Muhittin Taskapili

Aims: To evaluate long-term clinical outcomes and factors associated with recurrence after nasolacrimal drainage procedures with bicanalicular silicone intubation. Methods: This retrospective cohort included 1576 patients (2094 eyes) treated between 2008 and 2025 at a tertiary referral center. All tubes underwent square-knot fixation without additional intranasal fixation; no comparator group was available. Success required a Munk score of 0–1 and patent irrigation at final follow-up, coinciding with tube removal for eyes followed for only three months. Generalized estimating equation (GEE) logistic regression accounted for bilateral eye correlation. Sensitivity analyses compared pediatric and adult patients, repeated multivariable GEE in adults, and stratified follow-up (3–12, 13–24, and >24 months). Results: Recurrence occurred in 5.9% of eyes (123/2094), ranging from 5.5% after external dacryocystorhinostomy to 13.2% after probing with intubation (p=0.016). External dacryocystorhinostomy comprised over 90% of procedures, limiting comparisons. Epiphora, postoperative complications, and tube exposure occurred in 6.7%, 11.0%, and 5.3%, respectively; exposure was not significantly associated with recurrence. Multivariable GEE identified associatio with probing [odds ratio (OR) 2.79, 95% confidence interval (CI) 1.22–6.37; p=0.015], increasing age (OR 1.01, 95% CI 1.00–1.03; p=0.048), and attending-surgeon procedures (OR 1.69, 95% CI 1.07–2.69; p=0.026). Recurrence was higher with longer documented follow-up. Conclusion: Standardized square-knot fixation was accompanied by 5.9% recurrence and 11.0% postoperative complications. Associations are descriptive and hypothesis-generating given subgroup imbalance, incomplete covariate information, variable follow-up, and residual confounding. The attending-surgeon association may reflect case selection or other unmeasured factors. These findings do not establish causality, fixation superiority, comparative effectiveness, or surgeon performance.

To evaluate the anatomical, functional, and aesthetic outcomes of phenylephrine-guided bilateral Müller muscle-conjunctival resection (MMCR) using a standardized resection algorithm designed to optimize eyelid symmetry by preoperatively accounting for Hering's phenomenon in patients with mild-to-moderate ptosis METHODS: This retrospective clinical study included patients with good levator function and a positive phenylephrine test who underwent simultaneous bilateral MMCR planned according to a phenylephrine-based resection algorithm. The protocol aimed to simulate postoperative eyelid position and unmask contralateral ptosis related to Hering's law, thereby enabling individualized bilateral surgical planning in a single session. Preoperative and postoperative best-corrected visual acuity (BCVA), margin reflex distance1 (MRD-1) and upper eyelid symmetry were evaluated at postoperative months 1 and 3 RESULTS: A total of 118 eyes from 59 patients (31 females, 28 males) were included. The mean preoperative MRD-1 was 1.24 ± 0.95 mm in the right eye and 1.32 ± 0.84 mm in the left eye. At postoperative month 3, the mean MRD-1 increased to 2.68 ± 0.91 and 2.61 ± 0.78, respectively. Comparison of preoperative and postoperative MRD-1 values demonstrated demonstrated a statistically significant improvement in both eyes at months 1 and 3 (p < 0.001 for each eye). Postoperative MRD-1 outcomes were not significantly different when stratified by the magnitude of the preoperative phenylephrine response (p = 0.32 for right eye, p = 0.06 for left eye). Excellent eyelid symmetry was achieved in 44 patients (74.6%), satisfactory symmetry in 12 (20.3%), and poor symmetry in 3 patients (5.0%). Revision surgery was required in 5 patients (8.4%) during follow-up CONCLUSION: Phenylephrine-guided bilateral MMCR using a standardized resection algorithm is a safe, effective, and highly predictable surgical approach for achieving optimal eyelid symmetry in patients with mild-to-moderate ptosis. Preoperative simulation of postoperative eyelid position by accounting for Hering's phenomenon allows accurate bilateral surgical planning in a single session and may reduce the need for secondary procedures, making this technique a strong first-line alternative to more invasive ptosis repair methods.

