizumab, or aflibercept) for retinal vascular disorders. All of the subjects were treated in only 1 eye. A complete ophthalmological examination, including evaluation of tear break-up time (TBUT), the Schirmer 1 test, the Oxford Grading Scale, and the Ocular Surface Disease Index (OSDI) questionnaire, corneal topography, and specular microscopy were performed in both eyes 1 month after the last injection.
RESULTS: In this study, 49 eyes of 49 patients who underwent regular intravitreal injection in 1 eye were enrolled. The mean age was 63.85±9.8 years (range: 29-86 years). A mean of 4.06±1.7 (range: 3-11) injections were administered. There was no significant difference in the intraocular pressure, TBUT, Schirmer 1, fluorescein staining, or specular microscopy parameters (p>0.05). The mean non-invasive TBUT first and average values; the central, thinnest, and apex corneal thickness measurements; the anterior chamber depth, irido-corneal angle, corneal volume, and keratometry values were similar in each individual (p>0.05 for all parameters). The mean OSDI score was 27.5±17.6 for the injected eyes and 15.9±12.9 for the non-injected eyes (p<0.0001).
DISCUSSION AND CONCLUSION: Intravitreal anti-VEGF injections had no effect on ocular surface, corneal endothe-lium, and anterior segment parameters.

3.Comparison of the Retinal and Choroidal Structures in 3 Refractive Groups
Gözde Aksoy Aydemir, Alper Halil Bayat, Emre Aydemir, Şerife Şule Çınar, Ayşe Sevgi Karadağ
doi: 10.14744/bej.2021.47568  Pages 90 - 95
INTRODUCTION: This study investigated the retinal layer thickness, choroidal thickness (CT), and retinal nerve fiber layer (RNFL) parameters in 3 refractive groups.
METHODS: A total of 201 eyes of 201 subjects were enrolled in this prospective and comparative study. The patients were divided into 3 groups according to refractive status: Group 1 consisted of 60 eyes of myopic subjects, Group 2 comprised 72 eyes of emmetropic subjects, and 69 eyes of hyperopic subjects were categorized as Group 3. The retinal layer thickness, CT, and RNFL parameters were measured using optical coherence tomography and compared between groups.
RESULTS: The mean age of the patients was 22.33±10.11 years in Group 1, 21.55±8.3 years in Group 2, and 23.73±11.08 years in Group 3 (p=0.741). Group 1 consisted of 34 women and 26 men, Group 2 contained 44 women and 28 men, and Group 3 was made up of 45 women and 24 men (p=0.124). The mean spherical equivalent value was −6.16±2.01 D in Group 1, 0.13±0.5 D in Group 2, and 5.48±1.32 D in Group 3 (p<0.001). The RNFL and macular thickness values were lower in the myopic patients compared with those of the other groups (p<0.05). The CT measurement was lower in the myopic patients and higher in the hyperopic patients compared with the emmetropic patients (p<0.05).
DISCUSSION AND CONCLUSION: The myopic patients had a lower CT and RNFL thickness measurement than the emmetropic and hyperopic patients, whereas the hyperopic patients had a higher CT than the other patient types.

