Turkish Journal of Ophthalmology最新文献

Jeune syndrome (JS), first described by Jeune as asphyxiating thoracic dystrophy, is an autosomal recessive osteochondrodysplasia with characteristic skeletal abnormalities and variable renal, hepatic, pancreatic, and ocular complications. Approximately 1 in every 100,000 to 130,000 babies is born with JS. Most patients with JS have respiratory distress due to inadequate lung development and many lose their lives due to respiratory failure. Those who survive have serious comorbidities. In terms of ophthalmological diseases, JS is classified among the hereditary syndromic retinopathies. Most, if not all, hereditary syndromic retinopathies can be analyzed in two main groups: inherited metabolic diseases and ciliopathies. The main cause of ocular pathologies in JS is genetic mutations in ciliary proteins that prevent normal function of retinal photoreceptor cells. Here we describe a patient with JS who presented with the complaint of night blindness. Although Snellen visual acuity was 20/20, the patient's visual function was severely impaired due to photoreceptor dysfunction caused by ciliopathy secondary to the genetic mutation. This case shows that in patients with syndromic comorbidities accompanying nyctalopia, even those with perfect visual acuity, hereditary retinal dystrophies should be considered and asphyxiating thoracic dystrophy (JS) included in the differential diagnosis. Multimodal retinal imaging, including structural and functional assessments, should be used for the diagnosis and genetic counselling should also be provided.

We present the case of a patient who came to the emergency department with a significant decrease in vision and dilated pupil in the left eye. Since neurological pathologies were primarily considered, diffusion brain magnetic resonance imaging (MRI) and brain computed tomography (CT) were requested. After the results were reported as normal, we were consulted. On examination, the anterior segment was normal but we detected shiny pearl-like formations in the anterior vitreous, condensation at the inferior of the posterior vitreous, and a scar in the macula. When we evaluated the orbital section of the current brain CT, we detected an intraocular foreign body (IOFB). On the brain MRI, we saw a large artifact that obscured the left orbit and surrounding anatomical structures. When we questioned again, we learned that he had been admitted to another emergency department two months prior due to an object hitting his left eye, where the eye was only washed with saline. Our case emphasizes that ocular siderosis caused by IOFBs should be kept in mind in the differential diagnosis of anisocoria, especially before MRI. Because metallic objects may move during MRI, undiagnosed IOFBs can cause serious ocular side effects.

Objectives: To evaluate the clinical features of pediatric non-infectious uveitis (NIU) patients treated with adalimumab (ADA) and the efficacy of ADA in patients unresponsive to conventional immunosuppressive therapy.

Materials and methods: The records of 91 NIU patients aged ≤16 years who received ADA therapy were evaluated retrospectively. The patients' demographic and clinical characteristics and treatment approaches were recorded. The efficacy of ADA in patients treated for at least 1 year after failure of conventional immunosuppressive treatment was evaluated by comparing the best corrected visual acuity (BCVA), severity of intraocular inflammation, uveitis flare-ups, topical and systemic corticosteroid (CS) use, and central macular thickness (CMT) values before and after ADA treatment.

Results: The study included 103 eyes of 53 patients, of whom 29 (54.7%) were female. The mean age at presentation was 8.2±3.4 (range: 3-16) years. The mean follow-up period was 41.6±28.2 (range: 18-120) months. Twenty-six patients (49.0%) had anterior uveitis, 22 (41.5%) had intermediate uveitis, and 5 (9.4%) had panuveitis. The mean duration of ADA treatment was 23.0±13.7 (range: 12-60) months. Uveitis flare-ups developed in only 13 patients (24.5%) while on ADA treatment. When pre- and post-treatment periods were compared, the mean number of uveitis flare-ups, intraocular inflammation severity, mean dose of topical and systemic CS, and mean CMT values were significantly lower in the post-treatment period (p<0.05). The mean BCVA was significantly improved after 6 and 12 months of ADA treatment compared to the pre-treatment visual acuity (p<0.05).

Conclusion: ADA effectively controlled intraocular inflammation, reducing the need for systemic and topical CS and improving visual outcomes in pediatric NIU.

Objectives: To assess the appropriateness and readability of large language model (LLM) chatbots' answers to frequently asked questions about refractive surgery.

Materials and methods: Four commonly used LLM chatbots were asked 40 questions frequently asked by patients about refractive surgery. The appropriateness of the answers was evaluated by 2 experienced refractive surgeons. Readability was evaluated with 5 different indexes.

Results: Based on the responses generated by the LLM chatbots, 45% (n=18) of the answers given by ChatGPT 3.5 were correct, while this rate was 52.5% (n=21) for ChatGPT 4.0, 87.5% (n=35) for Gemini, and 60% (n=24) for Copilot. In terms of readability, it was observed that all LLM chatbots were very difficult to read and required a university degree.

Conclusion: These LLM chatbots, which are finding a place in our daily lives, can occasionally provide inappropriate answers. Although all were difficult to read, Gemini was the most successful LLM chatbot in terms of generating appropriate answers and was relatively better in terms of readability.

Objectives: To compare the efficacy of two different silicone hydrogel bandage contact lenses (BCLs) in terms of visual rehabilitation and ocular discomfort following photorefractive keratectomy (PRK).

