COMPARISON OF THE EFFECTS OF EIGHT DIFFERENT TOPICAL NONSTEROIDAL ANTI-INFLAMMATORY DRUGS ON REDUCING INTRAVITREAL INJECTION-INDUCED PAIN.

PURPOSE: To compare topical nonsteroidal anti-inflammatory drug (NSAID) efficacy on intravitreal injection-induced pain reduction and determine the most efficient topical NSAID. METHODS: This randomized-controlled study included 662 eyes of 662 patients. Based on the types of NSAID administered before intravitreal injection, eight subgroups were formed. In the control group, a sterile saline solution was applied instead of NSAIDs. The visual analog scale was used to assess pain scores after intravitreal injection. The visual analog scale scores were noted immediately and 6 hours following injection (sixth hour). RESULTS: Nepafenac 0.3%, nepafenac 0.1%, and bromfenac 0.09% had the lowest scores, immediately after and after 6 hours, with no significant differences. Diclofenac and ketorolac had higher visual analog scale scores than the first trio but lower scores than the control group. Flurbiprofen, pranoprofen, and indomethacin did not significantly affect immediate pain; however, at the sixth hour, the visual analog scale scores were significantly reduced. CONCLUSION: Nepafenac 0.3%, nepafenac 0.1%, and bromfenac 0.09% were the most effective NSAIDs for pain reduction. Although some NSAIDs did not have a significant effect on immediate pain, they all provided significant benefits at the sixth hour.

Accuracy of Different Lens Power Calculation Formulas in Patients With Mature Cataracts.

Introduction To compare the prediction accuracy of lens power calculation formulas in patients undergoing mature cataract surgery. Methods A total of 90 operations involving the Alcon SA60AT IOL implant (Alcon, Geneva, Switzerland) were analyzed in terms of mean refractive prediction error (PE) and mean absolute prediction error (MAE) using backward calculation in a retrospective design. Results A negative PE was observed in SRK/T, Holladay 1, Holladay 2, Hoffer Q, Haigis, and Emmetropia Verifying Optical (EVO) formulas. In contrast, positive PEs were observed in Barrett Universal II (BAUII), Kane, and Radial Basis Function (RBF) formulas. Negative PE was observed with all formulas, except BAUII, in patients with a shallow anterior chamber depth (ACD). While the SRK/T, Holladay 1, BAU, Kane, and RBF formulas demonstrated positive PE, the Holladay 2, Hoffer Q, Haigis, and EVO formulas indicated negative PE. In patients with deep ACD, positive PE was observed in all formulas, barring Holladay 2 and EVO. No significant differences were identified between the formulas concerning MAE and percentages of 0.25 diopter (D), 0.50 D, 0.75 D, and 1.0 D across all study groups. Conclusion Although the new generation formulas provide very good results, achieving the best with a single formula is still impossible.

The role of inflammatory biomarkers in predicting primary acquired nasolacrimal duct obstruction and postoperative recurrence.

This study aims to determine the relationship between systemic inflammatory biomarkers and primary acquired nasolacrimal duct obstruction and to evaluate whether they can be used as indicators in determining the risk of recurrence after dacryocystorhinostomy. This retrospective, comparative case series was conducted with 57 primary acquired nasolacrimal duct obstruction patients and 58 age- and gender-matched controls. All subjects underwent a complete ophthalmologic examination and complete blood count measurements. The mean neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammation index were significantly higher in patients with primary acquired nasolacrimal duct obstruction (p = 0.005, p = 0.01, and p = 0.003, respectively). In recurrent patients, the neutrophil-to-lymphocyte ratio was significantly higher than in those who did not develop a recurrence (p = 0.029). The area under the curve was determined as 0.775 (p = 0.029) for the neutrophil-to-lymphocyte ratio in predicting recurrence. The neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammation index levels were significantly higher in patients with primary acquired nasolacrimal duct obstruction compared to healthy controls. The neutrophil-to-lymphocyte ratio might be used as a simple and inexpensive indicator for predicting recurrence in patients with primary acquired nasolacrimal duct obstruction.

