INTRODUCTION: Clear corneal incision (CCI) architecture in modern microincision cataract surgery (MICS) plays an undeniable role in postoperative refraction. The goal of this study was to evaluate the effect of hinge incision prior to two-step CCI on postoperative refractive astigmatism after cataract surgery and to demonstrate the schematic presentation of these postoperative astigmatic changes via double-angle polar plots.
METHODS: This study involved a consecutive case series of patients who had MICS. The first incision was performed as a two-step CCI, whereas the second was made as a hinge incision prior to 2-step CCI. The preoperative corneal and postoperative refractive astigmatism and surgically induced astigmatism (SIA) were calculated by vectorial analysis. Hotelling’s T2 test was performed to compare the centroid values of preoperative and postoperative corneal astigmatism.

RESULTS: A total of 63 eyes from 57 subjects were evaluated. Group I consisted of 27 eyes with the two-step CCI, and Group II included 36 eyes with the hinge incision prior to two-step CCI. No significant difference was found between the groups in terms of age, sex, axial length, keratometry readings, implanted intraocular lens power, and postoperative spherical equivalent. The centroids of corneal astigmatism postoperatively increased to 0.21 D at 87.6°±0.61 with no significance in Group I (p=0.525) and to 0.70 D at 90.6°±0.47 with significance in Group II (p=0.032). The difference in postoperative centroids between the two groups was also significantly different (p=0.043). Finally, the centroids of SIA were 0.12 D at 85.5°±0.50 and 0.22 D at 91.1°±0.49 for Group I and Group II, respectively, with no significance.

DISCUSSION AND CONCLUSION: A hinge incision did not have an unfavorable effect on postoperative refractive astigmatism; therefore, it may be preferred for controlled entrance to the anterior chamber.

INTRODUCTION: The current study aimed to test the quality and educational utility of the videos of retinal detachment surgery available on YouTube.
METHODS: YouTube was searched using the keywords “retinal detachment, retinal detachment surgery” in October 2019. The steps of pars plana vitrectomy surgery were standardized according to the literature. The videos were evaluated in a blinded fashion by two retina specialists with the use of the Modified DISCERN, Health on the Net Foundation (HON)code, the Journal of American Medical Association (JAMA) checklist, and the Global Quality Score (GQS).
RESULTS: A total of 125 videos were reviewed. The total surgery score was 3.11 (2.16–3.67 IQR), and the most commonly shown surgical stages were photocoagulation and core vitrectomy (n = 99 [79.2%] and n = 97 [77.6%], respectively). In the multivariate linear regression model, the duration of video (minutes) (β- Coefficient 0.033, p<0.001), the HONcode score (β-Coefficient 0.310, p=0.005), and GQS (β-Coefficient 0.768, p<0.001) were associated with better educational content, whereas JAMA and Modified DISCERN scores were not.
DISCUSSION AND CONCLUSION: So far, the educational value of YouTube videos has been unsatisfactory. Assessing the videos using tools such as HONcode, video duration and GQS may provide better educational perspective to ophthalmology trainees.

INTRODUCTION: To compare upper eyelid blepharoplasty patients’ suture techniques with interrupted cutaneous in one eye and running cutaneous in the other in terms of edema, ecchymosis, and scar index.
METHODS: Among patients whose suture techniques with interrupted cutaneous in one eye and running cutaneous in the other, 34 patients in the vicryl group and 46 patients in the polypropylene group were included in the study. The patients’ edema and ecchymosis levels on postoperative days 1, 7, and 30 days and 3 months were selected. The Manchester Scar Scale was used to evaluate the scar index at 30 days and 3 months after surgery. Suture material (either 6-0 polypropylene sutures or 6-0 vicryl sutures) were evaluated independently.
RESULTS: In vicryl group, there was significantly less ecchymosis and edema first week postoperatively in interrupted sutured eyelid than running sutured eyelid (p=0.001, p=0.011, respectively). In polypropylene group, there was significantly less ecchymosis at the first day and first week postoperatively in interrupted sutured eyelid than running sutured eyelid (p=0.025, p=0.001, respectively). The total scar index scores in both groups at first month and third month were significantly better at the interrupted sutured eyelid than running sutured eyelid (p<0.05, for all).
DISCUSSION AND CONCLUSION: In upper eyelid blepharoplasty, an interrupted suture technique yielded the lowest rates of edema, ecchymosis, and scar formation compared with a running suture technique.

