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Objectives: to investigate the effect of the novel coronavirus disease 2019 (COVID-19) pandemic on the clinical practice of ophthalmologists in our country. Materials and methods: a questionnaire consisting of 22 questions was delivered to 250 ophthalmologists via e-mail and a smartphone messaging application. A total of 113 ophthalmologists completed the survey. The questions included the participants’ demographic data (age, years in practice, institution, and city), changes in their working conditions and institutional preventive measures implemented during the pandemic, their personal COVID-19 experiences, the prevalence of telemedicine applications, and their attitudes toward these practices. Results: nearly half (47.8%) of the 113 ophthalmologists were 36 to 45 years old. In terms of years in practice, the largest proportion of respondents (28.3%) had 6-10 years of experience. Most of the participants worked in private/foundation universities (37.2%), while 22.1% worked in education and research clinics. Participants working at public universities most often reported that they or a close contact had to work in COVID wards (89.5%). Triage was performed in 51.5% of ophthalmology outpatient clinics, with 88.0% of these participants reporting that patients with fever, cough, or dyspnea were directed to the pandemic clinic without ophthalmological examination. All participants working in public hospitals, education and research clinics, and public university hospitals had postponed elective surgeries, whereas 12.5% of those working in private practice and 20.5% of those working in private/foundation universities reported that they continued elective surgeries. While 80.8% of the participants did not conduct online interviews or examinations, 40.4% stated that they considered telemedicine applications beneficial. Seventy-seven percent of participants expressed concern about a decrease in their income during the pandemic, with this being especially common among participants working in private practice (87.5%) and private/foundation university hospitals (85.7%). Conclusion: ophthalmologists across our country have been affected by this pandemic at a level that will change their clinical approach. We think that ophthalmologists impacted by the difficulty of providing personal protective equipment and economic concerns should be supported more during the pandemic., NA

PURPOSE To investigate the repeatability of choroidal vascularity index (CVI) measurements in centered and decentered (regarding pupil entry position of the beam) directional subfoveal optical coherence tomography (OCT) scans with (CVI1) and without (CVI2) brightness adjustment. METHODS Thirty-two eyes of 32 healthy volunteers were included in this prospective study. First, the fovea was evaluated by a single horizontal enhanced depth imaging OCT scan in a centered direction. Then, the same subfoveal horizontal line was scanned in a decentered direction. The agreement between CVIs obtained from these centered and decentered directional OCT scans was investigated using Bland-Altman analysis and intraclass correlation coefficient. RESULTS Intraclass correlation coefficient between centered and decentered CVI1 was 0.71 (95% CI: 0.48-0.85, P value < 0.001). Intraclass correlation coefficient between centered and decentered CVI2 was 0.73 (95% CI: 0.5-0.86, P value < 0.001). The mean difference between centered and decentered directional measurements for CVI1 and CVI2 were 0.5 and 0.8, respectively. CONCLUSION There is moderate agreement between CVIs obtained from centered and decentered directional single OCT scans of the same subfoveal area. Studies investigating choroidal vascularity should be standardized by using the same OCT beam direction in all scans.

SIGNIFICANCE Choroidal vascularity index measured by image binarization method from peripapillary optical coherence tomography sections has been found significantly lower in papilledema patients than healthy controls. PURPOSE The purpose of this study was to compare peripapillary choroidal parameters in papilledema patients with control subjects. METHODS Peripapillary spectral domain optical coherence tomography scans of 34 patients with papilledema and 34 healthy controls are acquired for the study. Images are binarized with the ImageJ software (National Institutes of Health, Bethesda, MD) to calculate total choroidal area, stromal area, luminal area, and choroidal vascularity index. RESULTS Total choroidal area, luminal area, and choroidal vascularity were significantly lower in papilledema patients compared with healthy controls on right (1.343 ± 0.286 vs. 1.694 ± 0.344, P < .001; 0.880 ± 0.209 vs. 1.167 ± 0.255, P < .001; 65.28 ± 2.99% vs. 68.68 ± 2.81%, P < .001, respectively) and left eyes (1.376 ± 0.308 vs. 1.647 ± 0.339, P < .001; 0.899 ± 0.231 vs. 1.134 ± 0.237, P < .001; 64.92 ± 3.44 vs. 68.84 ± 3.23, P < .001, respectively). No difference was found between active and remitted stages of papilledema in terms of choroidal parameters. CONCLUSIONS Peripapillary total choroidal area, luminal area, and choroidal vascularity index are significantly reduced in patients with papilledema. These parameters might be beneficial tools for evaluating choroidal vascularity in papilledema quantitatively and differential diagnosis for optic disc edema.

