ISSN: 2459-1777 | E-ISSN 2587-0394
Volume : 8 Issue : 3 Year : 2023
Beyoglu Eye Journal - Beyoglu Eye J: 8 (3)
Volume: 8  Issue: 3 - 2023
1.Pupillographic Analysis of COVID-19 Patients: Early and Late Results After Recovery
Gamze Ucan Gunduz, Aysegul Mavi Yildiz, Ozgur Yalcinbayir, Mehmet Baykara, Esin Sogutlu Sari, Sevde Isleker, Nilufer Aylin Acet Ozturk
PMCID: PMC10521134  doi: 10.14744/bej.2023.30592  Pages 149 - 156
OBJECTIVES: We aimed to investigate the short- and long-term static and dynamic pupillary responses of patients recov-ered from coronavirus disease-19 (COVID-19) using quantitative infrared pupillography.
METHODS: This study included patients who recovered from COVID-19 (Group 1) and age- and gender-matched controls (Group 2). A detailed ophthalmic examination was performed at 1 month and 6 months after the diagnosis of COVID-19. Photopic, mesopic, and scotopic pupil diameters (PDs) were measured using a quantitative infrared pupillography which was integrated into Scheimpflug/Placido photography-based topography system. PDs at 0, 2nd, 4th, and 6th seconds, and average pupil dilation speeds at 2nd, 4th, 6th, and 8th seconds were recorded.
RESULTS: Eighty-six eyes of 86 patients (Group 1: n=42; Group 2: n=44) were included. While the mean photopic, mesopic, and scotopic PDs were significantly larger in the COVID-19 group than the control group in the 1st month (p=0.035, p=0.017, p=0.018, respectively), no statistically significant difference was found in the 6th month. Besides, average pupil dilation speeds and PDs at the 0, 2nd, 4th, and 6th seconds were not statistically significantly different between the two groups in the 1st month and 6th month.
DISCUSSION AND CONCLUSION: PDs were significantly larger in COVID-19 patients in all light intensities in the 1st month after COVID-19. However, pupillary dilation was transient, and no significant difference was found in the 6th month. We suggest that the transient pupillary dilation may be secondary to the autonomic nervous system dysfunction and/or optic nerve and visual pathways alterations following COVID-19.

2.Could Corneal Densitometry be a Progression Criterion for Subclinical Keratoconus?
Hasan Kızıltoprak, Kemal Tekin, Halil Ibrahim Atesoglu, Dilara Özkoyuncu Kocabaş, Mustafa Koç, Mustafa Ilker Toker
PMCID: PMC10521129  doi: 10.14744/bej.2023.85688  Pages 157 - 165
OBJECTIVES: The objective of this study is to investigate the changes in topometry, tomography, and corneal densitometry in subclinical keratoconus (SK) at the 6-month interval.
METHODS: The clinical keratoconus and SK groups included 25 eyes; the control group included 22 eyes from 22 patients. Corneal topographic, tomographic, topometric, and densitometric values obtained using the Pentacam HR imaging system were analyzed.
RESULTS: Posterior elevation (PE), Keratoconus index (KI), index of height asymmetry (IHA), index of height decentration (IHD), Dp, Da, Final D, maximum pachymetric progression index (PPImax), and maximum Ambrósio relational thickness parameters showed significant changes between the baseline and the 6th-month follow-up in SK group (p<0.05 for all values). There were significant changes in all zones except a central layer of 6–10 zone, anterior, and central layer of 10–12 zone between the baseline and the 6th-month follow-up in the SK group (p<0.05, for all values). The changes in mean±s-tandard deviation of KI, IHA, IHD, PPImax parameters, and corneal densitometry values of the posterior layer of 0–2 mm and 2–6 mm zones were significant in the SK group compared to the controls (p<0.05, for all values).
DISCUSSION AND CONCLUSION: PE, KI, IHA, IHD, and PPImax parameters as well as increasing corneal light backscatter of the posterior central layer might be useful for follow-up of progression of SK. New multimeric parameters created by combinations of topometric, tomographic, and corneal densitometry parameters could be the future of SK follow-up.

