Comparison of the Effects of Eight Different Topical Non-Steroidal Anti-Inflammatory Drugs on Reducing Intravitreal Injection-induced Pain.

PURPOSE: To compare topical nonsteroidal anti-inflammatory drug (NSAID) efficacy on intravitreal injection (IVI)-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 IVI, eight subgroups were formed. In the control group, a sterile saline solution was applied instead of NSAIDs. The visual analog scale (VAS) was used to assess pain scores after IVI. The VAS scores were noted immediately and 6 hours following injection (6th hour). RESULTS: Nepafenac 0.3%, 0.1%, and bromfenac had the lowest scores, immediately after and after 6 hours, with no significant differences. Diclofenac and ketorolac had higher VAS 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 6th hour, the VAS scores were significantly reduced. CONCLUSION: Nepafenac 0.3%, 0.1%, and bromfenac were the most effective NSAIDs for pain reduction. Although some NSAIDs did not have a significant effect on immediate pain, they all provided significant benefit at the 6th hour.

Evaluation of the structural changes of uveitis patients by optical biometry.

Objective (Aim): To observe the ocular structural changes in active and inactive uveitis patients. Methods: This retrospective study involved 30 patients (32 eyes) with anterior and intermediate uveitis cases and 54 eyes of 54 cases in a control group, who were admitted to the Ophthalmology Department at Trakya University. In the study group, 14 patients were females, 16 patients were males and in the control group 26 volunteers were females, and 28 volunteers were male of the 54 volunteers. Anterior chamber depth, axial length, intraocular pressure, lens thickness, central corneal thickness, steep and flat values in keratometry, corrected visual acuity in both eyes, anterior chamber cells, and vitreous cells were measured and compared between three groups (two uveitis groups - active and inactive - and control group). Results: In the comparison of the median values of axial length, central corneal thickness, and steep and flat values of keratometry, the values of the patients with active uveitis were higher than the ones in the control group in each parameter, but no significant difference was observed. The anterior chamber depth parameter value was higher, the lens thickness value was lower in patients with active uveitis than the values in the control group and the differences were statistically significant (p<0,05). No significant structural differences in the values of the active and inactive group patients (p>0,05) were observed. Conclusions: Only lens thickness and anterior chamber depth parameters were statistically significant in patients with active uveitis, compared with the inactive uveitis group. Anterior chamber depth measurement values were higher and lens thickness measurement values were lower in patients with active uveitis when compared with the control group. Abbreviations: AAU = Acute anterior uveitis, CAU = Chronic Anterior Uveitis, AC = Anterior Chamber, IOP = Intraocular Pressure, IVCM = in vivo Confocal Microscopy, AS-OCT = Anterior Segment Optical Coherence Tomography, UBM = Ultrasound Biomicroscopy, LFP = Laser Flare Photometry, KP = Keratic Precipitates, OCT = Optical Coherence Tomography, AL = Axial Length, ACD = Anterior Chamber Depth, LT = Lens Thickness, CCT = Central Corneal Thickness, Ks = Steep Value of Keratometry, Kf = Flat Value of Keratometry, AUP = Active Uveitis Patients, IUP = Inactive Uveitis Patients, SUN = Standardization of Uveitis Nomenclature.

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.

The Relationship Between Anthropometric Z-Score Measurements and Ocular Structures in Turkish Children.

Objective (Aim): This study explores the contact between anthropometric Z-score values and ocular parameters in children. Recent studies investigated the relationship, and contact between anthropometric measurements and ocular parameters in children, and height, weight, body mass index, and percentile curves are mostly used as anthropometric data. However, today, different scoring systems such as "Z-score" classify anthropometric values. Methods: Height and body mass index Z-scores were calculated for 725 children. Biometric and refractive measurements of all children were noted. For different reference values, those with a Z-score below the negative value of the reference were defined as a low Z-score, those between the negative and positive value of the reference were defined as a normal Z-score, those with a Z-score greater than the positive value of the reference were defined as a high Z-score. The mean ocular measurement results in the low, normal, and high Z-score groups were compared, and they were pointed to reach the reference value in both negative and positive sides which created the foremost critical contrast between the groups. Results: For a value of "-1" and "+1.5" in the height Z-score, from low to normal and from there to high Z-score group, axial length, and average corneal radius increased, and average corneal power decreased significantly. Anterior chamber depth increased from normal to high Z-score group, but no critical distinction was made between low and normal Z-score groups. Moreover, no critical distinction was observed in spherical equivalent refraction, central corneal thickness for height, and all values of body mass index. Conclusion: Considering a Z-score value of "-1" and "+1.5" as a reference value in children and anticipating the changes that may happen in the ocular structures of children at both ends of the Z-score, it may be useful to understand the effect of body development on ocular development more. Abbreviations: AL = Axial Length, ACD = Anterior Chamber Depth, BMI = Body Mass Index, NCHS = The United States National Center for Health Statistics, WHO = World Health Organization, NFHS 2 = National Family Health Survey 2, SER = Spherical Equivalent Refraction, CR = Average Corneal Radius, CP = Average Corneal Power, CCT = Central Corneal Thickness, HFAsZ = Height for Age Z-Score, BMIsZ = BMI for Age Z-Score, L = Low Z-score, N = Normal Z-score, H = High Z-score.

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.

Corneal epithelium and limbal region alterations due to glaucoma medications evaluated by anterior segment optic coherence tomography: a case-control study.

AIM: To investigate the corneal epithelial and limbal epithelial alterations in patients under topical glaucoma treatment using anterior segment-OCT (AS-OCT) and to determine the changes of the limbal region due to the preservatives and glaucoma drugs, that can progress to limbal stem cell deficiency (LSCD). Limbal thickness was measured by AS-OCT to evaluate limbal cell deficiency. METHODS: Forty-seven patients using topical medication for glaucoma, and 48 control subjects were enrolled in this matched case-control study. The patients were divided into four groups according to the treatment regimens. Group 1: One-drug regimen, Group 2: Two-drug regimen, Group 3: Three-drug regimen, Group 4: Four-drug regimen For the ocular surface evaluation; tear break-up time with standard fluorescein sodium sterile strip application, Schirmer test-I, Ocular Surface Disease Index Questionnaire, and AS-OCT were performed. RESULTS: A total of 95 subjects were included: 47 eyes of 47 patients with glaucoma medication and 48 eyes of 48 healthy subjects. There was a statistically significant difference between patients and controls according to BUT, SCH, and OSDI (p < 0.001). The mean central corneal epithelium thickness was 48.5 ± 5.3 in patients and 54.5 ± 5.9 in controls (p < 0.001). The mean central total corneal thickness was 529.2 ± 41.2 in patients and 536 ± 35.3 in controls (p = 0.335). The mean limbal epithelium thickness was 64.1 ± 9.1 in patients and 76 ± 11.5 in controls (p < 0.001). CONCLUSION: Using at least one glaucoma drug caused limbal area injury, changed ocular surface measurements, and significantly reduced the limbal epithelial thickness where the stem cells reside. The limbal epithelial thickness measurement by AS-OCT seems to be an innovative, non-invasive, and promising technique for detecting and staging corneal damage in topical glaucoma therapy.