ISSN: 2459-1777 | E-ISSN 2587-0394
Volume : 9 Issue : 1 Year : 2024
Beyoglu Eye Journal - Beyoglu Eye J: 9 (1)
Volume: 9  Issue: 1 - 2024
1.A Systematic Review of Cyclophotocoagulation Techniques: Continuous Wave Versus Micropulse for Glaucoma Treatment
Christopher Andrean Putra Johansyah, Leliana Bambang
PMCID: PMC10944853  doi: 10.14744/bej.2024.47123  Pages 1 - 7
Objectives: Micro-pulse cyclophotocoagulation (MP-CPC) represents the latest iteration of minimally invasive laser pro-cedures aimed at reducing intraocular pressure (IOP) through the disruption of pigmented ciliary body epithelium. This systematic review aims to assess the efficacy and safety profile of the MP-CPC procedure in comparison to CW-CPC for the treatment of glaucoma.
Methods: We initiated a search on PubMed, ScienceDirect, and the Cochrane Library databases for studies that com-pared micro-pulse and traditional CW-CPC in terms of their efficacy and safety profiles. We employed medical sub-ject headings terms and keywords such as “cyclophotocoagulation,” “cyclodestructive,” “photocoagulation,” “CPC,” “mi-cropulse,” “micro-pulse,” and “glaucoma” within the timeframe from 2015 to 2023. We assessed the success rate, IOP reduction, antiglaucoma medications, and complications of MP-CPC and CW-CPC.
Results: We included six articles in this study, comprising two randomized controlled trials, three retrospective, and one prospective cohort, published between 2015 and 2023. Five out of six reported a significant reduction in IOP for both pro-cedures with comparable success rates observed in MP-CPC compared to CW-CPC. One article reported an increase in IOP in MP-CPC. Both groups reported a decrease in the number of antiglaucoma medications, while one study reported an increase in medications in both MP-CPC and CW-CPC groups. Complication rates were lower in the MP-CPC group with two articles reporting a significant decrease compared to the CW-CPC group.
Conclusion: MP-CPC has shown promising results in the treatment of glaucoma in the adult population. With compa-rable results in IOP reduction and fewer instances of serious ocular complications, MP-CPC may open new possibilities for the use of cyclophotocoagulation procedures in the earlier stages of glaucoma. However, its efficacy in the pediatric population and for neovascular glaucoma remains less defined, thus warranting further studies to establish optimal laser parameters for different types of glaucoma and specific populations of glaucoma patients.

2.Understanding the Etiopathogenesis of Non-Arteritic Anterior Ischemic Optic Neuropathy with Laboratory Findings
Neslişah Kutlu Uzakgider, Seda Karaca Adiyeke, Hasan Aytogan
PMCID: PMC10944851  doi: 10.14744/bej.2023.09815  Pages 8 - 13
OBJECTIVES: The role of inflammation and hemostasis in non-arteritic anterior ischemic optic neuropathy (NAION) was investigated by examining related blood tests. The predictive values of these laboratory indicators and their effects on prognosis were reviewed.
METHODS: In this study, 48 patients diagnosed with NAION and 50 healthy volunteers were included. All subjects under-went full ophthalmological examination. All patients were treated with oral corticosteroids (methylprednisolone 1 mg/kg/day) for 15 days after that corticosteroid medication was reduced and stopped. Each patient was monitored at least for 12 months. The mean platelet volume (MPV), platelet distribution width (PDW), neutrophil/lymphocyte ratio (NLR), and red cell distribution width (RDW) values were recorded. These findings were compared with control group.
RESULTS: The mean MPV, RDW, and NLR values were significantly higher in NAION group (respectively, p<0.001, p=0.006, and p<0.001). There was no statistically significant difference between group 1 and group 2 in PDW values, but the mean PDW value was higher in the patient group compared to the control group (p=0.435). Based on the receiver operating characteristic (ROC) curve, the NLR had the strongest predictive value. This was followed by MPV, RDW, and PDW with lower diagnostic predictive values.
DISCUSSION AND CONCLUSION: MPV, NLR, and RDW were found to be elevated and have diagnostic predictive values in NAION patients. Easily accessible and simple laboratory methods could help us show systemic inflammation and ischemic events in NAION patients. As a result, inflammatory reactions besides ischemic changes may play a role in the etiopathogenesis of NAION. These biomarkers can be evaluated to ensure that patients with risk factors for the development of NAION.

