Purpose: The purpose of this study was to evaluate the treatment results and complications of XEN-45 microstent implan- tation in open-angle glaucoma. Methods: In this study, 17 eyes of 17 patients who underwent XEN-45 implantation with 0.2 mg/cc mitomycin-c between June 2016 and February 2018 were retrospectively examined. Pre- and post-operative best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of antiglaucomatous drugs, endothelial cell count (ECC), retinal nerve fiber layer (RNFL) thickness, number of post-operative needlings, and post-operative complications were evaluated. Results: The mean age of the patients (11 M, 6 F) was 62.6±19.8 (29–94) years and mean follow-up period was 16.8±3.5 (12–21) months. The mean IOP which was 27.6±6.0 (21–40) mmHg before glaucoma surgery decreased significantly to 14.1±3.3 3.4 (8–20) mmHg at the last visit (p<0.001). The number of antiglaucomatous drugs was 3.9±0.8 (2–5) preopera- tively and 1.7±1.3 (0–3) at the final examination (p=0.001). Pre-operative BCVA was 0.78±0.99 LogMAR and 0.8±0.99 LogMAR at the last visit (Wilcoxon test, p=0.99). The ECC was 2356.8±533.3 (1635–3275) cells/mm2 preoperatively and 2338.7±472.7 (1712–3178) cells/mm2 at the last visit and did not show statistically significant difference (p=0.470). The pre- and post-op- erative RNFL thickness measurements were 61.4±11.8 (43–82) μm and 61.3±11.5 (45–82) μm at the last visit, respectively (p=0.764). Needling was required in 4 (23.5%) eyes. Post-operative complications were observed in four eyes (23.5%). In the early post-operative period (≤1 month), shallow anterior chamber and hypotony were detected in 1 eye and were treated medically. As late complications (>1 month), Tenon’s cyst in two eyes and fibrotic bleb in one eye were observed. Conclusion: XEN-45 implant surgery in open-angle glaucoma patients is an effective surgical procedure for IOP control. With preserved visual acuity and ECC, causing no devastating complications, it can also be considered as a very safe option in open-angle glaucoma cases.

Purpose: The purpose of the study was to investigate detailed optic disc, choroid, and retinal microvascular morphological changes in active Thyroid ophthalmopathy (TO) patients due to thyroid disease using Optical Coherence Tomography An- giography (OCTA). Methods: Forty-six (34 females and 12 males) active TO patients and 41 (28 females and 13 males) healthy participants were included in the study. All patients underwent clinical examinations and ophthalmologic evaluations at first and last visits for visual acuity measurement, eyelid opening measurement, Clinical Activity Score (CAS) assessment (TO patients with CAS ≥3 were recorded, indicating active TO), exophthalmometry, cornea, and fundus examination, and those with initial intraocular pressure range of 14–21 mm Hg were included in the study. The overall degree of TO was assessed using the NOSPECS Score. The diagnosis of TO was made by a specialist according to the Bartley and Gorman Criteria. Results: The mean retinal nerve fiber layer (RNFL) thickness was significantly different between the groups (p<0.001), with active TO patients having a thinner RNFL thickness than the control group (p<0.001). When temporal and inferior RNFL thicknesses were compared (p=0.01, p=0.01), different results were obtained when compared to the control group, but there were no significant differences in upper and nasal RNFL thicknesses (p=0.604, p=0.513). Choroidal thickness (CT) measurements were significantly higher in the macular region in TO patients than in healthy individuals (p<0.05). The mean FAZ area in the TO group was found to be 0.303±0.104 mm2 at a significantly larger level compared to the control group (0.260±0.100) (p=0.037). Conclusion: Significant differences were detected in the RNFL, CT, FAZ area, superficial and deep retinal vessels, and RPC in TO patients. The data obtained showed that the OCTA device is an important guide for diagnosis, treatment and follow-up in the early stages of TO.

