ISSN 2757-8135 | E-ISSN 2757-9816
Volume: 1  Issue: 2 - 2021
Melis Palamar
Page VII

2.Visual and topographical outcomes following accelerated corneal crosslinking in progressive keratoconus
Emine Esra Karaca, Dilay Ozek, Fatma Sema Akkan Aydoğmuş, Gökhan Çelik, Ozlem Evren Kemer
doi: 10.14744/eer.2021.21931  Pages 57 - 63
PURPOSE: The purpose of the study was to evaluate changes in vision and the optical performance of the cornea in patients with keratoconus following treatment with accelerated corneal crosslinking (CXL).
METHODS: Sixty-two eyes of 40 keratoconus patients with 12-month follow-up of after accelerated CXL (9 mw, 10 min) were included in the study. Best-corrected visual acuities (BCVAs), follow-up time, simulated keratometry values, spherical equivalent (SE), manifest astigmatic correction (MAC), total root mean square (RMS), low order aberrations (LOA)-RMS, high-order aberrations (HOAs)-RMS, horizontal coma, vertical coma, horizontal trefoil, vertical trefoil, spherical aberration, thinnest pachymetry (thin), and central corneal thickness values before and after the treatment were reviewed retrospectively. The patients were divided into two groups as those with maximum keratometry values below 51 D (Group 1) and above 51 D (Group 2).

RESULTS: In Group 1, the improvement in BCVA was not significant (p=0.09) but the improvement in Kmax (p=0.001) and SE (p=0.001) was significant. In Group 2, mean BCVA showed improvement of three lines from 0.78±0.5 to 0.48±0.48 logMAR (p=0.016). In addition, the mean Kmax flattened by 0.52 D (p=0.016). SE decreased up (p=0.001) and the improvement in RMS HOA was significant (p=0.005) in Group 2. In Group 1, change in BCVA was correlated with change in SE and spherical aberration (p<0.05, for all). In Group 2, the change in BCVA has significant association with the change in MAC, total RMS HOA, vertical coma, vertical trefoil, and spherical aberrations (p<0.05, for all).

CONCLUSION: Accelerated CXL leads to visual, refractive, topographic, and HOAs improvement, particularly in severe keratoconus.

3.Analysis of patients undergoing amniotic membrane transplantation at a tertiary referral hospital
Mine Karahan, Atılım Armağan Demirtaş, Seyfettin Erdem, Sedat Ava, Leyla Hazar, Mehmet Emin Dursun, Yasin Çınar, Uğur Keklikçi
doi: 10.14744/eer.2021.04706  Pages 64 - 68
PURPOSE: In this study, we aimed to determine amniotic membrane transplantation (AMT) indications, early results and demographic analysis of patients who underwent AMT in our clinic according to age and gender.
METHODS: The records of 154 patients who underwent AMT at the Ophthalmology Clinic between April 2017 and September 2019 were reviewed retrospectively. Examination findings and demographic data of the patients were examined and recorded. Patients were divided into five groups: 0–10 years (Group 1, n=7), 11–20 years (Group 2, n=9), 21–40 years (Group 3, n=23), 41–60 years (Group 4, n=32), and over 60 years (60–89 years) (Group 5, n=83).
RESULTS: Ninety-five (61.7%) of the patients included in the study were male and 59 (38.3%) were female. The mean age of the patients was 55.72±22.53 (Range: 0–89) years. The most common indications for AMT in all age groups were corneal ulcer (n=47, 30.5%), corneal melting (n=32, 20.8%), and persistent epithelial defect (PED) (n=21, 13.6%). The most common age groups for AMT were Group 5 (n=83, 53.9%), Group 4 (n=32, 20.8%), and Group 3 (n=23, 14.9%). The most common indications for AMT in children and adolescents (0–20 years) were corneal ulcer (n=6, 37.5%) and corneal chemical burns (n=5, 31.2%), while in adults over 21 years of age, AMT indications were corneal ulcer (n=41, 29.7%) and corneal melting (n=29, 21.0%).

CONCLUSION: The most common indications for AMT in our study were corneal ulcer, corneal melting, and PED. According to the indications, AMT may be a simple and easily applicable surgical method that can be used in the reconstruction of the ocular surface in many corneal and conjunctival pathologies.

