Objective: To compare the success and reactivation rates between laser photocoagulation and intravitreal anti-VEGF injection for the treatment of retinopathy of prematurity (ROP). Materials and Methods: A total of 434 patients with ROP were included in the study, with 299 treated with laser photocoagulation (group 1) and 135 treated with intravitreal anti-VEGF injection (group 2). Outcome measures included birth weight, gestational age, disease stage, presence of plus disease, type of first intervention, time of postpartum ROP onset, date and time of recurrence after the first intervention, type of second intervention following recurrence, and sex. Results: Laser photocoagulation (LP) was performed in 299 premature patients, and intravitreal anti-VEGF injection was the first intervention in 135 patients. The overall reactivation rate for ROP after treatment was 6.5% (n=28). The reactivation rates for group 1 and group 2 were 3.7% (n=11) and 12.6% (n=17), respectively, with the difference being significant (p<0.001). Over the past 11 years, there has been a shift from laser treatment to anti-VEGF therapy, with anti-VEGF therapy linked to a 3.77-fold higher risk of reactivation. Low birth weight, low gestational age, and aggressive posterior ROP were identified as factors contributing to an elevated risk of reactivation. The median time to reactivation was similar for both group 1 and group 2 patients (p>0.05). Conclusion: Both laser application and anti-VEGF injection were effective for the treatment of ROP. However, initial LP has a lower reactivation rate.

PURPOSE:To systematically review the extant literature on pediatric endoscopic dacryocystorhinostomy (endoDCR) and to perform a meta-analysis of the pooled success rate and complication profile. METHODS:A comprehensive literature search was conducted using PubMed, Cochrane Library, and Web of Science databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they reported the pediatric endoDCR success rate with a minimum follow-up of 3 months and at least 10 patients. Data on success rates, complications, age, follow-up time, and silicone stent removal time were extracted. Statistical analyses were performed using comprehensive meta-analysis software. RESULTS:Twenty-nine studies comprising 1502 pediatric eyes were included. The pooled success rate was 87% (95% CI: 0.83-0.90). The I² statistic was 58.47%, indicating moderate to substantial heterogeneity. Egger's test indicated significant publication bias (p < 0.00001). Complication rates varied considerably: while some studies reported minor complications in up to 60% of cases, others documented serious, but rare, events such as cerebrospinal fluid rhinorrhea (0.28%). The most common complications included bleeding/epistaxis, tube prolapse, adhesions/synechiae, and granulation tissue. CONCLUSION:EndoDCR is an effective and generally safe surgical option for pediatric nasolacrimal duct obstruction, with a high pooled success rate and acceptable variability in outcomes. However, variation in complication reporting and methodological heterogeneity across studies highlights the need for standardization in future research.

AIM: To compare the 24-month clinical results of the Keiki Mehta body pressure (BP) glaucoma implants (KMI) versus the Ahmed glaucoma valve implants (AGVI; FP-7Model) in neovascular glaucoma (NVG). METHODS: Patients with NVG and uncontrolled intraocular pressure (IOP) exceeding 21 mm Hg despite maximum-tolerated antiglaucoma medications were included in this retrospective study and treated with either KMI, or AGVI. Preoperative and postoperative IOP (at the 1d, 1, 3, 6, 12, and 24mo), number of glaucoma medications needed, success rate, postoperative complications, and visual acuity were evaluated. RESULTS: The study enrolled 41 patients, comprising 19 (11 males) in the KMI group (mean age: 58.8±10.6y) and 22 (11 males) in the AGVI group (mean age: 60.2±16.8y). Preoperative IOP was similar between the groups (P=0.077). Postoperative IOP at the 1st day and 1st month were lower in the KMI group compared to the AGVI group (P=0.003 and P=0.001, respectively). No significant difference was found between the groups at other time points. In both groups, 1st day and 24th month values were lower than baseline values (all P<0.001). At the end of 24mo, the number of antiglaucoma agents required, the success rate and total complications rate were similar between the groups (P=0.444, P=0.843, P=0.233, respectively). CONCLUSION: KMI may be an alternative to AGVI in the management of NVG. To the best of our knowledge, this study is the first to compare the results of AGVI versus KMI for the treatment of NVG.

