Turkish Journal of Ophthalmology最新文献

Hyaluronic acid (HA) filler injection is one of the most common methods for managing signs of aging in the periorbital area and is considered a safe and reversible procedure. The purpose of this review was to perform a comprehensive analysis of the incidence, risk factors, pathophysiology, signs and symptoms, and treatment methods of complications related to cosmetic periocular HA filler injections, as well as review hyaluronidase indications, appropriate dosage, and safety measures. Complications were classified as immediate injection-related reactions (erythema, early edema, bruising/hematoma), early complications (loss of vision, acute infection, early contour irregularities, persistent edema), late complications (late edema, late contour irregularities), blue discoloration, xanthelasma palpebrarum, and filler in the orbit. Prospective and retrospective studies as well as case reports were reviewed. Immediate injection-related reactions such as erythema, edema, and bruising/hematoma were the most reported complications, followed by early contour irregularities and blue discoloration. Persistent and late edema and late contour irregularities were reported less frequently. These were mainly minor complications that were reversible through conservative management or hyaluronidase injection. Filler-related loss of vision, xanthelasma palpebrarum, and filler in the orbit were infrequent but potentially serious complications that could cause patients significant distress. These were mainly reported through case reports and case series. Urgent treatment with high dose hyaluronidase is necessary for successful management of injection-related vision loss. Physicians must have a thorough knowledge of orbital anatomy, the signs and symptoms of complications, and how to avoid them, and must be equipped to intervene immediately if necessary.

Objectives: To evaluate the response and interpretative capabilities of two pioneering artificial intelligence (AI)-based large language model (LLM) platforms in addressing ophthalmology-related multiple-choice questions (MCQs) from Turkish Medical Specialty Exams.

Materials and methods: MCQs from a total of 37 exams held between 2006-2024 were reviewed. Ophthalmology-related questions were identified and categorized into sections. The selected questions were asked to the ChatGPT-4o and Gemini 1.5 Pro AI-based LLM chatbots in both Turkish and English with specific prompts, then re-asked without any interaction. In the final step, feedback for incorrect responses were generated and all questions were posed a third time.

Results: A total of 220 ophthalmology-related questions out of 7312 MCQs were evaluated using both AI-based LLMs. A mean of 6.47±2.91 (range: 2-13) MCQs was taken from each of the 33 parts (32 full exams and the pooled 10% of exams shared between 2022 and 2024). After the final step, ChatGPT-4o achieved higher accuracy in both Turkish (97.3%) and English (97.7%) compared to Gemini 1.5 Pro (94.1% and 93.2%, respectively), with a statistically significant difference in English (p=0.039) but not in Turkish (p=0.159). There was no statistically significant difference in either the inter-AI comparison of sections or interlingual comparison.

Conclusion: While both AI platforms demonstrated robust performance in addressing ophthalmology-related MCQs, ChatGPT-4o was slightly superior. These models have the potential to enhance ophthalmological medical education, not only by accurately selecting the answers to MCQs but also by providing detailed explanations.

Glaucoma is typically a disease that occurs in advanced age, requiring lifelong monitoring and treatment with topical medications, laser procedures, or surgery. Patients with glaucoma may also experience oculoplastic issues due to the natural aging process or as a result of glaucoma treatment or surgery. Eyelid surgery in these individuals can lead to complications and undesirable results. Therefore, it is crucial for oculoplastic surgeons to be aware of the incidence and risk factors associated with oculoplastic problems specific to glaucoma patients. Understanding these potential complications is essential for taking necessary precautions and achieving successful surgical outcomes. The purpose of this review is to raise awareness among ophthalmologists specializing in oculoplasty and glaucoma and to contribute to the quality of life of glaucoma patients.

Objectives: To evaluate the indications, efficacy, and safety of adalimumab (ADA) in treating active non-infectious uveitis (NIU) in the Turkish population in a real-world setting.

Materials and methods: This retrospective observational study included patients diagnosed with NIU treated with ADA on-label. The study assessed the impact of ADA treatment on best corrected visual acuity (BCVA), number of immunosuppressive therapies (IST), immunosuppressive drug load, and the frequency of required local treatment. BCVA was monitored at baseline and subsequent months to determine the onset of functional efficiency of ADA treatment.

Results: A total of 289 eyes of 146 patients (60 females, 86 males) diagnosed with NIU and treated according to the ADA protocol were included in the study. The mean age was 37.6±14.4 years (range, 4-73) and the median follow-up was 30 months (interquartile range, 18-57). The most common indication for ADA was panuveitis, with a diagnosis of Behçet's uveitis. The use of ADA reduced the number of IST, immunosuppressive drug load, and need for local treatment (p<0.001, 0.002, and <0.001, respectively). Corticosteroids could be discontinued in all but one patient. Following ADA, a significant improvement in BCVA was observed from the first month (p<0.001 for baseline vs. month 1) and stabilization occurred after the sixth month (p=0.751 for month 6 vs. 12). Side effects were reported by 55.2% of patients during IST, while only 8 patients (5.5%) experienced ADA-related side effects. At the end of the follow-up period, 8.9% of patients switched to a weekly dosing schedule. Patients who switched to a weekly regimen required more local treatment before and after ADA treatment (p=0.02 and 0.001, respectively), and the number of concomitant IST and drug load were higher during standard-dose ADA use (p<0.001 and p=0.025, respectively).

