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Purpose To evaluate the serum inflammatory marker levels in serous macular detachment (SMD) secondary to diabetic macular edema (DME). Material and Methods Patients with DME were divided into two groups according to the presence of SMD. Group 1 consisted of 40 patients with SMD, Group 2 consisted of 40 patients without SMD, and Group 3 consisted of 40 healthy subjects. Neutrophil and mean platelet volume (MPV) were obtained from blood samples. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and the systemic immune inflammation index (SII) were calculated. In Group 1 and 2 sub-group analysis was done according to grade of diabetic retinopathy (DR) and the results were analyzed in these subgroups. Results The neutrophils, MPV, NLR, and SII levels were significantly higher in Group 1 ( p = 0.000, p = 0.004, p = 0.000, p = 0.001, respectively). In subgroup analysis; the neutrophils, NLR, and SII levels were significantly higher in patients with proliferative DR ( p = 0.044, p = 0.046, p = 0.046, respectively) and the SII levels were significantly higher in patients with severe nonproliferative DR in Group 1 ( p = 0.039). The mean CMT values were 548.8 ± 138.3 µm in Group 1 and 420.1 ± 112.7 µm in Group 2. The CMT values were significantly higher in Group 1 ( p: 0.000). However, there was no significant correlation between the CMT values and the systemic inflamatuar markers levels ( p>0.05) in both of the groups. Conclusions NLR and SII levels were significantly higher in DME with SMD, especially in advanced cases. Elevated serum inflammatory markers might be associated with a higher incidence of SMD.

To evaluate effects of glaucoma and central corneal thickness (CCT) on optic nerve head biomechanics.Four groups were formed according to CCT measurements and the presence of glaucoma. Glaucomatous patients with thin ( 510 µ) and thick ( 570 µ) corneas composed groups 1 and 3, respectively. Nonglaucomatous patients with thin and thick corneas composed groups 2 and 4, respectively. Real-time elastography (RTE) was performed on all groups, and optic nerve strain rate (ONSR), orbital fat strain rate (OFSR), and strain ratio of orbital fat to the optic nerve and medial and lateral parts of the optic nerve (SROFON, SROFMON, SROFLON, respectively) were obtained and compared between groups. The correlations between CCT and these parameters were also investigated.Statistically significant difference was not found between groups in terms of strain rate of optic nerve and orbital fat, SRFON, SROFMON and SROFLON. There was a positive correlation between ONSR and OFSR and mean CCT in patients with CCT thinner than 510 µ (p: 0.03 r: 0.26, p: 0.01 r: 0.32 respectively).SROFON, SROFLON and SROFMON values did not differ between glaucomatous and nonglaucomatous patients with thin or thick CCTs. The correlations between CCT and OFSR and ONSR were found to be statistically significant in patients with thin CCT.

Background: The aim of this study is to investigate the distribution of refractive errors needed to be correct in childhood. Material and methods: Children applied and received glasses prescriptions were recruited. Age, gender, spherical, cylindrical error, and spherical equivalent (SE) were noted. The refractive errors were classified as myopic, hyperopic and cylindrical errors according to the SE and prescriptions. Cylindrical errors were subdivided into myopic, hyperopic. Children were classified into 4 groups. Group 1, 2, 3 and 4 composed of children whose ages were between 0–5, 6–10, 11–15 and 16–18 years, respectively. Results: There were 846 children in group 1, 3931 in group 2, 5948 in group 3, 3896 in group 4, and a total of 14621 children. The rates of myopia and hyperopia were 72.4% and 27.6%. Myopic and hyperopic astigmatism were found in 29.1% and 11.3% of children. Myopia, myopic astigmatism increased with age (p < 0.05). The hyperopia rate decreased with decreasing age (p < 0.05). The frequency of myopia, myopic astigmatism was higher in both male and female children (p < 0.05). The rate of myopia was higher in females (p < 0.05). There was no statistically significant difference in terms of cylindrical value between genders. The statistically significant difference was found in terms of mean SE among all groups and a negative correlation was present between age and mean SE. A lower negative correlation was stated between age and cylindrical value. Conclusion: Corrected myopic and myopic astigmatism errors were higher than hyperopic refractive errors. The prevalence of myopia increased by age and was higher in females. The need for glasses was highest in children whose age range was between 11 and 15 years.

Background: The aim of this study is to analyze the numbers and the economic burden of intravitreal anti-VEGF agents and intravitreal dexamethasone (IVD) implants administered to patients with diabetic retinopathy (DR), age-related macular degeneration (AMD) and retinal vein occlusion (RVO). Material and methods: The retrospective case-control study included 1525 patients diagnosed with DME, neovascular AMD and RVO, and received intravitreal anti-VEGF and IVD between January 2016 and December 2018. Intravitreal anti-VEGF administration was performed within the framework of the Pro Re Nata (PRN) regimen. The prices of anti-VEGF agents and IVDs were calculated on the average of the prices in the relevant year. Results: The total number of intravitreal injections in 3 years was 5864. During the 3-year follow-up, on average, ranibizumab (Lucentis) was applied 3.56 ± 2.25 times, alfibercept (Eylea) was applied 3.31 ± 2.16 times, and IVD (Ozurdex) was applied 1.70 ± 0.83 times. The anti-VEGF numbers in 2016, 2017 and 2018 were 1997, 1801, 2066, respectively. In total, the 3-year drug cost was 3,587,812.44 USD. Conclusions: The economic burden of intravitreal anti-VEGF and IVD treatment for retinal diseases is so important to developing countries such as Turkey. The economic burden created by anti-VEGF agents and IVDs in Turkey will reduce in a serious sense, and the legal concerns of physicians will decrease thanks to the decision taken by the Turkish Medicines and Medical Devices Agency (TMMDA).

