ISSN: 2459-1777 | E-ISSN 2587-0394
Volume : 7 Issue : 4 Year : 2023
Beyoglu Eye Journal - Beyoglu Eye J: 7 (4)
Volume: 7  Issue: 4 - 2022
1.Dynamic and Static Pupil Changes After Near Work: Comparison Between Reading a Book and Using a Smartphone
Ali Mirzajani, Narges Akhgar, Ebrahim Jafarzadehpour, Jamileh Abolghasemi, Alireza Jamali, Zohreh Fakhimi
PMCID: PMC9794501  doi: 10.14744/bej.2022.64325  Pages 253 - 260
OBJECTIVES: Decreased static pupil size due to accommodation is a common clinical finding; however, changes in pupillary dynamic responses after near-work activities such as reading a book and using a smartphone are not well understood.
METHODS: The present study was performed on 76 right eyes of 76 volunteers (mean age: 20.95±2.34 years) who had ocular near activity more than 4 h per day. The participants were divided into two groups based on the dominant activity, reading a book (Group 1) or using a smartphone (Group 2). Evaluation of dynamic and static parameters of the pupil was performed before and after 1 h of continuous routine eye activity in both groups and compared.
RESULTS: Near work reduced pupil diameter (PD) in all static components (p<0.001) and the amount of change in the min PD (p=0.039) and mesopic PD (p=0.043) were different between two groups and were higher in Group 1 (both, p<0.05). Dynamic elements showed a decrease in initial diameter, amplitude and velocity of contraction and dilation, and an increase in other components so that the changes after using smartphone were significant in all dynamic parameters (all, p<0.05), but reading the book only made a significant difference in the initial diameter, amplitude, and velocity of contraction and duration of dilation (all, p<0.05); the changes were only different in the initial diameter between the two studied groups, which was higher in Group 1 (p=0.047).
DISCUSSION AND CONCLUSION: The present study showed that reading a book and using smartphone cause changes in the pupil compo-nents, which were decreasing in diameter components and velocity of changes and increasing in latency of changes; the type of ocular work may affect the changes.

2.Corneal Effect of Air Bubble After Phacoemulsification
Ali Keles, Suleyman Korhan Karaman
PMCID: PMC9794514  doi: 10.14744/bej.2022.65902  Pages 261 - 266
OBJECTIVES: The aim of the study was to investigate the effect of air bubble on the cornea at the end of the cataract surgery with phacoemulsification.
METHODS: This prospective and case–control study included 71 patients with air bubble injected into the anterior cham-ber at the end of the operation and 63 age-sex-matched control patients without air bubble. Endothelial cell density (ECD), coefficient of variation (CV), hexagonality rate (HEX), and central corneal thickness (CCT) measurements were taken using non-contact specular microscopy preoperatively and at 1-day, 1-week, and 1-month postoperatively.
RESULTS: No significant difference was determined between the groups preoperatively in respect of mean visual acuity, anterior chamber depth, ECD, CV, HEX, and CCT values (p>0.05). The intraoperative average ultrasound power, effective phaco time, and ultrasound time values were similar (p>0.05). The CCT value was lower in the study group than in the control group on post-operative day 1 (p=0.012), but similar at 1 week and 1 month (p=0.102, p=0.330, respectively). No significant difference was determined between the groups in mean visual acuity, anterior chamber reaction, ECD, CV, and HEX values at 1-day, 1-week, and 1-month postoperatively (p>0.05).
DISCUSSION AND CONCLUSION: Air bubble may be used as an alternative method to reduce corneal edema on the 1st post-operative day. According to the results, although air bubble has no detrimental effect, there is also seen to be no protective effect on the corneal endothelium.

