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Zafer Cebeci, Nur KirDepartment of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Capa, Istanbul, TurkeyAbstract: Diabetic macular edema (DME) is the leading cause of sight-threatening complication in diabetic patients, and several treatment modalities have been developed and evaluated to treat this pathology. Intravitreal agents, such as anti-vascular endothelial growth factors (anti-VEGF) or corticosteroids, have become more popular in recent years and are widely used for treating DME. Sustained release drugs appear to be mentioned more often nowadays for extending the period of intravitreal activity, and corticosteroids play a key role in inhibiting the inflammatory process in DME. A potent corticosteroid, dexamethasone (Ozurdex®), in the form of an intravitreal implant, has been approved for various ocular etiologies among which DME is also one. This review evaluates the role of implants in the treatment of DME, mainly focusing on the dexamethasone intravitreal implant.Keywords: diabetes mellitus, diabetic macular edema, vascular endothelial growth factor, dexamethasone, Iluvien, corticosteroid

Introduction: The aim of the study was to analyse the clinical and demographic features of infants with gestational age (GA) of 32-37 weeks and birth weight (BW) of >1,500 g who developed treatment requiring retinopathy of prematurity (ROP)., Methods: Data on the infants with a GA of 32-37 weeks and BW >1,500 g who developed treatment requiring ROP (TR-ROP) were collected retrospectively from the 33 ROP centres in Turkiye. GA, BW, type of hospital, neonatal intensive care units (NICUs) level, presence of an ophthalmologist and neonatologist in the same hospital, length of stay in NICU, duration of oxygen therapy, comorbidities, type of ROP, and timing for TR-ROP development were analysed., Results: A total of366 infants were included in the study. Mean GA and BW were 33 ± 1 weeks and 1,896 ± 316 g, respectively. Duration of hospitalization was 3-4 weeks in 46.8% of them. The first ROP examination was performed at postnatal 4-5 weeks in 80.3% of infants, which was significantly later in level 2 and lower NICUs and non-university clinics. At the first ROP examination, any stage of ROP was detected in 90.9% and TR-ROP was detected in 15.3% of the infants. The mean postnatal week of TR-ROP development was 6.16 ± 2.04., Conclusion: Routine ROP screening thresholds need to be expanded in hospitals with suboptimal NICU conditions considering the development of TR-ROP in more mature and heavier preterm infants. The first ROP examination should be earlier than the fourth postnatal week., (© 2024 S. Karger AG, Basel.)

Purpose: To provide consensus on the clinical use of intravitreal dexamethasone (DEX) implant for the treatment of diabetic macular edema (DME) in Turkey., Methods: A panel of 22 retina experts prepared 77 statements of recommendation, and 80 retinal specialists practicing in Turkey were chosen to vote either in support or against each one. A Delphi-based method was used through which the ophthalmologists were able to view all of the results anonymously after two rounds and modify their subsequent answers. The survey was conducted via a mini website, and statements without consensus were resent to the specialists with the latest vote results a week later., Results: A total of 72 ophthalmologists answered the first and second round questions. After the first stage, consensus was achieved on 55 of the statements, leaving 22 without agreement. After the second stage, consensus was reached on 11 of the remaining statements. Strong consensus was achieved on statements regarding the etiopathogenesis of DME and the first-line indications and safety of the DEX implant procedure. The panel recommended the use of DEX implant for patients with an arterial thromboembolic event in the last three months and also agreed that pro re nata DEX implant treatment not only provides better outcomes for DME patients but also reduces the treatment burden for those who could not receive an adequate number of anti-vascular endothelial growth factor (VEGF) injections., Conclusion: This study provides clinical consensus and recommendations about the use of DEX implant in the clinical practice of DME management in Turkey.

