Neurofibromatosis type 1 and pneumoconiosis: A case report on a coincidence.

Neurofibromatosis (NF) is a neurocutaneous syndrome characterized by the development of central or peripheral nervous system tumors. The most common form, known as NF1 or Von Recklinghausen's disease, presents with distinct clinical features, including cutaneous and ocular manifestations, along with various other organ and systemic symptoms. While the lung findings associated with neurofibromatosis lack specificity, they can include parenchymal cysts and bullae formation, primarily in the upper-apical regions. Additionally, progressive fibrotic changes, such as ground-glass areas, consolidations, and paving stone patterns, may manifest in the basal parts of the lungs. In this case report, a case of NF1 diagnosed in adulthood and accompanying pneumoconiosis was discussed as a coincidence.

Subthreshold laser treatment for non-center involved diabetic macular edema via non-damaging retinal laser therapy (NRT).

PURPOSE: To evaluate the efficacy of subthreshold laser treatment via non-damaging retinal laser therapy (NRT) in patients with non-center involved diabetic macular edema (non-CI DME). METHODS: In this prospective controlled study, NRT with 577 nm wavelength was performed to the edematous inner subfields as needed at 3 monthly intervals, while the control group received no treatment. If CI-DME developed in either group, intravitreal anti-VEGF was performed and the eye was excluded from subsequent analysis. RESULTS: A total of 75 eyes (36 study eyes, 39 controls) were evaluated. The change in superior, nasal and temporal inner subfield thicknesses over time and between groups was found significant (P = 0.004, P < 0.001, P = 0.04 respectively). Best corrected visual acuity (BCVA) change was not significant over time and between groups (P = 0.69). Rates of CI-DME development requiring intravitreal anti-VEGF treatment were not different during the first and second years (P = 0.171, 0.908). No laser scar was detected in any eye in fundus autofluorescence imaging. CONCLUSION: NRT performed as needed at 3 monthly intervals is effective after 21 months of follow up in the treatment of non-CI DME and it was safe. With this method, it may be foreseen that BCVA will be better preserved in the long term by avoiding the possible side effects of conventional laser.

Deferoxamine-related bilateral maculopathy with optical coherence tomography findings.

BACKGROUND: We present a case of bilateral maculopathy associated with deferoxamine mesylate (DFO) treatment. METHODS: A 53-year-old man with myelodysplastic syndrome (MDS) received DFO therapy due to elevated ferritin levels. He was then referred to ophthalmology clinic due to blurred vision. He was diagnosed as bilateral neurosensory retinal detachment of the macula. During follow up, best corrected visual acuity (BCVA), optical coherence tomography (OCT), fundus fluorescein angiography (FFA), and fundus autofluorescence (FAF) were evaluated. RESULTS: At first visit, OCT showed bilateral foveal neurosensory detachment. Hyperfluorescence of the macula and the peripapillary region were found on FFA. After discontinuation of DFO, BCVA improved from 20/120 to 20/60 with resolution of the foveal detachments on OCT scan. Four weeks later, FAF showed bilateral mottled hyperautofluorescence and hypoautofluorescence at the macula and the peripapillary region. CONCLUSION: Deferoxamine can cause acute retinal toxicity. Haematologists should be alert to visual complaints associated with DFO therapy, as early diagnosis and discontinuation of the medication allows recovery of visual function with residual fundus findings.

Real Life Multicenter Comparison of 24-Month Outcomes of Anti-VEGF Therapy in Diabetic Macular Edema in Turkey: Ranibizumab vs. Aflibercept vs. Ranibizumab-Aflibercept Switch.

