Digital Evaluation of the Changes in Eyelid and Ocular Surface Measurements and the Correlation of These Parameters with Visual Field Parameters After Upper Eyelid Blepharoplasty.

Objectives: We aimed to evaluate the change in eyelid and ocular surface parameters that were measured using a digital measurement program, the change in the visual field (VF), and the correlation between ocular surface area (OSA) and VF parameters in patients who underwent upper eyelid blepharoplasty for involutional dermatochalasis. Methods: Patients who underwent upper eyelid blepharoplasty for involutional dermatochalasis between August 2015 and August 2019 were included in the study. The difference between preoperative and postoperative 3rd month values of manually measured margin reflex distance 1 (MRD1), digitally measured eyelid and ocular surface parameters (MRD1, MRD 2 [MRD2], upper eyelid crease height [ECH], pretarsal show height [PTH], eyebrow line-height [EBH] and OSA), and VF parameters were evaluated. The correlation between preoperative and postoperative values of manually and digitally measured MRD1 and also preoperative and postoperative values of OSA and VF parameters were analyzed. Results: Thirty-six eyes from 36 patients were included in this study and the mean age of patients was 57.93±7.64 years. There were statistically significant changes between preoperative and postoperative values in means of the manually measured MRD1 and the digitally measured MRD1, PTH, OSA, and ECH (p<0.001). However, the postoperative changes in the mean MRD2 and EBH were not statistically significant (p=0.664 and p=0.983). There were moderate positive correlations between pre- and post-operative OSA values and pre- and postoperative values of manual and digital MRD1. A statistically significant agreement was observed between the change in OSA and the change in all VF parameters (Bland-Altman analysis test). Conclusion: Digital measurements can be used to evaluate the changes in eyelid and ocular surface parameters in patients who underwent upper eyelid blepharoplasty surgery. OSA provides fast results in accordance with linear measurements and is compatible with the change in the VF.

Posterior sub-Tenon triamcinolone injection in the treatment of postoperative cystoid macular edema secondary to pars plana vitrectomy.

Purpose: To evaluate the efficacy and safety of posterior sub-Tenon triamcinolone (PSTA) in chronic postoperative cystoid macular edema (PCME) after pars plana vitrectomy (PPV). Methods: Consecutive 22 patients who developed chronic PCME after PPV and underwent PSTA treatment were included in this retrospective study. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured pre injection and post injection at one month, three months, six months, and at last visit. The patients were divided into three groups according to the injection response status: complete, partial, and resistant. Results: The mean follow-up period was 26.4 ± 16.2 months after PSTA. According to pre-injection values, there was a significant improvement in the values of BCVA and CMT at the first, third, and sixth months and at the last examination (P < 0.05). In the final examination, PCME recovered completely in 12 patients, partially in 8 patients, and resistance was observed in 2 patients. Conclusion: Posterior sub-Tenon triamcinolone seems to be effective in chronic PCME following PPV.

The short-term effects of intravitreal bevacizumab injection on intraocular pressure, cornea, iridocorneal angle, and anterior chamber.

Background: Transient increase in intraocular pressure (IOP), changes in anterior chamber parameters, and changes in aqueous humor dynamics may occur after intravitreal injections because of intravitreal volume changes. Objective: In this observational study, we investigated the early effects of intravitreal bevacizumab (IVB) injection on IOP, central corneal thickness (CCT), corneal volume (CV), anterior chamber depth (ACD), and iridocorneal angle (ICA). Method: The patients who had one single-dose IVB (2.5 mg/0.1 mL) injection were included in the study. The patients underwent IOP, CCT, CV, ACD, and ICA measurements before and 1 h and 1 day after the injection. Pre-injection and post-injection values were compared. Results: Forty-two eyes of 42 patients were included in the study, and the mean age of patients was 60.1 ± 7.4 years. The mean IOP measurements before and after injection at 1 h and day 1 were 15 ± 2.4, 17.4 ± 2.4, and 14.7 ± 2.3, respectively. The mean IOP, CCT, and CV values 1 h after injection were significantly higher than pre-injection values (p < 0.05, p < 0.05, and p = 0.02, respectively). Conversely, mean ACD and ICA values 1 h after injection were significantly lower than pre-injection values (p = 0.01 for both). There were no statistically significant differences on the first day after injection for all parameters. Conclusion: IVB (2.5 mg/0.1 mL) injection causes transient increases in IOP and transient decreases in ACD and ICA at the first hour after injection. Related to elevation in IOP, CCT and CV may increase transiently. These changes return to baseline values on the first day after injection.

