Turkish Journal of Ophthalmology最新文献

Objectives: To evaluate the current practices in uveitic cataract surgery based on expert opinions and identify areas of agreement and divergence.

Materials and methods: A descriptive, cross-sectional expert survey was conducted among tertiary referral centers and university hospitals in Türkiye. A structured 10-item questionnaire was electronically distributed to uveitis specialists who had at least 5 years of experience in uveitis, were in active clinical practice, and managed at least 50 uveitic cataract cases per year. The questionnaire addressed preoperative preparation, intraoperative approach, and postoperative management. Multiple answers were permitted. Descriptive statistics were used for analysis. The terms "strong consensus", "consensus", and "divergence" were used to categorize levels of agreement.

Results: Strong consensus was observed for a 3-month inflammation-free period before surgery (85%, 17/20), continuation of conventional immunosuppressants without dose adjustment (95%, 19/20), and preference for hydrophobic acrylic intraocular lenses in uveitis associated with juvenile idiopathic arthritis (80%, 16/20). In postoperative management, 80% (16/20) tapered topical steroids within 4-6 weeks. For biologic therapies, 75% (15/20) adjusted surgical timing based on pharmacodynamic half-life. Preoperative topical steroid strategies showed divergence, with no dominant protocol. Steroid coverage strategies were practiced differentially; 65% (13/20) relied on topical steroids alone in anterior uveitis, while 60% (12/20) used intravenous steroids for posterior/panuveitis. Non-steroidal anti-inflammatory drug use for macular edema prophylaxis varied widely, and recurrence management involved systemic steroids (70%, 14/20), periocular injections (55%, 11/20), or intravitreal therapy (40%, 8/20).

Conclusion: Expert consensus highlights standardized perioperative strategies in uveitic cataract care. However, considerable variation persists in several key areas, emphasizing the need for further research. Personalized approaches remain crucial.

Objectives: To evaluate foveal lesion and preferred retinal locus (PRL) locations and their effects on visual acuity in juvenile macular dystrophy (JMD) patients.

Materials and methods: In this retrospective study, 14 JMD patients (28 eyes) with bilateral central vision loss were examined using scanning laser ophthalmoscope/optical coherence tomography. Best-corrected visual acuity (BCVA), dimensions and location of the macular lesion, PRL location, and PRL stability were evaluated.

Results: Mean BCVA was 0.84±0.17 logarithm of the minimum angle of resolution. PRL was superiorly located in 64.3% of eyes and nasally located in 35.7%. PRL location was significantly associated with patient age (r=0.541, p=0.002); nasally located PRLs were more common in younger patients (mean age 15.1±2.8 years) while superiorly located PRLs were more common in older patients (mean age 22.4±6.9 years). Superiorly located PRLs were significantly closer to the fovea than nasally located PRLs (p=0.014). Visual acuity worsened as lesion size increased and PRL-fovea distance increased. PRL-fovea distance was longer in younger patients and positively correlated with lesion dimensions and PRL-lesion distance.

Conclusion: In JMD patients, PRLs are predominantly located superiorly or nasally. In younger patients, PRLs are typically located nasally and farther from the fovea, with poorer visual acuity compared to older patients. Cortical adaptation mechanisms may play a role in changing PRL location with age. Understanding PRL characteristics in JMD is crucial for developing effective low-vision rehabilitation strategies.

Objectives: Diabetic retinopathy (DR) is one of the primary causes of vision loss among people living with diabetes and is expected to rise globally in the coming years. Effective screening strategies are essential, particularly in developing countries where resources and access to specialized care are limited. Our objective was to assess how accurately different screening methods detect DR, specifically artificial intelligence (AI)-based tools, portable fundus cameras, and trained non-ophthalmologist personnel, implemented in a developing country.

Materials and methods: A literature search was conducted in ScienceDirect, PubMed, and the Cochrane Library. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. While all included studies were reviewed qualitatively, only those evaluating AI-based screening tools were included in the meta-analysis. Meta-analysis was performed using MetaDisc 2.0 to calculate pooled sensitivity, specificity, diagnostic odds ratio, and likelihood ratios for any DR, referable DR, and vision-threatening DR.

Results: A total of 25 studies were included, with 21 AI-based studies eligible for the meta-analysis. The pooled sensitivity and specificity respectively were 0.890 (95% confidence interval [CI]: 0.845-0.924) and 0.900 (95% CI: 0.832-0.942) for any DR, 0.933 (95% CI: 0.890-0.960) and 0.903 (95% CI: 0.871-0.928) for referable DR, and 0.891 (95% CI: 0.393-0.990) and 0.936 (95% CI: 0.837-0.977) for vision-threatening DR. Meta-regression identified camera type as a significant factor. Portable fundus cameras and general physicians showed good agreement with the gold standards.