Changes in intra-ocular pressure, ocular pulse amplitude and choroidal thickness after trabeculectomy.

CLINICAL RELEVANCE: Glaucoma is one of the most common causes of blindness. Although high intra-ocular pressure (IOP) is the most important risk factor, ocular blood flow also has an effect on prognosis. BACKGROUND: The aim of this study was to investigate the IOP, ocular pulse amplitude (OPA) and choroidal thickness (CT) changes after trabeculectomy and to determine whether trabeculectomy has an effect on ocular blood flow. METHODS: This retrospective, comparative case series was conducted with 33 eyes of 33 patients who underwent trabeculectomy due to uncontrolled glaucoma. The fellow eyes of 20 patients who were followed up with medical therapy were included as a control group. IOP and OPA were evaluated using a dynamic contour tonometer. Subfoveal choroidal thickness (SFCT) was obtained with enhanced depth imaging (EDI) mode of Spectralis-OCT. RESULTS: The mean IOP was 21.6 ± 6.3 mmHg at baseline and 13.8 ± 0.9 mmHg after trabeculectomy (p ˂ 0.001), and the mean OPA was 4.1 ± 1.5 at baseline and 2.6 ± 1.6 mmHg after trabeculectomy (p ˂ 0.001). The mean SFCT was 292.2 ± 63.2 µm at baseline and 303.8 ± 70.4 µm after trabeculectomy (p = 0.024). The change in OPA was strongly positively correlated with the change in IOP (r = 0.597, p ˂ 0.001) and SFCT change was positively correlated with OPA change (r = 0.34, p = 0.05). There was no difference between the two groups in terms of IOP, OPA and SFCT values measured after trabeculectomy (respectively, p = 0.264, p = 0.627 and p = 0.949). CONCLUSION: The large IOP decrease following trabeculectomy causes a decrease in OPA and choroidal thickening. On the other hand, trabeculectomy has no effect on OPA change.

Prognostic factors associated with the course of vitreomacular traction in eyes with age-related macular degeneration.

CLINICAL RELEVANCE: Vitreomacular traction(VMT) is a clinical syndrome that can cause decreased vision and may affect the treatment response in cases of age-related macular degeneration(AMD). Factors affecting the course of VMT in AMD cases will guide the clinician in terms of patient management. BACKGROUND: The aim of this study was to determine the prevalence of VMT in patients with AMD, to evaluate the natural course of VMT, and to investigate factors associated with the prognosis of VMT in eyes with AMD. METHODS: This retrospective case series was conducted with 55 eyes of 46 patients who were diagnosed as having AMD accompanying with VMT. Demographic data, complete ophthalmologic examination findings, type of AMD, receiving an intravitreal injection(IVI), number of IVIs, and the presence of complete spontaneous release were obtained from the medical records of the patients. The horizontal length of VMT(HLVMT), central macular thickness(CMT), the horizontal length of choroidal neovascularization(HLCNV) were evaluated from spectral-domain optical coherence tomography(SD-OCT) images. RESULTS: Spontaneous release was observed in 7(28%) eyes of the exudative AMD group and 10(33.3%) eyes of the nonexudative AMD group. On the last visit, the HLVMT was increased in 22(40%) of the eyes and a decrease in HLVMT was observed in 8(14.5%) of the eyes. In the remaining 12(21.8%) eyes had unchanged HLVMT. In all eyes with CNV, the area of VMT corresponded in 100% with localization of the CNV complex. No significant difference was found between the eyes with spontaneous release and persistent traction in terms of the type of AMD, IVI, HLVMT, age, gender, and crystalline lens status. CONCLUSION: In this study, VMT was observed at higher rates in eyes with exudative AMD compared to the eyes with nonexudative AMD. However, spontaneous release rates were found close to those with idiopathic VMT independently of the type of AMD, HLVMT, and IVI.