Introduction This study aimed to evaluate the agreement between two advanced anterior segment imaging devices, Anterion (Heidelberg Engineering GmbH, Heidelberg, Germany) and Sirius (CSO, Florence, Italy), in measuring keratometric and pachymetric parameters in patients with moderate to severe dermatochalasis. Methods Keratometric and pachymetric measurements were obtained using Anterion and Sirius devices in patients with moderate to severe dermatochalasis. The agreement between the two devices was assessed by comparing anterior and posterior corneal keratometry and corneal thickness. Statistical analyses were performed to determine the significance of differences and correlations between the measurements. Results Statistically significant differences were observed between the two devices in anterior and posterior corneal keratometry, except for posterior astigmatism and corneal thickness. However, these differences were clinically insignificant(low refractive differences). The study found excellent agreement between Anterion and Sirius for most parameters, with strong correlations and minimal disparities in measurements. Posterior astigmatism showed moderate agreement but still exhibited a strong correlation between the devices. Conclusion Both Anterion and Sirius provide reliable keratometric and pachymetric measurements in patients with dermatochalasis, allowing for interchangeable use. Accurate preoperative evaluations are essential for cataract or refractive surgery, as dermatochalasis may affect corneal measurements.

Purpose: To present the clinical manifestations, ocular complications and treatment results of pediatric pars planitis (PPP) Methods: This retrospective clinical study was conducted at a tertiary care center and included 28 children (51 eyes) aged 16 years or younger. Visual acuity (VA), anterior chamber cell (ACC) grade, vitritis grade, central macular thickness (CMT), fundus fluorescein angiography (FFA) score, treatment approach, complications, and relapse rate were recorded. All data were analyzed for baseline, third month, sixth month, ninth month, and twelfth month. Results: The mean or median follow-up duration was 12 months. A total of twenty patients (71%) were administered Methotrexate (MTX) and the mean MTX dosage was 8.6 +/- 1.1 mg. Ten patients (35%) were administered corticosteroid, and the mean dosage was 29.6 +/- 4.2 mg. Adalimumab was administered to 16 patients (57%). There was a significant improvement in VA (-0.068, p = 0.025) during the first 3 months of follow-up. There were no significant changes in the VA during the subsequent follow-up periods. ACC grade decreased significantly in the third month (-0.765, p < 0.001), while vitritis grade decreased significantly in the sixth month (-0.502, p < 0.001). There was no significant change in CMT in all study eyes during the follow-up periods. However, there was macular edema in 14 eyes (27%) in baseline examination. After treatment, CMT was lower than 250 mu m in 8 eyes (57%) in the last follow-up. Conclusion: Immunosuppressive therapy is effective in suppressing intraocular inflammation. Treatment should be aimed at controlling inflammation, macular edema, and papillitis. Early diagnosis and aggressive treatment are important for a good visual prognosis.

