2022 Issue 4 at a Glance:
Esteemed colleagues,
In the 4th issue of 2022, the Turkish Journal of Ophthalmology features eight original studies and three case reports.
In their retrospective clinical study titled “Intraocular Lens Elongation Technique with Haptic Modification for Sulcus Implantation”, Baykara et al. evaluated 11 patients in whom a Sensar AR40e lens with modified haptics extending the total diameter from 13 mm to 14.5 mm was placed in the sulcus. The authors reported observing no intraocular lens dislocation or decentration in any eye during the 6-month postoperative follow-up period and concluded that this cost-free and easily performed technique would allow stable sulcus implantation in eyes with insufficient capsular support.
In another retrospective study titled “The Effect of Anterior Segment Depth on the Accuracy of 7 Different Intraocular Lens Calculation Formulas”, Kesim et al. analyzed the data of 184 patients with axial length of 22.5-24.5 mm who underwent cataract surgery. Anterior segment depth (ASD) was classified into three groups (Group 1: ASD <7.30 mm, Group 2: ASD 7.30-7.90 mm, Group 3: ASD >7.90 mm) and its effect on the accuracy of 7 different intraocular lens formulas (SRK/T, Holladay I, Hoffer Q, Haigis, Olsen OLCR, Barrett II, Hill-RBF) was examined. Subgroup analysis was also performed based on mean keratometry (K) values (Subgroup 1: K <42.0 D, Subgroup 2: K 42.0-44.5 D, Subgroup 3: K >44.5 D). The mean predictive error, mean absolute error, and median absolute error values of each group and the effect of ASD on the predictive errors of the lens formulas were compared. The authors reported that ASD may have an effect on the accuracy of lens formulas, and that for eyes with axis length of 22.5-24.5 mm, lens formula estimates were significantly hyperopic as ASD increased.
Aslan Katırcıoğlu et al. conducted a retrospective study titled “Clinical Results of the Use of Amniotic Membrane Transplantation Alone or in Combination with Adjuvant Therapies in Conjunctival Fornix Reconstruction” including 27 patients who underwent surgery for fornix obliteration. Symblepharon lysis and amniotic membrane transplantation were performed in all patients, and advanced cases underwent amniotic membrane transplantation in combination with 0.04% mitomycin C application, oral mucosa transplantation, fornix anchoring sutures, eyelid surgery, fibrin glue, and limbal autograft. After a mean follow-up of 45.04±8.4 months, the clinical success rate was 88.8%. The authors reported that although amniotic membrane transplantation alone is a successful method in early-stage conjunctival fornix obliteration, combined surgeries are more effective in advanced-stage fornix obliteration.
In their study titled “Ophthalmological Manifestations in Autism Spectrum Disorder”, Gutiérrez et al. evaluated 344 patients with autism spectrum disorder (in 4 groups: autism, Asperger syndrome, pervasive developmental disorder not otherwise specified, and “other”) over 8.5 years from an ophthalmological perspective. Refractive error (48.4%) and motility disorder (15.4%) were detected most frequently in the patients. The most common refractive errors were hyperopia and astigmatism, and the rate of myopia was higher in Asperger syndrome. The prevalence of strabismus was higher in the autism and “other” groups, while exotropia was more common in the autism group. Convergence was reported to be normal in approximately half of the patients, and the rate of nystagmus was low (0.9%). The authors emphasized that ophthalmological problems are more common in autism spectrum disorders than in the general pediatric population and that ophthalmologic evaluation is necessary in these children.
In a prospective clinical study titled “Optical Coherence Tomography Angiography Findings in Primary Open-Angle and Pseudoexfoliation Glaucoma”, Düzova et al. evaluated vascular density in the optic disc and macular region in glaucomatous and normal eyes using optical coherence tomography angiography and investigated its relationship with structural and functional test results. Eyes with primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma with similar visual field losses were found to have lower vascular density than normal eyes, and a strong correlation was found between structural and functional tests and vascular density values. The authors also observed that vascular density was lower in eyes with pseudoexfoliative glaucoma compared to the POAG group.
Concerning the medical treatment of glaucoma, Tekeli and Köse conducted a prospective clinical study titled “Evaluation of the Use of Brinzolamide-Brimonidine Fixed Combination in Maximum Medical Therapy” in which they showed a significant decrease in intraocular pressure (IOP) values during 6 months of follow-up in 92 patients with glaucoma and ocular hypertension who were switched to a maximum medical therapy regimen including brinzolamide-brimonidine fixed combination (BBFC). The number of topical antiglaucoma drugs used by the patients decreased significantly, while allergic reaction occurred in 8 patients (8.7%), conjunctival hyperemia developed in 5 patients (5.43%), and irritation and discomfort were reported by 2 patients (2.5%). As a result, the authors stated that using BBFC in the treatment of glaucoma provided effective IOP reduction with acceptable adverse effects.
In their retrospective study titled “Frequency of RPE65 Gene Mutation in Patients with Hereditary Retinal Dystrophy”, Kahraman et al. investigated the frequency and clinical findings of hereditary retinal dystrophy associated with RPE65 gene mutation, for which a gene therapy drug received FDA approval in 2017. They evaluated 460 hereditary retinal dystrophy patients who underwent genetic analysis and found that homozygous RPE65 gene mutation was detected in 11 cases. The authors concluded that RPE65 gene mutation is a rare autosomal recessive inheritance disorder among the hereditary retinal dystrophies, which are a genotypically and phenotypically heterogeneous group, and they emphasized the importance of genetic screening due to the increase in gene therapy opportunities.
Şekeroğlu et al. conducted a retrospective study titled “Prevalence of Serous Macular Detachment in Recurrent Macular Edema Secondary to Retinal Vein Occlusion” evaluating 71 patients who were treated for retinal vein obstruction-related cystoid macular edema (CME) and serous macular detachment (SMD) and developed recurrent CME during follow-up. The 45 patients whose initial treatment was single-dose dexamethasone implant (Group 1) and the 26 patients who initially received three loading doses of ranibizumab (Group 2) had similar time to CME recurrence (mean 4.7±0.8 months) and prevalence of SMD accompanying recurrent CME (Group 1: n=27, 60.0%, Group 2: n=14, 53.8%). SMD was found to be more common in central retinal vein occlusion than branch retinal vein occlusion cases (71.4% vs. 48.8%), and initial treatment was shown to have no effect on the prevalence of SMD accompanying recurrent CME.
The first case report of the issue, from Cankurtaran and Şekeryapan Gediz, is titled “Sub-Tenon Triamcinolone Acetonide Injection in the Acute Treatment of Handheld Laser-Induced Maculopathy.” They reported that early sub-Tenon triamcinolone acetonide injection was effective the treatment of handheld laser-induced retinal injury, which is common in recent years and can result in blindness.
In an article titled “Outer Retina Rupture from Subretinal Blood with Spontaneous Sealing and Visual Recovery in Frosted Branch Angiitis from Familial Mediterranean Fever: A Case Report”, Vofo and Amer reported that an 18-year-old female patient with familial Mediterranean fever (an autoinflammatory disease) developed sudden vision loss secondary to retinal pathology that resolved with systemic steroid therapy.
Finally, Sundaram and Gelkopf pointed out in their case report titled “Abducens Nerve Palsy as a Presenting Symptom of Multiple Sclerosis” that isolated sixth nerve paralysis could be seen as an initial symptom in multiple sclerosis (MS), a demyelinating disease of the central nervous system, and emphasized that MS should also be considered in the etiology of young patients without risk factors.
Respectfully on behalf of the Editorial Board,
Nilgün Yıldırım, MD
