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.

This case report describes a surgical technique using double-layer human amniotic membrane (hAM) grafting to repair a high myopic macular hole (MH)-related chronic retinal detachment (RD) with subretinal bands in a child with Knobloch syndrome. A 4-year-old boy diagnosed with Knobloch syndrome presented with macular atrophy in the right eye and chronic total RD with subretinal bands associated with a myopic MH in the left eye. The surgery involved an encircling band, pars plana vitrectomy, and subretinal band extraction through a retinotomy. The retinotomy and MH were sealed using hAM with a 5000 centistoke (cS) silicone oil (SO) tamponade. RD recurred two weeks postoperatively due to hAM contracture, leading to MH reopening. A second intervention included replacing the contracted graft with two larger hAM grafts; the first positioned under the MH and the second over the MH in a sandwich configuration, with 5000 cS SO tamponade. Eighteen months after SO removal, a flat retina, closed MH, and ambulatory vision were achieved. In conclusion, double-layer hAM grafting provides a strong seal for MH in high myopia-associated RD where conventional techniques fail.

Objectives: To examine the characteristics of preoperative strabismus, the impact of surgical treatment on existing strabismus, and the features of strabismus developing postoperatively in pediatric cataract patients.

Materials and methods: The records of patients who underwent surgery for pediatric cataract and had at least 1 year of follow-up were reviewed. Preoperative strabismus types, changes in strabismus after surgery, and the characteristics of postoperative new-onset strabismus were examined.

Results: Seventy-seven pediatric cataract surgery patients were evaluated, 58 (75.3%) with congenital cataract and 19 (24.7%) with acquired cataract. The mean follow-up duration was 63 months (range: 13-185 months). Cataracts were bilateral in 39 patients and unilateral in 38 patients. Strabismus was present preoperatively in 21% of unilateral cases and 20.5% of bilateral cases. In unilateral cases, 50% had esotropia (ET) and 50% had exotropia, while in bilateral cases, these rates were 75% and 25%, respectively. Orthotropia was achieved postoperatively for at least for 1 year of follow-up in 25% of patients with preoperative deviation, all of whom had ET. Twenty-nine (47.5%) of 61 patients who had no deviation preoperatively developed strabismus postoperatively. The rate of new-onset postoperative strabismus in patients with unilateral cataract was 91.6% for those operated before 1 year of age and 38.5% in those operated after the age of 1 year (p=0.001). For bilateral cases, these rates were 50% and 22.2%, respectively (p=0.155).

Conclusion: Strabismus development is commonly observed in pediatric cataracts. While preoperative strabismus may resolve after surgery, postoperative rates remain high, especially in unilateral cases operated before 1 year of age. When managing pediatric cataracts, it is important to carefully evaluate not only for deprivation amblyopia but also strabismic amblyopia. Long-term systematic follow-up after cataract surgery is essential for optimal visual outcomes.

Objectives: To assess the clinical characteristics and risk factors associated with spontaneous consecutive exotropia (ScXT) in children diagnosed with refractive accommodative esotropia (RAET).

Materials and methods: A retrospective analysis of medical records was conducted on 19 patients who demonstrated a spontaneous transition from RAET to exotropia (XT). Patients who received strabismus surgery or botulinum toxin injection were excluded from the study. The control group consisted of 31 age-matched patients with RAET who demonstrated successful optical alignment at both near and distance. The ophthalmological examination findings of the study and control groups were compared. Independent two-sample t-test and Pearson's chi-square test were used to evaluate the data of the patients.

Results: The study examined patients diagnosed with RAET who developed consecutive XT. Among them, 15 (78.9%) were female and 4 (21.1%) were male. The mean age at esotropia (ET) onset was 22.68 months (standard deviation [SD]: 12.91). The control group consisted of 16 (51.6%) female and 15 (48.4%) male patients, with a mean age at ET onset of 25.09 months (SD: 15.47). Mean age at onset did not differ between the groups (p=0.55). The mean interval between ET onset and appearance of XT was 7.53 years (SD: 1.49). Cycloplegic refraction measurements taken during the initial examination indicated that the study group exhibited greater degrees of hypermetropia in their right (p=0.01) and left (p=0.04) eyes than did the control group. Furthermore, the incidence of inferior oblique muscle overaction was higher among the study group (p=0.03).

Conclusion: The findings indicate that patients with high hypermetropic refraction values should be monitored for an extended period due to the increased risk of developing subsequent XT. Concomitant inferior oblique overaction can increase the risk of ScXT.