Objectives: To establish normative data for anterior segment parameters in healthy pediatric and adult populations using swept-source optical coherence tomography (SS-OCT), and to evaluate the influence of age and sex on these parameters. Methods: This retrospective study included the right eyes of 390 healthy participants. Subjects were divided into three age groups: Group 1 (6–17 years, n = 97), Group 2 (18–45 years, n = 144), and Group 3 (46–77 years, n = 149). All patients were categorized according to their biological sex as female and male. Exclusion criteria were corneal pathology, prior intraocular/refractive surgery, recent contact lens use, severe dry eye, ectatic disorders, low-quality imaging, and refractive error of ±2.0 D or greater. Measurements of anterior and posterior keratometry, total corneal power (TCP), central corneal thickness (CCT), thinnest corneal thickness (TCT), pupil diameter (PD), lens thickness (LT), and white-to-white distance (WTW) were obtained using the Anterion® SS-OCT system. Data were analyzed using SPSS software. Results: Group 1 demonstrated the highest PD and CCT values, whereas LT was lowest. In adults, LT increased with age and was significantly higher in males older than 45 years. Keratometric analysis revealed greater anterior and total steep astigmatism in the pediatric group, independent of sex. Adult females had significantly higher anterior and posterior keratometry values compared with males. In the pediatric cohort, females exhibited greater CCT, while WTW varied with age. PD decreased with age, whereas LT increased. Conclusions: Anterior segment parameters measured with SS-OCT show significant variations across different age groups and between sexes. Normative data, particularly for pediatric and adult populations, may serve as valuable reference values in keratorefractive surgical planning and corneal pathology assessment. Future studies with larger cohorts, especially in pediatric populations, are warranted.

Purpose: Behçet’s disease (BD) is an autoimmune chronic systemic inflammatory disease characterized by a versatile clinical spectrum. Growth arrest specific protein 6 (GAS6)/soluble AXL (sAXL) signaling pathway draws attention in the resolution of inflammation, and its deficiency is associated with chronic inflammatory, autoimmune diseases, as well as clearance of apoptotic cells by phagocytes – efferocytosis. In this study, it was aimed to investigate whether GAS6/sAXL, interleukin (IL)-10, nitric oxide (NO), and BCL-2 levels were associated with inflammation and efferocytosis contributes to the pathogenesis of BD. Methods: A total of 37 Behçet patients with ocular involvement and 30 healthy control subjects were included in this study. GAS6, sAXL, IL-10, NO, and BCL-2 levels were quantified using enzyme-linked immunosorbent assay (ELISA) method. Results: Serum GAS6, sAXL, IL-10, NO, and BCL-2 levels were significantly lower in patients with BD compared to the controls (P < 0.005, P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively). In correlation analysis, research parameters decreased in patients with BD was significantly correlated with each other: GAS6–IL-10 (r = 0.585, P < 0.001), GAS6–BCL-2 (r = 0.541, P < 0.001), sAXL–BCL-2 (r = 0.696, P < 0.001), IL-10–NO (r = 0.717, P < 0.001), IL-10–BCL-2 (r = 0.759, P < 0.001), and NO–BCL-2 (r = 0.541, P < 0.001). Conclusion: In conclusion, decreased serum BCL-2 level may be an indicator of increased apoptosis in these patients and decreased levels of GAS6/sAXL, IL-10, and NO may indicate insufficient clearance of apoptotic bodies released as a result of increased apoptosis in BD patients.

Aims: To evaluate the vision-related quality of life (VR-QOL) in patients with low vision, who underwent epiretinal membrane (ERM) surgery with pars plana vitrectomy. Methods: Twenty subjects with unilateral ERM and 20 healthy subjects as CG were included in the study. The National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) was used. In ERM cases, the two-step 23 G vitrectomy was performed with a similar technique by the same experienced vitreoretinal surgeon. The relationship between the composite score and visual acuity was evaluated. Reliability analysis was performed. Flexible discriminant analysis was performed to group individuals according to the NEI VFQ-25 results. Results: The preoperative best corrected visual acuity (BCVA) in ERM group was 1.04±0.41. Postoperative visual improvement reached statistical significance (p<0.001) and postoperative 6th month BCVA was 0.61±0.41. The composite score was significantly lower in patients with ERM than in CG (p=0.017). The subscale scores were significantly lower in the patients with ERM than in the CG in general vision, ocular pain, near activities and distance activities (p<0.001, p=0.005, p<0.001, p=0.003, respectively). There was a statistically significant correlation between the composite score and visual acuity (R2=0.19, p=0.004). The scale has high reliability (Cronbach's alpha=0.8743). The accuracy of the flexible discriminant function was found to be 100%. Conclusion: The NEI VFQ-25 questionnaire may help to define the effects of ERM surgery since visual acuity does not fully reflect VR-QOL. Impaired binocular vision may be associated with the deterioration of VR-QOL in patients with ERM in the postoperative period.

