ISSN 2757-8135 | E-ISSN 2757-9816
Volume: 1  Issue: 3 - December 2021
Cezmi Akkin
Page VII

2.Comparison of corneal biomechanical properties in primary open angle glaucoma, normal-tension glaucoma, and ocular hypertension
Duygu Tüzün Sayın, Cigdem Altan, Banu Solmaz, Berna Basarır
doi: 10.14744/eer.2021.47965  Pages 115 - 121
PURPOSE: The aim of the study is to compare the biomechanical properties of the cornea and intraocular pressure (IOP) in primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), ocular hypertension (OHT), and normal eyes (N) measured by the ocular response analyzer (ORA).
METHODS: This is a retrospective, cross-sectional, and comparative clinical trial. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann IOP (IOPg), and corneal compensated IOP (IOPcc) were obtained using an ORA for all patients. IOP using Goldmann applanation tonometry (IOPGAT) and ultrasonic central corneal thickness (CCT) were also measured for each eye. Results were compared between groups.
RESULTS: The mean CH in POAG, NTG, OHT, and normal control eyes was 9.2±2.1 mmHg, 9.9±1.6 mmHg, 10.1±2.0 mmHg, and 10.93±1.4 mmHg; CRF was 13±2.3 mmHg, 10.7±1.7 mmHg, 13.3±1.9 mmHg, and 11.1±1.7 mmHg; CCT was 567.9±44.5 µm, 553.9±35.0 µm, 576.7±35.5 µm, 558.9±41.3 µm, respectively. CH was significantly lower in the POAG group compared with the OHT and N group (p<0.05). CRF was significantly lower in the NTG group compared with the POAG and OHT group (p<0.05). There was a positive correlation between CCT and CH, CRF in all eyes. We found that IOPGAT, IOPcc, and IOPg were positively correlated with CCT and CRF, and negatively correlated with CH in all eyes.
CONCLUSION: In this study, CH was lower in the POAG and NTG groups. CRF was higher in the POAG and OHT groups. Further studies may help explain the relationship between the pathogenesis of glaucoma and corneal biomechanical properties.

3.Evaluation of Turkish ophthalmologists awareness about novel coronavirus 19
Onur Furundaoturan, Özlem Barut Selver, Gülden Hakverdi, Melis Palamar
doi: 10.14744/eer.2021.33042  Pages 122 - 128
PURPOSE: To understand the objective and subjective awareness of ophthalmologists about novel coronavirus (nCov)-19 pandemic, the virus, the usage habits of Personal Protective Equipment (PPE), and sanitary products, also to measure their self-confidence during the pandemic.
METHODS: An anonymous, self-administered survey was emailed to Turkish ophthalmologists. It consisted of 4 parts to col-lect data about demography, the knowledge of nCov-19, the usage of PPE, and sanitation products. Relying on the answers to the survey, two groups were conducted as “well-informed” and “poorly-informed.” The volunteers were also divided into those who use PPE correctly and those who do not. The statistical evaluation, according to the characteristics of the par-ticipants, such as risk statements, workplaces, pandemic assignments, conducted subgroups, and age groups, was done.
RESULTS: Three-hundred and sixty-five ophthalmologists completed the survey. Three hundred ten (85%) volunteers consid-ered themselves at high risk, 209 (57%) were confident about taking all precautions. Only 200 (54.8%) participants declared to have enough knowledge about ocular involvement, only 88 (24.1%) of them felt confident enough at daily practice. Es-pecially who had pandemic assignment was the most pessimist. Younger ophthalmologists and the residents stated using insufficient PPE. Two hundred twenty-nine (62.7%) volunteers were well-informed and 245 (67.3%) of them use PPE correctly. Most of the participants (166, 45.4%) did not have sufficient information about the sanitation agents.
CONCLUSION: Ophthalmologists should be careful during daily practice due to the intimate nature of the examination. Most of the participants declared themselves at high risk, especially who had a pandemic assignment. Particularly, younger vol-unteers were not confident about taking enough precautions. The knowledge about the virus, PPE, and sanitation products was insufficient.