Comparison of Intravitreal Dexamethasone Implant and Posterior Subtenon Triamcinolone Injection in the Treatment of Diabetic Macular Edema in Vitrectomized Eyes.

INTRODUCTION: The aim of this study was to compare posterior subtenon triamcinolone (PSTA) application and intravitreal dexamethasone phosphate (DEX) implant in the treatment of diabetic macular edema (DME) in vitrectomized eyes. METHODS: This retrospective study included 64 (48.12%) patients who received PSTA and 69 (51.88%) patients who received DEX implants in DME treatment after vitrectomy. Best corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were analyzed before injection; at 1, 3, and 6 months after injection. The postinjection values were statistically compared with the preinjection value. RESULTS: All postinjection CMT values in both groups were lower than the preinjection value (p < 0.05 for all). There were statistically significant increases in all postinjection BCVAs of the DEX group and postinjection 1-month BCVA of the PSTA group (p < 0.05 for all). However, there was no significant difference in BCVA values of the PSTA group at 3 and 6 months after injection (p > 0.05 for both). There was no statistically significant difference in all postinjection IOP values of the PSTA group (p > 0.05 for all). However, significant increases in IOP were observed in the DEX group at 1 and 3 months after injection (p < 0.05 and p = 0.02, respectively). The number of additional injections between the 3rd and 6th months after the initial injection was statistically higher in the PSTA group (p = 0.006). CONCLUSION: Both intravitreal DEX and PSTA administration are effective in the treatment of DME after vitrectomy. However, visual improvement persisted longer, and the need for additional injections was less in patients who received DEX.

Cases of toxic anterior segment syndrome after primary pterygium surgery.

PURPOSE: Toxic anterior segment syndrome (TASS) is an acute, sterile, inflammatory reaction of the anterior segment after intraocular surgeries. We aimed to report an outbreak of TASS which occurred following pterygium surgeries. METHODS: A case series. RESULTS: Four eyes of four patients developed TASS associated with formaldehyde after uneventful primary pterygium surgery with conjunctival autograft. No patients reported pain; all patients demonstrated diffuse corneal edema, epithelial defects, and anterior chamber inflammation without hypopyon, fibrin formation, and vitreous involvement on the first postoperative day. TASS diagnosis was made based on clinical findings. All patients were treated with hourly topical 1% prednisolone acetate (Pred Forte, Allergan, CA), moxifloxacin 0.5% (Vigamox, Alcon, TX), and 0.24% of hyaluronic acid (Artelac complete, Bausch & Lomb). Oral steroid (prednisolone 1 mg/kg) was added on the first week and gradually tapered over weeks. None of the affected corneas improved spontaneously. Best-corrected visual acuity ranged from 20/25000 to 20/200 in the second month after surgery. Keratoplasty was scheduled for all patients. CONCLUSIONS: This is the first study to present TASS cases after pterygium surgery. Clinicians should be aware of TASS that can emerge after an extraocular surgery. In our analysis, since 2% formaldehyde was used by the operating room personnel for cleaning and sterilizing reusable ocular instruments, it was thought that formaldehyde was the most likely cause.

Surgical management of glaucoma following different keratoplasty techniques.

