Efficacy of gonioscopy-assisted transluminal trabeculotomy and trabeculectomy in patients with primary open-angle glaucoma and pseudoexfoliative glaucoma: A single surgeon's experience.

PURPOSE: To compare the intraocular pressure (IOP)-lowering efficiency of gonioscopy-assisted transluminal trabeculotomy (GATT) and trabeculectomy (TRAB) with mitomycin C in patients with primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG). METHODS: In this retrospective comparative study, consecutive patients with POAG or PEXG who underwent GATT or TRAB by a single surgeon and with a follow-up period of at least 1 year were included. Surgical success rates, change in best-corrected visual acuity, IOP, the need for antiglaucoma medication, surgical complications, and the need for additional glaucoma surgery were compared. Surgical success was defined as an IOP reduction of ≥30% or an IOP of ≤18 mmHg. Complete success was defined as without medication. Qualified success was defined as with or without topical medication. RESULTS: The mean baseline IOP was 27.4 ± 8.3 and 24.6 ± 7.6 mmHg (P = 0.13) with the mean number of medications being 3.7 ± 1.0 and 3.7 ± 1.1 (P = 0.98) in TRAB and GATT, respectively. At 12 months, the mean IOP was 15.3 ± 3.5 and 12.5 ± 4.6 mmHg (P = 0.24) with the mean number of medications being 0.9 ± 1.2 and 0.8 ± 1.4 (P = 0.76) after GATT and TRAB, respectively. IOP was lowered from baseline by 52.7% ± 17.5% after TRAB and 45.7% ±18.6% after GATT (P = 0.12). There was no decrease in best-corrected visual acuity in either group. The qualified surgical success rate was 94.4% in the GATT group and 94.9% in the TRAB group (P = 0.75). Percentage of complete success was 64.1% and 52.8% (P = 0.22) after TRAB and GATT, respectively. CONCLUSION: In patients with POAG and PEXG, GATT was as effective and safe as TRAB in lowering IOP and reducing the number of antiglaucomatous drugs.

Long-Term Outcomes of Adalimumab Treatment in Conventional Treatment-Resistant Serpiginous Choroiditis.

BACKGROUND/OBJECTIVES: To investigate the long-term efficacy and safety of adalimumab(ADA) in the treatment of patients with serpiginous choroiditis (SC) refractory to conventional therapy through quantitative parameters. SUBJECTS/METHODS: A retrospective analysis was conducted on patients diagnosed with SC clinically and through fundus autofluorescence(FAF). Patients receiving ADA treatment were included. Demographic and clinical characteristics of the patients, association with tuberculosis (TB) infection, number of immunosuppressive therapies, recurrences, best corrected visual acuity (BCVA) change, and ADA-related side effects were recorded. The progression rate before and after ADA was calculated based on the area involved by FAF. RESULTS: Sixteen eyes of 8 patients (3 female/5 male) were enrolled to the study. The median (IQR) age was 53.5 (16.5) years. Diagnosis was SC in 4, ampiginous choroiditis in 3, and TB-related serpiginous-like choroiditis in 1 patient. Peripapillary involvement was present in 10 of 16 eyes. The area involved by FAF continued to progress under ADA treatment, however the progression rate was decreased (p = 0.143).The BCVA was preserved (p = 0.772). The number of systemic and local treatments decreased with ADA (p = 0.025 and 0.019, respectively). Additionally, the number of recurrences was reduced with ADA (p = 0.002). Median (IQR) follow-up was 45(28.75) months. Two patients experienced ADA-related side effects (pulmonary TBand rash). CONCLUSIONS: Our findings suggest a promising role for ADA in halting the progression of SC and have implications for improving outcomes. Despite the evidence in the literature at the level of case reports, ADA can be used effectively with close monitoring for potential risks.

Optic Nerve Head, Peripapillary and Macular Microvascular Characteristics in Patients With Unilateral Pseudoexfoliation Glaucoma.

PRCIS: In unilateral pseudoexfoliation glaucoma (PEXG), there may be decreased choroidal vascularity index (CVI), radial peripapillary capillary plexus' perfusion and flow. CVI may also be reduced in fellow eyes, suggesting that PEXG is bilateral disease. PURPOSE: Evaluation of peripapillary and macular choroidal microvascularity and radial peripapillary capillary plexus in both eyes with unilateral PEXG and healthy eyes. MATERIALS AND METHODS: Ninety-six eyes of 48 patients with unilateral PEXG [PEX (+): 48 eyes with PEXG; PEX (-): 48 eyes without PEX] and the right eyes of 45 age- and sex-matched healthy controls were included in the study. CVI was calculated on enhanced depth imaging optical coherence tomography scans. Radial peripapillary capillary vascular layer were evaluated by OCT-angiography. RESULTS: Macular CVI (mCVI), temporal and nasal peripapillary CVI (pCVI) was significantly decreased in the PEX (+) compared with the PEX (-) and control group ( P <0.05 for all). Although there was a significant difference between PEX (-) and the control group in terms of mCVI and temporal pCVI, there was no significant difference between the 2 groups in terms of nasal pCVI ( P =0.008, P =0.036, and P =0.604, respectively). There was a significant difference in perfusion density (PD) and flux index (FI) between PEX (+) group, PEX (-) group and control group in all quadrants and average value ( P <0.05 for all). Although the PD and FI values in all quadrants and average values of the PEX (-) group were lower than the control group, this difference was not significant. CONCLUSIONS: CVI in the macula and peripapillary region was significantly decreased in eyes with PEXG. Similarly, PD and FI were lower in eyes with PEXG. Low mCVI and temporal pCVI can also be seen in eyes without PEX.