Materials and methods: This prospective study included 60 eyes of 30 patients who underwent bilateral PRK surgery to correct myopia and/or astigmatism refractive errors. Following surgery, lotrafilcon A BCLs were applied to the right eye and senofilcon A BCLs were applied to the left eye. When the BCLs were removed on postoperative day 5, subjective ocular symptoms of discomfort were evaluated on a scale of 0 to 10, where 0 indicated no discomfort and 10 indicated maximum discomfort. The postoperative spherical equivalents (SE) of both eyes were compared at 15 days and 1 month. Postoperative SE ≤ ±0.50 diopters was accepted as emmetropia. The number of patients who achieved emmetropia was also compared at 15 days and 1 month postoperatively.

Results: Scores for ocular discomfort in the first 5 days postoperatively did not differ significantly between the BCLs (p>0.05). However, a statistically significant difference was observed between the two lenses in terms of SE values at postoperative 15 days and 1 month (p<0.05). Eyes fitted with the senofilcon A BCL demonstrated better postoperative visual rehabilitation.

Conclusion: Although post-PRK ocular discomfort scores did not differ significantly between the two BCLs, the senofilcon A lenses performed better in terms of achieving the target SE postoperatively.

Objectives: This study aimed to examine the publication rates of abstracts related to oculoplastic surgery and orbital diseases presented at the Turkish Ophthalmological Association National Congresses (TOA-NCs) in 2013-2022.

Materials and methods: The study included abstracts in the field of oculoplastic surgery and orbital diseases accepted for presentation at TOA-NCs between 2013 and 2022. These abstracts were reviewed in terms of presentation type (oral, poster), number of authors, study setting (university, training and research, private, public, or abroad hospital), study type (case, clinical, or basic science), study topic (eyelid, lacrimal system, orbit, or thyroid eye disease), journal publication status, time to publication (months), publishing journal (national, international), and journal impact factor.

Results: A total of 802 presentations (233 [29.1%] oral, 569 [70.9%] poster) were included in the study. Of these, 122 abstracts (15.2%) were published (56 [45.9%] oral, 66 [54.1%] poster presentations). The publication rate for oral presentations was higher than for poster presentations (24.0% vs. 11.6%, p<0.05). The median publication time and journal impact factor were 18 months (range, 1-88) and 1.3 (range, 0.1-5.17), respectively. Case abstracts had a publication rate of 6.3%, while clinical studies had a higher rate of 21.8% (p<0.05). Publication time was negatively correlated with journal impact factor (r=-0.211, p=0.039).

Conclusion: The 10-year publication rate (15.2%) of abstracts presented in the field of oculoplastic surgery and orbit at TOA-NCs was found to be lower than that of other international ophthalmology meetings. It is noteworthy that the publication rate of oral abstracts and clinical studies was significantly higher. To enhance the scientific publication potential in Türkiye, which has many active ophthalmologists and ophthalmology clinics, it would be beneficial to identify and address negative factors, support clinicians, and strengthen their connections with the basic medical sciences.

Objectives: This study compared the readability of patient education materials from the Turkish Ophthalmological Association (TOA) retinopathy of prematurity (ROP) guidelines with those generated by large language models (LLMs). The ability of GPT-4.0, GPT-4o mini, and Gemini to produce patient education materials was evaluated in terms of accuracy and comprehensiveness.

Materials and methods: Thirty questions from the TOA ROP guidelines were posed to GPT-4.0, GPT-4o mini, and Gemini. Their responses were then reformulated using the prompts "Can you revise this text to be understandable at a 6^th-grade reading level?" (P1 format) and "Can you make this text easier to understand?" (P2 format). The readability of the TOA ROP guidelines and the LLM-generated responses was analyzed using the Ateşman and Bezirci-Yılmaz formulas. Additionally, ROP specialists evaluated the comprehensiveness and accuracy of the responses.

Results: The TOA brochure was found to have a reading level above the 6^th-grade level recommended in the literature. Materials generated by GPT-4.0 and Gemini had significantly greater readability than the TOA brochure (p<0.05). Adjustments made in the P1 and P2 formats improved readability for GPT-4.0, while no significant change was observed for GPT-4o mini and Gemini. GPT-4.0 had the highest scores for accuracy and comprehensiveness, while Gemini had the lowest.

Conclusion: GPT-4.0 appeared to have greater potential for generating more readable, accurate, and comprehensive patient education materials. However, when integrating LLMs into the healthcare field, regional medical differences and the accuracy of the provided information must be carefully assessed.

Cataract surgery is the most frequently performed surgery worldwide. Although it is an effective surgical treatment option for improving patients' visual acuity, various complications can occur postoperatively. One such complication is the presence of retained lens material in the anterior chamber, which can lead to intraocular inflammation, increased intraocular pressure, corneal edema, and endothelial cell loss. Treatment options include observation and surgical removal of the retained lens material. Another notable treatment option is the use of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser to fragment the retained lens material. In this paper, we aim to present two cases from our clinic where Nd:YAG laser treatment was applied to patients with retained small lens fragments in the anterior chamber following cataract surgery. It was observed that in both patients, the retained lens fragments were resorbed by the first day after Nd:YAG laser treatment, and no complications developed.