ISSN 2757-8135 | E-ISSN 2757-9816
Volume: 2  Issue: 4 - December 2022

Page I

2.Visual and refractive effects of collagen cross-linking in keratoconus
Seher Koksaldi, Canan Asli Utine, Mustafa Kayabasi, Zeynep Ozbek
doi: 10.14744/etd.2022.08370  Pages 147 - 152
PURPOSE: Evaluation of visual and refractive effects of collagen cross-linking (CXL) in progressive keratoconus (KCN).
METHODS: A total of 95 eyes of 77 patients were retrospectively analyzed. The changes in uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively); spherical or cylindrical refraction and spherical equivalent of refractive error (SPH, CYL, and SE, respectively); central corneal thickness (CCT); and mean keratometry values (K) in the Scheimpflug corneal tomography (Pentacam, Oculus®, Germany) were evaluated at the 1st, 3rd, and 6th post-operative months and the past visit, as compared to pre-operative values.
RESULTS: During follow-up, there was a progressive improvement in the mean UDVA and CDVA. Significant improvement was seen in CDVA at the 3rd month (from 0.51±0.23 to 0.59±0.22), in UDVA at the 6th month (from 0.34±0.24 to 0.44±0.25), and in SPH and SE values at the last control (from −2.75±3.50D to −1.92±2.52D for SPH; from −3.51±4.45D to −3.07±3.05D for SE). The mean CCT decreased in the post-operative 1st month and gradually increased in the 3rd and 6th months (from 466.87±63.94 μm to 449.76±50.09 μm, 443.92±42.44 μm, and 454.30±46.86 μm for 1st, 3rd, and 6th months, respectively); almost returned to pre-operative values. There was no significant change in mean CYL and K values throughout the follow-up (from −2.40±2.11D to −2.45±1.77D for CYL; from 46.89±3.66D to 47.35±5.04D for K).
CONCLUSION: CXL seems to not only slow down the progression of KCN but also improve the visual acuity, which may be a result of ultrastructural changes that occur in the corneal stroma postoperatively, rather than a simple corneal flattening effect.

3.Evaluation of the optic disk and macular vessel density in inactive thyroid eye disease using optical coherence tomography angiography
Zeynep Yilmaz, Ayse Burcu Dirim, Ibrahim Cagri Turker, Selam Yekta Sendul, Mehmet Demir, Emine Betul Akbas Ozyurek, Dilek Guven
doi: 10.14744/eer.2022.07078  Pages 153 - 159
PURPOSE: The purpose of the study was to evaluate the vascular density (VD) in the optic disk (OD) head and macula by optical coherence tomography angiography (OCT-A) in patients with inactive thyroid eye disease (TED), as well as the rela-tionship between extraocular muscle (EOM) thickness and the VD of the retina and OD.
METHODS: The study group and control group each consisted of 65 eyes of 65 participants. The foveal, parafoveal, and per-ifoveal VD were examined for both superficial capillary plexus and deep capillary plexus. In addition, choriocapillaris flow, foveal avascular zone (FAZ) areas, and the perimeter were calculated. The thicknesses of the peripapillary retinal nerve fiber layer (RNFL) and VD were recorded. EOM thickness was measured with magnetic resonance imaging.
RESULTS: VD was significantly lower in all quadrants for the superficial foveal areas, as well as the deep and superficial para-foveal and perifoveal areas in the study group (p<0.05 for all). The study group had significantly lower choriocapillaris flow area (2.08±0.1; 2.12±0.10 p=0.049) and higher FAZ (0.29 (0.22–0.36); 0.26 (0.17–0.32) p=0.037) and perimeter (2.08±0.46; 1.92±0.35 p=0.03) values compared with the controls. VD was higher in the inferior half of the peripapillary region in the study group than the controls (p=0.045).
CONCLUSION: Macular VD measured using OCT-A was found to be significantly lower in TED patients compared to healthy controls. It is thought that noninvasive quantitative retinal perfusion analysis using OCT-A may be useful in the follow-up of TED, close monitoring of complications, and early treatment decision.

