Prognostic factors and clinical features of rhino-orbital-mucormycosis cases: an update for patient and visual survivals.

AIM: To determine the frequency of patients' vision survival and prognostic factors and evaluate clinical features in rhino-orbital mucormycosis. METHODS: Forty-three eyes of 43 patients followed up with orbital mucormycosis infections were included in the study. Demographic characteristics of the patients, symptoms at admission, ophthalmologic and non-ophthalmologic examination findings, clinical findings during follow-up, medical and surgical procedures, and complications were recorded. Patient survival was determined by assessing the incidence of mortality, and vision survival was defined as achieving a final visual acuity of at least light perception. RESULTS: Twenty-seven (62.8%) patients were male, and 16 (37.2%) were female. When the underlying disease status of the patients was examined, it was observed that all patients had an underlying disease and diabetes constituted the majority (65.2%). Periorbital swelling (69.8%) and ophthalmoplegia (53.5%) were the most common symptoms and findings at the admission of patients with mucormycosis infection. The disease resulted in death in 22 (51.2%) patients. The presence of fever and shorter duration of antifungal therapy were associated with lower patient survival. Exenteration surgery was not found to be associated with the survival of the patients. Frozen eye, loss of pupillary light reflex, and development of central retinal artery occlusion were associated with lower vision survival. CONCLUSION: This study presents one of the most extensive patient series in the literature on rhino-orbital mucormycosis. Knowing the patients' symptoms at the time of admission and the clinical findings during the infection process will increase awareness about the disease.

A Rare Presentation of Anthrax: A Pediatric Patient with Palpebral Anthrax.

Anthrax is a rare zoonotic disease in humans caused by Bacillus anthracis. The most common form of this disease is cutaneous anthrax. Rarely, eye involvement may occur. In this case, a nine-year-old male patient with anthrax on his left eyelids is presented. From the patient's history, it was learned that a slight papular reaction occurred on the left side of the eye, then the lesion enlarged within three days, and edema developed around the eye. On the fifth day of the patient's preseptal cellulitis diagnosis, progress in eye lesions and necrosis and eschar formation around the eyes were detected, while Bacillus anthracis polymerase chain reaction (PCR) positivity was detected on the fifth day of the patient's complaints. The patient was treated with ciprofloxacin and clindamycin and a clinical response was achieved. Anthrax should be kept in mind in the differential diagnosis of preseptal and orbital cellulitis, especially in patients who have close contact with animals. If palpebral anthrax is not treated effectively on time, it can leave scars on the eyelids and cause permanent deformities and loss of function. Early diagnosis and initiation of antibiotic therapy significantly reduce the occurrence of complications. In this case report, a pediatric case with eyelid anthrax, which is rarely seen in anthrax disease, is presented.

Scleral fixation of iris-Intraocular lens complex (Reper®) with Canabrava double-flanged technique: a case report.

A 38-year-old patient who developed aphakia and aniridia secondary to trauma suffered from vision loss. To improve her vision, an iris-intraocular lens complex (Reper®) was fixed to the sclera with Canabrava's double-flanged technique. There was a satisfactory increase in the patient's visual acuity and no complications were observed during the 6-months follow-up. Canabrava technique simplifies and improves the fixation of the iris-intraocular lens complex to the sclera. It is a safe option that does not require scleral flaps or knots.

Obsructive sleep apnea syndrome: is it a risk factor for ocular surface disease and ocular comorbidities?

PURPOSE: To investigate the accompanying ocular findings in patients with obstructive sleep apnea syndrome (OSAS) and evaluate the susceptibility to ophthalmological diseases. MATERIALS AND METHODS: In this cross-sectional study, qualifying study subjects were patients who had been diagnosed with severe OSAS (apnea/hypopnea index (AHI > 30/h), n = 31), and control subjects (n = 30) who had an AHI index of < 5 (as normal). General ophthalmological examination, eyelid laxity measurements, corneal topography, visual field, retinal nerve fiber layer parameters, dry eye tests were performed on the patients. RESULTS: It was observed that the two groups had similar characteristics in terms of gender, age, presence of hypertension, diabetes, and body mass index. According to eyelid laxity measurements, the incidence of loose eyelids was higher in the OSAS patient group. Choroidal thickness was thinner in the study group than in the control group. Schirmer test and tear break-up time were significantly lower in the study group than in the control group. The percentage of meibomian gland loss in meibography and the ocular surface disease index score for symptoms was significantly higher in the study group than in the control group. CONCLUSION: In this study, we found significant changes in ocular surface parameters, eyelid laxity, choroidal thickness, and visual field indices in OSAS patients. Dry eye syndrome might be related eyelid laxity and inflammation in OSAS patients. Early diagnosis and follow-up of ocular diseases in OSAS, which affect the quality of life and visual prognosis in advanced ages, are important.

