2018 Issue 5 at a Glance:
For this issue of our journal, we have selected six original articles, three of which concern the anterior segment and three concerning the posterior segment, five case reports, and a letter to the editor that we believe are valuable additions to the literature and that you will read with interest.
Pseudoexfoliation is an age-related systemic disorder characterized by the progressive accumulation of abnormal fibrillar extracellular material in the ocular and extraocular tissues. Pseudoexfoliation syndrome (XFS) is characterized by the presence of pseudoexfoliation material on anterior segment structures such as the anterior surfaces of the iris and the anterior lens capsule. XFS has been associated with increased risk of pseudoexfoliation glaucoma (XFG) and cataract. The LOXL1 gene, which encodes an enzyme necessary for elastogenesis and collagen cross-linking, has been identified as a risk factor for developing XFS. Yaz et al. conducted a study evaluating three single nucleotide polymorphisms (SNPs) of LOXL1 (rs3825942, rs1048661 and rs2165241) in individuals with XFS and XFG in the Turkish population. Their analysis of DNA obtained from 58 XFG patients, 48 XFS patients, and 171 healthy age- and sex-matched control subjects (277 people in total) showed that LOXL1 gene polymorphism was a significant factor in XFS and XFG pathogenesis, and that the T allele of rs2165241 was the most important distinguishing risk factor in the study group (see pages 215-220).
Descemet membrane endothelial keratoplasty (DMEK) provides rapid and effective visual rehabilitation, but the graft preparation and unfolding stages of the procedure can be challenging. In their prospective, ex vivo, experimental study, Koçluk et al. evaluated whether various medium temperatures affected the unrolling times of DMEK grafts from donor corneas that could not be used due to positive serology, and determined that different BSS temperatures had no effect on the opening time of Descemet membrane rolls (see pages 221-226).
Aksoy et al. conducted a study comparing anterior segment parameters in pseudoexfoliative glaucoma (PEXG), primary closed-angle glaucoma (PCAG), and healthy eyes with dual Scheimpflug corneal topography. Forty-seven eyes of 38 patients with PEXG, 30 eyes of 15 patients with PCAG, and 66 eyes of 33 healthy participants were evaluated with a Galilei G4 Dual Scheimpflug Analyzer imaging device. The authors report that anterior chamber volume, anterior chamber depth, and mean anterior chamber angle were statistically significantly lower in the PCAG eyes than in the other groups, and emphasized that dual Scheimpflug corneal topography is a valuable diagnostic tool in the objective measurement of anterior segment parameters in glaucoma (see pages 227-231).
The Bosphorus Retinal Study Group, consisting of nine tertiary health care institutions, is conducting a multicenter retrospective study to evaluate the real-life outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) therapy in patients with age-related macular degeneration (AMD). This initial report presenting 12-month results shows that the number of visits and injections achieved using a pro re nata (as needed) treatment regimen was suboptimal and insufficient (see pages 232-237).
In a cross-sectional study including 196 eyes of 98 AMD patients over 50 years of age, Gürbüz Yurtseven et al. investigated the relationships between AMD and refractive error and axial length, the sociodemographic characteristics that may influence it, and biochemical variables. They showed that hypermetropic refractive error and short axial length were associated with AMD independent of demographic and systemic findings, and essential hypertension was the most common comorbid systemic disease accompanying AMD (see pages 238-244).
Değirmenci et al. evaluated the effect of yellow micropulse laser (MPL) on best corrected visual acuity (BCVA) and retinal thickness in patients with non-center-involving parafoveal diabetic macular edema (DME). Nine eyes of 8 patients who underwent MPL therapy were examined retrospectively, changes in parameters between pre-treatment and 3-month post-treatment values were analyzed, and it was found that parafoveal retinal thickness was significantly reduced after MPL. The authors concluded that MPL can be used as an alternative to conventional argon laser in the management of non-center-involving DME (see pages 245-249).
Özdemir and Patel present their diagnosis, follow-up, and treatment of a preterm infant born at 24 weeks gestation and birth weight of 600 g who was screened for retinopathy of prematurity (ROP) using a noncontact wide-angle fundus imaging system. They emphasized the importance of using noncontact ultra-wide-angle fundus imaging together with indirect ophthalmoscopy in ROP screening (see pages 250-253).
Pregabalin is a gamma-aminobutyric acid (GABA) analogue with antiepileptic, analgesic, and anxiolytic effects. Tanyıldız et al. describe the case of a 24-year-old woman who presented with a 2-week history of blurred vision following a suicide attempt using pregabalin and was diagnosed with bilateral serous macular detachment. After 1 month of treatment with topical 0.1% nepafenac 3 times a day, her signs completely resolved and her visual acuity improved. The authors pointed out the necessity of detailed questioning of drug use history in patients with serous macular detachment or macular infarction (see pages 254-257).
Karaca et al. observed neuritis characterized by optic disc edema and star-shaped macular exudates in a 36-year-old male patient who presented with sudden and painless unilateral vision loss and had a history of consuming raw meat. Serological tests were positive for Toxocara. Combined treatment with steroid and albendazole resulted in increased visual acuity and complete regression of all clinical signs. In this case report, the authors emphasized that ocular toxocariasis can also be seen in adults, and raw meat consumption should be questioned when a patient presents with neuroretinitis (see pages 258-261).
Pachychoroid neovasculopathy (PNV) is a form of type 1 neovascularization characterized by dilated choroidal vessels in areas with increased choroidal thickness. Biçer et al. diagnosed PNV in a 50-year-old male patient with a 2-month history of blurred vision using fundus autofluorescence, fundus fluorescein angiography, indocyanine green angiography, spectral domain optical coherence tomography, and optical coherence tomography angiography, examined the findings obtained with these methods, and indicated the importance of multimodal imaging in the diagnosis of pachychoroid spectrum diseases (see pages 262-266).
The Harada-Ito (HI) procedure is a strabismus surgical technique developed to treat torsional diplopia caused by excyclotorsion associated with superior oblique muscle palsy. The main indication for the procedure is acquired trochlear nerve palsy following closed head injury, particularly from traffic accidents. Ayyıldız et al. reported that HI surgery in three patients with torsional diplopia due to acquired trochlear nerve paralysis successfully eliminated their torsional diplopia, but that patients should be adequately informed preoperatively about the outcomes of treatment. (See pages 267-273).
In a letter to the editor written in response to Aksoy et al.’s article entitled “Topography and Higher Order Corneal Aberrations of the Fellow Eye in Unilateral Keratoconus”, Koç and Tekin share their views that the term ‘unilateral keratoconus’ is inaccurate, that it may be confused with ‘subclinical keratoconus’, and that posterior elevation and pachymetry data are more sensitive indexes for early diagnosis of keratoconus (see pages 274-275).
Respectfully on behalf of the Editorial Board,
Özlem Yıldırım, MD