Aim: Our aim in this study was to evaluate postoperative complications and dry eye parameters after reconstructive surgery for primary periocular malignant lesions. Materials and Methods: Patients who underwent reconstructive surgery after malignant eyelid and periocular tumor excision were evaluated in two groups: those with defects involving the lid margin and those with defects sparing the lid margin. Demographics, histopathology, lesion location, horizontal eyelid defect size, surgical procedure, postoperative complications, and dry eye test results were compared between the groups. Results: The study included 68 patients: 35 with lesions involving the lid margin and 33 with lesions sparing the lid margin. The mean age was 69.9 +/- 14.95 years. Histopathology confirmed basal cell carcinoma in 86.8% of the cases, and 54.4% of the tumors were on the lower lid. Cases involving the lid margin had more postoperative complications, as well as a higher rate of postoperative dry eye disease (DED) (p<0,05). Discussion: Our results indicate that reconstructive surgeries for tumors involving the lid margin are more prone to postoperative complications and may also cause the onset or exacerbate preexisting DED.

PURPOSE:This study was conducted to investigate the effect of injectable platelet-rich fibrin on the recovery of compromised epithelium due to crosslinking treatment. METHODS:In this comparative study, the epithelial closure rates and in vivo confocal biomicroscopy results of 26 patients with keratoconus who underwent subconjunctival injection of injectable platelet-rich fibrin near the limbus after epithelium-off corneal crosslinking treatment were compared with those of 25 patients who did not receive the injection of injectable platelet-rich fibrin. RESULTS:The average time to epithelial defect closure in the injectable platelet-rich fibrin group was 2.76 ± 0.90 days compared to 3.56 ± 0.86 days in the non-injectable platelet-rich fibrin group (p=0.003). At the end of the 1st month, the mean subbasal nerve plexus density was 1.26 ± 1.61 nerves/mm2 in the injectable platelet-rich fibrin group, whereas it was 0.72 ± 0.89 nerves/mm2 in the non-injectable platelet-rich fibrin group (p=0.016). By the 3rd month, the density increased to 3.42 ± 1.13 nerves/mm2 in the injectable platelet-rich fibrin group and 2.36 ± 1.15 nerves/mm2 in the non-injectable platelet-rich fibrin group (p=0.002). Similarly, the anterior stromal keratocyte density at the end of the 1st month was 93.6 ± 33.5 cells/mm2 in the injectable platelet-rich fibrin group compared to 67.3 ± 26.4 cells/mm2 in the non-injectable platelet-rich fibrin group (p=0.001). By the end of the 3rd month, the density increased to 255.2 ± 45.7 cells/mm2 in the injectable platelet-rich fibrin group and 222.1 ± 43.6 cells/mm2 in the non-injectable platelet-rich fibrin group (p=0.011). In the non-injectable platelet-rich fibrin group, one patient developed a sterile infiltrate at the end of the 1st week, whereas no complications were observed in the injectable platelet--rich fibrin group. CONCLUSION:Subconjunctival injectable platelet-rich fibrin application is an effective and safe method for corneal epithelial healing after crosslinking treatment.

Objective To evaluate the effect of full-thickness wedge resection (FTWR) on ocular surface and in vivo confocal microscopy (IVCM) findings in patients with floppy eyelid syndrome (FES). Methods The study included two groups: a surgical treatment (ST) group (26 eyes) consisting of patients who underwent FTWR surgery, and a conservative treatment (CT) group (30 eyes). Pre-treatment and post-treatment ocular surface disease index (OSDI), tear break-up time (TBUT), corneal fluorescein staining (CFS), IVCM findings along with the body mass index (BMI), FES grade, the presence and the treatment of obstructive sleep apnea syndrome (OSAS) were recorded and compared between the groups. Results The groups were comparable in terms of BMI, FES grade, and OSAS data. After six months, TBUT in the ST group significantly increased to 12.92 ± 1.15, compared to 8.10 ± 1.60 in the CT group ( p = 0.000). The CFS and OSDI scores were significantly lower in the ST group (0.15 ± 0.37, 18.0 ± 8.3, respectively) compared to the CT group (0.90 ± 0.61, 27.3 ± 9.3, respectively) ( p = 0.000). IVCM analysis revealed a significant decrease in dendritic cell count (ST: 22.0 ± 12.4, CT: 39.5 ± 15.1, p = 0.000) and nerve tortuosity (ST: 1.38 ± 0.64, CT: 2.00 ± 0.59, p = 0.000), with a significant increase in total nerve density (ST: 4.27 ± 0.83, CT: 3.57 ± 0.90, p = 0.002) in the ST group compared to the CT group after six months. Conclusion In our retrospective cohort, FTWR surgery was shown to be an effective and reliable surgical treatment for FES, improving both ocular surface and IVCM findings. Patients with moderate to severe stages of FES not responding to conservative treatment may benefit from eyelid tightening.

