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Objectives:To evaluate age-related differences in clinical patterns of ocular graft-versus-host disease (GVHD).Materials and Methods:In this cross-sectional study, patients diagnosed with ocular GVHD were evaluated in two groups: Group I included those aged 18 years or younger and Group II included those over 18 years of age. Demographic and clinical information were recorded and compared between the groups.Results:Forty eyes of 20 patients were included (11 patients were in Group I and 9 patients were in Group II). Follow-up was at least 6 months. All patients had burning, dryness, and foreign body sensation. Conjunctival hyperemia, cicatricial conjunctivitis, and limbal stem cell disease was observed more frequently in Group II. In addition to non-preserved artificial tears, cyclosporine A 0.05% (65%) and autologous/allogeneic serum eye drops (80%) were given and silicone plugs were inserted (28%). In Group I, an improvement in GVHD scoring and best corrected visual acuity was observed after 6 months of treatment (p

Objectives:This survey study of ophthalmologists investigated the prevalence and clinical manifestations of ocular surface disease (OSD) in glaucoma patients, assessment methods used, risk factors, glaucoma drugs considered responsible, and treatment approaches.Materials and Methods:A questionnaire prepared jointly by the Turkish Ophthalmological Association Cornea and Ocular Surface Society and Glaucoma Society using SurveyMonkey was sent to ophthalmologists via e-mail. The distribution of parameters was compared with chi-square test and p

Abstract Background To compare central corneal thickness (CCT) values measured by three different devices: slit-scanning topography (SST), ultrasonic pachymetry (UP), and optical coherence tomography (OCT) in diabetic eyes and compare the CCT values in patients with and without diabetic retinopathy. Methods Ninety-six patients with diabetes mellitus were included in this prospective study and divided into two groups according to the presence of diabetic retinopathy, as Group I with retinopathy and Group II without. The CCT of 96 eyes was measured by three different devices; SST (Orbscan II), UP and OCT. The results of CCT measurements with three different devices were compared. Also, the intergroup differences in CCT measurements were evaluated. Results The CCT was statistically insignificantly different between the two groups. Although the three methods of CCT measurements correlated well with each other, SST showed significantly (p

AIM: To evaluate the clinical characteristics of adenoviral keratoconjunctivitis, the management modalities, as well as the incidence of subepithelial corneal infiltrates (SEI). METHODS: Patients with characteristic clinical symptoms and signs, who presented to our clinic within the first week of symptoms and received the diagnosis of adenoviral keratoconjunctivitis between January 2013 and April 2016, were included in the study. A total of 211 patients were included in the study. Patients were evaluated for the incidence of clinical signs, late complications, management preferences, and the effect of diluted povidone-iodine (d-PVP-I) 2%. RESULTS: Patients’ mean age was 33.03±14.76y. We observed an increase in the number of cases according to the years. At presentation and/or early follow-up, the clinical signs were conjunctival hyperemia (100%), conjunctival follicules (79.1%), edema of the eyelids (39.3%), chemosis (16.1%), pseudomembrane formation (16.6%), and corneal epitheliopathy (29.9%). During late follow-up 13.3% patients developed conjunctival subepithelial fibrosis, and 39.8% developed SEI. A significant decrease in the incidence of SEI development was observed in patients who used d-PVP-I 2% (P=0.032; 33.3% vs 45.9%, respectively in patients who received d-PVP-I 2% and who did not). CONCLUSION: Adenoviral keratoconjunctivitis has a tremendous effect on patient’s comfort and abilities in short-term. Additionally, almost half of the patients develop visual problems related to SEI. According to our clinical experience, using d-PVP-I 2% in the first days of adenoviral keratoconjunctivitis might be helpful in reducing the risk of SEI as a complication.