Purpose: To evaluate the effect of topical antiglaucomatous medications on central corneal epithelial thickness measured by anterior segment optical coherence tomography. Materials and methods: A total of 153 eyes of 153 patients using topical antiglaucomatous medications and 110 eyes of 110 control subjects were enrolled. Glaucoma type, duration of therapy, the number of drugs, and drops/day were noted in the patient group. Patients and control subjects underwent ocular examinations including Schirmer test, slit lamp examination for tear film break-up time, and anterior segment optical coherence tomography for central corneal thickness and central corneal epithelial thickness. Central corneal epithelial thickness and other data were evaluated separately with regard to glaucoma type, duration of therapy, the number of drops, and drugs in the patient group. Results: The mean ages of the patients and controls were 60.1 ± 10.8 and 58.7 ± 11.2 years, respectively. The groups were similar with regard to mean age and gender (p = 0.058, p = 0.734, respectively). The median (interquartile range) central corneal thickness was 536 (54) µm in patients and 552 (53) µm in controls (p = 0.011). The median (interquartile range) central corneal epithelial thickness of patients and controls were 56 (4) µm and 60 (8) µm, respectively (p Conclusion: Using topical antiglaucomatous medications seems to affect the central corneal epithelial thickness in glaucoma patients. Central corneal epithelial thickness was thinner in glaucoma patients than controls. Anterior segment optical coherence tomography might be helpful to evaluate the effect of antiglaucomatous medications on central corneal epithelial thickness during treatment.

Purpose: To investigate whether pseudoexfoliation syndrome affects arterial stiffness by using cardio-ankle vascular index measurement. Methods: This cross-sectional case-control study included 55 patients with pseudoexfoliation syndrome and 106 age- and gender-matched healthy control subjects. All subjects underwent a complete ophthalmic exa mination of both eyes and cardio-ankle vascular index measu rements. Echocardiographic and body mass index measurements were performed in all patients, and the results were recorded. A binary regression model was used to determine the relationship between cardio-ankle vascular index and pseudoexfoliation. Results: There were no significant differences between the pseudoexfoliation and control groups in baseline clinical and demographic characteristics, echocardiographic measurements of left ventricular ejection fraction, and body mass index. The mean cardio-ankle vascular index value was significantly higher in the pseudoexfoliation group than in the controls (9.47 ± 1.23 vs. 8.33 ± 1.50, p

Purpose: To evaluate the efficiency and possible complications of intravitreal dexamethasone (IVD) implant in diabetic macular edema (DME) resistant to treatment of three consecutive intravitreal ranibizumab (IVR) injections. Methods: Fifty eyes of 38 patients were considered in this study. The best corrected visual acuity (BCVA), central macular thickness (CMT), and values of intraocular pressure (IOP) were examined preoperatively and postoperatively in the 1st, 2nd, 4th, and 6th months of IVD implantation. Results: Twenty of the patients were women, and 18 of the patients were men. Mean age was 64.63 ± 7.15 (52–83) years. Mean number of IVR injection before IVD implantation was 3.4 ± 0.38. Mean BCVA (logMAR) was 0.874 ± 0.398 before IVD implantation, 0.598 ± 0.306 at the 1st month, 0.602 ± 0.340 at the 2nd month, 0.708 ± 0.359 at 4th month, and 0.800 ± 0.370 at 6th month. Mean of CMT was 519.700 ± 155.802 μm before IVD implantation, 274.000 ± 73.112 μm at the 1st month, 307.98 ± 87.869 μm at the 2nd month, 387.82 ± 110.503 μm at 4th month, and 478.54 ± 163.743 μm at 6th month. Improvements in BCVA and CMT were statistically significant (P

Purpose: To evaluate ophthalmic examination results which were performed with slit-lamp biomicroscope, in patients with laboratory-confirmed SARS-CoV-2 infection. Methods: In the present study, 50 ...

To evaluate the influence of strong fixation preference on clinical and surgical outcomes, in non-amblyopic patients with basic-type intermittent exotropia (IXT). The records of patients were retrospectively investigated. Non-amblyopic patients with the diagnosis of basic-type IXT were enrolled and divided into two groups according to the presence of strong fixation preference (SFP). Best-corrected visual acuity, refractive errors, deviations in near and distance, convergence patterns, motor fusion, stereopsis were evaluated and compared. Patients who underwent surgery in each group composed subgroups and postoperative deviations, convergence patterns, motor fusion, and stereopsis were compared. Seventy-seven patients were enrolled and divided into two groups according to the presence of SFP: patients with SFP composed Group 1 and patients with alternating fixation composed Group 2. Statistically significant difference was seen between groups in terms of motor fusion (p: 0.02). Other parameters did not differ between groups. Data obtained from patients in subgroups of each group were not statistically different. The evaluation of basic-type exotropic patients according to their fixation preference revealed us that motor fusion might be affected by strong fixation preference. We also observed that SFP did not affect surgical success rates, convergence patterns, and stereopsis of exotropic patients.

To assess topographic findings, anterior segment parameters and high-order aberrations (HOAs) by using corneal tomography in children with 2 diopters (dp) or more astigmatism. Children with 2 dp or more astigmatism (study group) and children with astigmatism less than 1 dp (control group) were recruited. Corneal astigmatism, mean, steep, flat keratometry (K) findings, anterior and posterior K results and anterior segment parameters including anterior chamber depth, kappa distance, horizontal corneal diameter, mean, central, middle, peripheral corneal thicknesses (CT), white-to-white (WTW) distance and pupil diameter were measured by Galilei G4 Dual Scheimpflug corneal tomography. HOAs were also assessed and compared between groups. Fifty-eight eyes of 37 children in the study group and 37 eyes of 37 children in the control group were enrolled. The mean ages of groups were 9.7 ± 2.4 years and 9.3 ± 1.6 years in study and control groups, respectively. The mean astigmatism was 3.3 ± 1.1 dp and 0.5 ± 0.3 dp in study and control groups, respectively (p

