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Ocular complications of leprosy patients often develop insidiously and with few if any symptoms. This study involves measurement of the pupil cycle time (PCT) to evaluate the autonomic nerve system of the iris to determine the presence of subclinical intraocular involvement. The study included 19 lepromatous (LL), 19 borderline lepromatous (BL), and five borderline tuberculoid (BT) leprosy patients and involved 25 healthy volunteers, 10 patients with pulmonary tuberculosis and eight with Duhring disease. The PCT was measured in these groups. In all leprosy groups included in the study the PCT was higher than in the control groups. Moreover, the PCT of the leprosy patients without any intraocular involvement was higher than in the controls. These results show that in the ophthalmic examination of leprosy patients without any symptoms the fact that autonomic nerve system of the eye is affected by the leprosy can often be determined by measuring the PCT. [ABSTRACT FROM PUBLISHER]

Leprosy is one of the leading causes of corneal hyposensitivity. In this article the corneal sensitivity of 143 leprosy patients was examined, and correlations between corneal hyposensitivity and anterior segment pathology were detected. Twenty four healthy volunteers were examined as controls. Various degrees of corneal loss of sensitivity were found in 46.2% of leprosy patients. Lagophthalmos, chronic lepromatous granulomatous uveitis, iris atrophy, and social blindness were found 4.5-16.6 times more frequently in eyes which developed severe corneal hyposensitivity. [ABSTRACT FROM PUBLISHER]

The intraocular pressures of a total of 286 eyes of patients with lepromatous and borderline lepromatous leprosy who never had regular ophthalmological care or local eye treatment were measured. The patients were categorised according to the type of leprosy they had, and the eyes were categorised as without or with chronic plastic iridocyclitis. In patients with lepromatous and borderline lepromatous types of leprosy the intraocular pressure was significantly lower in eyes with chronic plastic iridocylitis 10.1 (3.6) mmHg than in both unaffected eyes 11.0 (3.2) mmHg and control eyes 13.5 (2.5) mmHg. It has been shown that chronic plastic iridocyclitis which remains untreated for years results in a lower intraocular pressure than normal. [ABSTRACT FROM PUBLISHER]

Objectives: To investigate choriocapillaris flow voids (FV) with a new optical coherence tomography angiography (OCTA) image processing strategy that can eliminate artifacts caused by vitreous opacities, sub-retinal pigment epithelium fluid and deposits, and subretinal fluid (SRF) by thresholding the en-face OCT image of the outer retina., Materials and Methods: We retrospectively reviewed medical records of patients with drusen and patients with active central serous chorioretinopathy (CSC). FV number (FVn), average area (FVav), and maximum area (FVmax) and the percentage of nonperfused choriocapillaris area (PNPCA) obtained using the proposed strategy were compared with those obtained by removing only artifacts caused by the superficial capillary plexus (SCP)., Results: The SRF group included 21 eyes with active CSC and the drusen group included 29 eyes with nonexudative age-related macular degeneration. FVav, FVmax, FVn, and PNPCA obtained using the algorithm were significantly lower than those obtained by removing only SCP-related artefacts in both groups (all p<0.05). The algorithm was also able to remove 96.9% of artifacts secondary to vitreous opacities and all artifacts secondary to serous pigment epithelial detachments., Conclusion: Choriocapillaris nonperfusion areas on OCTA images may be overestimated in eyes with RPE abnormalities and SRF due to artifacts. These artifact areas on choriocapillaris OCTA images can be removed using thresholded images of the outer retina en-face OCT scans. Our new artifact-removal strategy is useful in the assessment of choriocapillaris FV in eyes with SRF, drusen, drusen-like deposits, and pigment epithelial detachment., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2023 by Turkish Ophthalmological Association Turkish Journal of Ophthalmology, published by Galenos Publishing House.)