3.Evaluation of Optical Coherence Tomography Findings and Choroidal Thickness in Beta-Thalassemia Major Patients Using Chelation Therapy
Sadık Etka Bayramoğlu, Gönül Aydogan, Mehmet Erdogan, Dilbade Yıldız Ekinci, Nihat Sayin
PMCID: PMC9794503  doi: 10.14744/bej.2022.62534  Pages 267 - 272
OBJECTIVES: This study aims to analyze the posterior segment of the eye in children with thalassemia major (TM) treated with chelation therapy.
METHODS: Forty-four patients diagnosed with TM and 44 age- and gender-matched participants without systemic diseases were included in this cross-sectional comparative study. A complete ophthalmologic examination, including visual acuity and fundus examination, was performed on all participants. The study and control groups’ optic coherence tomography (OCT) evaluation was performed with a spectral domain featured OCT device. Central macular thickness (CMT), macular volume, ganglion cell complex (GCC) thickness, retinal nerve fiber layer (RNFL) thickness, subfoveal choroidal thickness (CT), CT at 1 mm temporal to the fovea, CT at 1 mm nasal to the fovea, CT at the 1 mm temporal to the optic nerve head, and CT at the 1 mm nasal to the optic nerve head were compared between the study and control groups.
RESULTS: The mean ages for the study group and for the control group were 15.2±6.2 and 14.2±4.9 years, respectively. The mean subfoveal CT was 287.73±47.04 µm in the TM group and 312.66±39.95 µm in the control group (p=0.014). CT at the nasal to the fovea and temporal to the optic nerve head was thinner in the TM group than in the healthy group. The mean CMT, macular volume, GCC thickness, and RNFL thickness of the study and the control groups were similar. No significant difference was found between the patients with and without deferoxamine therapy concerning macular thickness, GCC thickness, and macular and peripapillary CT.
DISCUSSION AND CONCLUSION: Our results suggested that subfoveal, perifoveal, and peripapillary CTs were significantly thinner in children with TM than the control group. The use of deferoxamine did not cause a further reduction in CT.

4.Sensitivity and Specificity of the Optical Coherence Tomography Angiography for Detection of Neovascularization and Evaluation of Peripheral Ischemia in Diabetic Retinopathy
Sema Tamer Kaderli, Aylin Karalezli, Cansu Kaya, Şafak Korkmaz, Sabahattin Sul
PMCID: PMC9794513  doi: 10.14744/bej.2022.92668  Pages 273 - 281
OBJECTIVES: The purpose of this study was to identify the sensitivity and specificity of optical coherence tomography an-giography (OCTA) parameters for the presence of neovascularization elsewhere (NVE) and to investigate the relationship between ischemic areas.
METHODS: This study included 59 eyes with non-proliferative diabetic retinopathy (NPDR) and 36 eyes with proliferative diabetic retinopathy (PDR). The foveal avascular zone (FAZ), vessel density (VD) for the superficial and the deep capillary plexus (DCP), choriocapillaris flow area (CCP), and non-perfusion area (unit²) were recorded. The area under the curve (AUC) under the receiver operating characteristic curves, sensitivity and specificity were calculated for statistically signif-icant outcomes. Later, based on visual acuity, PDR group was subdivided into group 2A: PDR eyes with VA ≤0.2 logMAR and group 2B: PDR eyes with VA>0.2 logMAR. Non-perfusion area and OCTA features were compared between the subgroups.
RESULTS: The VD in DCP was significantly lower, FAZ and non-perfusion area were larger in PDR group (p=0.001, p<0.001, and p<0.001). The AUC for presence of NVE, for the VD, was 0.710 (p=0.012) with sensitivity and specificity of 64% and 65%, for the FAZ was 0.746 (p<0.001) with sensitivity and specificity of 72% and 72.7%. There was a sig-nificant positive correlation between the FAZ and non-perfusion area (For NPDR, p=0.025, for PDR p<0.001). There was a significant negative correlation between the VD in DCP and ischemic area in PDR group. (p<0.001) In group 2B, non-perfusion area and FAZ were larger than group 2A. The VD and CCP flow area were also lower in group 2B (All, p<0.05).
DISCUSSION AND CONCLUSION: In cases with decreased VD in DCP and increased FAZ, the probability of PDR increases. Despite the sensi-tivity and specificity of the OCTA indices for the prediction of NVE being moderate, the OCTA is very useful in evaluating the microvascular structure in DR.