Purpose: We aimed to compare the aqueous humor total oxidant status, total antioxidant capacity, and levels of interleukin-6 and vascular endothelial growth factor between patients with diabetic retinopathy and controls and to correlate these levels with the DR status. Methods: Patients who underwent cataract surgery were enrolled. The first group (control group) comprised patients without diabetes; the second group comprised diabetic patients without retinopathy; the third group comprised patients with nonproliferative diabetic retinopathy; and the fourth group comprised patients with proliferative diabetic retinopathy. All patients underwent full ophthalmologic examination before cataract surgery. Prior to surgery, samples of aqueous humor sampling were obtained and stored at -80 °C. Total antioxidant capacity, total oxidant status, and levels interleukin-6 and vascular endothelial growth factor were investigated in these samples and correlated with diabetic retinopathy status. Results: This study analyzed 86 pairs of eyes of 86 patients. All groups were statistically similar in age and sex, but the total antioxidant capacity was lowest in patients with proliferative diabetic retinopathy. Moreover, the total oxidant status and levels of vascular endothelial growth factor and interleukin-6 were found to slightly increase according to the retinopathy status. Conclusion: Oxidative stress, interleukin-6, and vascular endothelial growth factor in the aqueous humor seem to play important roles in the pathogenesis of diabetic retinopathy, especially in the proliferative type.

To measure and evaluate the thickness of the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) in patients with Parkinson's disease using optical coherence tomography (OCT).58 eyes of 30 patients with Parkinson's disease and 60 eyes of 30 healthy individuals were enrolled to this study according to defined criteria. RNFL thickness, central macular thickness (CMT) and ganglion cell-inner plexiform layer (GC-IPL) thickness were measured in these groups. The Parkinson's patient group was also subjected to Unified Parkinson's Disease Rating Scale (UPDRS) and Mini Mental Status Exam (MMSE).No difference was found between the two groups with respect to age, sex and the best corrected visual acuity (BCVA). Mean, superior, and inferior quadrant RNFL values in the Parkinson's patients were found statistically significantly lower than those in the control group (P 0.001, P 0.049, P 0.001, respectively). While CMT was statistically similar between the groups, GC-IPL thickness was statistically significantly lower in Parkinson's patients (p = 0.028). There was no significant correlation between the duration of Parkinson's disease and RNFL thickness. While there was not any correlation between UPDRS total and motor scores and superior and temporal quadrant RNFL thicknesses, a significant negative correlation was established between RNFL nasal, inferior quadrant and RNFL mean thicknesses (P = 0.022; P = 0.035; P = 0.002, respectively). A significant positive correlation was found between MMSE and nasal and mean RNFL thicknesses (P = 0.046; P = 0.019, respectively).RNFL and GC-IPL thicknesses were found lower in Parkinson's patients. These parameters may be useful to evaluate neurodegeneration and to monitorize neuroprotective therapies.

Emine Dogan,1 Ozkan Sever,2 Burcin Köklü Çakir,1 Erkan Celik1 1Department of Ophthalmology, Sakarya University Medical Education and Research Hospital, Sakarya, Turkey; 2Department of Ophthalmology, Namik Kemal University School of Medicine, Namik Kemal University, Tekirdag, Turkey Purpose: The aim of this study was to evaluate the effect of initial intravitreal ranibizumab injection on visual acuity (VA) and central macular thickness (CMT) for the treatment of macular edema (ME) with and without serous retinal detachment (SRD) secondary to branch retinal vein occlusion (BRVO). Materials and methods: Fifty-two BRVO eyes, treated with intravitreal ranibizumab injection for ME with and without SRD, were retrospectively reviewed. Patients were divided into two groups according to spectral domain optical coherence tomography (SD-OCT). The efficacy of intravitreal ranibizumab injection at first month was assessed by analyzing the change in best-corrected VA and reduction in CMT with SD-OCT. Results: There were 21 patients with SRD and 31 patients with only CME (no-SRD). CMT was significantly greater in the SRD group than in the CME group (451±62.2 µm vs 383.5±37.2 µm, respectively, P

Objective Diabetes mellitus (DM) is a chronic hyperglycemic state and is associated with microvascular structural alterations. This study aimed to investigate the diameters of capillary loops and morphostructural changes using nailfold video capillaroscopy (NVC) in patients with type 2 DM with and without diabetic retinopathy (DR). Methods This cross-sectional, single-center study was conducted in patients with type 2 DM who were followed in outpatient clinics of ophthalmology and internal medicine. General demographic data were collected from patients. An ophthalmologist examined all patients in terms of DR. A rheumatologist blinded to the clinical data performed NVC. The diameters of apical, arterial, and venous loop of capillaries were measured, and the microvascular changes of capillaries were scored. Results In this study, 44 patients with type 2 DM with DR (47.7% males) and 20 patients with type 2 DM without DR (55% males) were included. In our study, patients with type 2 DM with DR had more frequent capillary hemorrhage, more frequent ectasia, more frequent giant capillary, and more frequent neo-angiogenesis than patients with type 2 DM without DR. However, these findings were not statistically significant. Conclusion Further controlled studies with large sample size are needed to determine the characteristic NVC findings of DR in patients with type 2 DM.

Summary Purpose To investigate the effects of artificial tear treatment on central corneal epithelial thickness, and central, mid-peripheral and peripheral corneal thicknesses in patients with dry eye disease (DED). Material-methods Patients with DED underwent ocular examinations, including Schirmer-2 test, slit lamp examination for tear break-up time (BUT), corneal topography (CT) for measuring mean central, mid-peripheral and peripheral corneal thickness values and anterior segment optic coherence tomography (AS-OCT) for obtaining central corneal epithelial thickness. After artificial tear treatment (carboxymethylcellulose and sodium hyaluronate formulations) for one month, patients were examined again at a second visit and the results were compared. Results Sixty-one eyes of 33 female dry eye patients (mean age: 38.3 ± 5.7 years) were enrolled. The mean follow-up time was 36.4 ± 3.3 days. The mean tear BUT and Schirmer-1 tests revealed significant improvement after treatment (P = 0.000, P = 0.000, respectively). Central corneal epithelium and mean mid-peripheral corneal thicknesses measured significantly higher after treatment ( P = 0.001, P = 0.02). Changes in central and peripheral corneal thicknesses were not statistically significant. Conclusion Artificial tear treatment in dry eye patients seems to increase central corneal epithelial and mid-peripheral corneal thicknesses. Measurement of corneal epithelial thickness can be a useful tool for evaluation of treatment response in dry eye patients. Further long-term prospective studies are needed to investigate this item.

