ISSN 2757-8135 | E-ISSN 2757-9816
Volume: 3  Issue: 1 - April 2023

Pages I - V


Page VI

3.Efficacy of intravitreal aflibercept monotherapy in treatment naive cases with diabetic macular edema
Sefik Can Ipek, Nilufer Kocak, Mahmut Kaya, Taylan Ozturk, Suleyman Kaynak
doi: 10.14744/eer.2023.43153  Pages 1 - 6
PURPOSE: Incidence of diabetes mellitus (DM) increases rapidly in our country as well as around the world, posing a serious threat to public health. Diabetic retinopathy (DR) is the most common microvascular complication in patients with DM since microvascular damage secondary to chronic hyperglycemia starts affecting retina in the early stages of the disease. Our aim is to evaluate the real-life outcomes of intravitreal aflibercept monotherapy in treatment naive cases with diabetic macular edema (DME).
METHODS: This study was retrospective case–control study. Medical charts of 75 treatment naive cases with DME were re-viewed retrospectively. A total of 127 eyes that received intravitreal aflibercept monotherapy between January 2017 and December 2018 in our Retina Unit were enrolled. Demographics and the results of their initial and all follow-up ophthalmo-logic examinations as well as the number and frequency of intravitreal shots were noted for each participant. Chi-square, Mann–Whitney U, and Wilcoxon signed-rank tests were used for statistical analysis.
RESULTS: Of the total 75 patients with a mean age of 61.2±10.4 years, 38 (50.7%) were male. Mean follow-up period was 10.2±6.3 months. Mean baseline best-corrected visual acuity and central macular thickness scores were 56.8±19.9 ETDRS let-ters and 397.8±162.4 μm, whereas they were found as 67.9±16.9 ETDRS letters and 311.0±116.8 μm at the last visit (p<0.001 and p<0.001, respectively). Aflibercept monotherapy was found to provide better anatomic prognosis in eyes with serous macular detachment (p<0.001), and better anatomic as well as functional prognosis in eyes without any concomitant vitre-omacular interface disorders (p=0.037 and p=0.042, respectively).
CONCLUSION: Intravitreal aflibercept monotherapy proves to be an effective and reliable treatment option in treatment-naive DME cases, even in those with marked optical coherence tomography biomarkers indicating poor outcomes.

4.Effect of intravitreal dexamethasone implant (Ozurdex®) injections on corneal biomechanical properties measured using ocular response analyzer
Ilayda Korkmaz, Cumali Degirmenci, Cezmi Akkin, Melis Palamar, Serhad Nalcaci, Filiz Afrashi
doi: 10.14744/eer.2022.86580  Pages 7 - 11
PURPOSE: The purpose of the study was to evaluate Ocular Response Analyzer (ORA) measurements and endothelial cell density (ECD) in patients who received intravitreal dexamethasone implant (Ozurdex®) injection for diabetic macular edema.
METHODS: Twenty-three eyes of 13 patients who receive intravitreal dexamethasone implant injection (Group 1) for diabetic macular edema and 33 eyes of 33 healthy individuals (Group 2) were included in the study. All participants underwent a complete ophthalmologic examination including intraocular pressure measurement with Goldmann applanation tonome-ter (IOP-GAT), ORA measurements, and specular microscopy.
RESULTS: The mean age of the patients was 65.43±8.20 (49–75) in Group 1 and 61.94±4.52 (56–71) in Group 2 (p=0.114). The mean IOP-GAT was significantly higher in Group 1 (18.22±3.41; range 12–28 mmHg) than in Group 2 (15.41±3.07; range 8–21 mmHg) (p=0.02). The mean ECD was 2632.4±209.6 (2232–3067) cell/mm2 in Group 1 and 2567±206.37 (2140–2854) cell/mm2 in Group 2 (p=0.60). The mean corneal resistance factor (CRF) was 12.16±2.35 (7.4–15.3) mmHg in Group 1 and 10.18±1.83 (6.7–14.2) mmHg in Group 2 (p=0.02). Mean corneal hysteresis (CH) in Groups 1 and 2 was 8.87±2.45 (4.1–13.4) mmHg and 10.47±1.43 (6.9–13.2) mmHg, respectively (p=0.001). Mean corneal compensated IOP and Goldman correlated IOP (IOPg) were higher in Group 1 (24.72±7.12; range 12.1–36.4 mmHg and 23.21±7.01; range 14.2–36.2 mmHg) than in Group 2 (14.95±3.6; range 8.3–22.9 mmHg and 14.33±3.84; range 6.3–21.7 mmHg) (p<0.001). IOP-GAT was correlated with IOPg (p=0.01).
CONCLUSION: Intravitreal Ozurdex® injection effects IOP, while it has no significant effect on ECD. Ozurdex® injections changed corneal biomechanical properties such as CH and CRF. Thus, ORA may be a useful to avoid underestimating the IOP and missing the alteration of elastic properties of the cornea.