5.The Effect of Pathological Retinal Changes on Retinal Capillary Circulation in Myopic Patients
Ali Mert Koçer, Yasin Şakir Göker, Furkan Emre Söğüt
PMCID: PMC9794508  doi: 10.14744/bej.2022.97759  Pages 282 - 290
OBJECTIVES: Myopia is a common ocular disorder worldwide, leading to degenerative changes in the retina which is highly susceptible to vascular impairment. The aim of the study was to investigate the effects of pathological retinal changes on the retinal capillary structures using optical coherence tomography angiography (OCTA) in myopic patients.
METHODS: Thirty-two patients with high myopia (HM), 29 patients with pathological myopia (PM), and 38 healthy subjects with emmetropia (EM) were enrolled in this study. OCTA was performed to measure the following parameters: Foveal avascular zone (FAZ) area; FAZ perimeter; FAZ acircularity index (AI); and superficial, deep, and radial peripapillary capil-lary (RPC) vessel densities. Axial length (AL), spherical equivalent, and anterior chamber depth were evaluated.
RESULTS: Significant differences in the mean AL values were observed between the EM group and the other groups (p<0.001 for all); however, no significant differences were observed between the HM and PM groups (p=0.135). Significant differences in FAZ parameters, except for AI, were found among the three groups (p<0.05 for all). In all regions, except for the fovea and inside disc, the capillary plexus vessel densities were significantly lower in the PM group than in the other groups and were lower in the HM group than in the EM group (p<0.05 for all).
DISCUSSION AND CONCLUSION: Significant differences identified in capillary densities between the HM and PM groups, both of which present similar AL measurements, suggest that pathological retinal findings have significant effects on retinal perfusion independent of the effect of AL.

6.Peripapillary Choroidal Vasculature in Pediatric Eyes with Type 1 Diabetes Mellitus
Murat Hasanreisoğlu, Cem Kesim, Nur Sena Uzunay, Ayse Yildiz Tas, Melisa Zisan Karslioglu, Afsun Sahin
PMCID: PMC9794507  doi: 10.14744/bej.2022.24471  Pages 291 - 297
OBJECTIVES: Choroidal vasculature change in children with diabetes mellitus is not investigated enough although it could reflect clinical outcome.
METHODS: Pediatric Type 1 diabetes mellitus (T1DM) patients and healthy controls were retrospectively evaluated. Peri-papillary retinal nerve fiber layer optical coherence tomography (OCT) images of the right eyes were analyzed. Choroidal parameters including total choroidal area, luminal area, stromal area, and choroidal vascularity index were measured through image binarization.
RESULTS: Twenty eyes of 20 patients were compared with 46 eyes of 46 healthy controls. Mean total choroidal area, luminal area, and stromal area were 1.59±0.35, 1.10±0.24, and 0.50±0.13 mm2 in patients’ eyes and 1.52±0.49, 1.05±0.34, and 0.47±0.17 mm2 in healthy eyes. No difference was found in choroidal vascularity indices between patients and healthy eyes (68.8±3.9% vs. 69.4±4.4%, p=0.521). Temporal choroidal vascularity index was significantly higher than its nasal counterpart in healthy eyes (71.8±5.0% vs. 68.6±4.9%, p<0.001) which was not significant in patients’ eyes (70.7±4.0% vs. 68.9±5.1%, p=0.067). Temporal quadrant had the highest choroidal vascularity index score among all quadrants in healthy controls (all p<0.05), whereas no choroidal vascularity index difference between quadrants was detected in patients (p=0.75).
DISCUSSION AND CONCLUSION: Peripapillary choroidal vasculature has shown subtle sectoral changes which did not reflect the overall peri-papillary OCT section in pediatric T1DM patients when compared with healthy controls.

