ISSN 2757-8135 | E-ISSN 2757-9816
Volume: 2  Issue: 1 - March 2022
Suzan Guven Yılmaz
Page I

2.Assessment of meibomian glands with topography in patients using unilateral antiglaucoma drops
Abdullah Albakeri, Arzu Taşkıran Çömez
doi: 10.14744/eer.2022.54264  Pages 1 - 8
PURPOSE: The study aims to evaluate the function and morphology of the meibomian glands and tear function tests in patients with unilateral glaucoma.
METHODS: The files of 1100 glaucoma patients attending, Ophthalmology clinic from 2014 to 2018 were screened. In total, 38 eyes from 38 out of 84 patients using antiglaucomatous agents in one eye who abided by the criteria and accepted participation were included in the study. After general ophthalmologic examination including best corrected visual acuity, biomicroscopic and ophthalmoscopic examination, ocular surface disease index (OSDI) survey, tear osmolarity, noninvasive tear breakup time (NITBUT), meibography (MEBG) and lower lid tear meniscus height (TMH) measurement, followed by Schirmer test and tear breakup time (TBUT) were measured, respectively.
RESULTS: With mean age of 68.6±12.8 years, 13 patients (34.3%) were female and 25 were male (65.7%). Mean duration of medication use was 37.97 months with mean OSDI score of 33.76±16.2 C4.10–77). The difference between NITBUT and atrophy percentage of meibomian glands in glaucomatous and control eyes was identified to be significant (NITBUT: 9.08±2.98; 12.01±4.30; p=0.001, MEBG 41.15 ±14.04%, 28.33%±11.77%, p=0.001). A significant decrease was observed for TMH, TBUT and Schirmer test for eyes administered drops compared to control eyes (p=0.001; p=0.0001; p=0.009, respectively) and tear osmolarity was identified to be significantly high (p=0.0001).
CONCLUSION: In addition to the negative effects of topical antiglaucomatous drops on tear aqueous components, patients should be monitored for dry eye findings as closely as for intraocular pressure and popularizing the use of preservative-free medications is important in terms of patients’ treatment compliance.

3.Clinical features and treatment results of Fuchs uveitis syndrome
Semir Yarımada, Mine Esen Baris, Cumali Değirmenci, Halil Ates, Suzan Guven Yilmaz
doi: 10.14744/eer.2022.02886  Pages 9 - 15
PURPOSE: The study aims to evaluate the clinical features and treatment results of patients with Fuchs uveitis syndrome (FUS).
METHODS: A retrospective chart review was carried out for all the FUS patients who were treated and followed up at the Uvea Unit of our clinic between 2008 and 2019. Demographic data of all patients and best corrected visual acuity (BCVA), intraocular pressure (IOP) values, anterior and posterior segment examination findings at the time of diagnosis, and the complications along with medical and surgical treatments were analyzed.
RESULTS: The mean age of 56 patients included in the study was 40.19±9.69 (20–66) years and the mean follow-up period was 25.91±33.86 (1–154) months. The mean BCVA was 0.43±0.73 (0–3.1) LogMAR, and the mean IOP value was 17.75±9.64 (8–52) mmHg. At the time of admission, 19.6% patients were under systemic immunosuppressive treatment with corticosteroid and/or immunomodulator agents. The most common presenting symptoms were visual disturbance and blurriness (39.2%). Moreover, the most common complications were cataracts (53.5%) and IOP elevation (26.7%). Phacoemulsification was performed in 50% of eyes with cataracts, and BCVA showed a statistically significant increase postoperatively (p<0.0001). While pressure could be controlled with medical treatment in 73.3% of eyes with high IOP, 26.7% of eyes required glaucoma surgery. BCVA was found <2.10 logMAR in 20% eyes with glaucoma at the last visit.
CONCLUSION: In eyes with FUS, the most common presenting symptom was visual loss and blurriness and the most common complications were cataract and IOP elevation. While the surgical treatment of cataracts can be successfully performed, blindness may develop in eyes with glaucoma despite treatment. Therefore, early diagnosis is essential to prevent unnecessary steroid use in these cases.