Objetivo: Comparar e investigar los parámetros de la tomografía de coherencia óptica (OCT) de los lados sanos y afectados de pacientes con pérdida auditiva neurosensorial súbita idiopática (PANSI). Método: La evaluación ocular bilateral de los pacientes diagnosticados con PANSI se realizó con OCT. Se registraron los valores de espesor del complejo de células ganglionares (CCG) y de la capa de fibras nerviosas de la retina (CFNR), y se examinaron las diferencias entre los dos ojos. Resultados: Se evaluaron 39 pacientes, con una edad media de 44.82 ± 14.90 años. Se determinó que el grosor de la CFNR de los ojos era una media de 89.87 ± 3.65 μm en el lado afectado y 103.87 ± 3.98 μm en el lado de control sano (p = 0.0001). Se determinó que el CCG medio era 90.46 ± 3.49 μm en el lado afectado y 103.77 ± 3.96 μm en el lado de control sano (p = 0.0001). Conclusiones: Se encontró una diferencia estadísticamente significativa entre los ojos sanos y afectados de pacientes con PANSI con respecto al CCG medio y al espesor medio de la CFNR. La OCT podría ser una técnica útil para medir esta degeneración neuronal.

OBJECTIVE:The objective of the study is to compare the optic coherence tomography (OCT) parameters of the healthy and affected sides of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) and to investigate the relationships between these and the improvement in hearing levels. METHODS:A bilateral eye evaluation of patients diagnosed with ISSNHL was performed with OCT. The ganglion cell complex (GCC) and retina nerve fiber layer (RNFL) thickness values were recorded and the differences between the two eyes were examined. RESULTS:An evaluation was made of 39 patients with a mean age of 44.82 ± 14.90 years. The RNFL thickness of the eyes was determined to be mean 89.87 ± 3.65 µm on the affected side and 103.87 ± 3.98 µm on the healthy control side (p = 0.0001). The mean GCC was determined to be mean 90.46 ± 3.49 µm on the affected side and 103.77 ± 3.96 µm on the healthy control side (p = 0.0001). CONCLUSIONS:A statistically significant difference was observed between the healthy and affected eyes of patients with ISSNHL with respect to mean GCC and mean RNFL thickness. OCT could be a useful technique for measuring this neural degeneration.

Purpose To evaluate the corneal epithelial mapping, ocular surface parameters and their relationship with each other in lower eyelid ectropion patients according to severity. Methods This retrospective study included 48 lower eyelid ectropion patients and 63 healthy individuals as control group. Ocular surface and tear functions were evaluated with ocular surface staining score, tear film break-up time (BUT), non-invasive tear break-up time (NIBUT) and ocular surface disease index (OSDI). Meibography scores and corneal epithelial thickness (CET) mapping were evaluated. The lower eyelid ectropion was classified and divided into subgroups as follows: mild, moderate and severe. Results There was no significant differences between the groups for age and gender. Compared to controls, CET was significantly thinner at inferior ( p = 0.047) and inferior nasal quadrants ( p = 0.023) in the ectropion patients. Lower BUT and NIBUT, higher OSDI scores and higher ocular surface staining were observed in the ectropion patients . In the subgroups determined according to the severity of ectropion, ocular surface damage was found to be significantly higher as the severity of ectropion increased ( p < 0.05). Conclusion Patients with lower eyelid ectropion had worse ocular surface findings and more ocular complaints. Furthermore, the inferior and inferior nasal CETs were thinner in patients with lower ectropion.

