Objectives: Vernal keratoconjunctivitis (VKC) poses a significant challenge in ocular inflammation management, necessitating potent anti-inflammatory interventions. Despite its restricted utilization, tacrolimus has emerged as a promising agent in inflammation control. However, the specific efficacy of topical tacrolimus in VKC remains underexplored. Methods: A systematic review was conducted to evaluate the impact of topical tacrolimus on VKC, adhering meticulously to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies were meticulously retrieved from comprehensive databases including Cochrane Library, PubMed, EBSCO Host, ProQuest, and Google Scholar, with a focus on English-language publications. This systematic review protocol was prospectively registered with PROSPERO (CRD42022302291).
Results: The review encompassed 11 studies involving 607 participants, with an average age of 8.45 years. Tacrolimus concentrations utilized in the interventions spanned from 0.005% to 0.1%, delivered through eye ointment or drops. Across the studies, topical tacrolimus demonstrated significant reductions in both the total objective signs score and total subjective symptoms score. Adverse events reported encompassed sensory experiences such as burning sensation, ocular stinging, pain, redness, and sporadic photophobia.
Conclusion: This systematic review underscores the notable efficacy of topical tacrolimus in ameliorating the clinical manifestations and symptomatic burden associated with VKC. Furthermore, tacrolimus exhibited a favorable safety profile, with minor adverse effects reported infrequently.

OBJECTIVES: The shift from outdoor play to prolonged use of electronic devices among children, exacerbated by the COVID-19 pandemic, has raised concerns about its impact on visual health. This study explores the relationship between the excessive use of digital devices and the development of various refractive errors in children. This study aims to inves-tigate the association between excessive screen time (including smartphones, tablets, computers, and televisions) with different types of refractive errors and axial length (AL) elongation in a cohort of school-aged children in North-West Algeria. It is a cross-sectional analysis focused on a representative sample from this region.
METHODS: Over a 1-year period, 208 schoolchildren (416 eyes), aged 6–18 years (mean age: 6.21±3 years), underwent comprehensive eye examinations at the ophthalmic service of the pediatric hospital EHS Canastel, Oran. Cycloplegic measurements assessed the refractive errors, while A-scan ultrasonography measured the ocular biometry. The study also evaluated children’s technology usage patterns, including daily screen time, types of devices used, and time spent outdoors.
RESULTS: The study revealed a significant decrease in mean spherical equivalence (SE) in both eyes over the 1-year period. In the right eye (RE), SE dropped from −0.96 D to −1.48 D, and in the left eye (LE) from −0.70 D to −1.39 D. Myopic astigmatism was the most prevalent condition, affecting 51% of children, especially younger screen users (p<0.001). Axial length (AL) increased in both eyes, with an average elongation of 0.54 mm in the RE and 0.57 mm in the LE. There was a strong correlation between excessive screen use and the progression of myopic astigmatism, along with changes in spher-ical equivalence. Factors such as device type, screen time, and reduced outdoor activity were significantly associated with the progression of refractive errors and AL elongation (p<0.005).
DISCUSSION AND CONCLUSION: Prolonged use of digital screens is significantly correlated with increased risks of myopic astigmatism, AL elongation, and changes in spherical equivalent values. These findings emphasize the urgent need for further research and public health measures to address the impact of prolonged digital device use on children’s vision.

OBJECTIVES: To assess the agreement between the automated analysis program and a manual program for quantification of corneal nerve morphology.
METHODS: Twenty-seven non-diabetic controls (mean age: 48.6±5.9 years) and 60 subjects with diabetes (mean age: 52.1±6.5 years) were enrolled. Corneal nerve fiber density (CNFD), branch density (CNBD), and fiber length (CNFL) were quantified by the manual (CCMetrics software, University of Manchester, UK) and automated program (ACCMetrics software, University of Manchester, UK). Bland–Altman plots were generated to assess agreement between the two methods.
RESULTS: There were no differences in gender, age, total cholesterol, and LDL between the two groups, whereas BMI, HbA1c, and triglyceride were significantly higher and HDL was significantly lower in the T2DM group. CNFL was overestimated in the diabetic group and CNFD was underestimated in both groups with ACCMetrics (p=0.001, p<0.001, respectively). The Bland–Altman plots for both groups demonstrated good agreement for CNFL, with a wide limit of agreement (LoA) of 95% for CNFD and CNBD.
DISCUSSION AND CONCLUSION: Manual and fully automated protocols for sub-basal nerve evaluation had lower agreement in the measurement of CNFD and CNBD than CNFL in healthy controls and subjects with diabetes.