Objectives: To determine the prevalence of diabetic retinopathy (DR), retinal vein occlusion (RVO), and retinal artery occlusion (RAO) in a tertiary care hospital in Türkiye.

Materials and methods: The electronic records of all patients over the age of 18 years admitted to a tertiary care general hospital between January 2022 and January 2024 were retrospectively analyzed. For each of the three diseases, demographic data such as age, sex, and common complications were evaluated.

Results: A total of 140,344 patients were retrospectively analyzed. Of these patients, 44.6% (n=62,575) were male and 55.4% (n=77,769) were female. The number of patients diagnosed with retinal vascular disease was 1,963 and 52.3% (n=1,028) of these patients were female. The prevalence of retinal vascular diseases in the general population was 1.4% (95% confidence interval [CI]: 1.34% to 1.46%). The prevalence of DR, RVO, and RAO was 1.12% (95% CI: 1.07% to 1.18%), 0.27% (95% CI: 0.24% to 0.3%), and 0.01% (95% CI: 0% to 0.01%), respectively. Among these three diseases, DR was statistically more common in women (p=0.048) and RAO in men (p=0.015), while RVO (p=0.079) was not associated with sex. In patients with DR, macular edema was more common in patients older than 50 years, while neovascularization was more common in patients younger than 50 years. The development of macular edema and neovascularization was not associated with sex in patients with these three diseases.

Conclusion: This is the first study to report the demographic data of patients diagnosed with retinal vascular diseases in Türkiye. However, there is a need for nationwide, multicenter, hospital and community-based studies including different geographical regions of Türkiye that examine the data of patients in detail.

Objectives: To analyze the clinical characteristics of patients with abnormal head posture (AHP) due to ocular causes and investigate the effect of treatment on the change in AHP.

Materials and methods: Patients with AHP admitted to the strabismus unit of our clinic between 2011 and 2022 were retrospectively analyzed. The patients' clinical and demographic data and change in AHP after treatment were recorded.

Results: A total of 172 patients, 86 females (50%) and 86 males (50%), with a mean age of 14.1±13.9 years were included in the study. The most common ocular causes of AHP were fourth cranial nerve palsy (50%), Duane retraction syndrome (16.9%), and A-V pattern strabismus (15.1%). Sixth cranial nerve palsy, third cranial nerve palsy, nystagmus blockade syndrome, extraocular muscle fibrosis, Brown syndrome, oculocutaneous albinism, and heavy eye syndrome were diagnosed less frequently. The most common AHP type was head tilted position (52.3%), followed by head turned (40.1%), chin down/up (3.5%), and combined form (4.1%). There was a significant relationship between AHP type and diagnosis (p<0.001). Amblyopia was present in 55 (35.7%) and absent in 99 (64.3%) patients. There was a significant relationship between amblyopia and both diagnosis (p<0.001) and AHP type (p=0.003). Of 172 patients, 100 (58.1%) underwent strabismus surgery, 10 (5.8%) had botulinum toxin injection, and 2 (1.2%) were prescribed prism glasses. Sixty patients (34.9%) were only followed up. Among 94 patients who continued follow-up, AHP was reduced in 77.3% and completely resolved in 16.7% of patients treated surgically, and was reduced in 50% and completely resolved in 25% of those treated with botulinum toxin.

Conclusion: The causes of AHP are varied. Ophthalmological and orthoptic examinations should be performed in patients presenting with AHP, and strabismus surgery or botulinum toxin administration may reduce or completely correct AHP in eligible patients.

The purpose of this report is to present simultaneous bilateral penetrating keratoplasty (PK) in Acanthamoeba keratitis (AK). A 42-year-old male with keratoconus, wearing bilateral hybrid contact lenses, presented with pain in the left eye. He had a history of intrastromal corneal ring segment placement in the right and PK in the left eye. His best corrected visual acuity (BCVA) was 20/640 in the right eye and 20/2000 in the left. Slit-lamp examination revealed a ring-shaped infiltration on the left. Despite two months of broad-spectrum topical antibiotic therapy, microbiological examination of corneal scraping samples was repeated but revealed no evidence of microbial agents. In vivo confocal microscopy findings were not compatible with AK. During the follow-up, corneal infiltration and stromal melt were observed in the right eye. Corneal scraping samples from the right eye were sent for microbiological examination, but again no microbial agents were identified. Histopathological examination revealed spherical cysts consistent with AK. Corneal perforation developed in the right eye, while simultaneous wound dehiscence occurred in the left eye. Since the patient had a history of renal failure, simultaneous bilateral tectonic-therapeutic PK was performed to minimize the risks arising from general anesthesia. Postoperative BCVA was 20/50 in the right eye and 20/125 in the left eye at 6 months. Diagnostic tools can be misleading in eyes with altered anatomy. Careful examination and a timely decision to perform tectonic-therapeutic PK are vital in preventing devastating complications.