Aim: Non-arteritic anterior ischemic optic neuropathy (NAION) is one of the most common causes of sudden, painless vision loss in individuals over the age of 50 and represents the second most frequent optic neuropathy after glaucoma. Our aim was to retrospectively evaluate refractive errors in individuals diagnosed with unilateral and bilateral NAION and to compare these parameters with those of healthy individuals, thereby elucidating the association between hyperopia, and the disease. Method: This retrospective study included 52 patients diagnosed with NAION at our neuro-ophthalmology department between January and December 2024. Spherical equivalent (SE) values obtained by autorefractometry were classified as emmetropic (−0.50 to +0.50 D), myopic (< −0.50 D), or hyperopic (≥ +0.50 D). Refractive error distributions and mean SE values were compared among three groups: bilateral NAION (12 patients, 24 eyes), unilateral AION (40 patients, 40 eyes), and healthy controls (40 individuals, 40 eyes). Results: In the control group, refractive error distribution was 32.5% emmetropic, 22.5% myopic, and 45.0% hyperopic, while in the bilateral NAION group, 66.7% were hyperopic, 25.0% emmetropic, and 8.3% myopic; whereas in the unilateral NAION group, 45.0% were hyperopic, 27.5% emmetropic, and 27.5% myopic. Mean SE values were +1.12 ± 1.44 D (range, −1.12 to +4.00) for the bilateral NAION group, +0.18 ± 1.14 D (range, −2.12 to +3.00) for the unilateral NAION group, and +0.19 ± 0.99 D (range, −2.25 to +1.87) for controls. Differences among groups were statistically significant (p = 0.003). Post hoc analysis demonstrated significantly greater hyperopia in the bilateral NAION group compared with both the unilateral NAION and control groups. No significant difference was observed between the unilateral NAION and control groups. Conclusion: Patients with bilateral NAION demonstrated significantly higher levels of hyperopia compared with those with unilateral NAION and healthy controls. These findings suggest that hyperopia may represent a potential risk marker for bilateral NAION. Careful follow-up of hyperopic patients with unilateral NAION may be warranted to enable early detection and management of contralateral-eye involvement.

Purpose: To evaluate the relationship between phacoparameters and inflammation parameters (anterior chamber flare (ACF), macular and peripapillary choroidal vascular index (mCVI and pCVI)) changes after cataract surgery. Study design: Prospective study Methods: This prospective observational study included patients without systemic and ocular diseases who underwent uncomplicated cataract surgery that may have affected intraocular inflammation. Preoperative, postoperative 1st week, 1st, 3rd and 6th months ACF were measured. At the same visits, mCVI and pCVI were calculated. The relationship between phacoparameters and postoperative ACF, mCVI and pCVI values were evaluated by correlation analysis. Results: Fifty eyes of 50 patients were included in the study. Postoperative 1st week ACF was significantly higher than preoperative ACF (p<0.001). ACF decreased significantly from postoperative 1st week to 6th months. Postoperative 1st month and 3rd month mCVI were significantly higher than preoperative mCVI (p<0.001, p=0.04, respectively). It was observed that pCVI reached its peak value in the 1st postoperative week and decreased to base value in the postoperative 6th month. A strong positive linear correlation was found between total cumulative dissipated energy (CDE) and the difference between postoperative 1st week and preoperative ACF (p<0.001, r=0.68). Conclusion: Particularly in the early period after phacoemulsification, ACF, mCVI and pCVI increased. The increase in ACF lost its significance at the third month and the increase in mCVI and pCVI remained significant, which may indicate that the inflammatory effect of cataract surgery lasts longer in the posterior segment. Total CDE can be used to predict postoperative inflammation levels.