4.Ocular surface changes and meibomian gland dysfunction evaluation in patients with Stevens–Johnson syndrome
Irmak Karaca, Özlem Barut Selver, Melis Palamar, Sait Eğrilmez, Ayşe Yağcı
doi: 10.14744/eer.2021.39974  Pages 69 - 74
PURPOSE: The purpose of the study was to assess the ocular surface changes and Meibomian gland (MG) dysfunction with meibography in patients with chronic ocular involvement due to Stevens–Johnson syndrome (SJS).
METHODS: Twelve eyes of 6 patients with SJS who had chronic ocular involvement (Group 1) and 64 eyes of 32 healthy individuals (Group 2) were enrolled. Comprehensive eye examination including Schirmer 1 test, tear film break-up time (t-BUT), fluorescein staining of ocular surface and Oxford scoring, ocular surface disease index (OSDI) questionnaire, and assessment of lower and upper eyelid MG (from grade 0 [no loss of MG] to grade 3 [>2/3 gland loss of the total MG]) with an infrared filter of slit-lamp biomicroscope was performed.

RESULTS: The mean ages of Group 1 and Group 2 were 42.2±9.9 (range, 31–58) and 45.4±11.7 (range, 33–59), respectively (p=0.667). In Group 1, mean best-corrected visual acuity, Schirmer 1 test, and t-BUT were lower, while Oxford scale and OSDI scores were higher significantly in comparison to Group 2 (p<0.05). The lower, upper and total (upper+lower) meiboscores were 2.7±0.4 (range, 2–3), 2.8±0.3 (range, 2–3), and 5.6±0.5 (range, 5–6) respectively, and significantly higher than Group 2 (p<0.001, for all variables).

CONCLUSION: SJS seems to be associated with severe MG dysfunction that can objectively be demonstrated with meibography, in addition to other ocular surface problems. Future studies are needed to validate these findings.

5.Retrospective analysis of open globe injuries during coronavirus disease-19 lockdown in Turkey
Zeynep Akgün, Cumali Değirmenci, Serhad Nalçacı, Filiz Afrashi, Cezmi Akkin
doi: 10.14744/eer.2021.69775  Pages 75 - 78
PURPOSE: The objective of the study was to evaluate open globe injuries and injury type, injury grade, and demographic characteristics of patients with penetrating eye injury during the coronavirus disease (COVID)-19 lockdown in Turkey.
METHODS: Patients who were admitted to our clinic with a diagnosis of penetrating/perforating eye injury between March 11, 2020–June 1, 2020 (Group 1), and March 11, 2019–June 01, 2019 (Group 2), were retrospectively analyzed. Ophthalmologic examination findings, ocular trauma score (OTS), causes of injury, and mechanism of injury were recorded. Data and findings were compared with SPSS.
RESULTS: A total of 47 (1.74%) of 2688 patients in 2019 and 21 of 1130 patients (1.85%) in 2020 referred to our clinic from the emergency department were hospitalized with the diagnosis of penetrating/perforating eye injury. There was no difference between the groups in terms of age and gender (p=0.60 and p=0.73, respectively). The mean best-corrected visual acuity (BCVA) at the first examination was 1.46±1.0.9 (0–3.5) log MAR in Group 1 and 1.09±1.05 (0–3.5) log MAR in Group 2 (p=0.19). The mean OTS was calculated as 56.00±25.96 (12–100) in Group 1 and 69.63±23.78 (13–100) in Group 2. The difference was statistically significant (p=0.05). Final BCVA was 1.31±0.91 (0–3) log MAR in Group 1 and 0.53±0.77 (0–3) log MAR in Group 2 (p=0.005).

CONCLUSION: During the COVID-19 lockdown, there was a significant decrease in emergency consultations and penetrating injuries. The OTS and final BCVA of patients were lower than the previous year. COVID-19 locking may have an effect on the reduction of ocular trauma.