Scleral fixation of iris-Intraocular lens complex (Reper®) with Canabrava double-flanged technique: a case report / Fixação escleral de um complexo íris-lente intraocular (Reper®) com técnica de flange duplo de Canabrava: relato de caso

ABSTRACT A 38-year-old patient who developed aphakia and aniridia secondary to trauma suffered from vision loss. To improve her vision, an iris-intraocular lens complex (Reper®) was fixed to the sclera with Canabrava's double-flanged technique. There was a satisfactory increase in the patient's visual acuity and no complications were observed during the 6-months follow-up. Canabrava technique simplifies and improves the fixation of the iris-intraocular lens complex to the sclera. It is a safe option that does not require scleral flaps or knots.

RESUMO Uma paciente de 38 anos desenvolveu afacia e ani­ridia secundárias a um trauma, levando à perda da visão. Para melhorar sua visão, um complexo de íris e lente intraocular (Reper®) foi fixado à esclera com a técnica de flange duplo de Canabrava. Houve um aumento satisfatório na acuidade visual do paciente e nenhuma complicação foi observada durante o acompanhamento de 6 meses. A técnica de Canabrava simplifica e melhora a fixação do complexo de íris e lente intraocular na esclera. É uma opção segura que não requer retalhos ou pontos esclerais.

Tarsorrhaphy with Sutureless Amnion Transplantation: Practical Management of Ocular Surface Pathologies.

Objectives: The objective of the study was to evaluate the technique of tarsorrhaphy combined with sutureless amniotic membrane transplantation in the treatment of resistant ocular surface pathologies. Methods: In this study, the post-operative results of patients who underwent tarsorrhaphy combined with sutureless amniotic membrane between May 2016 and July 2021 were evaluated. In this technique, we have placed the amniotic membrane on the ocular surface, and then simple tarsorrhaphy has been performed. We used this technique in our six patients during COVID-19 pandemic period at the bedside. The outcomes of corneal epithelial healing, visual acuity, pain score, patient tolerance, and adverse events were evaluated. Results: Fourteen patients (eight females and six males) were included in the study. The mean age of the patients was 65.7 years (range 9-96 years). The mean follow-up period was 9 months (range 6-12 months). In all cases, epithelial defect healed completely and it was seen that this new technique facilitated resolution of pain and inflammation and promoted epithelialization in our 14 cases with resistant ocular surface pathologies. Post-operative pain score was significantly lower than pre-operative pain score (p<0.05). Conclusion: Our results demonstrate that tarsorrhaphy with sutureless amniotic membrane accelerates the ocular surface healing process and increases the efficiency of amniotic membrane. This method has an important advantage that it can be performed at bedside. Patients and ophthalmologists need such an innovative treatment which is effortless, effective, and practical especially for the pandemic period.

Multicenter case series of standalone XEN implant vs. combination with phacoemulsification in Turkish patients.

PURPOSE: To evaluate and compare the efficacy, safety and needling timing and rates of standalone XEN implant vs. combination with phacoemulsification in Turkish patients. METHODS: Retrospective, multicenter study which included the data of patients, who had open angle glaucoma including primary open angle glaucoma and pseudoexfoliation glaucoma, underwent standalone XEN implantation (XEN alone) and combined surgery with phacoemulsification (XEN + Phaco) between 2016 and 2018. RESULTS: The study included 26 eyes of 24 patients in XEN alone group and 32 eyes of 30 patients in XEN + Phaco group. The mean intraocular pressure (IOP) was 23.3 ± 6.0 mmHg and 24.4 ± 7.4 mmHg at baseline (p = 0.838), and it reduced to 16.3 ± 3.0 mmHg and 16.4 ± 2.3 mmHg at 12-month follow-up (p = 0.436) in XEN alone and XEN + Phaco groups, respectively (reduction: %30 and %33, P = 0.642). The mean number of medications reduced from 2.9 + 0.7 before surgery to 0.9 + 0.9 on month 12. In XEN alone and XEN + Phaco groups, the needling rates were 42.3% and 31.2% (p = 0.491), and the mean time to needling was 3.7 ± 3.2 months and 4.9 ± 8.0 months (p = 0.696), respectively. Hypotonia (17.2%) and hyphema (10.3%) were the most frequent complications, respectively. In XEN alone and XEN + Phaco groups, partial success was achieved in 73.1% and 71.9% of eyes when defined as IOP < 18 mmHg with any medication, respectively (p = 0.920). CONCLUSION: The XEN implant provides significant reduction in IOP and number of medications, either standalone or combination with phacoemulsification. Both procedures need intensive postoperative care, requiring needling in approximately one-third of patients.