3.The Effect of Photochromic Contact Lenses on Pupil Size
Aysun Sanal Dogan, Beyhan Gol Ozcan, Osman Çelikay, Zuhal Yıldız, Alperen Bahar
PMCID: PMC10521127  doi: 10.14744/bej.2023.56688  Pages 166 - 169
OBJECTIVES: Photochromic contact lenses (PCL) are designed to increase the comfort of patients, in bright light condi-tions. The aim of the study was to evaluate the effect of PCL on pupil size.
METHODS: The study was conducted with 30 patients who were admitted to the contact lens department. Automated pupilography images of the right eyes of patients were obtained without contact lenses (group 1) in scotopic (S: 0.4 lux), mesopic (M: 4.0 lux), and photopic (p=40 lux) conditions. The procedures were repeated with silicone hydrogel contact lenses (Group 2) and with silicon hydrogel PCL (group 3).
RESULTS: Mean age was 23.87±3.27 (17–30) years and male/female ratio was 10/20. The mean spheric equivalent of their right eyes was −3.60±1.73 (−0.50–−7.50). Pupil diameters of Group 3, under scotopic conditions, were larger than Group 1 and 2 (p=0.001, p=0.044). There was no difference between groups under mesotopic and photopic conditions. Pupil diameters at the different illumination levels were similar regarding gender.
DISCUSSION AND CONCLUSION: Similarity in mesotopic and photopic pupil sizes compared to all groups may be a result of insignificant pupil changes of photochromic lenses in indoor conditions or insufficient time for lens activation.

4.Agreement among Goldmann Applanation Tonometer, Easyton Transpalpebral Tonometer, Tonopen, and Icare in Patients with Keratoconus
Merve Beyza Yıldız, Alev Özçelik köse, Gokhan Celik, Osman Kızılay, Serhat Imamoglu, Elvin Yıldız
PMCID: PMC10521132  doi: 10.14744/bej.2023.56933  Pages 170 - 176
OBJECTIVES: The objective of the study is to evaluate the agreement between Goldmann applanation tonometer (GAT) and Easyton transpalpebral tonometer, Tonopen, and Icare in patients with Keratoconus.
METHODS: This cross-sectional study included 46 eyes of 26 patients with keratoconus. Intraocular pressure (IOP) is measured using easyton, icare, tonopen, and GAT. Measurements were compared and the influences of corneal topographic variables on IOP measurement were evaluated. Bland–Altman plots were used for assessing agreement between different tonometers.
RESULTS: The mean age of the participants was 24.08±6.76 (range, 18–47) years (15 males and 11 females). The highest of the mean IOP values measured with different tonometers was obtained with Easyton (12.33±1.65), followed by Tonopen (11.59±2.17), GAT (10.67±1.52), and Icare (10.04±2.33). The mean IOP value measured with Easyton was significantly higher than that measured with GAT (p<0.001). There was no significant difference between GAT and either Tonopen (p=0.154) or Icare measurements (p=0.732). There was no significant difference between Tonopen and Easyton mea-surements (p=0.421). Icare measurements were correlated with central corneal thickness and keratometric values. GAT measurements were correlated with only Kmax. Thirty-eight (82.6%) of the differences were within the agreement limits (assumed clinically important deviation of up to ±2 mmHg) of GAT and Tonopen, 73.9% (n=34) were within the agree-ment limits of GAT and Icare, and 78.3% (n=36) were within the agreement limits of GAT and Easyton.
DISCUSSION AND CONCLUSION: Compared with GAT, the gold standard method, Easyton IOP readings were higher, while both Tonopen and Icare readings were similar to GAT. All three tonometers showed acceptable agreement with the GAT, however, Tonopen showed the greatest agreement.