4.Intraocular Pressure Change and Sustained Intraocular Pressure Elevation After Pars Plana Vitrectomy
Kübra Şerefoğlu Çabuk, Osman Çekiç
doi: 10.14744/bej.2021.92408  Pages 96 - 101
INTRODUCTION: The aim of this study was to investigate the incidence and influential factors of changes in intraocular pressure (IOP) and sustained IOP elevation (SIOPE) after an uncomplicated pars plana vitrectomy (PPV).
METHODS: In all, 41 eyes of 41 patients who underwent PPV due to the presence of epiretinal membrane, macular hole, or vitreomacular traction syndrome were included in the study. In the vitrectomized eye, an elevated IOP of ≥21 mmHg or an increase of ≥6 mmHg from the preoperative IOP on 2 or more postprocedure visits or the addition of a new IOP-lowering medication during follow-up was defined as sustained IOP elevation. The results of procedures performed with a 20-G instrument and a 23-G instrument were compared.
RESULTS: The mean postoperative IOP was significantly higher than the preoperative IOP in vitrectomized eyes (preoperative IOP: 15.2±3.1 mmHg; postoperative 1st month: 17.4±5.8 mmHg, p=0.018; 6th month: 17.3±2.6 mmHg, p=0.02; 12th month: 16.7±2.6 mmHg, p=0.020). While no significant difference in IOP was detected between the vitrectomized and fellow eyes preoperatively, the IOP was significantly higher in the vitrectomized eyes in the 1st, 6th, and 12th months (p=0.040, p <0.001, p <0.001, respectively). SIOPE was detected in 15 vitrectomized eyes (37%) and 1 fellow eye (2%). The postoperative first day IOP was significantly lower in the vitrectomized eyes (11.1±6.1 vs 15.4±2mmHg; p<0.001) and significantly lower in the 23-G group than the 20-G group (9.3±5.2 vs 15.7±5.8; p=0.001).
DISCUSSION AND CONCLUSION: IOP may rise significantly in comparison with the fellow eye or the preoperative IOP, even after an uncomplicated PPV. SIOPE and preoperative IOP values should be taken into consideration in addition to cross-sectional IOP findings in the evaluation of PPV.

5.Epidemiological Profiling of Mechanical Ocular Trauma and Analysis Using Proposed New Classification for Ocular Adnexal Injuries
Abha Shukla, Manisha Singh, Ashish Garg
doi: 10.14744/bej.2021.60252  Pages 102 - 107
INTRODUCTION: Mechanical ocular trauma can result in wide spectrum of injuries with varying levels of severity. A complete ophthalmic examination is important to achieve a thorough evaluation and provide optimal management. The ocular adnexa play a significant role in the protection of the globe via various mechanisms. Open and closed globe injuries directly affect the visual outcome. Although adnexal injuries may not affect the vision directly, they can lead to severe ocular morbidity in terms of a cosmetic blemish, watering, a long healing period, severe complications, or permanent disfigurement. Currently, there is no appropriate classification of adnexal injuries. This study examined the causes, and effects of adnexal injuries to prepare a new classification system for adnexal injuries.
METHODS: A retrospective study of ocular injuries was conducted at a tertiary care center in Gwalior, India. The data of 600 mechanical ocular trauma patients were analyzed and the demographic details, mode of injury, type and sub-type of ocular injury were recorded. The injuries were divided into open and closed globe injuries using the Birmingham Eye Trauma Terminology classification system. Adnexal injuries were categorized by type and sub-type using a proposed classification system.
RESULTS: Among the 600 cases, there were 34 closed globe injuries, 26 open globe injuries, and 540 adnexal injuries. Only 10% of the cases could be classified using the conventional classification system.
DISCUSSION AND CONCLUSION: The existing classification system is not optimally comprehensive; the majority of the cases could not be categorized. A more detailed framework of classification of adnexal injuries will facilitate better assessment and management.

6.Comparison of Adult Refractive Disorder Measurements Using HandyRef-K, Retinomax, Plusoptix, and Table-top Autorefractometer Devices
Zeynep Seymen, Sinan Bekmez, Erdem Eris, Burçin Kepez Yıldız, Aslı Vural, Tülin Öğreden, Irfan Perente
doi: 10.14744/bej.2021.28247  Pages 108 - 114
INTRODUCTION: This study was conducted to compare refractive error measurements recorded using the Nidek HandyRef-K handheld autorefractometer (HDY; Nidek Co. Ltd., Tokyo, Japan), Plusoptix A09 photorefractor (PO; Plusoptix GmbH, Nuremberg, Germany), Retinomax K-plus 3 (RTX; Right Mfg. Co. Ltd., Tokyo, Japan), and a table-mounted autorefractometer/ keratometer (TTR; URK 800, Unicos Co. Ltd., Daejeon, Republic of Korea).
METHODS: Patients aged ≥18 years underwent measurement of refraction without cycloplegia using 4 devices and the spherical power (SP), cylindrical power (CP), and spherical equivalent (SE) values were analyzed and compared.
RESULTS: A total of 181 eyes of 181 patients were enrolled in the study. The mean age of the patients was 33.08±0.95 years (range: 18-79 years). There was a significantly significant difference in the SP, CP, and SE values determined by the devices (p<0.001). The SP and SE values of the RTX and the HDY were similar, while the other device results were different (Wilcoxon signed-rank test, p=0.004). The CP values of the PO and the TTR, the HDY and the TTR were also comparable.
DISCUSSION AND CONCLUSION: The HDY, RTX, and the PO are suitable for screening in clinical practice, but the findings strongly suggest that they should be used with caution.

