Real-World Outcomes of Anti-VEGF Treatment for Neovascular Age-Related Macular Degeneration in Turkey: A Multicenter Retrospective Study, Bosphorus Retina Study Group Report No: 1

Objectives: To evaluate the real-world outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in neovascular age-related macular degeneration (nAMD) patients. Materials and Methods: Multicenter, retrospective, interventional, non-comparative study. The records of nAMD patients treated with an anti-VEGF agent on a pro re nata treatment regimen basis between January 2013 and December 2015 were reviewed. The patients who completed a follow-up period of 12 months were included. Primary outcome measures of this study were the visit and injection numbers during the first year. Results: Eight hundred eighty eyes of 783 patients met the inclusion criteria for the study. Mean number of visits at month 12 was 6.9±2.5 (range: 1-15). Mean number of injections at month 12 was 4.1±1.9 (range: 1-11). Mean visual acuity at baseline and months 3, 6, and 12 was 0.90±0.63 LogMAR (range: 0.0-3.0), 0.79±0.57 LogMAR (range: 0.0-3.0), 0.76±0.57 LogMAR (range: 0.0-3.0), and 0.79±0.59 LogMAR (range: 0.0-3.0), respectively. Mean central retinal thickness at baseline and months 6 and 12 was 395±153 μm (range: 91-1582), 330±115 μm (range: 99-975), and 332±114 μm (range: 106-1191), respectively. Conclusion: The numbers of visits and injections were much lower than ideal and were insufficient with the pro re nata treatment regimen

Verisyse versus Veriflex Phakic Intraocular Lenses: Refractive Outcomes and Endothelial Cell Density 5 Years after Surgery

Purpose. To compare refractive stability, central endothelial cell density (ECD), and complications between Verisyse (Abbott Medical Optics, Netherlands) and Veriflex (Abbott Medical Optics, Netherlands) phakic intraocular lenses (pIOL) over five years. Methods. We retrospectively reviewed the medical records of patients who underwent Verisyse or Veriflex pIOL implantation for surgical correction of myopia. Patients with a 5-year follow-up period were included in the study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent of manifest refraction (SE), and ECD were compared between the groups preoperatively and 1, 3, and 5 years postoperatively. Results. The study included 47 eyes in the Verisyse group and 50 eyes in the Veriflex group. There was no significant difference in mean SE, UDVA, CDVA, and ECD preoperatively or postoperatively. In both groups, there was a statistically significant myopic shift between 1-year and 5-year visits (−0.25 ± 0.30 D and −0.23 ± 0.48 D in the Verisyse and Veriflex groups, respectively). There was no significant difference between the groups in terms of efficacy and safety indexes at 5 years. ECD loss was highest during the first year (3.9% loss in the Verisyse group and 3.9% loss in the Veriflex group, p=0.670). At 5 years, the mean cumulative ECD losses in the Verisyse and Veriflex groups were 7.42% and 7.64%, respectively (p=0.709). Cataracts developed in 2.1% of the eyes in the Verisyse group and in 2.0% of those in the Veriflex group. No sight-threatening complications were observed. Conclusion. Verisyse and Veriflex pIOLs are highly effective for treating high myopia up to 5 years after surgery. Longitudinal studies with longer follow-up periods are necessary to determine the endothelial safety profile

Rotational Stability of a New Posterior Chamber Toric Phakic Intraocular Lens

Purpose. To evaluate the refractive results and rotational stability of Eyecryl toric phakic intraocular lens (pIOL). Methods. In this retrospective single-surgeon case series, manifest refraction, visual acuities, endothelial cell density (ECD), and pIOL rotation were evaluated over 6 months. Results. 43 eyes from 23 patients were included. At 6 months, the SE was within ±0.50  D of emmetropia in 30 (70%) eyes and within ±1.00  D of emmetropia in 39 (91%) eyes. The efficacy and safety indices were 1.25 ± 0.38 and 1.41 ± 0.34, respectively. Mean ECD was 2719 ± 296 cells/mm2 at the preoperative visit and 2779.42 ± 422 cells/mm2 at the 6-month visit (p>0.05). The mean value of absolute axis orientation error was 4.95 ± 5.28°. Mean absolute change in axis orientation between visits was less than 3° for all visit intervals. Ninety percent or more of lenses were found to rotate 5° or less between all visit intervals. None of the patients experienced a vision-threatening complication, and no patient required secondary IOL repositioning. Conclusion. The pIOL appears to effectively reduce subjective manifest astigmatism and provide good visual acuity. Its position was found to be stable throughout the follow-up