OBJECTIVES: The objective of the study was to evaluate the changes in the meibomian glands (MGs) and ocular surface parameters after corneal cross-linking (CXL) in keratoconus patients.
METHODS: Forty-eight eyes of 48 keratoconus patients that underwent epi-off CXL were included in this prospective study. Upper and lower lid MGs were assessed with non-contact meibography at preoperatively, 1st, 3rd, 6th, and 12th month after CXL. Uncorrected distance visual acuity (UCVA), corrected distance visual acuity (BCVA), spherical equivalent (SE), and corneal tomography findings (K1, K2, Kmean, and Kmax) were recorded at each visit. Ocular surface staining score (Oxford grade), ocular surface disease index (OSDI) questionnaire, and non-invasive tear break-up time (NI-TBUT) were evaluated at preoperatively and 12 months after CXL.
RESULTS: K1, K2, Kmean, and Kmax were decreased at post-operative 12th month compared to baseline (p=0.004, p<0.001, p<0.001, and p<0.001, respectively). UCVA, BCVA, and SE did not change between preoperatively and post-operative 12 months (p=0.142, p=0.306, and p=1.000, respectively). NI-TBUT showed similarity between pre-operative and 12 months values (p=0.180), while OSDI scores significantly decreased (p<0.001). MG loss in the upper and lower lids did not show significant difference compared to pre-operative values at any of the follow-up visits (p=0.121 and p=0.117, respectively).
DISCUSSION AND CONCLUSION: CXL treatment did not significantly affect the NI-TBUT and MGs morphology, while improving ocular symptoms.

OBJECTIVES: To evaluate the epidemiology, etiology, and outcomes of pediatric open-glob injury patients treated at a tertiary medical center in Istanbul, Türkiye.
METHODS: The records of 56 pediatric patients who underwent primary open-globe injury repair at our clinic between 2016 and 2021 were retrospectively reviewed. Data about demographics, date-setting of the injury, type of the traumatizing object, injury size, and zone were collected. The initial and final best-corrected visual acuities (VAs), associated features, trauma-hospital admission, and hospital admission-surgery durations were also recorded. The Pediatric Penetrating Ocular Trauma Score (POTS) was calculated to evaluate its effect on the final VA.
RESULTS: Fifty-six eyes of 56 patients with a median age of 8 years who were followed up for at least 6 months were included. The majority of the injuries took place at home (62.5%), while the most common traumatizing object was a knife (10.7%). The mean size of injury was 4.73±2.92 mm; of which 60.7% (34) cases were in zone 1, 33.9% (19) cases in zone 2, and 5.4% (3) cases in zone 3 injury according to Ocular Trauma Classification group. The mean VA of 1.48 ± 1.21 logMAR at presentation was improved to 0.83±1.13 logMAR at the last visit (p<0.001). The POTS was significantly correlated with the final VA (p=0.001; r=−0.473). Iris prolapse was observed in 31 patients (55.4%), whereas the lens was injured in 26 (46.4%) cases and displayed a significant influence on the post-operative visual outcome (p=0.019). The mean duration between trauma-hospital admission was 18.9±43.8 h; while hospital admission-surgery was 8.6±3.7 h.
DISCUSSION AND CONCLUSION: Our study demonstrated that the VA at presentation and the presence of lens injury are visual prognostic factors for pediatric open-globe injuries.