Purpose To determine the etiology and anatomic localization of uveitis, the frequency of intraocular pressure (IOP) elevation, and the type of secondary glaucoma and to assess the medical, surgical, and postoperative complications in adult and pediatric patients with acute or chronic uveitis. Methods A total of 307 eyes of 186 patients who were followed up in the Uvea-Behget Unit of the Ophthalmology Department, Erciyes University, Turkey, were included in the study. Demographic, ocular, and systemic data were recorded; ophthalmological examinations were performed; and recurrences and complications of uveitis were identified. The eyes with IOP over 22 mmHg, types of secondary glaucoma, their etiologies, efficiency of medical and surgical treatments, and complications were recorded. Results The mean age was 33 +/- 12 years (range: 6-65). Of the 186 patients, diagnoses were as follows: idiopathic uveitis in 84 (45.2%), Behget disease in 65 (34.9%), ankylosing spondylitis in eight (4.3%), juvenile idiopathic arthritis in five (2.7%), herpetic keratouveitis in three (1.6%), Fuchs iridocyclitis in three (1.6%), Vogt-Koyanagi-Harada syndrome in three (1.6%), tuberculosis uveitis in three (1.6%), Crohn disease in three (1.6%), ocular toxoplasmosis in two (1.1%), multiple sclerosis in two (1.1%), Lyme disease in two (1.1%), rheumatoid arthritis in two (1.1%) and tubulointerstitial nephritis in one patient (0.5%). Secondary glaucoma was detected in 67 (21.9%) of 307 eyes, which developed in 13.7% and 26.8% of the eyes with acute and chronic uveitis, respectively. Of 67 eyes, it was open-angle glaucoma in 58 (86.5%), angle-closure glaucoma in six (9.0%), and neovascular glaucoma in three (4.5%). Control of IOP was achieved by medical therapy in 53 eyes (79.1%) and by surgery in 12 eyes (17.9%), whereas evisceration was required in two eyes (3.0%). Laser iridotomy was performed in four eyes (33.4%), trabeculectomy with mitomycin-C (MMC) in six eyes (50.0%), laser iridotomy plus trabeculectomy with MMC in one eye (8.3%), and express mini shunt implantation in one eye (8.3%). After surgery, IOP was controlled without anti-glaucomatous agents in six eyes (50%) and with anti-glaucomatous agents in the remaining six eyes (50.0%). Conclusion Secondary glaucoma is one of the most important complications of uveitis and may result in severe visual impairment. Early diagnosis and appropriate treatment can prevent these potential complications.

Purpose: To compare superficial and deep vascular characteristics of the optic disc in retrobulbar optic neuritis using optical coherence tomography angiography (OCT-A).Methods: Nineteen patients with unilateral non-infectious retrobulbar neuritis were included in the study. The contralateral eyes of each patient were served as controls. OCT-A scans of the optic discs were performed in a 4.5 x 4.5 mm rectangular area, while macular OCT-A scans were performed in a 6 x 6 mm rectangular area. Various parameters, including radial peripapillary capillary (RPC) density, peripapillary retinal nerve fibre layer (pRNFL) thickness, cup volume, rim area, disc area, cup-to-disc (c/d) area ratio, and vertical and horizontal c/d ratios were automatically obtained using the instrument software. The density for superficial capillary plexus (SCP) and deep capillary plexus (DCP) were assessed using macular OCT-A. Parapapillary choroidal microvascular (PPCMv) density was calculated using MATLAB software.Results: Parafoveal inferior, perifoveal total and inferior SCP densities were significantly decreased in eyes with optic neuritis when compared with contralateral control eyes in OCT-A measurements (respectively, p = 0.027, p = 0.041, p = 0.045). The axial lengths, (p = 0.72), vertical and horizontal cup-disc ratios, and disc area, cup-disc areas, cup volumes, and pRNFL thicknesses between the groups were similar (for each, p>0.05).Conclusions: This study demonstrated for the first time that patients with retrobulbar optic neuritis had decreased SCP densities, though it did not cause any changes in PPCMv density.

