Turkish Journal of Ophthalmology最新文献

Synchysis scintillans, also known as cholesterolosis bulbi, is a degenerative eye pathology characterized by the accumulation of cholesterol crystals in the vitreous. It is typically observed bilaterally but can rarely be unilateral. It can be triggered by severe trauma, chronic inflammation, chronic retinal detachment, hyphema, vitreous hemorrhage, Coats’ disease, and retinoblastoma. In this report, we present a case with an uncommon association of anterior chamber synchysis scintillans and neovascular glaucoma.

The choroid plays an important role in the pathophysiology of the eye. Multimodal imaging offers different techniques to examine the choroid. Fundus fluorescein angiography offers limited visualization of the deep layers of the fundus due to the barrier property of the retinal pigment epithelium. Therefore, indocyanine green angiography (ICGA) is widely used in the angiographic examination of the choroidal structure. ICGA is an important component of multimodal imaging in the diagnosis and treatment of many degenerative, tumoral, and inflammatory diseases of the choroid and retina. This review presents the general characteristics of ICGA and a practical approach to its clinical use.

Objectives: To evaluate the use of the Amsler grid test (AGT) in screening for age-related macular degeneration (AMD), one of the most common causes of blindness, in primary healthcare settings.

Materials and methods: The AGT was applied to 700 eyes of 355 people aged 50 and over who applied to a family health center in Ankara and had no eye complaints. The test was considered positive if the lines on the AGT card were seen as broken or curved, there was a difference in shape or size between the squares, or a color change or blurring was described in any area. An ophthalmologist was consulted if the AGT was positive in one or both eyes. Patients considered suitable by ophthalmologists were evaluated with optical coherence tomography. AGT results were compared with ophthalmologist examination and tomography findings in terms of AMD detection.

Results: The AGT was positive in 97 (13.9%) and negative in 603 (86.1%) out of 700 eyes included in the study. A total of 184 eyes, 79 with a positive AGT and 105 eyes with a negative test, were evaluated by an ophthalmologist. As a result of examinations and tests performed by ophthalmologists, AMD was detected in a total of 67 eyes: 42 of 79 eyes with positive AGT and 25 of 105 eyes with negative AGT but referred to an ophthalmologist for different reasons. In our study, the AGT had 62.7% sensitivity and 68.4% specificity.

Conclusion: The AGT is an inexpensive and easily applicable test. Although moderate sensitivity and specificity were found in our study; further studies are needed to evaluate the suitability of its use for AMD screening in primary care with limited facilities.

Objectives: The aim of the present study was to evaluate any conjunctival metaplastic changes by impression cytology in patients who underwent topical 1% voriconazole treatment for severe fungal keratitis.

Materials and methods: The study was conducted at Ege University Faculty of Medicine, Departments of Ophthalmology and Medical Pathology. Patients who were treated with 1% topical voriconazole for fungal keratitis for at least 3 months were included. The used topical voriconazole treatment was initiated as one drop every hour and was tapered according to clinical improvement in all patients. Treatment was continued 4 times a day for at least 3 months. Impression cytology samples were collected at least 3 months after cessation of topical voriconazole from the affected eyes and from the fellow eyes as a control group. Collected specimens were transferred to the pathology department for evaluation and grading (Nelson’s grading system).

Results: The mean age of the patients was 57.68±17.32 years (range, 22-87 years). The impression cytology grade of the inferior bulbar conjunctiva was 1.73±0.77 (range, 0-3) in the study group and 1.19±0.98 (range, 0-3) in the control group (p=0.03). The impression cytology grade of the temporal bulbar conjunctiva was 1.69±0.73 (range, 0-3) in the study group and 1.15±0.88 (range, 0-3) in the control group (p=0.02). The impression cytology grades of the nasal and superior bulbar conjunctiva did not differ statistically (p values 0.13 and 0.17, respectively).

Conclusion: Topical voriconazole is an effective broad-spectrum antifungal drug, but it induces conjunctival squamous metaplasia. Clinicians should be aware of this possible side effect of topical voriconazole and should carefully evaluate the conjunctiva of treated patients at each visit to detect possible metaplastic changes.

A 56-year-old man was referred to our clinic for unilateral nodular scleritis unresponsive to systemic corticosteroids. A localized, nodular hyperemia on the nasal bulbar conjunctiva surrounding a central cyst-like lesion together with vascular engorgement was observed on slit-lamp examination of the left eye. No abnormal fundoscopic findings were noted. Surgical exploration revealed an embedded episcleral brown colored, soft to touch, splinter-like organic foreign body (FB) which was confirmed by the histopathological examination. Nodular hyperemia resolved during the postoperative follow-up period, and mild scar tissue accompanied by scleral thinning developed in the left nasal bulbar conjunctiva. Ocular injury associated with FBs may cause significant ocular morbidity depending on the nature and location of the FB. Severe visual disability may occur if left untreated. Subconjunctival FBs are rare and may present with a clinical picture mimicking episcleritis or scleritis. History of trauma involving a FB should always be assessed for an accurate differential diagnosis and appropriate management of patients with anterior scleritis.

Objectives: To evaluate the demographic, etiological, and accompanying clinical factors in eyelid lacerations (EL).

Materials and methods: The records of patients who presented to our clinic between 2018 and 2022 with eyelid trauma were retrospectively reviewed. Age, gender, cause of injury, clinical findings, accompanying ocular findings, and additional complications were analyzed.

Results: The study included 135 patients (106 male, 29 female) with a mean age of 37.0±18.6 years. Among the patients, 29 (21.4%) were 18 years old or younger, 93 (68.8%) were between 19 and 64 years old, and 13 (9.6%) were 65 years old or older. EL were most caused by various sharp objects in 44 patients (33%), blunt trauma in 40 patients (30%), falls in 30 patients (22%), and traffic accidents in 21 patients (15%). Fifteen eyes (11.1%) had foreign bodies at the wound site. Thirty patients (22.2%) (20 lower eyelid, 10 upper eyelid) had accompanying canalicular lacerations. Twenty-three (17%) patients had accompanying conjunctival lacerations, 14 (10.3%) had open-globe injury, 10 (7.4%) had corneal epithelial defects, 9 (6.6%) had intravitreal hemorrhage, 6 (4.4%) had hyphema, and 5 (3.7%) had retinal detachment. Four patients had lid notching and 1 patient (0.7%) had ectropion. Five patients (3.7%) required suturing. No additional complications were observed.

Conclusion: EL are more commonly seen in young adulthood and in males. The most common mechanism of injury is impact by various objects. Eyelash margin and canalicular lacerations frequently accompany these injuries. Serious ocular pathologies such as hyphema and open-globe injury can accompany eyelid trauma.