Purpose: The purpose of the study was to evaluate the vascular density (VD) in the optic disk (OD) head and macula by optical coherence tomography angiography (OCT-A) in patients with inactive thyroid eye disease (TED), as well as the relationship between extraocular muscle (EOM) thickness and the VD of the retina and OD. Methods: The study group and control group each consisted of 65 eyes of 65 participants. The foveal, parafoveal, and perifoveal VD were examined for both superficial capillary plexus and deep capillary plexus. In addition, choriocapillaris flow, foveal avascular zone (FAZ) areas, and the perimeter were calculated. The thicknesses of the peripapillary retinal nerve fiber layer (RNFL) and VD were recorded. EOM thickness was measured with magnetic resonance imaging. Results: VD was significantly lower in all quadrants for the superficial foveal areas, as well as the deep and superficial parafoveal and perifoveal areas in the study group (p<0.05 for all). The study group had significantly lower choriocapillaris flow area (2.08±0.1; 2.12±0.10 p=0.049) and higher FAZ (0.29 (0.22–0.36); 0.26 (0.17–0.32) p=0.037) and perimeter (2.08±0.46; 1.92±0.35 p=0.03) values compared with the controls. VD was higher in the inferior half of the peripapillary region in the study group than the controls (p=0.045). Conclusion: Macular VD measured using OCT-A was found to be significantly lower in TED patients compared to healthy controls. It is thought that noninvasive quantitative retinal perfusion analysis using OCT-A may be useful in the follow-up of TED, close monitoring of complications, and early treatment decision.

Purpose: Evaluation of visual and refractive effects of collagen cross-linking (CXL) in progressive keratoconus (KCN). Methods: A total of 95 eyes of 77 patients were retrospectively analyzed. The changes in uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively); spherical or cylindrical refraction and spherical equivalent of refractive error (SPH, CYL, and SE, respectively); central corneal thickness (CCT); and mean keratometry values (K) in the Scheimpflug corneal tomography (Pentacam, Oculus®, Germany) were evaluated at the 1st, 3rd, and 6th post-operative months and the past visit, as compared to pre-operative values. Results: During follow-up, there was a progressive improvement in the mean UDVA and CDVA. Significant improvement was seen in CDVA at the 3rd month (from 0.51±0.23 to 0.59±0.22), in UDVA at the 6th month (from 0.34±0.24 to 0.44±0.25), and in SPH and SE values at the last control (from −2.75±3.50D to −1.92±2.52D for SPH; from −3.51±4.45D to −3.07±3.05D for SE). The mean CCT decreased in the post-operative 1st month and gradually increased in the 3rd and 6th months (from 466.87±63.94 μm to 449.76±50.09 μm, 443.92±42.44 μm, and 454.30±46.86 μm for 1st, 3rd, and 6th months, respectively); almost returned to pre-operative values. There was no significant change in mean CYL and K values throughout the follow- up (from −2.40±2.11D to −2.45±1.77D for CYL; from 46.89±3.66D to 47.35±5.04D for K). Conclusion: CXL seems to not only slow down the progression of KCN but also improve the visual acuity, which may be a re- sult of ultrastructural changes that occur in the corneal stroma postoperatively, rather than a simple corneal flattening effect.

The present case reports a 70-year-old female patient who presented with bilateral exophthalmos, lagophthalmus, and ex- posure keratitis. An aggressive topical treatment was commenced that included fortified vancomycin and ceftazidime. She was subsequently diagnosed with severe thyroid ophthalmopathy (TO) due to severe static and dynamic tremor that raised suspicion and abnormal thyroid function tests indicating Graves’ Disease. She was diagnosed with bilateral exposure keratitis secondary to TO in which the clinical activity score was assessed as 5. As her TO was sight-threatening, she was administered intravenous pulse methylprednisolone, followed by bilateral balanced 2-wall (medial and lateral) decompression and lateral temporary tarsorrhaphy surgeries. As her exophthalmos and lagophthalmos improved postoperatively, both eyes’ keratitis significantly regressed, and left scar tissue in the cornea. This extreme case should raise awareness for clinicians in the eti- ological investigation of exposure keratopathy to identify sight-threatening thyroid ophthalmopathy and promptly initiate appropriate treatment.