The aim of this study was to compare the outcomes of diabetic macular edema (DME) treated with aflibercept (AFB) or ranibizumab (RNB) only, and after switching from RNB to AFB. This was a retrospective, real-world, multicenter (7 cities) 24 month study. Overall, 212 eyes in the AFB group, 461 in the RNB group, and 141 in the RNB to AFB group were included. The primary endpoints were differences in visual acuity (VA) and central macular thickness (CMT) from baseline to the final visit. The secondary outcomes were the percentage of eyes that achieved ≥10 letters gain and ≥10 letters loss in vision at month 12 and 24, and the percentage of eyes that achieved a thinning of ≥20% in CMT at month 3 and month 6. The results showed that VA did not significantly differ at baseline (AFB: 0.62 ± 0.38, RNB: 0.61 ± 0.36, RNB to AFB: 0.61 ± 0.38), at checkpoints, or at the final visit (AFB: 0.46 ± 0.38, RNB: 0.5 ± 0.37, RNB to AFB: 0.53 ± 0.36) (p > 0.05). Though the mean CMT at baseline was significantly thicker in the RNB to AFB group (479 ± 129.6 µm) when compared to the AFB (450.5 ± 122.6 µm) and RNB (442 ± 116 µm) groups (p < 0.01), similar measurements were obtained after 12 months. The percentages of eyes that gained or lost ≥10 letters in the AFB, RNB, and RNB to AFB groups at year 1 and 2 were similar, as was the percentages of eyes that demonstrated ≥20% CMT thinning at month 3 and 6. Our study showed similar visual improvements in non-switchers (AFB and RNB groups) and switchers (RNB to AFB group) through 2 years follow-up, however, AFB patients required fewer injections, visits, or need for additional treatments.

Perspective of Workers' Union Representatives on COVID-19 Measures in Turkish Workplaces in the First Year of the Pandemic

Background: Severe acute respiratory syndrome coronavirus-2, the virus causing coronavirus disease-2019, is a biological hazard in workplaces. Thus, protective measures should be applied. Despite their potential role, the perspective of workplace representatives on coronavirus disease-2019 measures is rarely investigated. Aims: To assess the perspective of workplace union representatives on coronavirus disease-2019 measures in their workplaces in the first year of the pandemic in Turkey. Study Design: A descriptive observational study. Methods: This national descriptive study included workplace chief representatives of 33 workers' unions. A 42-item electronic survey was used to collect data to evaluate the practice of job organization, social distancing and personal protective equipment use, sanitization, and occupational safety and health training. Results: The study included 509 workplace chief representatives' responses. Results showed that several administrative measures, including suspending production or work, encouraging workers to take leave, implementing alternate work schedules, isolating any coronavirus disease-2019 case from other workers in a designated room, and avoiding face-to-face meetings, were not available in more than half of the workplaces. The mean number of available measures was significantly high (p < 0.001) in the industrial sector and workplaces with 250 or more workers. Almost all union representatives (98.8%) reported at least one diagnosis of coronavirus disease-2019 among workers, and 12.6% reported a positive history of coronavirus disease-2019-related mortality. The regression model for any history of coronavirus disease-2019 mortality in workers demonstrated a significantly increased association with workplaces with 250 or more workers compared with workplaces with less than 250 workers (odds ratio =2.99, 95% confidence interval =1.65-5.44, p < 0.001). Conclusion: The results indicate failure in administrative measures and the need for improvement in medium- and small-sized workplaces and the non-industrial sector. All local and national stakeholders need to pay special attention to address these issues. Future studies should evaluate on-site coronavirus disease-2019 workplace measures and their effectiveness.

Tracheobronchial variations in Pneumoconiosis cases: multidetector computed tomography diagnosis.

Background: Tracheobronchial variations (TBVs) are more common than previously believed due to the increasing use of multi-detector computed tomography (MDCT). This study aimed to assess TBVs in cases of pneumoconiosis, one of the oldest occupational diseases that still poses a threat to public health. Methods: This was a descriptive study that involved reviewing chest MDCT images of 34 cases of pneumoconiosis and 34 control cases retrospectively from January 2020 to April 2022. Variations in the trachea, right main bronchus, left main bronchus, lobar and segmental branches of the cases in the patient and control groups were evaluated according to Boyden's nomenclature. Results: The frequency of TBV was 32.4% in pneumoconiosis cases. Although the frequency of TBV was higher in the patient group than in the control group, the difference was not statistically significant (p=0.086). Furthermore, there was no significant difference in terms of TBV classification between the patient and control groups (p=0.407). Additionally, the presence of TBV did not affect the distribution of International Labour Organization categories in pneumoconiosis cases (p=0.360). Conclusions: Although our study provides initial insights into the occurrence of TBVs in pneumoconiosis cases, further research is needed to clarify the relationship between these variations and the disease.

