Turkish Journal of Ophthalmology最新文献

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.

Objectives: To discuss the results of scleral contact lens fit in patients with difficult corneal and ocular surface pathologies.

Materials and methods: This single-center, retrospective case-series included 49 eyes of 34 patients who underwent scleral lens fitting for visual acuity improvement from February 2018 to 2023. All patients underwent Orbscan/Pentacam corneal topography before a complete ophthalmological exam. The first trial lens was chosen according to manufacturer guidelines and topographic parameters. Best corrected Snellen visual acuity was assessed with spectacles before fit and over-refraction after fit and converted to logarithm of the minimum angle of resolution (logMAR). The vault was evaluated both at the slit-lamp and with anterior segment optic coherence tomography when possible.

Results: Twenty-one patients (61.8%) were male and the mean age was 37.4±14.8 years (range: 12-71). Twenty-three eyes (46.9%) had keratoconus, 11 eyes (22.4%) had refractive error after penetrating keratoplasty, 7 eyes (14.3%) had irregular astigmatism due to corneal scar, 4 eyes (8.2%) had advanced stage Steven-Johnson syndrome, 2 eyes (4.1%) had corneal perforation repair, and 2 eyes (4.1%) had severe dry eye. The appropriate lens was determined after 3.7±1.9 trials (range: 1-8 trials.) Although five patients refused scleral contact lenses due to cost, lenses were successfully fitted and used in 39 eyes of 29 patients. The mean daily wear time was 9.3±4.5 hours (range: 2-16) and mean follow-up was 52±49 months (range: 12-180). Mean uncorrected logMAR visual acuity and mean spectacle-corrected logMAR visual acuity was 1.09±0.47 and 0.67±0.50, which improved significantly to 0.13±0.20 after scleral contact lens fitting.

Conclusion: Scleral lens fit is a time-consuming practice for the ophthalmologist and an intimidating task for the patient. However, in addition to their good optical results, they provide very good comfort and stability. Although the large diameter may seem like the major disadvantage during scleral lens trial, the cost becomes more of an issue in developing countries.

Objectives: To assess real-world outcomes of selective laser trabeculoplasty (SLT) in naive patients compared to SLT as adjunctive treatment (AT), investigating SLT's intraocular pressure (IOP) reduction and its potential to decrease topical medication.

Materials and methods: Patients undergoing SLT with no prior glaucoma surgery or laser treatment were grouped based on the intended objective: SLT as primary treatment (PT), SLT as AT, and SLT as substitutive treatment (ST). Survival in the PT and AT groups was defined as ≥20% IOP reduction from baseline and IOP ≤21 on two consecutive visits with the same or fewer medications and no additional glaucoma procedure, including repeat SLT. Survival in the ST group was defined as decreasing topical medication while maintaining or reducing IOP.

Results: The study included 120 eyes of 120 patients with a mean follow-up of 32.7 months. The PT group showed superior IOP reduction than the AT group at 24-36 months (22.1% vs. 14.5%, p=0.039). Non-responders comprised 28.6% of the PT group and 37.0% of the AT group. The PT group demonstrated better survival rates than the AT group at 12, 24, and 36 months (69.0% vs. 47.1%, 38.8% vs. 31.4%, and 31.1% vs. 23.5%, respectively). In the ST group, 34.2% of patients were successful at 12 months, increasing to 38.3% at 24 months. At 24 months, 50.0% of patients had reduced at least one medication.

Conclusion: SLT showed two-thirds effectiveness, with one-third being non-responders. It was more effective as PT, with higher IOP reduction and success rates. SLT reduced topical medication in half of patients.

Minimally invasive glaucoma surgeries (MIGS), such as Kahook Dual Blade (KDB), bent ab interno needle goniectomy (BANG), gonioscopy-assisted transluminal trabeculotomy (GATT), OMNI, Trabectome, Streamline, and TrabEx+, have significantly advanced the treatment of glaucoma by improving aqueous humor outflow and reducing intraocular pressure (IOP). These innovative procedures target the trabecular meshwork (TM) and Schlemm’s canal, offering effective alternatives to more invasive filtration surgeries. By enhancing the natural drainage pathways, MIGS can achieve notable reductions in IOP and minimize the need for long-term glaucoma medications. Each device has a distinct mechanism of action. The KDB excises a strip of TM, while BANG uses a bent hypodermic needle for controlled goniectomy. GATT performs a 360-degree trabeculotomy using a microcatheter or Prolene (polypropylene) suture to open Schlemm’s canal. OMNI combines canaloplasty and trabeculotomy in a single procedure. The Trabectome ablates TM tissue with electrical energy, whereas Streamline performs viscodilation to expand outflow channels. TrabEx+ facilitates goniectomy with integrated irrigation and aspiration. Clinical studies have shown these MIGS techniques to be both safe and effective, with fewer complications compared to traditional surgeries like trabeculectomy or tube shunt implantation. MIGS procedures are particularly appealing due to their reduced recovery time and lower risk profile. However, further research is essential to establish their long-term efficacy and durability. Continued advancements and comprehensive long-term studies will ensure that MIGS provide sustainable and reliable benefits for glaucoma patients, optimizing treatment strategies in clinical practice.