Purpose: To compare the surgical outcomes of Muller muscle conjunctival resection (MMCR) and levator advancement (LA) in patients with mild to moderate blepharoptosis. Methods: A retrospective review of patients who underwent surgery for mild to moderate ptosis between 2015 and 2020 was performed. The degree of ptosis was graded based on the amount of upper eyelid drooping: mild ≤ 2 mm and moderate < 4 mm. Surgical success was defined as post-operative marginal reflex distance 1 (MRD1) ≥ 4.0 and ≤ 5.0 mm, and a satisfactory eyelid contour. Results: A total of 82 eyes of 65 patients underwent ptosis repair surgeries. MMCR was performed in 48 eyes and LA in 34 eyes. Under-correction was detected in 8.3% and 11.8% of the patients in MMCR group and LA group respectively. There was no patient with over-correction in the MMCR group postoperatively, 3 patients in the LA group had over-correction (0% vs. 8.8% respectively). The success rate in our study was found to be 91.7% in the MMCR group and 72.2% in the LA group. Conclusions: The MMCR and LA procedures are effective approaches in treating patients with mild to moderate eyelid ptosis in our population. Each procedure had its superiority in selected groups of patients. However, the complication rate and duration of surgery were found to be lower in MMCR group. Abbreviations: LA = Levator Advancement, LF = Levator Function, MMCR = Muller Muscle Conjunctival Resection, MRD 1 = Marginal Reflex Distance.

Objective: To compare the efficacy of dexpanthenol/ sodium hyaluronate fixed combination with sodium hyaluronate eye drops in the treatment of dry eye disease (DED) and ocular surface inflammation (OSI) following cataract surgery. Material and Methods: Sixty-three patients who underwent cataract surgery were included in this study. In addition to the standard postoperative treatment, one group (study group, n=30 eyes) received dexpanthenol/sodium hyaluronate fixed combination eye drops, while the other group was given sodium hyaluronate eye drops (control group, n=33 eyes). The 2 groups were compared in terms of best-corrected visual acuity, tear break-up time (TBUT), corneal flourescein staining, ocular surface disease index (OSDI) and in vivo confocal microscopy (IVCM) findings. Results: While TBUT was significantly greater in the study group than the control group (11.2, 8.9, respectively), corneal floresein staining (0.13, 0.48, respectively) and OSDI (10.8, 17.1, respectively) were significantly lower in the study group compared to the control group at postoperative 4 months. In IVCM, the number of dendritic cells and activated keratocytes were significantly lower in the study group (40.8, 13.9 respectively) compared to the control group (51.2, 18.0, respectively). In addition, while the total number of nerves in the study group (4.57) was higher than that of the control group (3.91), the nerve tortuosity was lower in the study group (1.57, 2.18, respectively). Conclusion: Dexpanthenol/sodium hyaluronate fixed combination eye drops could be preferred as an adjuvant for the treatment of DED and OSI following cataract surgery.

ObjectiveTo evaluate the effects of lipid-containing Rohto Dry Aid eye drops and sodium hyaluronate eye drops on the ocular surface and in vivo confocal microscopy (IVCM) findings in patients using systemic isotretinoin.MethodsThis retrospective study included 71 patients using systemic isotretinoin for acne vulgaris. Ocular surface and tear functions were evaluated with the tear break-up time (TBUT), corneal fluorescein staining (CFS), and the ocular surface disease index questionnaire (OSDI). Meibography was used for the staging of Meibomian gland dysfunction (MGD) while IVCM was used for the analysis of corneal micro-structural changes. The data of 36 patients using Rohto Dry Aid (the Rohto group) and 35 patients using sodium hyaluronate (the SH group) were recorded. Pre-treatment, first month and third month data were analyzed.ResultsLonger TBUT, lower OSDI score, and less CFS were observed in the first and third months after treatment in the Rohto group (p < 0.001). There was no significant change in TBUT and CFS in the first month (p > 0.05) in the SH group (p < 0.05) but lower TBUT and more CFS were observed in the third month. There was no significant change in the OSDI score in the SH group. There was a significant decrease in dendritic cells, activated keratocytes, and nerve tortuosity with IVCM in both groups. However, no significant difference was found between the two groups.ConclusionRohto Dry Aid, with its support of the lipid layer, is an effective and safe treatment agent that can improve both ocular surface and IVCM findings in evaporative dry eye cases with MGD.

