Iatrogenic dry eye disease (DED) has emerged as a significant but overlooked complication in both ophthalmic surgery and aesthetic medicine. Characterized by disruption of tear film homeostasis, ocular surface inflammation, and neurosensory dysfunction, this condition may arise acutely or chronically following medical interventions. The Tear Film and Ocular Surface Society Dry Eye Workshop II and III reports have highlighted iatrogenic DED as a distinct clinical entity, underscoring its multifactorial etiology and the need for tailored risk mitigation strategies. Refractive procedures such as laser in situ keratomileusis and photorefractive keratectomy are frequently implicated due to corneal nerve transection and subsequent hypoesthesia, which impair blink dynamics and lacrimal gland feedback. Cataract surgery, though largely safe, contributes via surface desiccation, intraoperative light exposure, and topical medication toxicity. Oculoplastic interventions, including blepharoplasty, introduce mechanical alterations that disrupt eyelid function and tear film distribution. Moreover, the growing demand for periocular cosmetic procedures such as botulinum toxin injections and permanent eyeliner tattooing has introduced additional risks, particularly in individuals with preexisting meibomian gland dysfunction or marginal tear function. Emerging evidence suggests that the cumulative effect of repeated exposures and inadequate preoperative screening has led to a rise in persistent ocular surface morbidity. Prevention therefore necessitates a multidisciplinary approach encompassing ophthalmologists, dermatologists, plastic surgeons, and primary care providers. Systematic pretreatment ocular surface assessment, patient counseling, and adoption of minimally disruptive techniques are essential. By integrating evidence-based risk stratification into routine care, clinicians can significantly reduce the burden of iatrogenic DED and preserve long-term visual quality and patient satisfaction in the face of expanding therapeutic and cosmetic practices.
Objectives: To compare the refractive profiles and clinical characteristics of affected and fellow eyes in unilateral Duane retraction syndrome (DRS), emphasize subtype-related variations, and assess the impact of motility restriction and ocular findings on refractive status. Materials and Methods: This retrospective cross-sectional study included 191 patients with unilateral DRS, comprising type I (n=162), type II (n=7), and type III (n=22). Best-corrected visual acuity (BCVA), cycloplegic autorefraction, astigmatism classification, and ocular alignment/motility findings were analyzed across DRS subtypes. Results: The mean age at examination was 6.67±7.13 years, and 62.3% of the patients were female. Amblyopia was observed in 23.0% of patients, anisometropia in 18.6%, and abnormal head posture in 52.7% of patients. Esotropia (42.0%) was more prevalent than exotropia (11.7%), and the majority of patients (61.4%) exhibited grade 4 horizontal limitation. Compared with fellow eyes, DRS eyes exhibited a substantially lower BCVA (p<0.001), higher spherical power (p=0.025), and greater cylindrical power (p<0.001). In both DRS (60.7%) and non-DRS (72.3%) eyes, the predominant pattern was with-the-rule astigmatism. There were no discernible variations in astigmatism subtypes among motility limitation grades or DRS subtypes. The cylindrical refractive error was independently associated with abnormal head posture (p=0.007) and horizontal deviation type (p=0.029) according to multiple regression analysis. Conclusion: Unilateral DRS is characterized by diminished visual function and increased refractive error, with cylindrical outcomes affected by head posture and type of deviation. The findings highlight the importance of integrating motility parameters into refractive evaluation and surgical planning in DRS.