5.Evaluation of dry eye in eyes with unilateral pterygium
Pelin Kiyat, Omer Karti
doi: 10.14744/eer.2023.74946  Pages 12 - 15
PURPOSE: The purpose of this study was to determine if eyes with unilateral pterygium are more likely to suffer from dry eye symptoms and more prone to have abnormalities in dry eye parameters than healthy eyes.

METHODS: Forty eyes of 20 patients were enrolled. The eyes that were diagnosed as having pterygium were considered as Group 1 and other healthy eyes of the same patients were defined as Group 2. The existence of dry eye was tested with tear film break-up time, Schirmer-1 test, Oxford scale, and Ocular Surface Disease Index (OSDI) score assessments.

RESULTS: Median tear film break-up-time measurement and Schirmer 1 value were lower in Group 1; however, no statistically significant difference was detected (p=0.06 and p=0.308, respectively). Median OSDI score and median Oxford scale score were higher in Group 1; however, no statistically significant difference was detected (p=0.05 and p=0.250, respectively).
CONCLUSION: Between eyes with pterygium and healthy ones, there was difference in dry eye test results. These results may show that there might be a relationship between pterygium and dry eye disease regardless of the genetic background and environmental factors.

6.Evaluation of the relationship between dry eye and cataract surgery
Pelin Kiyat, Omer Karti
doi: 10.14744/eer.2022.06078  Pages 16 - 19
PURPOSE: This study’s aim is to evaluate the presence of dry eye in patients who had cataract surgery in the past 3 months and compare the results with the patients’ healthy eyes.
METHODS: Twenty patients were enrolled and both eyes were examined. Two groups were established, Group 1 was made up of eyes that had cataract surgery in the past 3 months and Group 2 of eyes that had not undergone the intervention. Dry eye presence was tested with tear film break-up time, Schirmer-1 test, Oxford scale, and Ocular Surface Disease Index (OSDI) score assessments.

RESULTS: Median tear film break up-time measurement was lower and the difference was statistically significant (p=0.037). Median OSDI and Oxford scale scores were higher in Group 1 and median Schirmer 1 value was lower in Group 1; however, no statistically significant difference was detected (p=0.063, p=0.545, and p=0.825, respectively).
CONCLUSION: Between eyes with prior cataract surgery and those without, there were significant differences in the results of dry eye tests. We advise ophthalmologists to be aware that cataract surgery can trigger the development of dryness of the ocular surface and when any pathology detected on ocular surface after the surgery, it should not be neglected to prevent more serious consequences and to maintain ocular surface homeostasis.

7.Change in brow position following upper blepharoplasty in patients with dermatochalasis coexisting only cosmetic complaint
Emrah Mat
doi: 10.14744/eer.202.18189  Pages 20 - 25
PURPOSE: Study aims to assess the effect of pure blepharoplasty on the eyebrow position in patients with Grade 1 lateral dermatochalasis causing cosmetic complaints.
METHODS: This retrospective study includes patients undergoing upper eyelid blepharoplasty between December 2019 and November 2021. Patients with prior eyebrow or eyelid surgery and neurotoxins treatment were excluded from the study. Photographs were investigated using NIH ImageJ program to measure eyebrow position from medial canthus, mid pupillary level, and lateral canthus measured before and 6 months after the operation.
RESULTS: The mean pre-operative distance between the pupillary light reflex and the lowest eyebrow hair was 16.95 mm, and the mean post-operative height was 16.79 mm. This difference was not statistically significant (P=0.29). The mean pre-opera-tive lateral canthus to the lowest eyebrow hair (LBH) was 17.75 mm, and the mean post-operative height was 17.60 mm. This difference was not statistically significant (P=0.18). The mean pre-operative medial canthus to the LBH was 18.72 mm, and the mean post-operative height was 18.59 mm. This difference was not statistically significant (P=0.24).

CONCLUSION: The present study represents that the position of the eyebrow may not be influenced significantly following a blepharoplasty procedure among female patients with Grade 1 lateral dermatochalasis and coexisting cosmetic complaints.