Objectives To evaluate the effect of treatment with high-dose glucocorticoids (HDG) on ocular surface parameters and in vivo confocal microscopy (IVCM) findings in patients with active thyroid eye disease (TED). Methods This study included 15 active TED patients treated with a cumulative HDG dose of 4.5g (500 mg and then 250 mg for 6 weeks each). Disease activity was assessed by the clinical activity score (CAS), Graves' Orbitopathy-specific Quality of Life (GO-QoL) questionnaire, ocular surface disease index (OSDI), tear break-up time(T-BUT), ocular surface staining and IVCM. Results The mean follow-up time was 48.6 months. The treatment resulted in a significant improvement in the T-BUT, ocular surface staining values. In comparison to the baseline, a notable reduction in CAS, OSDI and an increase in GO-QoL were seen after one year. IVCM showed a significant decrease in the number of dendritic cells, activated keratocytes, the degree of tortuosity, there was also a significant increase in the number of basal epithelial cells and total nerves over one-year period. All of those changes remained stable during the follow-up period. Conclusion HDG treatment results in a sustained decrease in corneal inflammatory cells, an increase in tear film stability, and an improvement in disease symptoms and QoL scores for up to 4 years.

To evaluate the effect of dexpanthenol 2

OBJECTIVE: Our aim is to measure the stiffness values in different regions of the eye with shear wave elastography (SWE) in patients with glaucoma and to compare the results with healthy eyes to investigate whether there is a change in the elasticity of the ocular compartments in glaucoma patients.MATERIAL AND METHODS: In this study, we compared 12 patients with open-angle glaucoma and 32 healthy volunteers using an SWE-equipped ultrasonography device. Only the right eye was evaluated in all patients. First, the eye globe was generally examined in B-mode. Then, the stiffness values of the optic nerve head, retro-orbital nerve, sclera-retina complex and retro-orbital adipose tissue in the posterior segment and the stiffness values of the cornea, lens and anterior chamber in the anterior segment of the eye were measured with SWE in kiloPascal and both groups were compared statistically.RESULTS: No statistically significant differences were found between the patient and control groups in terms of the stiffness values recorded in the measurements performed in different parts of the eye.CONCLUSIONS: Although SWE is an easily applicable method, no significant differences were found between glaucoma and control groups. However, thanks to this study, reference values for different parts of the eye in normal individuals have been determined.

The aim of this study was to assess the effect of different grades of dermatochalasis (DC) and upper eyelid blepharoplasty (UEB) surgery on corneal epithelial thickness (CET), objectively using anterior segment-optical coherence tomography (AS-OCT) measurements. 90 eyes of patients with DC were divided into three groups according to the severity of the DC. Forty-one eyes of age and sex-matched patients without DC were randomly selected as the control group. The study did not include patients with more than 2 D of spherical refractive error and more than 1.5 D of astigmatism, a history of previous eyelid surgery, ocular surface disease, contact lens use, and ophthalmic eye drop use. CET measurements of all the patients were performed with an AS-OCT (RTVue-XR, Optovue Inc., USA). There were statistically significant differences in the CET of the superior, superonasal, superotemporal, inferotemporal, and temporal sectors between the DC and control groups (p = 0.001, p = 0.02, p = 0.03, p = 0.02, p = 0.04, respectively). While there were no differences in CET among the sectors of the control group, there was a difference in CET among some sectors of the DC group. When the DC group was subdivided by severity, there was no difference between subgroups for CET across all sectors both preoperatively and postoperatively. In the measurements made 6 months after UEB surgery, the CET in all sectors increased statistically significantly compared to those measured in the preoperative period. This study revealed that DC reshaped the corneal epithelium and UEB surgery restored this remodeling 6 months after surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

