Nihat Sayın

Juvenile systemic lupus erythematosus (jSLE) is a chronic multisystem autoimmune disease characterized by immune dysregulation and autoantibody production.1 Compared with adult-onset disease, jSLE ...

Purpose: To compare the anatomical and functional outcomes of DME treatment with anti-VEGF between patients with and without macular ischemia and investigate the association between OCT biomarkers and macular ischemia. Methods: Retrospective, multicenter, real-world analysis. Based on FFA before treatment, patients were divided into two groups: those with macular ischemia and those without macular ischemia. BCVA, CMT at 0, 6, and 12 months and treatment burden were recorded. Cyst patterns, EZ and/or ELM status, DRIL, hyperreflective foci, and presence of subretinal fluid were evaluated at every visit in OCT. Results: A total of 1004 eyes from 770 patients were included. Macular ischemia was detected in 238 eyes (23.7%). Baseline BCVA was significantly lower in the ischemic group (0.81 ± 0.53 logMAR vs. 0.55 ± 0.39 logMAR, p = 0.0001). After adjustment for baseline covariates, ischemic eyes demonstrated longitudinal BCVA improvement at months 6 and 12 despite persistently lower overall vision levels. CMT significantly decreased over time in both groups without significant differences in anatomical response. Treatment burden was comparable between groups. Disorganization of retinal inner layers, hyperreflective foci, and vitreomacular interface abnormalities were significantly associated with macular ischemia. Conclusion: In real-world settings, eyes with macular ischemia showed meaningful functional and anatomical improvement after anti-VEGF therapy in DME, despite worse visual acuity throughout follow-up. Macular ischemia was associated with poorer final visual outcomes but did not preclude treatment response.

Assessment of Dietary Nutritional Profile in Turkish Patients with Age-Related Macular Degeneration - Turkish Journal of Ophthalmology

To evaluate the functional and anatomical outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in treatment-naïve diabetic macular edema (DME) eyes exhibiting disorganization of the retinal inner layers (DRIL) at baseline, and to examine associations between DRIL and systemic or imaging biomarkers in a large multicenter real-world cohort. This multicenter retrospective cohort study included 221 eyes with baseline DRIL among 1321 treatment-naïve DME eyes followed at eight tertiary centers in Türkiye. All eyes initially received a bevacizumab loading dose, followed by a pro re nata (PRN) regimen with bevacizumab, aflibercept, or ranibizumab according to clinical response. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and DRIL status were assessed using spectral-domain OCT at baseline and at months 3, 6, and 12. Mean BCVA and CMT improved significantly at 12 months across all treatment groups (p < 0.001). In univariate analyses, eyes switched to aflibercept showed superior functional (0.58 logMAR) and anatomical (370.7 μm) outcomes compared with bevacizumab and ranibizumab (p = 0.039 and p = 0.001, respectively). However, in multivariable regression analyses adjusting for baseline characteristics and treatment intensity, anti-VEGF agent type was not independently associated with outcomes. Baseline DRIL was negatively correlated with BCVA and CMT improvement and positively correlated with systemic lipid parameters (p < 0.01). In this large real-world multicenter study, anti-VEGF therapy provided meaningful anatomical and functional improvements in DRIL-positive DME eyes. Although aflibercept appeared superior in univariate analyses, this difference was not sustained after adjustment, indicating that baseline characteristics rather than treatment selection may be the primary determinants of outcome. Unlike prior studies that focused primarily on corticosteroids, this study provides one of the largest datasets evaluating anti-VEGF efficacy in DRIL-positive eyes. Findings underscore DRIL as a strong prognostic OCT biomarker with potential to guide individualized treatment planning and optimize therapeutic outcomes in DME.