What Hundreds of Millions of Patients With Dry Eye Will Find on YouTube: A Quality and Reliability Research of the YouTube Videos.

PURPOSE: The aim of this study was to evaluate the demographic features, quality, and reliability of YouTube videos addressing dry eye disease (DED). METHODS: The term "dry eye disease" has been searched on YouTube. The first 500 videos that emerged using the defined search term were evaluated. Duplicated-split videos, videos shorter than 60 seconds, videos with a language other than English or videos with an unintelligible English accent, and videos unrelated to DED were excluded. Video uploaders, types, origins, durations, and viewer interactions of the videos were noted. DISCERN, the Global Quality Score, and the Video Quality Score (created by the authors) were used to evaluate the video quality. RESULTS: Of the 500 videos, 262 videos were excluded, and the remaining 238 videos were evaluated. Videos were of moderate quality on all 3 scoring systems. The medical institute and academic society videos had the highest quality ( P < 0.05). The quality of videos uploaded by physicians was significantly lower than medical institute and academic society videos and was higher than the others ( P < 0.05). User interactions and video duration were weakly positively correlated with the video quality ( P < 0.05). CONCLUSIONS: Among YouTube videos on DED, only a minority are of good or excellent quality. Videos uploaded by medical institutes or academic societies scored higher in quality than those uploaded by physicians, which, in turn, scored higher than those uploaded by all others. User interactions were weakly correlated with quality values, suggesting user interactions are not good indicators of the quality of YouTube videos on DED.

The reliability of trabeculectomy surgical videos on the internet for educational purposes in the changing world.

BACKGROUND AND PURPOSE OF THE STUDY: The use of social media that facilitates access to surgical training is increasing among general practitioners/surgeons. The present study aimed to evaluate the educational quality of videos on social media and the medical education websites in terms of trabeculectomy surgery. METHODS: In this cross-sectional and register-based study, the term "trabeculectomy" has been searched on 22 websites containing medical surgery training videos. Demographical features and descriptive statistics of videos are noted. All videos were evaluated independently by two ophthalmologists according to DISCERN, Journal of American Medical Association, and Global Quality scoring system. The main 11 steps of trabeculectomy surgery were taken into consideration in each video and Video Quality Score was determined based on these steps. THE MAIN FINDINGS: In total, 731 videos were watched and 634 were excluded and 97 videos were included in the study. The total quality of all videos according to DISCERN, JAMA, GQS, and VQS scores were 31.6 ± 9.1 (poor quality), 1.3 ± 0.4 (poor quality), 2.6 ± 0.9 (fair quality), and 6.9 ± 2.1 (poor quality) respectively. Only 6 of the 97 evaluated videos included all the steps of trabeculectomy surgery. Videos have longer duration, videos with narration or videos with descriptive subtitles were found to be significantly higher quality than those are not. CONCLUSSION: The educational quality of internet videos may be far from the quality it should be and it is indisputable that it is necessary to be able to access surgical educational videos that are peer-viewed and whose quality is not doubted.

Evaluation of the educational quality and reliability of YouTube videos addressing eyelid ptosis surgery.

PURPOSE: To evaluate the educational content, quality, and reliability of YouTube videos addressing anterior approach ptosis surgery. METHODS: A search on YouTube using the term "ptosis surgery" was performed between March 20 and March 26 2021. The quality, reliability, and accuracy of the contents of 38 videos meeting the inclusion criteria were evaluated by two independent ophthalmologists using the DISCERN questionnaire and the Journal of the American Medical Association (JAMA) benchmark criteria. The Global Quality Score (GQS) and a surgical scoring system were used to assess the educational value of the content. RESULTS: The mean DISCERN score was 32.8 ± 10, and the mean JAMA score was 1.3 ± 0.5, indicating poor quality; the mean global quality score was 3.1 ± 1.1, indicating moderate quality; and the mean surgical score was 7.5 ± 2.7, indicating moderate to good quality. The surgical, DISCERN, and GQS scores of the videos uploaded by physicians were significantly higher than those of the videos uploaded by private clinics (p = .015, p= .049, and p= .01, respectively). There was a significant positive correlation between the surgical, DISCERN, JAMA, and GQS scores (p< .001). A significant positive correlation was found between video duration and surgical score (p= .013), DISCERN score (p ˂0.001), and GQS score (p ˂0.001). CONCLUSION: Videos with known sources, uploaded by physicians, and supported by audio narration may be useful in obtaining educational information. However, the available videos are not a reliable source of educational information about ptosis surgery.