To evaluate patient satisfaction with samfilcon A contact lenses (CLs) in intensive digital device users with myopia and to compare patient satisfaction with samfilcon A lenses to prior experience with senofilcon A or lotrafilcon B CLs. This was a comparative, prospective, national study conducted at 14 centers in Turkey. Subjects were adults aged 18 and 45 years with myopia (range −0.25 D to −6.00 D) who spend a minimum of 3 hours viewing digital devices (e.g., computer, smartphone). A subgroup of patients were habitual lens wearers (senofilcon A or lotrafilcon B lens wear for at least 6 months prior to enrollment). The primary assessment was patient satisfaction with samfilcon A lenses (0–100 Likert scale). Secondary assessments included patient satisfaction with samfilcon A lenses compared to patients’ habitual lenses, investigator satisfaction with samfilcon A lenses and investigator-evaluated slit lamp examination findings. Samfilcon A lenses were given high overall ratings from both patients and investigators, with a low incidence of ocular symptoms. Overall, patients were highly satisfied with samfilcon A lenses for comfort, vision and overall performance, and stated that they would consider wearing these lenses in the future. Among habitual senofilcon A or lotrafilcon B lens wearers, samfilcon A lenses were rated significantly better than the habitual lenses in regard to comfort, vision and overall performance. Investigator assessments were also highly favorable, both at initial fit and after 4 weeks of follow-up, with no significant findings noted on slit lamp examination. Samfilcon A lenses were rated highly by investigators in regard to fit, handling and slit lamp findings, and by novice and habitual lens wearers in regard to comfort, vision and overall performance. These results support the use of samfilcon A lenses among digital device users who seek day-long comfort and good visual acuity.

Pellucid marginal degeneration (PMD) is a non-inflammatory progressive ectatic disorder of the cornea. It has similar features with other ecstatic diseases like keratoconus and keratoglobus but location in the cornea shows difference. Typical location of the PMD is the inferior quadrant of the cornea, but it may rarely develop in the superior quadrant. Here we present clinical finding and treatment of a reverse PMD case. 60 years-old male had bilateral low vision. Vision loss was begun 5 years after cataract operation. There were bilateral high astigmatism and PMD in superior quadrant of the corneas of the both eyes. Vision of the patient increased with sclera contant lens application.

Parry-Romberg syndrome (PRS) may overlap localized scleroderma (morphea) lesions with linear depression (en coup de sabre [ECDS]). Overlap case with PRS and ECDS was presented. Enophthalmos, uveitis, ocular torticollis, keratic linear precipitates, and anti-double-stranded DNA positivity were identified. Subendothelial keratic precipitates detected by an in vivo laser scanning confocal microscopy were the first profiled in the literature. Patients must be evaluated and followed up carefully by their clinics to prevent misdiagnosis and unnecessary procedures such as surgery of ocular torticollis as muscular torticollis.