7.Intraocular Pressure Elevation After Posterior Subtenon Triamcinolone Acetonide Injection in Pediatric Non-Infectious Uveitis
Kubra Ozdemir Yalcinsoy, Pinar Cakar Ozdal, Emine Sen, Ufuk Elgin
PMCID: PMC9794505  doi: 10.14744/bej.2022.97752  Pages 298 - 303
OBJECTIVES: The objectives of the study were to evaluate non-infectious pediatric uveitis patients developing elevated intraocular pressure (IOP) and glaucoma following posterior subtenon triamcinolone acetonide (PSTA) injection.
METHODS: The data of 26 pediatric (<18 years) patients with active uveitis were retrospectively evaluated. Exclusion cri-teria were patients with a previous IOP >21 mmHg and previous subtenon or intraocular steroid injection. The IOP values of the patients before and after the PSTA injection and the treatments administered were recorded.
RESULTS: PSTA injection was used in a total of 40 eyes. The mean IOP was 14.0±2.3 (12–19) mmHg before PSTA. The IOP was elevated (≥21 mmHg) in 19 eyes (48%) after PSTA with a mean IOP of 32.9±11.7 mmHg (22–55). The mean interval time to IOP elevation was 3.3±1.9 weeks (1–8). The IOP was controlled in 15 eyes (79%) with topical anti-glaucomatous and these patients were considered as having transient IOP elevation. Trabeculectomy with mitomycin C was required in 4 eyes (21%) in whom the IOP could not be controlled despite the use of maximum topical medication and oral aceta-zolamide at a mean duration of 9.7±3.6 months (4–19). Subtenon deposit excision was performed in 2 eyes (11%). The mean IOP at the last follow-up was 16.0±2.4 mmHg (12–20).
DISCUSSION AND CONCLUSION: In our study, an IOP elevation rate as high as 47% was found in pediatric non-infectious uveitis patients following only a single PSTA injection. Steroid-induced IOP elevation and resistant glaucoma can develop even after the first PSTA administration in pediatric uveitis. Filtration surgery and the excision of subtenon triamcinolone deposits, when present, are important in glaucoma management. The risk/benefit ratio must be carefully considered when administering steroid injections to children with uveitis.

8.Neuro-Ophthalmic Manifestations of Intracranial Space Occupying Lesions in Adults
Sarang Gotecha, Megha Kotecha, Prashant Punia, Ashish Chugh, Vridhi Shetty
PMCID: PMC9794506  doi: 10.14744/bej.2022.50469  Pages 304 - 312
OBJECTIVES: The purpose of this study is to evaluate the epidemiology, neuro-ophthalmic, and clinical characteristics of intracranial space occupying lesions (ICSOLs) in adult patients.
METHODS: All patients above 16 years presenting with brain tumors confirmed by magnetic resonance imaging and treated surgically in our institute were included in this study. Epidemiology of the patients along with neurological and ophthalmic manifestation was evaluated.
RESULTS: A total of 252 patients were included in the study ranging from 18 years to 79 years. Supratentorial location was more common than infratentorial location. The most common neurological symptom in our study was headache followed by seizures. Ophthalmic manifestations were present in (73.4%) of patients. The most common visual symptoms and signs were visual loss, strabismus, papilledema, and visual field defects. The most common histopathological diagnosis seen in our study was meningiomas followed by high-grade gliomas.
DISCUSSION AND CONCLUSION: Ocular signs and symptoms can be considered as a window to the brain through which ICSOLs can be detected. The most common neurological manifestation of ICSOL in our study was headache with or without true localizing signs and symptoms. More frequently, these patients present to an ophthalmologist before a neurosurgeon with related ocular manifestations. Hence, through our study, we emphasize the importance of a detailed ophthalmological examina-tion in these patients which can aid in early diagnosis and prompt management of such lesions.

9.Tarsorrhaphy with Sutureless Amnion Transplantation: Practical Management of Ocular Surface Pathologies
Altan Atakan Ozcan, Burak Ulas, Emine Ciloglu
PMCID: PMC9794511  doi: 10.14744/bej.2022.10327  Pages 313 - 319
OBJECTIVES: The objective of the study was to evaluate the technique of tarsorrhaphy combined with sutureless amniotic membrane transplantation in the treatment of resistant ocular surface pathologies.
METHODS: In this study, the post-operative results of patients who underwent tarsorrhaphy combined with sutureless amniotic membrane between May 2016 and July 2021 were evaluated. In this technique, we have placed the amniotic membrane on the ocular surface, and then simple tarsorrhaphy has been performed. We used this technique in our six patients during COVID-19 pandemic period at the bedside. The outcomes of corneal epithelial healing, visual acuity, pain score, patient tolerance, and adverse events were evaluated.
RESULTS: Fourteen patients (eight females and six males) were included in the study. The mean age of the patients was 65.7 years (range 9–96 years). The mean follow-up period was 9 months (range 6–12 months). In all cases, epithelial defect healed completely and it was seen that this new technique facilitated resolution of pain and inflammation and promoted epithelialization in our 14 cases with resistant ocular surface pathologies. Post-operative pain score was significantly lower than pre-operative pain score (p<0.05).
DISCUSSION AND CONCLUSION: Our results demonstrate that tarsorrhaphy with sutureless amniotic membrane accelerates the ocular surface healing process and increases the efficiency of amniotic membrane. This method has an important advantage that it can be performed at bedside. Patients and ophthalmologists need such an innovative treatment which is effortless, effective, and practical especially for the pandemic period.