INTRODUCTION: In our clinic, although we prefer to perform dacryocystorhinostomy (DCR) under general anesthetics, we also perform it under local anesthetics for patients with a high risk of general anesthesia. Herein this study, we aimed to present our experiences in external DCR under both general and local anesthetics in a tertiary clinic.
METHODS: Medical records of the patients who had epiphora, were followed up in the oculoplastic section between January 2014 and December 2020 were collected. Patients who underwent external DCR were included in the study. Patients were divided into two groups: local and general anesthesia. All demographic characteristics of patients, previous DCR, history of dacryocystitis, surgery time, perioperative complications, and the American Society of Anaesthesiology (ASA) physical status score were recorded.
RESULTS: A total of 106 eyes from 82 patients were included in the study. The mean age of the patients was 57±24 years (range 18–89) and the median age was 56. Of 82 patients, 49 were female and 33 were male. 24 patients underwent bilateral external DCR. The mean surgery time for the general group and the local group was 66±12 min and 52±7 min, respectively. A significant difference was observed between the general and local groups in terms of the duration of the surgery (p=0.03). Of these, 11 patients underwent revision DCR during the follow-ups, and 7 patients were in the general group and 3 patients were in the local group. The overall success rate was 90%.
DISCUSSION AND CONCLUSION: External DCR surgery with both general and local anesthesia is a very effective technique for the treatment of nasolacrimal duct obstruction. In addition, local anesthesia may be brought to mind as an option considering less bleeding, shorter discharge time, and cost-effectivity and also to avoid perioperative and postoperative systemic complications for patients with high risks of general anesthesia.

INTRODUCTION: To determine whether treatment time of congenital nasolacrimal duct obstruction (CNLDO) has any effect on refractive amblyopia risk factors (ARFs).
METHODS: This is a cross-sectional study and it was conducted in the Pediatric Ophthalmology Department at Kayseri City Training and Research Hospital. The ages of 174 patients who underwent probing were obtained from electronic medical charts and used to divide the patients into two groups: an early-probing group (<24 months old) and a late-probing group (≥24 months old). After inclusion criteria were applied, a pediatric ophthalmologist examined 189 eyes of the 174 patients. The groups were evaluated and compared for cycloplegic refractive errors.
RESULTS: The median age of patients who underwent probing was 30 months (ranging from 11–44 months). A total of 40 of 189 eyes (21.2%) examined had refractive ARFs, which were significantly more prevalent in the late-probing group (p=0.044). The ARFs associated with astigmatism were greater in the late- versus the early-probing group (p=0.037), whereas no other refractive ARFs or anisometropia differed between the groups (p=0.887 for myopia, p=0.364 for hyperopia, and p=0.672 for anisometropia). Astigmatic ARFs were significantly higher in the late-treatment group.
DISCUSSION AND CONCLUSION: Astigmatic ARFs were significantly higher in the late-treatment group. Therefore, ophthalmologists should regularly monitor the refractive status of children with CNLDO, especially those treated after 24 months old.

INTRODUCTION: To evaluate fluorescein effect on the corneal endothelium by endothelial specular microscopy in diabetic retinopathy patients undergone fundus fluoresecein anjiography (FFA).
METHODS: One hundred thirthy four diabetic retinopathy patients undergone FFA aged between 42 and 74 years were included study. We checked the corneal endothelial cell density (ECD), coefficient of variation of cell area (CV/polymegethism) and percentage of hexagonal cells (6A/pleomorphysm) before FFA and 1 hour, 1 day, 1 week after the procedure.
RESULTS: The mean baseline ECD was 2223±216 cells/mm2. The mean ECD before and 1 hour (2234±224 cells/mm2), 1 day (2237±231 cells/mm2), 1 week (2226±219 cells/mm2) after the procedure weren’t significantly different (p=0.243; repeated measure ANOVA). The mean of the coefficient variations of the endothelial cell size before and 1 hour,1 day, 1 week after the procedure were 0.327±0.07, 0.319±0.06, 0.322±0.06, 0.325±0.07 respectively (p=0.281; repeated measure ANOVA). The mean of the baseline percent of hexagonal cells (pleomorphism) in the endothelium was 61.7±5.2, and the postoperative 1 hour, 1 day, 1 week percent were 62.3±5.7, 61.9±6.1, 61.3±5.9, respectively (p= 0.317; repeated measure ANOVA).