Objective In this study, we aimed to evaluate the choroidal thickness in patients with unilateral strabismic amblyopia by using spectral domain-enhanced depth imaging-optical coherence tomography (SD-EDI-OCT) (Heidelberg Engineering GmbH, Heidelberg, Germany). Methods Twenty-five children with strabismic amblyopia and 20 age- and sex -matched healthy controls were included in this study. Seven sections were obtained, each comprising 25 repetitive images from each section at 200-micron intervals, and measurements were taken from nine different points at vertical and horizontal lines (1 and 3 mm from the subfoveal, superior, inferior, temporal, and nasal regions), centered on the fovea, using SD-EDI-OCT. Choroidal thickness values were obtained by measuring the distance between the basal border of the retinal pigment epithelium and the choroidoscleral border. The MannWhitney U test was used to compare choroidal thickness between the amblyopic and the control groups. Results The mean age of children with amblyopia and that of controls were 8.4 +/- 2.7 and 9.9 +/- 3.3 years, respectively (p=0.120). The mean subfoveal choroidal thickness was 372.8 +/- 78.9 gm in amblyopic eyes and 372.4 +/- 79.3 gm in the fellow eyes, both of which were thicker than the control eyes (310.9 +/- 76.3 gm; p<0.05 for each). Similarly, the mean values for the choroidal thickness of the amblyopic children at 1 mm nasal (320 +/- 86 gm), 1 mm superior (363 +/- 70 gm), and 3 mm superior (336 +/- 62 gm) were also significantly thicker than those of the corresponding control eyes (p<0.05 for each). There was a negative correlation between the subfoveal choroidal thickness and axial length (r=-0.332, p=0.005). There were no correlations between the choroidal thickness, age, and visual acuity. Conclusions The choroidal thicknesses of strabismic and fellow eyes were similar in patients with strabismic amblyopia. However, the choroidal thickness of both eyes in strabismic children was significantly thicker than those of the healthy controls. Emmetropization may be defective in both eyes of strabismic amblyopic patients.

Introduction: This study aimed to investigate the role of the brain-sparing effect (BSE) on retinopathy of prematurity (ROP) in fetal growth restriction (FGR). Methods: In this retrospective study, 127 pregnant women were divided into two groups considering the cerebroplacental ratio (CPR): FGR with abnormal CPR group (n = 74) and the appropriate for gestational age with normal Doppler group (n = 53). CPR was computed using the pulsatility index (PI) and resistance index (RI) to quantitate the waveforms [middle cerebral artery (MCA) PI/umbilical artery (UA) PI and MCA RI/UA RI: a result <1 was taken into account as abnormal]. ROP screening results of newborns were recorded from electronic files. Results: After adjusting for co-variants, BSE was not related to ROP (adjusted odds ratio [aOR], 1.06; 95% confidence interval [CI], 0.23-4.95). Gestational age at delivery <30 weeks (aOR, 2.55; 95% CI, 1.04-6.93) and birth weight <1500 g (aOR, 5.15; 95% CI, 1.15-25.2) were independently associated with ROP. Preeclampsia, emergency cesarean section birth, or 48 h completion after the first steroid administration were not associated with ROP. Conclusions: Gestational age at delivery <30 weeks and birth weight <1500 g are independent risk factors for ROP in FGR whereas the BSE is not a risk factor.