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: To investigate visual and anatomical outcomes of vitreoretinal surgeries in patients with Eales' disease., Materials and Methods: In this retrospective study, 22 eyes of 21 patients with vitreous hemorrhage (VH) or tractional retinal detachment (TRD) secondary to Eales' disease who underwent vitreoretinal surgery between January 1997 and December 2015 and had at least 1 year of follow-up were included., Results: The mean best corrected visual acuity (BCVA) was significantly higher at final visit (0.6±0.9 logMAR) than the preoperative values (1.8±1.1 logMAR) (p<0.001). After surgery, BCVA was stable in 4 eyes (18.2%), increased in 16 eyes (72.7%), and decreased in 2 eyes (9.1%). Although the mean BCVA was better in the VH group (0.3±0.34 logMAR) than the TRD group (0.9±1.1 logMAR), the difference was not statistically significant (p=0.1). Multivariable linear regression analyses revealed that final BCVA was negatively associated with preoperative or postoperative proliferative vitreoretinopathy grade C (PVR-C), preoperative retinal detachment involving the macula, postoperative neovascular glaucoma, and long preoperative duration of disease, and positively associated with preoperative BCVA. Final BCVA was not associated with preoperative retinal and disc neovascularization, rubeosis iridis, total posterior hyaloid detachment, preoperative retinal laser photocoagulation, indication of surgery, diameter of sclerotomy (20 or 23 gauge), preoperative lens status, preoperative or postoperative epimacular membrane, peroperative iatrogenic retinal breaks, postoperative hypotony, cystoid macular edema, and new or recurrent retinal detachment. The primary anatomic success rate was 81.8% and the final anatomic success rate was 90.9%., Conclusion: In Eales' disease, good visual results can be obtained with vitreoretinal surgery if the detachment area does not involve the macula and PVR-C does not develop pre- or postoperatively.

Objectives: To evaluate the outcomes of 23-gauge pars plana vitrectomy (PPV) under air compared with standard PPV for idiopathic macular hole (MH)., Materials and Methods: In this prospective, comparative, interventional case series, 42 eyes of 42 patients with idiopathic MH were enrolled. Twenty-one eyes had vitrectomy with an air-infused technique and 21 eyes underwent vitrectomy with a traditional balanced salt solution-infused technique as a control group. Effective vitrectomy time, total surgery time, microperimetry (MP1), and anatomical and functional results were evaluated., Results: The mean effective vitrectomy time was significantly lower in the air group than in the control group (7.5±0.3 min and 13.3±0.5 min, respectively, P<0.001). The mean total surgery time was significantly lower in the air group than the control group (21.8±2.0 min and 25.9±1.1 min, respectively, P<0.001). There were no statistically significant changes between preoperative and 3-month postoperative retinal sensitivity values evaluated by MP1 in either group. Anatomical success at 3 months was 100% in both groups. Intraoperative complications noted during the air-infused vitrectomy were retinal touch (10%) and sudden hypotony (10%); in the two pseudophakic eyes, migration of air into the anterior chamber occurred in one (50%) and fogging of the intraocular lens in one eye (50%)., Conclusion: Vitrectomy under air infusion for idiopathic MH showed some advantages over a traditional vitrectomy technique in terms of vitreous visualization, effective vitrectomy time, and total surgery duration, without significantly increasing intraoperative and postoperative complication rates. Postoperative microperimetry results indicated no specific damage to the retina or optic nerve related to the continuous air infusion.

Objectives: To assess outcomes of a risk-based algorithm-guided treatment protocol for neovascular age-related macular degeneration., Materials and Methods: Two hundred and ten eyes of 184 patients managed with anti-vascular endothelial growth factor (anti-VEGF) agents according to a protocol consisting of one of three initial regimens depending on risk with at least 2 years of follow-up were retrospectively evaluated. The “short-term monthly injections” protocol was used for low-risk patients with low-risk lesions and good fellow-eye vision. Patients with low-risk lesions but without good fellow-eye vision, or those with good fellow-eye vision and high-risk lesions were managed according to the “short-term treat-and-extend (TREX)” protocol. The “extended TREX” protocol was for patients with high-risk lesions and low fellow-eye visual acuity., Results: The initial treatment plan consisted of short-term monthly injections in 62 eyes (30%), the short-term TREX regimen in 120 eyes (57%), and the extended TREX regimen in 28 eyes (13%). Overall, 63% of cases met the criteria for cessation of treatment. Approximately 58% of these cases had recurrence, at a mean of 13 months. The mean change in VA from baseline was +9.0 letters at 12 months and +8.0 letters at 24 months. VA improved during a mean follow-up of 46.8±22 months, with a mean of 3.4±1.6 anti-VEGF injections per year., Conclusion: The risk-based algorithm-guided treatment protocol yielded visual outcomes similar to those of the common alternative treatment and monitoring regimens, with a dramatically reduced number of injections, as required by the individual lesion and vision in the fellow eye.

