Use of a dexamethasone implant to treat macular edema following pars plana vitrectomy and removal of the primary epiretinal membrane.

PURPOSE: The purpose of this study was to evaluate the effectiveness and safety of an intravitreal dexamethasone (DEX) implant for the treatment of macular edema (ME) following pars plana vitrectomy (PPV) and removal of the primary epiretinal membrane (ERM) and to assess the impact of the integrity of the ellipsoid zone (EZ) and disorganization of the retinal inner layer (DRIL) grade on visual and anatomical outcomes. METHODS: Forty-two pseudophakic patients who developed ME following PPV and removal of the primary stage 2-3 ERM were included. Patients were divided into two groups when ME was diagnosed via spectral domain optic coherence tomography (SD-OCT). In the DEX group (n = 22), DEX was implanted for the treatment of ME. In the control group (n = 20), only observation was conducted, without any treatment. The best-corrected visual acuity (BCVA) and macular thickness (MT) of the two groups were compared at baseline and 1, 6, and 12 months after DEX implantation. The effects of OCT parameters such as EZ integrity and DRIL grade were also evaluated in terms of decreases in MT and increases in VA in the treatment of ME with DEX implantation. Intraocular pressure (IOP), number of DEX implantations and adverse effects were also recorded. RESULTS: While a statistically significant increase in the mean BCVA was observed in the DEX group (p < 0.001 at months 1, 6, and 12, respectively), no such increase was detected in the control group (p = 0.169, p = 0.065, and p = 0.058 at months 1, 6 and 12, respectively) compared with the baseline. A statistically significant decrease in the mean MT was observed in the DEX group (p < 0.001 at months 1, 6, and 12); however, no significant difference was observed in the control group (p = 0.081, p = 0.065, and p = 0.054 at months 1, 6 and 12, respectively) compared with the baseline. Significant differences were found between the two groups in terms of the increase in BCVA (p < 0.01) and decrease in MT (p < 0.01) at all visits, with the outcomes being more favorable in the DEX group. A statistically significant relationship was found between the increase in VA and EZ integrity and DRIL grade in both groups. Ten patients (45.4%) received two injections of DEX during the follow-up. An increase in IOP was observed in five patients (22.7%) who were treated with topical antiglaucomatous drops. No significant side effects were observed. CONCLUSION: DEX implantation was found to be effective and safe for the treatment of ME following PPV and primary ERM removal, although some eyes may require repeated injections to achieve visual and anatomical success. Additionally, a relationship was found between EZ integrity, DRIL grade and visual-anatomical outcomes.

Comparison of three different intraocular lens implantation techniques in the absence of capsular support: sutured scleral, haptic flanged intrascleral, and four flanged intrascleral fixations.

INTRODUCTION: After lens extraction, if the capsular bag insufficiency occurs, there are different IOL implantation techniques. IOL implantation in the posterior chamber is safer in eyes with low endothelial cell count, peripheral anterior synechiae, shallow anterior chamber, and glaucoma. Alternative approaches for scleral fixation techniques, both with and without sutures, continue to undergo development. In this study, we aimed to compare the postoperative outcomes of the sutured scleral fixation (SSF), haptic flanged intrascleral fixation (HFISF) and four flanged intrascleral fixation (FFISF) IOL implantation techniques in eyes with the absence of capsular support. MATERIALS AND METHODS: A hundred and thirty-seven aphakic eyes with the absence of capsular support were included in the study. The patients were divided into three groups: group 1-SSF, group 2-HFISF (Yamane technique), and group 3-FFISF. Surgical time in minutes, preoperative and postoperative parameters such as best corrected visual acuity (BCVA), corneal astigmatism, lenticular astigmatism, intraocular pressure (IOP), specular microscopy, central macular thickness (CMT) were recorded. Pseudophacodonesis was assessed at 6 months postoperatively using a slit lamp, and early and late complications were recorded. RESULTS: Of the 137 eyes, 69 eyes were included in the SSF group, 41 eyes in the HFISF group, and 27 eyes in the FFISF group. No statistically significant differences were observed among the three groups in terms of age, gender, preoperative mean BCVA, corneal astigmatism, IOP, endothelial cell density, and CMT. It was observed that the mean BCVA significantly improved compared to the preoperative visual acuity in all three groups. Postoperative lenticular astigmatism, pseudophacodonesis score, percentage of the endothelial cell loss were found to be higher in FFISF groups. The surgical time was found to be shorter in the HFISF group. IOL decentration was observed in 1.44% of the SSF group and 7.40% of the FFISF group. Cystoid macular edema was observed in 5.79% of the SSF group, 4.87% of the HFISF group, and 7.40% of the FFISF group. Retinal detachment was observed in 1.44% of the SSF group and 7.31% of the HFISF group. CONCLUSIONS: The optimal technique for treating aphakia without capsular support remains uncertain. Surgeons are tasked with a complex decision, aiming for both excellent vision and minimal risk. This decision is based on their expertise, the distinctive ocular condition of the patient, and the availability of essential operating room equipment. In this study, the following findings were observed: in the HFISF technique, the average surgical time was found to be shorter, the SSF technique demonstrated greater stability in terms of astigmatism and pseudophacodonesis and the FFISF technique was recognized for its relatively straightforward application method. It is important to note that the three IOL implantation techniques yielded comparable outcomes in terms of postoperative BCVA, as well as early and late complications.

