ISSN: 2459 - 1777 | E-ISSN 2587-0394
Volume : 8 Issue : 1 Year : 2023
Beyoglu Eye Journal - Beyoglu Eye J: 8 (1)
Volume: 8  Issue: 1 - 2023
1.Factors Influencing Stereopsis Outcomes in Adults Following Strabismus Surgery
Bengi Demirayak, Aslı Vural, Fatih Guven, Selin Şimşek Alkan, Ismail Umut Onur
PMCID: PMC9993413  doi: 10.14744/bej.2023.33154  Pages 1 - 4
OBJECTIVES: The aim of the study was to evaluate binocular vision after adult strabismus surgery and to investigate the predictive factors on improvement stereoacuity.
METHODS: Patients aged upper from 16 years who underwent strabismus surgery in our hospital reviewed retrospec-tively. Age, existence of amblyopia, pre-operative and postoperatively fusion ability, stereoacuity, and deviation angle were recorded. Patients were divided into two groups according to final stereoacuity; 200 sn/arc and lower: Good stereopsis (Group 1), upper 200 sn/arc: Poor stereopsis (Group 2). Characteristics were compared between groups.
RESULTS: A total of 49 patients, who were 16–56 years of age, were included in the study. The mean follow-up time was 37.8 months (range 12–72 months). Of patients, 26 had improvement in stereopsis scores after surgery (53.0%). Group 1 includes 200 sn/arc and lower (n=18, 36.7%) and Group 2 includes higher than 200 sn/arc (n=31, 63.3%). The presence of amblyopia and higher refraction error was frequent significantly in Group 2 (p=0.01 and p=0.02, respectively). The existence of fusion postoperatively was significantly frequent in Group 1 (p=0.02). Type of strabismus and the amount of deviation angle were not found in a relationship with good stereopsis.
DISCUSSION AND CONCLUSION: In adults, surgical correction of horizontal deviation improves stereoacuity. Having no amblyopia, having fusion after surgery, and low refraction error are predictive for the improvement in stereoacuity.

2.Evaluation of Eyelid, Angle, and Anterior Segment Parameters Using Scheimpflug Camera and Topography System in Obstructive Sleep Apnea Syndrome
İrem Işık, Serpil Yazgan, Fatma Erboy, Mustafa Doğan
PMCID: PMC9993417  doi: 10.14744/bej.2022.94899  Pages 5 - 13
OBJECTIVES: The purpose of the study was to investigate the eyelid hyperlaxity, anterior segment, and corneal topographic parameters in patients with obstructive sleep apnea syndrome (OSAS) using Scheimpflug camera and topography system.
METHODS: In this prospective and cross-sectional clinical study, 32 eyes of 32 patients with OSAS and thirty-two eyes of 32 healthy subjects were evaluated. The participants with OSAS were selected from those with an apnea-hypopnea index ≥ 15. The minimum corneal thickness (ThkMin), apical corneal thickness (ACT), central corneal thickness (CCT), pupillary diameter (PD), aqueous depth (AD), aqueous volume (AV), anterior chamber angle (ACA), horizontal anterior chamber diameter (HACD), corneal volume (CV), simulated K readings (sim-K), front and back corneal keratometric values at 3 mm, RMS/A values, highest point of ectasia on the anterior and posterior corneal surface (KVf, KVb), symmetry indices and keratoconus measurements were taken by combined Scheimpflug-Placido corneal topography and compared with healthy subjects. Upper eyelid hyperlaxity (UEH) and floppy eyelid syndrome were also evaluated.
RESULTS: There were no statistically significant difference between groups in terms of age, gender, PD, ACT, CV, HACD, simK readings, front and back keratometric values, RMS/A-KVf and KVb values, symmetry indices, and keratoconus mea-surements (p>0.05). ThkMin, CCT, AD, AV, and ACA values were significantly higher in OSAS group compared to the control (p<0.05). UEH was detected in two cases in the control group (6.3%) and in 13 cases in the OSAS group (40.6%) and the difference was significant (p<0.001).
DISCUSSION AND CONCLUSION: The anterior chamber depth, ACA, AV, CCT, and UEH increase in OSAS. These ocular morphological changes occurring in OSAS may explain why these patients prones to normotensive glaucoma.

