ISSN: 2459 - 1777 | E-ISSN 2587-0394
Volume : 7 Issue : 3 Year : 2022
Beyoglu Eye Journal - Beyoglu Eye J: 7 (3)
Volume: 7  Issue: 3 - 2022
INVITED REVIEW
1.Role of Atropine in the control of Myopia Progression- A Review
Raju Kaiti, Ranjila Shyangbo, Indra Prasad Sharma
doi: 10.14744/bej.2022.07742  Pages 157 - 166
Abstract | Full Text PDF

ORIGINAL ARTICLE
2.Evaluation of Vision-Related Quality of Life After Unilateral Implantation of a New Trifocal Intraocular Lens
Cem Ozturkmen, Cem Kesim, Afsun Sahin
doi: 10.14744/bej.2022.75768  Pages 167 - 172
OBJECTIVES: The objective of the study was to evaluate visual performance and subjective quality of life after unilateral implantation of a new trifocal intraocular lens (IOL) in young and middle-aged patients.
METHODS: Patients that underwent unilateral cataract surgery with implantation of trifocal TFNT00 IOL with an em-metropic fellow eye were included in the study. Vision related daily activity performance was evaluated in postoperative 6th month. Patients were divided in two groups according to the uncorrected near visual acuity of their fellow eyes: İn Group I if worse than the operated eye and in Group II if equal or better than the operated eye. The visual function-14 (VF-14) questionnaire was used with scores of 4 with no difficulty, 3 points with mild difficulty, 2 points with moderate difficulty, 1 point with severe difficulty, and 0 point if unable to perform.
RESULTS: Twenty-one patients were enrolled in this study. Patients had good visual performance, showing VF-14 scores above 3 in all categories. Reading small print (3.67±0.48) and driving at night (3.67±0.48) were found to be the most dif-ficult tasks to perform. No significant difference was found between two groups in any category that was investigated by the VF-14 questionnaire.
DISCUSSION AND CONCLUSION: Unilateral implantation of TFNT00 trifocal IOL is well tolerated with good patient satisfaction assessed by VF-14 questionnaire in subjects that have cataract in one eye, encouraging single-eye surgical procedure in this particular group of patients.

3.Interobserver and Intraobserver Agreements of the Detection of Demodex Infestation by in Vivo Confocal Microscopy
Ayse Yildiz Tas, Burak Mergen, Erdost Yıldız, Betul N Bayraktutar, Ekrem Çelik, Afsun Sahin, Ceyhun ARICI
doi: 10.14744/bej.2022.37880  Pages 173 - 180
OBJECTIVES: The purpose of the study was to determine interobserver and intraobserver agreement, repeatability, and intrasubject variation of the detection of Demodex infestation in eyelids of blepharitis patients using in vivo confocal microscopy (IVCM).
METHODS: Eighty-three eyes of 42 blepharitis patients were included in the study. All eyelids were evaluated from tempo-ral to nasal with IVCM using section mode and 10 lashes with their follicles were imagined, and every image with suspicion of Demodex infestation was recorded. Two experienced and two inexperienced ophthalmologists were masked for the diagnosis and interpreted the IVCM images regarding the presence of Demodex infestation with a 3-week interval. Inter-observer and intraobserver agreements were calculated with Cohen’s kappa and its variant statistics between and within experienced observers and between inexperienced observers.
RESULTS: While average sensitivity for the diagnosis of demodicosis in IVCM images was 83.35% for experienced and 51.35% for inexperienced observers, the average positive predictive value was 88.6% for experienced observers and 91.05% for inexperienced ones. Interobserver agreement between experienced observers was moderate (κ = 0.529) and intraobserver agreements within experienced observers were perfect (κ = 0.918 for observer-1; κ = 0.958 for ob-server-2). Interobserver agreement between inexperienced observers was poor (κ = 0.162) and intraobserver agreements within inexperienced observers were fair (κ = 0.427 for observer-3; κ = 0.475 for observer-4).
DISCUSSION AND CONCLUSION: The sensitivity, interobserver and intraobserver agreements in IVCM image analysis for the detection of Demodex infestation were highly associated with the clinical experience on IVCM imaging. In the hands of an experienced clinician, IVCM could be reliable for the diagnosis of ocular demodicosis.