Systemic immune-inflammation index could be associated with pseudophakic cystoid macular edema after an uneventful phacoemulsification surgery in patients without risk factors.

BACKGROUND: To evaluate the association between serum biomarkers and pseudophakic cystoid macular edema (PCME) in eyes without risk factors after uneventful phacoemulsification cataract surgery. METHODS: This is a case-control study. Patients without risk factors and who developed clinically significant PCME after uncomplicated phacoemulsification surgery were enrolled in the study. The age- and sex-matched control group that had normal fundus examination findings and 10/10 visual acuity in the first week, first month and following postoperative control visits was randomly recruited from the same study cohort. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were obtained from the preoperative complete blood count (CBC) test and compared between the two groups. Linear regression analysis was used to assess the relationship between central macular thickness (CMT) and biomarkers. A binary logistic regression model was generated to evaluate the significance of the biomarkers in predicting PCME. The receiver operating characteristic (ROC) curves of the significant parameters in the logistic regression model were presented to detect the area under the curve (AUC), the cut-off point, the sensitivity and the specificity. RESULTS: The study cohort included 5352 patients. Of these patients, 52 (0.97%) met the inclusion criteria, and 60 age- and sex-matched patients were recruited as the control group. PLR, NLR, and SII were significantly different between the two groups (p = 0.006, p = 0.002, p < 0.001, respectively). According to the linear regression analysis, SII was found to have a significant relationship with CMT (p < 0.001). Only SII was assessed as significant in the logistic regression model (p = 0.046). In the ROC curve, the AUC of SII was 0.709. The sensitivity and specificity of SII for PCME prediction were 65.38% and 75%, respectively, and the cut-off point was 433.70. CONCLUSION: SII is associated with the occurrence of PCME in eyes without risk factors after uneventful phacoemulsification surgery. SII could be a useful tool to predict PCME in eyes without risk factors.

Outcomes of the Ophthalmic Examinations in Patients Infected by SARS-CoV-2.

Purpose: To evaluate ophthalmic examination results which were performed with slit-lamp biomicroscope, in patients with laboratory-confirmed SARS-CoV-2 infection.Methods: In the present study, 50 patients with laboratory-confirmed SARS-CoV-2 infection, were enrolled. Ophthalmic examination with slit-lamp biomicroscopy was performed and the results were evaluated.Results: The mean age of 50 patients (24 females, 26 males) included in this study, was 58,26 ± 18,91 years. In nine patients, bilateral acute follicular conjunctivitis was present. In two patients, acute anterior uveitis was seen. Optic disc and macula were normal in all patients. Preauricular lymphadenopathy (LAP) was found in 6 (12%) patients. Of these six patients, five had follicular conjunctivitis, and one had anterior uveitis.Conclusion: Acute follicular conjunctivitis with preauricular LAP and anterior uveitis were detected and no fundus pathologies were found in detailed ophthalmic examination in patients with laboratory-confirmed SARS-CoV-2 virus infection.

Evaluation of Conjunctival Swab PCR Results in Patients with SARS-CoV-2 Infection.

PURPOSE: The study objective was to identify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in conjunctival swabs from patients with confirmed SARS-CoV-2 infection. METHODS: Forty patients who tested positive by real-time reverse transcription (rRT)-polymerase chain reaction (PCR) of nasopharyngeal and oropharyngeal swabs were enrolled. Conjunctival swabbing was used to collect the tear and conjunctival secretions of patients. RESULTS: Conjunctival swab rRT-PCR was positive for three patients and negative for 37 patients. Ten of the patients (25%) were diagnosed with conjunctivitis during the ophthalmic examination. Of these patients, one was found positive by conjunctival swab rRT-PCR, and nine were found negative. The difference between patients who tested positive or negative using conjunctival swab rRT-PCR was without statistical significance in terms of the presence of conjunctivitis (p = .720). CONCLUSION: The rate of positivity from conjunctival swab rRT-PCR was 7.5% in patients with confirmed SARS-CoV-2 infection.

Conjunctival attachment of a tick: case report.

PURPOSE: To describe a case of conjuctival tick attachment and the method of removal with blunt forceps. METHODS: Case report. RESULTS: A 36-year-old man presented with a complaint of foreign body sensation in his right eye. He was found to have a tick (Ixodes spp) embedded in his conjunctiva. The tick was removed completely mechanically with a blunt forceps. The patient was examined and followed for tick-transmitted diseases. The patient had no systemic signs and symptoms in follow-up. CONCLUSIONS: The ophthalmologist should maintain an index of suspicion that tick infestation of ocular tissues may present in urban locations. Careful examination, obtaining serology to check for zoonoses, and complete removal should be performed to ensure an uneventful recovery.