Conclusion: These findings support the potential of AI-assisted DR screening in low-resource settings and highlight the complementary roles of portable imaging and task-shifting to trained non-specialists.

The feline leukemia virus subgroup C receptor (FLVCR1) gene plays a role in heme, choline, and ethanolamine transport. In biallelic pathogenic FLVCR1 variants, macrocytic anemia may be associated with childhood- or adult-onset neurodegeneration of the retina, spinal cord, and peripheral nervous system. In patients with FLVCR1 variants, optic atrophy and retinitis pigmentosa are previously described ocular findings, but neurotrophic keratopathy has not been reported. In this study, we describe two patients with homozygous novel likely pathogenic variants in terms of their clinical findings, including neurotrophic keratopathy. On examination, the 2-year-old sister had bilateral central corneal clouding, leukoma, absent corneal reflexes, normal fundus findings, and protruding ears. The 5-year-old sister exhibited significant bilateral corneal leukoma and scarring, optic disc pallor, absent corneal reflexes, and autoamputation-like defects on the fingertips of both hands. Next-generation sequencing analysis of the 5-year-old patient revealed a homozygous likely pathogenic c.160dup p.Arg54ProfsTer36 variant of the FLVCR1 gene that was not listed in the GnomAD, ESP6500, ExAC, or Clinvar databases. FLVCR1 mutations can disrupt choline transport and therefore acetylcholine production. Acetylcholine increases cGMP in the cornea, promoting epithelial growth. A lack of this neurotransmitter in the cornea leads to epithelial destruction. The development of neurotrophic keratopathy in this patient and her sibling may be a new phenotypic feature of this novel variant.

Objectives: To compare the predictive performance of the SRK/T and Kane formulas in eyes with keratoconus undergoing cataract surgery.

Materials and methods: A consecutive series of keratoconic eyes that underwent cataract surgery were retrospectively analyzed. Intraocular lens power was calculated using the SRK/T and Kane Keratoconus formulas. Subjective refraction was evaluated 1 month postoperatively. The mean prediction error (MPE) and percentage of eyes with a prediction error within ±0.50 diopters (D) and ±1.00 D were calculated. Patients were divided into two categories: early-stage (stage 1) and advanced-stage (stage 2-3) keratoconus.

Results: Thirty eyes of 25 patients were included in the study. A comparison of MPE between the two formulas in the stage 1 keratoconus group revealed no statistical difference. However, the MPE for the SRK/T formula was found to be significantly higher (p=0.005) in the stage 2-3 group. In the stage 1 group, 84.6% of eyes were within the PE range of ±1.00 D based on the Kane formula, while 76.9% of eyes fell within the ±1.00 D range according to the SRK/T formula. In stage 2-3 group, 41.2% of eyes were within the PE range of ±1.00 D based on the Kane formula, while 29.4% of eyes fell within the ±1.00 D range according to the SRK/T formula.

Conclusion: A comparison of the two formulas showed no statistically significant differences in early-stage keratoconus. However, in advanced keratoconus cases, the Kane formula exhibited superior accuracy.

Objectives: To evaluate the safety and efficacy of a modified novel surgical approach for the drainage of subretinal fluid (SRF) during pars plana vitrectomy (PPV) for the repair of rhegmatogenous retinal detachment.

Materials and methods: This retrospective consecutive interventional case series included 15 eyes of 15 consecutive patients who were followed for at least 3 months. All patients underwent 25-gauge (G) PPV with retinal penetration using 25/32G subretinal cannula and SRF aspiration. Laser photocoagulation was not applied around the drainage area in any case. Primary outcomes included visual acuity and the presence of SRF at 1 month.

Results: SRF was not detected in any case at postoperative 1 month. Mean (±standard deviation) logarithm of the minimum angle of resolution visual acuity improved from 1.44±1.11 to 0.43±0.59 at the last visit (p<0.01). Cataract surgery was performed in the same sitting in 5 of 11 phakic eyes (45%). Single-site drainage was effective in 11 eyes (73.4%) while two-site drainage was performed in the remaining 4 eyes (26.6%). Retinal pigment epithelium defects were observed at the drainage site in 3 eyes (20%). During follow-up, redetachment due to proliferative vitreoretinopathy occurred in one case (6.6%) and epiretinal membrane in 2 cases (13.3%). Cataract developed in 3 of the 6 remaining phakic eyes (50%).

Conclusion: Transretinal drainage of SRF with the assistance of 25/32G subretinal cannula is effective with low complication rates. This drainage technique may positively affect early postoperative outcomes.