4.Comparison of corneal higher-order aberrations after femtosecond lasik and smile for patients with large scotopic pupil size
Burçin Kepez Yıldız, Burcu Kemer Atik, Beril Tülü Aygün, Yusuf Yıldırım, Fevziye Öndeş Yılmaz, Dilek Yaşa, Alper Ağca, Ahmet Demirok
doi: 10.14744/eer.2021.88598  Pages 129 - 135
PURPOSE: The aim of the study was to compare changes in corneal higher-order aberrations (HOAs) after femtosecond-as-sisted laser-assisted in situ keratomileusis (FS-LASIK) or small incision lenticule extraction (SMILE) in patients with large sco-topic pupil sizes over 7 mm.
METHODS: Myopic patients who underwent SMILE or FS-LASIK surgeries were retrospectively reviewed. There were 59 eyes of 36 patients with large scotopic pupil sizes over 7 mm who were enrolled into the study. The patients were divided into two groups: Group A was the FS-LASIK group and Group B included the SMILE patients. Demographic features, pre-operative and post-operative best-corrected and uncorrected visual acuities, manifest spherical equivalent (SE) values, and corneal HOAs were recorded and compared.
RESULTS: There were 26 eyes of 17 patients included in Group A, while 33 eyes of 19 patients were included in Group B. The mean follow-up time was 11.7±8.68 months in Group A and 14.7±8.88 months in Group B (p=0.19). The pre-operative mean SE values were −3.66±0.23 D in Group A and −5.28±0.89 D in Group B (p=0.001). Post-operative best-corrected visual acuity (BCVA; Snellen) scores were 0.9±0.16 in Group A and 0.89±0.17 in Group B (p=0.89). Root mean square values of spherical aberration, trefoil, secondary astigmatism, and total HOA were compared between two groups in terms of change between post-operative and pre-operative period (p=0.16, 0.95, 0.79, and 0.77, respectively).
CONCLUSION: The outcomes of patients with large pupil diameters who underwent FS-LASIK or SMILE due to myopia and myopic astigmatism were similar in terms of corneal HOAs.

5.Correlation between structural and functional tests in primary open-angle glaucoma
Oksan Alpogan, Meltem Toklu, Necla Tükenmez Dikmen
doi: 10.14744/eer.2021.36844  Pages 136 - 142
PURPOSE: The objective of this study was to evaluate the correlation between functional (visual field and visual evoked po-tentials [VEP]) and structural (optical coherence tomography [OCT]) test findings in primary open-angle glaucoma (POAG) patients.
METHODS: A total of 56 eyes of 28 patients with POAG were tested. A complete ophthalmological examination, with a visual field test, OCT exam, and VEP recording, was performed. Measurements of the intraocular pressure, N75-P100 amplitude, N75 and P100 latency of VEP, retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness, mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI) of the visual field were recorded. The parameters were assessed for correlations.
RESULTS: The RNFL and PSD parameters were negatively correlated (r=-0.324, p=0.015). The RNFL was positively correlated with the N75-P100 amplitude (r=0.586, p=0.000). The GCC demonstrated a positive correlation with the MD and a negative correlation with the PSD (r=0.431, p=0.001; r=-0.264, p=0.049, respectively). The P100 latency and the VFI were negatively correlated (r=-0.344, p=0.009). The N75 latency was positively correlated with the RNFL and the GCC (r=0.375, p=0.004; r=0.324, p=0.015, respectively).
CONCLUSION: The results of this study indicated that the OCT and visual field findings showed good structure-function cor-relation. The N75-P100 amplitude and P100 latency of VEP was correlated with OCT and visual field parameters.