PURPOSE: To investigate the results of surgical management of glaucoma following different keratoplasty techniques. METHODS: Medical records of 628 cases who underwent keratoplasty were reviewed. One hundred and eighty-eight patients (29.9%) who developed post-keratoplasty glaucoma were evaluated. Patients who could not be controlled with maximal medical treatment and underwent glaucoma surgery were included in this study. Trabeculectomy, Ahmed glaucoma valve (AGV) implantation or diode laser cyclophotocoagulation (DLC) were applied. RESULTS: Glaucoma surgery was performed in 55 (29.3%) patients who had uncontrolled post-keratoplasty glaucoma. In penetrating keratoplasty group (n = 42), DLC was applied to 30 (71.4%) eyes, AGV to 11 (26.2%) eyes, and trabeculectomy in 1 (2.4%) eye. In Descemet's membrane endothelial keratoplasty group (n = 8), DLC was applied to 4 (50%) eyes, trabeculectomy for 3 (37.5%) eyes and AGV for 1 (12.5%) eye. In deep anterior lamellar keratoplasty group (n = 5), DLC was applied to 2 (40%) eyes, trabeculectomy to 2 (40%) eyes and AGV to 1 (20%) eye. While a statistically significant decrease was found in intraocular pressure (IOP) and anti-glaucomatous medication after surgery (p < 0.05 for each), no significant difference was found in best corrected visual acuity (BCVA). During follow-up, DLC was applied as re-glaucoma surgery in 19 (34.5%) cases. A significant reduction in IOP together with number of anti-glaucomatous medications was found with re-operation; however, a significant decrease in BCVA was noted (p < 0.05 for each). CONCLUSION: Glaucoma surgeries after keratoplasty are effective in decreasing IOP and the number of anti-glaucomatous medication. While BCVA doesn't change after the first glaucoma surgery, after re-operation significant decrease may occur.

Early intraocular pressure changes following different keratoplasty techniques and association with cornea parameters and anterior chamber depth.

Background: Corneal transplantation surgery is associated with an increased risk of intraocular pressure (IOP) elevation. Increased IOP may cause irreversible vision loss and graft failure.Purpose: We aimed to evaluate early IOP changes following different keratoplasty techniques and to investigate the relationship between corneal thickness (CT), keratometry values, anterior chamber depth (ACD), and IOP changes. Methods: We included patients who underwent penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), and Descemet membrane endothelial keratoplasty (DMEK) in this observational study. ACD, CT, and keratometry measurements were repeated postoperatively at hour 24, week 1, and month 1. IOP measurements were repeated at postoperative hours 6 and 24, week 1, and month 1 by Tono-Pen XL. Results: In total, 22 patients underwent PK, 12 patients underwent DALK, and 19 patients underwent DMEK. The difference between the IOP preoperatively and postoperatively hour 6, and between the IOP preoperatively and postoperatively hour 24 was statistically significant in the three types of surgery (p < 0.05 for each). The difference between preoperative and postoperative week 1 IOP was statistically significant only in the PK group (p = 0.023). When the IOP was compared between the three types of surgeries, the IOP at postoperative week 1 in the PK group was significantly higher than the DALK and DMEK groups (p = 0.021). There was no correlation between ACD, CT, K values, and IOP in any group. Conclusion: IOP may increase in all types of keratoplasty during the first hours after surgery, but PK has a risk of high IOP longer in the early postoperative period. PK patients should be followed more carefully during postoperative week 1 to check for an increase in IOP.

Early choroidal structure and choroidal vascularity index change after carotid stenting.

PURPOSES: We aimed to evaluate changes in subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) in the first postoperative day and month in patients with severe internal carotid artery (ICA) stenosis after ICA stenting. METHOD: The patients who diagnosed with severe ICA stenosis and was performed ICA stenting were included in the study. Patients with any ocular disease and refractive error more than 3 diopters were not included in the study. The imaging of the choroid was performed using enhanced depth imaging (EDI) techniques by spectral domain optical coherence tomography (SD-OCT) (OptovueRTVue XR, Optovue Inc., Fremont, CA).The choroidal vascularity index (CVI), total choroidal area (TA), luminal area (LA), and stromal area (SA) were measured in the subfoveal 2 mm area. These measurements before ICA stenting was compared with the first day and first month after ICA stenting. RESULTS: The study included 41 eyes from 41 patients (11 women [26.83%]; 30 men [73.17%]). The mean age of patients was 62.25 ± 4.85 (57-71) years. The differences in subfoveal CT, TA, LA, SA between before ICA stenting and 1 day after ICA stenting, before ICA stenting and 1 month after ICA stenting was statically significant(p<0.05 for each). CONCLUSION: We have observed increases in SFCT, CVI, LA, SA, and TA on the 1st day and 1st month after ICA stenting in patients with severe carotid stenosis.  Improvement in choroidal thickness and choroidal vascular flow is seen even in the early period of ICA stenting.