Anti-vascular endothelial growth factor therapy in diabetic macular edema: real-life outcomes from a multicenter study in Turkey over 36 months.

PURPOSE: This study aimed to report the visual and anatomical outcomes of intravitreal anti-VEGF treatment for diabetic macular edema (DME) in a real-world clinical setting from Turkey over 36 months. METHODS: This is a retrospective, multicenter (7 sites) study. The medical records of 1072 eyes (both previously treated and naive eyes) of 706 consecutive patients with visual impairment due to center-involving DME treated with intravitreal anti-VEGF injections between April 2007 and February 2017 were reviewed. The eyes were divided into mutually exclusive three groups based on the duration of follow-up (12, 24, or 36 months). Primary outcome measures were changes in visual acuity (VA) and central macular thickness (CMT) from baseline to final visit in each cohort, frequency of visits and intravitreal anti-VEGF injections. As secondary endpoints, VA outcomes were assessed in subgroups stratified by baseline VA [<70 ETDRS letters and ≥70 ETDRS letters] and loading dose status of anti-VEGF injections. RESULTS: VA increased by a mean of 8.2 letters (12-month cohort, p < 0.001), 5.3 letters (24-month cohort, p < 0.001), and 4.4 letters (36-month cohort, p = 0.017) at final visits. The eyes with <70 VA letters achieved more significant VA improvement at final visits in all cohorts compared with eyes with >70 VA letters (p < 0.001). The mean decreases in CMT from baseline to last visits at 12-, 24-, and 36- month cohorts were -100.5 µm, -107.7 µm, and -114.3 µm, respectively (p < 0.001). The mean number of injections given were 4.6, 2.3, and 1.8 during years 1 to 3, respectively. Patients who received loading dose showed greater VA gains than those who did not in all follow-up cohorts. CONCLUSION: Our study revealed that anti-VEGF treatment improved VA and CMT over a follow-up of 36 months. Although these real-life VA outcomes following anti-VEGF therapy for DME were similar to other real-life studies, they were inferior to those noted in randomized controlled trials, mainly due to undertreatment.

Optical coherence tomography and neurodegeneration in epilepsy.

PURPOSE: To compare optical coherence tomography measurements; central macular thickness, ganglion cell complex, and retinal nerve fiber layer thickness in patients with epilepsy versus healthy controls. METHODS: We evaluated 28 eyes of 28 patients with epilepsy and 34 eyes of 34 healthy subjects. Central macular thickness, ganglion cell complex, and retinal nerve fiber layer thickness measurements were performed by spectral-domain optical coherence tomography. RESULTS: Superior and superotemporal quadrant ganglion cell complex, average, and superior quadrant retinal nerve fiber layer thickness measurements were significantly lower in epilepsy group compared to healthy control subjects. Central macular thickness was significantly lower in polytherapy group compared to monotherapy group. Ganglion cell complex and retinal nerve fiber layer thickness measurements were not significantly different between polytherapy and monotherapy groups. CONCLUSION: The present study shows that epileptic patients taking antiepileptic drugs have reduced ganglion cell complex and retinal nerve fiber layer thickness compared to healthy controls. This can be related to the epileptic process in the brain. Optical coherence tomography may be a useful tool for showing the neurodegeneration in patients with epilepsy.

Comparison of Optical Coherence Tomography Angiography Findings in Patients with Behçet's Disease and Healthy Controls.