OBJECTIVE Blood pressure variability (BPV) is considered as a novel risk factor for cardiovascular disease including left ventricular hypertrophy, vascular stiffness, and renal dysfunction. In this study, we aimed to determine the relationship between ambulatory BPV with subclinical organ damage and vascular stiffness parameters in normotensive healthy subjects. METHODS A total of 100 healthy subjects over 18 years of age were included in this cross-sectional study. We divided the participants into two groups according to the median value of the SD of mean 24-h blood pressure (BP) (Group 1: SD of mean 24-h BP 10.15). BPs of these subjects were recorded over a 24-h period using ambulatory BP monitoring. Mobil-O-Graph device was used to estimate the augmentation index (AIx), pulse wave velocity (PWV), and ambulatory BP measurement. The choroidal thickness was measured by using optical coherence tomography device. RESULTS The mean age of the patients was 25.4 ± 5.0 years. Choroidal thickness was correlated with PWV, AIx, protein excretion, and SD of systolic and diastolic BP (P < 0.05). Additionally, participants with higher BP variability have lower choroidal thickness and higher AIx. CONCLUSION We showed that even in normotensive subjects, BPV correlates with choroid thickness. Thus, BPV can be an early prognostic parameter for pathologic vascular changes.

Purpose To investigative the effects of sex steroids on hyperosmolar stress-induced proinflammatory cytokine expression of tumor necrosis factor-alpha (TNF-α), interleukin (IL)-8, and IL-6, and on the mitogen-activated protein kinase pathway in immortalized human corneal epithelial cells (hCECs). Methods Immortalized hCECs were cultured with keratinocyte-free medium until reaching 80% confluency with either 10 M dihidrotestosteron (DHT) or 10 M 17-β-estradiol, and then, the medium was changed to hyperosmolar for various time points. After hyperosmolar treatment, a real-time polymerase chain reaction was performed to show the TNF-α, IL-8, and IL-6 gene expression levels in hCECs. In addition, the treated cells were lysed, and Western blot analysis was applied for phosphorylated and nonphosphorylated forms of extracellular signal-regulated kinase 1/2 (ERK1/2), p38 kinase, and c-Jun N-terminal kinase 1/2 (JNK1/2). hCECs viability was measured with Annexin V/propidium iodide. Results Pretreatment with 10 M DHT or 17-β-estradiol inhibited the high osmolarity-induced expression of TNF-α, IL-8, and IL-6. The upregulation of p-ERK, p-JNK, and p-p38 with high osmolarity was inhibited partially by DHT, but 17-β-estradiol pretreatment only affected p-p38 for a short time interval. In addition, DHT increased cell viability of hCECs under hyperosmolar conditions. Conclusions Our results demonstrated that DHT and 17-β-estradiol decreased the proinflammatory cytokine gene expression levels which were stimulated by high osmolarity in immortalized hCECs. The mitogen-activated protein kinase signaling pathway is partially involved in the regulatory effects of DHT on hCECs. These findings may contribute to the etiologic role and therapeutic implications of sex steroids in certain ocular surface diseases.