Corneal dellen development after strabismus surgery.

This study aimed to evaluate the frequency of corneal dellen development, the healing process, and associated factors that affecting the development and healing of corneal dellen formation after strabismus surgery. In this retrospective study, the records of 714 eyes of 1264 patients who underwent limbal approach strabismus surgery between January 2005 and January 2020 were examined and 47 eyes of 44 patients with corneal dellen were included in the study. Demographic features, ophthalmological examination findings, dellen occurrence and healing time, dellen localization, and the type of surgery were obtained from the medical records of the patients. Corneal dellen development rate was found to be 3.7%. A moderate positive correlation was determined between both mean dellen occurrence time (r = 0.387, p = .007), and mean dellen healing time (r = 0.376, p = .014) with age. In patients who underwent monocular two muscle surgery had significantly higher rates of dellen formation compared to patients who underwent single muscle surgery (p˂0.001). Corneal dellen was significantly higher in eyes undergoing single muscle rectus resection surgery than single muscle rectus recession surgery (p < .001). It was observed that corneal dellen developed more frequently after resection surgery, developed earlier in younger patients, and heals later in elderly patients. Therefore, patients can be followed up closely, keeping in mind the development of dellen, especially after resection surgery.

NATURAL COURSE OF VITREOMACULAR TRACTION IN EYES WITH DIABETIC RETINOPATHY AND FACTORS ASSOCIATED WITH SPONTANEOUS RELEASE.

PURPOSE: The aim of this study was to determine the natural course of vitreomacular traction (VMT) in patients with diabetic retinopathy and to evaluate the factors associated with VMT relief. METHODS: Seventy-four eyes of 65 patients with VMT accompanying diabetic retinopathy were evaluated retrospectively. The presence of intravitreal injection and the presence of panretinal photocoagulation were obtained from the medical records of the patients. Spontaneous release of VMT, the horizontal length of vitreomacular traction, the presence of hyperreflective retinal spots, the presence of the epiretinal membrane, and the grade of VMT were evaluated from the spectral-domain optical coherence tomography images. Factors associated with the spontaneous release of VMT were evaluated by logistic regression analysis. RESULTS: Spontaneous release was observed in 28 eyes (37.8%). The horizontal length of VMT was lower in the release of the VMT group compared with the persistent VMT group (P = 0.03). The persistent VMT group had a higher rate of hyperreflective retinal spots and epiretinal membrane compared with the release of the VMT group (respectively; P = 0.003 and P = 0.031). No statistically significant difference was observed between the release of VMT and persistent VMT groups in terms of intravitreal injection and panretinal photocoagulation treatment (respectively; P = 0.938 and P = 0.36). The absence of hyperreflective retinal spots was the most important prognostic factor for the spontaneous release of VMT (P = 0.029). CONCLUSION: Spontaneous release of VMT observed higher rates of patients without hyperreflective retinal spots, epiretinal membrane, and patients with lower horizontal length of VMT.

Comparison of macular thickness change by optical coherence tomography after uncomplicated cataract surgery in eyes with and without exfoliation syndrome.