3.Choroid and Retinal Effects of Epilepsy and Epilepsy Subgroups
Isil Merve Torun, Taha Baysal, Mirac Aysen Unsal, Murat Sonmez
PMCID: PMC10944848  doi: 10.14744/bej.2023.19942  Pages 14 - 19
OBJECTIVES: The objective were to evaluate structural alterations in the retina and choroid tissue of epilepsy patients and subtypes using enhanced depth imaging optic coherence tomography (EDI-OCT).
METHODS: 46 epilepsy patients and 50 sex- and age-matched control patients were analyzed in the study. Patients’ epilepsy types were recorded. The central macular thickness (CMT), retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and choroidal thickness (CT) were investigated through the Spectralis-OCT device (SD-OCT). Image-J program was used to calculate the total choroidal area (TCA), the luminal area (LA), stromal area (SA), and the choroidal vascularity index (CVI).
RESULTS: CMT, TCA, LA, and SA outcomes were substantially reduced in epilepsy patients than in healthy controls. There was no significant difference between CT, RNFL, GCL, CVI results. There were no statistically significant differences be-tween patients with partial and generalized epilepsy (p>0.05 for each).
DISCUSSION AND CONCLUSION: According to the results of our study, epilepsy disease has effects on the posterior segment of the eye. To the best of our knowledge, our study is the first to evaluate CVI in patients with epilepsy and the epilepsy subgroups.

4.Treatment of Infantile Esotropia – Comparison Between Botulinum Toxin A and Bilateral Medial Rectus Recession
Cagri Mutaf, Bulut Ocak, Asli Inal, Leyla Hazar, Birsen Gokyigit
PMCID: PMC10944856  doi: 10.14744/bej.2024.90958  Pages 20 - 25
OBJECTIVES: The objective of the study is to evaluate the examination findings, treatment methods, and follow-up results of children diagnosed with infantile esotropia (IE) and to compare botulinum toxin A (BTA) and bilateral medial rectus (MR) recession surgery.
METHODS: We retrospectively reviewed the medical records of patients who were diagnosed with IE. The age of the patient and the angle of deviation were taken into account to determine the treatment. Patients who underwent bilateral MR recession surgery and BTA injection were analyzed and the BTA and surgical groups were compared. Successful cor-rection was defined as orthotropia and a deviation of up to 10 prism diopters (PD) after one surgical procedure or 1–3 botulinum injections.
RESULTS: Two hundred and forty-six patients with esotropia were included in the study. Twelve were followed up with re-fractive correction only. BTA injection was administered to 110 patients, while 124 patients underwent bilateral MR reces-sion. The age of the patients ranged from three to 39 months. Patients were followed for at least 6 months, with a mean follow-up of 24.3 months in the BTA group and 21.7 months in the surgical group (p=0.23). The mean pre-treatment angle deviation was 38.9 PD in the BTA group and 40.1 PD in the surgical group (p=0.62). The success rate for patients with more than 30 PD of deviation was 72% in the surgical group compared to 36% in the BTA group (p<0.001). No statistically significant difference in success rate was observed in patients with deviations <30 PD (surgery 62%, BTA 55%, p=0.26).
DISCUSSION AND CONCLUSION: Surgical treatment of IE was more successful than BTA injection in patients with large angle deviations (>30 PD). BTA injection can be considered as an alternative to surgery in cases of small to moderate angle deviations (<30 PD).

