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

Page I

2.Front Matters

Pages II - V

3.Investigation of the effects of intracameral carbachol on oxidative stress and apoptosis in rat corneas
Omer Faruk Yilmaz, Ali Akal, Ufuk Ozkan, Sezen Kocarslan, Nurten Aksoy
doi: 10.14744/eer.2023.03016  Pages 101 - 107
PURPOSE: Our study aims to investigate the effects of intracameral carbachol on oxidative stress and apoptosis in rat corneas.
METHODS: In this experimental study, 28 Wistar albino male rats were used. There were 9 rats in the carbachol group, 9 in the balanced salt solution (BSS) group, and 10 in the sham group. The carbachol group was injected with 0.01 cc of carba-chol, and 0.01 cc of BSS was injected intracamerally into the BSS group. No drug was injected into the sham group, but the anterior chamber was entered with an empty syringe. Blood serum samples and corneas of rats were taken 1 week later. Caspase-3 and caspase-8 were immunohistochemically examined in rat corneal endothelial to investigate apoptosis. To determine oxidative stress in corneal endothelial tissue and serum, total antioxidant status (TAS), total oxidant stress (TOS), oxidative stress index (OSI), arylesterase (ARES), and paraoxonase (PON) levels were measured.
RESULTS: The mean OSI values in the rat serum of the carbachol group were significantly lower than those of the sham and BSS groups (P = 0.05 and P = 0.004, respectively). The mean TOS value of the carbachol group’s rat serum was significantly lower than the mean of the BSS group (P = 0.001). There was no significant difference in the mean TAS, TOS, OSI, ARES, and PON levels from the rat cornea of the carbachol, BSS, and sham groups (P > 0.05). All corneas in the carbachol group were caspase-3 negative, and a statistically significant difference was found among the sham, BSS, and carbachol groups (P = 0.002). No significant difference was observed among the sham, BSS, and carbachol corneas in caspase-8 staining (P = 0.094).
CONCLUSION: Our study demonstrates that intracameral carbachol is a safe intracameral drug. Carbachol reduced oxidative stress in rat serum compared to rats injected with BSS and the sham group. In addition, carbachol did not increase oxidative stress in rat corneas compared to the BSS and sham groups. Similarly, immunohistochemical examination showed that car-bachol did not increase apoptosis in rat corneas and had a protective effect.

4.Association between health insurance membership and cataract surgery utilization: A systematic review and meta-analysis
Farisa Shauma Fachir, Syamsul Arifin, Silvia KristantiTri Febriana, Tenri Ashari Wanahari
doi: 10.14744/eer.2023.36035  Pages 108 - 113
PURPOSE: The purpose of this study is to determine the association between health insurance and the use of cataract surgical services.
METHODS: We conducted a systematic review and meta-analysis according to preferred reporting items for systematic review and meta-analysis guidelines. A literature search was performed on PubMed and ProQuest databases, screening all related articles in the past 10 years (2012–2022). Data were analyzed using RevMan 5.3 software, with pooled effect estimates re-ported as an odds ratio (OR) with a 95% confidence interval (CI).
RESULTS: A total of seven observational studies with a total of 27,054 patients with cataracts were identified and included in the meta-analysis. The pooling results of these studies suggest that there is a statistically significant association between health insurance membership and cataract surgery utilization. Those who have health insurance are 1.28 times more likely to use cataract surgical services (OR 1.28, 95% CI 1.18–1.39, P < 0.00001).
CONCLUSION: There is an association between health insurance membership and cataract surgery utilization. These results can guide focused interventions aimed at enhancing cataract surgery coverage.

5.Distribution of intraocular pressure and central corneal thickness by age and gender: a population-based study
Saadet Gültekin Irgat, Nilgun Yildirim
doi: 10.14744/eer.2023.09709  Pages 114 - 121
PURPOSE: The aim of the study was to examine the distribution of intraocular pressure (IOP) and central corneal thickness (CCT) by age and gender in the Turkish population.
METHODS: In this population-based cross-sectional study, 3556 patients aged 40 years and older in Eskişehir were examined. Demographic, systemic, and eye health questions were asked of all subjects. IOP was measured with a Tono-Pen and a CCT ultrasound pachymeter. Statistical significance was accepted as P < 0.05.
RESULTS: The mean age of the study was 56.86 ± 10.19 and 70.6% were women. The mean IOP was 16.06 ± 3.11 mm Hg and CCT was 553.83 ± 34.34 µm. IOP correlated positively with CCT (r = 0.137; P < 0.001). Age negatively correlated with IOP and CCT (r = −0.057, P < 0.001; r = 0.037, P = 0.05). When evaluated by gender, the mean age of women was 55.99 ± 9.98 years, IOP was 16.21 ± 3.10 mm Hg, and CCT was 552.44 ± 33.90 µm, whereas these values were 58.98 ± 10.41 years, 15.68 ± 3.11 mm Hg, and 557.17 ± 35.17 µm in men (P < 0.001 for each parameter). Multiple regression analysis revealed a significant correlation between IOP and CCT (unstandardized regression coefficient B = 0.013/µm, P < 0.001), age (B = –0.013/year, P < 0.05), and gender (B = 0.551, P < 0.001). CCT proved to be the independent variable with the greatest influence on IOP (standardized regression coefficient beta: 0.141, R2 = 0.028; F = 34.067; P = 0.000).
CONCLUSION: In our study, IOP and CCT decreased with age in both genders. IOP was found to be positively correlated with CCT and female gender and negatively correlated with age, and CCT was the key variable for IOP.