6.Investigation of systemic inflammatory biomarkers in acute post-cataract surgery endophthalmitis
Çağrı Ilhan, Mehmet Çıtırık, Mehmet Murat Uzel, Kemal Tekin
doi: 10.14744/eer.2021.96268  Pages 79 - 83
PURPOSE: This study aims to investigate changes in systemic inflammatory biomarkers, including neutrophil, lymphocyte, monocyte, and platelet counts, mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in acute post-cataract surgery endophthalmitis (APSE) cases.
METHODS: This retrospective case–control study was conducted with 36 patients who underwent pars plana vitrectomy due to APSE and 36 age- and gender-matched healthy subjects who underwent uneventful cataract surgery. Neutrophil, lymphocyte, monocyte, and platelet counts, and MPV were obtained through peripheral blood sampling before pars plana vitrectomy in the APSE group and before cataract surgery in the control group. All these biomarkers and NLR and PLR were compared with statistical methods.
RESULTS: The mean age and male-to-female ratio were similar between APSE and control groups (p>0.05, for both). The mean values of neutrophil, lymphocyte, monocyte, and platelet counts, MPV, and PLR were also similar between groups (p>0.05, for all). The mean values of NLR were 2.68±0.78 (1.15–4.18) in the APSE group and 2.04±0.50 (1.06–3.33) in the control group (p=0.019). NLR value of ≥2.10 was determined as a predictor of APSE with 72% sensitivity and 63% specificity.
CONCLUSION: NLR is a systemic inflammatory biomarker that is higher in APSE cases than in healthy subjects. Higher NLR values in presumed APSE cases can be considered as a finding in favor of APSE, which should be considered with other findings.

7.Evaluation of the relationship between cataracts and serum adiponectin levels: A cross-sectional study
Oğuz Dikbaş, Atılım Armağan Demirtaş, Burak Ünlü, Sembol Yıldırmak, Yaşar Küçüksümer
doi: 10.14744/eer.2021.99608  Pages 84 - 88
PURPOSE: Adiponectin is an adipocytokine, which plays an important role in preventing oxidative stress. In this study, we evaluated serum adiponectin levels in diabetes mellitus (DM) patients and the association of serum adiponectin levels with cataractogenesis.
METHODS: This was a prospective case–control study performed in the department of endocrinology and metabolism and department of ophthalmology. In total, 47 individuals with type 2 DM and 21 controls were included in the study. Patients with type 1 diabetes, heart failure, hepatic failure, and renal failure, as well as those younger than 18 years or older than 90 years, were excluded from the study.
RESULTS: Although the DM group had a higher frequency of cataracts, the finding was not statistically significant (p=0.067). The serum adiponectin level was lower in the DM group (p<0.001). Glucose, body mass index, and waist circumference values were higher in the DM group (p<0.001, p=0.008, and p<0.001, respectively). In addition, serum adiponectin levels were lower in the DM group with cataracts (DM group with cataracts vs. controls; p=0.008; and DM group without cataracts vs. controls: p=0.738).
CONCLUSION: Lower serum adiponectin levels were detected in DM patients with cataracts. To the best of our knowledge, this is the first study to demonstrate an association between lower adiponectin levels and the presence of cataracts. We hypothesize that adiponectin may play an important role in the pathogenesis of cataracts.

8.The promising retinal optical coherence tomography biomarkers in common macular diseases: A brief summary of the literature
Onur Furundaoturan, Filiz Afrashi
doi: 10.14744/eer.2021.00719  Pages 89 - 98
The recent developments in imaging technologies such as optical coherence tomography (OCT) helped produce high-quality and high-resolution retinal images. This progress revealed some parameters called biomarkers, which are helpful clinical decision-making indicators. This review aims to highlight valuable OCT biomarkers related to common macular diseases. Besides the most frequent disorders such as diabetic retinopathy and age-related macular degeneration, also retinal vein occlusion and epiretinal membrane were evaluated in the current article. The mentioned markers can help determine prognosis, assess treatment response, and even predict surgical success; however, there is a need for wider and prospective studies. It is essential to evaluate biomarkers together with multimodal imaging and the clinical characteristics of the patients.