5.Assessing the Efficacy of the PAUL Glaucoma Implant in Pseudoexfoliative Glaucoma
Ali Olgun, Murat Karapapak
PMCID: PMC10944855  doi: 10.14744/bej.2024.96729  Pages 26 - 32
OBJECTIVES: The aim of the study was to evaluate the outcomes and complications associated with PAUL glaucoma im-plant (PGI) surgery in pseudoexfoliation glaucoma (PXG) patients, comparing them with a primary open-angle glaucoma (POAG) control group.
METHODS: A retrospective analysis included 39 PXG and 29 POAG eyes undergoing PGI surgery between January 2020 and December 2022. Surgical success was defined as intraocular pressure (IOP) between ≤21 and ≥6 mmHg at 12 months and no loss of light perception. Demographic data, ocular examinations, and complications were recorded.
RESULTS: PXG patients (68.5±9.9 years) differed significantly in age from POAG patients (54.1±10.6 years) (p<0.05). Surgical success rates at 12 months were 97.4% (PXG) and 86.2% (POAG). No significant inter-group differences in gender, laterality, lens status, vertical cup/disc ratio, or pre-operative best-corrected visual acuity were observed. Mean IOP comparisons showed significant differences within both groups (p<0.001). Ripcord suture removal occurred at mean 30.3±7.43 days (PXG) and 30.6±9.89 days (POAG). Median pre-operative AGM use was 4 (PXG) and 3 (POAG). No sig-nificant differences were noted postoperatively.
DISCUSSION AND CONCLUSION: To the best of our knowledge, this is the first study to evaluate the results of PGI in PXG and POAG, demonstrating a remarkable success rate and limited complications. Encouragingly, PXG patients with a history of unsuc-cessful filtration surgery demonstrated positive outcomes. The findings affirm PGI as a promising surgical intervention for PXG and POAG, exhibiting high success rates and manageable complications.

6.Complete Blood Cell Count-Derived Inflammation Biomarkers in Patients with Xanthelasma Palpebrarum
Sule Berk Ergun, Busra Kurt
PMCID: PMC10944854  doi: 10.14744/bej.2024.48802  Pages 33 - 37
OBJECTIVES: Xanthelasma palpebrarum (XP) is the most common type of cutaneous xanthoma, characterized by yel-lowish cutaneous plaques commonly located near the medial canthus of the eyelid. Although dyslipidemia significantly contributes to its development, inflammation is also believed to be another element in the pathogenesis, especially in normolipidemic patients. Recently, cell counts derived from complete blood counts have been identified as indicators of systemic inflammatory conditions and have also been under discussion concerning their relevance to ocular diseases. This study aimed to assess inflammation indices derived from complete blood cell counts (CBC) in XP patients with normal lipid levels.
METHODS: Patients who had been referred to the oculoplasty department with the diagnosis of XP between January 2020 and January 2023 and age-matched control subjects were retrospectively reviewed. Patients who had abnormal lipid profiles and systemic diseases such as diabetes mellitus, hypertension, malignancy, cardiovascular diseases, systemic infec-tions, and inflammatory diseases were not included in the study. CBC parameters were analyzed and compared between the groups.
RESULTS: The study comprised 27 normolipidemic patients with XP and 27 age-matched healthy individuals as the control group. There were no statistically significant differences between the two groups in terms of age (p=0.143). The mean hemoglobin, neutrophil, monocyte, lymphocyte, platelet, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, and aggregate index of systemic inflammation values were higher in the patient group, but the differences were not statistically significant (p>0.05). The mean red cell distribution width and platelet-to-lymphocyte ratio appeared to be lower in the patient group compared to the control group; however, no significant differences were observed between the two groups (p=0.272, p=0.387, respectively).
DISCUSSION AND CONCLUSION: This study might offer insights into the pathogenesis of XP, yet numerous questions remain unanswered, awaiting further investigation in future studies.