AIM: To evaluate the inhibitory effect of subconjunctival bevacizumab as single- and multiple-dose application, and compare their effects on corneal neovascularization in a rat model. METHODS: Thirty adult Sprague-Dawley rats were used in this experimental study. The central cornea of the rats was cauterized chemically. The rats were randomly enrolled into three groups. All groups received subconjunctival injections. In Group 1 (control group, n=10), 0.05 mL 0.9% NaCl solution was injected on the first day. In Group 2 (single-dose group, n=10), 0.05 mL bevacizumab (1.25 mg) was injected on the first day. In Group 3 (multiple-dose group, n=10), four doses of 0.05 mL bevacizumab (1.25 mg) were injected on the first, third, fifth and seventh day. Slit-lamp examination of all rats was performed at the third and ninth day. Digital images of the corneas were taken and analyzed using image analysis software to calculate corneal neovascularization area. All rats were sacrificed on the tenth day. In corneal sections, the number of blood vessels, state of inflammation and collagen formation was evaluated histopathologically. RESULTS: In Group 3, corneal edema grades were significantly lower than Group 1 and Group 2 (P=0.02, and P=0.035, respectively). The mean percentage of neovascularized corneal area in Group 3 was significantly lower than Group 2 (P=0.005). On histopathological examination, Group 2 and Group 3 showed significantly less number of blood vessels than Group 1 (P=0.005, and P=0.001, respectively). Additionally, Group 3 showed significantly less number of blood vessels compared to Group 2 (P=0.019). Inflammation and edema grades were significantly lower in Group 3 compared to Group 1 (P=0.001). CONCLUSION: Subconjunctival bevacizumab injection is effective in inhibition of newly formed corneal neovascularization. The multiple-dose bevacizumab treatment seems to be more effective compared to single-dose treatment.

Adenoviral conjunctivitis may lead to subepithelial corneal infiltrates as a late complication. Herein, we aim to present a 19-year-old healthy female, who developed bilateral disciform keratitis three weeks after suffering adenoviral conjunctivitis. She presented with widespread subepithelial corneal infiltrates in addition to central corneal edema with white distinct border resembling immune stromal ring, as well as Descemet's folds and keratic precipitates in the central area. Following topical corticosteroid and ganciclovir for 10 days, her condition improved. After 1 month, she had another episode. Short-term topical corticosteroids in addition to long-term topical cyclosporine and nonpreserved artificial tears were able to prevent further recurrences.

AIM: To evaluate central macular thickness (CMT) and mean choroidal thickness (MCT) in eyes with branch retinal vein occlusion (BRVO), before and after ranibizumab treatment using spectral domain-optical coherence tomography (SD-OCT). METHODS: Forty-two patients with unilateral BRVO and macular edema were included in this study. There were 25 men and 17 women. Using SD-OCT, choroidal thickness was measured at 500 µm intervals up to 1500 µm temporal and nasal to the fovea. MCT was calculated based on the average of the 7 locations. All the eyes with BRVO were treated with intravitreal ranibizumab (0.5 mg/0.05 mL). Comparisons between the BRVO and fellow eyes were analyzed using Mann-Whitney U test. Pre-injection and post-injection measurements were analyzed using Wilcoxon test and repeated measure analysis. RESULTS: At baseline, there was a significant difference between the BRVO and fellow eyes in MCT [BRVO eyes 245 (165-330) µm, fellow eyes 229 (157-327) µm] and CMT [BRVO eyes 463 (266-899) µm, fellow eyes 235 (148-378) µm (P=0.041, 0.0001, respectively)]. Following treatment, CMT [295 (141-558) µm] and MCT [229 (157-329) µm] decreased significantly compared to the baseline measurements (P=0.001, 0.006, respectively). Also BCVA (logMAR) improved significantly (P=0.0001) in the BRVO eyes following treatment. After treatment CMT [BRVO eyes 295 (141-558) µm, fellow eyes 234 (157-351) µm] and MCT [BRVO eyes 229 (157-329) µm, fellow eyes 233 (162-286) µm] values did not reveal any significant difference in BRVO eyes and fellow eyes (P=0.051, 0.824, respectively). CONCLUSION: In eyes with BRVO, CMT and MCT values are greater than the fellow eyes, and decrease significantly following ranibizumab injection.