A 74-year-old male patient, who previously had central corneal opacity, presented to our clinic with decrease in vision, and diffuse corneal edema following uncomplicated phacoemulsification and intraocular lens implantation. With topical treatment of steroids and artificial tears, the edema resolved in peripheral cornea and remained edematous in the central cornea during the following 2.5 months. Optical coherence tomography showed Descemet membrane detachment (DMD) in the edematous area. Intracameral perfluoropropane (C3F8) was injected. In the following days, Descemet membrane reattached and corneal edema resolved. The visual acuity increased to 20/40. Following uneventful phacoemulsification, if corneal edema is refractory to treatment, DMD should be remembered. In cases where corneal opacity interferes with the detailed examination of cornea, optical coherence tomography is helpful. In those patients, C3F8 injection is a viable option even in the late post-operative weeks.

The aim of this study was to assess the efficacy of sutureless amniotic membrane (AM) technique using a symblepharon ring-AM patch on the persistent epithelial defects and resistant to medical treatment. Two patients to whom an AM patch was applied to the ocular surface using a polymethyl methacrylate symblepharon ring due to corneal surface disorders are evaluated. The implantation of ring-AM was not complicated. Irritation and epithelial defect decreased in both cases. Eventually, vascularized leukoma developed. Ring-AM implantation is a non-invasive and easy procedure in the treatment of ocular surface disease. Ring-AM is an effective and safe biologic bandage in patients, who refuse surgical procedure or to whom surgery is contraindicated due to systemic diseases.

Syphilis is a sexually transmitted systemic disease caused by the spirochete Treponema pallidum. If left untreated, syphilis progresses in four stages: Primary, secondary, latent, and tertiary. Since the turn of the 20th century, the global prevalence of syphilis has sharply increased. Syphilis and human immunodeficiency virus (HIV) coinfection are common because they share similar transmission routes. Ocular syphilis (OcS) is a rare syphilis complication, but its prevalence has recently in- creased as a result of the rise in syphilis cases. OcS may occur at any stage of syphilis. However, it may not always be accom- panied by systemic findings. In such cases, ocular involvement may be the disease’s first and only manifestation. OcS can affect any structure of the eye, yet the most common manifestations are posterior uveitis and panuveitis. Due to the variety of clinical manifestations, the disease is known as “the great imitator.” As a result, syphilis serology is advised for any patient with unknown intraocular inflammation. Although clinical signs can be indicative of OcS, it is diagnosed using laboratory tests. Multimodal ocular imaging is required for differential diagnosis, treatment, and follow-up. It is highly recommended that patients with suspected or confirmed syphilis be tested for HIV infection. OcS is treated just like neurosyphilis with systemic penicillin. If OcS is treated promptly and effectively, a good visual prognosis is possible; otherwise, it may lead to permanent blindness.

urpose: The aim of the study was to investigate the possible adverse effect of intracameral cefuroxime (ICC) on corneal endothelium by comparing it with subconjunctival gentamycin (SCG) injection. Methods: Patients were divided in two groups; ICC (1 mg/0.1 ml) and SCG (40 mg/ml). Corrected distance visual acuity, anterior segment examination, intraocular pressure measurement, specular microscopy (endothelial cell density, coefficient of variation (CV), hexagonality, and central corneal thickness (CCT) were performed before surgery and at postoperative controls on week 1, month 1, and month 3. Results: Fifty-one eyes received ICC, 37 eyes SCG, and the mean ages of the patients were 70.0±5.5 and 69.2±6.6 (p=0.644). Endothelial cell loss at month 1 was 17.07% in ICC and 16.75% in SCG group (p=0.899). CCT returned to pre-operative values in SCG group at month 1 (p=0.483). Whereas in ICC eyes, a statistically significantly higher CCT still persisted at month 1 (p=0.015). CV showed no statistically significant difference at three post-operative visits compared to baseline in SCG group. Whereas in ICC group, a statistically significant increase was observed in CV at week 1 (p=0.000) and month 1 (p=0.012). At month 3 visit, a statistically significantly lower hexagonality was observed in ICC when compared with SCG (p=0.019). Conclusion: Results of our study showed that the licensed ICC use after phacoemulsification is safe as SCG in clinical point of view. However, abnormalities in CCT, CV, and hexagonality suggest subclinical endothelial toxicity of cefuroxime.