DISCUSSION AND CONCLUSION: The results of this study demonstrated that fluorescein has no toxic effect on corneal endothelium.

INTRODUCTION: To assess multifocal electroretinogram (mf-ERG) values in patients with diabetic macular edema (DME) who were treated with intravitreal ranibizumab (IVR).
METHODS: Thirty eyes of patients with DME, who underwent three consecutive monthly injections of IVR and as required thereafter, were evaluated. Best corrected visual acuity (BCVA) (log MAR), optical coherence tomography (OCT) features [diameters of cyst and subretinal fluid, hyperreflective dots (HRDs)], and mf-ERG were evaluated at baseline, 1 month, and 6 months throughout the follow-up period. The correlation of mf-ERG values and OCT features, BCVA, and the duration of disease were investigated.
RESULTS: In the study group, the baseline P1 and N1 amplitudes were significantly lower than the control group, and P1 and N1 implicit times were significantly higher in patients with DME than in the control group in all rings (All p<0.05) The mean response density (P1 amplitude, nV/deg2) values increased over 6 months in rings 1, 2, and 3 (p<0.001, p=0.003, p=0.006). There was a negative correlation between the diameter of the cyst and the initial response density of P1 (for horizontal diameter: r=–0.658, p=0.03; for vertical diameter: r=–0.597, p=0.037; for the area of the cyst, r=–0.603, p=0.021). There was a significant negative correlation between the subretinal fluid and HRD reduction and the response density of P1 increase (all p<0.05). At baseline and 6 months, the correlation between BCVA and the P1 and N1 amplitude of the central ring was significant (for baseline P1: r=–0.649, p=0.01; for N1: r=–0.575, p=0.02; for 6-month P1, r=–0.603, p<0.001; for N1: r=–0.591, p=0.005).
DISCUSSION AND CONCLUSION: The combination of OCT and mf-ERG can be used to evaluate the functional recovery in DME.

INTRODUCTION: To compare the number of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections performed during 2020 with that in the same period in 2019.
METHODS: The study investigated anti-VEGF injections performed in 2019 and 2020. Injections performed on 923 eyes of 858 patients were evaluated. The patients were treated for diabetic macular edema (DME), age-related macular degeneration (AMD), and retinal vein occlusion (RVO). Injections, new cases, and patients who either completed or did not complete three loading doses in 2019 and 2020 were first compared. The same comparisons were then performed between the pandemic period in 2020 and the same period in 2019.
RESULTS: While 2070 injections were performed on 670 eyes in 2019, 1478 injections were applied to 253 eyes in 2020 (p=0.001). The number of naive eyes was 163 in 2019 and 83 in 2020. During the pandemic period in 2020, 967 injections were performed on 181 eyes, compared with 1721 injections on 532 eyes in the same period in 2019 (p=0.001). While 86.5% of patients completed three injections in 2020, the rate was 78.9% for the same period in 2019 (p=0.025).

DISCUSSION AND CONCLUSION: The COVID-19 pandemic caused a significant decrease in the number of patients presenting to the hospital, and delays occurred in treatment protocols. However, patients admitted to the hospital during this period adapted better to the loading doses. In conclusion, the pandemic caused significant disruption to treatment, and this will inevitably result in anatomical and functional worsening in the eye.

INTRODUCTION: Investigation of the compatibility between central corneal thickness (CCT) measurements in healthy eyes by comparing standard ultrasound pachymetry (USP) with noncontact tono-pachymetry (NCT) and specular microscopy (SM) devices was aimed.
METHODS: Forty-five eyes of 45 healthy volunteers aged between 18 and 60 years were included in this study. CCT of all cases was evaluated with USP, NCT, and SM devices. The same examiner performed all examinations. Bland–Altman plots and intraclass correlation coefficients were used to evaluate the agreement between instruments.
RESULTS: The mean age of the patients was 31±10.2 years. Fifteen (33.3%) cases were male and 30 (66.7%) were female. The mean CCT measured using NCT (559.3±39 μm) was significantly higher than those measured using SM (534.8±41 μm) and USP (542.6±43 μm, p<0.001). Bland–Altman analysis showed that the difference between the first, second, and third measurements was evenly dispersed around the mean, with no clear trend toward over- or underestimation by either NCT, USP, or SM. The 95% limits of agreements were 0.30–48.72 μm for NCT, –12.63–46.04 μm for the USP, and –24.41–8.80 μm for the SM. Correlation analysis between the three devices showed a very strong positive correlation (p<0.001).
DISCUSSION AND CONCLUSION: Significant differences were observed between CCT measurements in healthy individuals used in ophthalmology practice and performed with different devices. This situation should draw attention to the fact that in diseases such as glaucoma and endothelial insufficiency, corneal thickness monitoring should be done with the same device and the devices should not be used interchangeably.