Objectives To determine optimal cut-off values for first and average non-invasive tear break-up time (NIBUT-f and NIBUT-av, respectively) in dry eye disease (DED), as well as evaluate their correlation with other tests. Materials and Methods This retrospective study included 46 patients with DED and 35 healthy controls. All subjects were assessed using the Ocular Surface Disease Index questionnaire. NIBUT measurements and meibography images were obtained using the Sirius topography device. The conventional diagnostic tests Schirmer-I, tear break-up time (TBUT), ocular surface staining (OSS), Marx line score, and lid wiper epitheliopathy (LWE) grade were performed. Results The cut-off values of NIBUT-f and NIBUT-av for DED diagnosis were identified as 10.7 and 12.2 seconds, respectively. The area under the curve (AUC) was 0.93 (95% confidence interval [CI]: 0.889-0.992) for NIBUT-f and 0.92 (95% CI: 0.872-0.985) for NIBUT-av. For the differentiation between evaporative and mixed DED subtypes, the NIBUT-av cut-off value was 7.2 seconds, with an AUC of 0.63 (95% CI: 0.512-0.743). NIBUT-av showed a positive correlation with TBUT (p<0.001, r=0.905) and Schirmer-I (p<0.001, r=0.403) but a negative correlation with OSS (p<0.001, r=-0.700), meibomian gland loss (p<0.001, r=-0.601), LWE grade (p<0.001, r=-0.597), and Marx line score (p<0.001, r=-0.539). Conclusion NIBUT is a highly sensitive and specific non-invasive diagnostic tool for DED that correlates with other ocular surface and meibomian gland function tests.
Objectives: To compare the refractive prediction accuracy of contemporary intraocular lens (IOL) calculation formulas based on swept-source optical coherence tomography (OCT) biometry in cataract surgery with capsular tension ring (CTR) implantation, and to assess for systematic postoperative refractive tendencies. Materials and Methods: This retrospective study included 98 eyes of 92 patients who underwent phacoemulsification with in-the-bag IOL and CTR implantation. Preoperative biometry utilized swept-source OCT (ARGOS, Alcon). Refractive prediction accuracy was evaluated for the Barrett Universal II, Haigis, SRK/T, and Holladay II formulas. Main outcomes included mean prediction error, mean absolute error (MAE), median absolute error (MedAE), and percentages of eyes within ±0.25, ±0.50, and ±1.00 diopter (D). Results: The mean age was 73.0±8.1 years, and the mean axial length was 23.03±1.04 mm. Barrett Universal II yielded the lowest MAE and MedAE (0.36±0.34 D and 0.24 D, respectively), followed by Holladay II (0.40±0.32 D and 0.30 D). Higher MAE was observed with SRK/T (0.45±0.37 D) and Haigis (0.54±0.45 D). MAE differed significantly among the formulas (p<0.001), with pairwise comparisons showing that Barrett Universal II and Holladay II performed similarly (p>0.05) and better than both Haigis and SRK/T (all p≤0.003). The highest percentage of eyes within ±0.25 D was observed with Barrett Universal II (52.04%), whereas Holladay II showed the highest percentage within ±0.50 D (69.39%), and the two formulas tied within the ±1.00 D range (both 92.86%). Prediction errors were positive for all formulas, indicating a mild hyperopic shift. Conclusion: In eyes undergoing cataract surgery with CTR implantation, Barrett Universal II and Holladay II showed more favorable refractive prediction accuracy than Haigis and SRK/T. A mild hyperopic shift was observed across all formulas. This finding may be clinically relevant when selecting the target refraction or IOL power in these eyes.
Objectives: This study aims to assess the concentrations of angiopoietin-1, angiopoietin-2, and Tie-2, which are implicated in the pathophysiology of proliferative diabetic retinopathy (PDR), in the vitreous fluid and to evaluate the expression profiles of microRNA (miR)-145-5p, miR-542-3p, miR-5195-3p, miR-126-3p, miR-211-3p, and miR-204-5p. Materials and Methods: The study included 25 patients with PDR and 25 non-diabetic individuals as controls. Vitreous angiopoietin-1, angiopoietin-2, and Tie-2 levels were measured using enzyme-linked immunosorbent assay (ELISA). miRNA expression levels were evaluated using real-time polymerase chain reaction. Results: Vitreous angiopoietin-1 and 2 levels were significantly lower in the PDR group when compared to controls (p<0.05). The PDR group also had a lower angiopoietin-1/angiopoietin-2 ratio and higher Tie-2 levels, but these differences did not reach statistical significance (p>0.05). Significantly higher levels of miR-126-3p and miR-204-5p were detected in the PDR group (p<0.05), whereas miR-211-3p, miR-5195-3p, miR-542-3p, and miR-145-5p did not show statistically significant differences (p>0.05). Conclusion: Our data demonstrate that increased miR-204-5p and miR-126-3p expression may be associated with angiogenesis-related alterations in PDR. These findings provide insight into PDR-related angiogenesis and suggest that these microRNAs may represent potential biomarkers of disease-related vascular alterations.