4.Corneal sensitivity in patients with lamellar ichthyosis
Revan Yıldırım Karabağ, Ozlem Barut Selver, Huseyin Onay, Ilgen Ertam, Melis Palamar
doi: 10.14744/eer.2022.87597  Pages 16 - 19
PURPOSE: The purpose of the study was to evaluate the ocular surface and corneal sensitivity in patients with lamellar ichthyosis (LI).
METHODS: Eleven eyes of 11 patients with LI (Group 1) and 11 eyes of 11 healthy individuals (Group 2) were enrolled into this cross-sectional study. Detailed ophthalmological examination along with ocular surface fluorescein staining with Oxford scoring, tear film break-up time, Schirmer 1 test, ocular surface disease index (OSDI) score assessment, and evaluation of corneal sensitivity with Cochet-Bonnet esthesiometer was performed.
RESULTS: The mean ages of Group 1 and Group 2 were 24.54±10.22 years (range, 11–37) and 26±7.53 years (range, 16–40), respectively (p=0.764). Male/female ratio was 5/6 in Group 1 and 4/7 in Group 2. Mean tear film break-up time and the corneal sensitivity of the superior and inferior region of cornea were lower (p=0.00008; p=0.019; and p=0.006, respectively), and OSDI and Oxford scores were significantly higher in Group 1 (p<0.00001 and p=0.002, respectively). No significant difference in terms of Schirmer 1 test and corneal sensitivity of central, temporal, and nasal regions was detected (p>0.5).
CONCLUSION: LI is not only associated with evaporative type dry eye but also decreased corneal sensitivity of peripheric cornea. Therefore, to prevent uninvited complications, LI patients should be examined for dry eye regularly, even if they do not have any complaints.

5.Assessment of C-reactive protein to albumin ratio in patients with retinal vein occlusion
Işıl Kutlutürk Karagöz, Muhammed Nurullah Bulut
doi: 10.14744/eer.2021.14622  Pages 20 - 24
PURPOSE: The relationship between retinal vein occlusion (RVO) and hematologic parameters has been previously demonstrated. However, there is lacking data regarding the role of C-reactive protein (CRP) to Albumin Ratio (CAR) in patients with RVO. In this study, we aimed to investigate the relationship between CAR and RVO.
METHODS: A total of 126 people were included in our study, including 63 patients diagnosed with central RVO (CRVO) in our hospital and 63 control patients. All clinical, demographical, and laboratory parameters were entered into a dataset and compared between the CRVO group and the controls.
RESULTS: The mean age of the patients was 54±11 years (Female: 47.6%). CRP and CAR were significantly higher in patients with CRVO compared to controls (p<0.001, p<0.001, respectively). Logistic regression analysis demonstrated that high CAR level was an independent determinant of CRVO (Odds Ratio: 3.300, 95% Confidence interval: 1.681–6.480; p=0.001).
CONCLUSION: Higher CAR levels may be an associated predictor of CRVO.

6.Does facial mask use make our eyes dry? Change in tear meniscus measurements and conventional dry eye tests during facial mask use
Basak Bostanci Ceran, Serdar Ozates, Hasan Basri Arifoglu, Emrullah Tasindi
doi: 10.14744/eer.2022.24633  Pages 25 - 29
PURPOSE: The objective of the study is to evaluate the effect of mask use on tear meniscus (TM) measurements obtained by anterior segment optical coherence tomography (AS-OCT) and on conventional dry eye tests.
METHODS: Right eyes of 86 healthy individuals were included in the study. Lower TM parameters were measured with ASOCT and TM height (TMH) and depth (TMD) were calculated with facial masks on and 1 h after taking the masks off. Schirmer’s and tear break up time (TBUT) tests were measured under the same circumstances.
RESULTS: Mean age of the individuals was 34.4±9.6 years. Of the 86 individuals, 40 (46.5%) were male and 46 (53.5%) were female. Mean age did not differ between genders (p=0.309). Mean TMH and TMD were significantly lower in individuals with face mask (p<0.001, p<0.001, respectively). TBUT score was significantly lower in individuals with face mask (p<0.001). The mean Schirmer score did not significantly change between measurements (p=0.471). The mean mask on and mask off TMH, TMD, Schirmer’s test, and TBUT outcomes did not significantly differ between males and females in the study (p>0.05 for all).
CONCLUSION: Wearing facial masks seem to affect the TM parameters and decrease TBUT of the patients. This may explain the irritation symptoms in the eyes of the patients when using masks. Appropriate measurements should be taken in order to relieve these ocular symptoms, since wearing masks become a daily routine of our lives for protection against airborne pathogens.