PURPOSE: To investigate optical coherence tomography angiography (OCTA) findings in patients with Behçet's disease (BD). METHODS: Ninety-four eyes of 49 patients with BD and 53 eyes of 53 healthy subjects were included. Vascular density (VD), foveal avascular zone (FAZ) area, perifoveal capillary hypoperfusion, perifoveal capillary network disorganization, and FAZ irregularity were analyzed. RESULTS: OCTA revealed retinal VD reduction and higher perifoveal capillary hypoperfusion, perifoveal capillary network disorganization and FAZ irregularity in ocular Behçet's compared to nonocular Behçet's (p = .000). However, compared to normal eyes, there was no difference between any OCTA measurements in nonocular BD patients. The mean area of FAZ was not different in any group (p = .266). In ocular Behçet, visual acuity was inversely correlated with FAZ area and FAZ irregularity. CONCLUSION: Retinal VD decreases and perifoveal microvascular network changes in ocular Behçet's. FAZ irregularity may be a more valuable marker than FAZ area for indicating ocular involvement.

SPONTANEOUS SUPRACHOROIDAL HEMORRHAGE ASSOCIATED WITH IATROGENIC COAGULOPATHY.

PURPOSE: To present a case of spontaneous suprachoroidal hemorrhage in a patient on anticoagulation. METHODS: Single case report. RESULTS: A 68-year-old woman with a history of hypertension, atherosclerosis, and heart failure presented with massive spontaneous suprachoroidal hemorrhage in the left eye. She had no known ophthalmic pathology. She was taking warfarin and she had a high international normalization ratio. Despite medical and surgical therapy, there was no improvement and vision deteriorated to no light perception. CONCLUSION: Spontaneous expulsive suprachoroidal hemorrhage is a rare entity. Advanced age, systemic anticoagulation, and hypertension are strong risk factors. It is important to monitor international normalization ratio in warfarinized patients; particularly, uncontrolled high levels may cause spontaneous suprachoroidal hemorrhage in the absence of predisposing ocular pathology.

Risk factors for suture requirement and early hypotony in 23-gauge vitrectomy for complex vitreoretinal diseases.

PURPOSE: To find out the rate of suture requirement and post-operative hypotony in a series of 23-gauge pars plana vitrectomy cases and analyze the factors affecting post-operative hypotony and leakage of sclerotomy leading to suture placement. METHODS: This is a single-center retrospective interventional case series. Eighty-four eyes underwent 23-gauge vitrectomy. Primary endpoint measures were rate of leakage of 23-gauge sclerotomies requiring suture placement at the end of surgery and rate of early post-operative hypotony. Secondary endpoint measures were risk factors for early hypotony and leakage requiring suture placement at the end of surgery. RESULTS: Suture placement in at least one sclerotomy because of sclerotomy leakage was required in 28.6 % (24 of 84) of eyes at the end of surgery. Early post-operative hypotony was seen in 14.3 % (12 of 84). Silicone oil endotamponade and single-step surgery were found as factors increasing the risk of sclerotomy leakage leading to suture placement. Suture placement was the only significant factor increasing the risk of early post-operative hypotony. CONCLUSION: Sclerotomy sutures may be required in 23-gauge surgery, more frequently in cases of single-step sclerotomy and/or silicone oil endotamponade. Meticulous suturation of leaking sclerotomies may decrease the rate of post-operative hypotony.

''The association of normal tension glaucoma with Buerger's disease: a case report''.

BACKGROUND: To report a case of a 48-year-old man with Buerger's disease who presented with bilateral normal-tension glaucoma (NTG). CASE PRESENTATION: A 48-year-old man who had been diagnosed with Buerger's disease 12 years ago, and received bilateral below-the-knee amputations for ischemic ulcers of the lower limbs, presented at our clinic due to a sudden loss of visual acuity in the left eye. A fundus exam revealed a cup-to-disc ratio of 0.5 for the right eye and 0.8 for the left eye, arteriolar constriction in both eyes, retinal edema in the inferopapillary area, and splinter hemorrhages and soft exudate in the left eye. We diagnosed the patient as having acute nasal branch retinal artery occlusion in the left eye and bilateral NTG, as a result of the ophthalmologic examination and the other findings. CONCLUSION: Although the pathomechanism of NTG is still unknown, previous studies have suggested that patients with NTG show a higher prevalence of vasospastic disorders. We present the second report of NTG associated with Buerger's disease to be described in the literature.