AIM: To compare superficial and deep vascular properties of optic discs between crowded discs and controls using optical coherence tomography angiography (OCT-A). METHODS: Thirty patients with crowded discs, and 47 control subjects were enrolled in the study. One eye of each individual was included and OCT-A scans of optic discs were obtained in a 4.5×4.5 mm2 rectangular area. Radial peripapillary capillary (RPC) density, peripapillary retinal nerve fiber layer (pRNFL) thickness, cup volume, rim area, disc area, cup-to-disc (c/d) area ratio, and vertical c/d ratio were obtained automatically using device software. Automated parapapillary choroidal microvasculature (PPCMv) density was calculated using MATLAB software. When the vertical c/d ratio of the optic disc was absent or small cup, it was considered as a crowded disc. RESULTS: The mean signal strength index of OCT-A images was similar between the crowded discs and control eyes (P=0.740). There was no difference in pRNFL between the two groups (P=0.102). There were no differences in RPC density in whole image (P=0.826) and peripapillary region (P=0.923), but inside disc RPC density was higher in crowded optic discs (P=0.003). The PPCMv density in the inner-hemisuperior region was also lower in crowded discs (P=0.026). The pRNFL thickness was positively correlated with peripapillary RPC density (r=0.498, P<0.001). The inside disc RPC density was negatively correlated with c/d area ratio (r=-0.341, P=0.002). CONCLUSION: The higher inside disc RPC density and lower inner-hemisuperior PPCMv density are found in eyes with crowded optic discs.

Objective To evaluate the effect of adalimumab (ADA) on choroidal thickness (ChT) and choroidal vascularity index (CVI) in eyes with non-infectious uveitis (NIU). Methods Thirty-seven eyes with NIU including Behçet disease (BD), sarcoidosis, ankylosing spondylitis (AS), juvenile idiopathic arthritis and idiopathic arthritis, 38 eyes of non-uveitic (NU) patients including BD, AS and rheumatoid arthritis, and 40 healthy control eyes were included. ADA was used for anti-TNF-naive adult (80 mg) or paediatric (40 mg) patients with refractory NIU, then 40 mg every 2-week (20 mg in children<30 kg) with controls at weeks 1, 4, 12, and 24. Images were used to measure central, nasal, and temporal ChT, and the luminal area (LA), stromal area, and total choroidal area (TCA) were analysed using enhanced-depth imaging optical coherence tomography (EDI-OCT) by ImageJ software. The CVI was then calculated as the ratio of LA to TCA. Results Mean ages were similar between the groups. Mean (SE) subfoveal ChT measurements for each location were also similar (for each, p > 0.05). However, calculated CVI values in eyes with NIU (0.63 ± 0.007) were significantly ( p < 0.001) lower than NU eyes (0.66 ± 0.006) and controls (0.70 ± 0.007) ( p < 0.001). Moreover, CVI was significantly lower in NU eyes compared to controls ( p < 0.001). There were no significant CVI changes between the consecutive visits after ADA therapy in eyes with NIU (for each, p > 0.05). Conclusions Decreased CVI in NIU and NU eyes indicates that systemic inflammation affects the choroidal vasculature and perfusion both in the presence and absence of ocular involvement. Although CVI may be used as a possible novel tool in monitoring ocular involvement and progression of NIU, CVI does not seem to be a biomarker for treatment monitoring in NIU.

PURPOSE:To examine the long-term efficacy and safety of adalimumab (ADA) in patients with Behçet uveitis (BU).METHODS:A systematic review and meta-analysis of observational studies was performed. Pooled results are presented as mean difference or standardized mean difference (std diff) and 95% confidence intervals (CI). Visual acuity (VA), intraocular inflammation grade, central macular thickness, corticosteroid (CS) sparing effect and adverse events were evaluated.RESULTS:Ten studies were included finally for quantitative and qualitative synthesis. ADA therapy resulted in 0.124 (95%CI: 0.084, 0.165) logMAR improvement in VA. In addition, ADA therapy resulted in decreased grade of intraocular inflammation [std diff, -1.187 (95%CI: -1.508, -0.866)] and macular thickness [std diff, -0.564 (95%CI: -0.843, -0.286)] and caused a decrease in CS dosage [std diff, -1.809 (95%CI: -2.420, -1.198)]. The pooled rate of overall adverse events for ADA in 301 patients was 8.5% (95%CI: 0.039, 0.177).CONCLUSION:ADA is an efficient therapy that improves VA and controls intraocular inflammation, macular edema and retinal vasculitis. As the disease exposure time increased, improvement in VA was less. The safety and CS-sparing effect of ADA were demonstrated with few adverse effects. The results provided evidence that ADA can be used safely and efficiently as the first-line drug in patients with BU.