Objectives: To compare macular thickness, best-corrected visual acuity (BCVA), and intraocular pressure (IOP) changes after Nd: YAG laser capsulotomy for posterior capsule opacification (PCO) in diabetic and non-diabetic eyes. Materials and Methods: Thirty-six eyes of 25 diabetic patients and 40 eyes of 25 non-diabetic patients were included. All patients was treated with Nd: YAG laser capsulotomy. Macular thickness measured by optical coherence tomography (OCT), IOP, and BCVA were evaluated before and 1 week, 1 month, and 3 months after the procedure. Results: There was no difference between the two groups in age, gender, and applied laser technique. The time interval between cataract surgery and laser capsulotomy was shorter in the group of diabetic patients (p=0.009). In both groups, BCVA was significantly increased 1 week after laser capsulotomy (respectively, p=0.023, p=0.016). However, there was no statistically significant difference between the two groups. There was no significant difference in macular thickness before and after the procedure between the two groups (p>0.05). However, in group 1, cystoid macular edema was observed in 2 eyes during follow-up. Despite prophylactic treatment, IOP remained around 21-30 mmHg in 3 patients in group 1 and 4 patients in group 2 at first day and at the end of the 1st week. IOP was controlled except in one glaucoma patient. In the two groups, IOP values before and after laser capsulotomy were not statistically significantly different (p>0.05). At first day, +2 cells in the anterior chamber were detected in 3 patients in group 1 and in 2 patients in group 2; at 1 week after routine topical steroid treatment, anterior chamber reaction was not observed. Conclusion: It is known that there is a breakdown in the blood-aqueous and inner blood-retinal barriers in diabetes, however, no difference was determined in visual improvement, macular thickness, and IOP when comparing diabetic to non-diabetic eyes. We observed that Nd: YAG laser capsulotomy is a safe and effective method for posterior capsular opacification in diabetic and non-diabetic patients. (Turk J Ophthalmol 2015; 45: 47-51)

To evaluate dynamic thiol/disulfide homeostasis in patients with chronic central serous chorioretinopathy (cCSC).This prospective study included 34 cCSC cases and 37 healthy individuals who were age- and sex-matched. A new colorimetric method for measuring thiol/disulfide homeostasis was used. Native thiol, total thiol/disulfide levels, disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol ratios were measured.The age and gender distributions were similar in both main groups. The mean duration of disease was 47.29 ± 24 months. Native and total thiol levels were significantly lower among the cCSC group relative to the control group (p0.001). There was not a statistically significant difference between the cCSC and the control group in terms of disulfide levels (p = 0.492). While disulfide/native thiol and disulfide/total thiol ratios were elevated, the native thiol/total thiol ratio was decreased in the cCSC group (p = 0.017, 0.021, 0.036, respectively). Ratios obtained using plasma native thiol, total thiol, and disulfide levels differed significantly between the both groups.Disulfide/thiol ratio was significantly greater in cCSC patients relative to healthy control subjects. Our results suggest that the oxidative process is involved in the pathogenesis of the cCSC.

Erkan Celik, Burcin Cakir, Elif Betul Turkoglu, Emine Doğan, Gursoy Alagoz Sakarya University Medical Education and Research Hospital, Sakarya, Turkey Purpose: We aimed to evaluate the effect of cataract surgery on subfoveal choroidal thickness (CT) and ganglion cell complex (GCC) thickness, as measured by enhanced depth imaging-optical coherence tomography (OCT). Methods: This prospective study included 30 eyes of 30 patients who had undergone uneventful phacoemulsification surgery for senile cataract but had no previous ocular surgery or other ocular abnormality. Best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure, axial length, and central corneal thickness were measured preoperatively. The operative times (OTs) and effective phaco times were also recorded in each case. OCT measurements were performed at the preoperative visit and 1month after cataract surgery. Study of CT and GCC thickness changes was the primary objective, but central macular thickness (CMT) and peripapillary retinal nerve fiber layer (RNFL) thicknesses were also obtained by OCT. Results: The mean subfoveal CT was 294.4±39.2µm preoperatively and 301.4±39.9µm postoperatively (P

Purpose: The aim of the present study was to evaluate visual acuity (VA) and central macular thickness (CMT) to assess the influence of serous retinal detachment (SRD) in eyes with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods: Sixty-one eyes with BRVO from 61 patients with ME were analyzed and divided into two groups according to the spectral domain optical coherence tomography (OCT) findings of SRD and cystoid macular edema (CME). All patients underwent complete ophthalmic examinations and OCT measurements (Cirrus, Carl Zeiss Meditec Inc, Dublin, CA). Patients with marked retinal hemorrhage, diabetic retinopathy, previous laser photocoagulation, and/or intravitreal injection were excluded. Results: The mean age of included patients (37 males, 24 females) was 65.4 ± 11.4 (53-77) years. There were 21 patients with SRD and 40 patients with CME. All of the 21 patients with SRD had CME. VA was significantly worse in the SRD group compared with the CME (non-SRD) group (0.82 ± 0.34 logMAR vs 0.64 ± 0.38 logMAR; P=0.005). Conversely, CMT was significantly greater in the SRD group than in the CME group (465 ± 115 µ vs 387 ± 85 µ; P=0.00004). Conclusion: SRD may be associated with decreased VA. The prognosis of patients with BRVO and SRD requires further investigation.