Evaluation of the Cataract Surgery 2018 Survey in Terms of Achieving Refractive Cataract Surgery Targets.

Objectives: The aim of this study was to show at what rate the technological equipment used in cataract surgery by Turkish ophthalmologists and their knowledge are reflected in practice and how up to date they are. Materials and Methods: A questionnaire conducted using SurveyMonkey was used to evaluate the answers to 17 questions from 823 members of the Turkish Ophthalmological Association. Results were evaluated in subgroups according to the participants' age, occupational status, institutions, and whether they conducted relevant academic activities, and the data were compared as inadequate, standard, and contemporary approaches according to the determined criteria. Results: Optical biometry devices were used at rates of 77.7% and 67.3% for intraocular lens (IOL) power calculations and keratometric measurements in preparation for cataract surgery, respectively. For IOL power calculation, third-generation formulas, especially the SRK-T, were used most commonly (46.2%), followed by second-generation formulas (21.9%), and fourth/fifth-generation formulas and multiple evaluations for different axial lengths (31.9%). The most common incision size was 2.8 mm (51.6%), while the percentage of 2.2 mm and shorter incisions considered to be neutral in terms of surgically induced astigmatism was 18.8%. When selecting incision location, approaches to reduce corneal astigmatism were reported by 28.9%, neutral approaches by 26.2%, and insensitive approaches by 44.9%. Additionally, 55.6% of participants never implanted toric IOLs and 50.7% did not use presbyopia-correcting IOLs. The proportion of surgeons who have experience with femtosecond laser-assisted cataract surgery was 10.3% and the rate of intracameral antibiotic injection at the end of the operation was 89.4%. Conclusion: It was seen that Turkish cataract surgeons were able to use high technology for surgical preparation and surgery at high rates, but this was not reflected in practice at same rate in terms of achieving contemporary standards of refractive cataract surgery.

The Role of Topical Azithromycin in the Treatment of Meibomian Gland Dysfunction.

PURPOSE: The efficacy of topical azithromycin (AZ) supplementation to systemic AZ has not been studied. This study evaluates the efficacy of topical AZ supplementation to systemic AZ, warm compresses, artificial tears, and lid scrubs for the treatment of meibomian gland dysfunction (MGD). METHODS: Eighty-five patients with stage 4 MGD were enrolled in the study. The patients enrolled into the study were divided into 2 groups. Group 1 comprised 55 patients who received preservative-free topical 1.5% AZ administered as a unit dose, and group 2 comprised 30 patients who did not receive topical AZ. Both groups were prescribed artificial tear eye drops and systemic AZ. Fluorescein tear film breakup time (TBUT), corneal staining, Ocular Surface Disease Index (OSDI) symptom scores, and meibum quality were evaluated at baseline and after 1 and 3 months. RESULTS: The mean age of patients in group 1 was 48.3 ± 13.4 years (25 men and 30 women) and in group 2 was 50.7 ± 10.2 years (12 men and 18 women). After treatment at the first and third month, group 1 showed significant improvement in mean TBUT, mean corneal staining score, meibum quality, and mean OSDI scores compared with baseline (P < 0.05). In group 2, only the OSDI score and meibum quality improved significantly after treatment compared with baseline (P < 0.05). CONCLUSIONS: These results demonstrate clinically and statistically greater improvement in MGD-associated signs and symptoms with the addition of topical AZ to the systemic treatment.

[External ophthalmomyiasis: case reports]. / Oftalmomiyazis eksterna: olgu sunumlari.

We report two cases with external ophthalmomyiasis due to infestation with the larvae of Oestrus ovis. During an ophthalmologic examination, motile larvae were seen on the conjunctiva, which were removed and sent to the Department of Parasitology for identification. Microscopic examination of the specimens revealed that both patients were infested with the first stage larvae of O. ovis. The patients were treated with topical antibiotics and steroids and recovered without any complications. O. ovis larvae are the most common cause of ophthalmomyiasis worldwide. They are usually seen in underdeveloped, agricultural areas with high numbers of livestock, especially during Spring and Summer. These kind of infestations should be kept in mind in cases of conjunctivitis in the warm months of the year.