4.Evaluation of Sudden Visual Loss and Central 10-Degree Visual Field Change Following Glaucoma Surgery in Severe and End-Stage Eyes
Alev Özçelik Köse, Mehmet Serhat Mangan, Sevcan Yildiz Balci, Nursal Melda Yenerel, Serhat Imamoglu, Hatice Tekcan
doi: 10.14744/bej.2022.27037  Pages 181 - 187
OBJECTIVES: The purpose of the study was to evaluate the sudden visual loss and central 10-degree visual field (VF) change following glaucoma surgery in eyes with severe and end-stage glaucoma.
METHODS: This was a single-center retrospective study. The charts of patients with severe and end-stage glaucoma who had undergone trabeculectomy and Ahmed glaucoma valve (AGV) implantation surgery were reviewed. Patients who had 10-2 Humphrey VF automated (HVFA) at follow-up were included and classified into two following groups: With split fixation on 10-2 HVFA before surgery split fixation group (SFG) and those without split fixation (WSFG).
RESULTS: The data of 37 patients in SFG and 28 patients in WSFG were reviewed. The mean follow-up duration was 2.06±0.24 years in SFG and 2±0.3 years in WSFG. 10-2 HVFA revealed that SFG had a mean MD –25.8±5.2 dB preop-eratively and –25.2±1.1 dB (p=0.18) at last visit, WSFG had a mean MD −9.8±4.8 dB preoperatively and −10.8±1.5 dB at last visit (p=0.10). In SFG, the mean intraocular pressure (IOP) decreased from 30.1±9.5 mmHg to 12.3±0.62 mmHg (p<0.001), and in WSFG, the mean IOP decreased from 30±6.9 mmHg to 12.3±0.90 mmHg at last visit (p<0.001). There was no statistical difference for visual acuity of both the groups at the follow-up (p=0.30 and p=0.70). In SFG, one patient had wipe-out phenomenon who had undergone AGV surgery.


DISCUSSION AND CONCLUSION: Although wipe-out phenomenon was a rare complication, it can develop not only after trabeculectomy but also after AGV surgery, and patients with split fixation and severe and end-stage glaucoma were at risk for this phenomenon regardless of the type of surgery. Both trabeculectomy and AGV surgery appear to provide stability of the central 10° VF.

5.Investigation of eNOS G894T Gene Polymorphism in Patients with Pseudoexfoliation Syndrome: A Preliminary Study
Özer Dursun, Ayça Yılmaz, Şenay Balcı Fidancı, Lülüfer Tamer, Mustafa Vatansever, Ömer Özer, Erdem Dinç
doi: 10.14744/bej.2022.29484  Pages 188 - 192
OBJECTIVES: The aim of this study is to investigate the relationship between pseudoexfoliation syndrome (XFS) and pseu-doexfoliative glaucoma (XFG) and endothelial nitric oxide synthase (eNOS) G894T polymorphism.
METHODS: Seventy-eight eyes of 78 patients who had undergone uncomplicated cataract surgeries for senile cataract were included in this study. Forty patients with XFS were included in the study group, and 38 patients without XFS constituted the control group. Patients with XFS were divided into two subgroups according to their XFG development, and subgroup analysis was performed. Venous blood samples were taken from all patients before surgery and 894 G>T (rs1799983) polymorphism on the eNOS gene was evaluated by RT-PCR.
RESULTS: While the mean age in the control group was 65.97±10.64 years (23 males and 15 females), the mean age in the study group was 73.05±6.79 years (30 males and 10 females), (p<0.001). Regression analysis of the risks caused by the genotype and alleles between the control and study groups revealed that the homozygous alleles were more common in the study group, and heterozygous or mutant alleles have reduced the development of XFS approximately 2-folds. How-ever, this was not statistically significant (p=0.11). Similarly, when subgroup analysis was performed, it was found that there was no significant relationship between XFG in patients with XFS and gene polymorphism.
DISCUSSION AND CONCLUSION: In this study, it was observed that there was no relationship between the G894T polymorphism in the eNOS gene and the development of XFS/XFG.