7.Graft-versus-host disease and dry eye
Cansu Kaya, Aylin Karalezli, Cem Simsek
doi: 10.14744/eer.2022.54227  Pages 30 - 34
Graft-versus-host disease (GVHD) is an important problem of hematopoietic stem cell transplantation. Dry eye disease (DED) is one of the most common complications of ocular GVHD, and patients experience symptoms such as blurred vision, pho-tophobia, sand stinging, pain, burning, and redness. DED can progress to keratopathy, ulceration, and visual loss if treatment is delayed or appropriate treatment cannot be arranged. Treatment of people with GVHD needs a multidisciplinary approach to ensure early diagnosis and to recognize all clinical signs of GVHD and to define disorder category and severity. The aim of the treatment is to improve the quality and quantity of tears, to protect the corneal epithelial integrity, and to reduce the inflammation on the ocular surface to reduce the severity of the symptoms and prevent their progression. In conclusion, patients with GVHD should be evaluated ophthalmologically very carefully, especially the condition of the ocular surface and the findings of DED before and after transplantation, and it is important to carry out ophthalmological examinations and follow-up of these patients at regular intervals. Thus, early diagnosis, prevention of possible complication, and correct planning of treatment, when necessary, are very important before serious, perhaps permanent, and life-threatening conse-quences are experienced.

8.Macular phototoxic injury due to cataract extraction and trifocal intraocular lens implantation
Aylin Karalezli, Sema Kaderli, Sabahattin Sul
doi: 10.14744/eer.2021.52724  Pages 35 - 38
A 53-year-old woman underwent to the right uncomplicated cataract surgery and a trifocal intraocular lens (IOL) implan-tation. Twenty-six days after the surgery, the patient was admitted to our department with reduced vision. Slit-lamp exam-ination of anterior chamber showed a clear cornea with deep anterior chamber and a centralized IOL. Fundus examina-tion showed macular hole-like lesion in the fovea. Optic coherence tomography showed parafoveal edema, photoreceptor integrity line disruption, and outer retinal atrophy in the fovea. Fluorescein angiography showed corresponding areas of hyperfluorescence without leakage, consistent with phototoxic maculopathy resulting from the operating microscope. She had been diagnosed with systemic lupus erythematosus (SLE) 10 years ago. We aimed to present a patient who had pro-found visual loss secondary to presumed macular phototoxicity following cataract extraction and IOL implantation possibly related to underlying SLE. Patients with SLE may be prone to phototoxic damage during eye surgery.

9.Intraorbital ectopic lacrimal gland mimicking malignant orbital tumor
Melis Palamar, Banu Yaman, Naim Ceylan, Nazan Özsan, Nazan Çetingül
doi: 10.14744/eer.2021.03511  Pages 39 - 41
A 6-year-old boy with left proptosis which was realized 2 months earlier was evaluated. The left eye movements were restricted in all gaze positions. The left lacrimal gland was hypertrophic on examination. An orbital magnetic resonance imaging revealed a mass lesion starting from the lacrimal gland region extending through the superior and lateral orbit causing a pressure on the lateral rectus muscle. An incisional biopsy from both the lacrimal gland and the orbital part of the mass revealed no tumor cells but minimally inflamed lacrimal gland tissue which supported an ectopic lacrimal gland in the orbit. Although rare, ectopic lacrimal gland of the orbit might mimic orbital malignancies in children. Histopathologic confirmation is mandatory for differential diagnosis.

10.Acute non-arteritic ischemic optic neuropathy following conjunctival malignant melanoma excision
Ozlem Barut Selver, Melis Palamar, Elif Demirkilinc Biler, Banu Yaman, Onder Uretmen
doi: 10.14744/eer.2021.07279  Pages 42 - 45
The aim of the study was to report a patient who developed acute non-arteritic ischemic optic neuropathy following con-junctival melanoma excisional biopsy. An otherwise healthy 55-year-old man presented with a 3-month history of progres-sively growing pigmented lesion in the left eye. Clinical examination revealed a dark pigmented conjunctival lesion adjacent to temporal limbus with an evident feeder vessel. With the initial diagnosis of conjunctival melanoma; excisional biopsy, alcohol epitheliectomy, cryotherapy (double-thaw), episclerectomy, and amniotic membrane transplantation for ocular sur-face reconstruction were performed. Histopathological examination confirmed the diagnosis. Four months after surgical intervention, sudden visual loss in the operated eye occurred. According to detailed neuro-ophthalmological examination, patient was diagnosed as acute non-arteritic ischemic optic neuropathy. Non-arteritic ischemic optic neuropathy is a mul-tifactorial disease and may occur after several ophthalmic surgeries. To the best of our knowledge, this is the first reported case of non-arteritic ischemic optic neuropathy following conjunctival melanoma excision.