4.Optical coherence tomography angiography evaluation of retinochoroidal and optic disc microvascular morphology in thyroid ophthalmopathy
Ozgur Erogul, Hamidu Hamisi Gobeka, Muberra Akdogan, Mustafa Dogan, Murat Kasikci, Abdullah Caliskan, Leyla Eryigit Erogul
doi: 10.14744/eer.2022.08379  Pages 160 - 166
PURPOSE: The purpose of the study was to investigate detailed optic disc, choroid, and retinal microvascular morphological changes in active Thyroid ophthalmopathy (TO) patients due to thyroid disease using Optical Coherence Tomography An-giography (OCTA).
METHODS: Forty-six (34 females and 12 males) active TO patients and 41 (28 females and 13 males) healthy participants were included in the study. All patients underwent clinical examinations and ophthalmologic evaluations at first and last visits for visual acuity measurement, eyelid opening measurement, Clinical Activity Score (CAS) assessment (TO patients with CAS ≥3 were recorded, indicating active TO), exophthalmometry, cornea, and fundus examination, and those with initial intraocular pressure range of 14–21 mm Hg were included in the study. The overall degree of TO was assessed using the NOSPECS Score. The diagnosis of TO was made by a specialist according to the Bartley and Gorman Criteria.
RESULTS: The mean retinal nerve fiber layer (RNFL) thickness was significantly different between the groups (p<0.001), with active TO patients having a thinner RNFL thickness than the control group (p<0.001). When temporal and inferior RNFL thicknesses were compared (p=0.01, p=0.01), different results were obtained when compared to the control group, but there were no significant differences in upper and nasal RNFL thicknesses (p=0.604, p=0.513). Choroidal thickness (CT) measurements were significantly higher in the macular region in TO patients than in healthy individuals (p<0.05). The mean FAZ area in the TO group was found to be 0.303±0.104 mm2 at a significantly larger level compared to the control group (0.260±0.100) (p=0.037).

CONCLUSION: Significant differences were detected in the RNFL, CT, FAZ area, superficial and deep retinal vessels, and RPC in TO patients. The data obtained showed that the OCTA device is an important guide for diagnosis, treatment and follow-up in the early stages of TO.

5.Treatment results of standalone XEN-45 implantation in patients with primary and secondary open-angle glaucoma
Meryem Erbey, Mine Esen Baris, Halil Ates, Suzan Guven Yılmaz
doi: 10.14744/eer.2022.19484  Pages 167 - 172
PURPOSE: The purpose of this study was to evaluate the treatment results and complications of XEN-45 microstent implantation in open-angle glaucoma.
METHODS: In this study, 17 eyes of 17 patients who underwent XEN-45 implantation with 0.2 mg/cc mitomycin-c between June 2016 and February 2018 were retrospectively examined. Pre- and post-operative best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of antiglaucomatous drugs, endothelial cell count (ECC), retinal nerve fiber layer (RNFL) thickness, number of post-operative needlings, and post-operative complications were evaluated.
RESULTS: The mean age of the patients (11 M, 6 F) was 62.6±19.8 (29–94) years and mean follow-up period was 16.8±3.5 (12–21) months. The mean IOP which was 27.6±6.0 (21–40) mmHg before glaucoma surgery decreased significantly to 14.1±3.3 3.4 (8–20) mmHg at the last visit (p<0.001). The number of antiglaucomatous drugs was 3.9±0.8 (2–5) preopera-tively and 1.7±1.3 (0–3) at the final examination (p=0.001). Pre-operative BCVA was 0.78±0.99 LogMAR and 0.8±0.99 LogMAR at the last visit (Wilcoxon test, p=0.99). The ECC was 2356.8±533.3 (1635–3275) cells/mm2 preoperatively and 2338.7±472.7 (1712–3178) cells/mm2 at the last visit and did not show statistically significant difference (p=0.470). The pre- and post-op-erative RNFL thickness measurements were 61.4±11.8 (43–82) μm and 61.3±11.5 (45–82) μm at the last visit, respectively (p=0.764). Needling was required in 4 (23.5%) eyes. Post-operative complications were observed in four eyes (23.5%). In the early post-operative period (≤1 month), shallow anterior chamber and hypotony were detected in 1 eye and were treated medically. As late complications (>1 month), Tenon’s cyst in two eyes and fibrotic bleb in one eye were observed.
CONCLUSION: XEN-45 implant surgery in open-angle glaucoma patients is an effective surgical procedure for IOP control. With preserved visual acuity and ECC, causing no devastating complications, it can also be considered as a very safe option in open-angle glaucoma cases.

6.Visual outcome of macular hole surgery based on pre-operative hole configuration in optical coherence tomography from a developing country-Nepal
Saurav Piya, Sweta Singh, Jeena gurung, Simanta Khadka, Bikram Bahadur Thapa, Shanti Gurung
doi: 10.14744/eer.2022.83703  Pages 173 - 179
PURPOSE: To predict the post-operative visual outcome considering the pre-operative factors and macular hole (MH) indices based on hole configuration in OCT.
METHODS: Twenty-six eyes of 26 patients with full thickness MH (Stage II, III, and IV) were enrolled in this retrospective observational study between June 2017 and April 2019. Preoperative morphological parameters of MH such as base and min-imum diameter, vertical height, left arm, and right arm length were calculated manually using the software in the cirrus optical coherence tomography (OCT) machine. MH Index (MHI), hole form factor (HFF), traction hole index, and diameter hole index were calculated and correlated with post-operative best-corrected visual acuity (VA) at last follow-up. 23-gauge pars plana vitrectomy, internal limiting membrane peeling with 12% C3F8 tamponade was performed in all patients and was followed up to 6 months postoperatively.
RESULTS: The median value of patient’s age, duration of symptoms, pre- and post-operative best corrected VA were 60 years, 9 months, 1.15 logMAR, 0.80 logMAR, similarly axial length, minimum hole diameter, base diameter of the MH, and central subfoveal macular thickness (CMT) were 22.8 mm, 646.5 μm, 736.5 μm, and 291 μm, respectively. Post-operative visual out-come after MH surgery is better in patients with MHI ≥0.5, HFF ≥0.9, and CMT ≥300 μm.
CONCLUSION: Pre-operative measurement of MH indices calculated from OCT images can be a prognostic factor in determining the post-operative visual outcome of MH surgery.