Intravitreal Anti-Vascular Endothelial Growth Factor Therapy for Diabetic Macular Edema in Türkiye: 48-Month Data, BOSPHORUS-DME Study Group Report No. 1 - Turkish Journal of Ophthalmology

Diabetic macular oedema (DME) is a leading cause of visual impairment worldwide. Real-world evidence is essential for understanding treatment effectiveness and guiding practical decision-making in routine clinical care. The aim of this work is to evaluate the cost-effectiveness of early versus late switching to intravitreal aflibercept or ranibizumab in eyes with DME refractory to intravitreal bevacizumab loading treatment. This multicentre retrospective study included treatment-naïve refractory DME eyes that initiated bevacizumab between 2021 and 2023. Eyes were divided into three groups: no switch, early switch (3-6 months), and late switch (after 6 months). Public healthcare costs from 2021-2023 were used to calculate the cost per 0.1 improvement in best-corrected visual acuity (BCVA) and per 100 μm reduction in central macular thickness. Cost-effectiveness ratio and incremental cost-effectiveness ratio analyses were performed. A total of 229 eyes in the no-switch group, 328 eyes in the early-switch group, and 63 eyes in the late-switch group were analysed. At month 12, the greatest BCVA gain was observed in the early-switch group (p = 0.02). Mean injection numbers were 5.7 ± 1.4 (no-switch), 7.2 ± 1.5 (early-switch), and 6.6 ± 1.4 (late-switch) (p < 0.001). Cost-effectiveness ratio for visual acuity improvement was €4,838, €10,395, and €10,848 for the no-switch, early-switch, and late-switch groups, respectively. Incremental cost-effectiveness ratio analysis showed additional costs of €15,654 for early switching and €54,856 for late switching compared with no switching. Central macular thickness reduction was greatest in the no-switch group and lowest in the late-switch group (p = 0.05). Although early switching yields the greatest visual improvement and faster rehabilitation, it incurs higher costs. The no-switch strategy provided modest visual improvement at the lowest cost, resulting in the most favourable cost-effectiveness ratio. Late switching produced limited benefit at high cost, rendering it an unfavourable option. Treatment decisions should balance clinical efficacy and cost-effectiveness on an individual basis.

Internal Drainage of Subretinal Fluid Using 25/32 Gauge Cannula in Eyes with Rhegmatogenous Retinal Detachment - Turkish Journal of Ophthalmology

Introduction: Study aims to investigate the relationship between the location of retinal vascularization and plus severity with re-treatment rates in intravitreal bevacizumab (IVB) treated eyes. Methods: For this retrospective, observational study, 200 eyes treated with IVB for Type 1 retinopathy of prematurity (ROP) and aggressive-ROP were included. The pre-treatment retinal vascularization was evaluated by analyzing quantitative measurements of optic disc to fovea distance (DFD), disc diameter, and shortest and longest distance between the optic disc and ridge of wide-field fundus photographs (WFPs). Plus severity was qualified in five grades such as normal, pre-plus, mild plus, moderate plus, and severe plus, by evaluating WFPs. Re-treatments up to 60 weeks postmenstrual age (PMA) were evaluated. Re-treated eyes up to first month after initial treatment were labeled as early re-treatment group, and re-treated eyes after the first month of initial treatment up to 60 weeks PMA were labeled as middle term re-treated group. Results: 36% of eyes had zone Ⅰ, 64% of eyes had zone Ⅱ disease, and 42% eyes had mild plus disease. Forty-three (21.5%) eyes of 23 infants underwent re-treatment prior to 60 weeks PMA. Thirteen eyes and 30 eyes were in the early and middle term re-treated groups, respectively. In middle term re-treated group, 27 (13.5%) eyes re-treated for progressive reactivated disease, and 3 (1.5%) eyes re-treated for prophylactic purposes. Advanced pre-treatment retinal vascularization and high birth weight were negatively associated with the re-treatment rate (p=0.016, odds ratio=0.774; p=0.041, odds ratio=0.999, respectively). There was a positive association between the re-treatment rate and pre-treatment plus severity (p=0.044, odds ratio =1.449). The lower ratio of shortest distance between the optic disc and ridge to DFD was considered as an independent predictive variable for higher rate of re-treatment (p=0.002; odds ratio: 0.450). Conclusion: The location of retinal vascularization and plus disease showed a wide distribution in bevacizumab treated eyes. Graded evaluation of retinal vascularization and plus severity may help predict the need for additional treatment. Unresponsiveness to the initial treatment, increased fibrotic activity, progressive reactivated stage 2-3 ROP and extraretinal new vessels, and prophylactic purposes were the main re-treatment indications.

