2024 Issue 3 at a Glance:
Esteemed colleagues,
This issue of our journal includes 6 original research articles, 1 review, and 3 case reports from various fields of ophthalmology that we hope will be an interesting and useful read for you.
Laser-assisted in situ keratomileusis (LASIK) is safe and effective and the most commonly performed refractive surgical method. Because corneal tissue is removed, all excimer laser procedures affect corneal biomechanics. Post-LASIK ectasia (PLE) is characterized by progressive thinning and steepening of the cornea that causes refractive aberration and severe vision loss. Tanrıverdi et al. treated 26 eyes of 16 patients with PLE with the modified Cretan protocol (combined transepithelial phototherapeutic keratectomy and accelerated corneal collagen cross-linking) and evaluated visual, refractive, tomographic, and aberrometric results and point spread function (PSF) preoperatively and 6, 12, and 24 months after treatment. They stated that the modified Cretan protocol in PLE patients is an effective and safe treatment option that can provide significant improvement in visual stabilization and topographic parameters over 24-month follow-up (See pages 120-126).
Fabry disease (FD) is a rare X-linked lysosomal storage disease characterized by impaired glycosphingolipid metabolism due to absence or deficiency of the alpha-galactosidase A enzyme (α-Gal). Cardiopathy, neuropathy, and cerebrovascular diseases are the most serious clinical findings associated with increased morbidity and mortality in FD. Although ophthalmological involvement is quite common in FD and is among the early signs of the disease, it is often overlooked. Korkmaz et al. included 30 eyes of 15 patients diagnosed based on clinical findings, genetic analysis, and biochemical evaluation in their prospective cross-sectional study evaluating the ocular findings of patients with FD admitted to a tertiary eye clinic in Türkiye. Corneal verticillata, which is considered to be the most characteristic ocular finding in FD, was not detected in approximately one-third of the patients, and only 26.6% of the patients had cataract, another well-known ocular finding in FD. The authors emphasized that awareness among ophthalmologists about the findings and incidence of FD may facilitate early and accurate diagnosis (See pages 127-132).
A prospective study by Sert et al. aimed to examine changes in tear oxidative stress levels and tear film functions after conjunctiva-Müller muscle resection (CMMR) and blepharoplasty in patients with blepharoptosis and dermatochalasis. The study included 32 healthy controls and 62 patients with blepharoptosis or dermatochalasis, in whom 20 eyes underwent CMMR surgery and 42 eyes underwent upper blepharoplasty. Tear levels of oxidative stress markers (8-2’-deoxyguanosin [8-OHdG] and 4-hydroxy-2-nonenalhydroxy [4-HNE]) were determined by enzyme-linked immunosorbent assay and tear film functions were evaluated preoperatively and at postoperative 1 and 6 months. Patients with dermatochalasis or blepharoptosis were shown to have higher levels of oxidative stress markers in the tear film compared to the healthy controls. Blepharoplasty and CMMR did not cause any difference in Schirmer or Ocular Surface Disease Index scores at postoperative 1 and 6 months, while CMMR caused a temporary decrease in tear break-up time and increase in tear oxidative stress markers levels (See pages 133-139).
Neurofibromatosis type 1 (NF-1) is an autosomal dominant disease caused by deletions or mutations in the neurofibromin gene on chromosome 17p11.2. NF-1 is characterized by a range of findings such as nerve tumors that can develop in various parts of the body, skin pigmentation changes (cafe au lait spots, axillary and inguinal freckling), vascular abnormalities, and bone lesions (pseudoarthrosis, sphenoidal wing hypoplasia), and ocular involvement is also common. The NF-1 diagnostic criteria determined by the National Institute of Health include the presence of two or more Lisch nodules on the iris and optic nerve glioma as ophthalmological findings. It has been suggested that the presence of at least two choroidal anomalies defined as “bright, patchy nodules” in optical coherence tomography (OCT) or infrared reflectance (IR) imaging should also be used as a diagnostic criterion for NF-1. These choroid-level lesions are hamartomatous nodules and are also referred to as “Yasunari nodules”. In their retrospective study titled “Multimodal Imaging Characteristics and Diagnostic Value of Choroidal Nodules in Patients with Neurofibromatosis Type 1”, Ahmadova et al. examined 54 eyes of 27 patients and found that Yasunari nodules were frequently observed in NF-1 cases and can be easily detected with multimodal imaging techniques, especially with IR imaging. As choroidal nodules can be seen before the appearance of Lisch nodules, this study highlights the importance of Yasunari nodules in the diagnosis of NF-1 (See pages 140-148).
