PurposeTo evaluate ciliary muscle (CM) morphology and accommodative function in children with accommodative esotropia (AE) versus healthy controls, and determine subtype-specific differences independent of refractive and biometric confounders.MethodsProspective cross-sectional study of 74 eyes from 37 children with AE (non-refractive, refractive, and partially accommodative subtypes) and 70 eyes from 35 controls. Cycloplegic refraction, axial length (AL), swept-source OCT (CM thickness at 1, 2, and 3 mm posterior to scleral spur [CMT1-3], maximum thickness, cross-sectional area, linear/curved length [CMLarc]), and accommodative function using the Tonoref III, measuring minimum accommodative value (Min AV), maximum accommodative value (Max AV), and total accommodative amplitude (TAA) were assessed. Generalized estimating equation models adjusted for spherical equivalent and AL.ResultsAfter adjustment, AE patients showed higher Min AV (3.04 vs. 0.09 D, p = 0.001) and longer CMLarc (5489.10 vs. 5367.19 µm, p = 0.029). TAA and Max AV did not differ. Subtype analysis revealed: partially accommodative AE had higher Min AV (p = 0.007) and greater CMT1 (p = 0.041); non-refractive AE showed lower pupil diameter during accommodation (p = 0.008), longer CMLarc (p = 0.013), and shorter scleral spur-maximum thickness distance (p = 0.037); refractive AE had longer CMLarc (p = 0.040). Higher Min AV correlated with longer CMLarc (r = -0.255), thinner CMT3 (r = -0.224), and smaller cross-sectional area (r = -0.236).ConclusionChildren with AE demonstrate subtype-specific alterations in CM morphology and accommodative function independent of refractive error and AL, offering new insights into AE pathophysiology.

PURPOSE:To compare accommodative function and ocular biometric parameters between patients with Duane retraction syndrome (DRS) and healthy controls. METHODS:In this age- and sex-matched case-control study, 44 eyes of 30 DRS patients and 78 eyes of 39 healthy controls underwent comprehensive evaluation. Accommodative amplitude (AA) and pupil dynamics (ΔPD with accommodation) were assessed using the Tonoref III (Nidek), with three consecutive measurements. Biometric parameters (axial length [AL], lens thickness [LT], anterior chamber depth [ACD], central corneal thickness [CCT]) were measured using the Lenstar 900 (Haag-Streit). RESULTS:Patients and controls were comparable in age (P = 0.305), CCT (P = 0.347), ACD (P = 0.597), LT (P = 0.297), and sex distribution (P = 0.709). DRS patients exhibited more hyperopia (mean spherical equivalent refraction -0.02 ± 1 D vs -0.63 ± 1.1 D [P = 0.019]) and shorter AL (22.57 ± 0.8 mm vs 23.1 ± 1 mm [P = 0.010]). AA showed no intergroup differences (P = 0.393), but DRS patients had a more hyperopic refractive state than controls at both the point of minimum accommodation (0.86 ± 1.2 D vs 0.06 ± 1.4 D [P = 0.006]) and the point of maximum accommodation (-1.8 ± 2.4 D vs -3 ± 2.7 D [P = 0.024]). Pupil parameters (minimum and maximum PD, ΔPD) were similar between groups (P > 0.05). CONCLUSIONS:DRS patients demonstrate similar accommodative amplitude to control patients, although in our patient sample they tended to be more hyperopic than age-matched patients presenting for refractive assessment, and to adopt more hyperopic refractive states during assessment of accommodative performance.

