INTRODUCTION: This study evaluated anterior segment surgeries performed during the coronavirus 2019 (COVID-19) pandemic. Prevention of virus transmission is a critical consideration for surgeons, and includes assessment of etiology, the referral region, demographic characteristics, and the surgery to be performed.
METHODS: The data of 144 patients who underwent anterior segment surgery between March 19, 2020 and June 1, 2020 were retrospectively reviewed. The patient demographic data and details of ophthalmological examination findings, the region patients were referred from, and the type of surgery performed were recorded and analyzed.
RESULTS: A total of 144 patients, 49 women (34%) and 95 men (66%), were included in this study. The mean age of the patients was 31.30±25.88 years (range: 1–86 years). The presenting complaint was in the right eye in 43.7% of the cases, in the left eye in 52.8%, and in both eyes in 3.5% of the cases. While 94.4% of the applications were from Istanbul, the remaining 5.6% were from outside the province. Though 43.7% of the cases were patients seen previously at the study hospital in Istanbul, 56.3% presented for the first time. This hospital was the first referral center in only 39.6% of the cases. Evaluation of etiology indicated that corneal perforation (18.1%) was the most common, followed by keratitis (13.2%). The most common surgical intervention applied was amnion membrane transplantation (19.4%), followed by perforation repair (16.7%).
DISCUSSION AND CONCLUSION: Ophthalmological surgeries continue to be performed during the ongoing COVID-19 pandemic, however, special algorithms must be used to reduce the risk of COVID-19 transmission and to ensure continuity of healthcare for ophthalmology patients.

INTRODUCTION: This study was a prospective evaluation of changes in the results of visual field tests taken before and after pterygium excision.
METHODS: This was a prospective, single-center study. Seventy-five eyes of 75 patients who had undergone pterygium excision with autograft implantation were enrolled. All of the patients had stage III pterygium according to the Johnston classification. The mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI) global index changes after pterygium excision were compared to evaluate the effect of pterygium on visual field analysis.
RESULTS: The mean preoperative MD value was -3.04±2.63 dB (range: -14.84–0.62 dB) and the mean postoperative MD value was -1.83±2.09 dB (range: -13.82–1.74 dB) (p<0.001). The mean preoperative PSD value was 2.59±1.92 dB (range: 1.16–12.76 dB) and the mean postoperative PSD value was 2.41±1.62 dB (1.15–13.29 dB) (p>0.05). The mean preoperative VFI value was 96.01±4.46% (range: 68–100%) and the mean postoperative VFI value was 96.28±4.18% (range: 70–100%) (p>0.05).
DISCUSSION AND CONCLUSION: After pterygium excision, the MD improved significantly. However, the PSD and VFI did not change significantly. The significant change in MD value was related to the reduction in corneal light scattering, contrast sensitivity, aberrations, and blockage on the optic axis.

INTRODUCTION: This study was designed to evaluate factors affecting visual gain following accelerated crosslinking (A-CXL) in pediatric cases with keratoconus.
METHODS: Pediatric patients with a diagnosis of keratoconus who underwent A-CXL for 10 minutes ultraviolet A (UV-A) 9 mW/cm² between February 2015 and May 2019 and had at least 1 year of follow-up data were analyzed retrospectively. Uncorrected visual acuity, best corrected visual acuity (BCVA), and refractive value changes (spherical, cylindrical values) at the preoperative and postoperative 12th month were compared. Correlation analysis was used to evaluate the relationships between visual gain and corneal topography values (K1, K2, Kmaximum [Kmax], anterior elevation, posterior elevation) obtained using a Sirius topography device (Costruzione Strumenti Oftalmici, Florence, Italy).
RESULTS: A total of 33 eyes of 22 patients (mean age: 16.85±1.15 years) who underwent A-CXL (9 mW/cm2 UVA irradiation for 10 minutes) were included in the study. The mean BCVA had increased from 0.45±0.27 logMAR to a mean of 0.33±0.24 logMAR at the end of 1 year (p=0.014). Changes to spherical and cylindrical values were not statistically significant (p>0.05). The correlation analysis revealed a statistically significant relationship between visual gain and the preoperative BCVA and the preoperative Kmax.
DISCUSSION AND CONCLUSION: The study results indicated that the visual gain at 1 year after A-CXL (10 minutes at 9 mW/cm²) was associated with preoperative BCVA and Kmax values in pediatric cases of keratoconus.