3.Long-Term Clinical Results of Trabectome Surgery in Turkish Patients with Primary Open Angle Glaucoma and Pseudoexfoliative Glaucoma
Yasemin Ün, Cihan Büyükavşar, Doğukan Cömerter, Murat Sönmez, Yıldıray Yıldırım
PMCID: PMC9993416  doi: 10.14744/bej.2023.13540  Pages 14 - 20
OBJECTIVES: The objectives of the study were to analyze the long-term results of trabectome surgery in Turkish patients with primary open angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG) and to characterize the risk factors for failure.
METHODS: This single-center retrospective non-comparative study included 60 eyes of 51 patients diagnosed with POAG and PEXG, who underwent trabectome alone or phacotrabeculectomy (TP) surgery between 2012 and 2016. Surgical suc-cess was defined as a 20% decrease in intraocular pressure (IOP) or IOP≤21 mmHg and no further glaucoma surgery. Risk factors for further surgery were analyzed with the Cox proportional hazard ratio (HR) models. The cumulative success analysis was undertaken with the Kaplan–Meier method based on the time to further glaucoma surgery.
RESULTS: The mean follow-up period was 59.4±14.3 months. During the follow-up period, 12 eyes required additional glaucoma surgery. The mean pre-operative IOP was 26.9±6.8 mmHg. The mean IOP at the last visit was 18.8±4.7 mmHg (p<0.01). IOP decreased 30.1% from the baseline to the last visit. The average number of antiglaucomatous drug mole-cules used was 3.4±0.7 (range 1–4) preoperatively and 2.5±1.3 (range 0–4) at the last visit (p<0.01). The risk factors for further surgery requirement were determined as a higher baseline IOP value (HR: 1.11, p=0.03] and the use of a higher number of preoperative antiglaucomatous drug molecules (HR: 2.54, p=0.09). The cumulative probability of success was calculated as 94.6%, 90.1%, 85.7%, 82.1%, and 78.6% at three, 12, 24, 36, and 60 months, respectively.
DISCUSSION AND CONCLUSION: The success rate of trabectome was 67.3% at 59 months. A higher baseline IOP value and the use of a higher number of antiglaucomatous drug molecules were associated with an increased risk of further glaucoma surgery requirement.

4.Comparison of Intravitreal Dexamethasone Implant and Intravitreal Ranibizumab Efficacy in Younger Patients with Branch Retinal Vein Occlusion
Seda Gürakar Özçift, Erdinc Aydin, Emine Deniz Egrilmez, Feray Koc, Erdem Eriş
PMCID: PMC9993420  doi: 10.14744/bej.2023.42243  Pages 21 - 25
OBJECTIVES: This study aimed to compare the effects of dexamethasone (DEX) implants and ranibizumab (RAN) injec-tions in younger patients with macular edema due to branch retinal vein occlusion (RVO) in a 6-month follow-up.
METHODS: The treatment-naive patients with macular edema secondary to branch RVO were included retrospectively. Med-ical records of patients who were treated with intravitreal RAN or DEX implant were evaluated before and at the 1st, 3rd, and 6th months after the injection. Primary outcome measures were the change in best-corrected visual acuity (BCVA) and central retinal thickness. The level of statistical significance was set at 0.05/3=0.016, according to the Bonferroni correction.
RESULTS: Thirty-nine eyes of 39 patients were included in the study. The mean age of the study population was 53.82±5.08 years. Median BCVA in the DEX group (n=23) at baseline, 1st, 3rd, and 6th month was 1.1, 0.80 (p=0.002), 0.70 (p=0.003), and 1 (p=0.018) logarithm of the minimum angle of resolution (log-MAR), respectively (p<0.05). Median BCVA in the RAN group (n=16) at baseline, 1st, 3rd, and 6th months was 0.90, 0.61, 0.52, and 0.46 logMAR, respectively (p<0.016 for all comparisons). Median central macular thickness (CMT) in the DEX group at baseline, 1st, 3rd, and 6th months was 515, 260, 248, and 367 μm, respectively (p<0.016 for all comparisons). Median CMT in the RAN group at baseline, 1st, 3rd, and 6th months was 432.5 (p<0.016), 275 (p<0.016), 246 (p<0.016), and 338 (p=0.148) μm.
DISCUSSION AND CONCLUSION: There is no significant difference in treatment efficacies in both visual and anatomical outcomes at the end of the 6th month. However, RAN can be considered the first choice in younger patients with macular edema secondary to branch RVO because of the lower side effect profile.