7.Evaluation of Infectious Uveitis at a Tertiary Referral Center in Turkey: A 31-year Retrospective Study
Hasan Öncül, Caner Kara, Pınar Çakar Özdal
doi: 10.14744/bej.2021.48726  Pages 115 - 123
INTRODUCTION: The aim of this study was to examine the demographic and clinical characteristics of patients with infectious uveitis over time.
METHODS: The records of a total of 2032 patients treated for uveitis were retrospectively analyzed and 369 eyes of 324 patients diagnosed with infectious uveitis were included in the study. The patients were divided into 2 groups according to the date of presentation. The first group comprised patients seen between January 1988 and August 2009, and patients who presented between September 2009 and April 2019 were classified in the second group.
RESULTS: The prevalence of infectious uveitis was 15.1% in the first group and 16.8% in the second group. A statistically significant decrease was observed in the number of toxoplasmosis patients in the second group (p=0.031). There was no significant difference in the number of patients with herpetic anterior uveitis (HAU) (p=0.215). A significant increase was recorded in the number of patients with tuberculosis and acute retinal necrosis (ARN) (p=0.006 and p=0.041, respectively). While there were no patients diagnosed with cytomegalovirus (CMV) anterior uveitis in the first group, 19 patients were diagnosed with the disorder in the second group. There was a decrease in the rate of legal blindness among the patients who were treated in the second period compared with the first period; however, this difference was not statistically significant (p=0.069).
DISCUSSION AND CONCLUSION: Toxoplasmosis and HAU were the 2 most common causes of infectious uveitis. The incidence of CMV anterior uveitis, tuberculosis related uveitis, and ARN increased over the period studied.

8.Magnitude of Diurnal Change in Retinal Vessel Density: Comparison Between Exfoliative Glaucoma and Primary Open-Angle Glaucoma
Atılım Armağan Demirtaş, Seyfettin Erdem, Mine Karahan, Uğur Keklikçi
doi: 10.14744/bej.2021.66934  Pages 124 - 132
INTRODUCTION: The aim of this study was to investigate the magnitude of diurnal fluctuation in the superficial parafoveal vessel density (pfVD) and radial peripapillary capillary-peripapillary vessel density (RPC-ppVD) in exfoliative glaucoma (XFG) patients using optical coherence tomography angiography (OCTA) and to compare the findings with those of primary open-angle glaucoma (POAG) patients with glaucomatous damage of comparable severity
METHODS: A total of 50 patients with XFG and 48 with POAG were examined in this retrospective cross-sectional study. The OCTA readings and intraocular pressure (IOP) values were obtained at 9 am, 11 am, 2 pm, and 4 pm on the same day. The maximal change in the IOP and vessel density (VD) values was evaluated to determine the magnitude of diurnal variation.
RESULTS: No significant difference was found in the magnitude of the average diurnal superficial-pfVD, RPC-ppVD and IOP change between the XFG and POAG groups. Comparison of the diurnal variation of sub-sector VD revealed that the magnitude of the diurnal variation in the VD of the inferonasal peripapillary and superior parafoveal regions was greater in the XFG group than that of the POAG group (p=0.004 and p=0.021, respectively). Furthermore, the differences persisted after correcting for the confounding factors of IOP, mean deviation (MD), and global retinal nerve fiber layer (RNFL) values. The magnitude of the average superficial-pfVD and the average RPC-ppVD was not correlated with the MD, total ganglion cell complex, global RNFL, or the magnitude of IOP values in either group.
DISCUSSION AND CONCLUSION: The eyes of XFG patients demonstrated more significant diurnal fluctuation in VD (including the superior superficial-pfVD as well as the inferonasal RPC-ppVD) when compared with POAG patients, despite no statistical significance between groups in the IOP variation.