INTRODUCTION: To evaluate and compare the effects of hybrid contact lenses (HCLs) and mini-scleral contact lenses (MSCLs) on visual acuity, spherical equivalent, topographic astigmatism, and higher-order aberrations (HOAs) in eyes with advanced keratoconus.
METHODS: We reviewed the medical records of 43 eyes of 27 patients diagnosed with advanced keratoconus fit hybrid contact lenses (AirFlex®) and mini-scleral contact lenses (Mini-misa®). Pre-fitting examinations included best corrected visual acuity (BCVA), spherical equivalent, topographic findings (topographic astigmatism, maximum keratometry, mean keratometry, central corneal thickness, thinnest corneal thickness, and corneal HOAs. Post-fitting examinations included lens corrected visual acuity, spherical equivalent, topographic astigmatism, corneal HOAs, and contact lens-related discomfort symptoms.
RESULTS: Mean BCVA (log MAR) improved significantly from 0.65±0.27 to 0.14±0.09 with HCL and 0.58±0.25 to 0.15±0.13 with MSCL (p<0.05). The mean spherical equivalent and topographic astigmatism measurements decreased significantly in both groups (p<0.05). Eight patients in the HCL group experienced lens-related discomfort. Root-mean square HOA decreased significantly in both groups (p<0.05).
DISCUSSION AND CONCLUSION: Significant improvements in visual acuity, spherical equivalent, topographic astigmatism, and HOAs were observed with both lenses. However, higher patient comfort with scleral lenses may lead to higher compliance in patients with advanced keratoconus.

A 61-year-old patient with end-stage liver cirrhosis was admitted for cataract surgery with corrected distance visual acuities (CDVAs) of 0.3, in both eyes. His international correction ratio (INR) for blood coagulation was 2.1 without any anticoagulants, and general anesthesia was contraindicated. He was deemed inoperable for liver transplantation. Two weeks after uneventful phacoemulsification in his right eye under topical anesthesia, he underwent phacoemulsification for the cataract in the left eye. However, during surgery, extensive zonular dialysis was noted and the surgery proceeded with extracapsular cataract extraction and anterior vitrectomy, during which a rapid suprachoroidal hemorrhage (SCH) was noted. The incisions were then rapidly sutured. Intravenous 150 cc of 18% mannitol and 2 mg midazolam and sublingual 5 drops of nifedipine were given, and he was placed in the slightly reverse-trendelenburg position. Following suturation of the incision, the globe was left aphakic, slightly hypertonic with no loss of vitreous through the incisions. The postoperative treatment regimen of topical prednisolone and moxifloxacin eye drops of each per hour, cyclopentolate three times a day, and peroral prednisolone 40 mg was commenced. Despite no retinal reflex on the first day and no light perception for 2 weeks, transscleral SCH evacuation with limited pars plana vitrectomy was performed in the postoperative third week. Despite recurrent hemorrhage and intravitreal inflammatory bands, choroidal detachments regressed slowly with the improvement of CDVA up to 0.6 with aphakic contact lens correction at 3 months. The patient passed away due to complications of liver cirrhosis at 6 months.

We present a case report of 26-year-old female patient with acute visual impairment, who had been treated with 50 mg/day topiramate for 5 days for migraine prophylaxis. Ocular examination showed bilateral anterior chamber narrowing and macular striae. She had no previous ocular pathology, but her cycloplegic refraction showed a myopic shift of about 6 diopters. Topiramate was stopped and the patient's unaided visual level and macular stria returned to normal with topical steroid and cyclopentolate treatment. Recognition of this side effect and discontinuation of the causative drug may prevent angle closure and related vision loss.