PURPOSE: To evaluate the effect of exfoliation syndrome (ES) on macular thickness after uncomplicated cataract surgery. METHODS: 87 patients (87 eyes) who underwent uncomplicated cataract surgery were included in the study. Optical coherence tomography (OCT) films were taken in addition to the routine ophthalmologic examination before the surgery and at postoperative 1st week, 1st, 3rd and 6th months. Mean macular thickness, central macular thickness and macular volume values obtained from the 6 × 6 mm macular map in the OCT measurements were recorded. The cases were divided into two groups as Group 1: cases without ES and Group 2: cases with ES. The macular values obtained from the OCT measurements of the two groups were compared with statistical methods. RESULTS: Eighty-seven eyes were included in the study; while 51 had no ES (Group 1), 36 had ES (Group 2). The mean age of all cases was 66.70 ± 9.13 years. While the mean macular thickness, central macular thickness and macular volume were similar at the preoperative visit and the postoperative 1st week of all cases (each p value > 0.05); these values were higher at the postoperative 1st, 3rd and 6th month compared to the preoperative and the postoperative 1st week values (each p value < 0.05). The highest values were obtained at the postoperative 1st month; while the values of 1st, 3rd and 6th months were statistically similar (each p value > 0.05). No statistically significant difference was observed between Group 1 and Group 2 in terms of macular volume, central macular thickness and average macular thickness in these periods. CONCLUSION: Exfoliation syndrome has not been evaluated as a risk factor for an increase in macular thickness after uncomplicated cataract surgery.

Evaluation of Clinical Findings, Optical Coherence Tomography, Fundus Fluorescein Angiography, and Indocyanine Green Angiography Imaging in Patients with Polypoidal Choroidal Vasculopathy.

OBJECTIVES: The aim of this study was to describe clinical findings as well as spectral-domain optical coherence tomography (SD-OCT), fundus fluorescein angiography (FA), and indocyanine green angiography (ICGA) findings of polypoidal choroidal vasculopathy (PCV). METHODS: This retrospective, observational case series included 144 eyes of 103 patients who were diagnosed with PCV between January 2014 and August 2016. Best corrected visual acuity, 90-diopter lens slit-lamp fundus biomicroscopy examination findings, color fundus photography, SD-OCT, FA, and ICGA findings were evaluated at the time of diagnosis. RESULTS: Sixty-six patients (93 eyes, 64.1%) were male and 37 (51 eyes, 35.9%) were female. Sixty-two (60.2%) patients had unilateral involvement. The most common SD-OCT finding was retinal pigment epithelial detachment (PED). Red-orange subretinal lesions were seen in 20 eyes (13.9%). There was a single polyp in 21 (14.6%) eyes, and more than 1 polyp in 123 (85.4%) eyes observed with ICGA imaging. The polyps were located in the peripapillary area in 10 (6.9%) eyes, the macular area in 91 (63.2%) eyes, and the extramacular area in 1 (0.7%) eye. A significant branching vascular network was seen in the ICGA images of 112 (77.8%) eyes. CONCLUSION: In this study, the majority of patients were male, with unilateral macular polyps. A serous PED and an exudative pattern were the most common clinical manifestations. SD-OCT showed specific findings for PCV, but ICGA was the most useful test for diagnosis.

Evaluation of Axial Length Changes after Combined Phacovitrectomy for Macula-off Rhegmatogenous Retinal Detachment.