Objectives: To compare the outcomes and complications of dislocated intraocular lens (IOL) extraction and secondary iris-claw IOL (ICIOL) implantation in vitrectomized and non-vitrectomized eyes., Materials and Methods: This retrospective study included 19 vitrectomized eyes and 11 non-vitrectomized eyes that underwent dislocated IOL extraction and secondary anterior chamber ICIOL implantation between June 2014 and September 2017 and had at least one year of follow-up., Results: There were no significant differences between the groups in terms of demographic data, operative time, baseline anatomic and functional measurements, or postoperative changes in these measurements (all p>0.05). Postoperative best corrected visual acuity was significantly higher than preoperative values in both groups (both p<0.05). Complication rates did not differ between the groups (all p>0.05). In both groups, endothelial cell density was significantly lower at postoperative 1 year compared to preoperative measurements. There was no significant difference between groups regarding endothelial cell loss (p=0.49). One vitrectomized eye had corneal decompensation. Other complications included hyphema, transient increase of intraocular pressure, secondary glaucoma, pupillary irregularity, and dislocation of ICIOL. Mean operative time was 26.4±5.9 minutes., Conclusion: Dislocated IOL extraction and secondary anterior chamber ICIOL implantation is a safe treatment option in both vitrectomized and non-vitrectomized eyes.

Laser devices are widely used for medical, military, industrial and entertainment purposes. This extensive and unregulated use of lasers can cause a variety of maculopathies that can result in permanent vision loss. Uncontrolled and inappropriate use of laser instruments should be prevented with strict rules. We strongly emphasize the importance of changing the general misperception that lasers are safe to use for entertainment purposes. In this study we aim to report the clinical features of three patients with a history of maculopathy caused by exposure to laser light in an entertainment venue., Competing Interests: No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study received no financial support.

Occult macular dystrophy is an inherited macular dystrophy characterized by a progressive decline of bilateral visual acuity with normal fundus appearance, fluorescein angiogram and full-field electroretinogram. This case report presents a 20-year-old female patient with bilateral progressive decline of visual acuity for six years. Her visual acuity was 3-4/10 in both eyes. Anterior segment and fundus examination, fluorescein angiogram and full-field electroretinogram were normal. She could read all Ishihara pseudoisochromatic plates. Fundus autofluorescence imaging was normal. There was a mild central hyporeflectance on fundus infrared reflectance imaging in both eyes. Reduced foveal thickness and alterations of the photoreceptor inner and outer segment junction were observed by optical coherence tomography in both eyes. Central scotoma was also found by microperimetry and reduced central response was revealed by multifocal electroretinogram in both eyes. These findings are consistent with the clinical characteristics of occult macular dystrophy., 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 report outcomes of photodynamic therapy (PDT) and combined therapy with PDT and intravitreal bevacizumab (IVB) in patients with polypoidal choroidal vasculopathy (PCV)., Materials and Methods: Thirty-four eyes of 31 patients with subfoveal PCV were evaluated. Nine eyes were treated with PDT and 25 eyes treated with combined therapy of PDT and IVB. All eyes had a follow-up period of at least 12 months. In this retrospective study the demographic features, best corrected visual acuity, fundus color photography, optical coherence tomography, fluorescein angiography and indocyanine green angiography of the 34 eyes were evaluated., Results: Visual acuity improved but did not change significantly in the patients treated with PDT and combined PDT+IVB therapy (p=0.149; p=0.087). Although the mean central foveal thickness decreased in both groups, there was no statistically significant difference between groups (p=0.98). The polypoidal lesions regressed in 6 (66.7%) of 9 eyes in the PDT monotherapy group and 16 (64%) of 25 eyes in the PDT+IVB combined therapy group., Conclusion: Both PDT and a combined therapy of PDT and IVB yielded successful outcomes in patients with PCV., Competing Interests: No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study received no financial support.

Stiff skin syndrome (SSS) is a disease similar to scleroderma with an unknown etiology. Stone-hard areas of skin are observed from birth or in early childhood. In this article we describe a 15-year-old girl with skin hardening and limitation of movement. We diagnosed the case as SSS, of which we have not encountered a similar report in the Turkish literature.

This study compared the effect of three laser systems: CO2 (10.600 nm), Nd:YAG (1.064 nm), and ArF excimer (193 nm) lasers on dentin hard tissue and on temperature increases of the pulp chamber. Sixty-six third molar teeth were used and randomly divided into three groups. A class I cavity was made to expose the dentin, and the pulp in the pulp chamber was removed via a hole bored in the cervical area. The pulp chamber was subsequently refilled with silicon grease, and a NiCr/NiSi thermocouple was inserted through the hole into the pulp chamber. The dentin surface was then lased for 30 s at the same settings (3 W, 2 mm spot size, 20 pps) with each laser. The average internal temperature increases were as follows: CO2, 37 degrees C; Nd: YAG, 28 degrees C; and ArF excimer, 1 degrees C. Scanning electron microscopy of the dentin in the occlusal cavity revealed extensive carbonization, isolated balls of recrystallized material, and the presence of smear layer at some dentinal tubule orifices for the CO2 and Nd:YAG lased teeth. Smear layer was also observed for the ArF excimer samples; however, they exhibited far less surface cavities than the others and seemed to undergo little morphological change on the dentin.