6.Comparison of the reliability and repeatability of central corneal thickness measurements from four different non-contact devices
Sema Malgaz, Huseyin Mayali, Mustafa Erdogan, Muhammed Altinisik, Suleyman Sami Ilker
doi: 10.14744/eer.2021.63825  Pages 143 - 149
PURPOSE: To compare the reliability and repeatability of central corneal thickness (CCT) values from four different non-con-tact measurement devices.
METHODS: The study was conducted in 130 right eyes of 130 subjects with no ophthalmological pathology other than re-fractive errors. For each eye, data were recorded by making three consecutive measurements with a Scheimpflug camera (Pentacam, Oculus Optical gerate GmbH, Wetzlar, Germany), specular microscope (SM) (Cellchek XL; Konan Medical USA, Torrance, CA, USA), Lenstar LS 900® (Haag-Streit AG, Switzerland), and anterior segment optical coherence tomography (AS-OCT) (Carl Zeiss Meditec, Inc. Dublin, CA, USA). All measurements were analyzed using intraclass correlation coefficients (ICC), ANOVA or Friedman test, and Bland-Altman plots.
RESULTS: There were no statistically significant differences among the three consecutive measurements made with four de-vices (p=0.449, p=0.270, p=0.540, p=0.881, respectively). ICC values were 0.972, 0.997, 0.998, and 0.998, respectively. The closest agreement between measurements was a difference of 12.87 μm (95% limits of agreement [LoA]: −5.41, 20.33 μm) between AS-OCT and Pentacam, while the lowest agreement was between SM and Lenstar measurements, which had a difference of 31.92 μm (95% LoA: −21.80, 42.04 μm). This difference was 14.66 μm (95% LoA: −19.18, 10.14 μm) for AS-OCT and Lenstar, 31.86 μm (95% LoA: −17.22, 46.50 μm) for AS-OCT and SM, 30.22 μm (95% LoA: −23.04, 37.40 μm) for SM and Pentacam, and 17.28 μm (95% LoA: −14.34, 20.22 μm) for Pentacam and Lenstar.
CONCLUSION: The CCT measurements of the four different devices are highly consistent and have high repeatability. The highest ICC values were obtained with the SM, while the lowest ICC value was obtained with AS-OCT. Differences in average CCT values were similar between the AS-OCT, Lenstar, and Pentacam devices, while the difference was greater with SM. In clinical practice, CCT measurements obtained with SM should not be used interchangeably with measurements obtained with the other three devices.

7.Analysis of tear osmolarity, stability and production in systemic sclerosis
Huseyin Mayali, Mustafa Erdogan, Muhammed Altinisik, Emin Kurt, Suleyman Sami Ilker
doi: 10.14744/eer.2021.63935  Pages 150 - 155
PURPOSE: To analyze tear film characteristics using objective tests in patients with scleroderma or systemic sclerosis (SSc), a rare condition for which there is limited literature data.
METHODS: This cross-sectional study included 31 SSc patients and a group of age- and sex-matched controls. Tear quantity, stability, and osmolarity were assessed in both groups with Schirmer I test (S1T), fluorescein tear film break-up time (TBUT), and the TearLab Osmolarity System, respectively.
RESULTS: There was no significant difference in age or sex between the groups. The median disease duration was 6 (0.83–30) years. Compared to the control group, the SSc patient group showed significantly higher mean tear osmolarity (307.84±5.86 mOsm/L vs. 294.87±8.55 mOsm/L) and lower TBUT (5.68±2.07 s vs. 10.06±1.20 s) and S1T (4.55±2.26 mm/5 min vs. 10.06 ± 1.20 mm/5 min) values (p<0.001 for all). Age and disease duration were not significantly correlated with the results of objective dry eye tests in SSc patients, and there were no significant correlations among the test parameters (p>0.05 for all).
CONCLUSION: Tear characteristics are affected in SSc, with patients demonstrating decreased tear production, shorter TBUT, and tear hyperosmolarity.

8.Retinal arterial macroaneurysm
Kim Jiramongkolchai, J. Fernando Arevalo
doi: 10.14744/eer.2021.47966  Pages 156 - 160
Retinal arterial macroaneurysms (RAMs) are acquired focal round fusiform dilatation of the retinal arterioles that occur at branch points or arteriovenous crossing. RAM most commonly affects the superotemporal retinal artery. Although RAM is usually a self-resolving condition in which most patients are asymptomatic, acute vision loss can occur from exudation, ede-ma, retinal hemorrhage, or vitreous hemorrhage. Treatment should consider the lesion characteristics of RAM. Observation, antiangiogenics, and surgical intervention are current options to manage symptomatic RAM.