CASE REPORT
9.Posterior Scleritis Simulating Choroidal Melanoma: A Case Report
Simanta Khadka, Raghunandan Byanju, Sangita Pradhan
doi: 10.14744/bej.2021.56338  Pages 133 - 139
Nodular posterior scleritis (NPS) is rare; however, it is critical to differentiate it from similar intraocular pathologies to prevent inappropriate and potentially irreversible treatment. Multimodal imaging is beneficial in the diagnosis of NPS. This report describes the diagnosis and management of a case of NPS with corticosteroid therapy that led to complete resolution.

10.Bilateral Paraneoplastic Vitritis: A Case Report
Ezgi Karataş Yiğitaslan, Eyüp Sabri Uçan, Nurullah Akkoç, Ali Osman Saatci
doi: 10.14744/bej.2021.04706  Pages 140 - 144
This report describes the case of a patient who presented with bilateral vitritis that led to a diagnosis of small-cell lung cancer (SCLC). A 70 year-old man was examined due to bilateral gradual visual deterioration. Symmetrical vitritis was observed in both eyes with no evidence of other fundus pathology. The opthalmological diagnosis was bilateral paraneoplastic vitritis. The patient was an active smoker and had a short history of weight loss. A systemic evaluation resulted in a diagnosis of SCLC. The appropriate cancer treatment was provided, as well as a short-term oral steroid. The vitritis responded well to steroid treatment. Ocular manifestations can be an early sign of malignancy, and ophthalmologists should be aware of this possibility.

11.Detection of Subclinical Corneal Ectasia after Laser in Situ Keratomileusis: Corvis ST
Fevziye Ondes Yılmaz, Burçin Kepez Yıldız, Ahmet Demirok
doi: 10.14744/bej.2021.32559  Pages 145 - 150
Described herein are the cases of 2 patients who underwent bilateral femtosecond-assisted laser in situ keratomileusis (FS LASIK) surgery and subsequently developed unilateral postLASIK ectasia. The fellow eye of both patients was topographically normal, their visual acuity was 20/20, and the patients had no visual symptoms. However, a biomechanical assessment using the Corvis ST tonometer (Oculus Optikgerate GmbH; Wetzlar, Germany) revealed remarkable weakness not only in the ectatic eyes, but also in the fellow eye. Arrangements were made to perform corneal crosslinking for the eyes with manifest ectasia and close follow-up of the fellow eyes.

12.Long-term Follow-up of Optic Disc Pit Maculopathy Treated with Laser Photocoagulation: A Case Report
Sergios Taliantzis, Aslı Perente, Christina Mitsi, Eirini Kanella Panagiotopoulou, Ioannis Fotiadis, Doukas Dardabounis
doi: 10.14744/bej.2021.83723  Pages 151 - 154
This report describes a case of optic disc pit maculopathy treated successfully with laser photocoagulation. Optical coherence tomography (OCT) was used to assess the optic nerve and the macular area. Green laser photocoagulation was performed in an arcuate pattern to manage the macular edema. Eighteen months later, OCT showed complete regression of the macular edema. Fifty months after the laser treatment, visual acuity remained 20/20. The results of an Amsler grid test were negative and the macular area was visualized as normal. Slit-lamp laser photocoagulation is a minimally invasive technique that should be considered as a first-line treatment option in patients with optic pit maculopathy who retain their visual capacity.

13.A Case of Paracentral Acute Middle Maculopathy Occurring After Pars Plana Vitrectomy
Gülşah Gümüş, Neşe Alagöz, Cengiz Alagöz, Sehnaz Özçalışkan, Özgür Artunay
doi: 10.14744/bej.2021.00719  Pages 155 - 157
Paracentral acute middle maculopathy (PAMM) is a clinical finding that is thought to be a result of ischemia in the middle and deep capillary plexus of the retina. It has been reported in the literature that PAMM may be associated with systemic and vascular risk factors. This report describes a case of PAMM that occurred following a pars plana vitrectomy.

LETTER TO EDITOR
14.Possible Trinity of COVID-19, Diabetes Mellitus, and Retinopathy
Syed Nasir Ali Shah
doi: 10.14744/bej.2021.95914  Pages 158 - 159
Abstract | Full Text PDF

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