5.Evaluation of Macular Pigment Optical Density in Eyes with Hyperopic Anisometropic Amblyopia Using Fundus Reflectometry
Mahmut Kaya, Taylan Ozturk, Ziya Ayhan, Ferdane Atas, Betul Akbulut Yagci
PMCID: PMC10521122  doi: 10.14744/bej.2023.98159  Pages 177 - 183
OBJECTIVES: This study aimed to evaluate the macular pigment optical density (MPOD) scores in eyes with hyperopic ani-sometropic amblyopia and compare those with their fellow and control eyes using one-wavelength fundus reflectometry.
METHODS: This cross-sectional study enrolled 33 patients diagnosed with hyperopic anisometropic amblyopia aged 12–40 years. The control group consisted of 36 hyperopic and 42 emmetropic children, age-matched to the patients. Central macular thickness (CMT), MPOD, axial length (AL), best-corrected visual acuity, and refraction errors were measured between the study group and the control group.
RESULTS: Eyes with the diagnosis of hyperopic anisometropic amblyopia had significantly higher mean and maximum (max) MPOD scores compared with their fellow eyes as well as hyperopic and emmetropic eyes (p<0.001 for all). The mean AL in eyes with hyperopic anisometropic amblyopia was statistically shorter than that in hyperopic and emmetropic controls (p=0.027, p<0.001, respectively). The mean CMT was found to be thicker in eyes with hyperopic anisometropic amblyopia when compared to their fellow eyes, as well as hyperopic and emmetropic controls, eventhough there was no significant difference was found among the four groups (p=0.052). The mean MPOD levels were significantly correlated with the difference in CMT (r=−0.21, p=0.032), and logMAR visual acuity scores (r=−0.44, p<0.001) in the hyperopic anisometropic amblyopia group.
DISCUSSION AND CONCLUSION: The present study indicates that the MPOD is reduced in eyes with hyperopic anisometropic amblyopia. This reduction may be due to less visual stimulus-induced deterioration of foveal development and microarchitecture in anisometropic amblyopic eyes.

6.Effect of ILM Peeling on Anatomical and Visual Outcomes in Diabetic Tractional Retinal Detachment
Seren Pehlivanoğlu, Damla Bektaşoğlu, Şehnaz Özçalışkan, Cengiz Alagoz, Gurkan Erdogan, Özgür Artunay
PMCID: PMC10521131  doi: 10.14744/bej.2023.26986  Pages 184 - 192
OBJECTIVES: The objcetive is to compare the anatomic and functional outcomes of vitrectomy between internal limiting membrane (ILM) peeling and non-ILM peeling in diabetic tractional retinal detachment (TRD).
METHODS: Twenty-three eyes with diabetic TRD with ILM peeling were compared with twenty-four eyes with non-ILM peeling. Best-corrected visual acuity (BCVA) was recorded at baseline and 3, 6, 9, 12 months, and end of follow-up. The mean retinal thickness across nine different regions that defined in the Early Treatment Diabetic Retinopathy Study (ETDRS) were obtained. The ETDRS grid was used to determine the extent of macular involvement.
RESULTS: In the 1st month postoperatively, the mean BCVA of eyes with ILM peeling (1.08±0.63 LogMAR) was significantly better than eyes with ILM non-peeling (1.69±0.75 LogMAR, p=0.003). There was also a significant difference at 9 and 12 months between groups in BCVA, in favor of ILM peeling (p=0.012 and p=0.047, respectively). Seven patients (29.2%) developed epiretinal membrane (ERM), and one patient (4.1%) had ERM with the lamellar macular hole in the ILM non-peeling group, while only one patient developed ERM in ILM peeling group during the follow-up.
DISCUSSION AND CONCLUSION: ILM removal may be considered in diabetic TRD surgery, as it can provide rapid visual recovery. Moreover, post-operative ERM formation was less frequent in ILM peeled eyes within 1 year after surgery.

