Mine Esen Baris

Glaucoma is defined as a group of optic neuropathies characterized by the progressive degeneration of retinal ganglion cells (RGC).1 Lamina cribrosa (LC) is a fenestrated, three-dimensional meshwor...

Phenylephrine is widely used for pharmacological mydriasis in routine ophthalmic practice. While its vascular and pupillary effects are well established, its influence on anterior segment structures and intraocular inflammatory parameters remains unclear. This study aimed to evaluate the effects of topical phenylephrine on anterior scleral thickness (AST) and aqueous humor flare levels in healthy eyes. This prospective study included the right eyes of 20 healthy volunteers. Topical phenylephrine 2.5% was administered three times at 5-minute intervals. Measurements were obtained 45 min after the final instillation. Nasal and temporal AST were measured at the scleral spur (AST-0) and at 1000 μm (AST-1) and 2000 μm (AST-2) posterior to the scleral spur using anterior segment optical coherence tomography. Aqueous flare levels were assessed using laser flare photometry. Fellow untreated eyes served as controls. At the scleral spur level (AST-0), scleral thickness increased significantly in both nasal and temporal regions following phenylephrine administration (p = 0.0003 and p = 0.01, respectively). At 1000 μm posterior to the scleral spur, temporal AST decreased significantly (p = 0.005), while other changes in AST-1 and AST-2 were not statistically significant. Aqueous flare levels showed an increase after phenylephrine instillation; however, this change was not statistically significant (p = 0.2). No significant changes were observed in the fellow control eyes. Topical phenylephrine was associated with localized changes in anterior scleral thickness, characterized by thickening at the scleral spur and relative thinning posteriorly. Although aqueous flare levels tended to increase, this effect was not statistically significant and likely reflects a minimal effect size. These findings suggest that phenylephrine may be associated with alterations in scleral configuration without a clinically meaningful impact on intraocular inflammatory status in healthy eyes.

Objective To evaluate the clinical features, etiological distribution, complications, treatment responses, and the impact of co-existing MEFV gene variants on disease course in pediatric non-infectious uveitis. Methods This retrospective study included 73 patients (128 eyes) diagnosed with non-infectious uveitis and followed at a single tertiary center between 2017 and 2024. Demographic, clinical, laboratory, and treatment data were analyzed. The presence of MEFV variants, their subtype (Exon 10 vs non-Exon 10), and zygosity were evaluated in relation to clinical outcomes. Univariable and multivariable logistic regression analyses were performed. Results The mean age was 9.9 ± 4.4 years, and 52.1% of patients were male. Anterior uveitis was the most common subtype (54.3%). Overall, 48% of patients developed complications and 18.6% required surgical intervention. MEFV variants were detected in 28% of patients and were associated with an increased risk of surgical intervention in univariable analysis (OR: 5.00, 95% CI: 1.13–22.05, p = 0.034), although this was not significant in multivariable analysis. MEFV variants were not associated with overall complication risk. However, Exon 10 variants were significantly associated with an increased risk of complications (OR: 24.0, 95% CI: 1.14–505.19, p = 0.041) and showed a trend toward increased surgical requirement. ANA positivity was independently associated with complication development. Conclusion MEFV mutations may be associated with increased disease severity in pediatric non-infectious uveitis, particularly in relation to surgical intervention. Exon 10 variants appear to confer a higher risk of complications and may have prognostic value. MEFV testing may be considered in selected patients, especially those with severe or refractory disease. Further studies are needed to clarify the role of MEFV mutations and the potential benefit of targeted therapies such as colchicine. Key Points • Pediatric non-infectious uveitis in our cohort predominantly showed a chronic and persistent disease course. • MEFV variants were found in 28% of patients, were associated with earlier disease onset, and these patients had a significantly higher need for surgical intervention. • Exon 10 variants were associated with higher complication rates, increased surgical requirements, and poorer visual outcomes. • Screening for MEFV variants may help identify high-risk patients requiring closer monitoring and more intensive management.

Environmental sustainability has become a critical priority in global healthcare, as medical services substantially contribute to carbon emissions, resource use, and waste generation. Ophthalmology, with its high surgical volume and dependence on disposable materials, represents an important component of this burden. This study aimed to assess Turkish ophthalmologists’ awareness, attitudes, and clinical and surgical practices related to environmental sustainability. A nationwide cross-sectional survey was conducted between January and April 2025 among 640 actively practicing ophthalmologists across diverse clinical settings in Türkiye. The questionnaire included 26 multiple-choice items addressing demographics, sustainability knowledge and training, personal and institutional practices, and attitudes toward surgical materials. Only 10.3% (n = 66) of respondents reported good or very good sustainability knowledge, and 10.8% (n = 69) had received formal training. Younger ophthalmologists demonstrated significantly lower knowledge levels than older colleagues ( P = .03). Conversely, senior physicians more frequently agreed that sustainable practices would not increase healthcare costs ( P = .007). Although many participants supported implementing sustainability measures in ophthalmology, a considerable proportion indicated they would modify their use of surgical materials if legal restrictions were relaxed. Notably, 69.3% (n = 440) stated that disposable materials were not indispensable for surgical procedures. Although Turkish ophthalmologists demonstrate strong ethical support for sustainability, gaps in knowledge and regulatory constraints limit practical implementation. Targeted education, updated guidelines, regulatory reform, and institutional engagement are essential to advance environmentally responsible ophthalmic care.

