Lack of Response to Intravitreal Ranibizumab Treatment in Adult Onset Foveomacular Vitelliform Dystrophy Complicated with Choroidal Neovascularization: A Case Report

Adult-onset foveomacular vitelliform dystrophy (AOFVD) is a rare disease characterized by accumulation of yellowish deposits in the macula. Rarely, it may be complicated by choroidal neovascularization (CNV). Cases with CNV may be confused with occult CNV in age-related macular degeneration. In our case, we will present the visual and anatomical results of a patient with AOVF-related CNV, in which we administered 3 doses of intravitreal ranibizumab (IVR). A 59-year-old female patient, who attended our clinic with the complaint of decreased vision in both eyes, was diagnosed with AOVF-related CNV in both eyes and was treated with 3 doses of IVR for 3 months. Despite the improvement in visual and anatomical functions 1 month after the first dose, vision decreased, and anatomical functions regressed to the pre-injection state in continued injections. IVR therapy is not an appropriate treatment option in the treatment of AOVF-associated CNV.

YouTube as a source of patient information for pterygium surgery.

Background: Patients use the YouTube platform to get information about pterygium surgery, and this affects the treatment decisions of the patients. Objectives: The purpose of this study was to analyze the quality and reliability of YouTube videos as educational resources about pterygium surgery. Design: This is a register-based retrospective study. Methods: This was a retrospective, record-based study. A YouTube search was performed using the terms 'pterygium surgery' and 'pterygium eye surgery', resulting in the evaluation of a total of 200 videos. In the end, 122 English-language videos about pterygium surgery were recruited to study. All videos were rated with the DISCERN, the Journal of the American Medical Association (JAMA), and the Global Quality Score (GQS) systems. Results: The mean DISCERN, JAMA, and GQS values were 38.9 ± 10.9, 1.8 ± 0.8, and 2.2 ± 1, respectively. The YouTube videos about pterygium surgery had been uploaded by a physician in 63 (51.6%) and non-physicians in 59 (48.4%) cases. There was no significant difference between the two groups in terms of general characteristics and scores. Conclusions: Our results show that YouTube videos about pterygium surgery have low quality and credibility and are not sufficient in terms of providing patient information. Registration: Not applicable.

Evaluation of Vision-Related Quality of Life After Unilateral Implantation of a New Trifocal Intraocular Lens.

Objectives: The objective of the study was to evaluate visual performance and subjective quality of life after unilateral implantation of a new trifocal intraocular lens (IOL) in young and middle-aged patients. Methods: Patients that underwent unilateral cataract surgery with implantation of trifocal TFNT00 IOL with an emmetropic fellow eye were included in the study. Vision related daily activity performance was evaluated in postoperative 6th month. Patients were divided in two groups according to the uncorrected near visual acuity of their fellow eyes: In Group I if worse than the operated eye and in Group II if equal or better than the operated eye. The visual function-14 (VF-14) questionnaire was used with scores of 4 with no difficulty, 3 points with mild difficulty, 2 points with moderate difficulty, 1 point with severe difficulty, and 0 point if unable to perform. Results: Twenty-one patients were enrolled in this study. Patients had good visual performance, showing VF-14 scores above 3 in all categories. Reading small print (3.67±0.48) and driving at night (3.67±0.48) were found to be the most difficult tasks to perform. No significant difference was found between two groups in any category that was investigated by the VF-14 questionnaire. Conclusion: Unilateral implantation of TFNT00 trifocal IOL is well tolerated with good patient satisfaction assessed by VF-14 questionnaire in subjects that have cataract in one eye, encouraging single-eye surgical procedure in this particular group of patients.

Visual acuity, defocus curve and patient satisfaction of a new hybrid EDOF-multifocal diffractive intraocular lens.