Purpose: Glaucoma is a progressive, irreversible optic neuropathy that is the leading cause of blindness worldwide. In our study, we aimed to show the neuroprotective effect of erythropoietin (EPO) on glaucoma. Methods: Twelve male and 12 female albino Wistar rats (6 weeks old; 220±40 grams) from Aydin Adnan Menderes University Experimental Animal Center were used. All animals were housed in a fixed room on a 12/12 h light/dark cycle per day, with food and water provided ad libitum. Rats were divided into four groups as control and glaucoma groups, subconjunctival EPO and topical EPO groups. At the end of the 6th week, the right eyes were enucleated and total retinal thickness, ganglion cell complex (GCC), inner plexiform layer (IPL), and ganglion cell layer (GCL) thickness measurements were determined. Tis- sue samples stained with HE were examined under a light microscope and photographed. Retinal layer thickness measure- ments were determined for each eye using the ImageJ program (NIH, USA). The neuroprotective effect of EPO on glaucoma was evaluated by retinal layer thickness measurements. Results: GCL, IPL, retinal thickness, and GCC thickness were observed the least in the glaucoma group and the most in the control group. There was no significant difference between EPO administration routes (p>0.05). Cell layer thicknesses in each group were confirmed by immunohistochemical staining, and apoptotic cells were not detected by bax or bcl-2 staining. Conclusion: The structural contribution of topical and subconjunctival applications of EPO to retinal layers has been demon- strated, and the study needs to be repeated in larger series.

Purpose: The purpose of the study was to evaluate the effect of individual differences in interpupillary distance (IPD) on convergence and divergence amplitudes measured at near and at distant fixation targets. Methods: Ninety-three healthy subjects were enrolled. Group 1 included subjects with smaller than normal IPD (mean IPD = 58.2±1.4; 27 subjects), Group 2 included those with larger than normal IPD (mean IPD = 69.5±1.6; 31 subjects), and Group 3 included those with normal IPD (mean IPD = 63.10±2.22; 35 subjects). Outcome measures were best corrected visual acuity, binocular vision level (TNO test), convergence, and divergence amplitudes at near and at distance. Results: There was no statistically significant difference between Group 1, 2, and 3 regarding age or clinical characteristics. The differences in gender distribution between Groups 2 and 3 and between Groups 1 and 2 were significant (Chi-square test, p=0.001 for both). There was no statistically significant difference between the groups in the values of near conver- gence amplitude, near divergence amplitude, and distant convergence amplitude. There was a statistically significant differ- ence between in mean distant divergence amplitude between Groups 2 and 3 (p=0.01). Conclusion: Differences in IPD can affect an individual’s vergence amplitudes and binocular vision level. Especially, the in- dividuals with IPD larger than normal limits have the lowest mean values for all vergence amplitudes, while the normal IPD group had the highest.

Purpose: The objective of the study was to evaluate the error in predicted residual astigmatism (PRA) using measurements of corneal astigmatism obtained with IOLMaster-700 and Pentacam for toric intraocular lens (IOL) calculation in keratoconic eyes. Methods: For toric IOL calculations, we used keratometric astigmatism obtained by IOLMaster-700 and total corneal re- fractive power (TCRP) values determined by Pentacam Scheimpflug system. Using an online toric IOL calculator, PRA for keratometric astigmatism and TCRP with a toric IOL model suggested for keratometric astigmatism values was recorded. We also calculated the error in PRA as the difference between PRA with keratometric astigmatism and TCRP. For all calculations, vector analysis was used. Results: In our sample of 70 keratoconic eyes of 70 patients, the mean difference in PRA using TCRP instead of keratometric astigmatism measurements was −1.21±0.93 with a centroid of 0.85 at 25. The error in PRA was ≤1.0D in 36 eyes, between 1.0D and 3.0D in 26 eyes, and between 3.0D and 4.0D in eight eyes. Whereas 80% of eyes with with-the-rule astigmatism showed decreased cylindrical IOL power, 88.9% of eyes with against-the-rule astigmatism showed increased IOL power with TCRP instead of keratometric astigmatism. Conclusion: Using TCRP measurements instead of keratometric astigmatism in toric IOL calculations caused a considerable deviation in eyes with keratoconus, most probably due to the posterior corneal astigmatism.

