OBJECTIVES: The objectives of the study are to show up the healing processes after anterior stromal puncture (ASP) in the cornea using in vivo confocal microscopy (IVCM) and to investigate the efficacy of ASP in the treatment of recurrent corneal erosion (RCE).
METHODS: This is a prospective, non-randomized, consecutive series. Twenty-three eyes of 19 patients diagnosed with RCE were evaluated between March 2020 and January 2022. Outcome measures included age, sex, laterality, etiology of RCE, duration and recurrence of symptoms, additional treatments required, and complications. IVCM was performed on the same day, at 1st week, 1st, and 6th month.
RESULTS: Mean age was 41.5±11.3 years, 63.2% of patients were female and 65.2% of eyes had unilateral involvement. Corneal trauma (56.5%) was the most common cause. Mean follow-up was 21.1 months (range 8–33). At the final follow-up, 69.5% of eyes were symptom free, 17.4% required a second ASP, and 13% needed a third ASP. At the 1st week, the epithelium became intact. An increase in activated keratocytes and dendritic cells (DCs) with beading of nerve fibers was observed. At 1st month, DCs and activated keratocytes were still present. At the 6th month, a scar was left. The superficial and basal epithelial cell formation and subbasal corneal nerve plexus returned to normal.
DISCUSSION AND CONCLUSION: IVCM has a superiority in visualizing cornea at cellular level. After ASP which is a safe, practical, and cost-effective treatment option in paracentral or peripherally located RCE, IVCM may help the surgeon to better observe and understand the post-healing processes and explain the recurrences.

OBJECTIVES: To evaluate the efficiency and safety of autologous blood-assisted, sutureless conjunctival autograft surgery in the management of pterygium.
METHODS: This study included the eyes of 124 patients who were divided into two groups. Group 1 consisted of 62 patients who received autologous blood-assisted, sutureless conjunctival autograft, and Group 2 consisted of 62 patients who underwent conventional sutured conjunctival autograft surgery. The primary outcome measure was graft stability, and the secondary outcome measures were postoperative immediate patient comfort and recurrence rates at 12 months.
RESULTS: The mean duration of surgery was significantly shorter in Group 1 (9.84±2.64 min) than in Group 2 (17.90±4.42 min) (p<0.001). The postoperative pain visual analog scale score was significantly lower in Group 1 (p<0.001). The postoperative complications included graft loss in four patients in Group 1 and recurrence of pterygium in six patients in Group 2.
DISCUSSION AND CONCLUSION: The autologous blood-assisted, sutureless conjunctival autograft technique seems superior to the conventional sutured autograft technique in terms of postoperative patient comfort, lower recurrence rates, and shorter duration of surgery.

OBJECTIVES: Iris-claw intraocular lens (IC-IOL) implantation and sutureless scleral fixation of intraocular lenses (SSF-IOL) are two commonly preferred surgical approaches for the management of aphakic patients without sufficient capsular support. The aim of this study was to compare the outcomes of IC-IOL implantation and trocar-assisted SSF-IOL implan-tation.
METHODS: The medical records of secondary IOL implantation patients were retrospectively reviewed. All patients had a detailed ophthalmological examination, including LogMAR best-corrected distance visual acuity (CDVA), intraocular pressure (IOP), and endothelial cell density (ECD) preoperatively and postoperatively. SPSS 21.0 software was used for the statistical analysis.
RESULTS: There were 15 patients in the IC-IOL group and 12 patients in the SSF-IOL group. Age and gender distributions were similar between the groups (p=0.456 and p=0.398, respectively). Similarly, patients in both groups had similar CDVA preoperatively and postoperatively (p=0.51, p=0.48, respectively). Both IC-IOL and SSF-IOL implantation significantly increased CDVA (p=0.001 and p=0.005, respectively). IOP remained unchanged in both groups. However, ECD reduced significantly following both IC-IOL and SSF-IOL implantation (p=0.001 and p=0.005, respectively) and trocar-assisted SSF-IOL implantation resulted in significantly more endothelial loss compared to IC-IOL implantation (439.5±89 vs. 164.4±53, p=0.013).
DISCUSSION AND CONCLUSION: Both surgical approaches increased CDVA significantly and at similar levels. However, trocar-assisted SSF-IOL implantation resulted in significantly more endothelial loss compared to IC-IOL implantation. None of the patients developed bullous keratopathy, but this difference should be kept in mind, especially in patients with critically low ECD.