Effect of capsular tension ring on refractive results in cases with pseudoexfoliation syndrome.

PURPOSE: To investigate the effect of capsular tension rings (CTRs) on postoperative refractive results in patients with pseudoexfoliation (PSX) syndrome. MATERIALS AND METHODS: Sixty-nine patients with PSX syndrome who had uncomplicated cataract surgery between March 2016 and February 2019 were reviewed retrospectively. The patients were divided into two groups. The 35 patients in Group 1 received CTRs prior to intraocular lens implantation during cataract surgery, and the 34 patients in Group 2 had cataract surgery without CTRs. Significant zonular weakness, uncontrolled glaucoma, and ocular pathologies causing low visual acuity were excluded. The preoperative and postoperative keratometry and autorefraction measurements, preoperative expected refractive values, and absolute refractive error were recorded. RESULTS: The mean ages of patients were 73.54 ± 9.78 years in Group 1 and 72.23 ± 6.72 years in Group 2 (p = 0.521). There was no statistically significant difference between Group 1 and Group 2 in terms of expected preoperative refraction values (-0.52 ± 0.12,-0.56 ± 0.08, respectively, p = 0.118). There was a statistically significant difference in postoperative spherical equivalent values between Group 1 and Group 2 (-0.05 ± 0.97 and -0.92 ± 0.57, respectively, p < 0.01). A statistically significant difference was found between the two groups in terms of absolute refractive error (0.46 ± 0.74 in Group 1 and -0.34 ± 0.59 in Group 2 p < 0.01). CONCLUSION: CTR implantation causes hyperopic shift, which should be taken into consideration when calculating the lens power of intraocular lens in patients with PSX syndrome.

CHOROIDAL CHANGES DUE TO LONG-TERM USE OF N95 FACE MASKS.

PURPOSE: We aimed to examine the changes in choroidal stroma and vascular system due to long-term use of N95 mask in healthcare workers. METHOD: The healthcare workers included in the study were between the ages of 18-50, with best corrected visual acuity (BCVA) 10/10, spherical and cylindrical refractive errors less than 3 diopters, intraocular pressures (IOP) within normal limits, and axial lengths (AL) less than 25 mm. The choroid was imaged with enhanced depth imaging (EDI) techniques using SD-OCT. The choroidal vascularity index (CVI), total choroidal area (TA), luminal area (LA), and stromal area (SA) were measured in the subfoveal 2 mm area. Measurements were first made after wearing the N95 mask for at least 2 hours without removing it and repeated 1hour after removing, while doing office working. RESULTS: The study included 62 eyes from 62 participants (32 women [%51.61]; 30 men [%48.39]). The mean age of patients was 33.81± 8.88 years (20-50 years). The differences in subfoveal TA, LA, SA between 2 hours of N95 mask use and 1 hour after removal of the mask were statistically significant (p<0.05 for each). However, the difference in CVI between the mask use and removal of the mask was not statically significant (p=0.537) CONCLUSION: Due to CO2 retention and hemodynamic changes, choroidal vascular flow, the choroidal vascular area, and the choroidal stromal area may be affected by prolonged use of masks.

Prognostic factors affecting macular hole closure types.

PURPOSE: In this study, we aimed to evaluate the relationship between macular hole closure types assessed by optical coherence tomography (OCT) and the preoperative prognostic factors. MATERIALS AND METHODS: In total, 183 patients who underwent pars plana vitrectomy and internal limiting membrane peeling for idiopathic macular hole between August 2014 and August 2019 were reviewed retrospectively. The preoperative measurements of the macular hole including minimum linear diameter (MLD), basal hole diameter (BHD) and hole height (HH) were measured on OCT images. The patients were divided into two closure types on the basis of postoperative OCT findings (type 1 closure: retinal edges were flat and there was no defect of the neurosensory retina on the fovea; type 2 closure: retinal edges were flat and there was a defect of the neurosensory retina on the fovea). The difference of prognostic factors such as age; duration of symptoms; preoperative best-corrected visual acuity (BCVA); preoperative macular hole measurements, including MLD, BHD and HH; and rate of reopening between two types were statistically analysed. RESULTS: The mean age of patients was 66.33 ± 8.09 years (range: 48-88 years). According to OCT imaging, 117 eyes (63.9%) were classified into the type 1 closure group, and 66 eyes (36.1%) were classified into the type 2 closure group. There were no significant differences between two groups in age, duration of symptoms and preoperative BCVA (p = 0.694, p = 0.092 and p = 0.15). MLD and BHD were significantly larger, and reopening was significantly more common in type 2 group (p < 0.05, p = 0.04 and p < 0.005); however, there was no significant difference in HH between two groups (p = 0.239). CONCLUSION: Preoperative horizontal measurements of macular hole may help to determine postoperative visual expectations and anatomical success, and predict the possibility of reopening.