7.Short-term Effects of Intravitreal Dexamethasone Implant on Choroidal Structure in Eyes with Refractory Diabetic Macular Edema
Serdar Bilici, Enes Serbest, Suat Hayri Uğurbaş
PMCID: PMC10521124  doi: 10.14744/bej.2023.73644  Pages 193 - 197
OBJECTIVES: The objective of the study was to evaluate choroidal structural changes after intravitreal dexamethasone implant (IDI) in eyes with diabetic macular edema (DME) refractory to antivascular endothelial growth factor (VEGF) therapy.
METHODS: Twenty-three eyes of 14 patients with DME refractory to anti-VEGF therapy were included in this retro-spective study. Detailed ophthalmological examinations were recorded, and optical coherence tomography images were obtained before and 3 months after IDI. Choroidal images were binarized into the luminal area and total choroidal area. Subfoveal choroidal thickness and choroidal vascularity index (CVI) were calculated.
RESULTS: The mean best-corrected visual acuity (BCVA) and central macular thickness (CMT) were improved significantly (from 0.94 to 0.81 LogMAR, p=0.02, and from 464 to 371 µ, p=0.01, respectively) after IDI. There were no significant changes in both SCFT and CVI at the end of the follow-up period (from 446.3 to 428.8 µ, p=0.51 and from 63.1 to 63.7 p=0.35, respectively).
DISCUSSION AND CONCLUSION: IDI in eyes with DME refractory to anti-VEGF therapy improves BCVA and CMT but has no significant effect on SCFT and CVI in the short term.

8.Efficacy of Simultaneous Application of Subretinal Tissue Plasminogen Activator and Bevacizumab for Submacular Hemorrhages
Utku Limon, Tuğba Aydoğan Gezginaslan, Işılay Özsoy Saygın, Erdinç Bozkurt, Esra Kardes, Betül İlkay Sezgin Akçay
PMCID: PMC10521123  doi: 10.14744/bej.2023.34735  Pages 198 - 207
OBJECTIVES: The aim of the study was to evaluate the patients who received simultaneous subretinal tissue plasminogen activator (tPA) and bevacizumab for submacular hemorrhages secondary to neovascular age-related macular degeneration.
METHODS: This retrospective study included patients who underwent pars plana vitrectomy (PPV) with simultaneous sub-retinal tPA and subretinal bevacizumab with 18% SF6 tamponade. Anatomical and functional results of the patients before surgery and at the 1st, 6th, and 12th months after surgery, additional treatments, and complications after PPV were evaluated.
RESULTS: Eight eyes of eight patients were included in the study. The mean age of the patients was 72.38±92.3. The mean time from the onset of symptoms to treatment was 5.13±1.88 days. The patients’ mean best-corrected visual acuity (BCVA) was 2.23±0.14 logMAR at baseline. Mean BCVA increased significantly at 1st, 6th, and 12th months to 1.68±0.47 logMAR, 1.58±0.49 logMAR, and 1.51±0.58 logMAR, respectively (p=0.001 at all). The mean central foveal thickness (CFT) in measurable patients was 836.8±627.02 µm at baseline. Mean CFT decreased significantly to 370.13±66.13 µm in the 1st month, 373.38±78.33 µm in the 6th month, and 367.75±116.43 µm in the 12th month (p<0.05). The maximum measurable subretinal hemorrhage height at baseline was 814.2±556.45 µm. The mean number of anti-VEGFs performed for 12 months after surgery was 4.13±2.1. At month 12, the ellipsoid zone could not be detected in 6 (75%) patients.
DISCUSSION AND CONCLUSION: Administration of subretinal bevacizumab and subretinal tPA effectively removes subretinal hemorrhage under the fovea. Intravitreal anti-VEGF treatment must be continued, as choroidal neovascular membrane activity continues after surgery.

