2020 Issue 6 at a Glance;
Esteemed colleagues,
In the sixth and final issue of 2020, the Turkish Journal of Ophthalmology features six original studies, one review, four case reports, and two letters to the editor with a response from the authors.
In a comment on Keskinbora and Güven’s review titled “Artificial Intelligence and Ophthalmology”, Martins emphasized the privacy and security of personal data, the anonymization of data while using algorithms for common retinal diseases in different studies, and the difficulty of developing algorithms for rare retinal diseases. He also concluded his criticism by pointing out the common blind spot of all artificial intelligence applications: the contribution of the social and psychological aspects of human nature in diagnosis. In their response, Keskinbora and Güven state that sensitivity to data privacy and ethical issues continues, especially in advanced artificial intelligence applications, and this specific problem can be overcome by continuous monitoring and ethical evaluation of technological developments in the narrowest of the artificial intelligence categories. However, as both iris and retinal images are as unique as fingerprints, it is clear that anonymization efforts and the powers and access granted to artificial intelligence applications are issues that will continue this debate.
Cataract surgery and the continually developing modern optic designs of intraocular lenses have given rise to a patient group seeking excellent visual outcomes and comfort. Erdinest and London read with interest the article titled “Dry Eye Disease after Cataract Surgery: Study of its Determinants and Risk Factors” published in our journal by Garg et al. and offer their contribution to this topic. For this patient group, in addition to the use of topical lubricants, they recommend that patients with clinical signs of dry eye, even those who are asymptomatic, be treated with topical cyclosporine, which has been shown to improve visual acuity and contrast sensitivity after cataract surgery in patients who receive multifocal intraocular implants.
Gümüş et al. retrospectively analyzed the results of 59 patients titled “Prognostic Factors Affecting Graft Survival in Patients Undergoing Penetrating Keratoplasty for Infectious Keratitis”. Penetrating keratoplasty is an effective treatment option in keratitis patients who are resistant to treatment or have impending perforation, and the authors’ report that both performing re-keratoplasty and doing so early improved outcomes is encouraging for those undertaking surgery in these difficult cases.
Chitamparam et al. share the results of 27 eyes of 27 patients with culture-positive fungal keratitis in their study titled “Mycotic Keratitis in a Tertiary Hospital in Northeastern Malaysia”. In their cohort, which may serve as a reference for the Pacific Asian region, Fusarium was the most common organism causing mycotic keratitis and ocular trauma was identified as the main predisposing factor. Additionally, as a prognostic finding, they noted that peripheral ulcers may resolve without antifungal therapy, while visual prognosis was worse with centrally located ulcers.
Akkaya Turhan et al. conducted a study titled “Use of a Mini-Scleral Lens in Patients with Keratoconus” and demonstrated an increase in both high- and low-contrast visual acuity with mini-scleral lenses in 29 eyes of 24 patients. The authors’ emphasis that a successful mini-scleral lens fitting, which improves not only visual acuity but also contrast sensitivity, is facilitated by anterior segment optical coherence tomography (OCT) and the example images shown in the article also make this study interesting in terms of the use of current technology.
Cheong et al. studied vascular endothelial growth factor (VEGF) inhibitor therapy in 22 eyes with diabetic macular edema (DME) and determined that the effect of VEGF inhibitors in the treatment of DME was not related to increasing vascular density. They state that larger and longer term studies are needed to investigate the role of vascular density measurements in OCT angiography images as a biomarker of treatment response.
Aside from the complicated ocular evaluations such as zone, grade, and signs of threshold disease in retinopathy of prematurity, Şahinoğlu Keşkek et al. present a new and important awareness measure that requires a systemic investigation to assess retinopathy risk. In their retrospective study titled “Impact of Platelet Count in Retinopathy of Prematurity” based on the records of 137 newborns, they report that low platelet count in the first week after birth is an additional risk factor for retinopathy of prematurity in addition to the known risk factors of need for ventilation, low birth weight, and low gestational age.
Karaca et al. determined in their study titled “Evaluation of Periorbital Tissues in Obstructive Sleep Apnea Syndrome” (OSAS) that patients with OSAS had greater eyelid laxity and significantly more frequent and severe eyelash ptosis.
In this issue’s review on conjunctival melanoma, Koç and Kıratlı present classical treatment approaches as well as new treatment options and up-to-date information about the molecular biology of the disease. Although treatment is the area of our colleagues specializing in ocular oncology, its diagnosis is based on biomicroscopic examination of the eye (i.e., a part of routine ophthalmological evaluation) and therefore, referring patients for treatment and providing the first information about treatment options is the responsibility of every ophthalmologist. With its current content encompassing chemotherapy to radiotherapy, surgery to molecular biological treatment options, this review is a complete bedside reference.
Kahar et al. report the first patient with neuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome with neuroretinitis caused by Bartonella henselae, the pathogen responsible for neuroretinitis in cat scratch disease. With this case report, they aimed to increase awareness regarding POEMS syndrome and possible initial ocular symptoms among ophthalmologists.
Kalogeropoulos et al. emphasize that patients with non-ocular malignancy may present with posterior scleritis as an ophthalmic manifestation of paraneoplastic syndrome months before the onset of systemic symptoms and diagnosis of the malignancy, and that the possibility of malignant neoplasia should not be ignored in patients with posterior scleritis, particularly older adults.
In their case report titled “Cryptic Myiasis by Chrysomya bezziana: A Case Report and Literature Review”, Rana et al. present a destructive and rapidly progressive orbital myiasis that can also generally be seen in healthy tissues and requires early intervention to prevent mortality due to the possibility of intracranial invasion from the orbital apex, together with a comprehensive review of the literature.
Vision loss and blindness in children with Stickler syndrome have classically been associated with the presence of retinal detachment. In their case report, Navarrete et al. present a 9-year-old child with high myopia who presented with decreased visual acuity in both eyes and after 2 years of follow-up developed progressive unilateral vision loss accompanied by marked atrophy of the outer retinal layers and peripheral vascular leakage but without retinal detachment.
As our journal bids farewell to 2020, we have for you an issue more than half penned by international authors, as eight of the published articles, including two letters to the editor, are from ophthalmologists abroad. Thus, as our national ophthalmology journal exhibits its status as a reference in the global ophthalmology literature, we hope to reunite in 2021 for a joyful new year in which the global problems we have faced, especially the pandemic, are put behind us.
Respectfully on behalf of the Editorial Board,
Sait Eğrilmez, MD