Purpose To describe a minimally-invasive “harvesting-stripping technique” on a small segment of autogenous fascia lata (AFL) in small children with severe blepharoptosis under 3-years-old. Methods A single-surgeon, uncontrolled surgical trial was designed for 25 eyelids of 18 small children (5 girls, 13 boys) with severe blepharoptosis. Single- and short-skin incisions (2-cm) were made on the thigh and a final 3X0.6-cm or 3.5X1-cm AFL segment was excised according to the ptosis laterality. The surface area of the harvested AFL was calculated and dissected for a final 9-cmX2-mm-long fascial strip for each eye. Functional and aesthetic outcomes of the upper eyelids were evaluated and the feasibility, effectivity and advantages of this novel approach in younger patients were assessed. Results The mean age was 28.3 months (17–35) with a mean follow-up of 34.3 months (6–96). All eyelids achieved good or excellent functional and aesthetic results (except one), with no peri- or post-operative severe complications such as haemorrhage, wound infection, hypertrophied thigh scar, muscle prolapses, eyelid contour abnormalities, ptosis recurrence or overcorrection. Conclusions “Harvesting-stripping technique” with the AFL may be an alternative approach to correct severe upper blepharoptosis in small children under 3-years-old, which offers various benefits over conventional methods with non-autogenous materials.

Purpose: To evaluate the incidence of optic cracks and/or fractures during foldable acrylic intraocular lens (IOL) implantation via the manual Monarch delivery system with the cartridge and to determine factors that help to avoid such complications. Methods: Small-incision phacoemulsification surgery was performed in 702 eyes with visually significant cataract formation. A foldable acrylic soft IOL (AcrySofâ MA60BM/MA30BA, Alcon, Fort Worth, TX, USA) or a single-piece acrylic soft IOL (Acriva BBâ, VSY Biotechnology, Amsterdam, The Netherlands) was inserted in all eyes using a cartridge and viscoelastic agents (sodium hyaluronate, Healon®, Advanced Medical Optics, Santa Ana, CA, USA). Results: Postoperative central, paracentral, or peripheral optic cracks or fractures were encountered in a total of six of 702 eyes (0.85%). Four of six lenses (0.57%) had optic cracks within the IOL substance, whereas two of 702 cases (0.28%) had full-thickness IOL fractures in the substance in multiple locations. Three of the four lenses with optic cracks were noted to be handled by tying forceps during the cartridge insertion, and one of them was the complication of holding forceps. Two IOLs with full-thickness optic fractures were encountered during the insertion of the IOLs in the capsular bag as a result of direct trauma to the lens optic by the plunger of the injector system overriding the lens optic during cartridge passage. None of the patients suffered from glare or other visual disturbances postoperatively, and, therefore, none of the six eyes required lens replacement. Conclusion: The unintentional extensive pressure effect of the forceps during the holding process of the IOL or the direct trauma to the lens optic by the plunger of injector systems may cause optic cracks or fractures. Physicians should continue to monitor the eyes postoperatively regularly and must determine the benefits and risks to be derived from lens replacement, if such patients complain of significant glare, image degradation, and visual disturbances. We recommend the use of preloaded lenses, which have their own delivery systems and cartridges, to minimize the risk of such complications.