INTRODUCTION: Keratoconus (KCN) is a disorder that usually appears during adolescence and progressively reduces visual acuity. KCN may lead to differences in personality features as a result of vision loss and the numerous clinical examinations and treatment methods used from a young age. The aim of this study was to better understand the psychological characteristics of KCN patients and to define possible correlations between corneal topographic parameters and psychological state.
METHODS: A total of 59 KCN cases were included in the study group and were compared with 65 age- and sex-matched healthy individuals. All of the participants underwent a routine ophthalmic examination that included corrected distance visual acuity (CDVA), biomicroscopy, and fundoscopy. The KCN patients were evaluated busing Scheimpflug corneal topography. Psychiatric evaluations were performed using the Eysenck Personality Questionnaire Revised-Short Form (EPQ), the Self-Confidence Scale, the Maudsley Obsessive-Compulsive Inventory (MOCI), and the Beck Depression Inventory (BDI).
RESULTS: The mean age of the case and control groups was 23.98±5.7 years and 25.82±5.4 years, respectively. The KCN cases had significantly higher EPQ neuroticism subscale scores; higher MOCI subscale scores, with the exception of the doubting subscale; and higher BDI scores. Analysis of the KCN duration revealed a positive correlation with the checking and slowness subscales of the MOCI, however, there was no significant correlation between the psychometric scale scores, corneal topographic parameters, and CDVA.
DISCUSSION AND CONCLUSION: A substantially asymmetrical course and a relatively long period for KCN to result in severe vision loss might explain the lack of correlations between psychological parameters and visual acuity. Nonetheless, the apparent effect of vision loss on emotional distress cannot be disregarded; the day-to-day progressive loss of visual acuity and multiple, costly interventions may initiate or contribute to a depressive mood in KCN patients. A vicious depressive cycle and the exhaustion of long-term coping mechanisms might be underlying factors for the higher neuroticism scores seen among KCN patients. Both the personality traits and mental state of KCN patients demonstrate distinguishing properties; clinicians working with these patients should consider their mental state in addition to other factors in order to achieve better treatment outcomes.

INTRODUCTION: Information about the possible effect of statins on the human corneal endothelium is still not clear. This study was the first known investigation of the influence of statins on corneal specular microscopy (SM) and topography parameters.
METHODS: Thirty-four patients using a statin (atorvastatin) as hyperlipidemia treatment (Group 1) and 34 age- and sexmatched healthy subjects (Group 2) were prospectively included in the study. Demographic data and ophthalmic findings of participants were reported and analyzed. Cellular morphology was evaluated using the noncontact SM and corneal endothelial cell density (CECD) (cells/mm2), polymegathism (coefficient of variation in cell size [CV], %), and pleomorphism (% hexagonal cells [Hex]) data. Anterior chamber depth and volume, iridocorneal angle degree, average keratometry diopters were also measured with corneal topography.
RESULTS: The mean age was 53.03±7.23 years (range: 38–73 years) for Group 1 and 53.15±10.7 years (range: 34–80 years) for Group 2 (p=0.958). Group 1 consisted of 11 female and 23 male patients and Group 2 included 13 female and 21 male participants (p=0.798). The mean CECD density was significantly higher in Group 1 when compared with that of Group 2 (2544.34±244.76 cells/mm2 [range: 2126.60–3107.00 cells/mm2] vs 2404.53±285.46 cells/mm2 [range: 1839.80–2892.30 cells/mm2], p=0.034). There were no significant statistical differences in the CV and Hex values between the groups (p=0.450 and p=0.717, respectively). The corneal topographic measurements were also not significantly different.
DISCUSSION AND CONCLUSION: The findings of this study revealed higher CECD values in statin users. Statins may have beneficial effects on cornea morphology.