Scleral buckle infection after detachment surgery is a rare condition and it can occur even years after. We report two cases with scleral buckle infection who had undergone detachment surgery 11 and 12 years ago. The first patient was admitted to clinic with pain and discharge. Intense purulent discharge, conjunctival hyperemia, chemosis, and a large mass extending to the corneal surface were seen on her anterior segment examination. The second case had reconstruction surgery with oral mucosal greft for sponge exposure 4 years ago and she had purulent discharge, conjunctival chemosis and sponge were exposed on her anterior segment examination. During the surgery of both cases, yellowish-white multiple foci seen on buckle material which gave an impression of a fungal infection. We performed removal of the mass and scleral buckle in the first case, and removal of the scleral buckle, covering of thinned sclera with oral mucosal greft, and tarsorrhaphy in the second case. After Aspergillus grown on the culture media, lavage with voriconazole and voriconazole eye drop treatments completed and there was no recurrence in terms of detachment and infection.

Hydatid cyst is a rare parasitic disease caused by Echinococcus granulosus or Echinococcus alveolaris tapeworm. The most common sites that are affected are liver, lung, and central nervous system. Other rarely affected sites are orbit and bone. Herein, two cases of isolated primary orbital hydatid cysts that were surgically managed are presented.

Sclerochoroidal calcification is an uncommon degenerative ocular disease that is characterized with calcium deposits at the level of choroid and sclera. This condition could be related to calcium pyrophosphate metabolism disorders such as primary hyperparathyroidism. We presented a case who received the diagnosis of the primary hyperparathyroidism after the detection of asymptomatic fundus lesions on a routine eye examination.

In the first 4 weeks of life, an ocular infection is seen in 1–12% of newborns and this clinical situation is called “ophthalmia neonatorum.” The etiology includes bacterial, viral, and chemical causes. Unfortunately, severe conjunctivitis progressing to corneal ulceration and blindness may develop in the newborns due to inadequate ocular prophylaxis. The development of these cases can be prevented by screening the mothers during pregnancy and giving treatment if necessary and/or providing the newborns with appropriate ocular prophylaxis.

Purpose: The purpose of the study was to compare the effect of biometric formulas used in calculating intraocular lens (IOL) power on target refraction when planning cataract surgery in patients with diabetic macular edema (DME), age-related macular degeneration (AMD), or epiretinal membrane (ERM). Methods: The study was carried out in the Ege University Medicine Faculty Department of Ophthalmology after obtaining local ethics committee approval. Sixty-two eyes with cataracts and ERM, AMD, or DME that increased retinal thickness were included in the study group. Fifty-four eyes with cataracts and no retinal pathology were included in the control group. Lens power calculations based on measurements obtained with optical and ultrasound biometers were made using the SRK-T, Holladay 2, Hoffer Q, Haigis, and Barrett Universal 2 formulas and the results were compared. Results: In the study group, 31 eyes (50%) had DME, 16 (26%) had AMD, and 15 (24%) had ERM. The mean of arithmetic deviations from target refraction was lowest with the Barrett Universal 2 formula (p>0.05). When the Haigis formula was used, there was a significant deviation in both the study and control groups, while only the control group showed a significant deviation with the Hoffer Q formula (p<0.05). There was no significant difference between the groups in terms of absolute deviations (p>0.05). Conclusion: In cataract patients with maculopathy and increased retinal thickness, the likelihood of inaccurate IOL power calculation was lowest with the Barrett Universal 2 and highest with the Haigis formula. These results should be further examined in larger patient series.

Purpose: The purpose of the study was to compare the results of intravitreal bevacizumab in patients with macular edema (ME) due to branch retinal vein occlusion (BRVO) according to different ME morphologies. Methods: In this retrospective study, 24, 13, and 22 patients with ME type due BRVO were included in the serous retinal detachment group, cystoid ME group, and diffuse ME group, respectively. The best-corrected visual acuity (BCVA) was evaluated with an ETDRS chart, and central macular thickness (CMT) was evaluated by spectral domain optical coherence tomography at the 1st, 2nd, and 3rd months. Results: The mean ages of the patients were 64.25±7.80, 64.84±7.96, and 61.81±6.67 years in the serous, cystoid, and diffuse groups, respectively (p=0.414). While no significant difference was observed in the serous group in terms of BCVA and CMT at the 1st month after injection compared with that in the cystoid group (p=0.201 and p=0.986), BCVA and CMT values at the 2nd and 3rd months were statistically different (p=0.021, p=0.003, p=0.015, and p=0.006, respectively). When the serous group and the diffuse group were compared, only a significant difference was found in CMT at the 2nd month (p=0.016). Conclusion: Intravitreal bevacizumab treatment was more effective in terms of anatomical and visual results in the serous group compared with that in the cystoid group; however, at the end of the 3rd month, it showed similar results with the diffuse group.