OBJECTIVES: This study aims to investigate the influence of systemic inflammation on adult patients with acquired nasolacrimal duct obstruction (ANLDO).
METHODS: Peripheral venous blood analysis was performed on adult patients who underwent dacryocystorhinostomy for ANLDO between June 2020 and December 2022, during their remission period just before the surgery. Platelet, Neutrophil, Lymphocyte, Monocyte, White Blood Cell (WBC) count, Platelet/Lymphocyte ratio (PLR), Neutrophil/Lymphocyte ratio (NLR), Monocyte/Lymphocyte ratio (MLR), and systemic inflammatory index (SII) (calculated as platelet × (neutrophil/lymphocyte)) were compared with a volunteer control group.
RESULTS: The study included 54 adult patients with ANLDO and 54 individuals in the control group. The mean age was 42.5±14.4 years in the ANLDO group and 37.8±12.3 years in the volunteer control group. There was no significant difference in age between the groups (p=0.064). Platelet value (295.9±70.9→254.7±43.9), PLR value (143.8±77.7→119.0±36.1), and SII value (534.7±192.0→442.6±212.2) in the ANLDO group were significantly higher compared to the Control group (p=0.000, p=0.023, p=0.020, respectively). Neutrophil, lymphocyte, monocyte, NLR, MLR, and WBC values did not exhibit significant differences between the case and control groups (p=0.299, p=0.469, p=0.125, p=0.419, p=0.143, and p=0.465, respectively).
DISCUSSION AND CONCLUSION: The study revealed elevated systemic platelet counts in ANLDO patients, resulting in higher PLR and SII values. The authors suggest that a histopathological examination to assess the local impact of platelets or other inflammatory processes in nasolacrimal duct obstruction could offer valuable insights into the etiopathology of ANLDO.

OBJECTIVES: Investigation of the surgical correction effect on tear film functions and tear oxidative stress levels in patients with blepharoptosis and pseudoptosis.
METHODS: Sixty patients with blepharoptosis or pseudoptosis due to dermatochalasis and 30 healthy controls were included in the study. Forty eyes underwent upper blepharoplasty and 20 eyes underwent levator surgery. The tear oxidative stress levels (8-hydroxydeoxyguanosine [8-OHdG] and 4-hydroxy-2-nonenal [4-HNE]) were determined by enzyme-linked immunosorbent assay and tear film functions were evaluated pre-operatively and at the post-operative 1st and 6th months.
RESULTS: 8-OHdG and 4-HNE levels in tears were found higher in patients with dermatochalasis (86.3±38.2 ng/mL; 29.8±11.4 ng/mL, respectively) and blepharoptosis (95.3±43.8 ng/mL; 40.8±3.8 ng/mL, respectively) compared to healthy controls (52.9±14.0 ng/mL; 27.8±6.6 ng/mL, respectively). Both levels decreased 1 month after blepharoplasty surgery. The 8-OHdG level in tears of patients who underwent levator surgery increased 1 month after the surgery (p=0.008). No change was detected in tear function tests findings between visits in any patient group.
DISCUSSION AND CONCLUSION: Dermatochalasis and blepharoptosis may lead to an increase in the tear oxidative stress levels. Contrary to a decrease in these levels after blepharoplasty, they may increase in the early period after levator surgery followed by a return to normal levels at the 6th-month visit.

OBJECTIVES: Thromboembolic complications related to the COVID-19 infection are frequently reported. This study aims to evaluate the impact of a prior non-severe COVID-19 infection on retinal microcirculation with optical coherence tomography angiography (OCTA).
METHODS: A total of 83 eyes of 43 patients with a history of non-severe COVID-19 infection confirmed with a positive PCR test (Group 1) and 30 healthy controls (Group 2) underwent detailed eye examination, including optic coherence tomography angiography (OCTA, RTVue-XR Avanti) scanning. Vessel densities (VD) in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and foveal avascular zone were evaluated.
RESULTS: The mean duration between the COVID-19 positive PCR test and ocular examination was 144.6±82.2 days. VD of SCP and DCP in the foveal and perifoveal regions were significantly lower in Group 1 compared to Group 2 (p<0.05).
DISCUSSION AND CONCLUSION: A non-severe COVID-19 infection may cause a decrease in the VD of retinal SCP and DCP.