Background: To evaluate the results of corneal allogenic intrastromal ring segment (CAIRS) implantation in keratoconus.Methods: The medical records of patients with keratoconus who underwent CAIRS implantation were reviewed. The CAIRS, prepared by trephination from the donor cornea, was implanted into a tunnel created using the femtosecond laser. The depth of the tunnel was 200 μ; the inner diameter of the tunnel was 4.5 mm; and the outer diameter was 7 mm. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), keratometry, minimum corneal thickness (CT), endothelial cell density (ECD), and high order aberration values were recorded preoperatively and at the 1st, 3rd, and 6th months postoperatively.Results: A total of 23 eyes of 23 patients were included in the study. Preoperative UCVA (0.08 ± 0.01) and BCVA (0.25 ± 0. 11) values improved postoperatively and reached 0.40 ± 0.05 and 0.68 ± 0.09, respectively, at the end of the 6‐month follow‐up period (p¹ < 0.001, p² = 0.016; respectively). A statistically significant flattening of all keratometric values was observed in the postoperative period compared to preoperatively (p < 0.001 for all). There were no statistical differences between CT and ECC values at the preoperative and postoperative visits (p¹ = 0.654, p² = 0.769; respectively). In addition, coma aberration values were lower than the preoperative values at all postoperative visits (p < 0.05 for all).Conclusions: These results suggest that CAIRS implantation is a safe treatment option with good visual and keratometric outcomes for suitable patients with keratoconus.

In myopic eyes, the optic disc may become tilted and rotated, making glaucoma diagnosis more difficult. To determine the presence of tilted optic disc, the degree of optic disc rotation, and their effects on the angular location of superotemporal and inferotemporal retinal nerve fibre layer (RNFL) peaks in healthy myopic Caucasians. Non-glaucomatous healthy myopic Caucasian eyes with an axial length > 24 mm were evaluated. ImageJ was used to quantify optic disc tilt and torsion on red-free fundus photography. The RNFL was scanned using spectral-domain optical coherence tomography. The angle of the superotemporal and inferotemporal peaks with the vertical-horizontal meridian was measured. Fifty-four eyes of 54 individuals were evaluated. The axial length was correlated with the angular location for both the superotemporal (r = −0.549, p < 0.001) and inferotemporal (r = −0.415, p = 0.002) RNFL peaks; they were placed more temporally in eyes with higher axial lengths. For each 1 mm increase in axial length, the angle between the superotemporal peak and the temporal horizontal meridian decreased by 3.976°, and the angle between the inferotemporal apex and the temporal horizontal meridian decreased by 3.028°. The angle between the inferotemporal peak and the temporal horizontal meridian decreased by 0.231° for each 1° increase in optical disc torsion (R² = 0.09 Regression coefficient = −0.231, p = 0.027). The temporal shift of superior and inferior peaks, the thickening of temporal and nasal RNFL, the presence of tilted optic disc, and optic disc rotation may cause misinterpretation of the RNFL in myopic Caucasians. When evaluating peripapillary RNFL thickness in myopic individuals, it would be better to consider these to avoid misinterpretation.

A 42-year-old woman presented with bilateral proptosis, chemosis, leg pain, and vision loss. Orbital, chorioretinal, and multi-organ involvement of Erdheim-Chester disease, a rare non-Langerhans histiocytosis, with a negative BRAF mutation was diagnosed based on clinical, radiological, and pathological findings. Interferon-alpha-2a (IFNα-2a) was started, and her clinical condition improved. However, 4 months later, she had vision loss with a history of IFNα-2a cessation. The same therapy was administered, and her clinical condition improved. The Erdheim-Chester disease is a rare chronic histiocytic proliferative disease that requires a multidisciplinary approach and can be fatal if left untreated because of multisystemic involvements.

Millard-Gubler Sendromu (MGS), 6. ve 7. kraniyal sinir periferik felcine eşlik eden vücut karşı tarafında hemiparezi ya da hemipleji ile seyreder. Etiyolojide yaşa göre değişkenlik görülmekle birlikte pons hasarı ön plandadır. Tedavi ve prognoz esas olarak etiyolojiye bağlıdır. Kliniğimize sağ gözde içe kayma şikayetiyle başvuran 18 yaşındaki erkek hastada Millard-Gubler Sendromu düşünülmüş, ancak etiyoloji belirlenememiştir. Hastaya şaşılık ve lagoftalmus nedeniyle operasyonlar uygulanmış, sonuç olarak ortofori sağlanmış ve lagoftalmus düzeltilmiştir. Hastalara nöroloji kliniğinin bilgisi dışında yapılacak cerrahi müdahalelerin, hastalığın oküler bulgularını maskeleyebileceği unutulmamalı, multidisipliner yaklaşımla, nörolojik rehabilitasyonu da içeren konservatif tedavi uygulanmalıdır.