7.Surgical Outcomes in Congenital Nasolacrimal Duct Obstruction After Probing Failure: A One-Stage Approach
Murat Oklar, Seyhan Kocabas, Mehmet Can Ozen, Ozlen Rodop Ozgur
PMCID: PMC10944852  doi: 10.14744/bej.2024.74384  Pages 38 - 47
OBJECTIVES: This study evaluates the outcomes of a one-stage obstruction-based strategy for congenital nasolacrimal duct obstruction (CNLDO) in children who have prior probing failure. The objective is to assess the success rates of probing, balloon dacrioplasty (BDP), monocanalicular intubation (MCI), and external dacryocystorhinostomy (external DCR) performed in the same anesthesia session.
METHODS: A retrospective analysis included 55 eyes (45 patients, aged 12–120 months) with initial probing at another center. Procedures involved probing, probing plus BDP, MCI, and external DCR. For membranous obstruction (MO), the procedure concludes after probing; for incomplete complex obstruction (ICO) it includes BDP or MCI; and for complete complex obstruction (CCO), external DCR is performed. Success rates were assessed based on obstruction types and age groups, with improvement in symptoms and signs as the measure of success. Statistical analysis utilized Kruskal–Wallis, Fisher’s exact test, and logistic regression.
RESULTS: The overall success rate for all procedures was 72.7%. Success rates were 77.8% for MO, 66.7% for ICO, and 100% for CCO, introducing a promising perspective for the management of different CNLDO types. External DCR ex-hibited a 100% success rate, highlighting its effectiveness in cases of CCO. Success rates for interventions were 77.8% for probing, 61.5% for probing plus BDP, and 73.1% for MCI, emphasizing the feasibility and success of one-stage obstruction-based treatments. Age did not significantly correlate with success rates.
DISCUSSION AND CONCLUSION: The one-stage obstruction-based approach, which demonstrated favorable success rates in treating CNLDO and introduced a paradigm shift in the treatment strategy after probing failure, underscores the importance of tailoring interventions to the specific obstruction type. The study also highlights the feasibility and cost-effectiveness of performing multiple BDP, MCI, or external DCR procedures concurrently during the same anesthesia session, further emphasizing the crucial role of customizing treatments based on the nature of the obstruction.

8.A Multicentric Cross-Sectional Observational Study to Analyze the Effects of Moderate High Altitude on Ocular Health
Vibhuti Maria, Sanat Kumar Khanna, Richa Chaudhary, Saurabh Maheshwari
PMCID: PMC10944850  doi: 10.14744/bej.2023.81557  Pages 48 - 54
OBJECTIVES: Prolonged exposure to hypoxia at high altitudes can affect the eyes through various mechanisms, culminat-ing in reduced vision. Multiple studies on this subject have focused on the ocular effects of high altitude on intraocular pressure (IOP), corneal thickness, and the retina. However, there is a lack of literature on the effects of ‘moderate high altitude (2000–3000 m)’ on the eyes. Hence, we designed our study to determine the impact of moderate high altitude on the eyes.
METHODS: Methods: We recruited two age and gender-matched groups of 250 research participants, each at moderate high altitude (Group A) and plains (Group B), respectively, to determine the effects of moderate high altitude on ocular health, if any.
RESULTS: We found a statistically significant increase in dry eye in Group A. We also found four cases of central serous retinopathy and one case of central retinal vein occlusion in Group A. There was no statistically significant change in visual acuity, IOP, or central corneal thickness.
DISCUSSION AND CONCLUSION: There is a vast lacuna in the literature on this particular altitude range, and further studies are required to confirm our findings. It is also recommended that lubricant eye drops be advised as a standard prophylactic measure for all individuals traveling and staying at moderate high altitude.

9.Bilateral Iris Metastasis in a Patient with Small Cell Lung Carcinoma: A Case Report
Mukaddes Damla Ciftci, Sinan Ezirmik, Banu Yaman, Melis Palamar
PMCID: PMC10944849  doi: 10.14744/bej.2023.39200  Pages 55 - 58
Small cell lung carcinoma (SCLC) is a neuroendocrine tumor with high probability of early disseminated disease and para-neoplastic syndromes. Choroid is the most common uveal tissue affected by metastatic disease followed by iris and ciliary body. Herein, we present a 46-year-old male with bilateral multiple iris metastasis. Once diagnosed, the patient already had diagnosis of SCLC with cranial and bone metastases.

LookUs & Online Makale