Turkish Journal of Ophthalmology最新文献

Objectives: To evaluate the refractive outcomes, changes in intraocular pressure (IOP) and anterior chamber depth (ACD), and postoperative complications following lensectomy for angle-closure in cases of simple extreme microphthalmos.

Materials and methods: This retrospective study analyzed eyes with simple extreme microphthalmos (axial length <18 mm) that underwent lensectomy between January 2015 and July 2024. Data collection included demographic details, preoperative and postoperative best corrected visual acuity (BCVA), IOP, number of antiglaucoma medications, ACD, the diopter (D) of the implanted intraocular lens (IOL) according to the Hoffer-Q formula, postoperative refractive error, and surgical complications.

Results: A total of 20 eyes from 12 patients were analyzed, with a mean patient age of 55.4±8.7 years and an average axial length of 16.48±0.8 mm. The average power of the implanted IOL was 53.32±6.2 D, ranging from 44 to 64 D. The mean preoperative spherical refractive equivalent (SE) was +12.4±2.8 D, while the mean postoperative SE was -6.67±5.2 D (p<0.05). Postoperative spherical refractive error exceeding -1.00 D was detected in 15 eyes (75%). Postoperatively, significant decreases were observed in IOP and the need for antiglaucoma medication (p=0.02 for both). The mean ACD increased significantly after surgery compared to the preoperative ACD (p=0.01). The difference between the intended refractive outcome and the postoperative spherical refractive error was statistically significant (p<0.05). Postoperatively, 8 eyes (40%) had a BCVA of ≤0.7 logarithm of the minimum angle of resolution (logMAR), 10 (50%) had a BCVA between >0.7 and <1.4 logMAR and 2 eyes (10%) had a BCVA of ≥1.4 logMAR.

Conclusion: Lensectomy in cases of extreme microphthalmos effectively reduces IOP and reliance on antiglaucoma medications and increases the ACD. However, a notable incidence of postoperative myopic refractive error remains a concern.

Keratoprosthesis (KPro) implantation serves as a last resort for visual rehabilitation in patients with end-stage bilateral corneal blindness, particularly when conventional corneal transplantation is no longer viable. Advances in biomaterials and refinements in prosthetic design have significantly enhanced anatomical retention and visual outcomes. Among the various types available, the Boston type 1 and 2 devices and the modified osteo-odonto-KPro remain the most widely utilized globally. This review aims to support comprehensive clinical decision-making by providing an in-depth overview of the design characteristics, surgical considerations, and postoperative care protocols associated with the most widely used KPro devices. In addition, we discuss a broad range of influencing factors, including the status of the ocular surface, eyelid anatomy, tear film adequacy, underlying systemic or autoimmune diseases, and patient-related logistical and socioeconomic concerns. Special emphasis is placed on the importance of preoperative evaluation and counselling and the role of a multidisciplinary approach in achieving successful long-term outcomes. Drawing on current evidence and clinical experience, we propose a practical decision-making algorithm to aid ophthalmologists in selecting the most appropriate KPro tailored to individual patient profiles.

Objectives: To determine the bleb morphology and anterior segment changes after needling in trabeculectomy patients with filtration failure by anterior segment-optical coherence tomography (AS-OCT), and to identify morphological predictors of success.

Materials and methods: Thirty-two eyes of 32 patients who underwent trabeculectomy with mitomycin C and experienced filtration failure underwent bleb needling with subconjunctival 5-fluorouracil injection. AS-OCT imaging was performed before and at several time points up to 6 months post-needling. Intraocular pressure (IOP), anterior chamber depth, and bleb height and width were measured. Complete success was defined as achieving IOP ≤19 mmHg without medication, and qualified success as IOP ≤19 mmHg with medication at 6 months.