7.The revival of an old term with optical coherence tomography: Bacillary layer detachment
Ceren Durmaz Engin, Ali Osman Saatci
doi: 10.14744/eer.2022.83997  Pages 180 - 188
Bacillary layer detachment (BALAD) is a relatively new optical coherence tomography (OCT) finding described by the utilization of OCT and characterized by the separation within the photoreceptor inner segment. The most common ocular diseases associated with BALAD include Vogt-Koyanagi-Harada’s disease, neovascular age-related macular degeneration, and central serous chorioretinopathy, and it is frequently observed in inflammatory, infectious, traumatic, and mass lesions of the choroid. It usually has a benign course and can resolve spontaneously or with treatment in a very short time, accompanied by an increase in visual acuity. However, its prognostic significance is still contradictory, as studies with long-term follow-up have shown that BALAD is related with subretinal fibrosis. In this review, the anatomical definition, multimodal imaging findings, course, and prognosis of BALAD in various ocular diseases are discussed.

8.Scedosporium apiospermum keratitis treated with voriconazole
Nilgun Yildirim, Yasemin Oz, Yasemin Aydin Yaz
doi: 10.14744/eer.2022.72691  Pages 189 - 193
Fungi are among the most common agents of microbial keratitis, especially in developing countries and tropical regions. Early diagnosis and appropriate antifungal treatment are critical for clinical success in fungal keratitis (FK). A 35-year-old female patient was referred to our hospital because of the diagnosis of keratitis with resistant to topical antibacterial treatment. Her visual acuity was counting fingers at one meter for the right eye. Biomicroscopic examination revealed a large, white keratitis center with peripherally extension on cornea. Fungal hyphae were observed in microscopic examination and a filamentous fungus was isolated in culture of the corneal scrapings. It was identified as Scedosporium apiospermum by both phenotypic and molecular methods. She was treated with topical and oral voriconazole according to susceptibility testing result. It is important to early diagnosis, determine the causative agent and perform a susceptibility testing in FK.

9.Recovery of visual field in early treated optic nerve sheath meningioma: A case report
Sirin Serefli Gunes, Hulya Gokmen
doi: 10.14744/eer.2022.96158  Pages 194 - 198
We report the diagnosis and treatment process of a patient who underwent CyberKnife radiotherapy with diagnosis of optic nerve sheath meningioma (ONSM) to emphasize visual field recovery with an early treatment. A 46-year-old woman pre-sented with puffiness, discomfort, and enlargement in right eye. Right sided proptosis and optic disc edema were detected as accompanying findings. Visual acuity was 20/20 in both eyes. Blind spot enlargement and mild peripheral constriction were found on the right side of visual field test. The diagnosis was made on the basis of clinical and radiological findings. Magnetic resonance imaging demonstrated an ONSM. The lesion was treated by three fraction stereotactic CyberKnife ra-diation therapy with dose of 19.5 Gy. Visual acuity was preserved and visual field was completely recovered after 6 weeks of follow-up. Due to its typical clinical and radiological findings, ONSM can be diagnosed without tissue biopsy. In progressive cases, optic nerve functions may recover by CyberKnife radiation therapy performed before development of significant visual loss. However, patients should be observed for radiation complications.

10.Bilateral herpes simplex epithelial keratitis in a patient with pemphigus foliaceus
Turhan Mammadov, Canan Asli Utine
doi: 10.14744/eer.2022.29974  Pages 199 - 202
Bilateral herpetic keratitis is a rare event and can occur in atopy, measles, and immunodeficiency. Long-term use of systemic steroids for any autoimmune condition also creates iatrogenic immunodeficiency. A 62-year-old female with Pemphigus Foliaceus who had been on long-term steroids presented with bilateral epithelial herpetic keratitis. She received topical ganciclovir 5 times daily for a total of 10 days and intravenous (iv) acyclovir 5–10 mg/kg for 2 weeks for diffuse periocular skin involvement. In 2 weeks, corneal lesions completely disappeared with intact epithelium and no stromal involvement. Treatment was discontinued as no further ocular signs were observed. Peroral antiviral prophylaxis was not initiated since systemic steroids were also discontinued. Three months after resolution, she underwent bilateral cataract surgeries with per-operative and post-operative systemic prophylaxis during topical steroid use. Long-term systemic steroid use seems to be a predisposing factor for bilateral herpetic ocular infections.

11.Reviewer List

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