Background The use of neuroimaging, the General Movement Assessment (GMA), and the Hammersmith Infant Neurological Examination (HINE) to identify the risk of neurodevelopmental delay in early infancy is recommended. Aim The aim of this study was to examine the predictive power of neuroimaging, GMA and HINE for neurodevelopmental delay and cerebral palsy (CP) in infants with hypoxic ischemic encephalopathy (HIE) who were treated with hypothermia. Study design Retrospective cohort. Subjects and outcome measures This retrospective study included 47 (18 female and 29 male) infants who were treated with hypothermia due to HIE. Neonates with a diagnosis of HIE were followed and assessed using neuroimaging, GMA, HINE and the Bayley Scales of Infant and Toddler Development-II (Bayley II) between 3 m and 2 years of age. Results Out of the 47 infants with HIE, no fidgety movements were observed in 5 infants. The sensitivity and specificity in determining the psychomotor developmental index (PDI) score were 97% and 100%, respectively, for MRI; 92.9% and 100% for GMA; and 91.9% and 80% for the HINE. The sensitivity and specificity in determining the mental developmental index (MDI) score were 95% and 85.7%, respectively, for MRI; 90.5% and 80% for GMA; and 91.9% and 50% for HINE. The sensitivity and specificity in determining CP diagnosis at the age of 2 years were 83.3% and 95%, respectively, for MRI; 83.3% and 100% for GMA; and 83.3% and 87.8% for HINE. Conclusion The interpretation of MRI, GMA, and HINE that are performed within the early period of life may be the gold standard for the early detection of neurodevelopmental risks in 2-year-old infants with HIE. Clinical implementation of these methods in the early period in the follow-up of these infants offers useful information for the early identification of neurodevelopmental risk and for planning early intervention.

STUDY DESIGN Cross-cultural adaptation and psychometric analysis. OBJECTIVE To develop the Turkish version of the Fremantle Back Awareness Questionnaire (FreBAQ-T) and to evaluate its psychometric properties. SUMMARY OF BACKGROUND DATA There is a growing interest in the role that the disturbance of body perception may lead to long-lasting pain problems such as chronic low back pain (CLBP). The Fremantle Back Awareness Questionnaire (FreBAQ) is a simple and low-cost way of evaluating disturbed back awareness in people with CLBP. METHODS The FreBAQ was translated from English into Turkish using the forward-backward-forward method. One hundred four participants with low back pain completed the FreBAQ-T. The FreBAQ-T was repeated in 15 participants after 1 week to establish test-retest reliability. Although internal and external construct validity was investigated using Rasch analysis and Spearman correlation coefficient, respectively; reliability was evaluated in terms of internal consistency by Cronbach alpha and Person Separation Index. RESULTS All items of the FreBAQ-T were found to fit the Rasch Model (chi-square 6.17 [df = 9], P = 0.723). The internal construct validity was good, overall mean item fit residual was -0.305 (standard deviation: 0.369) and mean person fit residual was -0.290 (standard deviation: 1.349). The reliability was good with Cronbach alpha of 0.87 and Person Separation Index of 0.82. When the test-retest was examined via differential item functioning by time, none of the items showed differential item functioning. CONCLUSION The FreBAQ-T is a valid, reliable, and unidimensional scale for patients with CLBP. This scale will allow assessing back-specific perception in the Turkish population with CLBP. LEVEL OF EVIDENCE 3.

PURPOSE: To investigate the efficacy of lid wipes (LWs) containing terpinen-4-ol and sodium hyaluronate (Hy-ter(®)) for the treatment of seborrheic blepharitis compared to baby shampoo (BS). METHODS: This randomized, double-blind, active control, parallel group, multicentre clinical trial included 48 eyes of 48 patients with seborrheic blepharitis who were randomly divided into two treatment arms (1:1, n = 24) using block randomization. LWs or BS were prescribed twice a day for 8 weeks followed by a discontinuation period of 4 weeks. Change in Blepharitis Symptom measure (BLISS), Schirmer’s test, tear breakup time (TBUT), noninvasive TBUT (NI-TBUT), ocular surface disease index (OSDI) score, corneal and conjunctival staining, meibography, and Demodex count at different visits (Baseline, 4th, 8th, and 12th week) were the main outcome measures. RESULTS: The baseline values of both groups were similar (p > 0.05). Despite high clinical efficacy in both treatment arms, patients using LWs showed a lower BLISS score at the 8th and 12th-week visit (1.9 ± 2.2 versus 7.2 ± 6.6, p = 0.003; 4.0 ± 1.3 versus 5.8 ± 6.3, p = 0.026). NI-TBUT showed a significant increase starting from the 4th week for patients using LWs and 8th week for patients using BS. Both treatment modalities caused a reduction in the Demodex count after 4 weeks of treatment (p