Objectives: The aims of this study were to describe the clinical presentation and treatment modalities of acute retinal necrosis (ARN) and to evaluate complications and clinical outcomes according to the extent of retinal involvement at initial presentation., Materials and Methods: The medical records of 52 patients diagnosed with ARN were reviewed and 48 were included in the study. Patients were categorized into two groups according to the extent of retinitis at presentation: retinal involvement of 1-2 quadrants (Group A) or 3-4 quadrants (Group B)., Results: The mean age of the 14 women and 34 men at presentation was 51.3±13.6 years (range: 27-78). There were 40 unilateral and 8 bilateral cases. There were 11 eyes (19.6%) in Group A and 45 eyes (80.4%) in Group B. Eleven patients (22.9%) had a history of herpes simplex virus/varicella-zoster virus infection. One patient in Group A and 11 patients in Group B had received local or systemic corticosteroid therapy without concomitant antiviral treatment before referral. The median follow-up period was 29 months (range: 1-209) in Group A and 8.5 months (range: 0.75-209) in Group B. Mean visual acuity (VA) at presentation was 0.42±0.55 LogMAR (range: 0-2.0) in Group A and 1.28±0.95 LogMAR (range: 0-2.9) in Group B (p<0.05). The presence of endothelial keratic precipitates at presentation was significantly different between two groups (p=0.021). Retinal detachment (RD) occurred in 1 eye (9.1%) in Group A and 30 eyes (66.7%) in Group B (p<0.001). Optic disc pallor was seen in 36.4% (4/11) of eyes in Group A and 71.1% (32/45) of eyes in Group B (p=0.033). Other ocular complications were not significantly different between two groups. Mean final visual acuity was 0.29±0.41 LogMAR in Group A and 1.61±0.90 LogMAR in Group B (p<0.05)., Conclusion: The extent of retinal involvement at presentation affects visual outcomes and this shows the importance of early diagnosis and early initiation of antiviral treatment., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2022 by Turkish Ophthalmological Association | Turkish Journal of Ophthalmology, published by Galenos Publishing House.)

Purpose: To investigate preoperative and postoperative factors affecting functional success in anatomically successful retinal detachment surgery., Methods: Seventy-five eyes of 75 patients with rhegmatogenous retinal detachment who underwent anatomically successful surgery from 2014 to 2019 with more than 1 year follow-up were included in the study. Demographic characteristics, ocular examination findings, preoperative and postoperative spectral domain optic coherence tomography images were retrospectively evaluated., Results: The mean age was 53.9 ± 17 years (range, 11-85 years). The mean follow-up period was 36.7 ± 16 months (range, 14-72 months). The mean best-corrected visual acuity of the patients before surgery was 1.35 ± 1.24 and at postoperative 12 months was 0.66 ± 0.5 logarithm of the minimum angle of resolution. Patients who were operated in 7 days of visual symptoms onset were found to have better visual acuity at the first and subsequent postoperative exams. Preoperative proliferative vitreoretinopathy, vitreous hemorrhage, and extent of retinal detachment were found to have a negative effect on functional success at 12 months. Regeneration of the outer retinal layers had a positive effect on visual acuity at 12 months but did not significantly increase visual acuity after 12 months. Multivariate analysis showed that preoperative external limiting membrane integrity was significantly associated with better functional outcomes., Conclusions: Early intervention, presence of preoperative external limiting membrane integrity, and restoration of postoperative outer retinal layers positively affected functional success. The presence of preoperative vitreous hemorrhage, preoperative proliferative vitreoretinopathy, and the extent of retinal detachment had a negative effect on prognosis at 12 months.

Herein, we describe a neovascular age-related macular degeneration patient with retinal angiomatous proliferation (RAP) and polypoidal choroidal vasculopathy (PCV) coexisting in the same eye at the time of diagnosis. A 55-year-old woman presented with a history of decreased vision in her left eye. Fundoscopy, fluorescein and indocyanine green angiography, and optical coherence tomography imaging revealed RAP and PCV lesions in her left eye at first diagnosis. The patient received intravitreal ranibizumab therapy but developed tachyphylaxis after the first dose despite having three monthly doses. Switching to intravitreal aflibercept injection in our case resulted in anatomic and functional improvement., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Bullous central serous chorioretinopathy (CSCR) is a rare variant of CSCR characterized by severe serous retinal detachment which especially involves the inferior quadrants. Corticosteroid therapy administered for systemic or ocular misdiagnoses may induce and exacerbate CSCR. The purpose of this study was to report diagnosis and treatment results of an unusual case of bullous CSCR induced by systemic and periocular corticosteroid therapy received at another medical center due to a misdiagnosis of Vogt-Koyanagi-Harada disease., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Focal choroidal excavation is a choroidal pit that can be detected by optical coherence tomography. Central serous chorioretinopathy, choroidal neovascularization and polypoidal choroidal vasculopathy are pathologies associated with focal choroidal excavation. In this article, we present the follow-up and treatment outcomes of three eyes of two patients with focal choroidal excavation., Competing Interests: No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study received no financial support.