OBJECTIVES: The present study evaluates the rate of endophthalmitis in intravitreal injections (IVI) performed in a modular injection cabin that could be easily sited in a closet in an office environment, and the performance tests of the cabin in terms of heating, ventilation, and air conditioning (HVAC).
METHODS: The injections were given over approximately 18 months in the cabin and the demographics of the patients were screened retrospectively, and the cabin was subjected to HVAC tests.
RESULTS: A total of 7,238 injections were performed in the defined period, and no cases of endophthalmitis were encountered (0%). The results of the airflow and flow rate, particle count, pressure difference, decontamination time, light, moisture, and heat tests were all found to be above the standard defined by the International Organization for Standardization (ISO).
DISCUSSION AND CONCLUSION: An injection cabin is a practical modular construction that can be easily sited in any space without the need for special climatization, and provides a sterile and safe environment for IVI.

OBJECTIVES: The objective is to predict the development of retinopathy of prematurity (ROP) in discordant twins using a machine learning approach.
METHODS: The records of 640 twin pairs born at 32–35 weeks gestational age (GA) with birth weight (BW) discordance were evaluated retrospectively. The infants’ gender, GA, postmenstruel age at examination, BW, discordance rate, ROP Stages and Zones, and treatment options were recorded. The variables were used to develop a model to predict the development of ROP. Machine learning models were used for algorithm training and 10-fold cross-validation (CV) was applied for validation. The main measures were reported as sensitivity, specificity, receiver operating characteristic curve, and the area under the curve.
RESULTS: A total of 640 twin pairs underwent ophthalmic examination, of which 55 (4.3%) were ROP. The infants’ GA was 33.56±1.01 weeks (32–35 weeks) and BW was 1996±335 g (1000–3400 g). The mean discordance rate of the infants was 11.8±9.7% (0.0–53.9%). Using operating points, the Decision Tree algorithm detected ROP prediction with 71% sensitivity and 80% specificity in CV, while the Multi-Layer Perceptron algorithm detected 70% sensitivity and specificity. In addition, the X-Tree and Random Forest algorithms detected ROP prediction with 84% and 80% specificity, respectively.
DISCUSSION AND CONCLUSION: The results of this study support that BW discordance may be effective in the development of ROP in preterm twins and that artificial intelligence models can predict the development of ROP in accordance with clinical findings.

We present a case of Acute Macular Neuroretinopathy (AMN), which led to the coronavirus disease of 2019 (COVID-19) infection diagnosis. A 27-year-old female patient with flu-like symptoms later proven to be COVID-19 infection presented with acute-onset bilateral gray-like paracentral scotomas. Fundus examination showed a hypopigmented, wedge-like lesion on the superior temporal juxtafoveal area in the right eye, while no significant finding was found in the left eye. Infrared reflectance images demonstrated bilateral hyporeflective lesions in the parafoveal regions of the macula. Spectral-domain optical coherence tomography scans over the corresponding areas detected focal hyperreflectivity in the outer nuclear layer with disruption in the ellipsoid zone and retinal pigment epithelium layers. Based on these findings, the AMN diagnosis was considered. The COVID-19 infection diagnosis was confirmed by a polymerase chain reaction test. COVID-19 disease may cause retinal vascular complications such as AMN. AMN, which shares common viral prodromal symptoms with COVID-19 infection, may be a presenting sign of COVID-19 infection.

Idiopathic orbital inflammatory disease is a benign, non-infectious, and non-neoplastic space-occupying orbital and peri-orbital inflammation with no identifiable local or systemic causes. Patients usually present with eyelid and periorbital erythema and edema, proptosis, and decreased eye movements. In this report, a case of large serous retinal detachment accompanying a unilateral idiopathic orbital inflammatory disease attack is discussed. It demonstrates that very extensive and highly serous retinal detachment may accompany idiopathic orbital inflammatory disease attacks. Dramatic improvement in clinical findings and imaging can be observed with high-dose steroid treatment in a short time.

Gyrate atrophy (GA) is a hereditary condition characterized by ornithine aminotransferase deficiency-related large areas of retinal pigment epithelium and choriocapillaris lobular-shaped atrophy in the peripheral retina. In this report, we present a case of atypical presentation of GA. The aim of this report is to present two siblings, one of which was associated with a lamellar macular hole and with a history of previous diagnosis of retinitis pigmentosa. The delayed diagnosis of GA was made only after her brother, who was 5 years younger than her was diagnosed with GA. In addition, in this report, we evaluated GA in terms of multimodal imaging findings, differential diagnosis, and treatment of macular complications.