Evaluation of the effect of n95 face mask used by healthcare professionals on choroidal thickness.

PURPOSE: We aimed to show the changes in choroidal thickness (CT) with spectral domain optical coherence tomography (SD-OCT) after prolonged use of N95 mask. METHOD: The healthcare workers who use the N95 face-mask, between 30-50 years of age who have best corrected visual acuity (BCVA) ≥10/10, spherical or cylindrical refraction errors less than 2 diopters, with normal intra ocular pressure (IOP), axial length (AL) between 22-24 mm included in the study. The choroid was imaged with enhanced depth imaging (EDI) techniques using SD-OCT. CT was measured, subfoveal, at 1000 µm nasal and temporal of the center of the fovea. Measurements were first made after wearing the N95 mask for at least 2 h without removing it and repeated 15 min after removing. RESULTS: After 2 h of the N95 mask using without removal, the mean subfoveal CT was 293.56 ± 76.12(min:185, max:479), the mean temporal CT was 253.81 ± 63.48(min:172, max:384), the mean nasal CT was 239.18 ± 53.92(min:139, max:356). Fifteen minutes after removal of the N95 mask, the mean subfoveal CT was 250.56 ± 52.48(min:172, max:397), the mean temporal was 218.40 ± 53.58(min:129, max:354), the mean nasal CT was 210.67 ± 53.31(min:132, max:366). The differences in subfoveal, temporal and nasal CT between 2 h of N95 mask use and 15 min after removal of the mask were statistically significant (p < 0.05 for each). CONCLUSION: Hypercapnia due to prolonged use of the N95 mask may cause choroidal hemodynamic changes and transient increased choroidal thickness.

A Case of Paracentral Acute Middle Maculopathy Occurring After Pars Plana Vitrectomy.

Paracentral acute middle maculopathy (PAMM) is a clinical finding that is thought to be a result of ischemia in the middle and deep capillary plexus of the retina. It has been reported in the literature that PAMM may be associated with systemic and vascular risk factors. This report describes a case of PAMM that occurred following a pars plana vitrectomy.

Phototherapeutic Keratectomy in Macular and Granular Dystrophy: Two-year Results.

PURPOSE: To evaluate two-year outcomes of phototherapeutic keratectomy in granular and macular dystrophy and to investigate the effects of dystrophy type on results. METHODS: Sixty-three patients who underwent phototherapeutic keratectomy (PTK) for granular and macular dystrophy in the cornea funit of the University of Health Sciences Beyoglu Eye Research and Training Hospital were evaluated retrospectively. Patients under 18 years of age, patients with a follow-up period of less than 24 months, and patients who had previously undergone corneal surgery or excimer laser treatment were excluded from the study. Treatment values (ablation depth, optical zone, mitomycin-C (MMC) application time) and complications during and after treatment were recorded. Patients who had a decrease of two or more lines in their BCVA and those with recurrent or increased corneal opacities were considered to have severe recurrences. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded preoperatively and postoperatively at the 12th and 24th months. The values obtained before and after the PTK were compared with statistical methods. RESULTS: A total of 41 eyes (27 with granular dystrophy and 14 with macular dystrophy) were included in this study. There were no statistically significant differences between patients with granular dystrophy and macular dystrophy in terms of preoperative UCVA and BCVA, MMC application time, and follow-up period (p > .05). The mean age of patients with macular dystrophy was statistically smaller than that of patients with granular dystrophy (p = .04). The amount of ablation applied to macular dystrophy was statistically higher than for granular dystrophy (p = .03). The mean UCVA and BCVA showed statistically significant improvements at the 24th postoperative month (p < .5). There was no statistically significant difference between the UCVA and BCVA values of the patients with granular and macular dystrophy at the 12th and 24th months after the procedure. No recurrence was observed in any patient after 24 months. However, when the follow-up continued, severe recurrence was encountered in 2 patients with macular dystrophy at 26th and 40th months. Re-treatment procedures were needed in these two patients who had severe recurrence. CONCLUSIONS: Phototherapeutic keratectomy is an effective and safe option for treatment in both granular and macular corneal dystrophy. Recurrence is a more common problem in patients with macular dystrophy, and recurrent therapies or keratoplasty methods are needed more frequently.

