ISSN 2757-8135 | E-ISSN 2757-9816
Volume: 3  Issue: 2 - August 2023

Page I


Pages II - XIII

3.Evaluation of lacrimal punctum and tear meniscus in dry eye syndrome: a comparative spectral domain OCT study
Murat Kasikci, Özgür Erogul, Hamidu Hamisi Gobeka, Cansu Kaya
doi: 10.14744/eer.2023.72792  Pages 47 - 54
PURPOSE: The aim of the study was to evaluate lacrimal punctum and tear meniscus using anterior segment-optical coherence tomography (AS-OCT), and compare the results among dry eye syndrome (DES) patients with aqueous deficient dry eye (ADDE) and evaporative dry eye (EDE) subtypes, and healthy individuals.
METHODS: We included 62 eyes of 31 ADDE subtype DES patients (Group 1), 62 eyes of 31 EDE subtype DES patients (Group 2), and 62 eyes of 31 healthy individuals (Group 3). All participants underwent a thorough ophthalmic examination, including a non-anesthetic Schirmer test for DES confirmation and detailed assessment of the cornea, as well as the conjunctiva, globe, and tear film for increased reflex secretion. The lacrimal punctum and tear meniscus were then measured using a spectral domain OCT system with high-resolution scanning software.
RESULTS: Mean ages in Groups 1, 2, and 3 were 49.06±11.24, 46.74±11.68, and 45.48±9.17 years, respectively, (P=0.420). DES patients had significantly lower non-anesthetic Schirmer test (P<0.001), outer punctal diameter (P=0.012), punctal depth (PD) (P<0.001), tear well depth (P<0.001), and punctal reserve (P<0.001) than Group 3. Group 1 had significantly lower Schirmer test (P<0.001), PD (P=0.005), and tear well depth (P=0.003) than Group 2. Tear meniscus height (P=0.463), area (P=0.891), and angle (P=0.266) did not differ significantly among groups, nor did IOP (P>0.05).
CONCLUSION: AS-OCT could potentially be a useful optical diagnostic technique for in vivo lacrimal punctum microstructural and tear meniscus quantitative evaluation. It could also enable DES classification, leading to a better understanding of the underlying pathology and the avoidance of unnecessary tear drops.

4.Evaluation of existence of depression or anxiety symptoms in patients with bilateral cataract
Pelin Kiyat, Omer Karti, Osman Hasan Tahsin Kilic
doi: 10.14744/eer.2023.46855  Pages 55 - 59
PURPOSE: The purpose of this study was to evaluate if patients with bilateral cataract are more likely to have depression or anxiety symptoms when compared to age- and sex-matched volunteers who had already undergone bilateral uncomplicated cataract surgery in both eyes.
METHODS: Twenty patients who were diagnosed to have senile cataract in both eyes were included in the study. Furthermore, twenty volunteers who had already undergone bilateral uncomplicated cataract surgery were included. Patients with bilateral cataract were defined as “Group 1,” and volunteers with bilateral artificial monofocal intraocular lenses in the posterior chamber were defined as “Group 2.” Both Group 1 and Group 2 completed the “Hospital Anxiety and Depression Scale (HADS)” questionnaire. The scale was used to determine the anxiety and depression symptoms.
RESULTS: According to the HAD scale, in Group 1, 6 patients were detected as having mild depression symptoms, 2 moderate, and 6 severe. Furthermore, in Group 1, 5 patients were detected as having mild anxiety symptoms, 2 moderate, and 4 severe. In Group 1, high HAD scale scores were detected, which suggests a propensity toward depression and anxiety when compared to Group 2 (P=0.007, P<0.001, respectively).
CONCLUSION: In our study, in patients diagnosed with bilateral senile cataract, high scores were detected with the HAD scale. Ophthalmologists should be familiar with the possibility of tendency of senile cataract patients to depression or anxiety and consider screening these patients for these symptoms and consider referring for counseling. Furthermore, psychiatrists could ask their patients about their visual acuity condition and refer them to an ophthalmologist to plan a timely surgery for cataract.

