Veysel Levent Karabaş

Purpose: To investigate the anatomical and functional outcomes of pars plana vitrectomy (PPV) combined with a perifoveal centrifugal massage maneuver in eyes with advanced stage 4 idiopathic epiretinal membrane (iERM) associated with ectopic inner foveal layers (EIFL). Methods: This case series included 40 eyes of 40 patients with idiopathic stage 4 EIFL-ERM who underwent PPV with ERM peeling and adjunctive perifoveal centrifugal massage. Best-corrected visual acuity (BCVA), foveal center point (FCP), central macular thickness (CMT), and EIFL thickness were evaluated at baseline and during follow-up visits at 1, 3, 6, and 12 months, as well as at the final examination. Results: The mean patient age was 68.4±7.9 years, with a mean follow-up of 31.9±17.5 months. Baseline BCVA was 20/95 (0.68±0.32 logMAR). Significant improvement in BCVA was observed from month 3 onward and was maintained at the final visit (p=0.023 at 3 months; p<0.001 thereafter). FCP, CMT, and EIFL thickness showed progressive and significant reductions over time (all p<0.001). Stage transition analysis demonstrated that 22.5% of eyes improved by 3 months, 40.0% by 6 months, 67.5% by 12 months, and 90.0% by the final follow-up. Conclusion: Vitrectomy combined with perifoveal centrifugal massage was associated with favorable anatomical and functional recovery in stage 4 EIFL-ERM. This adjunctive technique may facilitate earlier stage regression and represents a potential refinement to standard iERM surgery.

Purpose: To compare baseline optical coherence tomography (OCT) characteristics and early visual response for predicting 12-month visual outcomes in eyes with diabetic macular edema (DME) treated with anti-vascular endothelial growth factor (anti-VEGF) therapy in a real-world setting. Methods: This multicenter, retrospective, longitudinal study included 255 treatment-naïve patients (337 eyes) with DME who received intravitreal ranibizumab or aflibercept using a pro-re-nata regimen following three loading doses. Baseline OCT biomarkers and changes in best-corrected visual acuity (BCVA) at month 3 were evaluated as predictors of visual improvement at month 12. Generalized estimating equation (GEE) logistic regression models accounted for inter-eye correlation and model discrimination was assessed using receiver operating characteristic analysis. Results: At month 3, 58.4% of eyes achieved at least a one-line improvement in BCVA. Early BCVA improvement was associated with visual gain at month 12 (odds ratio [OR] 5.78, 95% confidence interval [CI] 3.34–9.99, p < 0.001). Among baseline OCT parameters, preserved ellipsoid zone integrity (OR, 3.07; 95% CI, 1.09–8.64; p = 0.034) and absence of vitreomacular interface abnormalities (OR, 2.64; 95% CI, 1.02–6.84; p = 0.046) were associated with favorable outcomes. ROC analysis based on GEE-predicted probabilities showed higher discriminative ability for the early visual response model than for the baseline OCT model (AUC, 0.817; 95% CI, 0.768–0.865 vs. AUC, 0.766; 95% CI, 0.714–0.819; DeLong test, p = 0.037). Conclusion: Baseline OCT features provide useful pretreatment prognostic information; however, early visual response after the loading phase offers additional dynamic prognostic insight. These findings suggest that final prognostic judgment should not rely solely on baseline OCT morphology and should be refined after the initial treatment response is assessed.

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.

The aim of this study was to evaluate the real-world efficacy and safety of intravitreal faricimab for macular edema (ME) secondary to retinal vein occlusion (RVO) across a multicenter cohort with up to 52 weeks of follow-up. Data from 17 centers across Türkiye were retrospectively analyzed between 22 November 2024 and 1 March 2026. Patients with branch RVO (BRVO) or central RVO (CRVO) complicated by ME who received at least one intravitreal faricimab injection and had complete ophthalmic and optical coherence tomography (OCT) data with a minimum 4-week follow-up were included. Demographics, diagnosis, prior treatments, best-corrected visual acuity (BCVA; decimal converted to logMAR), central macular thickness (CMT), intraocular pressure (IOP), injection number, follow-up duration, and ocular/systemic adverse events were recorded at baseline, day 7, monthly after each of the first three injections, and at the final visit. A total of 70 patients (37 BRVO [52.9%], 33 CRVO [47.1%]) were included, with a mean follow-up of 23.69 ± 8.54 weeks; 44 (62.8%) were treatment-naïve and 26 (37.2%) were switch patients. When comparing baseline and final visits, treatment-naïve patients showed a mean CMT reduction of 306.9 ± 231.3 µm (from 594.1 ± 206.9 µm at baseline to 287.2 ± 89.9 µm at final visit; p < 0.001), while switch patients demonstrated a mean CMT reduction of 290.6 ± 114.3 µm (from 562.1 ± 107.3 to 271.5 ± 90.7 µm; p < 0.001). The mean logMAR BCVA gain was 0.77 (p < 0.001) in naïve and 0.38 (p < 0.001) in switch patients. IOP remained stable throughout, and no serious ocular or systemic adverse events were recorded. Faricimab demonstrated rapid anatomical and functional improvements in the RVO cohort, evident as early as day 7 after the initial injection. These findings support faricimab as a potent and reliable therapeutic option across both RVO subtypes in routine clinical practice.

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.

Age-related macular degeneration (AMD) represents one of the most common causes of permanent vision impairment in individuals over 50 years of age. This st