ISSN 2757-8135 | E-ISSN 2757-9816
Volume: 2  Issue: 3 - September 2022

Page I

2.Impact of posterior corneal astigmatism on deviation in predicted residual astigmatism for toric IOL calculations in keratoconic eyes
Erhan Özyol, Pelin Özyol
doi: 10.14744/eer.2022.29200  Pages 97 - 102
PURPOSE: The objective of the study was to evaluate the error in predicted residual astigmatism (PRA) using measurements of corneal astigmatism obtained with IOLMaster-700 and Pentacam for toric intraocular lens (IOL) calculation in keratoconic eyes.
METHODS: For toric IOL calculations, we used keratometric astigmatism obtained by IOLMaster-700 and total corneal re-fractive power (TCRP) values determined by Pentacam Scheimpflug system. Using an online toric IOL calculator, PRA for keratometric astigmatism and TCRP with a toric IOL model suggested for keratometric astigmatism values was recorded. We also calculated the error in PRA as the difference between PRA with keratometric astigmatism and TCRP. For all calculations, vector analysis was used.
RESULTS: In our sample of 70 keratoconic eyes of 70 patients, the mean difference in PRA using TCRP instead of keratometric astigmatism measurements was −1.21±0.93 with a centroid of 0.85 at 25. The error in PRA was ≤1.0D in 36 eyes, between 1.0D and 3.0D in 26 eyes, and between 3.0D and 4.0D in eight eyes. Whereas 80% of eyes with with-the-rule astigmatism showed decreased cylindrical IOL power, 88.9% of eyes with against-the-rule astigmatism showed increased IOL power with TCRP instead of keratometric astigmatism.
CONCLUSION: Using TCRP measurements instead of keratometric astigmatism in toric IOL calculations caused a considerable deviation in eyes with keratoconus, most probably due to the posterior corneal astigmatism.

3.Association between interpupillary distance and fusional convergence-divergence amplitudes
Medine Dag, Elif Demirkilinc Biler, Serap Bilge Ceper, Onder Uretmen
doi: 10.14744/eer.2022.25744  Pages 103 - 106
PURPOSE: The purpose of the study was to evaluate the effect of individual differences in interpupillary distance (IPD) on convergence and divergence amplitudes measured at near and at distant fixation targets.
METHODS: Ninety-three healthy subjects were enrolled. Group 1 included subjects with smaller than normal IPD (mean IPD = 58.2±1.4; 27 subjects), Group 2 included those with larger than normal IPD (mean IPD = 69.5±1.6; 31 subjects), and Group 3 included those with normal IPD (mean IPD = 63.10±2.22; 35 subjects). Outcome measures were best corrected visual acuity, binocular vision level (TNO test), convergence, and divergence amplitudes at near and at distance.
RESULTS: There was no statistically significant difference between Group 1, 2, and 3 regarding age or clinical characteristics. The differences in gender distribution between Groups 2 and 3 and between Groups 1 and 2 were significant (Chi-square test, p=0.001 for both). There was no statistically significant difference between the groups in the values of near conver-gence amplitude, near divergence amplitude, and distant convergence amplitude. There was a statistically significant differ-ence between in mean distant divergence amplitude between Groups 2 and 3 (p=0.01).
CONCLUSION: Differences in IPD can affect an individual’s vergence amplitudes and binocular vision level. Especially, the in-dividuals with IPD larger than normal limits have the lowest mean values for all vergence amplitudes, while the normal IPD group had the highest.