Objectives: To evaluate the clinical characteristics of patients who were followed in our clinic with the diagnosis of peripheral exudative hemorrhagic chorioretinopathy (PEHC)., Materials and Methods: Medical records of 12 patients who were diagnosed with PEHC in İstanbul University İstanbul Faculty of Medicine, Department of Ophthalmology between July 2006 and June 2014 were reviewed retrospectively., Results: This study included 21 eyes of 12 patients. Four (33.3%) of the patients were male and 8 (66.7%) were female and ages ranged between 73 and 89 years. Eight (66.7%) of the patients were referred to us with the diagnosis of choroidal mass. Unilateral involvement was found in 3 and bilateral involvement in 9 patients. Temporal quadrants were involved in all eyes. Fifteen eyes (71.4%) had subretinal hemorrhage and hemorrhagic/serous retinal pigment epithelial detachment, 11 (52.4%) had lipid exudation, 5 (23.8%) had chronic retinal pigment epithelium alterations, 2 (9.5%) had subretinal fibrosis and 1 (4.8%) had vitreous hemorrhage. PEHC lesions were accompanied by drusen in 11 eyes (52.4%), geographic atrophy in 2 eyes (9.5%), and choroidal neovascularization scar in 2 eyes (9.5%). Treatment was done in both eyes of a patient for lesions which threatened the macula, in a patient with bilateral macular edema and in a patient with vitreous hemorrhage. The remaining eyes were followed-up without any treatment because the lesions did not threaten the macula and they showed no progression during follow-up., Conclusion: PEHC is a degenerative disease of peripheral retina that is seen in older patients, and signs of age-related macular degeneration (AMD) may accompany this pathology. Especially in patients with AMD findings, the peripheral retina must be evaluated carefully for existing PEHC lesions., Competing Interests: No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study received no financial support.

Objectives: The aim of this study was to evaluate the clinical features, follow-up and treatment results of patients diagnosed with Coats' disease., Materials and Methods: Medical records of 27 patients diagnosed with Coats' disease in our clinic were reviewed retrospectively. All patients underwent complete ophthalmological examination and fundus photography was taken. Disease stage and treatment methods used were recorded., Results: Twenty-seven eyes of 27 patients were included in the study. Mean age was 9.03 years; 21 patients were male and 6 were female. Three patients were older than 18 years old. Based on the Shields classification, 1 (3.7%) eye was stage 2A, 4 (14.8%) eyes were stage 2B, 6 (22.2%) were stage 3A1, 3 (11.1%) were stage 3A2, 1 (3.7%) was stage 3B, 4 (14.8%) were stage 4 and 8 (29.6%) were stage 5. Fourteen patients underwent treatment, 12 of whom had combined therapy. The most common treatment modalities were laser photocoagulation and cryotherapy. Encircling band was done in one patient and pars plana vitrectomy in 3 patients. Enucleation was done in 5 patients., Conclusion: Coats' disease is a chronic disease and main goal of treatment is to eliminate the vascular anomalies and their complications using repetitive combination therapies. Treatment in the early stages can lead to functional success, and in advanced stages can result in a salvageable eye., Competing Interests: No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study received no financial support.

Background: The choice of prosthesis in hemiarthroplasty is controversial for geriatric patients after femoral neck fracture. We hypothesised that selection criteria for unipolar or bipolar prostheses could be constructed based on factors affecting mortality., Aims: THE AIMS OF THIS RETROSPECTIVE STUDY WERE: (1) to determine the factors affecting mortality of femoral neck fracture patients ≥65 years of age; (2) to compare patient mortality rates, radiological findings, and functional outcomes according to prosthesis type (unipolar or bipolar); and (3) to evaluate the persistence of inner bearing mobility of bipolar prostheses., Study Design: Retrospective comparative study., Methods: In total, 144 patients operated for hemiarthroplasty and aged ≥65 were included. We classified the patients into either unipolar or bipolar prosthesis groups. To reveal factors that affected mortality, age, sex, delay in surgery, and American Society of Anesthesiologists score were obtained from folders. Barthel Daily Living, Harris hip, and acetabular erosion scores were calculated and bipolar head movement was analysed for live patients., Results: One-year mortality was 31.94%. Age ≥75 (p=0.029), male sex (p=0.048), and delay in surgery ≥6 (p=0.004) were the patient characteristics that were related to increased mortality. There were no significant differences in sex, age, American Society of Anesthesiologists score, delay in surgery, mortality, or Barthel, Harris, acetabulum scores between the two groups. Twenty patients from each group were admitted for last follow-up. Bipolar head movement was preserved for 33.3% of patients. They were inactive patients with low Barthel and Harris scores., Conclusion: Although bipolar head movement was preserved in inactive patients, we suppose that this conferred no advantage to these patients, who could hardly walk. In this study, male patients, those aged ≥75 years, and those operated at ≥6 days had an increased risk of mortality. Also, although not significant in multivariate analysis, high American Society of Anesthesiologists score (≥3) was related to increased mortality. Considering that one of three patients died during the first postoperative year, we think that these patients should be operated as soon as possible, and expensive bipolar prostheses must be used selectively in regard to patient characteristics.