AIM: To compare the outcomes of combined phacoemulsification and non-penetrating deep sclerectomy(P-DS)with combined phacoemulsification and trabeculectomy(P-T)in patients who have cataract and moderate-to-severe primary open angle glaucoma(POAG)or pseudoexfoliative glaucoma(PXG).METHODS: In this prospective randomized study 40 eyes of 40 patients with cataract and POAG or PXG were evaluated. Complete eye examination and glaucoma tests were performed in all patients. Combined P-DS and P-T were performed under local anesthesia in 20 eyes in each group. Visual acuity(VA), intraocular pressure(IOP)and number of glaucoma medications were all recorded preoperatively and postoperative on 10d, 1, 3, 6 and 12mo. Complications, laser goniopuncture in P-DS group and needling in P-T group were also recorded.RESULTS: The age(P-DS, 66.3±11.0 and P-T, 70.2±9.3y)and sex distribution(P-DS, 7 female and 13 male, P-T, 9 female and 11 male)were similar in both groups(P>0.05). Number of POAG and PXG patients were 12 and 8, and 13 and 7 in P-DS and P-T groups, respectively(P>0.05). There was no difference between groups in terms of preoperative VA(P-DS, 0.69±0.22 and P-T, 0.76±0.22 logMAR), IOP(P-DS, 17.9±1.6 and P-T, 18.1±1.9 mm Hg)and number of medications(P-DS: 2.7±0.7 and P-T: 2.9±0.8),(P>0.05). VA increased, IOP and number of medications decreased in both groups postoperatively(PP=0.472). Postoperative number of medications were slightly better in P-T group(0.5±0.7)than in P-DS group(0.8±0.9)(P=0.307). There were no complications in both groups. Laser goniopuncture was applied in 7 eyes(once in 5 eyes and twice in 2 eyes)in P-DS group. Needling was performed in 1 eye in P-T group. CONCLUSION: In patients with coexisting cataract and glaucoma, both combined P-DS and P-T may be performed safely. Reliability and efficacy were similar in both groups. Follow-up of P-DS should be done cautiously and when necessary laser goniopuncture should be performed.

An 85-year-old male presented with painless bulging lesion over the cornea. Clinical history, diagnostic imaging studies, and histopathologic sections were evaluated. The patient clinically displayed an vascularized conjunctival lesion located at the superior bulbar conjunctiva with extension onto cornea covering 2/3 of his pupillary aperture superiorly. His visual acuity was counting fingers at 4 m. The patient underwent a total excision of the lesion including conjunctival and corneal parts. Histopathologic evaluation revealed spindle cell carcinoma which involves the whole conjunctival squamous epithelium with significant polarity loss, nuclear enlargement with hyperchromasia and pleomorphism, and mitotic activity. Diagnosis of spindle cell carcinoma is challenging because of overlapping histopathological features with other spindle cell tumors. The detailed pathologic examination is very important for the decision of proper treatment.

Aims: To investigate the effect of surgery type on the postoperative astigmatism in pterygium surgery. Settings and Design: Retrospective comparative clinical trial. Materials and Methods: Data of 240 eyes that underwent pterygium excision were investigated. Following removal of the pterygium, patients underwent 5 different types of surgeries: Conjunctival autograft with sutures (CAG-s) or fibrin glue (CAG-g), conjunctival rotational flap (CRF), or amniotic membrane transplantation with either suture (AMT-s) or with glue (AMT-g). The preoperative and postoperative keratometric measurements, evaluated using an automated keratorefractometer, were noted. Statistical Analysis: The overall changes in BCVA and astigmatic degree were evaluated using Wilcoxon signed rank test. The difference in astigmatic values between groups was calculated using one way analysis of variance (ANOVA). Results: The most commonly performed procedure was CAG-s (N = 115), followed by CAG-g (N = 53), CRF (N = 47), AMT-s (N = 15), and AMT-g (N = 10). Following surgery, astigmatic values decreased from 3.47 ± 2.50 D to 1.29 ± 1.07 D (P < 0.001, paired t test). The changes in astigmatism was significantly related to the preoperative size of the pterygium (ρ = 3.464, P = 0.005). The postoperative astigmatism correlated with preoperative astigmatism (ρ = 0.351, P < 0.001, Spearman correlation analysis). The changes in astigmatic values was not related to the method of surgery (P = 0.055, ANOVA). Conclusion: Pterygium results in high corneal astigmatism, which decreases to an acceptable level following excision. According to our study, the type of grafting as CAG, CRF or AMT or the use of suture or glue to fixate the graft does not have a significant effect on the change in astigmatism degree.