Purpose: To report a new corneal iron ring after hyperopic laser-assisted in situ keratomileusis (LASIK)., Methods: Three patients underwent hyperopic LASIK for the correction of hyperopia in both eyes. Spherical equivalent refraction of the patients ranged from +3.37 to +6.50 diopters. LASIK procedure was performed using automated corneal shaper and 193-nm argon fluoride excimer laser., Results: Both eyes of the patients were noted to have a corneal iron ring located at the paracentral area at 6-7 months after surgery. The localization of iron ring corresponded with outside border of central steep zone. Twelve-month examination showed there was no change in color, shape, and density of corneal iron ring., Conclusions: Corneal topographic changes induced by hyperopic LASIK may cause corneal iron ring to develop.

Purpose: Newborns at risk for retinopathy of prematurity (ROP) should be examined 4 to 8 weeks postpartum. Various treatment modalities including cryotherapy, are proposed to ablate the retinal proliferation, when serious and progressive ROP is detected. This study stresses as main risk factors low birth weight and short gestational age as pre-disposing to ROP and the efficiency of cryotherapy as a treatment modality., Methods: One hundred and twenty five newborns were examined before hospital discharge and after oxygen administration was terminated. Patients with suspected ROP returned for frequent follow-up visits. In patients with stage III ROP (ridge with extraretinal fibrovascular proliferation) ablation by cryotherapy was performed., Results: Retinal ridge and extraretinal proliferation characteristic of stage III ROP were detected in ten newborns. All surviving stage III patients were treated with cryoablation and two of them progressed to stage IV. Regression of ROP was observed in eight of the ten treated cases., Conclusions: With properly planned screening of newborns at risk for ROP, early diagnosis and treatment are possible. Cryotherapy seems to be effective for ablation of the proliferation.

The objective of this study was to detect ocular lesions of newly diagnosed leprosy cases admitted to Istanbul Leprosy Hospital. The patients were categorized according to sex, age, type of leprosy and duration of the disease. Their eyes were categorized as with or without ocular findings due to leprosy. The total number of patients was 21. The mean age was 22+/-4.6 years, the duration of the disease was 36.3+/-19.6 months. Madarosis was the most common finding in this group. It was found in 15 patients (71.4%, 95% confidence interval (CI) 47.8-88.7%). As a second common finding related to corneal alterations, 13 patients had nerve thickening (61.9%, 95% CI 38.4-81.8%). None of our patients had trichiasis, episcleritis, scleritis, cataract, iris atrophy, iris pearl, abnormal vitreous or retinal findings.

The purpose of this study was to show the safety, effectiveness, and predictability of simultaneous bilateral as compared to sequential unilateral photorefractive keratectomy in 273 normally sighted myopic eyes. An excimer laser with a fluence of 180 mj/cm2 at a frequency of 10 Hz was used at three ablation zones (5 mm, 6 mm, and 6.5 mm). There were no significant differences between the two groups' results. Mean refraction at six months was 0.34-0.96 D in group 1 simultaneous group and 0.32-0.95 D in group 2 sequential group. At 9 months after surgery, 84% of eyes had an uncorrected visual acuity of at least 20/40. The average pain score on the first postoperative day was 2.4 for group 1 simultaneous group and 2.3 for group 2 sequential group. No serious complications occurred. Despite the short follow up, simultaneous bilateral photorefractive keratectomy appears to be an effective and safe procedure for the correction of myopia.

Faeriefungin is a new antibacterial and antifungal agent derived from a strain of Streptomyces griseus var. autotrophicus. Under anesthesia, 12 albino rabbits underwent injection in their right eyes with 400, 200, 100, 40, 20, and 10 micrograms of faeriefungin. Retinal toxicity was assessed by electroretinography and light and transmission electron microscopy. Injection of 400 micrograms resulted in severe retinal toxicity, although indirect ophthalmoscopy was unremarkable. At 200 micrograms, there was moderate toxicity. Intravitreal injection of concentrations of 100 micrograms or less produced no neuroretinal toxicity. These data suggest that faeriefungin is a potentially useful drug in the treatment of fungal or bacterial endophthalmitis.