4.Effects of erythropoietin on neuroprotection in an experimental glaucoma model
Yusuf Onay, Tolga Kocaturk, Sinan Bekmez, Serhan Çamoğlu, Kemal Ergin
doi: 10.14744/eer.2022.73745  Pages 107 - 115
PURPOSE: Glaucoma is a progressive, irreversible optic neuropathy that is the leading cause of blindness worldwide. In our study, we aimed to show the neuroprotective effect of erythropoietin (EPO) on glaucoma.
METHODS: Twelve male and 12 female albino Wistar rats (6 weeks old; 220±40 grams) from Aydin Adnan Menderes University Experimental Animal Center were used. All animals were housed in a fixed room on a 12/12 h light/dark cycle per day, with food and water provided ad libitum. Rats were divided into four groups as control and glaucoma groups, subconjunctival EPO and topical EPO groups. At the end of the 6th week, the right eyes were enucleated and total retinal thickness, ganglion cell complex (GCC), inner plexiform layer (IPL), and ganglion cell layer (GCL) thickness measurements were determined. Tis-sue samples stained with HE were examined under a light microscope and photographed. Retinal layer thickness measure-ments were determined for each eye using the ImageJ program (NIH, USA). The neuroprotective effect of EPO on glaucoma was evaluated by retinal layer thickness measurements.
RESULTS: GCL, IPL, retinal thickness, and GCC thickness were observed the least in the glaucoma group and the most in the control group. There was no significant difference between EPO administration routes (p>0.05). Cell layer thicknesses in each group were confirmed by immunohistochemical staining, and apoptotic cells were not detected by bax or bcl-2 staining.
CONCLUSION: The structural contribution of topical and subconjunctival applications of EPO to retinal layers has been demonstrated, and the study needs to be repeated in larger series.

5.Comparative assessment of the endothelial toxicity of intracameral cefuroxime after phacoemulsification
Sertaç Tatlı, Bora Yüksel, Faruk Bıçak, Tuncay Kusbeci
doi: 10.14744/eer.2022.08108  Pages 116 - 123
PURPOSE: The aim of the study was to investigate the possible adverse effect of intracameral cefuroxime (ICC) on corneal endothelium by comparing it with subconjunctival gentamycin (SCG) injection.
METHODS: Patients were divided in two groups; ICC (1 mg/0.1 ml) and SCG (40 mg/ml). Corrected distance visual acuity, anterior segment examination, intraocular pressure measurement, specular microscopy (endothelial cell density, coefficient of variation (CV), hexagonality, and central corneal thickness (CCT) were performed before surgery and at postoperative controls on week 1, month 1, and month 3.
RESULTS: Fifty-one eyes received ICC, 37 eyes SCG, and the mean ages of the patients were 70.0±5.5 and 69.2±6.6 (p=0.644). Endothelial cell loss at month 1 was 17.07% in ICC and 16.75% in SCG group (p=0.899). CCT returned to pre-operative values in SCG group at month 1 (p=0.483). Whereas in ICC eyes, a statistically significantly higher CCT still persisted at month 1 (p=0.015). CV showed no statistically significant difference at three post-operative visits compared to baseline in SCG group. Whereas in ICC group, a statistically significant increase was observed in CV at week 1 (p=0.000) and month 1 (p=0.012). At month 3 visit, a statistically significantly lower hexagonality was observed in ICC when compared with SCG (p=0.019).
CONCLUSION: Results of our study showed that the licensed ICC use after phacoemulsification is safe as SCG in clinical point of view. However, abnormalities in CCT, CV, and hexagonality suggest subclinical endothelial toxicity of cefuroxime.