[Could plasma D-dimer levels be a predictive marker for prognosis in lung cancer?]. / Plazma D-dimer düzeyleri akciger kanserinde prognoz için bir belirteç olabilir mi?

INTRODUCTION: Plasma concentrations of circulatory markers of hemostatic activation which may be associated with tumor growth and dissemination have been shown to predict prognosis in malignancy. The present study was designed to investigate the prognostic value of plasma D-dimer level in lung cancer. MATERIALS AND METHODS: Plasma levels of the D-dimer in 138 lung cancer patients [98 non-small cell lung cancer (NSCLC), 40 small cell lung cancer (SCLC)] were measured before the initiation of any therapy and each chemotherapy. RESULTS: There were 124 (89.9%) men and 14 (10.1%) women with a mean age of 62.8 years (range 38-84). There were no statistically significant differences among the histopathologic types for NSCLC patients. Stage IIIA NSCLC group had statistically significant higher D-dimer level than stages I-II and IV. D-dimer levels were increased significantly after 4 cycles of chemotherapy in progressive disease. The median survival times in NSCLC patients were 26.6 months (95% CI, 17.6-35.6) and 15.9 months (95% CI, 4.2-27.7; p= 0.037) respectively, for patients with a low D-dimer level (≤ 1.2 ng/L) and a high D-dimer level (> 1.2 ng/L).With the cox-regression analysis, the plasma level of D-dimer and tumour stage were identified as independent predictive factors of the survival. CONCLUSION: These results suggest that plasmalevel of D-dimer can act as a predictive factor of decreased survival and a poor response to the treatment in lung cancer.

Decompression retinopathy and possible risk factors.

PURPOSE: To discuss the underlying mechanisms in decompression retinopathy. METHODS: Report of two cases. RESULTS: Retinal hemorrhages secondary to decompression retinopathy occurred following combined trabeculotomy-trabeculectomy with mitomycine-C (MMC) in one eye of a case of congenital glaucoma and pars plana vitrectomy-lensectomy in a case of vitreous condensation secondary to pars planitis. Both cases were operated under general anesthesia. Postoperative hypotony did not take place in either eye. The same surgical procedure was performed on the other eye of the patient with congenital glaucoma 1 week apart. Postoperative decompression retinopathy was not seen in this eye despite hypotony was recorded. CONCLUSION: Valsalva manoeuvre, hypotony and other factors may play a role individually or in combination in the pathogenesis of decompression retinopathy.

Hydrogel tissue adhesive for sealing corneal incisions.

The purpose of the study was to assess the efficacy of a newly developed hydrogel tissue adhesive for sealing corneal incisions in ex vivo rabbit eyes. Simple through-and-through central linear corneal incisions measuring 1-5 mm were created in enucleated rabbit eyes. As controls, the leaking pressures were measured immediately after the incisions had been made. Afterwards, the incisions were sealed with hydrogel adhesive in group 1 and with a single 10-0 nylon suture in group 2. The leaking pressure of each incision was measured after the wounds had been sealed in both groups. The leaking pressures of the controls and the sealed incisions were compared for statistical significance using the Wilcoxon signed rank test. The difference between the leaking pressures before and after sealing the incisions in groups 1 and 2 were compared using the Mann-Whitney rank sum test. The leaking pressures were significantly higher after sealing in both groups 1 and 2 compared to the controls for all incision sizes. The differences in the leaking pressures before and after adhesive application were higher than before and after suturing in all incision sizes. The differences were all statistically significant except for the 1-mm incisions. We conclude that the hydrogel glue has the potential to be used for sealing corneal incisions measuring up to 5 mm.