PURPOSE The comparison of the efficacy of swabs containing tea tree oil and chamomile oil and baby shampoo (BS) in the treatment of seborrheic blepharitis was aimed. METHODS This randomized, double-blind, parallel-group, active control, multicenter clinical trial included patients with seborrheic blepharitis using block randomization (BS, n=23; swabs, n=26). Patients were treated with BS or swabs for 8 weeks followed by 4 weeks of treatment withdrawal. Change in Blepharitis Symptom measure (BLISS), Demodex count, Ocular Surface Disease Index (OSDI) score, Schirmer test, tear breakup time (TBUT), noninvasive TBUT (NI-TBUT), corneal staining, and meibography at different visits (baseline, fourth, , and 12th week) were the main outcome measures. RESULTS Patients in both groups showed similar baseline parameters (P>0.05). Patients using swabs showed significantly lower BLISS scores compared with patients using BS at the 4th, 8th, and 12th week visits (3.6±6.1 vs. 6.3±4.5 P=0.011; 1.1±2.8 vs. 6.6±6.7, P

To compare corneal in-vivo confocal microscopy (IVCM) findings in patients with seborrheic blepharitis with healthy controls and to evaluate the correlation with theSixty-twoThe mean DCD of eyes in low (37.62 ± 25.18 cells/mm

The comparison of the diagnostic efficiency of a reference method (light microscopy [LM] using 10% potassium hydroxide [KOH]) with the use of 100% alcohol toEyelashes were epilated from the right eyes for the reference method and the left eyes for the alcohol group in 58 eyes of 29 patients. IVCM was used on the left eyes. The primary outcomes were the number ofThe rate ofKOH was found to be superior in terms of the quantification of mites compared to alcohol and IVCM.

Purpose: in vivo confocal microscopy (IVCM) is a noninvasive, reproducible, and inexpensive diagnostic tool for corneal diseases. However, widespread and effortless image acquisition in IVCM creates serious image analysis workloads on ophthalmologists, and neural networks could solve this problem quickly. We have produced a novel deep learning algorithm based on generative adversarial networks (GANs), and we compare its accuracy for automatic segmentation of subbasal nerves in IVCM images with a fully convolutional neural network (U-Net) based method. Methods: we have collected IVCM images from 85 subjects. U-Net and GAN-based image segmentation methods were trained and tested under the supervision of three clinicians for the segmentation of corneal subbasal nerves. Nerve segmentation results for GAN and U-Net-based methods were compared with the clinicians by using Pearson's R correlation, Bland-Altman analysis, and receiver operating characteristics (ROC) statistics. Additionally, different noises were applied on IVCM images to evaluate the performances of the algorithms with noises of biomedical imaging. Results: the GAN-based algorithm demonstrated similar correlation and Bland-Altman analysis results with U-Net. The GAN-based method showed significantly higher accuracy compared to U-Net in ROC curves. Additionally, the performance of the U-Net deteriorated significantly with different noises, especially in speckle noise, compared to GAN. Conclusions: this study is the first application of GAN-based algorithms on IVCM images. The GAN-based algorithms demonstrated higher accuracy than U-Net for automatic corneal nerve segmentation in IVCM images, in patient-acquired images and noise applied images. This GAN-based segmentation method can be used as a facilitating diagnostic tool in ophthalmology clinics. Translational relevance: generative adversarial networks are emerging deep learning models for medical image processing, which could be important clinical tools for rapid segmentation and analysis of corneal subbasal nerves in IVCM images., Scientific and Technological Research Council of Turkey (TÜBİTAK)

Aims One of the impairments evaluated in children with cerebral palsy (CP), which perhaps has been least investigated, is reduced selective motor control. The aim of the present study was to determine construct validity, discriminative validity, and intra- and interrater reliability of the Selective Control of the Upper Extremity Scale (SCUES). Methods Thirty-three children with unilateral CP, with a mean age of 11.5 +/- 3.3 years, at level I to IV according to the Manual Ability Classification System (MACS), participated. The children were video-recorded and scored using the SCUES. The videos were scored twice to determine the intra- and interrater reliability. Reliability was assessed using the intraclass correlation coefficient, the standard error of the measurement (SEM), and the smallest real difference (SRD). Differences in the SCUES scores were determined between the less- and more-affected arm and across all MACS levels for discriminative validity. Construct validity of the SCUES was established by the MACS, and the Jebsen Taylor Hand Function Test (JTT). Results SCUES scores were significantly different between the less- and more-affected arm (p< .001) and between the arm joints. SCUES scores were also significantly different among MACS levels (p< .001). The SCUES was strongly correlated with the JTT (Spearman's rho = -0.80,p< .001) and MACS (rho = -0.78,p< .001). Intra- and interrater reliability were excellent (intraclass correlation coefficient [ICC] > 0.75) for all joints of the more-affected extremity. The SRDs at the 95% confidence level for intra- and interrater reliability were 2.11 and 1.16, respectively. Conclusions The SCUES is a valid and reliable tool to assess selective motor control of the upper extremity in children with unilateral CP.