OBJECTIVES: To evaluate the reliability of optical biometry for correct intraocular lens (IOL) power calculation in eyes with macula-off rhegmatogenous retinal detachment (RRD) via comparing the axial lengths (AL) measured with optical biometry preoperatively and postoperatively. METHODS: This retrospective study was conducted with 25 eyes of 25 patients who underwent combined surgery (phacoemulsification and pars plana vitrectomy (PPV)) with the diagnosis of RRD with macular involvement. Best-corrected visual acuity (BCVA), biomicroscopic examination, intraocular pressure measurement and full fundoscopic examination were performed in all patients. Axial length was measured using optical biometry in all patients. The AL measurements were repeated in the postoperative third month in the patients using gas tamponade during vitreoretinal surgery and in the third month after the silicone oil removal in patients using silicone-oil tamponade during vitreoretinal surgery. RESULTS: The mean age of the patients was 61.60±7.33. Fifteen patients (60%) were female, and 10 (40%) were male. Postoperative BCVA values (0.40±0.28) were significantly higher than the preoperative BCVA values (0.14±0.22) (p<0.05). The preoperative mean value of AL was measured as 24.66±1.90 and the postoperative mean value of AL was 24.67±1.91. There was no statistically significant difference between the measured AL values in the preoperative and postoperative periods (p=0.258). CONCLUSION: Combined surgery (phacoemulsification and PPV) is a frequently applied method in RRD treatment. The correct AL measurement is important for the removal of refractive errors due to AL measurement in patients with macula-off RRD. Optical biometry provides accurate results in these cases.

Aflibercept in macular edema secondary to retinal vein occlusion: A real life study.

PURPOSE: To evaluate the real life outcomes of intravitreal aflibercept (IVAfl) treatment in patients with macular edema (ME) secondary to retinal vein occlusion (RVO) during the first year of treatment. METHODS: Retrospective case series. Newly diagnosed or persistent ME patients secondary to RVO who were treated with IVAfl and had a follow-up period of at least 12 months were included. Twenty-two patients (54.8%) received 3 loading month loading doses IVAfl initially, whereas 20 patients (45.2%) did not receive. Then the patients were treated on an as-needed treatment regimen. Primary outcome measures of this study included the change in best corrected visual acuity (BCVA) and central retinal thickness (CRT). Secondary outcome measures were the number of visits and injections. RESULTS: Forty-two eyes of 42 patients were included. Fourteen patients (33.3%) had central RVO, and 28 (66.7%) had branch RVO. Mean BCVA at baseline and month 12 was 0.98 ± 0.58 and 0.82 ± 0.65 LogMAR, respectively (p = 0.04). Mean CRT at baseline and month 12 was 511 ± 141 and 304 ± 95 µm, respectively (p < 0.0001). Mean number of visits was 5.9 ± 2.1 (range 3-11) and injections was 3.2 ± 1.7 (range 1-8) at month 12. CONCLUSION: In conclusion, IVAfl treatment seemed to be effective in patients with ME secondary to RVO with respect to visual and anatomical outcomes in real life. In this study the number of visits and injections was lower that randomized controlled trials, but the functional and anatomical outcomes are probably still acceptable.

The comparison of multimodal imaging findings of central serous chorioretinopathy patients in regard to the early anatomically treatment response to half-fluence photodynamic therapy: a retrospective case-control study.

BACKGROUND: To compare the multimodal imaging findings of chronic central serous chorioretinopathy (CSC) patients who are good or poor responders to low-fluence photodynamic therapy (PDT). METHODS: Retrospective, interventional comparative study. The CSC patients who were admitted to our clinic for the first time between January 2013 and December 2015 were included in the study. Patients were treated with PDT only if they did not show any sign of resolution after at least 6 months from the initial signs of the disease. The patients who showed full or partial response to PDT after 3 months of treatment were accepted as good responders, those who did not show any sign of resolution were accepted as poor responders. The optical coherence tomography (OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA) findings were compared between the two groups. RESULTS: A total of 101 eyes of 101 patients were included: 76 eyes (75.2%) were considered as good responders and 25 eyes (24.8%) as poor responders. In regards to OCT and FA findings there was not a significant difference between the two groups for all of the evaluated findings (p > 0.05 for all). In regards to ICGA findings, there was a statistically difference in the percentage of intense midphase hypercyanescence (p < 0.0001). CONCLUSIONS: The multimodal imaging findings of CSC patients were compared in regard to their PDT response. The presence of midphase hypercyanescence in ICGA seemed to be positive predictive factor for the PDT response in CSC patients.