Objectives: To evaluate the dietary nutritional profile according to the suggestions of the Age-Related Eye Disease Study 2 (AREDS2) in Turkish patients with age-related macular degeneration (AMD). Materials and Methods: The study included patients diagnosed with non-neovascular AMD in one or both eyes and who underwent routine follow-up in retina clinics at tertiary centers in İstanbul between May 12 and May 27, 2025. An ocular nutrition questionnaire prepared according to AREDS2 suggestions was translated into Turkish. The survey was conducted among our cohort after its reproducibility and validity were confirmed. Consumption of fish-shellfish, hazelnut-walnut-peanut, eggs, leafy greens, red pepper, carrot-pumpkin, and peppers-green tea-strawberry-citrus (eicosapentaenoic acid, docosahexaenoic acid, omega 3, lutein, zeaxanthin, beta-carotene, and antioxidant-rich foods, respectively), micronutrient supplementation, smoking, physical activity, anxiety about vision loss, education level, and monthly income were recorded. Results: A total of 530 patients from 7 clinics who answered all questions were evaluated. Adequate consumption of omega-3-rich foods consumption was reported by 19.3% of participants, whereas 57.2% reported no fish intake in the last week. Adequate consumption of foods rich in lutein/zeaxanthin, beta-carotene, and antioxidants was reported by 63.6%, 41.7%, and 4.7% of patients, respectively, and regular micronutrient supplementation was reported by 35.5%. Of the patients, 23.6% reported high anxiety about vision loss, 69.8% reported elementary or lower education, and 64.9% had a 20,000 TRY or lower monthly income. Micronutrient intake was positively associated with anxiety (p=0.0001) and education (p=0.02) but not with monthly income (p=0.1). Conclusion: According to this first report in Turkish patients with AMD which was evaluated nutrition profile based on AREDS2 suggestions, patients showed low adherence to AREDS recommendations for micronutrient intake and lifestyle modifications. Awareness among patients and ophthalmologists needs improvement.
This case report aims to present a modification of the temporal inverted internal limiting membrane (ILM) flap technique in macular hole surgery. The inverted ILM flap technique was first described in 2010 and was shown to yield superior functional and anatomical outcomes in large macular holes compared to traditional ILM peeling. However, flap displacement can be a major concern with the inverted ILM flap technique. In the first case, a failed large macular hole after temporal inverted ILM flap surgery was reoperated, and flap displacement was observed as the reason for failure. The displaced ILM flap was inverted again and the superior corner of the flap was tucked under the small ILM defect in the upper nasal macular area to stabilize it. Hence, it is called as “envelope modification”. Another patient with rhegmatogenous retinal detachment with coexistent macular hole underwent vitrectomy surgery with silicone oil. The retina was attached postoperatively, and the macular hole was closed with a flat-open pattern. During silicone oil removal, the envelope modification was used and the hole closed. Both patients had visual improvement. Although the inverted ILM flap technique is very effective for large macular holes, the modification described here may further improve the success rate.
Objectives: To evaluate the results and effectiveness of the intraoperative subretinal dual dye-assisted technique in patients treated in our clinic for recurrent rhegmatogenous retinal detachment (RRD), where small hidden retinal tears could not be detected before or during surgery. Materials and Methods: This retrospective observational study included 11 patients who underwent surgery in our clinic for recurrent RRD and in whom no retinal tears were detected during either preoperative or intraoperative examinations. Data from patients who underwent surgery using the modified subretinal MembraneBlue-Dual® (trypan blue 0.15% + Brilliant Blue G 0.025% + PEG 4%) dye method applied with a 41-gauge cannula were examined. Postoperative outcomes were analyzed. Results: In 38.4% of patients, retinal tears were located at the posterior edge of a previous laser retinopexy scar. Dye leakage was seen from the edge of a previously lasered retinal tear in 30.7% and from a new tear in 30.7%. At 1-year follow-up, anatomical success and permanent retinal reattachment were achieved in all of the patients. At postoperative 1 year, best corrected visual acuity had increased from 2.0±0.3 logarithm of the minimum angle of resolution (logMAR) to 0.7±0.1 logMAR. Conclusion: Occult small retinal tears that are undetectable in recurrent RRD can be successfully identified using the subretinal dye-assisted technique.