The pine processionary caterpillar is an insect that has multiple small, thin hairs around its body as a defense mechanism. These hairs have a hazardous effect on ocular structures and cause a broad range of reactions from conjunctivitis to endophthalmitis, referred to as ophthalmia nodosa. The diagnosis of the disease is based on the patient's history and the detection of the hairs on ocular structures. In this report, we present a patient with ophthalmia nodosa misdiagnosed as fungal keratitis, and the actual diagnosis was made by in vivo confocal microscopy. We also would like to increase awareness among ophthalmologists about the disease which has a growing distribution area due to climate change., NA

To evaluate clotting dynamics by a new tool called rotational tromboelastometry (ROTEM) in retinal vein occlusion.Thirty-six patients who were diagnosed with retinal vein occlusion and 43 age and sex matched healthy controls were included in this study. Diabetes and use of anticoagulant therapy were exclusion criteria. All study participants underwent detailed ophthalmologic and systemic medical examination, including blood pressure measurement, hemoglobin-hematocrit levels, platelet count, coagulation parameters including prothrombin time, activated partial thromboplastin time, fibrinogen levels, and D-dimer levels. Peripheral blood samples were collected and analyzed with ROTEM Coagulation Analyzer (Tem International, Munich, Germany).The RVO patients and controls did not differ with respect to age, sex, hemoglobin, hematocrit, platelet numbers, prothrombin time, activated partial thromboplastin time, fibrinogen levels, D-dimer levels, and glucose levels. When extrinsic thromboelastometry results were analyzed, RVO patients showed a significantly decreased clotting time (76.5 ± 15.0 vs. 95.0 ± 21 s, respectively; p = 0.01) and clot formation time (83.3 ± 22 vs. 99.7 ± 24s; p = 0.01) as compared with healthy controls. Other ROTEM parameters did now show any difference between two groups.Patients with retinal vein occlusion showed faster clotting time and shorter clotting formation time as compared with healthy controls. ROTEM detects the altered clotting dynamics and may be a useful tool to elucidate the disease pathophysiology. Further studies are needed to investigate if it can be used as a screening test for individuals who are under risk to develop RVO or as a first step test to evaluate hypercoagulable state in RVO.

Light cigarettes which are launched as fewer harmful threaten to community health because of so many diseases related with smoking. Therefore, research of light cigarette using rates and related factors might be beneficial along with research of smoking frequency in community. The aim of this study is to evaluate light cigarette smoking habit of staff and students of school of medicine. This cross-sectional study was conducted on staff and students of Ankara University School of Medicine in 2004. 216 (34%) light cigarette smokers of 627 people (344 students, 283 staff) were evaluated in this study. Questionarie form was applied to participants by face-to-face interview, chi-square and ANOVA analyse method were used for evaluation. Participant's profile was 51.4% male and 48.6% female. Mean age of the participants was calculated as 31.17 +/- 8.84. Light cigarette use was stated by 23.7% of smokers. Relationship between light cigarette use and various factors has been examined and it was found that light cigarette use rate was higher in females (p= 0.04). Smoking start age was detected lower in light cigarette smokers (18.59 +/- 2.87) rather than smokers (19.76 +/- 3.42). One over five person was found as light cigarette smokers among the participants. Light cigarette use rate is higher in females and smoking starting age is lower in light cigarette smokers. Relationship between female gender and smaller starting ages were considered as preference of the groups that had awareness in harmful effects of smoking especially light cigarette smoking and tried to reduce risks. In opposition to light cigarette had fewer harmful health effects, community must be made conscious about this belief may cause an increase in smoking prevalence in community.