Purpose:The purpose of this study was to evaluate macular microvascular alterations in children with accommodative esotropia (AE) using optical coherence tomography angiography (OCTA) and to determine whether these changes differ across AE subtypes independent of refractive and biometric confounders. Methods:This prospective cross-sectional study included 34 children with AE (68 eyes) and 35 age-matched healthy controls (70 eyes). AE was classified into refractive (n = 8), high accommodative convergence to accommodation (AC/A) ratio (n = 10), and partially accommodative (n = 16) subtypes. All participants underwent comprehensive ophthalmic examination and OCTA imaging. Vessel density (VD) was measured in the superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC), and outer retina (OR) across five macular regions. Generalized estimating equation models adjusted for spherical equivalent and axial length (AL) were used for comparisons. Results:The AE and control groups were age-matched (9.2 ± 2.3 vs. 9.8 ± 2.8 years, P = 0.356). No significant differences were found in SCP between groups. CC analysis revealed significantly reduced VD confined to the superior quadrant in high AC/A ratio (P = 0.005, q = 0.03) and partially accommodative (P < 0.0001, q < 0.001) AE subtypes compared with controls. OR analysis showed superior quadrant reductions in high AC/A ratio AE (P = 0.010, q = 0.04). DCP reductions in partially accommodative AE (P = 0.027, q = 0.09) and CC reductions in refractive AE (P = 0.041, q = 0.12) did not survive false discovery rate (FDR) correction. All other quadrants showed no significant differences. Conclusions:Children with AE exhibit significant, layer-specific microvascular alterations predominantly confined to the superior quadrant, with distinct patterns across AE subtypes. After FDR correction, CC findings in high AC/A ratio and partially accommodative subtypes, and OR findings in high AC/A ratio subtypes, remained significant. These findings suggest that chronic accommodative effort and convergence stimulation may influence retinal microvasculature, providing new insights into the pathophysiology of AE.

PURPOSE:To compare macular vessel density (VD) between Duane syndrome (DS) patients and healthy controls using optical coherence tomography angiography (OCTA). METHODS:In this prospective study, age- and sex-matched DS patients and healthy controls underwent OCTA using a Topcon DRI OCT-1 Triton device. VD was measured in the superficial capillary plexus (SCP), deep capillary plexus (DCP), outer retina (OR), and choriocapillaris (CC) across five macular quadrants (central, nasal, temporal, superior, inferior). The Benjamini-Hochberg procedure was applied to control the false discovery rate (FDR) across 20 primary comparisons. Generalized estimating equations accounted for inter-eye correlations. RESULTS:The study included 114 eyes from 64 participants (29 DS patients, 43 eyes; 35 control subjects, 71 eyes). Groups were comparable in age, sex, axial length, and other baseline characteristics (all p > 0.05). Before correction, DS patients showed nominally higher central SCP VD (22.55 ± 5.9% vs. 21.8 ± 5.2%, p = 0.031) and nominally lower VD in the DCP inferior quadrant (45.81 ± 5.7% vs. 48.19 ± 2.6%, p = 0.011), CC temporal quadrant (53.32 ± 2.6% vs. 54.21 ± 1.9%, p = 0.037), and CC superior quadrant (51.09 ± 3.5% vs. 52.7 ± 2.5%, p = 0.010). After Benjamini-Hochberg FDR correction, none of these differences retained statistical significance (all q > 0.05). No differences were observed in the OR (all p > 0.05). CONCLUSION:In this clinical study, no statistically significant macular vascular differences were identified between DS patients and healthy controls after rigorous correction for multiple comparisons. However, observed trends toward central SCP hyperperfusion and regional DCP and CC hypoperfusion generate hypotheses regarding potential mechano-vascular effects of chronic extraocular muscle co-contraction in DS. These findings warrant confirmation in larger prospective cohorts with pre-specified primary outcomes.

PURPOSE:This study aimed to objectively investigate the impact of chronic cigarette smoking on ocular surface inflammation by analyzing the correlation between tear levels of cotinine, a biomarker of active smoke exposure, and matrix metalloproteinase-9 (MMP-9), a key inflammatory mediator. DESIGN:Prospective, cross-sectional study. METHODS:In this cross-sectional study, tear fluid samples were collected from 35 chronic smokers and 50 never-smoked controls. Tear concentrations of cotinine and MMP-9 were quantified using enzyme-linked immunosorbent assay (ELISA). All participants underwent comprehensive ophthalmologic examination, including corneal topography with Pentacam HR. Statistical analyses were performed to compare biomarker levels between groups and assess their correlation and diagnostic utility. RESULTS:Tear cotinine and MMP-9 levels were significantly elevated in smokers compared to controls (p < 0.0001 and p = 0.002, respectively). A strong positive correlation was found between cotinine and MMP-9 levels in the smoking group (Spearman's ρ = 0.786, p < 0.0001). Receiver operating characteristic (ROC) curve analysis indicated that both biomarkers significantly discriminated smokers from non-smokers. No significant differences were found in corneal topography parameters between the groups. CONCLUSION:Chronic smoking significantly elevates tear MMP-9 levels, indicating subclinical ocular surface inflammation even in the absence of clinical disease. This study is the first to report a strong objective correlation between tear cotinine and MMP-9, establishing tear cotinine as a reliable biomarker for active smoking. Future studies on ocular surface inflammation must account for smoking status as a major confounding variable.

