Yusuf Yildirim

Cerebrotendinous xanthomatosis (CTX) is a rare yet treatable neurometabolic disorder caused by pathogenic variants in the CYP27A1 gene. Juvenile-onset cataracts may precede systemic signs, allowing for early diagnosis. This study evaluated the prevalence of CYP27A1 variants in patients with bilateral juvenile cataracts and described related clinical findings. This single-center retrospective study was conducted between May 2022 and April 2025 at Başakşehir Çam and Sakura City Hospital, Istanbul. Patients aged 6 months to 21 years with bilateral juvenile cataracts of undetermined etiology were included. Those with congenital, traumatic, or defined metabolic cataracts were excluded. All underwent ophthalmic evaluation and targeted CYP27A1 sequencing (exons 1-9, exon-intron boundaries) with confirmatory Sanger sequencing. Variants were classified per ACMG/AMP guidelines using ClinVar, HGMD, VarSome, and Franklin databases. Among 128 patients (42.2% male, 57.8% female; mean age 10.9 ± 9.4 years), two (1.5%, 95% CI: 0.2-5.4) carried a novel homozygous CYP27A1 c.398G > A (p.W133*) pathogenic variant, and three (2.4%, 95% CI: 0.5-6.9) had a heterozygous c.884 C > T (p.A295V) variant of uncertain significance. Both families had parental consanguinity. Both patients with homozygous pathogenic variants presented with bilateral cerulean cataracts. The absence of systemic symptoms at diagnosis highlights the feasibility of ophthalmology-based genetic screening for CTX. Identifying affected individuals before neurological onset enables timely initiation of oral chenodeoxycholic acid replacement therapy, which may reduce cholestanol and bile alcohol accumulation and help prevent irreversible complications. Incorporating CYP27A1 sequencing into the evaluation of bilateral juvenile cataracts may facilitate earlier detection of CTX and timely referral for appropriate management, especially in high-consanguinity regions.

To compare visual, refractive, and anatomical outcomes of lens extraction with Cionni ring and in-the-bag intraocular lens (IOL) implantation and Yamane in

Purpose: This study evaluates the efficacy of once-daily administration of 0.024% topical latanoprostene bunod (LBN) ophthalmic solution and its effects on macular vessel density (VD) in patients with primary open-angle glaucoma (POAG). Methods: A total of 86 eyes from 43 newly diagnosed POAG patients who had not received prior antiglaucoma treatment were included in this prospective study. Optical coherence tomography angiography (OCTA) was used to assess macular VD before and after LBN treatment. Changes in IOP and VD in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were analyzed. Results: The study included 43 patients (20 males, 23 females) with a mean age of 58.34 ± 15.28 years. After one month of LBN treatment, the mean IOP reduction was 8.3 mmHg, representing a 32.7% decrease. LBN significantly increased VD in both SCP and DCP, especially in the foveal and superior regions ( p < 0.05). A positive correlation was observed between intraocular pressure (IOP) reduction and VD increase in these regions. No significant changes were noted in the temporal, inferior, or nasal regions. Conclusion: LBN is an effective and well-tolerated treatment for IOP reduction in treatment-naïve POAG patients. It significantly increases macular VD, particularly in the foveal and superior regions, with VD changes correlating with IOP reduction. These vascular benefits likely result from nitric oxide (NO)-mediated microcirculatory improvements. Larger, long-term multicenter studies are needed to explore LBN's sustained vascular effects in glaucoma management.

Evaluating the Predictive Accuracy of the Kane and SRK/T Formulas in Keratoconus Patients Undergoing Cataract Surgery - Turkish Journal of Ophthalmology

Readability and Appropriateness of Responses Generated by ChatGPT 3.5, ChatGPT 4.0, Gemini, and Microsoft Copilot for FAQs in Refractive Surgery - Turkish Journal of Ophthalmology

Objective: This study explores the interest in international ophthalmology subspecialty fellowship training among young ophthalmologists in Türkiye, focusing on demographic factors, motivations, and barriers. Material and Methods: A cross-sectional study was conducted using an anonymous online survey from April to July 2024. A total of 232 ophthalmologists from 14 institutions were included. Participants were categorized into 3 groups: no interest (Group 1), interested but not applied (Group 2), and active applicants or past participants (Group 3). Factors associated with interest and application were assessed using Pearson's chi-square test in bivariate analyses and multinomial logistic regression analysis in multivariate analyses. Results: The mean age was 28.9±3.6 years; 48.3% were female. Group 1 included 43 participants (18.5%), Group 2 had 126 (54.6%), and Group 3 had 63 (27.2%). The most preferred subspecialties were cataract and refractive surgery (72%), cornea and ocular surface diseases (52.6%), and oculoplastic surgery (52.6%), with the latter significantly higher among residents. Most preferred destinations were the United Kingdom, the United States, Germany, and Canada. Career development was the primary motivator, while familial obligations were the main barrier. Specialists, those knowledgeable about opportunities, and those proficient in foreign languages were more likely to apply (p<0.05). Multivariate analysis revealed foreign language proficiency as a key differentiating factor between interest and non-interest groups (p<0.001). Conclusion: There is a strong interest in international ophthalmology subspecialty fellowships among young ophthalmologists in Türkiye. This study highlights significant demographic, sociological, and academic factors influencing this interest.