6.The Effect of Thyroid Eye Disease on Corneal Biomechanical Properties
Melis Cansu Comert, Sezen Yılmaz, Ayse Yildiz Tas, Afsun Sahin
doi: 10.14744/bej.2022.08941  Pages 193 - 198
OBJECTIVES: The aim of this study was to identify corneal biomechanical parameters measured by ORA in patients with TED compared to the healthy group. The NOSPECS classification of patients is used to assess the relation between biomechanical changes and disease severity
METHODS: We included 22 TED patients, diagnosed with TED for more than five years, and 43 healthy participants. The NOSPECS classification was assessed as mild (grade 1-3) and severe (grade 4-6) disease. For each group, corneal hystere-sis (CH), corneal resistance factor (CRF), central corneal thickness (CCT), Goldmann-correlated intraocular pressure (IOPg) and corneal compensated intraocular pressure (IOPcc) parameters were measured by ORA.
RESULTS: The mean age was 38.8±11.6 years for the TED patients and 42.9±15.58 years for the control group. For TED patients and healthy volunteers, the mean levels of CRF, CH, and CCT were measured as follows: 10.43±2.04 vs 10.28±1.91mmHg, p=0.67; 10.18±1.81 vs 10.21±1.68 mmHg, p=0.90; 550.31±35.73 vs 545.23±37.91 µm, p=0.47, respec-tively. These values were not significant between groups, but they were significantly higher in females compared to males in TED patients [CRF;10.68 (IQR: 9.49-12.14) vs 8.96 (IQR: 8.04-9.92) mmHg, p=0.002, CH; 10.43 (IQR: 9.48-11.25) vs 8.58 (IQR: 7.90-9.95) mmHg, p=0.003 and CCT; 554.25 (IQR: 536.05-579.52) vs 527.40 (IQR: 492.25-545.90) µm, p=0.014]. CRF values were negatively correlated with NOSPECS score (r=-0.317, p=0.036) and significantly higher CRF was observed in mild patients compared to severe disease (11.43 (IQR: 10.14-12.87) vs 9.46 (IQR: 8.75-10.28) mmHg, p=0.008).
DISCUSSION AND CONCLUSION: We found a significant gender effect on corneal biomechanical parameters of TED patients. CRF, CH and CCT values were significantly higher in females compared to males with TED. The clinical severity score of TED showed negative correlation with CRF. CRF value might be a useful parameter in follow-up of TED patients in clinical practice.