10.A Rare Cause of Preseptal Cellulitis: Cutaneous Leishmaniasis
Hazal Bircan, Nilay Yüksel
PMCID: PMC9794504  doi: 10.14744/bej.2022.32650  Pages 320 - 323
Cutaneous leishmaniasis (CL) is a protozoal disease that occurs in many parts of the world, usually caused by Leishmaniasis major and Leishmaniasis tropica and transmitted by sandfly bites. Eyelid involvement is rarely seen as the movement of the eyelids prevents the fly vector from biting the skin in this area. We report a case of cutaneous leishmaniasis with eyelid involvement causing preseptal cellulitis in a 71-year-old male patient.

11.Treatment of Intravitreal Ranibizumab Resistant Radiation Retinopathy with Intravitreal Dexamethasone Implant: A Case Report
Mehmet Cem Sabaner, Mustafa Dogan
PMCID: PMC9794502  doi: 10.14744/bej.2022.72602  Pages 324 - 328
A 43-year-old female patient presented with complaints of decreased vision in both eyes. Her medical history revealed the diagnosis of metastatic breast cancer. She was treated with chemotherapy, and whole-brain, manubrium sterni, and right chest wall radiation therapy. Best-corrected visual acuity (BCVA) was 20/200 and 20/160 in the right and left eye, respectively. Optical coherence tomography (OCT) confirmed the presence of cystoid macular edema (CME). OCT angiography confirmed the presence of microaneurysms, ischemia, and capillary drop-out on the macula. Fundus fluorescein angiography revealed multiple microaneurysms with surrounding ischemia and leakage. Based on these findings and medical history, a diagnosis of radiation maculopathy was considered. The patient was administered intravitreal four doses of ranibizumab injections. Laser photocoagulation was performed on the ischemic areas of the retina in both eyes. Despite the follow-up and treatment, the presence of residual CME and BCVA 20/200 in both eyes was determined; it was decided to change the treatment regimen to an intravitreal dexamethasone implant. One month after injection, BCVA was 20/80 in both eyes, and normal foveal contour and no edema as confirmed on OCT. The DEX implant showed a promising result and should be kept in mind in the treatment of radiation retinopathy.

12.Multimodal Imaging Characteristics of Circumscribed Choroidal Hemangioma Accompanying with Central Serous Chorioretinopathy: A Case Report
Irmak Karaca, Suzan Guven Yılmaz, Jale Menteş, Gueorgui Markov, Samuray Tuncer
PMCID: PMC9794509  doi: 10.14744/bej.2022.47113  Pages 329 - 333
A 42-year-old man presented with a temporal visual field defect in his right eye. His history revealed systemic steroid use before onset of his complaints. Multimodal imaging techniques including ultrasonography, fluorescein angiography, indocyanine green angiography, and optical coherence tomography angiography (OCTA) suggested the presence of circumscribed choroidal hemangioma (CCH) accompanying with central serous chorioretinopathy (CSCR) in the right eye, which might have worsened with systemic steroid treatment. CCH may rarely present with accompanying CSCR. Besides, OCTA is a non-invasive reliable method for the diagnosis of CCH in terms of visualizing vascular features of tumor.

13.Bilateral Hypertensive Papillopathy with Diffuse Retinal Telangiectasis
Utku Limon, Betül İlkay Sezgin Akçay
PMCID: PMC9794510  doi: 10.14744/bej.2022.71676  Pages 334 - 338
A 16-year-old type 1 diabetic female patient was consulted to our clinic for acute bilateral painless vision loss with a 2-week history in the right eye and a 1-week history in the left eye. At the initial visit, the best-corrected visual acuity was 0.2 in the right eye and 0.05 in the left eye. In fundus examination, both optic disks were pale and slightly swollen. In both eyes, superficial telangiectatic vessels were extending from the optic disk to the retina. Telangiectatic vessels disappeared within 10 days with systemic hypertension regulation and without any ocular treatment.

14.Reviewer List

PMCID: PMC9794512  Page 339
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