Objectives: To evaluate and compare the on-eye performance and comfort of two lotrafilcon B contact lenses, each manufactured using different surface moisturizing technologies, in individuals who use digital platforms for more than 3 hours daily. Materials and Methods: Twenty-nine asymptomatic habitual contact lens wearers participated in a randomized, double-masked crossover study. Each subject wore either Air Optix Aqua or Air Optix Plus HydraGlyde contact lenses for a month before switching to the other lens type for another month. Contact Lens Dry Eye Questionnaire 8 (CLDEQ-8) scores, biomicroscopic examination, tear function tests, and blink rates were recorded at baseline and at the end of each month. The patients were asked to complete a Likert-type questionnaire evaluating vision and comfort, along with first-impression ratings for visual clarity, comfort, and dryness with each lens. Results: The mean age of patients was 25.5±7.2 years. Tarsal papillary grade was significantly lower, and tear-film break up time was higher with Air Optix Plus HydraGlyde lenses compared to Air Optix Aqua lenses (p<0.05). There were no significant differences between the two lenses in terms of slit-lamp findings, Schirmer’s test, blink rate, or CLDEQ-8 scores (p>0.05). Air Optix Plus HydraGlyde lenses provided significantly better end-of-day comfort and less blurred vision, dryness, and eye tiredness (p<0.05). Conclusion: Air Optix Plus HydraGlyde lenses with advanced surface moisturizing technology were superior in terms of end-of-day comfort, end-of-month comfort, and visual clarity. Technological advances in silicone hydrogel lens surface treatments seem to be helpful in improving contact lens comfort in lens wearers with moderate daily exposure to digital devices.
Objectives: To demonstrate the efficacy and safety of repeated dexamethasone (DEX) implants in eyes with naïve diabetic macular edema (DME) using real-life data over a minimum of 36 months follow-up. Materials and Methods: This retrospective cohort study included treatment-naïve DME patients treated with intravitreal DEX monotherapy and followed for at least 36 months. Main outcomes were best corrected visual acuity (BCVA) and central macular thickness (CMT) change. Secondary outcomes were optical coherence tomography findings, including serous macular detachment, hard exudate, hyperreflective foci, cystoid degeneration, pearl necklace sign, epiretinal membrane (ERM), disorganization of the retinal inner layers (DRIL), ellipsoid zone and external limiting membrane (EZ-ELM) integrity, and intra-cystic hyperreflective material, as well as intraocular pressures and lens status. Results: The study included 74 eyes of 52 patients. The mean follow-up period and number of injections were 49.24±13.51 months and 6.83±2.76, respectively. Both BCVA and CMT improved significantly throughout follow-up (p=0.009; p<0.001). The mean BCVA increased by 7.9±2.1 letters, and 38 patients (51.3%) gained ≥10 letters. Hyperreflective foci (p<0.001), pearl necklace sign (p=0.012), and intra-cystic hyperreflective material (p=0.042) decreased significantly, while ERM (p=0.006), DRIL (p<0.001), and EZ-ELM defects (p<0.001) increased significantly. Conclusion: Intravitreal DEX monotherapy is a safe and effective treatment option for treatment-naïve DME patients in long-term follow-up.
