Turkish Journal of Ophthalmology最新文献

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.

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%).