Vogt-Koyanagi-Harada (VKH) is a multisystem autoimmune disorder affecting the eyes, central nervous system, ears, and skin. VKH accounts for approximately 0.4% to 1.7% of paediatric uveitis cases. This case series aims to describe seven paediatric VKH cases with markedly different courses, with the oldest presenting at 17 years old and the youngest at 3 years old, all followed at a tertiary eye care centre, and to review current paediatric VKH literature. Consistent with previous reports, this series shows a female predominance. Two cases involved systemic symptoms; one patient experienced a headache, and another exhibited skin involvement. All cases presented during the acute uveitic phase. One eye required vitreoretinal surgery due to severe exudative detachment and vitritis. Four cases had glaucoma in eight eyes, and one eye underwent tube shunt surgery due to refractory glaucoma. Cataract surgery was performed on three eyes across two cases. Cataract and glaucoma were the most common complications in this series, aligning with prior studies. In 4 of 7 cases, rapid treatment with adalimumab in addition to conventional therapy was achieved. The literature suggests that adalimumab is an effective and safe option for VKH refractory to standard treatments. Therefore, this medication may be recommended for paediatric patients who might have a potentially poor prognosis.

We present a case of a 66-year-old male patient with primary angle closure glaucoma who underwent cataract surgery. He was also under tamsulosin treatment for benign prostate hyperplasia. Due to high intraocular pressure and shallow anterior chamber, 150 mL of 20% mannitol was given intravenously, before phacoemulcification cataract surgery. The iris prolapsed from the main incision and the pupil constricted, right after the main incision was opened and the pupil shrank. An additional 150 mL of 20% mannitol was [...] ABSTRACT We present a case of a 66-year-old male patient with primary angle closure glaucoma who underwent cataract surgery. He was also under tamsulosin treatment for benign prostate hyperplasia. Due to high intraocular pressure and shallow anterior chamber, 150 mL of 20% mannitol was given intravenously, before phacoemulcification cataract surgery. The iris prolapsed from the main incision and the pupil constricted, right after the main incision was opened and the pupil shrank. An additional 150 mL of 20% mannitol was

Prevalence and Prognosis of Glaucoma/Elevated Intraocular Pressure in Patients with Uveitis - Turkish Journal of Ophthalmology

This study aimed to investigate the association of the TGFB1 -509C>T polymorphism with the development of Primary Open-Angle Glaucoma (POAG) and Primary Angle-Closure Glaucoma (PACG) in the Turkish population. This study included patients from the Ophthalmology Departments of İzmir Katip Çelebi University and Ege University, divided into three groups: POAG (n = 115), PACG (n = 53), and control (n = 96). Detailed eye examinations and peripheral blood sample collections for DNA isolation were performed. The TGFB1 -509C>T polymorphism was evaluated via PCR amplification and sequencing analysis on the Illumina Miniseq platform. No significant differences were found among the groups regarding demographic characteristics. The POAG and PACG groups had significantly different intraocular pressure and cup/disc ratio compared to the control group. However, no significant association was found between the TGFB1 -509C>T polymorphism and the development of POAG or PACG in terms of allele frequency, genotype, and dominant/recessive model analysis. In this study involving a well-defined Turkish sample, the TGFB1 -509C>T polymorphism was not associated with the development of POAG or PACG. However, given the limited sample size, especially in the PACG subgroup, these findings should be interpreted with caution. Further large-scale studies in broader Turkish populations are warranted to validate these results.

Purpose: To evaluate anterior scleral thickness (AST) in patients with ocular hypertension (OHT) using anterior segment-optical coherence tomography (AS-OCT). Methods: Forty-two eyes of 21 patients with OHT and 40 eyes of 40 healthy participants were included in this cross-sectional study. AST was measured at the level of the scleral spur (SS)(AST-0), 1000 µm posterior of the SS (AST-1), and 2000 µm posterior of the SS (AST-2) in the nasal and temporal quadrants using AS-OCT. Results: The mean ages were 58.2 ± 12 (27–78) for OHT group; 54.2 ± 9.8 (21–70) years for control group ( p > 0.05). The mean nasal AST-0, AST-1 and AST-2 were 647 ± 25.7 (592–689), 490.7 ± 16.4 (453–526), 513.6 ± 19.2 (481–554) µm in OHT group; 701.7 ± 44.9 (605–785), 521.7 ± 33.4 (433–579), 535.5 ± 33.3 (449–599) µm in control group, respectively. The mean temporal AST-0, AST-1 and AST-2 were 667 ± 28.9 (620–723), 495.9 ± 18.7 (459–545), 509.3 ± 24 (430–596) µm in OHT group; 718.1 ± 45.9 (618–796), 525.3 ± 29.8 (456–583), 533.4 ± 41 (450–611) µm in control group, respectively. Mean ASTs measured at all three points in OHT group were significantly thinner than in control group in both nasal and temporal quadrants ( p < 0.05). Conclusion: We found that the scleral thickness was significantly thinner in OHT patients. It is still unknown whether the sclera plays a role in the OHT pathogenesis by affecting the biomechanical response of the globe to IOP elevation. Or conversely, sclera may undergo structural changes secondary to long-term IOP elevation in OHT. Although there are hints about the relationship between sclera and IOP, the mechanisms are still unclear.