PURPOSE:To investigate changes in accommodation amplitude (AA) after strabismus surgery. METHODS:The medical records of patients who underwent full-tendon tenotomy on at least one rectus muscle between January 2023 and July 2023 were reviewed retrospectively. AA was evaluated objectively and monocularly with the autorefractometry (Tonoref III, ARK-1a, NIDEK Co Ltd, Gamagori, Japan). Accommodation amplitude was evaluated preoperatively and at the 1st week, 1st month, and 3rd month postoperatively. RESULTS:A total of 36 patients (67 eyes) were included. Mean age was 15.6 ± 6.4 (range, 6-28) years. Average AA decreased significantly in the 1st week compared to the preoperative, baseline value (P = 0.006) and increased significantly in the 1st month compared to the 1st week (P = 0.043). In the 3rd month, it increased slightly compared to the 1st month and reached the baseline value again (P = 0.096). Pre- and postoperative 3rd month values did not differ (P = 1). CONCLUSIONS:In this small study cohort, full-thickness rectus tenotomy reduced AA in the early postoperative period, but this impairment proved temporary, and AA regained preoperative values in the 3rd postoperative month.

To investigate the inhibitory effect of topically administered azithromycin (AZM), and moxifloxacin (MXF) against tumor necrosis factor-α (TNF-α) production in a rat model of endotoxin-induced uveitis (EIU). Thirty-six Wistar albino rats were divided into 6 equal groups. Groups 1, 2 and 3 were determined as sham, control group for topical AZM application and control group for topical MXF application, respectively. Sterile saline, topical AZM 1.5

Purpose: To compare the prevalence, magnitude and type of corneal astigmatism between Turkish individuals and Syrian refugees. Material and methods: Data of patients scheduled for cataract surgery between January 2019 and 2020 were reviewed. The patients were randomly stratified according to their ethnicity (Turkish individuals or Syrian refugees). Keratometry was performed with the keratometer of IOLMaster 500. Quantitative analysis was performed using the power vector method (J0 and J45). The association between age and astigmatism in the two groups was explored. Results: The study included 4085 eyes of 2049 patients (3962 eyes of Turkish individuals and 123 eyes of Syrian refugees). The mean magnitude of corneal astigmatism, J0, J45 and prevalence of against the rule (ATR) astigmatism and with the rule (WTR) astigmatism were 1.01 D, 0.06, 0.01 D, 37.6% and 43.7% in Turkish individuals and 1.13 D, −0.02, 0.07 D, 46.3% and 37.4% in Syrian refugees, respectively. There were no significant differences according to age, sex, right/left eyes, corneal astigmatism magnitude, keratometric values, J0 and J45 ( p > 0.05) between the two groups. Below 40 years of age, the mean corneal astigmatism magnitude in Syrian refugees was significantly higher than that in Turkish individuals ( p = 0.037). At all ages, ATR astigmatism prevalence was higher in Syrian refugees than in Turkish individuals. ATR astigmatic shift began at a younger age in Syrian refugees ( p = 0.037). Age- and sex-adjusted analysis showed that J0 was significantly lower in Syrian refugees than in Turkish individuals ( p = 0.013). Conclusion: The prevalence and magnitude of ATR astigmatism were higher and onset earlier in Syrian refugees than in Turkish individuals.

