Turkish Journal of Ophthalmology最新文献

Objectives: To determine patterns of peripapillary retinal nerve fiber layer (RNFL) damage in early- and late-stage glaucoma based on the Disc Damage Likelihood Scale (DDLS).

Materials and methods: This cross-sectional, multi-center study involved 267 eyes of 135 patients aged 18 years or older with suspected or diagnosed glaucoma. Exclusion criteria were high refractive errors, media opacities, trauma history, and systemic conditions affecting the optic disc. After a comprehensive ocular examination, the DDLS was used for glaucoma staging. Disease severity was classified into three zones: green, orange, and red. RNFL thickness was measured in four quadrants using optical coherence tomography. Patterns of RNFL damage were analyzed, especially in terms of the ISNT (inferior>superior>nasal>temporal) rule, and compared between the three groups.

Results: The male-to-female ratio was 1.59:1 and the mean age was 45.12±15.76 years. There were statistically significant differences among the groups for average, inferior, superior, and temporal RNFL thickness (p<0.00001). However, the difference in nasal RNFL was insignificant. The ISNT rule was the commonest pattern in the study participants (64.4%) and progressive loss of pattern was observed with increased disease severity.

Conclusion: This study revealed an association between disease severity and RNFL thinning in the inferior, superior, and temporal quadrants, while nasal RNFL showed no significant association with disease severity. The ISNT rule was more frequently observed in the early stages and diminished with advanced glaucoma. These results highlight RNFL thinning based on the DDLS as an important marker for glaucoma monitoring.

Objectives: To determine the microvascular changes of the retina and choroid in sickle cell anemia (SCA) patients and to investigate the relationship between the severity of sickle cell retinopathy and sickle cell maculopathy (SCM).

Materials and methods: In this cross-sectional study, 78 eyes of 39 patients with SCA were included in the patient group and 68 eyes of 34 healthy participants were included in the control group. Differences in foveal avascular zone (FAZ), retinal and subfoveal choroidal thickness (SFCT), and choroidal vascularity index (CVI) between the patient group and the control group were evaluated by swept source optical coherence tomography (OCT) and OCT angiography (OCTA) imaging. In addition, systemic and biological parameters were compared in patients with and without SCM.

Results: SCM was detected in 16 eyes of 8 patients. Proliferative sickle cell retinopathy (PSCR) was present in 10 patients. In logistic regression analysis, PSCR was found to be a risk factor for the development of SCM (p=0.015, odds ratio: 17.25, 95% confidence interval: 1.73-172.02). The temporal inner retinal layers were significantly thinner in the patient group compared to the control group. The patient group also exhibited significantly greater FAZ enlargement in both the superficial and deep capillary plexus when compared with the control group (p<0.001 for both). CVI was higher in the control group than in the patient group (p<0.001). SFCT was significantly thinner in the patient group (p=0.013). There was no significant difference between patients with and without SCM in terms of FAZ enlargement, CVI values, or systemic and biological factors.

Conclusion: In our study, PSCR was found to be a risk factor for the development of SCM. OCT and OCTA provide valuable information about microvascular changes in the retina and choroid in patients with SCM. Structural changes demonstrated by OCTA before the development of SCM are very important for follow-up and treatment in terms of visual prognosis of patients.

Myelinated retinal nerve fibers (MRNFs) result from a developmental anomaly in which ectopic oligodendrocytes myelinate retinal ganglion cell fibers. These fibers typically remain stable over time in the absence of pathology. We identified unilateral MRNFs in a patient during an ophthalmological examination associated with ocular hypertension. Over an 8-year follow-up period, we observed a progressive decrease in the retinal nerve fiber layer and a rarefaction of MRNFs, which we attributed to the lack of regular follow-up and treatment compliance. The absence of neuropathy control in this patient makes this description close to the natural evolution of the disease. Similar progressive disappearance of MRNFs has been observed in cases of Behçet's disease, pituitary adenoma, and open-angle glaucoma. In patients with known MRNFs, their disappearance should alert clinicians to potential optic nerve damage and prompt further examinations to determine the underlying cause.

Objectives: Ophthalmic screening is an important part of the medical care of children as some eye abnormalities can lead to irreversible vision loss if not treated in the first few months or years of life. The aim of this study is to evaluate the outcomes of the ophthalmic screening program in term infants aged ≤1 year who presented to a tertiary hospital in Türkiye.

Materials and methods: The records of 1,035 infants ≤1 year old who underwent ophthalmic screening between November 2019 and February 2022 were reviewed retrospectively. Demographic and medical details, parental complaints about the infants' eyes, family history of ocular, adnexal, and systemic pathologies, light reactions, red reflex test results, eye movements, blink response to light, fixation and following, noticeable strabismus, conjunctivitis, epiphora, anterior segment and fundus pathologies, and treatments applied were recorded. The referring physician (family physician, pediatrician) and reason for reference were also noted.