To evaluate the effect of smoking on ganglion cell complex and inner plexiform layer (GC-IPL) thickness measured by spectral domain optical coherence tomography (OCT).The right eyes of 36 smoking (study group) and 36 never-smoking (control group) healthy subjects were included in this study. After full ophthalmologic examination, axial length measurement (AL), ganglion cell complex-inner plexiform layer (GC-IPL) thickness, retinal nerve fiber layer (RNFL) thickness, and central macular thickness (CMT) values were measured by OCT. Statistical analysis was performed to compare GC-IPL, RNFL thicknesses, and CMT values between groups.The mean age [mean ± standard deviation (SD)] of 36 subjects in the study group was 26.2 ± 6.0 years, and the mean age of 36 subjects in control group was 25.7 ± 4.1 years. The mean ALs of the study group and the control group were 22.46 ± 0.88 and 22.36 ± 1.09 mm, respectively (p = 0.68). Mean GC-IPL thickness was 82.8 ± 3 µm in the study group and 84.3 ± 3 µm in the control group (p = 0.08). The mean RNFL values of study and control groups were 95. 8 ± 7.9 and 97. 3 ± 7.8 µm, respectively (p = 0.39). The mean CMT values of study and control groups were 248.3 ± 17.96 and 249.5 ± 17.18 µm, respectively (p = 0.78).Smoking does not seem to have any effect on GC-IPL thickness, mean RNFL and CMT values. Further studies in larger groups are needed to reveal the effect of smoking on these parameters.

The purpose of this study is to compare the choroidal thickness (CT) and ganglion cell complex (GCC) thickness of the normal fellow eyes and the amblyopic eyes using enhanced depth imaging optical coherence tomography (EDI-OCT) in young Turkish adults with hyperopic anisometropic amblyopia. Patients with unilateral hyperopic anisometropic amblyopia were enrolled and underwent a full ophthalmological assessment, including best-corrected visual acuity, cycloplegic refraction, and axial length (AL) measurements. Cirrus EDI-OCT was used to obtain subfoveal CT, GCC thickness, retinal nerve fiber layer (RNFL), and central macular thickness (CMT) measurements. Comparison was performed between the amblyopic eyes and the normal fellow eyes. Forty-three hyperopic anisometropic amblyopic patients were enrolled in this study. Mean age of 23 female and 20 male patients was 24.8 +/- A 7.4 years. Mean AL was 21.9 +/- A 1.3 and 22.4 +/- A 0.9 mm in amblyopic and fellow eyes, respectively (P < 0.05). Mean subfoveal CT measurements were 325.4 +/- A 44.2 and 317.9 +/- A 42.7 A mu in amblyopic and fellow eyes, respectively. There was no statistically significant difference between the groups (P > 0.05). Mean GCC thickness was 83.8 +/- A 3.6 A mu in amblyopic eyes and 83.5 +/- A 3.9 A mu in the fellow eyes. Statistically significant difference was not seen between the groups (P > 0.05). Mean RNFL and mean CMT measurements were also similar in two groups (P > 0.05). Subfoveal CT, CMT, RNFL, and GCC thickness measurements were not statistically significant between hyperopic anisometropic amblyopic eyes and normal fellow eyes.

To report the long-term visual results and anatomical outcome as assessed by optical coherence tomography (OCT) after pars plana vitrectomy (PPV) with removal of the internal limiting membrane (ILM) in diabetic macular edema (DME).Medical records of 27 eyes of 27 patients who underwent PPV with ILM removal for DME attributable to diffuse leakage were reviewed. This retrospective study included eyes that underwent PPV with ILM removal at our institution with preoperative and postoperative OCT assessment of DME. None of the eyes had OCT evidence of anteroposterior vitreomacular traction. Main outcome measures were foveal thickness and visual acuity changes.Foveal thickness decreased by at least 20% in 22 eyes (81.4%) and increased by at least 20% in 3 eyes (11.1%) with PPV and ILM removal (mean follow-up +/- SD, 27.6 +/- 7.2 months; range, 12-38 months). Mean foveal thickness decrease +/- SD was 178 +/- 164 microm (43.6%), with a mean preoperative foveal thickness +/- SD of 408 +/- 121 microm compared with a mean postoperative foveal thickness +/- SD of 230 +/- 74 microm (P0.001). Recurrence of DME was observed at postoperative month 24 in 2 eyes and postoperative month 30 in 1 eye. Visual acuity improved byor =2 lines in 10 eyes (37%) and decreased byor =2 lines in 3 eyes (11.1%). Mean best-corrected logMAR (logarithm of the minimum angle of resolution) visual acuity +/- SD was 0.75 +/- 0.35 preoperatively and 0.63 +/- 0.33 postoperatively (P = 0.033).PPV with ILM removal appears to be effective in reducing DME and improving visual acuity, and its effectiveness is maintained in the long term. Recurrence of DME may be observed in the late postoperative period.

Purpose To compare the effectiveness and safety of the "basic" technique with those of the "steamroller" technique in pneumatic retinopexy (PR) for primary rhegmatogenous retinal detachment. Methods In this prospective study, 40 eyes of 40 patients with primary rhegmatogenous retinal detachment were treated with PR by argon laser photocoagulation. PR with the steamroller technique (steamroller group) was performed randomly on 21 eyes of 21 patients, and 19 eyes of 19 patients were treated with PR with the basic technique (basic group). Main outcome measures were visual acuity, anatomical outcome, rate of proliferative vitreoretinopathy (PVR) development, and postoperative complications. Results Mean follow-up +/- SD was 14.7 +/- 9.9 months (range, 6-48 months). Single-operation success rate for all patients was 70% (28/40 eyes). Single-operation success rate was 74% (14/19 eyes) for the basic group and 67% (14/21 eyes) for the steamroller group (P = 0.629). PVR grade C-1 developed in one eye (5%) in each group. Overall success rate, after reoperations, was 100% for each group. Preoperative logMAR (logarithm of the minimum angle of resolution) visual acuity +/- SD was 2.01 +/- 0.43 in the basic group and 1.89 +/- 0.45 in the steamroller group (P = 0.434). Postoperative logMAR visual acuity +/- SD was 0.64 +/- 0.42 in the basic group and 0.46 +/- 0.35 in the steamroller group (P = 0.152). There was no statistically significant difference between basic and steamroller groups in terms of postoperative complications (P > 0.05). Conclusion Basic and steamroller techniques appear to be equally effective and safe in PR for primary rhegmatogenous retinal detachment. The risk for PVR development seems to be similar with either technique. Further studies with a large number of patients are required for a more reliable conclusion.