Objectives: To compare the effectiveness of expert-designed machine learning models and code-free automated machine learning (AutoML) models in classifying optical coherence tomography (OCT) images for detecting age-related macular degeneration (AMD) and distinguishing between its dry and wet forms.

Materials and methods: Custom models were developed by an artificial intelligence expert using the EfficientNet V2 architecture, while AutoML models were created by an ophthalmologist utilizing LobeAI with transfer learning via ResNet-50 V2. Both models were designed to differentiate normal OCT images from AMD and to also distinguish between dry and wet AMD. The models were trained and tested using an 80:20 split, with each diagnostic group containing 500 OCT images. Performance metrics, including sensitivity, specificity, accuracy, and F1 scores, were calculated and compared.

Results: The expert-designed model achieved an overall accuracy of 99.67% for classifying all images, with F1 scores of 0.99 or higher across all binary class comparisons. In contrast, the AutoML model achieved an overall accuracy of 89.00%, with F1 scores ranging from 0.86 to 0.90 in binary comparisons. Notably lower recall was observed for dry AMD vs. normal (0.85) in the AutoML model, indicating challenges in correctly identifying dry AMD.

Conclusion: While the AutoML models demonstrated acceptable performance in identifying and classifying AMD cases, the expert-designed models significantly outperformed them. The use of advanced neural network architectures and rigorous optimization in the expert-developed models underscores the continued necessity of expert involvement in the development of high-precision diagnostic tools for medical image classification.

Objectives: To evaluate the effectiveness of conventional therapy and 20% autologous platelet-rich plasma (aPRP) eye drops for moderate to severe dry eye disease (DED).

Materials and methods: In this prospective interventional study, 40 individuals (80 eyes) with moderate to severe DED were analyzed. Twenty patients each were randomly assigned to the study and control groups. The study group was given 20% aPRP eye drops; the control group was given artificial tears as per conventional treatment. Comprehensive eye examinations including evaluation of best corrected visual acuity (BCVA), tear meniscus height, tear break-up time (TBUT), Schirmer's test, corneal fluorescein staining, conjunctival impression cytology, and Ocular Surface Disease Index (OSDI) were conducted in both groups for 3 months. Pre- and posttreatment results were compared.

Results: The average age of patients in the study group was 51±14 years (range, 37-65 years), whereas that of the control group was 50±17 years (range, 33-67 years). After 3 months, there was a more significant decrease in OSDI score in the study group than in the control group (p<0.01). The BCVA data demonstrated no statistically significant difference (p>0.05). Measurements of tear meniscus height, Schirmer's value, and TBUT at 3 months showed statistically significant differences (p<0.01). The posttreatment improvements in fluorescein staining and impression cytology scores in the study group were markedly superior to those in the control group (p<0.01).

Conclusion: aPRP is both safe and more effective than conventional treatments for moderate to severe symptomatic DED.

Objectives: To compare the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) and bent ab interno needle goniectomy (BANG) in patients with open-angle glaucoma (OAG).

Materials and methods: This retrospective comparative study included 65 eyes diagnosed with OAG that underwent GATT (34 eyes) or BANG (31 eyes). Intraocular pressure (IOP) was measured using Goldmann applanation tonometry at baseline and during follow-up visits. Success was categorized as qualified (IOP ≤21 mmHg with ≥20% reduction) and complete (same criteria without medication). Complications and the need for further surgery were recorded.

Results: Preoperative mean IOP was 32.9±6.1 mmHg for GATT and 31.8±5.4 mmHg for BANG. At the final visit, mean IOP was reduced to 15.8±4.5 mmHg in the GATT group (51.9% reduction) and 17.9±5.7 mmHg in the BANG group (43.7% reduction). The complete success rate was 88.2% for GATT and 61.3% for BANG. Early failures were more frequent in BANG, while GATT showed fewer but later failures. Both procedures had minimal complications, with transient hyphema being the most common.

Conclusion: In this study, GATT provided greater and more sustained IOP reduction and higher long-term success rates compared to BANG, making it a more reliable option for managing OAG.

The discovery that binocular dysfunction may play a critical role in the development of amblyopia has led to the development of a novel approach based on contrast-rebalanced binocular stimulation of both eyes. This approach, known as dichoptic stimulation, enables the treatment of amblyopia by facilitating the cooperation of both eyes. Dichoptic treatment approaches are founded on the theoretical premise that binocular imbalance plays a significant role in both monocular and binocular impairments in amblyopia, and that preserving binocular function capacity is essential. Therefore, these approaches are designed to promote the collaborative functioning of the eyes, enhance stereopsis, and improve binocular fusion. This review systematically examines and synthesizes the existing literature on dichoptic stimulation techniques aimed at improving binocular function in the treatment of amblyopia. Based on various studies in the literature, the fundamental principles of these treatment methods are outlined, and the results obtained in comparison to traditional monocular treatments are highlighted. The clinical efficacy of dichoptic treatment methods is evaluated in terms of their contribution to enhancing binocular function in amblyopia. Additionally, information is provided regarding the outcomes, treatment durations, efficacy levels, and potential side effects of these treatment approaches in different patient groups. This review offers a comprehensive assessment of the integration of dichoptic treatment approaches into clinical practice, highlighting both their advantages and disadvantages, and aims to provide a guiding perspective on their future use.