Purpose: This study was designed to analyze the risk factors resulting in high intraocular pressure (IOP), which was accepted as IOP higher than 22 mmHg, following uncomplicated phacoemulsification. Materials and Methods: The records of 812 eyes of 584 patients who underwent uncomplicated phacoemulsification were evaluated. There were 330 men and 254 women ranging between the age of 26 and 89 years (65.4 ± 9.8 years). The preoperative, postoperative first day (day 1), first week (day 7), and first month (day 30) IOP values were analyzed. Data on history of diabetes, glaucoma, pseudoexfoliation (PXF), incision site, capsular staining with trypan blue, and surgeon were recorded. A multinomial regression analysis was performed to analyse the relationship of the factors with postoperative high IOP. Results: The mean IOP was 15.6 ± 4.3 mmHg preoperatively. Postoperatively that were changed to 19.7 ± 9.0 mmHg at day 1, 12.7 ± 4.5 mmHg at day 7, and 12.8 ± 3.7 mmHg at day 30. The factors such as surgeon, presence of PXF, diabetes, surgical incision site, and trypan blue were not related to the postoperative high IOP (P > 0.05, in all). The only factor that related to high IOP at all visits was glaucoma (P < 0.005). Conclusion: According to our results, preoperative diagnosis of glaucoma seems to be the only factor to affect the postoperative IOP higher than 22 mmHg.

A 3-day-old male newborn presented with a severe proptosis of the left eye leading to exposure keratopathy. He underwent debulking of the cyst and biopsy of the tumour and received the pathological diagnosis of epidermoid cyst of orbit. Clinicopathological features of this rare disease are discussed.

We report a case with severe head trauma and perforating globe injury in one eye and ischemic retinopathy and neovascular proliferation in the other eye. A 37-year-old male was brought to the emergency department after a motor vehicle accident with severe maxillofacial trauma. Ophthalmic examination revealed hematoma of the left eyelids as well as traumatic rupture and disorganization of the left globe. On the right eye, anterior segment and fundoscopic examination were normal. Primary globe repair was performed. At postoperative one-month visit, the right eye revealed no pathology of the optic disc and macula but severe neovascularization in the temporal peripheral retina. The patient was diagnosed as ischemic retinopathy and neovascular proliferation due to head trauma.

Objectives: Autologous dermis fat graft (DFG) is being used in both primary and secondary socket surgeries. In the present study, we aimed to evaluate patients’ satisfaction and possible intra- and postoperative complications in patients who had DFG transplantation. Materials and Methods: In this retrospective study, the results of 17 patients who were operated between October 2008 and October 2012 were evaluated. Of these cases, 7 had primary and 10 had secondary DFG. Patient satisfaction was evaluated by asking the patients to fill out a questionnaire graded from 1 (not satisfied) to 4 (very satisfied). Additionally, the incidence of complications and requirement for another operation was noted. Results: The average patient age was 30.5±17.9 years. Patients with primary grafts were 100% satisfied with the outcome and could wear their prosthesis without any discomfort. In this group, one patient had delay in epithelialisation of the graft and ptosis, which was treated with frontal sling surgery and artificial tears. In patients with secondary grafts, 6 patients (60%) were satisfied with the outcome. Four patients were not satisfied from the result. One had inferior lid laxity; however, after lateral tarsal strip surgery, she could wear her prosthesis. Another patient developed inferior forniceal adhesion. He was treated with mucous membrane grafting and artificial tears and could wear his prosthesis. One patient had infection and contraction of the socket due to inappropriate postoperative medication use. Following repeated DFG transplantation, he was able to wear his prosthesis. Another patient had fat atrophy prior to secondary DFG transplantation and developed atrophy of the graft following surgery. Her family refused additional surgery. This patient could not wear any prosthesis. Conclusion: According to our results, we believe that DFG transplantation is successful in primary implantation. In secondary cases, correct patient selection is important to achieve good outcome. (Turk J Ophthalmol 2015; 45: 65-70)

Patients with orbital infections present to our clinic usually with unilateral pain, hyperemia, and edema of the eyelids. The differentiation between preseptal and orbital cellulitis is utmost important in that the second requires hospitalization. Since in orbital cellulitis, the tissues posterior to the orbital septum are involved, signs such as conjunctival chemosis, limited eye movement, decreased vision, as well as afferent pupil defect secondary to optic nerve involvement may also be observed. Prompt intravenous antibiotic treatment should be started, and surgical drainage may be performed if patient shows failure to improve in 48 hours despite optimal management. Without treatment, the clinical course may progress to subperiosteal or orbital abscess, and even to cavernous sinus thrombosis. (Turk J Ophthalmol 2012; 42: Supplement 52-6)