6.Binocular function and stereopsis in neovascular age-related macular degeneration
Nur Demir, Belma Kayhan, Sukru Sevincli, Murat Sonmez
doi: 10.14744/eer.2023.30974  Pages 122 - 126
PURPOSE: A macular lesion preventing the foveal fixation could lead to the fixation from eccentric points in age-related macular degeneration (AMD). There is a lack of knowledge about the binocular function of these patients and the role of preferred retinal locus loci in binocularity. This study aims to examine binocular fusion and stereopsis in a unique group of patients who have unilateral choroidal neovascular membrane (CNVM) involving the fovea.
METHODS: Twenty-five patients with the diagnosis of the CNVM in one eye and type I or type II drusen in the other eye were examined. The Bagolini test was performed to determine binocular fusion. The Stereo Butterfly test was used for stereo acu-ity determination. CNVM measurements were done with an optical coherence tomography.
RESULTS: In the Bagolini test, 12 patients saw two lines with break in one of the lines. Eleven patients saw two lines crossing at higher or lower than the center. Two patients saw only one line. One of 25 patients had gross stereopsis (2500 s of arc). The area of the CNVM was extending to the perifovea in 2 patients suppressing the other eye. In remaining 23 patients, CNVM was located in fovea or extended up to the parafovea.
CONCLUSION: Binocular fusion is possible if the CNVM lesion size and location allow usage of the fovea-parafovea visual angle. Our study results support that the binocular function of patients with neovascular AMD depends on the corresponding retinal areas and the fusional limit of non-corresponding points.

7.The assessment of refractive outcome in patients who underwent pars plana vitrectomy and intraocular lens implantation in the same session due to lens or lens fragments drop
Yucel Ozturk, Abdullah Agin, Aysun Yucel Gencoglu
doi: 10.14744/eer.2023.30074  Pages 127 - 131
PURPOSE: The objective is to reveal the results of patients who underwent pars plana vitrectomy (PPV) in the same session due to lens nucleus drop during cataract extraction and to compare the refractive results according to uncomplicated pha-coemulsification (phaco) surgery.
METHODS: The study included 26 eyes of 26 patients who underwent PPV due to lens or lens fragments drop. Preoperative and postoperative best-corrected visual acuity (BCVA), intraocular pressure, spherical equivalent, and the intraocular lens (IOL) implantation methods applied were recorded. Refractive results were compared with the spherical equivalent of 24 eyes of 19 patients who underwent uncomplicated phaco surgery.
RESULTS: Three-piece IOL was implanted in the ciliary sulcus in 20 (77%) patients, and IOL was implanted in one (4%) patient with sutureless scleral fixation using the Yamane technique. In 5 (19%) cases, the surgeries were terminated as aphakic. Preoperative BCVA was 1.3±0.5 logMAR, and postoperative BCVA was 0.29±0.4 logMAR (P<0.001 for both subgroups). Preop-erative spherical equivalent was −4±2 D, and it was −0.8±1.4 D after the operation (P<0.001). In patients with PPV and IOL implantation, the postoperative spherical equivalent was −0.8±1.4 D, and it was measured as −0.7±0.6 D in the phaco-only group (P=0.37).
CONCLUSION: It is possible to achieve optimal results in uncomplicated phaco surgery using IOL measurements calculated with appropriate biometric formulas and advanced optical biometry devices in patients who have undergone PPV due to lens nucleus drop. IOL implantation can be easily planned in the same session for patients undergoing PPV.