5.Comparison of post-operative outcomes and patient-surgeon satisfaction with a needle-tipped electrocautery incision and a cold scalpel incision in upper eyelid blepharoplasty: Cohort study
Ali Altan Ertan Boz, Mahmut Atum
doi: 10.14744/eer.2023.28291  Pages 60 - 66
PURPOSE: The objective of the study is to compare post-operative outcomes and patient-surgeon satisfaction between a needle-tipped electrocautery incision and a cold scalpel incision in upper eyelid blepharoplasty
METHODS: The data from 247 patients who underwent bilateral upper eyelid blepharoplasty were retrospectively analyzed. Patients who underwent upper eyelid blepharoplasty with ptosis surgery or fat pad removal were excluded. The patients were divided into 2 groups, Group 1 - needle-tipped electrocautery incision and Group 2 - a cold scalpel incision. Pre-operative skin types of the patients, perioperative hemorrhage, and surgical time were observed. Post-operative ecchymosis on days 1 and 7 and scar cosmesis at months 1 and 6 were evaluated. Patients were asked about the level of satisfaction at 6 months.
RESULTS: One hundred and fifty-five patients, 75 patients in Group 1 and 80 patients in Group 2, were included in the study. No statistical differences were detected between the two groups for age, sex, and skin type. No serious complications were recorded. For surgeon satisfaction, surgical time and hemorrhage amount were statistically significantly lower in Group 1. Post-operative ecchymosis on days 1 and 7, scar cosmesis at months 1 and 6, and patient satisfaction at 6 months, the scores were similar between the groups.
CONCLUSION: The clinical difference between needle-tipped electrocautery and cold scalpel incision was not observed after upper eyelid blepharoplasty. Needle-tipped electrocautery should be used conveniently and reliably for skin incisions in upper eyelid blepharoplasty for good cosmetic results.

6.Comparison of clinical parameters in patients with cataract surgery during and before COVID-19 pandemic
Gulce Gokgoz Ozisik, Selim Cevher, Mehmet Baris Ucer
doi: 10.14744/eer.2023.46036  Pages 67 - 72
PURPOSE: The purpose of this study was to compare the clinical features of pre-pandemic and pandemic patients who had elective cataract surgery in our hospital.
METHODS: This study is a retrospective study. Cataract surgeries performed in our clinic between March 2019 and June 2021 were screened. Patient’s age, gender, eye laterality, cataract type, preoperatively best-corrected visual acuity (BCVA) in the eye with a cataract, pseudoexfoliation, and other compelling factors for surgery were noted. Considering that there was no elective cataract surgery in our hospital between March 2020 and June 2020 due to the COVID-19 pandemic, 1-year data before March 2020 and 1-year data after June 2020 were included in the study. Patient data from these two periods were compared with each other.
RESULTS: The pre-pandemic and pandemic groups had 560 eyes of 489 patients and 590 eyes of 534 patients, respectively. The patients in the pre-pandemic group were significantly older than those in the pandemic group (69 vs. 67 years, P=0.046). The mean BCVA differs according to the groups (0.163±0.148 vs. 0.130±0.132) (P<0.001). The rate of blindness was signif-icantly higher in the pandemic group than in the pre-pandemic group (39.3% vs. 31.4, P=0.006). There was no difference in the number of brown/mature cataracts between the two periods (P: 0.629). Diabetic retinopathy was significantly lower during the pandemic period. The number of traumatic cataracts increased substantially during the pandemic.
CONCLUSION: We encountered cataract patients with lower pre-operative best-corrected visual acuity during the pandemic.