5.Aqueous Flare and Intraocular Pressure in the Early Period Following Panretinal Photocoagulation in Patient with Proliferative Diabetic Retinopathy
Burcu Kemer Atik, Cigdem Altan, Seren Pehlivanoglu, Sibel Ahmet
PMCID: PMC9993421  doi: 10.14744/bej.2022.13471  Pages 26 - 31
OBJECTIVES: The aim of the study was to investigate the effect of panretinal photocoagulation (PRP) on aqueous flare and intraocular pressure (IOP) in the early period.
METHODS: Eighty-eight eyes of 44 patients were included in the study. The patients underwent a full ophthalmologic ex-amination including the best corrected visual acuity, IOP measured by Goldmann applanation tonometry, biomicroscopy, and dilated fundus examination before PRP. Aqueous flare values were measured by the laser flare meter. Aqueous flare and IOP values were repeated in both eyes at the 1st and 24th h after PRP. The eyes of the patients who underwent PRP were included in the study as the study group, and the other eyes as the control group.
RESULTS: In eyes treated with PRP, 1st h (19.44 pc/ms) and 24th h (18.53 pc/ms) aqueous flare values were statistically higher than before PRP (16.66 pc/ms) (p<0.05). In the study eyes which were similar to the control eyes before PRP, the aqueous flare was higher at the 1st and 24th h after PRP compared to control eyes (p<0.05). The mean IOP at the 1st h (18.69 mmHg) after PRP in study eyes was higher than both pre-PRP (16.25 mmHg) and post-PRP 24th h (16.12 mmHg) IOP values (p<0.001). At the same time, the IOP value at the 1st h after PRP was higher than the control eyes (p=0.001). No correlation was observed between aqueous flare and IOP values.
DISCUSSION AND CONCLUSION: An increase in aqueous flare and IOP values was observed after PRP. Besides, the increase in both values starts even in the 1st h, and the values at 1st h are the highest values. At the 24th h, while IOP values return to baseline, aqueous flare values are still high. In patients who may develop severe intraocular inflammation or cannot tolerate increased IOP (such as previous uveitis, neovascular glaucoma, or severe glaucoma), control should be performed at the 1st h after PRP to prevent irreversible complications. Furthermore, the progression that may develop in diabetic retinopathy due to increased inflammation should also be kept in mind.

6.Evaluation of Choroidal Vascular Structure in Hyperopic Anisometropic Amblyopia
Burak Ören, Hasan Kızıltoprak, Ferhat Önder, Dilara Özkoyuncu Kocabaş, Esat Yetkin, Abdurrahman Bilen
PMCID: PMC9993412  doi: 10.14744/bej.2022.27870  Pages 32 - 37
OBJECTIVES: The aim of the study was to investigate the choroidal structure of patients with anisohypermetropic amblyopia compared to that of healthy eyes in controls of the same age.
METHODS: The study comprises three groups: One group was the amblyopic eyes of patients with anisometropic hyper-metropia (AE group), another group was the fellow eyes of patients with anisometropic hypermetropia (FE group), and a final group of healthy controls. Both the choroidal thickness (CT) and choroidal vascularity index (CVI) values were obtained using the spectral-domain optical coherence tomography (OCT) method of improved depth imaging (EDI-OCT; Heidelberg Engineering GmbH, Spectralis, Germany, Heidelberg).
RESULTS: This study included 28 anisometropic amblyopic patients (AE and FE groups) and 35 healthy controls. Regarding the distribution of ages and sexes (p=0.813 and p=0.745), the groups were the same. The mean best-corrected visual acuity in AE, FE, and the control group was 0.58±0.76, 0.008±1.30, and 0.004±1.20 logMAR units, respectively. There was a significant difference in terms of CVI, luminal area (LA), and all the CT values between groups. Post hoc univariate analyses indicated that CVI and LA were significantly higher in AE compared to FE and the control group (p<0.05, for each). The temporal, nasal, and subfoveal CT values were considerably higher in AE compared to FE and the control groups (p<0.05, for each). However, there was no difference between FE and the control group (p>0.05, for each).
DISCUSSION AND CONCLUSION: The AE group had larger LA, CVI, and CT values compared to the FE and control groups. These results show that choroidal changes in amblyopic eyes in children are permanent in adulthood if untreated and are involved in the pathogenesis of amblyopia.