Amaç: Ailesel Akdeniz ateşi (AAA) olan hastalarda oküler yüzeyi değerlendirmektir. Gereç ve Yöntemler: Bu çalışmada, Haziran 2013-Haziran 2015 tarihleri arasında Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi Genetik Tanı Merkezine yönlendirilen AAA hastaları çalışmaya alındı. Oküler yüzey değişiklikleri; oküler yüzey hastalık indeksi (OYHİ) anketi, Schirmer testi, gözyaşı kırılma zamanı (GKZ), oküler yüzey boyama paterni ve meibografi ile değerlendirildi. Bulgular: Ortalama yaş 88 AAA hastasında (grup 1) 35,1±13,1 yıl (67-10) iken, 31 kontrol hastasında (grup 2) 34,6±12,7 yıl idi (66-11). OYHİ skoru grup 1'de 28,75±18,47 iken, grup 2'de 17,63±15,37 idi (p=0,03). Meibomian bez (MB) kaybı grup 1'de grup 2'den daha fazlaydı (sırasıyla %14,7±11,9 ve %9,9±8,9). Schirmer testi AAA grubunda kontrol grubuna göre daha kısa bulundu (sırasıyla 20,82±9,94 ve 26,03±8,28 mm). Grup 1'de ortalama GKZ 6,53±3,7 (1-15) iken, kontrol grubunda 11,64±2,97 (5-15) idi (p=0,0001). Ortalama fluoreseinle kornea boyanma skoru grup 1 ve 2'de sırasıyla 2,78±2,89 ve 0,19±0,4 idi. Ortalama Lisamin yeşili boyanma skoru grup 1'de 1,87±1,91 iken, grup 2'de 0,22±0,49 idi. Yeni AAA tanısı alan/kolşisin kullanmayan AAA'lı 26 hastayla önceden AAA tanısı konulmuş/kolşisin kullanan 62 hastanın oküler yüzeyinin değerlendirildiği test sonuçları benzer olarak saptandı. Homozigot M694V mutasyonu olan (16 hasta) ve olmayan (72 hasta) AAA hastaları karşılaştırıldığında, oküler yüzeyi değerlendirilen test sonuçları benzerdi. Sonuç: AAA hastalarındaki Akdeniz ateşi gen mutasyonu sonucu gelişen kontrol edilemeyen inflamasyonun hem MB kaybına neden olup gözyaşı buharlaşmasını artırarak hem de gözyaşı üretimini azaltarak kuru göze neden olabileceği düşünülmektedir. Çalışmamızda, M694V homozigot mutasyonunun ve kolşisinin oküler yüzeye önemli bir etkisinin olmadığı saptanmıştır.

OZET Kronik plak psoriazis hikayesi olan 62 yasindaki erkek hasta Turk hamaminda kese yaptirdiktan hemen sonra baslayan ve tum vucudu kaplayan yanma, kasinti ve pul pul eritematoz plak sikâyetiyle geldi. Psoriazis disinda sistemik veya okuler hastalik hikayesi yoktu. Hastanin oykusunde Turk hamaminda kese yapilmasina bagli olusan travma disinda presipite edici bir faktor saptanmadi. Hasta gozlerinde yanma, batma, sulanma, yabanci cisim hissi ve kizariklik sikâyetiyle goz klinigine basvurdu. Gorme keskinligi her iki gozde 10/10 idi ve fundus muayenesi dogaldi. Bilateral alt kapaklarda ektropion ve korneada yuzeysel noktasal erozyonlar mevcuttu. Cildin asiri kuru ve gergin oldugu izlendi. Travma sonrasi tum vucut alanini kaplayan asiri kuruluk, pullanmalar ve eritem gibi klinik bulgulara dayanarak eritrodermik psoriazis tanisi kondu ve cilt biyopsisi ile dogrulandi. Hastanin dermatolojik tedavisinde topikal kalsipotriol, topikal kortikosteroid ve nemlendiriciler kullanilirken, gozundeki lezyonlar icin koruyucu icermeyen goz yasi ve goz jeli kullanildi. Hastada 12 haftada total remisyon gozlendi. Anahtar Sozcu¨kler: Psoriazis; Ektropion; Eritrodermik psoriazis ABSTRACT We present a 62-year-old man with a history of chronic plaque psoriasis presented with scaly erythematous plaques with itching and burning that covered his entire body immediately after rubbing with a coarse bath-glove in a Turkish bath. He had no systemic and ocular disease history except psoriasis. No history or clinical evidence of precipitating factors except trauma was detected. The patient referred to our ophthalmology clinic with complaints of foreign body sensation and watering in his eyes. Visual acuity was 10/10 and intraocular and fundus examinations were normal. There were bilateral lower lid ectropion and superior punctate erosions on cornea. A diagnosis of erythrodermic psoriasis was made based on the clinical findings and was confirmed by skin biopsy. Patient was then treated with topical salicylic acid, calcipotriene for skin lesions, preservative free lubricants and jells for ocular lesions for 12 weeks with complete remission. Keywords: Psoriasis; Ectropion; Eritrodermic psoriasis