Comparison of retinal and choroidal changes in Fuchs' uveitis syndrome.

PURPOSE: The assessment of retinal and choroidal changes in eyes with unilateral Fuchs uveitis syndrome (FUS) with the fellow eye and healthy control group. METHODS: Thirty-nine unilateral FUS patients and 42 healthy control subjects were enrolled. Spectralis domain optical coherence tomography (SD-OCT, Spectralis; Heidelberg Engineering GmbH, Heidelberg, Germany) was used to evaluate retinal and choroidal structures. Retinal and choroidal thicknesses were recorded from OCT images. Choroidal images were binarized to calculate choroidal vascularity index (CVI) with ImageJ 1.52 s (National Institutes of Health, Bethesda, MD, USA) program. RESULTS: CVI was found to be significantly lower in the FUS group compared to the fellow eyes and healthy control groups (p = 0.039 and p = 0.046, respectively). There was no significant difference in central choroidal thickness in the FUS group compared to the fellow eyes and control groups (p = 0.552 and p = 0.321, respectively). There was no statistically significant difference between the 3 groups in terms of macular thickness in all quadrants (p > 0.05 for all quadrants). CONCLUSIONS: Affected eyes tend to decrease in CVI, while there is no difference in retinal and central choroidal thicknesses in patients with FUS compared to eyes of other unaffected eyes and healthy individuals. It may be because the chronic inflammation associated with the disease affects the vascular structure of the choroid.

Evaluation of the reliability, utility, and quality of the lid loading videos on YouTube.

PURPOSE: It is aimed to determine the utility, reliability and quality of the lid loading videos on YouTube, a video sharing platform. METHODS: A YouTube searches were made with the keywords 'Eyelid Loading,' 'Gold Weight Implantation,' 'Lid Loading for Lagophthalmos' (without user login, cleared search history, in incognito tab). A total of 75 videos were recorded. Length of videos (seconds), number of views, uploaded source (doctor/health institution/medical channel), number of subscribers, number of likes, time since uploading (days), video content (surgical/theoretical information), type of narration (verbal narration/subtitle) were recorded. DISCERN, The Journal of the American Medical Association (JAMA), and Global Quality Scores of the videos were evaluated and recorded by two experienced oculoplastic surgeons (KSC, HT). RESULTS: After the exclusion criteria, the remaining 46 videos were included in the study. The mean DISCERN score was 25.17 ± 6.88 (very poor quality), the JAMA score was 0.79 ± 0.63 (very poor quality), and GQS was 2.84 ± 1.03 (medium quality). Thirty videos (65.2%) had verbal narration, and 16 videos (34.8%) had subtitled narration. The DISCERN score and GQS were significantly higher in the videos with verbal narration compared to the narration with subtitles (p < 0.05). All three scores were positively correlated with each other. There was also a positive correlation between video length, number of subscribers, and DISCERN score. CONCLUSIONS: The videos about lid loading on YouTube are of poor reliability, accuracy, and educational quality. The duration of the video and the type of narration can be kept in the foreground when choosing the video. Experts must review the content that is uploaded to websites like YouTube.

The Impact of COVID-19 Pandemic on Ophthalmology Residency Education.

Objectives: The aim of this study is to investigate the theoretical, practical, and academic effects of the Coronavirus disease 2019 (COVID-19) pandemic on ophthalmology residents. Methods: The web-based survey consisting of 28 questions was sent through Email to 37 educators who provides resident training. We divided the pandemic period into three, according to the severity of the pandemic and the measures, compared with pre-pandemic period (PreP), separately. Between March 2020 and June 2020 was named as P1, June 2020-October 2020 was named as P2, and October 2020-March 2021 was named as P3. Results: Responses received from 35 centers (17 university hospitals, 18 training and research state hospitals). There were totally 458 residents in the hospitals. Two hundred and forty-six of them (53.71%) worked on COVID-19 duties, with an average working time of 69.57 days. There were significant decreases in the number of patients examined by resident doctors and theoretical training time in the P1, P2, and P3 periods compared to PreP (p<0.05 for all). Furthermore, in terms of the total number of surgeries in clinics and surgeries performed by residents, there were significant decreases in P1 and P2 compared to PreP (p<0.001 for both), but there was no significant difference in P3 (p=0.109). In the examinations held in the clinic, in the 1st year of the pandemic, the grade average was lower than before the pandemic (p<0.05). Seventeen residents (3.74%) resigned or moved to another hospital. Conclusion: The COVID-19 pandemic has severely affected the theoretical, practical, and academic training of ophthalmology residents.