Long-term results of aphakia management by scleral fixation intraocular lens placement with knotless transscleral Z-suture method.

PURPOSE: To evaluate the long-term refractive outcomes and complications of posterior chamber intraocular lens placement by scleral fixation surgery (SF-IOL) with the knotless Z-suture method. METHODS: The authors retrospectively reviewed the medical records of patients who underwent SF-IOL placement with the Z-suture method between January 2010 and December 2018 and who attended a follow-up after at least 1 year. Preoperative and postoperative best-corrected visual acuity (BCVA), anterior segment biomicroscopy, fundus examinations, and postoperative complications were evaluated. Lenticular astigmatism was calculated through the vector analysis method. RESULTS: One hundred thirty-six eyes of 136 patients (mean age 57.78 ± 22 years, 98 male/38 female) were included in the study. Of the 136 patients, 67 (49.3%) had a complicated cataract, 50 (36.8%) had pseudoexfoliation syndrome, and 19 (14%) had a trauma history. The mean follow-up period was 50.83 ± 27 months. The mean preoperative BCVA was 0.65 ± 0.24 LogMAR, and the postoperative BCVAs were: 0.40 ± 0.30 (p < 0.001) at 1 year; 0.40 ± 0.30 (p < 0.001) at 2 years; 0.41 ± 0.31 (p < 0.001) at 3 years; 0.43 ± 0.32 (p < 0.001) at 5 years; and 0.47 ± 0.24 (p = 0.03) at 8 years. Complications included retinal detachment in 2 patients (1.5%), cystoid macular edema in 4 patients (2.9%), increase in intraocular pressure in 5 patients (3.6%), suture loosening in 3 patients (2.2%), and IOL dislocation in 3 patients (2.2%). CONCLUSION: Scleral fixation of IOL with knotless Z-suture technique is an effective method to correct aphakia, with reliable long-term results.

Prognostic Factors Affecting Graft Survival in Patients Undergoing Penetrating Keratoplasty for Infectious Keratitis.

Objectives: To evaluate the prognostic factors affecting graft survival in patients undergoing penetrating keratoplasty (PKP) for infectious keratitis. Materials and Methods: Patients who underwent PKP for keratitis in our hospital between 2013 and 2018 were retrospectively reviewed. Patients who underwent therapeutic PKP at the inflammatory stage and were followed for at least 12 months were included in the study. Age, gender, follow-up period, time between diagnosis and surgery, lens status, presence of limbal involvement, presence of corneal ulceration, perforation, or corneal abscess, type of microorganism detected in culture, number of fortified medications used before surgery and duration of use, preoperative and postoperative visual acuity, postoperative graft transparency, postoperative complications, recurrence of infection, rate of re-keratoplasty, and indication for and timing of re-keratoplasty were recorded. The relationship between these findings and anatomic, therapeutic, and functional success were evaluated. Results: Fifty-nine patients were included in the study; 40 (67.8%) were male and 19 (32.2%) were female, and the mean age was 59.78±19.46 (6-91) years. Anatomic success was achieved in 58 patients (98.3%). Therapeutic success was achieved in 47 patients (79.7%) and there was a significant relationship between therapeutic success and re-keratoplasty and early re-keratoplasty (p<0.001 for both). Thirty-two patients (54.2%) had functional success and there was a significant relationship between the absence of postoperative complications and functional success (p=0.014). Conclusion: PKP is an effective treatment option in treatment-resistant keratitis or keratitis with impending perforation. The absence of postoperative complications and performing early re-keratoplasty in patients with recurrence increase the success rate.