Purpose: To evaluate the visual acuity, defocus curve and visual quality of life following bilateral implantation of a new hybrid extended depth of focus (EDOF)-multifocal diffractive intraocular lens (IOL). Methods: Patients who underwent cataract surgery with bilateral implantation of Tecnis Synergy IOL were enrolled in this study. The main outcomes were defined as uncorrected distant, intermediate and near visual acuities (UDVA, UIVA and UNVA, respectively), defocus curve and VF-14 questionnaire aimed for visual performance. Results: The mean ± SD values for binocular UDVA, UIVA and UNVA were -0.01 ± 0.04, 0.05 ± 0.03 and 0.03 ± 0.05 logMAR, respectively. Defocus curve showed a continuous vision above 0.16 logMAR between +0.50 D and -2.50 D. Patients had good visual performance with mean VF-14 scores above 3 points. Driving at night (3.47 ± 0.64) was found to be the most difficult task to perform. Spectacle independence was 100% for both distant and near vision. Conclusion: Bilateral implantation of Tecnis Synergy IOL in cataract patients shows good visual acuity and performance, covering a good visual range without any need of spectacles.

Astigmatic Vectorial Analysis in Pediatric Keratoconus After Unilateral Cross-Linking Treatment.

PURPOSE: The aims of this study were to evaluate the treatment response of pediatric keratoconus (KC) patients to unilateral corneal collagen cross-linking (CXL) in treated eyes, disease progression in untreated eyes, and define the predictive value of astigmatic parameters by astigmatic vectorial analysis. METHODS: Pediatric patients with KC with CXL-treated progressive eye and untreated fellow eye were included. Patients with other ocular conditions and a history of previous ocular surgery were excluded. Astigmatic changes in anterior and posterior corneal surfaces were evaluated with vectorial analysis. The receiver operating characteristic curves were analyzed to detect the best parameter that discriminates treated and untreated groups. RESULTS: Thirty-two eyes of 16 patients with at least 2-year follow-up were analyzed. The maximum keratometry (K) in CXL-treated eyes remained stable (from 53.51 ± 2.86-53.41 ± 2.84 diopter (D), P = 0.84) while the steepest K increased in untreated eyes (from 47.82 ± 1.71-49.59 ± 3.32 D, P = 0.03). The oblique components of corneal astigmatism in CXL-treated eyes were higher than those of fellow eyes (all P < 0.05), which significantly decreased in the anterior 3-mm zone after treatment (P = 0.048). The mean differential astigmatism magnitudes were significantly higher in treated eyes (all P < 0.05). The refractive centroid remained unchanged in treated eyes (P = 0.553) and shifted in the oblique direction in untreated eyes (P = 0.04). The oblique differential astigmatism in the anterior 7-mm zone showed the highest area under the curve value in predicting treatment efficacy (0.813, 95% confidence interval: 0.646-0.981, P < 0.001). CONCLUSIONS: Astigmatic vectorial analysis is an objective tool for longitudinal assessment of clinical outcomes in KC. Changes in the oblique components of corneal astigmatism might predict progression and treatment efficacy.

Comparative Analysis of a New Hybrid EDOF-Multifocal Diffractive Intraocular Lens with a Trifocal Diffractive Intraocular Lens.

PURPOSE: To compare visual acuity, defocus curve and visual quality of life performances of a new hybrid refractive-diffractive intraocular lens (IOL) and a trifocal diffractive IOL. METHODS: Patients who underwent cataract surgery with bilateral implantation of ZFR00V or TFNT00 IOLs were enrolled in this study. The main outcomes were defined as uncorrected distant, intermediate and near visual acuities (UDVA, UIVA and UNVA, respectively), defocus curve and VF-14 questionnaire aimed for visual performance. RESULTS: Fifty patients, of whom 30 had bilateral ZFR00V implantation, were enrolled in the study. Patients with ZFR00V had significantly better UIVA than patients with TFNT00 (0.05 ± 0.03 vs. 0.07 ± 0.04 logMAR, P = 0.02). Defocus curve showed significantly higher visual acuity in intermediate range for ZFR00V IOL between -1.00 and -1.50 dioptres (all P < 0.05). All patients had good visual performance with mean VF-14 scores above 3 points with no significant difference between two IOL models. Spectacle independence was 100% for both distant and near vision in both group of patients. CONCLUSION: Bilateral implantation of ZFR00V in cataract patients shows better intermediate visual acuity scores and similar daily visual performance when compared with trifocal TFNT00 IOL.