7.Assessment of Choroidal Vascularity in Inactive Thyroid Associated Orbitopathy
Seren Pehlivanoğlu, Funda Ebru Aksoy, Gamze Ozturk Karabulut, Uğur Tunç, Korhan Fazıl, Ozgur Artunay, Muhittin Taşkapılı
PMCID: PMC9993418  doi: 10.14744/bej.2022.04900  Pages 38 - 44
OBJECTIVES: The objectives of the study were to evaluate the vascular and stromal structure of the choroid in patients with inactive thyroid associated orbitopathy (TAO) by measuring choroidal vascularity index (CVI) and choroidal thickness (CT) using enhanced depth imaging (EDI) optical coherence tomography (OCT).
METHODS: The choroidal image was taken with EDI mode spectral domain (SD)-OCT. All scans were taken between 9.30 am and 11.30 am to avoid the diurnal variation of CT and CVI. To calculate CVI, macular SD-OCT scans were binarized using the publicly available software ImageJ and luminal area and total choroidal area (TCA) were measured. CVI was calculated as the proportion of LA to TCA. Furthermore, the relation between CVI and axial length, gender, and age was evaluated.
RESULTS: This study included 78 individuals with a mean age of 51.4±7.3 years. Group 1 consisted of 44 patients with inactive stage TAO, and Group 2 consisted of 34 healthy controls. Subfoveal CT was 338.92±73.93 µm in Group 1 and 303.97±40.35 µm in Group 2 (p=0.174). The CVI significantly differed between the two groups, which was higher in group 1 (p=0.000).
DISCUSSION AND CONCLUSION: Although CT was not different between groups, CVI which is the indicator of the vascular status of the choroid, was higher in patients with TAO in the inactive stage compared with healthy control subjects.

8.Overview of Epiphora Referred to Oculoplastic Surgery Clinic in Adults
Kübra Serbest Ceylanoğlu, Atakan Acar, Emine Şen
PMCID: PMC9993415  doi: 10.14744/bej.2023.38980  Pages 45 - 49
OBJECTIVES: The aim of the study was to evaluate etiological and demographic characteristics of the adult patients re-ferred to the oculoplastic surgery clinic of the tertiary care center with the complaint of epiphora.
METHODS: The medical records of the patients who applied to the oculoplastic surgery clinic with a complaint of epiphora between January 2014 and July 2021 were reviewed retrospectively. Etiology of epiphora, age, gender, duration of symp-tom, and follow-up period were evaluated. According to the etiological factors, nasolacrimal system disorders such as punctal stenosis, canalicular stenosis, canaliculitis, and acquired nasolacrimal system obstruction, respectively; the causes of epiphora were grouped as eyelid abnormalities such as entropion and ectropion, and hypersecretory tear secretion due to causes such as dry eye, allergy, and inflammation. The patients with epiphora over the age of 18 with at least 6 months of follow-up were included in the study. Patients with congenital or tumor-related nasolacrimal duct obstruction (NLDO) and epiphora due to trauma-related eyelid or canaliculi injury were not included.
RESULTS: A total of 595 medical fields were evaluated. Epiphora was present in 747 eyes of 595 patients. Of the patients, 221 (37%) were male and 376 (63%) were female. According to etiological evaluation of frequency, 372 (62.5%, 432 eyes) patients with NLDO, 63 (10.5%, 123 eyes) patients with punctal stenosis, 44 (7.3%) patients with ectropion, 38 (6.3%) patients with entropion, 37 (6.2%, 69 eyes) patients hypersecretory causes (dry eye, allergy, inflammation, etc.), 24 (4%) patients had primary canaliculitis, and 17 (2.8%) patients had epiphora due to canalicular occlusion.
DISCUSSION AND CONCLUSION: Epiphora is an important complaint that may occur due to different etiologies. A detailed examination of the anterior segment, lacrimal system and eyelids, and taking a history are the most important steps in the management of the patient.