7.Surgical Repair of Orbital Blow-Out Fractures: Outcomes and Complications
Can Öztürker, Yasin Sarı, Kemal Turgay Özbilen, Nihan Aksu Ceylan, Samuray Tuncer
doi: 10.14744/bej.2022.88156  Pages 199 - 206
OBJECTIVES: The purpose of this study is to evaluate the demographics of patients with orbital blow-out fractures, as well as the success and complications of surgical repair with porous polyethylene membrane sheet implants through transcon-junctival technique and to compare the results to previously published studies.
METHODS: This retrospective study included 57 patients diagnosed with orbital blow-out fractures referred to our clinic between 2018 and 2022. Seventeen patients (29.8%) underwent orbital fracture repair through a transconjunctival tech-nique employing porous polyethylene membrane sheets. The indications for surgery were enophthalmos >2 mm and persistent ocular motility restriction, diplopia, and strabismus. The success criteria were <2 mm of enophthalmos and complete correction of eye motility, diplopia, and strabismus.
RESULTS: The study group consisted of ten females and 47 males with a mean age of 31.12 years. The most common cause of injury was assaults (50.9%), followed by falls (38.6%), traffic accidents (5.3%), and accidental impacts (5.3%). The inferior wall (61.4%) was the most common fracture site, followed by the medial wall (21.1%) and a combination of the inferior and medial walls (21.1%). The surgically treated group showed a significant improvement in ocular motility restriction (88.2–23.5%, p=0.002), diplopia (70.6–23.5%, p=0.008), and enophthalmos (1.41 mm to 0.82 mm, p=0.012) after surgery. The surgery was successful in ten of 17 cases (58.8%), and the success rate was higher in patients who were treated early (77.8% vs. 37.5%), but the difference was not statistically significant (p=0.092).
DISCUSSION AND CONCLUSION: Orbital blow-out fracture repair using porous polyethylene membrane sheets through a transconjunctival approach is a safe and effective surgical technique for orbital blow-out fracture repair. Although patients who had early surgery had a higher success rate in our study group, larger study groups are needed to assess the effect of surgical timing on success.


8.Comparison of Ranibizumab Treatment Response of Superior and Inferior Temporal Branch Retinal Vein Occlusion: A Year Follow-Up
Esra Turkseven Kumral, Nursal Melda Yenerel, Nimet Yesim Ercalik, Levent Karabaş
doi: 10.14744/bej.2022.46794  Pages 207 - 212
OBJECTIVES: The aim of the study was to compare ranibizumab treatment response of macular edema secondary to superior and inferior temporal branch retinal vein occlusion.
METHODS: Sixty-four eyes of 64 patients treated with 0.5 mg/0.05 mL ranibizumab due to macular edema secondary to branch retinal vein occlusion were enrolled in this retrospective study. Thirty-eight eyes with superior temporal branch retinal vein occlusion were classified as Group 1 and 26 eyes with inferior temporal branch retinal vein occlusion as Group 2. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and the number of intravitreal injections were evaluated and compared between the groups.
RESULTS: The mean baseline, 3rd, 6th, 9th, and 12th month BCVA values in Group 1 were 0.77±0.47, 0.37±0.20, 0.37±0.22, 0.38±0.24, and 0.35±0.18 logarithm of the minimum angle of resolution (logMAR) and in Group 2 were 0.75±0.45, 0.37±0.18, 0.35±0.19, 0.32±0.17, and 0.28±0.20 logMAR, respectively. The mean baseline, 3rd, 6th, 9th, and 12th month CMT values in Group 1 were 522.92±136.01, 318.03±66.65, 287.53±48.27, 271.95±32.47, and 280.47±91.66 µm and in Group 2 were 524.08±145.51, 289.85±53.08, 268.96±31.57, 260.77±30.22, and 244.04±44.78 µm, respectively. BCVA and CMT improved significantly within both groups after the treatment (p<0.05) and there was no statistically significant difference between the groups (p>0.05). However, a significantly higher number of injections was needed for Group 1.
DISCUSSION AND CONCLUSION: Ranibizumab improved the visual and anatomical outcomes similarly in both superior and inferior temporal branch retinal vein occlusion with macular edema. However, more frequent injections were needed to achieve the same efficacy in superior temporal branch retinal vein occlusion.