7.Is the site of hemorrhage an indicator of the cause of hemorrhage in cases with non-traumatic subconjunctival hemorrhage?
Hakan Ozturk, Bediz Ozen
doi: 10.14744/eer.2023.84803  Pages 73 - 78
PURPOSE: To our knowledge, no study has so far assessed in detail the relationships between subconjunctival hemorrhage (SCH) sites and SCH causes in patients with non-traumatic SCH (NTSCH). Therefore, in this study, we aimed to investigate comprehensively these relationships.
METHODS: Four-hundred nineteen cases were included. SCH sites were classified as superior (n = 109), nasal (n = 114), tempo-ral (n = 84), and inferior (n = 112) areas. Etiological factors associated with NTSCH were determined as hypertension, diabetes mellitus, coagulation system disorders, conditions causing sudden venous congestion (CCSVC), and idiopathy. Relationships between SCH sites and causes were analyzed. In addition, evaluations were made according to age (≤60 and >60 years).
RESULTS: In cases aged ≤60 years, nasal site hemorrhage was more frequent than temporal (35.0% vs. 21.7%, P = 0.016) and inferior (35.0% vs. 15.2%, P < 0.001) site hemorrhages. In individuals aged >60 years, inferior site hemorrhage was more fre-quent than superior (39.1% vs. 23.8%, P = 0.012), nasal (39.1% vs. 18.8%, P < 0.001), and temporal (39.1% vs. 18.3%, P < 0.001) site hemorrhages. In cases aged ≤60 years, etiological factors were seen with similar frequency in superior, temporal, and infe-rior site involvements (P > 0.05), while hemorrhage in nasal site was most frequently associated with CCSVC (46.1%, P < 0.01). In individuals aged >60 years, etiological factors were observed with similar frequency in superior, nasal, and temporal site involvements (P > 0.05), while hemorrhage in inferior site was most frequently associated with hypertension (48.1%, P < 0.02).
CONCLUSION: We determined that nasal NTSCH was most frequently associated with CCSVC in cases aged ≤60 years, while inferior NTSCH was most frequently associated with hypertension in individuals aged >60 years.

8.Current concepts in pachychoroid spectrum diseases: insights into the pathophysiology
Sibel Demirel, Ozge Yanık, Gokcen Ozcan, Figen Batioglu, Emin Ozmert
doi: 10.14744/eer.2023.70783  Pages 79 - 90
The pachychoroid spectrum defines a group of diseases in which focal or diffuse thickness increase in the choroid layer is accompanied by dilated outer choroidal vessels and structural changes in the inner choroidal layers associated with it. This spectrum of diseases includes pachychoroid pigment epitheliopathy, central serous chorioretinopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy, focal choroidal excavation, peripapillary pachychoroid syndrome, and pachydrusen. Although these diseases have similar pachychoroid features, they have different clinical prognosis, ranging from a completely asymptomatic course to a very resistant clinical situation. The aim of this review is to summarize the current definition, underlying etiopathogenesis, examination findings, imaging features, differential diagnoses, and treatment approaches in light of current literature.

9.Harpoon technique for the management of dropped nucleus
Salih Sertac Azarsiz, Erol Erkan
doi: 10.14744/eer.2023.68077  Pages 91 - 93
Cataract extraction has various complications but dropped lens material should be properly managed to prevent further complications and visual impairment. We describe a cost-effective technique to deal with dropped nucleus using 26G IV cannula as a harpoon to fixate the lens. After performing complete standard vitrectomy, 26G IV cannula is inserted into the lens material and elevated up to anterior chamber for safe removal with phacoemulsification. Out technique is cost-effective and provides the maximum preventive measures for possible retinal damage and safe removal of the lens material.

10.Should all macular edema be treated with intravitreal injection? Importance of fundus fluorescein angiography in macular edema
Almila Sarigul Sezenoz, Sirel Gur Gungor, Sena Esra Gunay
doi: 10.14744/eer.2023.94695  Pages 94 - 100
Macular edema (ME) is a common entity that can accompany a wide range of diseases. Diagnosing the underlying cause of ME is therefore of great importance. We present two cases of persistent ME. The first patient was a 43-year-old female and the other was a 31-year-old male. Both patients were diagnosed with ME before applying to our clinic and were treated with intravitreal anti-VEGF injections. Detailed examination revealed vitritis and fundus fluorescein angiography showed vasculitic leakage in both patients. The patients were diagnosed as uveitic ME and treated accordingly. Moreover, the second patient was diagnosed with Behçet’s disease in a very short time. Multimodal imaging and detailed examination are crucial in handling of patients with ME. Especially in young patients, uveitis and vasculitis should be suspected.