9.The Prevalence of Positive Donor Corneoscleral Rim Culture and its Association with Ocular Infection After Transplantation
Ruveyde Bolac, Ece Turan Vural, Elvin Yildiz, Gizem Kaya, Sebahat Aksaray
PMCID: PMC9993419  doi: 10.14744/bej.2023.08931  Pages 50 - 54
OBJECTIVES: The aim of the study was to determine the prevalence of positive corneoscleral donor rim cultures and to report keratitis and endophthalmitis after keratoplasty.
METHODS: Eye bank records and medical records of patients who underwent keratoplasty between September 1, 2015, and December 31, 2019, were retrospectively reviewed. Patients who had routine donor-rim culture taken during surgery and followed up for at least 1 year in the post-operative period were included in the study.
RESULTS: A total of 826 keratoplasty procedures were performed. A total of 120 (14.5%) cases had a positive donor cor-neoscleral rim culture. Positive bacterial cultures were obtained from 108 (13.7%) of the donors. Bacterial keratitis was observed in one patient (0.83% of recipients) who had a positive bacterial culture. Positive fungal cultures were obtained from 12 (1.45%) donors, of whom one (8.33% of recipients) developed fungal keratitis. Endophthalmitis was observed in one patient whose culture result was negative. Both bacterial and fungal culture results were similar in penetrating and lamellar surgical procedures.
DISCUSSION AND CONCLUSION: Although the donor corneoscleral rims have a high positive culture result, the rate of bacterial keratitis and endophthalmitis is low, the risk of infection is high in patients with a fungal positive donor rim. Closer follow-up of patients with fungal positive donor corneo-scleral rim result and initiation of aggressive antifungal treatment when infection occurs will be beneficial.

10.Amniotic Membrane Transplantation for Macular Hole Closure
Feyza Çalış Karanfil, Yasin Toklu, Mücella Arıkan Yorgun
PMCID: PMC9993414  doi: 10.14744/bej.2023.09327  Pages 55 - 59
An idiopathic macular hole is an anatomic defect of the neurosensory retina that develops in the fovea. In this report, we present three macular hole cases that are refractory standard macular hole surgery and treated with AM transplantation (AMT). We reached anatomical success in all three cases without any complications or adverse effects. AMT is effective in achieving satisfactory hole closure for cases that are refractory standard surgery.

11.Wilson Disease Combined with Keratoconus: A Case Report
Adem Tellioğlu, Derya Özkan, Burcin Kepez Yildiz
PMCID: PMC9993411  doi: 10.14744/bej.2022.87487  Pages 60 - 63
A case of Wilson disease (WD) combined with keratoconus (KC) is described. A 30-year-old male diagnosed with WD presented to Ophthalmology Department due to progressive bilateral vision loss. Biomicroscopy revealed copper depo-sitional ring and mild central corneal ectasia in both eyes. The patient had essential tremors and mild speech disturbance. The keratometric values were K1 = 45.94 diopters (D), K2 = 49.10 D in the right eye, and K1 = 47.14 D, K2 = 51.22 D in the left eye. The maximal elevation points on the posterior elevation maps were 98 mm for the right eye and 94 mm for the left eye. The typical KC pattern was seen on corneal topography bilaterally. Based on these findings, the patient was diagnosed with KC, and corneal cross-linking treatment was recommended. WD rarely occurs in combination with KC, and only two cases have been reported; this is the third case of WD combined with KC so far.

12.Delayed Primary Reposition in a Patient with Traumatic Globe Avulsion: A Case Report
Fatma Savur, Yusuf Yıldırım
PMCID: PMC9993409  doi: 10.14744/bej.2022.27247  Pages 64 - 68
Globe avulsion is an extremely rare and difficult to manage emergency after trauma. Especially in cases of post-traumatic globe avulsion, management and treatment depend on the condition of the globe and the surgeon’s judgment. It can be done in primary reposition as well as enucleation in treatment. Recently published cases show that surgeons prefer primary reposition to reduce the psychological stress that may occur in these patients and to achieve better cosmetic results. We report the treatment and follow-up results of a patient whose globe avulsion was repositioned on the 5th post-traumatic day.

13.Central Toxic Keratopathy Following Corneal Collagen Cross-Linking
Mustafa Kayabaşı, Canan Aslı Utine
PMCID: PMC9993410  doi: 10.14744/bej.2023.38243  Pages 69 - 72
Abstract |Full Text PDF

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