9.The Impact of COVID-19 Pandemic on Ophthalmology Residency Education
Ali Safa Balcı, Cigdem Altan, Muhittin Taskapili
doi: 10.14744/bej.2022.58234  Pages 213 - 222
OBJECTIVES: The aim of this study is to investigate the theoretical, practical, and academic effects of the Coronavirus disease 2019 (COVID-19) pandemic on ophthalmology residents.
METHODS: The web-based survey consisting of 28 questions was sent through Email to 37 educators who provides res-ident training. We divided the pandemic period into three, according to the severity of the pandemic and the measures, compared with pre-pandemic period (PreP), separately. Between March 2020 and June 2020 was named as P1, June 2020–October 2020 was named as P2, and October 2020–March 2021 was named as P3.
RESULTS: Responses received from 35 centers (17 university hospitals, 18 training and research state hospitals). There were totally 458 residents in the hospitals. Two hundred and forty-six of them (53.71%) worked on COVID-19 duties, with an average working time of 69.57 days. There were significant decreases in the number of patients examined by res-ident doctors and theoretical training time in the P1, P2, and P3 periods compared to PreP (p<0.05 for all). Furthermore, in terms of the total number of surgeries in clinics and surgeries performed by residents, there were significant decreases in P1 and P2 compared to PreP (p<0.001 for both), but there was no significant difference in P3 (p=0.109). In the exami-nations held in the clinic, in the 1st year of the pandemic, the grade average was lower than before the pandemic (p<0.05). Seventeen residents (3.74%) resigned or moved to another hospital.
DISCUSSION AND CONCLUSION: The COVID-19 pandemic has severely affected the theoretical, practical, and academic training of ophthal-mology residents.

10.The Effect of COVID-19 Pandemic on Eye-Related Emergency Department Visits: A Comparison of 2-Year Results
Mevlüt Yılmaz, Kübra Serbest Ceylanoğlu, Emine Malkoç Şen
doi: 10.14744/bej.2022.58966  Pages 223 - 230
OBJECTIVES: The aim of this study was to examine the clinical and demographic impact of the COVID-19 pandemic on emergency department admissions to a tertiary eye care hospital.
METHODS: Records of admissions to the ophthalmology emergency department during the pre-pandemic period (Group 1) and pandemic period (Group 2) were retrospectively reviewed to cover the period between March 15, 2019, and March 15, 2021. Application numbers, demographic characteristics of patients were recorded. The cases were grouped by age, sex and diagnoses, and the findings were compared within and between the groups.
RESULTS: A total of 161, 941 patients (Group 1: 103, 178 and Group 2: 58, 763) were admitted to the emergency depart-ment of our hospital within 2 years. All admission diagnoses were significantly lower in the pandemic period than in the pre-pandemic period (p=0.001). However, the rate of sight-threatening cases or cases requiring urgent treatment (retinal diseases, uveitis, etc.) was significantly higher in the pandemic period than in the pre-pandemic period (p=0.001). The most common admission diagnoses were ocular infectious/inflammatory diseases while the foreign body on the ocular surface/ocular trauma group was second. Admissions for allergic and infectious diseases were significantly less during the pandemic period (p=0.001 and p=0.002, respectively). In both periods, the number of admissions of male patients was significantly higher than that of females. The most frequent applicant age group was the 17–40 years age group.
DISCUSSION AND CONCLUSION: This observational study reveals the changes caused by the COVID-19 pandemic in ocular emergency ad-missions. The data from our study may be helpful in planning healthcare delivery during and after the pandemic period.

CASE REPORT
11.Scleral Flap Wound Dehiscence with Valsalva Maneuver After Trabeculectomy with Mitomycin C
Sirel Gür Güngör, Almila Sarıgül Sezenöz, Ümit Ekşioğlu, Ahmet Akman
doi: 10.14744/bej.2022.34711  Pages 231 - 236
Incisional surgeries such as trabeculectomy reduce the resistance of the eye to trauma. Trabeculectomy is often per-formed together with mitomycin C, and late onset hypotony is already an expected complication in these eyes. This case report presents a patient who developed dehiscence of the scleral flap and hypotony maculopathy after Valsalva maneuver after 5.5 years of trabeculectomy. In a 6-month period, the patient’s hypotonic maculopathy became evident, and vision was affected after this period. Thereupon, the wound site was explored, and dehiscence of the scleral flap at the temporal wound site and increased aqueous outflow were detected. Repair was done with sterile pericardium patch. Post-operative vision, intraocular pressure, and hypotony maculopathy recovered very quickly. After incisional surgeries, patients should be warned against both external trauma and minor traumas such as eye rubbing and Valsalva maneuver.