8.Orbital rhabdomyosarcoma: Review
Ilayda Korkmaz, Banu Yaman, Naim Ceylan, Mehmet Kantar, Serra Kamer, Melis Palamar
doi: 10.14744/eer.2022.02996  Pages 26 - 31
Orbital rhabdomyosarcoma is the most common malignant orbital tumor of childhood originating from mesenchymal cells. The presenting symptom is usually acute onset unilateral proptosis. The rapidly progressive course of the findings may resemble infectious and inflammatory orbital diseases. Radiological imaging and histopathological examinations are crucial for differential diagnosis. The main goal of treatment with a multidisciplinary approach is to control both local and distant spread of the tumor and to prevent further damage. With the introduction of chemotherapy and radiotherapy in the treatment, the overall survival rate has in-creased. Thus, aggressive surgical approach for complete removal of the tumor has been abandoned.

9.Long-term management of gelatinous droplet dystrophy with phototherapeutic keratectomy and toric soft contact lenses
Zeynep Ozbek, Betul Akbulut Yagci, Bora Yuksel, Ismet Durak
doi: 10.14744/eer.2022.18209  Pages 32 - 35
The aim of the study was to report the results of phototherapeutic keratectomy (PTK) and toric contact lens fitting for a young man with recurrent gelatinous droplet dystrophy (GDD) after penetrating keratoplasty (PK). A 21-year-old man was referred for pain, photophobia, and decreased vision. The patient who experienced decreasing vision for 15 years had under-gone PK 2 years ago due to GDD. He was having frequent recurrent epithelial erosions lately. Visual acuity (VA) was counting fingers at 3 m in the right eye and 0.8 in the left eye. Biomicroscopic examiantion revealed nodular dystrophic lesions on the nasal side of the graft in the right eye. Keratometric values were K1: 54.5, K2: 52.5 in the right eye and K1: 41.2, K2: 39.7 in the left eye. PTK was performed twice in the right eye and once in the left eye in 3 years. Final VA was 0.5 and 0.8 in the right and left eyes, respectively (with glasses and toric contact lenses) during 10 years of follow-up. A superficial corneal scar was noted on the right graft and the left cornea. No recurrence of dystrophy was observed. PTK decreases photophobia and provides visual improvement in patients with GDD and may help defer PK in case of recurrent GDD.

10.Giant cell arteritis presenting with isolated cotton wool spots: a case report
Betul Akbulut Yagci, Aylin Yaman, Banu Lebe, Meltem Soylev Bajin, Ali Osman Saatci
doi: 10.14744/eer.2023.29494  Pages 36 - 40
This case aims to report a patient who presented with reduced vision in her left eye and was diagnosed with giant cell ar-teritis (GCA) associated with isolated cotton wool spots (CWS). An 82-year-old woman presented with reduced visual acuity of 20/200 in her left eye for a day. Fundus examination revealed only multiple peripapillary CWS in the left eye. She had an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). A preliminary diagnosis of temporal arteritis, intravenous high-dose steroid therapy, was administered for 3 days. Then, the systemic symptoms resolved, and her ESR and CRP dropped. Temporal artery biopsy confirmed the diagnosis of GCA. The next 2 months, in the fundus examination, CWS resolved completely. The patient continued using systemic steroids and subcutaneous methotrexate with long-term gradual reduction. This extreme case should raise awareness for clinicians in the etiological investigation of CWS to identify sight-threatening GCA and promptly initiate appropriate treatment.

11.Double neovascularization in the same eye with pachychoroid neovasculopathy: one exudative and the other non-exudative
Muhammed Altinisik, Selin Deniz Oruc, Mustafa Erdogan
doi: 10.14744/eer.2023.80774  Pages 41 - 45
Pachychoroid neovasculopathy (PNV) is a pachychoroid spectrum disease characterized by macular neovascularization (MNV), dilated outer choroidal vessels (pachyvessels), and/or increased choroidal thickness. In PNV cases, optical coherence tomography angiography (OCTA) can reveal MNV with high resolution. A 65-year-old male patient was admitted to our clinic with the complaint of decreased vision in the right eye. On dilated fundus examination, retinal pigment epithelium changes were present in the foveal and extrafoveal areas in both eyes. There was subretinal fluid in the fovea and irregular pigment epithelial detachment in the right eye. Subfoveal MNV was detected in 3 × 3 mm sections of OCTA. A non-exudative MNV was also detected in a larger 6 × 6 mm area imaged with OCTA. Simultaneous non-exudative quiescent MNV in the extrafo-veal region of the same eye can be observed. To avoid missing those cases, it is critical to perform OCTA imaging sections, including the extrafoveal areas.