We evaluated the toxicity of perfluorooctylbromide in the primate eye as a short-term postoperative vitreous substitute. Four eyes of 4 African green monkeys underwent complete vitrectomy and vitreous replacement with 1.5-2.0 ml of PFOB. One additional animal received BSS as a control vitreous substitute in one eye. Animals were examined twice weekly for clarity and consistency of the vitreous replacement substance. Anterior segment and lenses remained clear in all eyes, although in the immediate postoperative period one eye became inflamed and had a culture-negative vitritis. The other eyes showed a minimal anticipated postoperative vitreous inflammation. Emulsification of the PFOB began within 3 days of injection and progressed up to 3 weeks, precluding fundus examination and fluorescein angiography after 2 weeks. Eyes were enucleated and light microscopy performed at 2 days, 10 days, 33 days, and 45 days. No toxic effects to the retinal cells were detectable by histological examination, but perivasculitis of retinal vessels was noted at 45 days. Indirect examination was normal up to 10 days; thereafter, the fundus view was obscured by the emulsified PFOB. Because of cellular migration into the vitreous cavity and retinal perivasculitis, observed histologically, PFOB seems most suitable for intraoperative rather than postoperative use.

Full-thickness scleral diathermy using a standard electrode causes significant scleral damage and necrosis. Use of a modified (Jabbour's) diathermy electrode appears to cause minimal scleral damage. We evaluated the scleral changes following transscleral diathermy application using standard and modified diathermy electrodes to the peripheral retina and ciliary body. Twelve Dutch belted pigment rabbits were used in our experiment. Three eyes each were subjected to transscleral diathermy using standard and modified electrodes to produce chorioretinal scars and cyclodestruction. Eyes were examined with the slit lamp and indirect ophthalmoscope at weekly intervals for 4 weeks. Light and transmission electron microscopy was performed 1 hour after diathermy application in 4 animals and in the remaining 8 animals at 4 weeks. Chorioretinal scarring and ciliary body atrophy were successfully induced with both types of electrodes. However, scleral damage was less severe in eyes treated with the modified electrode as compared with the standard electrode.

The semiconductor diode laser is a near-infrared laser; its 810-nm wavelength is maximally absorbed by melanin and has substantial transmissibility through cornea and sclera. Indocyanine green is the best photosensitive dye for the diode laser. The level of corneal damage produced by 810-nm diode laser, with and without absorbing dye (indocyanine green), and photoablative capabilities of this wavelength were studied using albino rabbits. We concluded that the contact application of this wavelength to the cornea in the presence of energy-absorbing dye causes both stromal and endothelial thermal damage. Therefore, 810-nm near-infrared semiconductor diode lasers are not suitable for photorefractive keratectomy or photoablative reprofiling.

Two preparations of silicone gels were evaluated as long-term vitreous substitutes in the vitrectomized and lensectomized eyes of primates. Both preparations were injected in liquid form and polymerized in the vitreous cavity. There was no toxic effect on the ocular structures up to 13 months after implantation. Fundus examination and fluorescein angiography were possible through the less rigid gel, whereas the preparation with higher rigidity consistently appeared cloudy.

We investigated the toxicity of single doses of intravitreally administered interferon alpha-2a in albino rabbits. Following injection of interferon in doses of 40,000, 80,000, 160,000, 320,000, and 640,000 IU/0.1 mL, no significant histologic changes were detected by light and electron microscopy. Photopic and scotopic electroretinography showed no alteration of retinal function.

The 21-aminosteroids or lazaroids are a novel series of compounds being developed for the acute treatment of traumatic or ischemic injury of the nervous system. These compounds were specifically designed to localize within cell membranes and inhibit lipid peroxidation reactions. In this study, 21-aminosteroid U75412E was injected into the vitreous body of rabbit eyes to evaluate its suitability for intraocular injection and its toxicity on intraocular tissues. Doses ranged from 20 micrograms to 200 micrograms. Retinal toxicity was determined through light and transmission electron microscopy and electroretinography. No retinal toxicity was noted in doses of 30 micrograms and below.

The toxicity of a new antiviral agent, 6-methoxypurine arabinoside (ara-M), as a selective and potent inhibitor against varicella-zoster virus, was investigated after intravitreal injection in rabbit eyes. Intravitreal doses of ara-M ranging from 20 micrograms to 400 micrograms produced no retinal toxicity, as assessed by electroretinography and light and transmission electron microscopy. These data suggest a potential role for intravitreal ara-M in the antiviral treatment of varicella-zoster viral retinitis.