OBJECTIVES: Congenital nasolacrimal duct obstruction (CNLDO) is a condition that can lead to the development of anisometropia and amblyopia. This study aimed to identify refractive errors in children with unilateral and bilateral CNLDO.
METHODS: A total of 220 eyes from 110 patients with CNLDO were retrospectively analyzed in this study. All patients underwent at least one surgery, and their most recent refractive errors were compared based on the laterality of the disease. The risk factors for amblyopia were established in accordance with the 2013 and 2021 American Association for Pediatric Ophthalmology and Strabismus guidelines. The investigated risk factors included disease laterality, surgical technique, number of surgeries, age at the time of surgery, and manifest strabismus.
RESULTS: The nasolacrimal duct obstruction was unilateral in 66.4% (n=73) of the patients. The average ages at the last examination and at the time of surgery were 57.3±37.6 months (range: 12–153 months) and 29.6±22.3 months (range: 12–128 months), respectively. Hypermetropia was the most common refractive error, followed by astigmatism. The anisometropia and amblyopia rates were 11.8% (n=13) and 5.4% (n=6), respectively. No significant refractive difference was observed between the eyes in unilateral and bilateral CNLDO (p>0.05). After regression analyses, manifest strabismus was the only factor associated with amblyogenic risk factors in children with CNLDO (odds ratio = 0.132, 95% confidence interval = 0.529–17.400, p<0.001).
DISCUSSION AND CONCLUSION: As a result, children diagnosed with CNLDO should be treated at as optimal time as possible, and visual maturation should be monitored for the development of high hypermetropia, anisometropia, and amblyopia. These children should receive a complete ophthalmic examination, including cycloplegic refraction, and orthoptic evaluations.

OBJECTIVES: To report changes in the choroid, optic nerve, and macula in diabetes mellitus patients without diabetic retinopathy, and to compare these findings with age and sex-matched healthy volunteers. Furthermore, the duration of the disease was recorded and the impact on these parameters was aimed to be analyzed.
METHODS: In this study, 60 right eyes of diabetes mellitus (DM) patients without diabetic retinopathy who applied to our department for routine examination were enrolled. To evaluate the peripapillary retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL), Swept-Source Optical Coherence Tomography imaging was performed. In addition, images were recorded and processed by the image-j program and the ‘choroidal vascularity index’ (CVI) was calculated. The measurements were compared with 60 right eyes of age-sex-matched healthy volunteers. Furthermore, the patient group was divided into 2 subgroups according to disease duration and the measurements were compared with each other as well.
RESULTS: Both RNFL and GCL thickness values were observed to be thinner in DM patients group compared to the control group. CVI was found to be lower in DM group compared to the control group. In addition, the duration of the disease was significantly associated with the RNFL and GCL thinning and lower CVI.
DISCUSSION AND CONCLUSION: DM can lead to a decrease in RNLF and GCL thickness and also a decrease in CVI which can impair visual acuity even in the absence of diabetic retinopathy. Therefore, monitoring changes in the optic nerve, retina, and choroid layer is crucial in these patients.

Retinitis pigmentosa (RP) is an inherited disease involving progressive degeneration of rod and cone photoreceptors. It is highly heterogeneous and the resulting clinical phenotypes may differ in age at onset, progression, and severity. Mutations in the myosin VIIA (MYO7A) gene have been known to cause Usher syndrome, a condition characterized by RP and deafness. In this report, we present a rare case of RP without hearing loss associated with a novel MYO7A variant, p.Ser383TrpfsTer64. With this case, we also wanted to draw attention to the rare vitelliform-like appearance in the macula in patients with RP.

It is known that the incidence of lung cancer is increasing rapidly in both men and women. While no ocular findings may be observed in the early stage, ocular involvement may be observed in the advanced stage. The choroid is the most common site of intraocular metastasis in adults due to its rich vascularisation. In this report, a 52-year-old woman was referred to our clinic because of retinal detachment detected in an external center with complaints of flashes of light in the left eye 3 months ago and decreased vision for the past week. It was learned that she was diagnosed with advanced stage (stage IV) adenocarcinoma of the lung and received chemotherapy at regular intervals due to distant metastasis (liver and bone). Biomicroscopic fundus examination, B-Mode ultrasonography, fundus fluorescein angiography, and orbital magnetic resonance imaging revealed a choroidal mass. The current clinical picture was interpreted as distant metastasis of lung adenocarcinoma, no surgical intervention was planned for the secondary exudative retinal detachment, and the patient was consulted by the oncology clinic. In addition to chemotherapy, three cycles of radiotherapy were given within 1 week and the mass disappeared at the follow-up visit 2 months later. In the differential diagnosis of retinal detachment, metastasis of a diagnosed primary tumor should be considered as in our case. Early detection of these metastatic lesions and appropriate treatment strategies will prevent unnecessary vitreoretinal surgeries and complications.

Kimura disease (KD) is a rare chronic inflammatory disease of unknown etiology. It usually presents with regional lymphadenopathy in the head-and-neck region and swelling of the salivary glands and subcutaneous tissues. Periocular involve-ment in KD is rare. We report a case of KD on the eyelid as a rare cause of eyelid masses.