Purpose: The purpose of the study was to assess the effects of subthreshold yellow pattern laser (SYPL) treatment in diabetic macular edema (DME) using optical coherence tomography angiography (OCTA). Methods: Thirty eyes of 30 diabetic patients diagnosed as naïve DME (central subfield thickness [CST] <400 μm) between October 2018 and January 2020 at Ege University Faculty of Medicine, Department of Ophthalmology were prospectively included in the study. Fovea sparing SYPL were performed to the macula. Comprehensive eye examination along with OCTA was performed at baseline, 1st month, and 3rd month of follow-up. Data during the follow-up were compared with the baseline. Results: The mean age of the patients (15 male and 15 female) was 63.7±6.7 (48–74) years. The mean diabetes duration was 17.9±5.4 (13–27) years and mean HbA1c was 6.6±0.5 (5.7–7.7) g/dL. Best-corrected visual acuity (BCVA) did not show significant change during the follow-up (p=0.698). CST measurements were 323.7±40.1 (262–393) μm, 316.8±40.9 (268–377) μm and 318.1±39.9 (226–396) μm at baseline, 1st, and 3rd month, respectively (p=0.591). On OCTA, mean vessel density (VD) in superficial capillary plexus were 44.7±4.6 (37.4–52.3), 45.6±4.7 (38.6–54.9), and 44.6±3.9 (37.5–49.8); while mean VD in deep capillary plexus (DCP) was 43.1±4.8 (36.3–52.7), 45.3±4.8 (38.9–54.2), and 42.7±3.3 (37.4–49.3) at baseline, 1st, and 3rd month, respectively (p=0.383 and p=0.291). Foveal avascular zone area did not change significantly during the follow-up (p=0.998). Conclusion: SYPL treatment in DME appears to be safe with no statistically significant difference in macular capillary perfusion, as well as no change in BCVA and CST during the 3 months of follow-up.

Purpose: The objective of the study was to evaluate the factors affecting visual prognosis and to analyze optical coherence tomography findings after successful pars plana vitrectomy (PPV) surgery for rhegmatogenous retinal detachment (RRD). Methods: Forty-one eyes of 41 patients who underwent PPV for RRD for the 1st time between December 2010 and July 2013 were included in the study with a retrospective design. Patients were divided into two groups according to visual acuity: Group 1 consisted of 24 patients with improved final best corrected visual acuity (BCVA) after post-operative 6th month; Group 2 consisted of a total of 17 patients: 14 patients with stable final BCVA and 3 patients with deteriorated final BCVA after the post-operative 6th month. Correlation between preoperative and postoperative variables was assessed. Results: The mean follow-up period was 16.93±7.5 (range, 7–36) months. While 26 (63.4%) patients had macula-off RRD, 15 (36.6%) patients had macula-on RRD. Pre-operative BCVA (p<0.001) and post-operative BCVA (p=0.002) was significantly better in eyes with macula-on RRD. Pre-operative and post-operative BCVA were found to have positive correlation (p<0.001, r=0.58). The number of eyes with intact photoreceptor inner segment/outer segment (IS/OS) junction, disrupted IS/OS junction, foveal epiretinal membrane (ERM), and parafoveal ERM was 8 (33.3%), 2 (8.3%), 1 (4.2%), and 13 (54.2%) in Group 1, while it was 2 (11.8%), 3 (17.6%), 2 (11.8%), and 10 (58.8%) in Group 2, respectively. Conclusion: Pre-operative BCVA and absence of macular detachment are important prognostic factors in patients with RRD.