Autologous human fibrin glue in multilayered amniotic membrane transplantation.

We describe and evaluate the efficiency of autologous human fibrin glue in multilayered amniotic membrane transplantation in a 66-year-old female with a persistent deep corneal ulcer and descemetocele. Defective epithelium of descemetocele was removed; separate and multilayered amniotic membranes were transplanted using autologous human fibrin glue. Finally a large amnion at the top was sutured on the cornea.

Topical mitomycin C for the treatment of conjunctival tumor.

BACKGROUND: To evaluate the efficacy of topical mitomycin C (MMC) for the treatment of conjunctival tumor in a prospective design. METHODS: Nine patients (nine eyes) with conjunctival tumor were studied. The patients received topical MMC 0.04% four times daily by one to six courses. Each course consisted of medication for consecutive 7 days followed by 1 week without medication. Follow-up was conducted on patients for control of disease, and side effects. RESULTS: In 7 patients, the tumor completely disappeared during the mean follow-up period of 24.57 +/- 5.94 months (range 18-35 months) with no recurrence. In 1 patient, there was no regression of the tumor, and in 1 patient cessation of the treatment was needed because of an adverse effect of the drug. CONCLUSION: Topical MMC is effective for the treatment of conjunctival tumor. Longer follow-up and large series are needed to assess the duration of tumor control.

Pars plana vitrectomy in ocular injury with intraocular foreign body.

BACKGROUND: We evaluated 70 cases of ocular injuries with intraocular foreign bodies to determine the results of surgical management. METHODS: The site of penetration was cornea in 58 (82.9%), sclera in 8 (11.4%), and limbus in 4 (5.7%) eyes. The foreign body was in the vitreous in 40 (57.1%) and embedded in the retina in 30 (42.9%) cases. Before pars plana vitrectomy, the most common findings were found to be lens perforation (77.1%), vitreous hemorrhage (45.7%), endophthalmitis (20%), hyphema (4.3%), and retinal detachment (2.9%). RESULTS: After pars plana vitrectomy, visual acuity improved in 39 (55.7%), did not change in 19 (27.2%), and decreased in 8 (11.4%) cases. We observed secondary glaucoma in 11 (15.7%), retinal detachment in 10 (14.3%), and phthisis bulbi in 3 (4.3%) cases postoperatively. CONCLUSION: Pars plana vitrectomy is found to be an effective therapeutic approach in removing intraocular foreign bodies, but the preoperative and postoperative complications determine the visual outcome.

Non-Hodgkin lymphoma presenting with uveitis occurring after blunt trauma.

We report here an unusual patient suffering from visual loss with refractory uveitis which was occured after a blunt trauma to her left eye. While in the hospital cervical lymph node and anterior chamber aspiration cytology with immunohistochemical staining were performed. The histopathologic diagnosis was highly malignant B-cell non-Hodgkin lymphoma. After the inflammation of the eye was regressed with chemotherapy, pars plana vitrectomy-lensectomy was performed. She was free of inflammation and the best corrected visual acuity was increased. However, she had a refractory inflammatory episode with clumps of cells in the anterior chamber 10 months after the operation. Local radiotherapy to the left eye was applied. Radiotherapy provided local control and preservation of the vision. The present case is presented in order to emphasize the importance of systemic evaluation in uveitis and possible role of trauma leading migration of atypical cells into the eye.

The aqueous levels of TGF-beta2 in patients with glaucoma.

PURPOSE: To evaluate the aqueous levels of transforming growth factor beta-2 (TGF-beta2) in open angle glaucoma patients. METHODS: The aqueous levels of active TGF-beta2 were detected in 17 eyes of 17 patients using ELISA method. The control group consisted of 6 cataract extracted patients. RESULTS: Mean age of the patients (60.8 +/- 8.8 years) was similar to that of the controls (57.5 +/- 9.8 years) (p = 0.516). Levels of TGF-beta2 in aqueous samples of glaucoma patients (2.74+/- 1.23 ng/ml) were found to be elevated when compared to those of controls (1.67 +/- 0.32 ng/ml) (p = 0.020). CONCLUSION: We might suggest that the elevated levels of TGF-beta2 in the aqueous of glaucoma patients could play a role in the pathogenesis of glaucoma.