6.Ocular syphilis
Kubra Ozdemir Yalcinsoy, Pinar Cakar Ozdal
doi: 10.14744/eer.2022.57966  Pages 124 - 134
Syphilis is a sexually transmitted systemic disease caused by the spirochete Treponema pallidum. If left untreated, syphilis progresses in four stages: Primary, secondary, latent, and tertiary. Since the turn of the 20th century, the global prevalence of syphilis has sharply increased. Syphilis and human immunodeficiency virus (HIV) coinfection are common because they share similar transmission routes. Ocular syphilis (OcS) is a rare syphilis complication, but its prevalence has recently in-creased as a result of the rise in syphilis cases. OcS may occur at any stage of syphilis. However, it may not always be accom-panied by systemic findings. In such cases, ocular involvement may be the disease’s first and only manifestation. OcS can affect any structure of the eye, yet the most common manifestations are posterior uveitis and panuveitis. Due to the variety of clinical manifestations, the disease is known as “the great imitator.” As a result, syphilis serology is advised for any patient with unknown intraocular inflammation. Although clinical signs can be indicative of OcS, it is diagnosed using laboratory tests. Multimodal ocular imaging is required for differential diagnosis, treatment, and follow-up. It is highly recommended that patients with suspected or confirmed syphilis be tested for HIV infection. OcS is treated just like neurosyphilis with systemic penicillin. If OcS is treated promptly and effectively, a good visual prognosis is possible; otherwise, it may lead to permanent blindness.

7.Symblepharon ring-amniotic membrane application in persistent corneal epithelial defect
Altan Atakan Özcan, Burak Ulaş
doi: 10.14744/eer.2022.43531  Pages 135 - 138
The aim of this study was to assess the efficacy of sutureless amniotic membrane (AM) technique using a symblepharon ring-AM patch on the persistent epithelial defects and resistant to medical treatment. Two patients to whom an AM patch was applied to the ocular surface using a polymethyl methacrylate symblepharon ring due to corneal surface disorders are evaluated. The implantation of ring-AM was not complicated. Irritation and epithelial defect decreased in both cases. Eventually, vascularized leukoma developed. Ring-AM implantation is a non-invasive and easy procedure in the treatment of ocular surface disease. Ring-AM is an effective and safe biologic bandage in patients, who refuse surgical procedure or to whom surgery is contraindicated due to systemic diseases.

8.Anterior segment optical coherence tomography as a diagnostic tool in Descemet membrane detachment in a case with corneal opacity
Rana Altan Yaycioğlu
doi: 10.14744/eer.2022.46220  Pages 139 - 141
A 74-year-old male patient, who previously had central corneal opacity, presented to our clinic with decrease in vision, and diffuse corneal edema following uncomplicated phacoemulsification and intraocular lens implantation. With topical treatment of steroids and artificial tears, the edema resolved in peripheral cornea and remained edematous in the central cornea during the following 2.5 months. Optical coherence tomography showed Descemet membrane detachment (DMD) in the edematous area. Intracameral perfluoropropane (C3F8) was injected. In the following days, Descemet membrane reattached and corneal edema resolved. The visual acuity increased to 20/40. Following uneventful phacoemulsification, if corneal edema is refractory to treatment, DMD should be remembered. In cases where corneal opacity interferes with the detailed examination of cornea, optical coherence tomography is helpful. In those patients, C3F8 injection is a viable option even in the late post-operative weeks.

9.End stage thyroid ophthalmopathy presenting with bilateral exposure keratitis
Betul Akbulut Yagci, Canan Aslı Utine, Aylin Yaman
doi: 10.14744/eer.2022.79188  Pages 142 - 146
The present case reports a 70-year-old female patient who presented with bilateral exophthalmos, lagophthalmus, and exposure keratitis. An aggressive topical treatment was commenced that included fortified vancomycin and ceftazidime. She was subsequently diagnosed with severe thyroid ophthalmopathy (TO) due to severe static and dynamic tremor that raised suspicion and abnormal thyroid function tests indicating Graves’ Disease. She was diagnosed with bilateral exposure keratitis secondary to TO in which the clinical activity score was assessed as 5. As her TO was sight-threatening, she was administered intravenous pulse methylprednisolone, followed by bilateral balanced 2-wall (medial and lateral) decompression and lateral temporary tarsorrhaphy surgeries. As her exophthalmos and lagophthalmos improved postoperatively, both eyes’ keratitis significantly regressed, and left scar tissue in the cornea. This extreme case should raise awareness for clinicians in the eti-ological investigation of exposure keratopathy to identify sight-threatening thyroid ophthalmopathy and promptly initiate appropriate treatment.