9.Evaluation of Aqueous Flare in Graves’ Ophthalmopathy and its Relationship with Thyroid Hormones, Antibodies, and Clinical Activity Score
Hüsna Topçu, Burcu Kemer Atik, Berru Yargı Özkoçak, Ayşe Çetin Efe, Mehmet Göksel Ulaş, Kübra Şerefoğlu Çabuk
PMCID: PMC10521130  doi: 10.14744/bej.2023.80557  Pages 208 - 213
OBJECTIVES: The aim of this study was to assess intraocular inflammation in patients with active and inactive Graves’ ophthalmopathy (GO) using an aqueous laser flash meter and to assess its relationship with thyroid hormones, antibodies, and clinical activity score (CAS).
METHODS: Forty patients (29 females and 11 males) were included in the study. The patients were divided into two groups according to CAS; patients with CAS <3 (inactive) were included in Group 1 and patients with CAS ≥3 (active) were included in Group 2. The laser flare meter was used to measure the flare of aqueous humor. Each patient’s ocular findings, thyroid hormone, and antibody levels were also recorded.
RESULTS: The mean age of patients was 46.88±11.79 years in Group 1 and 44.50±12.59 years in Group 2 (p=0.555). The mean CAS was 0.88±0.65 in Group 1 and 3.57±0.85 in Group 2 (p<0.001). The mean aqueous flare was 6.5±2.2 ph/ms in Group 1 and 7.0±6.4 ph/ms in Group 2 (p=0.73). Hertel exophthalmometry, intraocular pressure (IOP), antithyroglobulin antibody, and thyroid stimulating hormone receptor antibody (TRAb) levels were similar in both groups (each p>0.05). There was no correlation between aqueous flare value and CAS, Hertel exophthalmometry, IOP, thyroid hormone, and antibody levels (each p>0.05). There was a significant correlation between CAS and antibody levels (each p<0.05).
DISCUSSION AND CONCLUSION: Flare values that are not much above the normal range may be an indication that intraocular inflammation is not elevated in GO patients. This suggests that the damage to the blood-aqueous barrier in these patients is not severe enough to increase intraocular inflammation.

10.The Effects of Blepharoptosis Surgery on Meibomian Gland, Tear Film, and Corneal Topography
Elif Ceren Yesilkaya, Emine Betül Akbaş Özyürek, Tuğçe Dursun, Ayşe Burcu Dirim, İbrahim Çağrı Türker, Semra Tiryaki Demir
PMCID: PMC10521128  doi: 10.14744/bej.2023.99266  Pages 214 - 220
OBJECTIVES: The objective of this study was to evaluate the Meibomian gland (MG), tear film, and corneal changes in the post-operative period following ptosis surgery using corneal topography.
METHODS: This non-comparative, case series study analyzed 30 eyes of 23 patients undergoing blepharoptosis surgery with an external approach. Ocular surface and tear film evaluation was performed at baseline and post-operative 3rd month. The corneal topography was used to assess the MG, the noninvasive tear film break-up time (NI-TBUT), K values, astigmatism, and corneal aberrations. For the examination of dry eyes, the I-TBUT, Schirmer, and ocular surface disease index (OSDI) questionnaires were also performed.
RESULTS: The study involved patients with a mean age of 55.1±18.11 years. Postoperatively, marginal reflex distance 1 is significantly increased (1.23±1.09 vs. 3.65±0.65; p=0.001). Results revealed no significant changes in Kmean (43.65±1.15 vs. 43.67±1.14; p=0.727), astigmatism (−1±0.74 vs. −0.99±0.68; p=0.910), and corrected distance visual acuity logMAR (0.09±0.1 vs. 0.07±0.11; p=0.497). There was a significant increase in MG loss area postoperatively (5.02±5.04–7.75±6.75; p=0.047), while the degree of MG loss did not significantly change (0.2±0.48 vs. 0.37±0.56; p=0.132). However, no sig-nificant differences were detected in Schirmer I test (17.4±4.7 vs. 16.1±5.5; p=0.711), I-TBUT (12.4±3.1 vs. 11.9±4.7; p=0.483), and OSDI questionnaire score (16.7±9.4 vs. 17.9±10.3; p=0.176) between baseline and post-operative mea-surements. Similarly, no significant changes were found in NI-TBUT (5.73±3.72 vs. 6.58 4.71; p=0.535) and NIAvg-TBUT (6.06±4.8 vs. 7.51±4.43; p=0.322) values.
DISCUSSION AND CONCLUSION: Surgical correction of blepharoptosis affects MG morphology without causing dry eye at the 3rd month. Post-operative corneal topography is useful in demonstrating changes in the MG.