Purpose: This study aimed to compare the effects of three different daily disposable contact lens materials on contrast sensitivity. Methods: The participants were aged 18-45 years, with spherical equivalent refraction between -0.50 D and -6.00 D, astigmatism below 0.75 D, and best contact lens-corrected visual acuity of 0.0 logMAR or better. Each patient was fitted binocularly with three daily disposable contact lenses made of different materials on three separate examination days. These materials were kalifilcon A, senofilcon A, and verofilcon A. The contrast sensitivity of each patient was recorded at spatial frequencies of 3, 6, 12, and 18 cycles per degree (cpd) under photopic (85 cd/m2) and mesopic (3 cd/m2) conditions. Results: The current study comprised 72 eyes of 34 female and two male patients. The mean age of the participants was 25.63 (± 0.80) years. Under photopic conditions, the participants’ contrast sensitivity was significantly better with senofilcon A than with kalifilcon A at a frequency of 12 cpd (p=0.008). Under mesopic conditions, participants’ contrast sensitivity was significantly higher with kalifilcon A than verofilcon A at 3 cpd (p=0.001), and with senofilcon A than verofilcon A at 12 cpd (p=0.004). The pre-lens non-invasive break-up times did not differ significantly between the three daily disposable contact lenses (p>0.05). Conclusion: In both photopic and mesopic lighting conditions, the participants in this study exhibited differences in contrast sensitivity when wearing three different daily disposable contact lens types, despite similar visual acuity and pre-lens tear film stability results in their clinical evaluations. These findings demonstrate the potential for subjective visual complaints arising from variations in the contrast sensitivity achieved by different daily disposable contact lenses.

Purpose: To compare the complications and postoperative outcomes of Nd:YAG laser anterior capsulotomy vs a needle aspiration approach for capsulorhexis in patients with intumescent cataracts. Setting: University of Health Sciences, Basaksehir Cam and Sakura City Hospital Department of Ophthalmology, Istanbul, Turkey. Design: Retrospective, cross-sectional study. Methods: Patients with intumescent cataract were divided into 2 groups. Group 1 (37 eyes) underwent Nd:YAG laser capsulotomy preoperatively, which reduced lens pressure. In Group 2 (31 eyes), the capsulorhexis was completed by reducing the intralenticular pressure by needle aspiration and then gradually expanding the capsule. Demographics, pre/postoperative parameters, complications, and surgical times were analyzed. Results: 68 eyes of 68 patients were evaluated. Age and sex exhibited no significant differences between groups. Group 2 had more complications than Group 1 (P = .041). Specifically, no capsular tear extensions were seen in Group 1 while 4 patients in Group 2 had tears extending to the lens periphery. Group 1 showed a significant decrease in surgical maneuvers and time (P = .028) while no significant difference was found in effective phacoemulsification time (P = .076). Conclusions: Nd:YAG laser capsulotomy effectively prevented capsular extensions and reduced surgical time in intumescent cataracts. This technique provides a safe alternative to traditional methods, potentially reducing intraoperative risks and improving surgical efficiency. The findings support Nd:YAG laser anterior capsulotomy as a viable approach for capsulorhexis in intumescent cataracts, emphasizing its potential benefits in reducing complications and enhancing surgical outcomes.

Purpose: To evaluate the long-term refractive outcomes of Eyecryl posterior chamber spherical phakic intraocular lens (pIOL) implantation in high myopia and endothelial cell density (ECD) change. Setting: Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. Design: Retrospective. Methods: Eyes that were not suitable for corneal refractive surgery, had high myopia between −6.00 diopters (D) and −20.00 D, had Eyecryl posterior chamber spherical pIOL implantation, and had at least 5 years of follow-up were included. Preoperative ECD was ≥2300 cells/mm² and cylindrical value was ≤2.0 D in all cases. Preoperative and postoperative first, third, and fifth years of refraction, uncorrected and corrected distance visual acuity (UDVA/CDVA), and ECD were recorded. Results: 36 eyes of 18 patients were examined. The mean UDVA and CDVA in postoperative fifth years were 0.24 ± 0.19 logMAR and 0.12 ± 0.18 logMAR, respectively. The safety and efficacy indices were 1.52 ± 0.54 and 1.14 ± 0.38, respectively. At 5 years, the spherical equivalent was ±0.50 D in 75% of eyes and ±1.00 D in 92% of eyes. After 5 years, the mean cumulative ECD loss was 6.91% (P = .07). The annual ECD loss was 1.57% in the first year, 0.26% between 1 year and 3 years, and 2.38% between 3 years and 5 years. Asymptomatic anterior capsule opacity developed in 1 eye 4 years after surgery. Rhegmatogenous retinal detachment developed in 1, and myopic choroidal neovascular membrane occurred in 1 eye. Conclusions: Eyecryl posterior chamber spherical pIOL implantation is one of the effective and safe refractive surgical methods in correcting high myopia with predictable and stable refractive results over a 5-year period. Longer-term studies are needed for complications such as decreased ECD, retinal complications, and lens opacity.