INTRODUCTION: The aim of this study was to evaluate the radial peripapillary capillary (RPC) and the optic nerve head (ONH) perfusion of patients with acromegaly using optical coherence tomography angiography (OCTA).
METHODS: Twenty-four eyes of 24 acromegaly patients comprised the study group and 24 eyes of 24 healthy individuals were used as a control group. The ONH and RPC vascular density (VD) was measured for each patient using OCTA. The insulin-like growth factor 1 (IGF-1) levels were also recorded and compared.
RESULTS: The VD of the inferior nasal ONH and nasal RPC was significantly lower in the acromegaly group than in the control group (p=0.047 and p=0.001, respectively). There was a significant negative correlation between the VD of the superior nasal ONH and the IGF-1 level (r=-0.283, p=0.038).
DISCUSSION AND CONCLUSION: The ONH and RPC VD values measured using OCTA were segmentally different in the acromegaly group compared with those of the control group. This method of non-invasive quantitative analysis of retinal perfusion using OCTA may be useful for future studies involving patients with acromegaly.

INTRODUCTION: The aim of this study was to investigate the effect of Helicobacter pylori (H. pylori) infection on choroidal thickness (CT), retinal nerve fiber layer (RNFL) thickness, and ganglion cell (GCL+IPL) complex thickness in childhood cases of gastritis.
METHODS: A total of 104 eyes of 52 children were included in the study. Two groups were created: 54 eyes of 27 H. pylori gastritis cases (Group 1) and 50 eyes of 25 gastritis without H. pylori cases (Group 2), as confirmed by an endoscopic biopsy. The mean subfoveal, submacular, and peripapillary CT, RNFL thickness, and GCL+IPL complex thickness was measured using spectral domain optical coherence tomography.
RESULTS: The mean subfoveal CT values were significantly higher in Group 1 compared with Group 2 (p=0.042). The mean submacular CT and peripapillary CT measurements of the eyes in Group 1 was greater than that of Group 2, but the difference was not statistically significant (p>0.05). There was also no statistically significant difference between the GCL+IPL complex or RNFL thickness values of the groups (p>0.05).
DISCUSSION AND CONCLUSION: H. pylori is a common gastrointestinal infectious agent with asymptomatic carriers in the population. The role of this agent in ocular pathologies in adult patients has been the subject of many recent studies, but secondary ocular findings in patients with H. pylori gastritis in childhood have not yet been investigated. The results of this study showed that the subfoveal CT value was significantly greater in children with H. pylori gastritis.

INTRODUCTION: This study investigated the contribution of vascular endothelial growth factor (VEGF) and stromal cell-derived factor-1α (SDF-1α) angiogenic mediators in eyes with age-related macular degeneration (AMD).
METHODS: Aqueous humor specimens taken during cataract surgery in 7 cases of intermediate stage (nonexudative) AMD and 7 cases of late stage (exudative) AMD were evaluated using chemiluminescent immunoassay testing in this prospective case-control study. Mediator levels were compared with the normal reference values of 7 patients without any disease other than cataract.
RESULTS: The groups were similar in terms of age and gender (p>0.05). The aqueous humor levels of VEGF in both the intermediate AMD (median: 224.3 pg/mL, range: 44.8–380.4 pg/mL) and late-stage AMD (median: 108.7 pg/mL, range: 61.9-223.5 pg/mL) patients were similar to those of the control group (median: 121.1 pg/mL, range: 24.9–156.6 pg/mL) (p=0.256). Moreover, there was no significant difference in the SDF-1α concentrations between the intermediate AMD (median: 160.9 pg/mL, range 130–166.3 pg/mL), late AMD (median: 161 pg/mL, range: 154.1.9–171.6 pg/mL), and control group values (median: 161 pg/mL, range: 155.2–219 pg/mL) (p=0.763).
DISCUSSION AND CONCLUSION: The aqueous humor levels of VEGF and SDF-1α were within the normal range in patients with intermediate and late-stage AMD.