11.Ocular Manifestations of Wernicke’s Encephalopathy in a Patient with Hyperemesis Gravidarum Complicating Pregnancy
Chris Diana Pius, Ksheeraja Ye
PMCID: PMC10521135  doi: 10.14744/bej.2023.03274  Pages 221 - 225
Wernicke’s encephalopathy (WE) is a condition resulting from thiamine deficiency and has been linked to conditions such as hyperemesis gravidarum, anorexia nervosa, hemodialysis, and chronic alcoholism. The aim of the report is to outline the ocular manifestations of WE. We present the case of a 33-year-old woman, who presented in her second trimester of pregnancy with persistent vomiting, nystagmus, ataxia, global confusion as well as hypotonia, and tremors. She was subse-quently diagnosed with WE complicating pregnancy. Ophthalmoscopy showed asymmetric superficial retinal hemorrhages at the peripapillary area in both eyes with associated retinal exudates. On treatment with thiamine supplementation, her systemic condition as well as ocular symptoms resolved. This is a rare case outlining the ocular manifestations of WE. This condition may cause serious, lasting neurologic impairments or death if not properly treated. Only 50% of these pregnancies end in the delivery of healthy offspring. Early diagnosis and treatment of these cases can prevent avertable consequences.

12.A Report on Children with CEP290 Mutation, Vision Loss, and Developmental Delay
Esra Şahlı, Pinar Bingol Kiziltunc, Aysun İdil
PMCID: PMC10521126  doi: 10.14744/bej.2023.37233  Pages 226 - 232
Mutations in CEP290, which encodes a centrosomal protein, cause Joubert syndrome, retinal dystrophy, and several other manifestations. Retinal dystrophy related to CEP290 mutation (Leber’s congenital amaurosis type 10) presents with a severe visual impairment from birth, wandering eye movements, and oculodigital reflex. Fundus examination may initially be normal, but varying degrees of retinal pigmentation can be detected over time. This report presents 4 children who were referred to the ophthalmology clinic with a lack of eye contact and the suspicion of low vision. The ophthalmological examination revealed very poor visual function, the vision slightly improved over time, and enophthalmos became evident. There was neuromotor retardation in their history and mutations in the CEP290 gene were revealed in the whole-exome analysis. Both pediatricians and ophthalmologists should be aware of the coincidence between severe vision loss and neuromotor retardation and should refer patients for genetic testing if they suspect it. Genetic diagnosis will enable pa-tients to be followed both neurologically and ophthalmologically and to benefit from rehabilitation opportunities that will contribute to visual and neurological development. It will also allow the family to receive genetic counseling on disease progression and heredity, and to follow ongoing gene therapy studies for mutations in the relevant gene.

13.A Rare Complication Causing Another Rare Complication: Corneal Dellen with Infiltration Secondary to Subconjunctival Silicon Oil
Sujatha Mohan, Gauhar Nadri, Sashwanthi Mohan
PMCID: PMC10521125  doi: 10.14744/bej.2023.74508  Pages 233 - 236
The usage of silicon oil (SO) in vitreoretinal surgery is associated with potential complications. One such complication is the extravasation of SO into the subconjunctival space through open sclerotomies. Subconjunctival SO (SCSO) can cause irregularities in the ocular surface which predisposes to complications like corneal dellen. This corneal dellen can get infected in rare situations. SCSO needs to be removed to stabilize the ocular surface. We present a case of corneal dellen with infiltration which developed as a consequence of SCSO and its management.

14.The Importance of Using CBI-LVC for Detecting Ectasia in Post-Refractive Eyes
Vanessa Ferraro, Renato Ambrósio Jr, Paolo Vinciguerra, Riccardo Vinciguerra
PMCID: PMC10521133  doi: 10.14744/bej.2023.82542  Pages 237 - 238
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