Abstract Background To determine the repeatability of corneal topography measurements in severe dry eye disease (DED). A comparison of corneal topography parameters between severe DED and healthy subjects was a secondary goal of this study. Methods Sixty-nine patients with severe DED and 46 healthy subjects were enrolled in the study. All participants underwent repeated corneal topography measurements with Pentacam (Oculus, Germany) within a half hour time. Both eyes of the participants were used in statistical analysis. A further subcategorization of severe DED patients was performed according to Ocular Surface Disease Index (OSDI) scores: 32–50, 51–70 and 71–100. The repeatability of corneal parameters was assessed with correlation coefficients (CC). Results The mean age of dry eye patients and healthy subjects were 40.8 ± 13.2 (17–66) and 39.8 ± 8.2 (18–61) years (p:0.604) respectively. No significant differences were found between severe DED and control groups according to analysed corneal parameters in both eyes (p:>0.05). All CCs were greater than 0.9 in severe DED group (p:<0.001). All CCs were also greater than 0.9 in severe DED patients among different OSDI groups (p:<0.001). Conclusions Corneal topography measurements are highly repeatable in severe DED with Pentacam. This is the first report about this topic. Nonetheless, further studies are needed with different topography devices for validation.

Objectives:To determine whether treatment time of congenital nasolacrimal duct obstruction (CNLDO) has any effect on refractive amblyopia risk factors (ARFs).Methods:This is a cross-sectional study and it was conducted in the Pediatric Ophthalmology Department at Kayseri City Training and Research Hospital. The ages of 174 patients who underwent probing were obtained from electronic medical charts and used to divide the patients into two groups: an early-probing group (<24 months old) and a late-probing group (≥24 months old). After inclusion criteria were applied, a pediatric ophthalmologist examined 189 eyes of the 174 patients. The groups were evaluated and compared for cycloplegic refractive errors.Results:The median age of patients who underwent probing was 30 months (ranging from 11-44 months). A total of 40 of 189 eyes (21.2%) examined had refractive ARFs, which were significantly more prevalent in the late-probing group (p=0.044). The ARFs associated with astigmatism were greater in the late- versus the early-probing group (p=0.037), whereas no other refractive ARFs or anisometropia differed between the groups (p=0.887 for myopia, p=0.364 for hyperopia, and p=0.672 for anisometropia). Astigmatic ARFs were significantly higher in the late-treatment group.Conclusion:Astigmatic ARFs were significantly higher in the late-treatment group. Therefore, ophthalmologists should regularly monitor the refractive status of children with CNLDO, especially those treated after 24 months old.

Objective: The primary aim of this study was to compare the retinal vessel caliber (RVC) with both arterial stiffness (AS) parameters and nocturnal blood pressure dipping status (DS) in essential hypertension (EH). Materials and Methods: The retinal vessel diameter of 101 patients with EH and 31 sex- and age-matched healthy controls was measured using retinal fundus photography. Venous blood samples were obtained for biochemical tests and anthropometric measurements were also recorded. The AS parameters of carotid-femoral pulse wave velocity (cfPWV), augmentation index (AIx), and central aortic pressure (CAP) were assessed using a non-invasive TensioClinic arteriographic system (TensioMed Kft., Budapest, Hungary). DS was evaluated using 24-hour ambulatory blood pressure measurements. The baseline characteristics, AS parameters, and the nocturnal DS of hypertensive patients were statistically compared with those of healthy individuals according to RVC values. Results: The hypertensive group had significantly higher heart rates (p=0.023); AS parameters (PWV [p<0.001], CAP [p<0.001]); and fasting glucose (p=0.028), creatinine (p=0.046), triglyceride (p=0.045), uric acid (p=0.014) and microalbuminuria (p=0.004) values than the healthy controls. Although there was a significant positive linear correlation between the duration of hypertension and PWV (p=0.024), AIx (aortic) (p=0.005) and AIx (brachial) (p=0.013), no significant difference between the EH patients and the control subjects was observed in the AS parameters and nocturnal DS values according to the RVC value. Conclusion: The results of this study did not demonstrate a significant correlation between the RVC and the AS parameters and nocturnal DS in EH. Additional prospective studies are warranted to reach a consensus on the clinical significance of RVC measurements in EH.