INTRODUCTION: The aim of this study was to examine and provide real-life data of patients with exudative-type age-related macular degeneration (AMD).
METHODS: A total of 189 eyes of 160 patients with exudative AMD treated with intravitreal anti–vascular endothelial growth factor therapy (anti-VEGF) injections (ranibizumab 0.3 mg/0.05 mL, aflibercept 2 mg/0.05 mL, bevacizumab 1.25 mg/0.05 mL) were included in the study. Patient demographic characteristics, and details of the clinical examinations, number of injections, best-corrected visual acuity (BCVA) measured with the Snellen chart, optical coherence tomography, and fundus fluorescein angiography images were evaluated at the first visit and during the follow-up period.
RESULTS: In the study group, 78 of the patients were female (48.8%) and 82 were male. The mean age was 72.20±8.97 years. While no treatment had been applied to 151 eyes before the first examination, 38 had previously received an intravitreal injection at another center. The mean number of patient visits was 5.83 in the first year, 4.68 in the second year, and 3.84 in the third year, and the mean number of injections was 4.70 in the first year, 2.08 in the second year, and 1.51 in the third year. The mean BCVA change between the first visit and the first, second, and third years was not statistically significant (p>0.05), and a significant change was observed in the mean central macular thickness (p<0.05).
DISCUSSION AND CONCLUSION: Anatomical and functional success was achieved with anti-VEGF treatment after fewer injections and visits than have been reported in randomized, controlled, clinical studies in the literature. The number of injections and visits recorded in this study was consistent with the data of other real-life studies.

INTRODUCTION: This was an assessment of one-snip punctoplasty outcomes in patients for whom adjunctive punctal re-dilatation was performed in-office for early postoperative cicatricial changes.
METHODS: A retrospective analysis was conducted of patients who underwent one-snip punctoplasty between March 2019 and February 2020 due to acquired punctal stenosis. Patients were followed up on the first, third, and seventh postoperative day, then weekly for the remainder of the first month, every 2 weeks over the next month, and then monthly. Punctal re-dilatation was performed if patients showed early clinical signs of re-stenosis. Demographic details, the number and timing of re-dilatation procedures, the timing of re-stenosis, and anatomical and functional success rates were analyzed.
RESULTS: The medical records of 148 eyes of 86 patients were evaluated. A re-dilation procedure was performed in a total of 57 (38.5%) puncta showing signs of early cicatrization. The first punctal re-dilatation was performed at a mean of 17.2±11.3 days (range: 3–57 days). Re stenosis was observed in 25 puncta (16.9%) at a mean of 5.6±3.1 weeks (range: 2–16 weeks). The anatomical success rate was 83.1% and the functional success rate was 79.1%. There were no significant differences in the anatomical and functional success rates between the patients who did and did not need adjunctive redilatation.
DISCUSSION AND CONCLUSION: In-office punctal re-dilatation may improve functional and anatomical success rates after one-snip punctoplasty by preventing recurrent punctal cicatrization.

INTRODUCTION: This study was a comparison of the outcomes of transcanalicular multidiode laser dacryocystorhinostomy (TCLDCR) and external dacryocystorhinostomy (EXDCR) treatment for patients with acquired nasolacrimal duct obstruction.
METHODS: Thirty-one consecutive patients who underwent TCLDCR (TCLDCR group) and 68 consecutive patients who underwent EXDCR (EXDCR group) due to acquired nasolacrimal duct obstruction were enrolled in the study. Follow-up visits were performed on the first day, and at the first week, first month, third month, sixth month, and every six months thereafter. Surgical success was defined as achievement of a patent osteotomy and a successful bicanalicular silicone intubation during the procedure. Anatomical success was defined by observation of a patent osteotomy on lacrimal irrigation, regardless of epiphora. The surgery time and intra- and postoperative complications were noted for each patient.
RESULTS: The TCLDCR group had a significantly shorter mean surgery time (27.9±5.5 minutes) compared with the EXDCR group (58.5±12.0 minutes) (p<0.001). However, the mean anatomical and functional rates of TCLDCR (58.0% and 54.8%, respectively) were significantly lower than those of the EXDCR group (94.1% and 91.1%, respectively) (both p<0.001). Two patients had "cheese wiring" damage of the lower canaliculus and 1 patient in the TCLDCR group had a full-thickness skin defect in the medial canthal region. No serious intra- or postoperative complication occurred in the EXDCR group.
DISCUSSION AND CONCLUSION: Although a TCLDCR procedure decreased the surgical time, it had a significantly lower success rate in the treatment of acquired nasolacrimal duct obstruction compared to EXDCR. The decision of the type of surgery should be made based on the cosmetic and success expectations of the patients and the presence of systemic problems.