Results: The mean age of the patients was 61.7±7.8 years (range, 44-76), and the mean interval between trabeculectomy and needling was 6.6±6.1 months (range, 1-26). IOP was 27.70±5.11 mmHg preoperatively (preop), 18.32±7.51 mmHg at 1 month, and 20.90±7.03 mmHg at 6 months. The decrease in IOP was statistically significant (p=0.015 and p=0.397, respectively). Bleb width was 3.74±0.67 mm preop, 4.16±0.55 mm at 1 month, and 3.9±0.49 mm at 6 months (p=0.001 and p=0.047, respectively). Bleb height was 0.45±0.16 mm preop, 0.41±0.11 mm at 1 month, and 0.40±0.11 mm at 6 months (p=0.812 and p=0.249, respectively). The success rate of needling was 75% at 1 month and 40.6% at 6 months. There were significant differences in age, preop IOP, and bleb height after needling between indistinct and encapsulated blebs. Choroidal effusion developed in 3 patients and resolved with medical treatment. Ahmed glaucoma valve implantation was performed in 6 patients who could not reach the target IOP.

Conclusion: AS-OCT imaging provides an objective and reproducible evaluation of bleb morphological changes after needling. Reduced bleb height, particularly in encapsulated blebs, and increased microcyst density observed on AS-OCT predict successful aqueous humor drainage. Incorporating AS-OCT assessments into clinical practice could improve postoperative management by enabling early detection of bleb dysfunction and guiding timely interventions.

Objectives: To compare the antiangiogenic effects of bevacizumab and a new potential bevacizumab biosimilar (anti-human VEGF GU01) on suture-induced corneal neovascularization (CNV) in rabbits.

Materials and methods: CNV was induced in the right eyes of 15 rabbits by placing 7-0 black silk suture in the corneal stroma (3 mm wide and 1-1.5 mm from the superior limbus). All sutures were removed on day 7, and the rabbits were randomly divided into three groups. An injection of 0.1 mL balanced salt solution (control group), 2.5 mg/0.1 mL bevacizumab (bevacizumab group), or 2.5 mg/0.1 mL of anti-human VEGF GU01 (potential bevacizumab biosimilar group) was administered subconjunctivally. After suturing, standard corneal images were obtained with a surgical microscope on day 7 (pre-injection) and day 14 (7 days post-injection) to analyze the CNV area, which was calculated in square millimeters using the ImageJ program. On day 14, all animals were sacrificed and corneal specimens were analyzed histopathologically by hematoxylin-eosin staining.

Results: On day 14, the percent reduction in CNV area was significantly greater in the bevacizumab and bevacizumab biosimilar groups compared to the control group (control: 24.6%, bevacizumab: 82.2%, biosimilar: 83.4%; p<0.05). There was no statistically significant difference between the bevacizumab and biosimilar groups with respect to the CNV regression rates (p>0.05).

Conclusion: This experimental study showed that the potential bevacizumab biosimilar anti-human VEGF GU01 was as effective as subconjunctival bevacizumab in the treatment of CNV.

Objectives: This retrospective study aimed to evaluate the one-year surgical success of gonioscopy-assisted transluminal trabeculotomy (GATT) and identify prognostic factors influencing surgical outcomes in eyes diagnosed with open-angle glaucoma.

Materials and methods: A total of 225 eyes (214 patients) treated with GATT between March 1, 2018, and June 1, 2024, were included in the study. Preoperative and postoperative data were analyzed. Complete surgical success (Criterion A) was defined as having an intraocular pressure (IOP) between 5 and 18 mmHg or at least a 30% reduction in IOP without the need for additional surgery. Overall success referred to achieving the same IOP with or without glaucoma medications. Surgical failure was defined as IOP >18 mmHg or <5 mmHg, significant vision loss, or the need for additional surgical intervention.

Results: The mean age of patients was 64.4±11.9 years, and the mean axial length (AL) was 24.0±2.0 mm. The mean preoperative IOP was 26.7±7.3 mmHg, which decreased to 14.3±6.5 mmHg at 12 months postoperatively (p<0.05). The rate of complete success according to Criterion A was 41.3%, while the rate of overall success was 87.6%. Multivariate analysis revealed that higher preoperative IOP (odds ratio [OR]: 1.07; p=0.02), longer AL (OR: 1.3; p<0.01), and postoperative IOP spikes (OR: 5.18; p<0.01) were significantly associated with surgical failure. Patients who underwent circumferential (360°) GATT had significantly higher success rates compared to those who received hemi-GATT (OR: 4.69; p=0.01). Glaucoma stage, presence of pseudoexfoliation glaucoma, history of prior trabeculectomy, and vitrectomy were not significantly associated with surgical outcomes (p>0.05 for all).