Survey of the Impact of the COVID-19 Pandemic on Ophthalmology Clinical Practice in Turkey

Objectives: To investigate the effect of the novel coronavirus disease 2019 (COVID-19) pandemic on the clinical practice of ophthalmologists in our country. Materials and Methods: A questionnaire consisting of 22 questions was delivered to 250 ophthalmologists via e-mail and a smartphone messaging application. A total of 113 ophthalmologists completed the survey. The questions included the participants' demographic data (age, years in practice, institution, and city), changes in their working conditions and institutional preventive measures implemented during the pandemic, their personal COVID-19 experiences, the prevalence of telemedicine applications, and their attitudes toward these practices. Results: Nearly half (47.8%) of the 113 ophthalmologists were 36 to 45 years old. In terms of years in practice, the largest proportion of respondents (28.3%) had 6-10 years of experience. Most of the participants worked in private/foundation universities (37.2%), while 22.1% worked in education and research clinics. Participants working at public universities most often reported that they or a close contact had to work in COVID wards (89.5%). Triage was performed in 51.5% of ophthalmology outpatient clinics, with 88.0% of these participants reporting that patients with fever, cough, or dyspnea were directed to the pandemic clinic without ophthalmological examination. All participants working in public hospitals, education and research clinics, and public university hospitals had postponed elective surgeries, whereas 12.5% of those working in private practice and 20.5% of those working in private/foundation universities reported that they continued elective surgeries. While 80.8% of the participants did not conduct online interviews or examinations, 40.4% stated that they considered telemedicine applications beneficial. Seventy-seven percent of participants expressed concern about a decrease in their income during the pandemic, with this being especially common among participants working in private practice (87.5%) and private/foundation university hospitals (85.7%). Conclusion: Ophthalmologists across our country have been affected by this pandemic at a level that will change their clinical approach. We think that ophthalmologists impacted by the difficulty of providing personal protective equipment and economic concerns should be supported more during the pandemic.

Pontine gaze deviation and face turn relieved by eye muscle surgery.

A 34-year-old woman developed a bilateral horizontal gaze palsy, left gaze deviation, and right face turn consequent to a pontine hemorrhage. A bilateral horizontal recession and resection of extraocular muscles in both eyes (Parks procedure) eliminated the gaze deviation and face turn. This is the first reported case in which this procedure was used to correct a face turn in a patient with bilateral horizontal gaze palsy but without ocular misalignment.

Coats-like lesions in Usher syndrome type II.

BACKGROUND: An unusual case of Usher syndrome type II associated with bilateral Coats-like exudative retinopathy is described. METHODS: A 14-year-old boy with congenital sensorineural deafness and normal vestibular functions presented with a recent history of night blindness. He was followed for 3 years with fundus photography, intravenous fluorescein angiography, electroretinography and audiometric testings. His parents refused any form of treatment. RESULTS: Fundoscopy showed bilateral retinitis pigmentosa and a single focus of subretinal exudation and overlying telangiectatic retinal vessels inferotemporal to the vascular arcade in the right eye. He had bilateral mild macular edema. A year later, a similar lesion developed inferotemporally in the left fundus. Electroretinography responses, particularly the rod-mediated signals, were significantly reduced. Audiometric studies documented hearing loss in high frequencies. His visual acuity declined from 20/40 to 20/80 RE and from 20/80 to 20/100 LE during follow-up. No new lesions developed. CONCLUSIONS: Coats-type exudative lesions may develop in patients with Usher syndrome type II. Although left untreated, only a minimal increase in exudation occurred over 3 years.

Intramuscular hydatid cyst of the medial rectus muscle.

PURPOSE: To describe a unique case of orbital hydatid cyst that was located solely within the medial rectus muscle. DESIGN: Retrospective, interventional case report. METHODS: A 20-year-old woman presented with right periocular pain induced by ocular movements. Magnetic resonance imaging studies showed a focal, well-circumscribed intramuscular cystic lesion of the right medial rectus muscle. The cyst was completely extirpated from the muscle, but some of the fluid content escaped into the surrounding tissues. Irrigation with hypertonic saline was performed. RESULTS: Histopathologic examination showed an acellular cyst wall with inner germinal layer, diagnostic for hydatid cyst. Two cycles of oral albendazole were administered with no recurrence. CONCLUSIONS: In the orbit, hydatid cyst may be localized primarily within an extraocular muscle and produce painful eye movements. Hydatid cyst must be considered in the differential diagnosis of solitary cystic enlargements of extraocular muscles.