INTRODUCTION: This study was performed to assess and analyze the retinal and choroidal thickness in amblyopic eyes using spectral-domain optical coherence tomography and enhanced depth imaging optical coherence tomography.
METHODS: A total of 67 children with amblyopia and 31 age- and gender-matched healthy non-amblyopic control subjects were enrolled in the study. The 67 amblyopic children were divided into 3 groups: hypermetropic amblyopia (Group 1). microesotropia (Group 2). and myopic anisometropia (Group 3). All of the participants underwent a detailed ophthalmologic examination and orthoptic assessment. The subfoveal choroidal thickness was measured at 500-. 750-. 1000-. and 15000-micron intervals nasally and temporally. Central macular thickness was also measured in the subfoveal. parafoveal inferior. parafoveal superior. parafoveal nasal. and parafoveal temporal superior. inferior. nasal. and temporal quadrants. All of the parameters of the amblyopic eyes. fellow eyes. and control eyes were compared.
RESULTS: In all. 34 female and 33 male patients were studied. The mean age was 8.6±2.8 years (range: 5–12 years). Comparison of the choroidal thickness and macular thickness measurements between the amblyopic and non-amblyopic eye of the same patient within each group revealed no statistically significant differences. Comparison of the findings in the amblyopic eyes of Group 1 and Group 3 with the control group revealed that the choroidal thickness measurements were smaller in the amblyopic eyes in all quadrants. however. only the nasal quadrant measurements demonstrated a statistical significance. The subfoveal macular thickness value was also smaller in both groups when compared with the control eyes.
DISCUSSION AND CONCLUSION: Our results indicated that amblyopia. whether anisometropic or microtropic. did not seem to significantly affect choroidal thickness.

This case report illustrates the successful use of the double-layer amniotic membrane technique in a child with glaucoma and aniridia. A 3.5 year-old girl with bilateral congenital glaucoma as well as aniridia, lens coloboma, nystagmus, and strabismus had been followed up since birth. Medical treatment did not result in the desired intraocular pressure improvement. An Ahmed glaucoma valve was implanted bilaterally. In a follow-up visit at 2 years of age, there were complaints of redness with watery discharge in the right eye. A biomicroscopic evaluation revealed tube erosion of the conjunctiva. The eroded area was dissected from the surrounding tissue and the area was closed using the new double layer amnion membrane technique. After the surgery, the intraocular pressure was normal. Subsequent follow-up indicated that the erosion defect was closed and stabilized. The double-layer amniotic membrane technique can be used successfully in cases of conjunctival tube erosion. To the authors' knowledge, this is the first published pediatric case report of using the novel technique of amniotic membrane transplantation for tube erosion.

Presented are 2 cases of acute corneal hydrops in keratoconus with Graves’ orbitopathy (GO). Two patients (Case 1: female, 54 years old; Case 2: male, 33 years old) with coexisting keratoconus and GO demonstrated typical findings of acute corneal hydrops (ACH) in 1 eye during the active stage of orbitopathy. There was no history of trauma. The ACH healed with scarring after management with a therapeutic contact lens and medical treatment in each patient within 3 months and 5 months, respectively. The development of ACH in keratoconus patients has previously been reported to be associated with male gender, ethnicity, age, eye rubbing, trauma, rapidly progressive disease, atopy, and vernal conjunctivitis. GO involves ocular surface inflammation and fluctuation of intraocular pressure. Active GO can be a risk factor for ACH in keratoconus patients.