Retinal vein occlusions (RVO) occur as a result thrombus blocking the retinal venous system, and the most common etiological factor is atherosclerotic retinal arteries compressing the veins at the arterial-venous junction. Risk factors for RVO include advanced age, diabetes mellitus, hypertension, atherosclerotic vascular disease, and glaucoma. The triglyceride-glucose (TyG) index, calculated with the formula ln(fasting TG [mg/dL] × fasting plasma glucose [mg/dL]/2) is a marker of atherosclerosis in cardiovascular diseases. A case-controlled observational study by Katipoğlu and Turan aiming to reveal the relationship between TyG index and RVO included 387 patients (181 females and 206 males) diagnosed with RVO and 115 patients (61 females and 54 males) as the control group. The TyG index was found to be higher in the RVO group (8.9±0.7) compared to the control group (8.8±0.6) (p=0.04), and the authors suggested that the TyG index, which is obtained by a simple calculation, could be a reliable indicator to identify individuals at high risk of RVO and to initiate treatment early (See pages 149-152).
Malik and Moin retrospectively evaluated the records of 18 patients with carotico-cavernous fistula who underwent digital subtraction angiography and subsequent endo-arterial balloon embolization and stated that this method was safe and simple with demonstrated effectiveness, especially when performed in a timely manner (See pages 153-158).
Tissue engineering (TE) aims to treat, repair, or replace damaged tissues and organs using cells and appropriate physiological factors together with bioengineering, biomedical engineering, and materials sciences. Areas of TE research also include developing disease models, creating tissue scaffolds for cells, and delivering active drug components to tissues. The fact that the eye is an easily accessible organ amenable to engineering applications has paved the way for the use of TE in ophthalmology. In this issue’s review, Utine and Güven describe in detail the application areas of TE in ophthalmology in light of the current literature (See pages 159-169).
Iridocorneal endothelial (ICE) syndrome is a disease group in which corneal endothelial cells proliferate and migrate to the iridocorneal angle and over the iris. There are three clinical variants: Chandler syndrome, progressive iris atrophy, and Cogan-Reese syndrome. In ICE syndrome, abnormally proliferating endothelial cells form a membrane over the iridocorneal angle and peripheral iris. This membrane can cause pupillary disorder, high intraocular pressure (IOP), corneal decompensation, and corneal edema due to peripheral anterior synechiae and peripheral iris traction. Güler Canözer et al. presented the in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) findings of three female patients who presented due to low vision and high IOP. The authors pointed out that ICE syndrome should be suspected especially in female patients with pupil irregularity and corneal edema accompanying unilateral IOP elevation, and noted that IVCM and AS-OCT are diagnostically useful non-invasive imaging methods that can reveal the abnormal structures and anterior segment migration of endothelial cells with epithelial characteristics in ICE syndrome (See pages 170-174).
Kayabaşı et al. detected multiple yellowish-white retinitis foci, vascular engorgement, and scattered intraretinal hemorrhages extending from the posterior pole to the peripheral retina in the right eye of a 78-year-old male patient who presented with complaints of a gradual decrease in vision in the right eye for 2 weeks and a history of chemotherapy and radiotherapy for lung cancer and Coronavirus Disease 2019 infection. The patient was diagnosed with endogenous endophthalmitis and received intravitreal vancomycin, ceftazidime, clindamycin, and dexamethasone. Vitreous culture demonstrated the presence of Aspergillus lentulus, and the patient was treated with intravitreal amphotericin-B and voriconazole injections and systemic amphotericin-B, voriconazole, posaconazole, and micafungin therapy. Vitreoretinal surgery was performed due to rhegmatogenous retinal detachment during follow-up. However, despite retinal reattachment, the patient required enucleation due to the development of a painful red eye. On histopathological examination, atypical squamous cells compatible with metastasis were detected beneath the neurosensory retina. By presenting this case, the authors emphasized that timely eye examination is vital in all immunosuppressed patients with ocular symptoms, and fungal pathogens should be considered as possible causes of endogenous endophthalmitis (See pages 175-179).
In traumatic injuries, cerebrospinal fluid (CSF) fistula can develop for various reasons. It most commonly presents as rhinorrhea and otorrhea, but oculorrhea can also occur in some cases, especially in patients with direct eye trauma. Akbulut and Bolat present the case of a 4-year-old child who was referred to a tertiary care center due to a dog bite to the left eyelid and was observed to have lid edema and increased lacrimation secondary to inflammation on initial examination. However, observation of an increase in clear discharge in the reverse Trendelenburg position and upon Valsalva maneuver during follow-up and subsequent positive halo sign and beta-transferrin test led to the diagnosis of a CSF fistula. A supraorbital craniotomy was performed via an eyebrow incision and the dural tear was repaired by primary suturing supported with a galeal graft and fibrin glue. The authors concluded that oculorrhea may be mistaken for lacrimation in patients with penetrating orbital trauma and CSF fistula must be considered (See pages 180-182).
We hope that the articles featured in the third issue of this year will be of interest to you and will guide your medical practice.
Respectfully on behalf of the Editorial Board,
Özlem Yıldırım, MD