Aims: There are few reports on 25-gauge transconjunctival sutureless vitrectomy (TSV) in cases of pseudophakic retinal detachment. We conducted this study to report the anatomic and functional outcomes of 25-gauge TSV in the treatment of primary pseudophakic retinal detachment (RD). Design: Prospective, interventional case series. Materials and Methods: Fifteen eyes of 15 patients with RD after cataract surgery with phacoemulsification were evaluated. Primary pseudophakic RDs with macular detachment and proliferative vitreoretinopathy Stage B or less were included in the study. Pars plana vitrectomy with the 25-gauge TSV system, perfluorocarbon liquid injection followed by air exchange, endolaser photocoagulation and sulfur hexafluoride gas (20%) injection were applied to all eyes. Results: Mean follow-up time was 9.2 months (range, six to 12 months). Retinal reattachment with a single operation was achieved in 93% of eyes and with additional surgery, the retina was reattached in 100% of eyes. Preoperative visual acuity was less than 20/200 in all eyes (range, hand motions to 20/400). Postoperative visual acuity was 20/40 or better in eight eyes (53%) and between 20/50 and 20/200 in seven eyes (47%). No severe hypotony was encountered and no sutures were required to close the scleral and conjunctival openings. Postoperative complications were macular pucker in one eye (7%) and cystoid macular edema in another eye (7%). Conclusions: Primary 25-gauge TSV system appears to be an effective and safe procedure in the treatment of uncomplicated pseudophakic RD.

Burçin Çakir, Erkan Celik, Nilgün Özkan Aksoy, Özlem Bursali, Turgay Uçak, Erdinç Bozkurt, Gursoy AlagozSakarya University Education and Research Hospital, Sakarya, TurkeyPurpose: To report toxic anterior segment syndrome (TASS) after cataract surgery possibly associated with intracameral use of cefuroxime.Methods: We conducted a retrospective chart review and analysis on the pre- and postoperative conditions of the subjects who had developed TASS.Results: The patient group consisted of 17 patients. Tyndallization and fibrin fibers were positive in all eyes. In four eyes, hypopyon formation developed. These reactions diminished on the third day and fully resolved 1 week after the operations with the use of intensive topical steroid and mydriatic therapy. To determine the etiology of TASS, infusion fluid, viscoelastics, and intracameral antibiotic agent were changed respectively. After changing intracameral antibiotic agent from cefuroxime axetile to moxifloxacin no new cases of TASS were diagnosed.Conclusion: All agents injected into the anterior chamber can cause TASS. Ophthalmologists and operating room staff need to pay careful attention to all drugs and irrigating solutions.Keywords: phacoemulsification, fibrin reaction, drug toxicityALetter to the Editorhas been received and published for this article

To compare the changes in vision related quality of life (VR-QoL) in patients with diabetic macular edema (DME) undergoing intravitreal ranibizumab (IVR) injection or focal/grid laser.In this prospective study, 70 patients with clinically significant macular edema (CSME) were randomized to undergo IVR injection (n=35) and focal/grid laser (n=35). If necessary, the laser or ranibizumab injections were repeated. Distance and near visual acuities, central retinal thickness (CRT) and The 25-item Visual Function Questionnaire (VFQ-25) were used to measure the effectiveness of treatments and VR-QoL before and after 6 months following IVR or laser treatment.The demographic and clinical findings before the treatments were similar in both main groups. The improvements in distance and near visual acuities were higher in IVR group than the laser group (p0.01). The reduction in CRT in IVR group was higher than that in laser treatment group (p0.01). In both groups, the VFQ-25 composite score tended to improve from baseline to 6 months. And at 6th month, the changes in composite score were significantly higher in IVR group than in laser group (p0.05). The improvements in overall composite scores were 6.3 points for the IVR group compared with 3.0 points in the laser group. Patients treated with IVR and laser had large improvements in composite scores, general vision, near and distance visual acuities in VFQ-25 at 6 months, in comparison with baseline scores, and also mental health subscale in IVR group.Our study revealed that IVR improved not only visual acuity or CRT, but also vision related quality of life more than laser treatment in DME. And these patient-reported outcomes may play an important role in the treatment choice in DME for clinicians.

Summary Purpose To reveal the indications, clinical outcomes and complications of capsular tension ring (CTR) implantation in a series of consecutive phacoemulsification surgeries during a three-year interval. Methods A review of all patients undergoing cataract surgery with insertion of a CTR between 2010 and 2013 was conducted at our tertiary teaching ophthalmology department. The demographic details of patients, indications and clinical outcomes of CTR implantation were evaluated. Results Between 2010 and 2013, 4316 phacoemulsification surgeries were performed and of these surgeries CTR implantation was done in 41 eyes of 36 patients. The indications of CTR implantation were zonular dehiscence or weakness associated with mature cataract (29.2%), trauma (24.3%), pseudoexfoliation syndrome (19.5%), retinitis pigmentosa (14.6%), degenerative myopia (9.7%), and lens coloboma (2.4%). Posterior chamber intraocular lens (PCIOL) was implanted into the capsular bag in all eyes. Dislocation of PCIOL was not observed in any case. Transient IOP increased in 5 eyes (12%) and corneal edema in 14 eyes were noted. Posterior capsular opasification in 1 eye (2.4%), anterior capsule phimosis in 1 eye (2.4%) and cystoid macular edema in 1 eye (2.4%) were detected as late complications. Conclusion The frequency of CTR implantation was 0.97% due to our study. In complicated cataract surgeries, CTR implantation seems to improve clinical outcomes.