Prognostic value of ocular trauma score for open globe injuries associated with metallic intraocular foreign bodies

Abstract Background The prognostic value of the ocular trauma score (OTS) in patients who underwent 23-gauge pars plana vitrectomy (23-G PPV) for surgical removal of posterior segment metallic intaocular foreign bodies (IOFB) was evaluated. Methods Patients who underwent 23-G PPV for surgical removal of retained metallic IOFBs were retrospectively analyzed. OTS score for each patient was calculated and raw scores were converted to their corresponding OTS categories. The final VAs in study patients were compared with their respective OTS categories. Results Twenty-five eyes from 25 patients were examined. Twenty-four (96%) of the patients were male, and the mean age was 34 ± 12 years. The time from injury to 23-G PPV was 9 ± 4 days. Fourteen (56%) patients had zone 1 trauma, eight (32%) patients had zone 2 trauma, and three (12%) patients had zone 3 trauma. Postoperative visual acuity was ≥ 20/200 in 14 (56%) of the patients and ≥ 20/40 in seven (28%) eyes. At the final visit, anatomical success was achieved in 86% of patients with retinal detachment at presentation. No statistically significant differences were found between our final VAs and OTS scores. Conclusion OTS, which provides prognostic information after general ocular trauma, may also provide valuable prognostic information for patients who undergo 23-G PPV for the surgical removal of metallic posterior segment IOFBs

Visual and Refractive Outcomes of Small-Incision Lenticule Extraction in High Myopia: 5-Year Results

Purpose. To report long-term visual and refractive results of small-incision lenticule extraction (SMILE) in treatment of high myopia. Materials and Methods. Medical records of patients who underwent SMILE for surgical correction of myopia or myopic astigmatism were retrospectively reviewed. Only patients with a preoperative spherical equivalent of subjective manifest refraction (SE) ≥ 6 D and a postoperative follow-up of 5 years were included in the study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and SE were analyzed preoperatively and at 1-, 3-, and 5-year postoperative periods. Results. Thirty-seven eyes of 37 patients were included in the study. The mean attempted SE was −7.47 ± 1.10 D (range −6.00 to −10.00 D). At the 5-year visit, the mean difference between achieved and attempted SE was −0.43 ± 0.47 (0.50 to −1.25 D). Mean postoperative UDVA and CDVA were 0.20 ± 0.18 and 0.06 ± 0.08 logMAR, respectively. At the 1-year visit, 70% and 97% of the eyes were within ±0.50 D and ±1.00 D of the intended correction. At the 5-year follow-up, 59% and 92% percent of the eyes were within ±0.50 D and ±1.00 D of the intended SE, respectively. At the 5-year visit, the efficacy index was 0.89 ± 0.26 and the safety index was 1.16 ± 0.20. Fifty-four percent of the eyes gained one or more lines of CDVA. Conclusion. SMILE with an intended correction of up to a spherical equivalent of 10 D is safe and effective. However, there is regression of the refractive effect over extended follow-up

Early Results with a New Posterior Chamber Phakic Intraocular Lens in Patients with High Myopia

Purpose. To report clinical results of a foldable, hydrophilic acrylic, single-piece, injectable, posterior chamber phakic intraocular lens (pIOL). Material and Methods. Medical records of patients who underwent posterior chamber phakic IOL (Eyecryl Phakic IOL, Biotech Vision Care, Ahmedabad, India) implantation for surgical correction of myopia were retrospectively reviewed. Only patients with at least a one-year follow-up were included. Manifest refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), endothelial cell density (ECD), and pIOL vault were analyzed at 1, 3, 6, and 12 months after surgery. Complications observed during and after surgery were also recorded. Results. The study included 58 eyes of 29 patients. Mean patient age was 32 ± 7 years. Spherical equivalent of manifest refraction was −13.41 ± 3.23 D preoperatively and −0.44 ± 0.55 D postoperatively. Preoperative CDVA was 0.29 ± 0.71 logMAR. Postoperative UDVA and CDVA were 0.21 ± 0.66 and 0.15 ± 0.69 logMAR, respectively, at the 12-month visit. At the 12-month visit, the efficacy index was 1.20 and the safety index was 1.39. Mean ECD was 2713 ± 339 cells/mm2 at the preoperative visit and 2608 ± 362 cells/mm2 at the 12-month visit (3.9% loss, p<0.001). ECD loss from 3 months to 12 months was not statistically significant. No significant cataract formation, significant endothelial cell loss, glaucoma, uveitis, or any other vision-threatening complication was observed. Conclusion. Based on postoperative experience, we have found that Eyecryl Phakic IOL is safe and effective for treating high myopia