PURPOSE:The aim of this study was to analyze the segmented layers of the macula in patients with obstructive sleep apnea and hypopnea syndrome (OSAS) using spectral domain optical coherence tomography (SD-OCT).MATERIAL AND METHODS:This single-center, cross-sectional study included 31 OSAS patients and 31 age- and gender-matched control subjects. SD-OCT and overnight polysomnography were performed on all participants. The OSAS patients were categorized according to disease severity (mild, moderate, severe). The groups were compared in respect of each segmented macular layer through the use of segmentation software on SD-OCT. Total retinal thickness (RT), peripapillary retina nerve fiber layer (pRNFL) thickness, central corneal thickness (CCT) and intraocular pressure (IOP) values were also compared between the groups.RESULTS:Mean CCT (p:0.015) and nasal pRNFL values (p:0.042) were lower and mean IOP was higher (p:0.018) in OSAS patients than in the control group. The statistical analysis revealed significantly thinner total RT, inner retinal layers (IRL), outer retinal layers (ORL), photoreceptor layers (PRL) and ganglion cell layer (GCL) thicknesses in the OSAS groups compared to healthy subjects. No significant differences were found between the three OSAS subgroups in all segmented macular layers and pRNFL measurements.CONCLUSION:The results of this study showed relatively thinner nasal pRNFL, total RT, IRL, ORL, PRL and GCL layers in OSAS patients compared to healthy subjects. Moreover, this thinning of the segmented layers was unrelated to disease severity.

Purpose The primary aim of this study was to assess the practice behaviors of physicians on pediatric vision screening (VS) in primary care settings in Turkey and compare the groups in respect of previous education on VS. Methods All physicians working in the primary care settings of Kayseri province of Turkey were directly administered a 24-item questionnaire at planned education seminars. The groups were compared according to a history of VS education (Group 1) and no history of VS education (Group 2). The self-reported questionnaire results were analyzed statistically. Results A total of 124 of 453 physicians completed the survey with a response rate of 27.3%. VS was reported to be performed as recommended by 70.2% of the participants. The physicians in Group 1 were significantly older ( P < 0.05) and more experienced ( P < 0.05) than those in Group 2. Group 1 performed the red reflex (RR) test significantly more frequently ( P < 0.05) and referred the patients to an ophthalmologist less frequently than Group 2 ( P < 0.05). Regression analysis revealed that age ( P < 0.05) and previous education ( P < 0.05) were the independent factors for visual acuity and RR testing, respectively. Practice-related factors were the most commonly reported barriers to VS in primary care settings. Conclusion Although there is a high rate of reported full adherence to the recommendations for pediatric VS, it seems to be more likely to be performed insufficiently. Practice-related barriers should be handled by publicly available education materials (e.g., YouTube videos). VS education should be added at an earlier stage of medical training programs.

Aim: To evaluate whether anterior segment parameters (ASPs) differ between patients with Graves’s ophthalmopathy (GO) and healthy individuals. Materials and Methods: In a case-control study, 62 patients with GO and 45 healthy sexand age-matched individuals were compared for ASPs obtained from Scheimpflug camera imaging (Sirius, Florence, Italy). The ASPs were anterior chamber depth (ACD), anterior chamber volume (ACV), iridocorneal angle (ICA), corneal volume, corneal curvatures (K1, K2, and Kmean), and white-to-white, apical, and thinnest corneal thickness. Results: Mean white-to-white corneal distance, corneal volume, ACD, ACV, ICA, K1, K2, and Kmean were similar between patients and controls (p = 0.815, p = 0.285, p = 0.522, p = 0.102, p = 0.275, p = 0.114, p = 0.566, p = 0.137, p = 0.405, and p = 0.447, respectively). There was a negative correlation between mean Hertel measurement and mean ACD (r = 0.284, p = 0.003), ACV (r = 0.283, p = 0.003), and ICA (r = 0.295, p = 0.002). Conclusion: The ASPs were not associated with significant alterations between patients with GO and controls.

To evaluate whether the systemic oxidative stress biomarkers increased in patients with vitreomacular traction syndrome (VMT). This study compared 25 patients diagnosed with VMT with 20 healthy controls. As a biomarker of systemic oxidative stress, malondialdehyde (MDA) was measured. Total oxidant status (TOS) and total antioxidant status (TAS) were measured to evaluate the systemic oxidant status. Serum MDA values were significantly higher among the patients (p < 0.001). The ideal cut-off value for MDA was determined to be 22.1 µmol/L, with 80% sensitivity and 75% specificity. The between-group differences were not statistically significant for TOS or TAS (p = 0.326 and p = 0.698, respectively). Increased MDA levels suggest that systemic oxidative stress may play a role in VMT.