PURPOSE To evaluate the effectiveness of pars plana vitrectomy (PPV) with removal of the internal limiting membrane (ILM) in diabetic patients with macular edema unresponsive to grid laser photocoagulation. METHODS In this randomized controlled study, 20 eyes of 10 patients with diabetic macular edema unresponsive to grid laser photocoagulation were evaluated. PPV with ILM removal was performed randomly in one eye each of 10 patients and taken as the study group; the untreated fellow eyes were taken as the control group. Main outcome measures were foveal thickness changes measured with optical coherence tomography and preoperative and post-operative visual acuity. Mann-Whitney U, Wilcoxon, and chi-square tests were used in statistical analysis. RESULTS The mean age of the patients was 61.5+/-6 years (range 51 to 71). All patients were followed up for 12 months. In the study group, mean foveal thickness was 391.3+/-91.6 microm preoperatively and 225.5+/-49.4 microm postoperatively (p=0.009). In the control group, mean foveal thickness was 356.2+/-140 microm at baseline and 318.4+/-111.1 microm at 12-month follow-up (p=0.138). Mean decrease in foveal thickness was 165.8+/-114.8 microm in the study group and 37.8+/-71.2 microm in the control group (p=0.016). In the study group, best-corrected log-MAR visual acuity was 0.71+/-0.43 preoperatively and 0.54+/-0.45 postoperatively (p=0.125). In the control group, best-corrected logMAR visual acuity was 0.43+/-0.44 at baseline and 0.59+/-0.55 at 12-month follow-up (p=0.235). In the study group, visual acuity improved by two or more lines in 4 eyes (40%) and remained stable in 6 eyes (60%). In the control group, visual acuity improved by two or more lines in 1 eye (10%) and decreased by two or more lines in 3 eyes (30%). CONCLUSIONS PPV with ILM removal appears to be an effective procedure for reducing diabetic macular edema unresponsive to grid laser photocoagulation. A further study with a large number of patients is required to assess the effectiveness and safety of this procedure.

Purpose To evaluate the effectiveness, feasibility, and safety of the transconjunctival sutureless vitrectomy (TSV) system for a variety of vitreoretinal diseases. Methods In this retrospective study, the authors evaluated 71 eyes of 63 patients who underwent pars plana vitrectomy (PPV) with the 25-gauge TSV system. The indications for surgical intervention were diabetic vitreous hemorrhage (29 eyes), diabetic macular edema (14 eyes), macular epiretinal membrane (13 eyes), endophthalmitis (5 eyes), vitreous opacities secondary to Behçet's disease (4 eyes), vitreous hemorrhage secondary to branch retinal vein occlusion (4 eyes), and vitreous hemorrhage secondary to age-related macular degeneration (2 eyes). Epiretinal membrane and internal limiting membrane removal, endolaser photocoagulation, and air-fluid exchange were performed when required. Results Mean follow-up was 3.6 months (range 1–8 months). Mean overall visual acuity (VA) was counting fingers (range light perception to 0.4) preoperatively and 0.2 (range 0.1 to 0.8) postoperatively (p=0.000). Statistically significant VA improvement was observed in eyes with vitreous hemorrhage, diabetic macular edema, and macular epiretinal membrane. VA improved postoperatively in all eyes with endophthalmitis and vitreous opacities secondary to Behçet's disease. The surgery was completed without conjunctival and scleral suturing in all eyes. Mean intraocular pressure (IOP) was 17.2 mmHg (range 10–26 mmHg) preoperatively, 12.4 mmHg (range 6–24 mmHg) on the first postoperative day, 16.6 mmHg (range 10–33 mmHg) at 1 week, and 15.4 mmHg (range 10–20 mmHg) at 1 month postoperatively. On the first postoperative day, IOP was below 10 mmHg (between 6 and 9 mmHg) in 12 eyes (16.9%). In these eyes, IOP was normalized within 1 week without affecting the visual outcome. Five eyes (7%) had transient increase of IOP controlled by topical antiglaucomatous medications. Vitreous washout using 25-gauge TSV system was performed in two eyes, in which vitreous hemorrhage recurred. Conclusions The TSV system was observed to be feasible, effective, and safe for a variety of vitreoretinal diseases. This minimally invasive and completely sutureless (transconjunctival) technique appears to decrease the convalescence period, operating time, and postoperative inflammatory response, and improve patient comfort.

Summary Purpose To compare the outcomes in the management of traumatic hyphema treated with topical corticosteroid plus supportive therapy versus only supportive therapy. Patients and methods In this retrospective study, 206 patients were divided into two groups; group I, 98 eyes were treated with topical corticosteroid 12 × 1 and supportive therapy including bed rest, keeping the head elevated (45 degrees), and hydration. In group II, 108 eyes were treated with only supportive therapy. Hyphema size, initial and final visual acuities and intraocular pressure, time to hyphema clearance, and incidence of rebleeding were evaluated. Results The time needed for hyphema resorption in the two groups were 60.25 ± 33.9 and 62.3 ± 28.9 hours respectively (P = 0.62). There was no significant difference in rebleeding rate between the topical corticosteroid group (4.01%) and non-steroid group (6.48%) (P = 0.67). The initial and final visual acuities were similar in the two groups (P = 0.86). In Groups I and II, the average intraocular pressures were 19.7 ± 8.01 and 14.2 ± 10.2 mmHg respectively. The difference between the two groups was statistically significant (P = 0.04). Conclusion Patients who were treated with topical corticosteroids were no less likely to experience a rebleed or a poor visual outcome than those treated with supportive therapy alone. Supportive therapy alone may be convenient and cost-effective management strategy in uncomplicated traumatic hyphema.