8.A tertiary hospital study on standard versus simplified consent forms for cataract surgery: Is there a perceptible or imperceptible influence on surgery decision-making?
Ibrahim Ethem Ay, Muberra Akdogan, Ayse Yesim Oral, Ozgur Erogul, Mustafa Dogan, Hamidu Hamisi Gobeka
doi: 10.14744/eer.2023.93063  Pages 132 - 138
PURPOSE: The aim of the study was to investigate the standard versus simplified consent forms (CFs) for cataract surgery to see if there was a difference that influenced patients’ surgery decisions.
METHODS: Four hundred patients scheduled for elective cataract surgery at a tertiary hospital between March 1, 2022, and June 30, 2022, were investigated. Patients signed the CFs on the day of surgery, either independently or with the assistance of a companion. Demographic data were collected, including age, gender, educational level, prior surgery, and whether or not they were alone.
RESULTS: The simplified CFs were far more likely to be read than the standard CFs, and the reading rate increased significantly with educational level (P < 0.001). No significant influential difference existed in the CF reading between patients reading in-dependently and those assisted by companions (P = 0.139). The simplified CFs influenced surgery-related patients’ decisions the most (P < 0.001).
CONCLUSION: In the CFs, a relatively simple, easily readable, and comprehensible language appears to have a significant per-ceptible, or at least imperceptible, influence on patients’ surgery decisions.

9.Optical coherence tomography angiography in myopic macular neovascularization
Selcuk Sizmaz, Ebru Esen, Püren Işık, Nihal Demircan
doi: 10.14744/eer.2023.95967  Pages 139 - 144
Pathologic myopia is a severe sight-threatening disorder complicated with the presence of posterior staphyloma, myopic maculopathy, or vitreomacular interface pathologies. Myopic maculopathy is the most common cause of MNV following age-related macular degeneration in the whole population. It is the most common cause of MNV in the presenile population. The diagnosis of MNV should be based on multimodal imaging. On the other hand, optical coherence tomography angiography is gaining popularity in the clinical course of patients with MNV. Its main advantage over dye angiography is the non-invasive nature. Optical coherence tomography angiography can show myopic MNV with very high sensitivity and specificity. It helps detecting the MNV under retinal hemorrhage. Since the image is not obscured by leakage, the neovascular tissue is depicted briefly with OCTA. According to the appearance, two types of myopic MNV has been described; one has a more regular structure with dense vascular hyperintensity and the other has a loose and disorganized appearance. More research is required to detect a clinical basis for these two types. Another advantage of OCTA is the ability of evaluating choriocapillaris which is supposedly takes part in the pathogenesis of myopic MNV and yet providing quantitative data on flow parameters.

10.A case of ocular toxoplasmosis presenting with neuroretinitis
Bilge Tarim, Meltem Kilic, Mualla Hamurcu
doi: 10.14744/eer.2023.44153  Pages 145 - 149
A 33-year-old female patient, who followed up in an external center with the diagnosis of optic neuritis 2 years ago, had complaints of decreased vision and headache for 1 week. In our examination, visual acuity was counting fingers from 2 m in the right eye and 1.0 in the left eye with a Snellen chart. The bilateral anterior segment was normal in the slit-lamp ex-amination. Color vision was 0/12 in the right eye and 12/12 in the left eye. In dilated fundus examination, optic nerve head edema was present in the right eye, while the optic nerve, macula, and retina of the left eye were normal. In the visual field, an inferior arcuate visual field defect was observed in the right eye. Anti-Toxoplasma immunoglobulin M resulted in 1240 IU/mL (positive) and immunoglobulin G 90.5 IU/mL (positive). Optical coherence tomography showed pigment epithelial detachment adjacent to the optic disc. Trimethoprim/sulfamethoxazole 800/160 mg 2 × 1, azithromycin 1000 mg loading, followed by 500 mg 1 × 1 (1 week) was started. On the 3rd day of the treatment, a prednisolone 1 mg/kg/day weekly reduction regimen was started. There was a macular star appearance with hard exudates in the macula with a rapid recovery with treatment. At the 6th-month follow-up, visual acuity was 0.5 in the right eye and 1.0 in the left eye, while the anterior segment slit-lamp examination was normal. In dilated fundus examination, the temporal part of the optic disc was pale and macular hard exudates were present in the right eye; and the left was normal.

11.Choroidal malignant melanoma: the importance of ultrasonography
Burak Ulas, Altan Atakan Ozcan, Saadi Aljundi, Kemal Yar
doi: 10.14744/eer.2023.82997  Pages 150 - 152
A 51-year-old Eastern Mediterranean male without known systemic medical illness referred to our clinic with a painless loss of vision for 2 months in the left eye. The diagnosis of choroidal malignant melanoma was suspected when fundus examination and ocular ultrasonography were done after the continuous deterioration in visual acuity. Orbital magnetic resonance imaging evaluation was consisted with choroidal melanoma and enucleation was performed. The post-operative histopathologic report confirmed the choroidal malignant melanoma. This report highlights the importance of B-scan ocu-lar ultrasonography in evaluating an eye with deteriorating visual complaints.