Results: Abnormal ophthalmological findings were detected in 136 infants (13.14%). The most common finding was congenital nasolacrimal duct obstruction (72.05%), followed by strabismus (8.82%), ptosis (4,41%), absence of following (3.67%), congenital cataract (2.94%), hemangioma of the adnexa (2.94%), nystagmus (2.94%), albino fundus (1.47%), preretinal hemorrhage (1.47%), and coloboma of the iris and choroid (1.47%). We detected abnormal red reflex in 4 infants who were not referred for red reflex abnormality by the referring physician, while another 4 infants referred for red reflex abnormality had no pathology on ocular examinations including the red reflex test.

Conclusion: The importance of ophthalmic screening in infants is well appreciated but there are inadequacies in performing and interpreting the red reflex test among family physicians and pediatricians. Efforts should be directed at improving vision screening skills, especially red reflex testing.

Objectives: This study aimed to identify the key factors contributing to non-adherence in patients using 0.01% atropine for progressive myopia control in a specific single-center Turkish population and to propose strategies to enhance adherence.

Materials and methods: This retrospective study included 30 patients (mean age: 10.67±3.47 years; age range: 5-16 years; 14 males and 16 females) diagnosed with progressive myopia and prescribed 0.01% atropine treatment in our clinic between January and June 2021. All participants had discontinued 0.01% atropine treatment before completion. The reasons for discontinuation were analyzed using patient records and categorized into factors such as light sensitivity, difficulties with near vision, ocular or systemic side effects, the need for monthly eye drop renewal, and the long treatment duration. Data on patients' age, sex, treatment adherence, and reasons for discontinuation were collected. Statistical analyses were performed using IBM SPSS Statistics software.

Results: The treatment discontinuation rate in our patient population was 14.92% (95% confidence interval: 10.23-19.61). The most common reasons for discontinuation were the need for monthly drop renewal (80%), long treatment duration (70%), and light sensitivity (60%). Discontinuation rates did not significantly differ by age group (p>0.05). The need for monthly renewal was more frequently reported as a barrier among female patients. Informed consent procedures had highlighted the long treatment duration and the need for monthly renewal, but these still represented barriers to adherence for some families.

Conclusion: To improve adherence to 0.01% atropine treatment for progressive myopia in our patient population, patient education and enhanced support systems are essential. Implementing strategies to address challenges related to monthly renewal and providing better information about the long-term benefits of treatment could help increase adherence rates.

Objectives: This study aimed to evaluate the anatomical and visual outcomes of internal limiting membrane (ILM) peeling in patients with macula-involving ("macula-off") retinal detachment treated with silicone oil endotamponade.

Materials and methods: The study included 19 eyes of 19 patients (Group 1, ILM peeled) and 33 eyes of 32 patients (Group 2, ILM not peeled) who underwent surgery for macula-off retinal detachment at Ege University Department of Ophthalmology. All patients underwent detailed ophthalmological examination and macular optical coherence tomography preoperatively, at postoperative 1 month, and 1 month after silicone removal.

Results: The mean age was 60.47±9.9 years in Group 1 and 57.56±10.63 years in Group 2. The average follow-up duration was 9.13±5.29 months. Preoperative visual acuity was 1.6±1.3 logarithm of the minimum angle of resolution (logMAR) in Group 1 and 1.1±0.8 logMAR in Group 2. At postoperative 1 month, visual acuity was 0.8±0.7 logMAR in Group 1 and 0.7±0.7 logMAR in Group 2 (p=0.1). At 1 month postoperatively, epiretinal membrane (ERM) development was not observed in Group 1, while 9 eyes in Group 2 developed ERM. Visual acuity after silicone removal was similar in both groups (p=0.2). Central foveal thickness (μm) and macular volumes (mm³) were comparable in both groups (p>0.05). Three eyes in Group 2 that developed ERM underwent surgery and their visual acuity improved.

Conclusion: ILM peeling during vitreoretinal surgery in cases of macula-off retinal detachment may be effective in preventing ERM formation, though it does not result in significant visual improvement. Further studies with longer follow-up and larger patient cohorts are needed.

Extraocular surgeries include a broad spectrum of procedures such as pterygium excision, removal of conjunctival tumors, and orbital exenteration. The objective of these surgeries is to address various ocular conditions, enhance visual function, and rectify cosmetic concerns. Nonetheless, as with any invasive procedure, these surgeries carry a risk of infection. To curtail this risk, prophylactic antibiotics are commonly used after extraocular surgeries. Administered via topical, oral, or intravenous routes, these antibiotics aim to prevent potential postoperative bacterial infections. The selection of these antibiotics is guided by their efficacy against prevalent pathogens associated with ocular infections, including Staphylococcus epidermidis and Pseudomonas aeruginosa. The choice of antibiotic, its route of administration, and duration of therapy can vary depending on the specifics of the surgery and individual patient risk factors. Moreover, in the context of extraocular surgeries, specific agents such as mitomycin C (MMC), interferon (IFN) alpha-2b, and 5-fluorouracil serve unique roles extending beyond infection prevention. MMC, an antitumor agent, aids in averting scarring and fibrosis in procedures like pterygium and glaucoma surgeries. IFN alpha-2b, with its antiviral and antiproliferative properties, is utilized to decrease the recurrence of conjunctival and corneal neoplasias postoperatively. This review examines the current understanding of prophylactic antibiotic use in certain extraocular surgeries and the role of antibiotics and some specific agents in enhancing surgical outcomes.