To investigate and compare the efficacy of autologous serum eye drops with amniotic membrane transplantation in eyes with neurotrophic corneal ulcers.In this retrospective study, 42 eyes of 42 patients (30 females and 12 males) with neurotrophic corneal ulcers were included and divided into group I (n = 20) who were treated with autologous serum eye drops and group II (n = 22) who underwent amniotic membrane transplantation. The epithelial healing time and best corrected visual acuity were performed before and after treatments.In group I, the mean age was 57.1 ± 10.1 years; and at the end of 6.7 ± 2.05 months follow up, 14 (70%) of 20 eyes healed completely with a minimal scarring and vascularization. Two patients had persistent epithelial defects, four patients healed incomplete because of deep stromal ulcers in eyes with post-herpes neurotrophic ulcers. In group II, the mean age was 58.7 ± 14.7 years. Seventeen eyes (72.7%) of 22 patients healed completely and there was no recurrence in these patients at the 6.8 ± 3.9 months follow-up period. Two incomplete healed patients had persistent epithelial defects caused by HSV and the other three patients had deep stromal ulcers caused by the abuse of topical anesthetics. The mean epithelialization time was 22.1 ± 8.0 days in group I and 20.0 ± 4.64 days in group II. In group I, best corrected visual acuity improved in 18 of 20 (90%) eyes and 17 of 22 (77.2%) eyes in group II.Both autologous serum eye drops and amniotic membrane transplantation are effective for eyes with neurotrophic corneal ulcers because of many epitheliotrophic factors. Also, we observed that multilayered amniotic membrane transplantation is more effective than autologous serum in deep corneal ulcers with postherpes neurotrophic keratitis in our cases.

Erkan Celik,1 Ozkan Sever,2 Fatih Horozoglu,2 Ates Yanyali3 1Sakarya University Medical Education and Research Hospital, Sakarya, 2Namik Kemal University, School of Medicine, Tekirdag, 3Haydarpasa Numune Medical Education and Research Hospital, Istanbul, Turkey Aim: To evaluate the effectiveness and safety of high-speed (5,000 cuts per minute) 23G transconjunctival sutureless vitrectomy (TSV) in severe diabetic fibrovascular proliferation (DFVP). Patients and methods: In this retrospective consecutive case series, patients who underwent 23G TSV for severe DFVP between October 2011 and March 2014 at our institution were evaluated. 23G TSV was performed with a high-speed (5,000 cuts per minute) cutter without a chandelier light. Results: The mean follow-up period was 8months (range: 4–23months). Of the 27 eyes of 27 patients, 14 eyes (52%) underwent concomitant phacoemulsification with posterior chamber intraocular lens implantation, nine eyes (33%) were pseudophakic, and four eyes were phakic (15%). DFVP was removed with ease in all, and visual acuity was improved in 18 (67%) eyes. Iatrogenic retinal tear was observed in four eyes (15%) and treated successfully during surgery. Suture placement to a single sclerotomy was performed in eight eyes (30%). Postoperative intraocular hemorrhage was observed in five eyes (18%). Cataract formation was observed in two of the four phakic eyes. Three (11%) patients had postoperative intraocular pressure rise. Postoperative hypotony (≤6mmHg) and endophthalmitis were not observed in any eye. Conclusion: The segmentation and removal of fibrovascular membranes with high-speed 23G TSV seems to be a safe and easy method in severe diabetic eye disease. Keywords: diabetic fibrovascular proliferation, transconjunctival sutureless vitrectomy, high speed

Purpose To evaluate the topographic changes in the cornea after pars plana vitrectomy (PPV) with 25-gauge transconjunctival sutureless vitrectomy (TSV) system. Design Prospective, interventional case series. Methods In this prospective study, we evaluated the topographic changes of the cornea in 32 eyes of 32 patients who underwent PPV with the 25-gauge TSV system. The topographic parameters that were analyzed statistically were the average corneal power, corneal surface cylinder, surface asymmetry index, and surface regularity index. Mean induced astigmatism was estimated by vector analysis software. Wilcoxon test was used for statistical analysis. Results There was no significant change in average corneal power, corneal surface cylinder, surface asymmetry index, and surface regularity index parameters at first day, first week, and first month after the operation. Mean induced astigmatism was 0.38 diopters at 15 degrees. Conclusions Corneal surface and astigmatic changes were observed to be insignificant in the early postoperative period after PPV with the 25-gauge TSV system.

Purpose To compare the effectiveness of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) with modified grid laser photocoagulation in diabetic macular edema. Design Randomized, comparative, interventional study. Methods In this prospective study, 24 eyes of 12 patients with bilateral diabetic macular edema were evaluated. PPV with removal of the ILM was performed at random in one eye of 12 patients (ILM group), and a single session of modified grid laser photocoagulation was performed in the fellow eyes (grid group). Main outcome measures were the foveal thickness measured with optical coherence tomography, preoperative, and postoperative visual acuities. Mann-Whitney U and Wilcoxon tests were used in statistical analysis. Results All patients were followed up for 6 months. In the ILM group, mean foveal thickness was 439.2 ± 106.5 μm preoperatively and 219.8 ± 63.2 μm postoperatively ( P = .002). In the grid group, mean foveal thickness was 407 ± 100.2 μm preoperatively and 378.5 ± 141.6 μm postoperatively ( P = .433). A mean decrease in foveal thickness was found to be 219.4 ± 127.6 μm in the ILM group and 28.5 ± 90.5 μm in the grid group ( P = .001). In the ILM group, best-corrected logMAR visual acuity was 0.75 ± 0.41 preoperatively and 0.53 ± 0.41 postoperatively ( P = .006). In the grid group, best-corrected logMAR visual acuity was 0.59 ± 0.27 preoperatively and 0.49 ± 0.27 postoperatively ( P = .058). Visual acuity improved by 2 or more lines in six eyes (50%) in the ILM group and in three eyes (25%) in the grid group. Visual acuity remained stable in six eyes (50%) in the ILM group and in nine eyes (75%) in the grid group. Conclusions PPV with ILM removal appears to be more effective than a single session of modified grid laser photocoagulation in the treatment of diabetic macular edema. Further studies with a large number of patients are required for a more reliable conclusion.