Simultaneous Transepithelial Topography-Guided Photorefractive Keratectomy and Accelerated Cross-Linking in Keratoconus: 2-Year Follow-Up

Purpose. To evaluate the visual, refractive, and topographic outcomes after simultaneous topography-guided transepithelial photorefractive keratectomy (transepithelial TG-PRK) using the Amaris Excimer laser platform and accelerated corneal cross-linking (CXL) in eyes with keratoconus. Materials and Methods. Patients with 2 years of follow-up were included in this retrospective case series. Manifest refraction (MR), uncorrected (UDVA) and corrected (CDVA) distance visual acuity, corneal topography, and pachymetry were evaluated at 1, 3, 6, 12, and 24 months after surgery. The root-mean-square of total higher-order aberrations (total HOA-RMS), coma (Coma-RMS), and spherical aberration (SA-RMS) were calculated for 4- and 6-mm diameters. Results. Forty-six eyes of 46 patients were included in the study. Stromal ablation was ≤50 μ in all patients. MR was −3.78±3.26 preoperatively and −1.39±1.82 postoperatively. Significant improvements were seen in the UDVA and Coma-RMS values at 1 month, CDVA and total HOA-RMS values at 3 months, and SA-RMS values at 1 year compared to preoperative levels. UDVA values further improved after 2 years, compared to the 1-year values. No patient lost two or more lines and keratoconus progression was not observed in any patient. Conclusion. Simultaneous transepithelial TG-PRK and accelerated CXL resulted in significant gains in CDVA without compromising CXL efficacy

Beyazlatma Özellikli Bir Diş Macununun İn Vitro Olarak Değerlendirilmesi

Amaç: Beyazlatıcı içerikli deneysel diş macununun, minedeki renk değişimine ve yüzey pürüzlülüğüne olan etkisini değerlendirmektir. Gereç ve Yöntemler: Çalışmada 30-adet sağlam, çürüksüz, boyutları birbirine yakın daimi dişler kullanıldı. Dişler rastgele olarak 6 deneysel gruba ayrıldı (n=5); Grup 1: Beyazlatıcı ajan içeren deneysel diş macunu (Zubio Test-1, Dar Kozmetik, İstanbul, Türkiye); Grup 2: Beyazlatıcı ajan içeren deneysel diş macunu (Zubio Test-2); Grup 3: Beyazlatıcı ajan içeren diş macunu (İpana 3D White luxe, İpana P&G, ABD); Grup 4: Bitkisel içerikli bir diş macunu (Gumgumix, Beka ilaç, İstanbul, Türkiye); Grup 5: Kahvede bekletilen; Grup 6: Suda bekletilen. Tüm örneklerden 3 farklı zaman aralığında (T1-T2-T3) renk ve yüzey pürüzlülüğü ölçümleri yapıldı. T1: Tüm örnekler 24-saat kahvede bekletildikten ve renklenmeleri sağlandıktan sonra; T2: Her gün 15 dakika (3 kez-5’er dakika) kahvede bekleme ve 10 saniye (2 kez-10’ar saniye) fırçalama işlemi yaptıktan 7 gün sonra; T3: Her gün 15 dakika (3 kez-5’er dakika) kahvede bekleme ve 10 saniye (2 kez-10’ar saniye) fırçalama işlemi yaptıktan 14 gün sonrayı göstermektedir. Veriler Kruskal-Wallis ve Friedman istatistik testleri ile değerlendirildi (P=0.05). Bulgular: Tüm test gruplarında renk değişimi görüldü ancak test gruplarının aralarında farklılıklar oluşmadı (P>0.05). Grup 2, sayısal olarak olumlu yönde en büyük değişimi oluştururken, diğer gruplarla arasında istatistiksel bir farklılık ortaya çıkarmadı. Zubio Test-2 diş macununun beyazlatıcı etkisi İpana 3D White luxe ve Gumgumix diş macunları ile benzer bulundu. 14 günlük araştırmanın sonucunda Zubio Test-2, Test-1’e göre daha yüksek yüzey pürüzlülük değerleri sergiledi. Sonuç: Zubio Test-2’nin, kahvenin neden olacağı renklenmeye karşı geleneksel beyazlatıcı diş macununa benzer koruyucu etki göstererek, renklenmeyi önleyici yönde etkili olabileceği söylenebilir