Conclusion: This study, the largest single-center investigation in Türkiye, reveals ADA to be a safe option with functional benefits across diverse indications and age ranges. Notably, ADA minimizes reliance on additional therapies.

Objectives: To evaluate the prevalence and clinical course of elevated intraocular pressure (EIP) and glaucoma in different types of uveitis.

Materials and methods: A retrospective chart review was performed for patients who were treated for any kind of uveitis at Ege University Ophthalmology Department between January 2003 and January 2023. Patients with transient/persistent increase in intraocular pressure (IOP), who were already under treatment with antiglaucoma medications at the initial examination, or who were diagnosed with glaucoma during follow-up were included. Demographic features, uveitis type, time between uveitis and glaucoma/EIP diagnoses, topical and systemic treatments for uveitis, and antiglaucoma medications and surgeries were recorded.

Results: A total of 2176 patient files (1206 anterior uveitis [AU], 247 intermediate uveitis [IU], 165 posterior uveitis [PU], 558 panuveitis [PanU]) were reviewed and 594 eyes of 440 (20.2%) patients (205 female, 235 male) were included in the study (292 eyes with AU, 80 eyes with IU, 44 eyes with PU, and 178 eyes with PanU). Glaucoma was observed in 220 eyes (37.0%) and EIP in 374 eyes (63.0%). Glaucoma was present in 120 eyes with AU, 23 eyes with IU, 13 eyes with PU, and 64 eyes with PanU. IOP was controlled with medical treatment in 458 eyes (77.1%) while glaucoma surgery/laser was needed in 113 eyes (19.0%). No treatment was required for 23 eyes (3.9%).

Conclusion: The prevalence rate of glaucoma/EIP was 20.3%. Glaucoma was most observed in eyes with AU (41.1%), while EIP was most common with IU (71.2%).

Objectives: To evaluate the long-term progression of macular telangiectasia type 2 (MacTel) using a standardized classification system and to assess the incidence, progression, and management strategies of complications such as macular neovascularization (MNV) and macular hole (MH).

Materials and methods: This retrospective study analyzed the medical records of patients diagnosed with MacTel at a tertiary referral center in Türkiye from January 2004 to February 2025. Patients with a minimum follow-up of 3 years and no confounding macular pathologies were included. Data collection included best corrected visual acuity (BCVA), multimodal imaging (optical coherence tomography [OCT], fundus autofluorescence, fluorescein angiography), and demographic variables. Disease severity was classified using the MacTel Classification System developed by Chew et al. Longitudinal changes in BCVA and OCT parameters were statistically analyzed.

Results: A total of 184 eyes from 94 patients (mean age: 63.89±9.98 years; mean follow-up: 79.27±50.69 months) were included. A significant decline in BCVA was observed (p<0.001). MNV was present in 29 eyes (15.8%), with 18 receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy (mean injections: 5.89±3.72). While posttreatment BCVA showed improvement (p<0.001), long-term visual outcomes were not significantly different from baseline (p=0.213). MH formation occurred in 8 eyes (4.3%), with 6 undergoing successful surgical closure. Structural retinal changes, including ellipsoid zone disruption and pigmentation, significantly progressed over time (p<0.001).

Conclusion: MacTel demonstrates a progressive decline in visual and structural integrity over extended follow-up. While anti-VEGF therapy offers short-term benefits for MNV, its long-term efficacy remains limited. MH development, though rare, poses a significant challenge, with variable surgical outcomes.

Objectives: To determine the effect of intravitreal ranibizumab (IVR) in patients with treatment-naïve retinopathy of prematurity (ROP) in terms of disease regression and need for rescue therapy.

Materials and methods: This study evaluated disease regression and rescue therapy requirement in treatment-naïve ROP cases treated with IVR. Among 188 screened patients, 80 had ROP. Thirty-eight patients (76 eyes) with type 1 ROP and aggressive ROP (AROP) were included. Treatment involved a single dose of 0.2 mg ranibizumab injected under aseptic conditions. Patients were monitored post-treatment for up to 6 months. Recurrence of disease was managed with argon laser photocoagulation targeting the peripheral avascular retina. Data analysis utilized t-tests for continuous variables and χ² tests for categorical data, with a significance threshold of p<0.05.

Results: The study included 19 males and 19 females, with 56 eyes having AROP and 20 eyes with type 1 ROP. All AROP cases required rescue therapy, with a mean interval of 3.43±0.84 weeks between treatments. Sixty percent of type 1 ROP eyes also needed laser therapy. While type 1 ROP cases had slightly higher gestational age and lower birth weight compared to AROP, these differences were not statistically significant (p=0.081 and p=0.27, respectively). However, the interval between treatments was significantly longer in type 1 ROP than in AROP (p=0.0016).

Conclusion: Ranibizumab demonstrated effectiveness in initial disease regression but was linked to reactivation in all AROP and 60% of type 1 ROP cases, highlighting the importance of more frequent follow-ups after ranibizumab injection, particularly for AROP patients.