The aim of the study was to investigate the quantitative differences between severe stage 3 and stage 4A retinopathy of prematurity (ROP) by evaluating the pre-treatment fundus photographs. Thirty-three eyes with clinical diagnosed as severe stage 3 were classified as severe stage 3 group. Twenty-two eyes with retinal detachment without foveal involvement were classified as stage 4A group. Quantitative measurements were performed on pre-treatment 130 degree fundus photographs. In the severe Stage 3 group, dense fibrous membranes, vertical tractional bands, and dragging were detected in 18 eyes (55%), in 5 eyes (15%), and in none of the eyes, respectively. In the stage 4A group, dense fibrous membranes, vertical tractional bands, and dragging were detected in 21 eyes (96%), in 22(100%) eyes, and in 17 eyes (77%), respectively. Dragging and vertical tractional bands were higher in the Stage 4A group than in the severe stage 3 group (p = 0.000). Disc-to-fovea distance, the width of the fibrous membranes, the total area of the fibrous membranes, total retinoschisis, and detachment areas were significantly higher in the stage 4A group than in the severe stage 3 group (respectively, p = 0.000,p = 0.006, p = 0.024,p = 0.000). Fibrous membranes and tractional bands can be detected in severe stage 3 ROP, but the width and the total area of the fibrous membranes and total retinoschisis-detachment area were found to be higher in stage 4A eyes. The dragging of the posterior pole can be an important diagnostic indicator for the diagnosis of stage 4A. Therefore this finding may be a simple auxiliary finding for diagnosis and prognosis of stage 4A ROP.

The human eye is an extraordinary organ that provides us with the ability to perceive the world in vivid detail. As the primary sensory organ for vision, the eye plays a critical role in our daily lives, allowing us to engage with our surroundings and experience the beauty of life. Its complex anatomy and functionality make it one of the most remarkable structures in the human body. Understanding the eye and maintaining its health are essential for preserving vision and overall quality of life. The anatomy of the eye is a marvel of biological engineering, consisting of components like the co ea, lens, retina, and optic nerve, all working together seamlessly to capture and process light. Each part is vital: the retina contains millions of photoreceptor cells that detect light, while the macula focuses on fine details. Common refractive errors, such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism, arise when light doesnt focus properly on the retina. These can be corrected with eyeglasses, contact lenses, or laser treatments. Eye diseases like cataracts, glaucoma, macular degeneration, and diabetic retinopathy pose significant threats to vision, often developing gradually and silently. Early detection of symptoms, such as blurred vision, difficulty seeing in dim light, or unusual visual disturbances, can make a difference in treatment outcomes. Regular eye exams are critical for identifying these conditions early and protecting your vision. Eye health is influenced by many factors, including age, lifestyle, and nutrition. A diet rich in vitamins A, C, and E, along with nutrients like lutein, zeaxanthin, and omega-3 fatty acids, can support eye health and reduce the risk of degenerative diseases. Protecting the eyes from injuries at home and work, reducing screen time, and ensuring proper lighting are also crucial preventive measures. For children, fostering good eye health habits early can have long-term benefits. Ensuring they have adequate vision for lea ing, limiting excessive screen time, and scheduling routine eye check-ups are essential steps. Mode treatments, including advanced laser technologies, cataract surgeries, and therapeutic options for glaucoma and macular degeneration, offer hope for preserving and restoring vision. Proper use of corrective eyewear, such as eyeglasses and contact lenses, alongside expert guidance, can optimize visual clarity and comfort. Representing the eyes anatomy and functions with clear, schematic visuals enhances understanding of its complexity. This book strives to simplify intricate concepts of ocular anatomy, common eye conditions, and preventive strategies while providing clinical insights. It is designed to serve as a valuable resource for students, healthcare professionals, and anyone invested in eye health. Dear readers, may this book illuminate your understanding of the eye and empower you to prioritize its care. Whether youre a medical student, a practitioner, or simply an enthusiast, we hope this book inspires your curiosity and equips you with practical knowledge for a lifetime of healthy vision.