Objectives: To investigate whether the combination therapy of Myopi-X^® peripheral progressive addition lenses (PAL; Novax^®) and atropine 0.05% provides an additive effect compared to monotherapies with either Myopi-X^® PAL or atropine 0.05%.

Materials and methods: This retrospective cross-sectional study reviewed the clinical records of 51 patients, categorized into three groups: 27 in the Myopi-X group, 13 in the atropine 0.05% group, and 11 in the combination therapy group using Myopi-X peripheral PAL with atropine 0.05%. Baseline characteristics, including age, cycloplegic spherical equivalent (SE), and axial length (AL), were compared between the groups. Twelve months after treatment initiation, changes in SE and AL were assessed and compared between the groups.

Results: Among the 51 patients analyzed, the baseline characteristics differed significantly between the groups, with the atropine 0.05% group showing a higher average age, longer AL, and lower SE compared to the other groups. After 12 months, no significant differences were found in SE changes between the treatment groups (p=0.35). Similarly, changes in AL did not significantly differ between the groups (p=0.10), although age had a significant impact on AL change (p=0.01). No significant differences were observed in pairwise comparisons of SE or AL changes between the groups.

Conclusion: In this study, combining atropine 0.05% with Myopi-X PALs did not provide an additive benefit. The literature suggests that both treatments are effective in slowing myopia progression individually; however, in our study, their combination did not significantly improve SE progression or axial elongation compared to monotherapies. Further randomized studies with larger patient groups are needed to confirm these findings and assess long-term effects.

The term pachychoroid was proposed as a term indicating an abnormal increase in choroidal thickness. Eyes presenting with pachychoroid changes often exhibit dilation of the large choroidal vessels, compressing the overlying choriocapillaris and Sattler’s layer. Pachychoroid spectrum diseases may present pathological findings such as pigment epitheliopathy, choroidal neovascularization (CNV), submacular serous detachment, and distinct choroidal and scleral alterations. Recent advancements in imaging modalities such as widefield indocyanine green angiography (WF-ICGA), optical coherence tomography angiography (OCTA), and enhanced depth imaging optical coherence tomography (OCT) have significantly improved our understanding of these conditions. WF-ICGA revealed venous outflow congestion in the peripheral retina as one of the characteristics of pachychoroid diseases. Scleral thickness measurements using ultrasound biomicroscopy and anterior segment OCT indicate that a thicker anterior sclera may contribute to choroidal congestion and disease pathogenesis. OCTA has emerged as a superior tool for identifying CNV and understanding the disease etiology, offering better sensitivity and specificity compared to traditional methods. These imaging advancements provide valuable insights into the structural and functional changes associated with pachychoroid diseases, potentially guiding future diagnostic and therapeutic strategies. The aim of the present review is to define the morphological characteristics of the pachychoroid spectrum of diseases, which share similar choroidal findings.

The main purpose of this review is to provide an overview of surgical strategies that can be implemented in keratoplasty to maximize resource utilization and enhance sustainability. To achieve this, we conducted a thorough search of PubMed to identify articles on sustainability and cost-effectiveness in surgical settings, as well as studies comparing the cost-effectiveness of different keratoplasty techniques. Our review shows that both penetrating keratoplasty and lamellar techniques are cost-effective. However, lamellar techniques offer greater long-term sustainability and cost efficiency in addition to improving patient vision. For corneal transplantation surgeries, strategies such as reducing operating room time, properly educating the surgical team, reusing instruments like trephines and punches, using surgical materials economically, and selecting the appropriate surgical technique are recommended to enhance sustainability and reduce costs. The strategies outlined could contribute to more sustainable practices in keratoplasty procedures. In conclusion, although ensuring the economical use of surgical materials is beneficial for improving sustainability and reducing costs during surgery, utmost care should be taken to preserve safety and effectiveness while taking measures to reduce costs, and a balance should be achieved between sustainability and patient safety.