Objectives:This study aimed to evaluate the 48-month visual and anatomical outcomes, as well as the number of clinic visits and intravitreal injections, in patients treated with three consecutive loading doses of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for diabetic macular edema (DME) under real-world conditions in Türkiye. Materials and Methods:In this retrospective, multicenter study conducted by the BOSPHORUS-DME Study Group, the medical records of 2,424 eyes of 1,696 patients who experienced vision loss due to DME and were treated with intravitreal anti-VEGF injections between January 2019 and January 2023 were reviewed. The study was carried out across eight tertiary referral hospitals located on the European side of İstanbul and in the province of Kocaeli. Seven cohort groups were created based on follow-up at baseline and months 3, 6, 12, 18, 24, 36, and 48. Best-corrected visual acuity (BCVA), central macular thickness (CMT), the number of clinic visits and injections, and the rates of anti-VEGF or dexamethasone switching were analyzed. Results:The study included a total of 2,424 eyes of 1,696 patients (mean age: 60.6±10.0 years; 46.4% female). The mean baseline BCVA and CMT were 0.34±0.24 (decimal) and 400±134 μm, respectively. At month 48, these values improved to 0.49±0.29 (p<0.0001) and 324±115 μm (p<0.0001). The mean cumulative number of injections at years 1, 2, 3, and 4 were 6.5, 9.6, 12.2, and 15.7, respectively. A switch in anti-VEGF therapy occurred between month 3 and 6 in 43.5% of eyes, mostly due to mandatory transition to on-label agents. Conclusion:This is the largest and longest real-world study on DME treatment conducted in Türkiye. It demonstrates that visual and anatomical gains can be sustained over a 48-month period. While the overall trend aligns with previous real-world studies, the higher injection frequency in our cohort appears to have contributed to more favorable outcomes. These findings underscore the importance of early intensive therapy and sustained treatment adherence in the real-world management of DME.
Ophthalmology significantly contributes to the healthcare sector’s carbon footprint. Despite recent increases in sustainability research in ophthalmology, there remains limited information on initiatives specific to pediatric ophthalmology and strabismus. This review aims to examine the existing literature and provide insights into sustainability and reducing carbon footprints in these areas. Although there has been no specific assessment of carbon emissions associated with congenital and developmental cataracts, measures related to cataract surgery and operating room practices remain relevant. Strabismus surgeries can be considered environmentally friendly, affordable, and energy-efficient procedures. Involving non-ophthalmologist personnel, expanding telemedicine applications, and restructuring outpatient services could reduce clinic congestion, lower costs, and improve sustainability. Some amblyopia examinations requiring long-term follow-up could be performed at local healthcare centers. While compliance and effectiveness are primary concerns in patching treatment, it is crucial to acknowledge that the patches generate significant waste and carbon footprints. Therefore, exploring alternative solutions is essential. Anesthesia poses an additional challenge for pediatric examinations, and various strategies have been suggested to reduce carbon dioxide emissions. Additionally, artificial intelligence is promising and its integration into pediatric ophthalmic examinations could further enhance sustainability. In brief, although pediatric ophthalmology and strabismus are considered environmentally friendly subspecialties of ophthalmology, especially in the operating room, there are many steps that can be taken for “sustainable ophthalmology,” from anesthesia to amblyopia treatment and outpatient clinic services.
This retrospective case series presents the characteristic features of superior segmental optic nerve hypoplasia (SSONH) in four patients who were initially misdiagnosed with normal-tension glaucoma (NTG), aiming to raise awareness of this rare condition in Türkiye. Four patients (two females and two males) with a mean age of 38 years were included. All were initially diagnosed with NTG and treated with brimonidine drops for three years. Comprehensive ophthalmological examinations were performed, including optic disc photography, optical coherence tomography retinal nerve fiber layer (RNFL) analysis, and visual field testing, with follow-up evaluations conducted over at least one year. Bilateral involvement was observed in two cases, and unilateral involvement in the other two. History of maternal diabetes was noted in 50% of the patients. During medication-free follow-up, all patients demonstrated stable structural and functional parameters, supporting the diagnosis of SSONH. These findings suggest that SSONH should be considered in young patients presenting with superior RNFL thinning and corresponding inferior visual field defects. The non-progressive nature of the condition helps differentiate it from glaucomatous optic neuropathy. Recognizing unilateral cases is essential for avoiding misdiagnosis.
