2017 issue 1 at a glance;
This issue of our journal includes six original articles, one review, and five case reports from Turkish ophthalmologists endeavoring to further science, selected with the aim of contributing to the global sharing of knowledge.
The accurate measurement of intraocular pressure (IOP) is particularly important in the diagnosis and treatment of pediatric glaucoma. Assessment of IOP in pediatric patients can be difficult due to noncompliance, and various instruments may yield different results. In a study aiming to compare IOP measurements made with the Tono-Pen (TP), Goldmann applanation tonometer (GAT), and non-contact tonometer (NCT) in pediatric patients, Eraslan et al., measured the IOP of patients with good compliance ranging from 5 to 17 years old in a seated position in outpatient conditions. They found that TP values were lower and NCT values were higher than GAT values, and emphasized that these differences should be considered when evaluating patients (see pages 1-4).
Güngör et al., used biomicroscopy and gonioscopy to investigate early signs of pseudoexfoliation (PEX) syndrome in the supposedly healthy fellow eye of patients with unilateral PEX syndrome. They report detecting early signs related to PEX, such as pigmentation and Sampaolesi’s line at the inferior angle, in these eyes (see pages 5-8).
Cat scratch disease (CSD) is a systemic condition caused by the gram-negative zoonotic bacillus Bartonella henselae. The most common clinical manifestation is lymphoid CSD, which is associated with regional lymphadenopathy and flu-like symptoms, but the disease may rarely show a disseminated course. The eye is the most commonly affected non-lymphoid organ in disseminated CSD. In their study, Oray et al., emphasize that CSD is not limited to neuroretinitis or optic neuritis, but can also manifest with superficial retinal infiltrates, retinal artery occlusion, or endophthalmitis, and therefore history of cat contact and Bartonella henselae serology are important for diagnosing the condition (see pages 9-17).
Kıvanç et al., evaluated the demographic characteristics and clinical outcomes of work-related open globe injuries in an industrialized region of Turkey. Their results indicate that approximately half of such injuries result in visual impairment or blindness. The authors bring attention to the social and psychological burden this places on workers, their families, employers, and society, and conclude that both workers and employers must be educated about protective measures in order to prevent occupational accidents (see pages 18-23).
Polycystic ovary syndrome (PCOS), also referred to as ovarian hyperandrogenemia, is the most common endocrinopathy in reproductive-age women. Studies in recent years have demonstrated that female sex steroids have ocular effects in addition to their systemic effects. Based on this, Adıyeke et al., compared anterior segment findings in PCOS patients and age-matched healthy women, and found significantly greater central corneal thickness and tear dysfunction in PCOS patients compared to controls (see pages 24-27).
In another original article in this issue, Çömez et al., compared retinal and optic disc features measured by optical coherence tomography (OCT) in the amblyopic and non-amblyopic eyes of patients with myopic and hypermetropic anisometropia. They found no significant differences between the eyes in terms of mean retinal nerve fiber layer (RNFL) thickness, macular thickness, macular volume, or optic disc area, and concluded that the amblyopic process does not have a pronounced effect on the RNFL, macula, or optic disc (see pages 28-33).
In their review, Çeliker et al., compare multispot lasers (MSLs) and conventional lasers in terms of efficacy and side effects when used for panretinal photocoagulation in diabetic retinopathy. They report that MSLs cause less retinal tissue damage, less pain, and provide better patient comfort. They also note that patients treated with short-duration, single-session MSL therapy must be followed to monitor its effectiveness, and we should not hesitate to apply additional treatment when necessary (see pages 34-41).
In the first case report of this issue, Şimşek et al., present a case of active Graves’ orbitopathy and psoriasis treated with rituximab. They report regression of the patient’s inflammatory signs associated with the disease but no change in proptosis after treatment. The authors note that currently available therapeutic approaches are not effective in one-third of patients, suggesting that rituximab, a monoclonal antibody against the CD20 antigen present in B cells, is a promising alternative treatment for Graves’ orbitopathy (see pages 42-46).
The second case report concerns a patient with anterior segment ischemia, one of the serious complications of strabismus surgery. Göçmen et al., describe the case of a 46-year-old male patient who presented with complaints of esotropia of the right eye due to a car accident and was diagnosed with sixth nerve palsy. They performed right medial rectus muscle recession 18 months after the trauma, followed 10 months later by full-thickness tendon transposition of the superior and inferior rectus muscles (with Foster suture). However, they were faced with a postoperative complication of anterior segment ischemia. The authors observed no persistent pathologic findings other than mild pupil irregularity at 1 month after topical and systemic cortisone therapy, but they also point out the importance of possible outcomes, which may be as serious as phthisis bulbi (see pages 47-51).
In another trauma-related study in this issue, Arıcı et al., present three pediatric patients with intraocular trauma due to pencils. In the first case, the corneal injury remained lamellar at the stromal level; in the second case, a pencil perforated the cornea and contacted the iris; and in the third case, pencil lead perforated both the cornea and iris, reaching the vitreous through the zonules. Patients 2 and 3 were treated with intracameral triamcinolone supplemented with topical anti-inflammatory and cycloplegic agents after surgical removal of the pencil lead; the authors report achieving favorable outcomes in all patients after treatment (see pages 52-55).
There are a few reports in the literature of childhood-onset, spontaneously regressing optic pit maculopathy (OP-M). Bayar et al., share a case of OP-M in a six-year-old pediatric patient which regressed without treatment. They bring attention to this rare clinical presentation and its spontaneous regression (see pages 56-58).
The topic of the final case report is Susac syndrome, a fairly rare disorder characterized by the triad of encephalopathy, sensorineural hearing loss, and branch retinal artery occlusion. The diagnosis of SS can be difficult due to the asynchronous presentation of its signs. In yet another pediatric case, Kola et al. report that they were able to diagnose this condition by the detection of retinal lesions using OCT (see pages 59-62).
Respectfully on behalf of the Editorial Board,
Tomris Şengör, MD