Purpose: To evaluate the topical glaucoma eye drops adherence prevalence and its association with beliefs and illness perceptions about glaucoma in Turkey. We also aimed to explore the factors linked to patients' total, voluntary, and involuntary non-adherence to medication in different patient attitudes. Material and Methods: A prospective study with cross-sectional design which included a total of 317 glaucoma patients who completed questionnaires. We assessed the adherence to medication, illness perceptions, and the beliefs about the glaucoma treatment by the "Reported Adherence to Medication scale," "the Brief Illness Perception Questionnaire," and "the Beliefs about Medicine-Specific Questionnaire," respectively. According to the RAM scale, voluntary and involuntary non-adherence scores were also distinguished. Different adherence categories in RAM scale were compared with perception and belief measures. Patient attitudes were assessed from the BMQ. We also performed attitudinal type comparisons with different adherence groups. Results: The full adherence prevelance to glaucoma medication was 40%. The proportion of voluntary and involuntary non-adherence was 26% and 57%, respectively. The adherence groups were similar in terms of belief measures but statistically different according to illness perceptions (consequences (p = 0.002), timeline (p = 0.008), personal control (p = 0.001), identity (p = 0.019), concerns (p = 0.003)), and attitude types (ambivalent (p = 0.030) and accepting (p = 0.029)). Conclusion: New strategies are required to improve patient adherence to glaucoma medication in Turkey. The beliefs about the glaucoma treatment and illness perceptions are also needed to be enhanced.

IntroductionThe purpose of this study is to evaluate the factors affecting multiple surgeries, worse visual outcome, eye removal (ER) and vitrectomy requirement in terror-related open-globe injuries (OGI) in the Turkish Military. Secondary purpose is to specify surgery and injury characteristics of terror-related OGI.MethodsA total of 372 eyes of 251 patients with OGI that occurred during terroristic attacks between January 1996 and January 2016 were included in the study. A retrospective investigation of the preoperative variables associated with further surgeries, visual outcome, vitrectomy requirement and evisceration/enucleation was achieved.ResultsA total of 1118 separate operative sessions with a median of 2 (1–14) surgeries were performed to 372 eyes. Preoperative factors predicting follow-up surgery included visual acuity (VA) <20/200, lens injury, vitreous haemorrhage (VH), presence of vitreous prolapse. Baseline VA <20/200, initial retinal detachment and ruptured globe injury were the independent factors of worse visual result. Ruptured globe injury (p:0.000) and initial vitreous prolapse (p:0.001) were significantly linked to ER surgery. Patients required vitrectomy significantly tend to have VH (p:0.000) and zone 3 injury (p:0.000) compared with non-vitrectomy group. Single surgery cases tend to have significantly better baseline (p:0.000) and final VA (p:0.007) and shorter follow-up period (p:0.000) compared with multiple surgery group.ConclusionsTerror-related OGI necessitate remarkable surgical follow-up and multiple surgery sessions with a relatively higher evisceration/enucleation rate than other types of OGI. A comprehensive surgical approach with multiple surgery types is needed to treat terror-related OGI.

ABSTRACT Objective: A scientometric analysis produced in ophthalmic genetics and gene therapy research is lacking. The purpose of this study is to present a holistic analysis of ophthalmic genetics literature. Methods: The data used in this study were obtained from the Web of Science (WoS) Core Collection. All published documents between 1975-2019 were included. The data exported from WoS enabled the extensive details of ophthalmic genetics related literature including countries, institutions, authors, citations and keywords. Scientometric network maps of keywords and also country and institution co-authorships were created with free software. Global contributions of the countries to the ophthalmic genetics literature were shown by a graphic. Results: The search query revealed a total of 2322 documents. Most of the documents were original articles (75.75%). USA was the leading country by producing 45.39% of all documents in ophthalmic genetics research followed by UK, Germany, China and France. Pennsylvania University was the most contributing institution in the literature (5.25%) followed by University College London and Moorfields Eye Hospital. The average citations per item was 29.4. The most used keywords over a 40-year period were 'family', 'cell', 'photoreceptor' and 'expression'. Conclusions: USA and UK dominated the ophthalmic genetics research. A substantial increase in the number of published documents in this field were observed after 2010.