9.Conjunctival resection in the management of peripheral ulcerative keratitis
Furkan Güney, Canan Aslı Utine, Üzeyir Günenç
doi: 10.14744/eer.2021.69875  Pages 161 - 166
Purpose: To present a case with refractory peripheral ulcerative keratitis (PUK) that was managed with conjunctival resection surgery in addition to medical treatment.
Material and Method: A 78-year-old female patient was admitted with sudden decrease in vision, redness and pain in the right eye. Her medical history was unremarkable except for early stage diabetes and hypertension. In the first examination, her visual acuities were counting fingers from 1 meter in the right eye and 1.0 in Snellen lines in the left eye. Biomicroscopy revealed crescent-shaped stromal ulceration with accompanying epithelial defect, stromal thinning and limbal inflammation in the temporal cornea consistent with PUK.Immediate management included bandage contact lens application, topical preservative-free dexamethasone, moxifloxacin, cyclosporine 0.05%, polyvinyl alcohol/povidone artificial tear eye drops, as well as I.V. pulse metiprednisolone. Rheumatology consultation revealed no underlying autoimmune disease. During her follow-up with oral maintenance dose streoids and topical medication, the ulcer progressed to perforation with protrusion of the iris. Therefore, surgical correction including conjunctival resection and amniotic membrane transplantation (AMT) had to be performed.
Results: In follow-up, healing in stromal ulceration was observed with dramatic improvementin ocular surface inflammation. Visual acuity improved to 0.2 in the 3rd month. Her cornea was transparent, anterior chamber was quiet, and PUK area was healed with no epithelial defect. The patient was followed up under topical cyclosporine and carboxy-methylcellulose maintenance therapy.
Conclusion: In PUK cases refractory to I.V. pulse steroid or immunosuppressive therapy, "conjunctival resection" surgery may be a useful tool in the armamentarium of cornea specialists, in order to remove perilimbal immune complexes, suppress inflammation and accelerate surface healing

10.Topical ivermectin in the treatment of blepharoconjunctivitis caused by demodex infestation
Altan Atakan Özcan, Burak Ulaş
doi: 10.14744/eer.2021.77486  Pages 167 - 169
The aim of this study was to present a case of chronic blepharoconjunctivitis due to Demodex infestation. A 46-year-old man patient presented with itching, burning, tearing, and redness in the right eye for 4 months. Biomicroscopic examination revealed chemosis, hyperemia, and papillary reaction in the right eye. Demodex in the hair follicles of eyelashes and their potential influence were suspected. For diagnosis, lash sampling with direct microscopic counting method was used. When Demodex infestation was diagnosed tea tree oil (TTO) treatment was started. However, TTO increased ocular allergy. After TTO was stopped, topical ivermectin treatment was started. Dramatic improvement was observed in 1 week. No recurrence was seen at 6 months follow-up. Rare causes should be considered in the selection of diagnosis and treatment in long-term unilateral conjunctivitis. Demodex infestation is often overlooked in the differential diagnosis of ocular surface diseases. Topical ivermectin was effective in the treatment of demodex.

11.Bilateral macular injury following red laser pointer exposure: A case report
Mahmut Kaya, Betül Akbulut Yağcı
doi: 10.14744/eer.2021.03521  Pages 170 - 173
We report the case of bilateral red laser pointer macular injury which developed macular neovascularization (MNV) in one eye. A 10-year-old boy presented with MNV in the right eye, and disruption of the outer retinal layers in the left eye fol-lowing exposure to a class 3a red laser pointer with 5 milliwatt energy at 650 nanometer wavelength, 3 weeks ago. After 2 consecutive monthly intravitreal ranibizumab injections in the right eye, no MNV re-activation was seen during 10 months of follow-up. This case emphasizes that laser pointer misuse or abuse can cause extensive photothermal injury which can lead to MNV.

12.Reviewer List

Page 174
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