Objective: To report perioperative findings of patients with multiple failed-dacryocystorhinostomy (DCR) and to determine the success rate of revision external (rEx-DCR) performed by a modified technique. Methods: Thirty-one eyes of 31 patients (19 women, 12 men) with recurrent dacryocystitis or epiphora following at least one previous failed-DCR were assessed regarding the time from initial surgery to recurrence and revision surgery, type of primary surgery (endoscopic, transcanalicular, Ex-DCR), recurrence number, stent usage and the success rate. Relief of epiphora and positive dye test were established as functional and anatomical successes, respectively. Results: The mean age was 43.0 years (8-78), with a mean follow-up period of 21.4 months (6-46). The mean reoperation number was 1.4 (1-5). The mean time from initial surgery to recurrence was 15.2 months (1-55) and to rEx-DCR, 19.8 months (4-65). Untouched medial canthal ligament was observed in 28 (90.3%), improper rhinostomy location in 26 (83.8%), inadequate osteotomy size in 25 (80.6%), single-anterior-flap-only in 5 (16.1%), membranous ostial scar formation in four (12.5%) and no flap in three (9.6%) patients. The success rate was 93.5%, which was lower than our primary modified Ex-DCR (99.1%). Conclusions: The most common reasons for recurrence were small and unsuitable osteotomy locations with intact medial canthal ligaments. “Double-mucosal flap” approach with an anterior sacco-mucosal complex suspension increases the functional success rate, and stent implantation is not obligatory if canalicular problems or small/ atrophic sacs do not exist. The knowledge of technical strategy and teaching pearls improves the success rates of primary and revision surgeries. Abbreviations: DCR = dacryocystorhinostomy, Ex-DCR = external DCR, EE-DCR = endoscopic endonasal DCR, TC-LA-DCR = transcanalicular laser-assisted DCR

Bilateral acute iris transillumination (BAIT) is characterized by abundant pigment discharge into the anterior chamber. Atonic pupil and severe intraocular pressure (IOP) elevations may be observed. Generally, there is a viral upper respiratory tract infection or systemic fluoroquinolone usage before BAIT. Two cases with a recent history of coronavirus disease 2019 (COVID-19) presented with a complaint of decreased vision. Elevated IOP and iris transillumination defects were observed in both patients. Both patients were diagnosed with BAIT. Although elevated IOP was controlled with medical treatment in 1 patient, glaucoma surgery was performed in the other patient because it could not be controlled with medical treatment. As both patients received no systemic treatment for COVID-19, the pressure rise seems to be directly related to the viral infection alone through the inflammatory process. Atypical ocular presentations of COVID-19 should be kept in mind as it can have serious consequences.

PURPOSE:Elevated intraocular presure secondary to angle closure in angle closure glaucoma is considered the primary mechanism in the development of optic nerve damage. There is evidence that vascular mechanisms may play a role in the pathogenesis of primary angle closure disease (PACD). We aimed to evaluate optic nerve head vessel density in PACD.METHODS:PubMed, Scopus, and Web of Science were searched. Observational investigations were included. A frequentist network meta-analysis was performed. The primary outcome was circumpapillary vessel density (cpVD), and the secondary outcome was peripapillary retinal nerve fiber layer (pRNFL) thickness.RESULTS:One thousand twenty four eyes from eleven studies were included in the study. There was no difference in cpVD between the primary angle closure glaucoma (PACG) and acute primary angle closure (APAC) group however, there was a significant decreasing in pRNFL thickness in the PACG group compared to APAC group. In the PACG and APAC group, cpVD and pRNFL thickness were decreased compared to primary angle closure (PAC), primary angle closure suspect (PACS), and control group. There was no difference in cpVD and pRNFL thickness between PAC, PACS and control group.CONCLUSION:This study has shown that the elevated intraocular pressure is an important factor affecting optical nerve perfusion in PACD. The decreasing in cpVD and RNFL thickness was more severe in the PACG and APAC group.