12.Temporomandibular Joint Dislocation in a Patient with Keratoconus Under General Anesthesia: A Case Report
Mukaddes Damla Ciftci, Tuba Kuvvet Yoldaş, Canan Bor, Melis Palamar
doi: 10.14744/bej.2022.93446  Pages 237 - 239
Keratoconus is a common disease in which the central or paracentral cornea undergoes progressive thinning, resulting in a cone-shaped cornea. It has been associated with many systemic disorders such as Down syndrome, osteogenesis imper-fecta, and joint hypermobility. Herein, temporomandibular joint dislocation under general anesthesia during supraglottic airway device placement before deep anterior lamellar keratoplasty procedure in a keratoconus patient is reported.

13.Unilateral Endogenous Bacterial Endophthalmitis Post-Coronavirus Disease-19 in an Healthy Asian Indian Male
Srinivasan Sanjay, Poornachandra Gowda, Ankush Kawali, Rohit Shetty, Veena Chamakochi Narayana, Sameeksha Agrawal, Padmamalini Mahendradas
doi: 10.14744/bej.2022.94546  Pages 240 - 246
Coronavirus disease 2019 (COVID-19) is associated with ocular involvement either during or after the infection. These include conjunctivitis, conjunctival hyperemia, chemosis, epiphora, reactivation of anterior uveitis, or presenting as an-terior sclero-uveitis, cotton wool spots, retinal hemorrhages, retinal artery/vein occlusion, ophthalmic artery occlusion, panuveitis, papillophlebitis, central serous retinopathy, presumed fungal endophthalmitis, and multifocal chorioretinitis. A 47-year-old Asian Indian male was diagnosed with COVID-19 and had no other systemic history of note at the time of admission. Three weeks later, he developed sudden loss of vision in the right eye (OD). Visual acuity in OD was per-ception of light. OD had features of endophthalmitis. OD underwent pars plana vitrectomy with intravitreal antibiotics. Anterior chamber tap for fungal culture and polymerase chain reaction for panfungal genome was negative. Culture of ocular specimens did not reveal bacterial growth. Vitreous sample showed few Gram-positive cocci in singles and pairs with no evidence of fungal elements. Polymerase chain reaction for eubacterial genome was positive. He was treated with topical and systemic antibiotics and steroids. Final follow-up 6 weeks later, OD had a best-corrected visual acuity which was 20/200 with a quiet anterior chamber, cataract, with a macular traction and reduced sub retinal exudates and fluid. Post-COVID-19 sequelae causing sight-threatening manifestations as illustrated by this case report needs early recognition and prompt treatment to achieve a favorable visual outcome.

14.A Combined Intervention of Single Vision Plus Lens and Tropicamide in the Treatment of Pseudomyopia: A Perspective Case Report from Nepal
Bipin Koirala, Aayush Chandan, Raju Kaiti, Manoj Mahat, Sanjeeta Sitaula
doi: 10.14744/bej.2022.44127  Pages 247 - 251
This study highlights the role of cycloplegic refraction in the detection of accommodative spasm and the use of tropi-camide 1% as cycloplegic and single vision plus lens for its management. This was a case study carried at tertiary eye hos-pital in Kathmandu, Nepal. In this study, 2 subjects presenting with complain of sudden onset of diminution of vision for near and distance along with asthenopic symptoms having history of prolonged near work were recruited. Pre-cycloplegic refraction showed fluctuating myopic refractive error which after cycloplegia showed a significant hyperopic shift. Single vision plus lens (base on post-mydriatic treatment) giving optimal vision for near and distance along with tropicamide 1% twice a day basis and abstinence of triggering factor was started as initial treatment modality. Subjects were kept under close surveillance and followed up fortnightly over 2 months. During this period, the dosages of tropicamide were gradu-ally tapered based on symptomatic relief of patient and no recurrence of the condition was observed in both subjects for next 2 month.

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