Conclusion: GATT is an effective and safe surgical option for various types of glaucoma. Higher preoperative IOP, longer AL, and postoperative IOP spikes increase the risk of surgical failure, whereas circumferential GATT is associated with improved success rates. GATT can also be considered as a potential alternative for patients with prior glaucoma surgery or advanced-stage glaucoma.

Objectives: This study aimed to evaluate the long-term outcomes of limbal stem cell deficiency (LSCD) treated with various limbal stem cell transplantation (LSCT) techniques.

Materials and methods: This retrospective study included 32 eyes of 29 patients who underwent LSCT. Clinical evaluation was performed based on preoperative and postoperative best corrected visual acuity (BCVA, logarithm of the minimum angle of resolution [logMAR]), degree of corneal neovascularization, extent of corneal involvement, and clarity of the central visual axis. Human leukocyte antigen (HLA) compatibility in allograft recipients was assessed via HLA tissue typing. The Kruskal-Wallis and Wilcoxon tests were used to compare variables between groups.

Results: A total of 84.4% (n=27) of the eyes had LSCD secondary to chemical injury. Median preoperative and postoperative BCVA (logMAR) values were 2.1 and 1.8 (p=0.01) in the conjunctival limbal allograft (CLAL) group (n=22; 18 living-related, 4 deceased donors), 0.9 and 0.7 (p=0.11) in the conjunctival limbal autograft (CLAU) group (n=4), and 2.1 and 1.3 (p=0.04) in the simple limbal epithelial transplantation (SLET) group (n=6; 3 autografts, 3 allografts), respectively. There was no statistically significant difference in BCVA improvement between groups. Median clinical scores improved from 10 to 6 in the CLAL group (p<0.001), from 7 to 4 in the CLAU group (p=0.11), and from 10 to 3 in the SLET group (p=0.03). Preoperatively, a statistically significant difference in clinical scores was observed only between the CLAU and SLET groups (p=0.029); however, no significant difference was found between groups postoperatively. HLA compatibility was 75% in 15 eyes that received living-related CLAL, and 100% in all 3 eyes that underwent allogeneic SLET.

Conclusion: Different LSCT techniques may be applied in LSCD depending on the underlying etiology and extent of involvement. Favorable outcomes can also be achieved with allogeneic approaches when HLA compatibility is ensured.

Objectives: To compare microvascular alterations in the optic nerve head between non-arteritic anterior ischemic optic neuropathy (NAION) and normal-tension glaucoma (NTG) and assess the correlation between vascular density (VD) and pattern electroretinography (PERG) changes.

Materials and methods: Patients with NTG and NAION underwent comprehensive ophthalmologic examinations, including optic coherence tomography angiography and PERG imaging. Demographic and clinical data were collected, and groups were matched for age, intraocular pressure, mean deviation, and global retinal nerve fiber layer thickness.

Results: The study included 25 eyes from the NAION group, 24 eyes from the NTG group, and 30 eyes from the control group. VD was significantly lower in the peripapillary, inferior hemi, inferior temporal, and temporal inferior regions in NAION patients compared to NTG patients (p=0.004, p=0.003, p=0.002, p=0.006, respectively). Analysis of PERG parameters revealed that the P50 amplitudes in both NAION and NTG patients were lower than those in the control group (p=0.001, p=0.012, respectively). A statistically significant difference between the NAION and NTG groups was observed only in N95 amplitude (p=0.035). N95 amplitude emerged as the most sensitive discriminator, while inferior temporal VD was the most specific discriminator. VD correlated with P50 latency, P50 amplitude, and N95 amplitude (p<0.050 for all).

Conclusion: Our findings highlight the diagnostic value of peripapillary vessel density and PERG parameters in distinguishing NAION from NTG. The observed correlations between PERG and VD suggest a complementary role for these measures in evaluating retinal ganglion cell function and microvascular alterations.