9.Optical coherence tomography angiography findings in patients with systemic lupus erythematosus
Sinan Emre, Mahmut Oğuz Ulusoy
doi: 10.14744/eer.2021.46330  Pages 99 - 103
Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that can affect eye, such as retina vascular occlusions are frequent with this disorder. We aimed to describe the optical coherence tomography angiography (OCTA) findings of SLE patients. We evaluated three SLE patients which one of them had retinal vein occlusion and active vasculitis in different eyes. Superficial capillary plexus, deep capillary plexus, and optic nerve head were evaluated using OCTA RTVue XR AVANTI. Two patients, with the lack of retinal pathologies, had no changes that were seen on OCT-A. Hypointense dark-grayish areas of retinal capillary non-perfusion/hypoperfusion, capillary telengiectasies, capillary rarefaction, and diffuse capillary network disorganization were seen on third patients’ OCT-A images. OCT-A shows better visualization of perifoveal microvascular structures than fundus fluorescein angiography in eyes with active and chronic SLE.

10.Femtosecond laser in situ keratomileusis subsequently sterile peripheral necrotizing keratitis: A case report
Öznur Işcan, Banu Torun Acar
doi: 10.14744/eer.2021.98698  Pages 104 - 106
The purpose of the study was to present the clinical course and treatment of a patient who developed peripheral necrotizing keratitis (PNK) after femtosecond laser in situ keratomileusis (LASIK). We report a 30-year-old female patient who applied for refractive surgery. On the post-operative 1st day, the patient came with severe eye pain. There was an infiltration line extending from 5 to 8 o’clock at the flap border in both eyes. Confocal microscopy showed no signs in favor of fungus, the endothelium adjacent to the flap margin was intact, and there was hyper reflectance at the flap margin. There was no secretion or burring, no cells and flares in the anterior chamber, no wrinkles in the flap, haze at the interface, and epithelial defects. Topical prednisolone acetate and 1 mg/kg oral methylprednisolone were started, clinical improvement started in the post-operative 1st week, and the patient had no complaints. In post-operative 1st month biomicroscopy, the flap margin was observed naturally. Sterile PNK, seen as a rare complication of refractive surgery, has been reported as a form of diffuse lamellar keratitis. It is very important to distinguish the picture from infection and inflammation. We think that the necrotizing keratitis that developed, in this case, is due to the use of high-energy femtosecond laser, which is a rare cause.

11.Use of amniotic membrane at outpatient conditions for acute ocular surface involvement of Stevens-Johnson syndrome
Denizcan Özizmirliler, Canan Aslı Utine, Zeynep Özbek
doi: 10.14744/eer.2021.58077  Pages 107 - 112
The purpose of the study is to present a case of Stevens-Johnson syndrome (SJS) with acute ocular surface involvement, who was managed by amniotic membrane application in outpatient clinic conditions. A 68-year-old female patient with a diagnosis of acute SJS, under topical skin therapy as well as intravenous steroid and immunoglobulin treatment at the Dermatology Service, was consulted for ocular involvement with red eyes and secretion in both eyes. At the initial examination, her visual acuities were counting fingers from 1 m in the right eye and from 10 cm in the left eye. In addition to bilateral pseudomembranous conjunctivitis, corneal epithelial irregularity and an epithelial defect of approximately 4 mm × 6 mm were present in the right and left eyes, respectively. Amniotic membrane was applied to the left eye with a sutureless ring (Amnioring®) that fits at the fornices, at outpatient clinic conditions. Topical treatment with steroids, cyclosporine, and hyaluronic acid eyedrops was commenced. During follow-up, a dramatic improvement in ocular surface inflammation was observed; chemosis regressed. The cornea was epithelialized preserving the stromal transparency. Keratinization at the eyelid ciliated margin, symblephora formation, corneal vascularization, and cicatrization was not observed. Topical steroid therapy was tapered; the patient was followed-up by reducing the doses of cyclosporine and hyaluronic acid. SJS has a poor prognosis in terms of corneal transplantation and keratoprosthesis surgeries. In patients at the acute stages of the disease, who cannot be admitted to operating room conditions, sutureless amniotic membrane application in outpatient clinic or even intensive-care unit conditions should be considered. This is a promising method, to prevent both short- and long-term complications of the ocular surface and irreversible corneal blindness.

12.The influence of coronavirus disease 2019 on myopia progression
Ali Nouraeinejad
doi: 10.14744/eer.2021.30602  Pages 113 - 114
Abstract | Full Text PDF