Sadık Altan Ozal

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

MicroRNA Profiles Targeting Angiopoietin-1, Angiopoietin-2, and TEK Receptor Tyrosine Kinase-2 Genes Associated with Angiogenesis in Proliferative Diabetic Retinopathy - 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.

Purpose: To compare anatomical and functional outcomes as well as postoperative complication rates between cryotherapy and illuminated endolaser retinopexy in chandelier-assisted scleral buckling (CASB) for rhegmatogenous retinal detachment. Methods: This retrospective study included 63 eyes from 63 patients treated with CASB between January 2021 and January 2024. Group 1 (n = 31) underwent retinopexy with cryotherapy, whereas Group 2 (n = 32) received illuminated endolaser through the same cannula as the chandelier light. All surgeries were performed using a noncontact wide-angle viewing system by a single experienced vitreoretinal surgeon. Outcome measures included best-corrected visual acuity (BCVA), intraocular pressure, swept-source OCT, and postoperative complications. Results: Mean BCVA improved significantly in both groups. In Group 1, BCVA improved from 1.39 ± 0.74 logMAR (approx. Snellen 20/490) to 1.01 ± 0.63 (20/204), P < 0.001. In Group 2, BCVA improved from 1.50 ± 0.67 (20/632) to 1.14 ± 0.66 (20/276), P < 0.001. Final BCVA ( P = 0.21) and retinal reattachment rates ( P = 0.67) were similar. However, cystoid macular edema (CME) occurred significantly more in Group 1 (19.3%) than in Group 2 (3.1%) ( P = 0.04). Rates of epiretinal membrane, cataract, and intraocular pressure elevation did not differ significantly ( P > 0.05). No buckle exposure or infection was observed. Conclusion: Both techniques are effective for CASB. Endolaser provides a lower risk of CME and enhanced surgical precision, suggesting it may be a favorable option in selected cases.

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.

Purpose The aim was to evaluate the effects of anti-VEGF and dexamethasone (DEX) implants on choroidal vascular structures in eyes with branch retinal vein occlusion (BRVO). Methods Eyes with temporal BRVO, unaffected fellow eyes, and age- and gender-matched healthy control eyes were retrospectively analyzed. Swept-source optical coherence tomography (SS-OCT) images were collected initially and at the 12-month follow-up visit. Choroidal vascularity index (CVI), choroidal thickness (CT), and central macular thickness (CMT) were measured. Demographic characteristics, treatment modalities, and best-corrected visual acuity (BCVA) were recorded. Results The study involved 305 eyes: 104 with BRVO, 104 healthy fellow eyes, and 97 eyes from healthy controls. Initially, BRVO eyes had lower CVI than fellow eyes and controls (p = 0.032, p = 0.001, respectively). CT was lower in BRVO eyes compared to fellow eyes and controls. Among BRVO eyes, 50 received DEX implants, 54 received anti-VEGF treatment. Significant CVI decrease at 12 months was seen in the anti-VEGF group (p = 0.014), while it remained similar in the DEX implant group (p = 0.619). No difference was observed among anti-VEGF agents. Conclusion The study primarily showed how different treatment approaches affected choroidal parameteres in a condition largely triggered by hypoxia. It suggested the use of CVI as a prognostic indicator to monitor anti-VEGF drug treatment in BRVO patients.

Purpose: This study aimed to evaluate whether corneal biomechanical alterations in keratoconus (KC) are associated with changes in the lamina cribrosa (LC), retinal nerve fibre layer (RNFL) and peripapillary microvascular structures by comparing these parameters with healthy controls. Methods: In this prospective, cross‐sectional, case–control study, 66 eyes of 66 KC patients and 76 eyes of 76 healthy controls were enrolled. Corneal morphological and biomechanical parameters were measured using Scheimpflug imaging (Pentacam) and a dynamic Scheimpflug analyser (Corvis ST). Posterior segment structures were evaluated using swept‐source optical coherence tomography (SS‐OCT) and OCT angiography (SS‐OCTA). The radial peripapillary capillary plexus (RPCP) density, RNFL thickness and LC parameters (lamina cribrosa thickness [LCT] and lamina cribrosa curvature index [LCCI]) were measured. The relationship between corneal biomechanical parameters and structural changes in the LC was evaluated by correlation analysis. Results: Biomechanical parameters were significantly poorer in the KC group compared to controls. RNFL thickness and RPCP density were significantly lower in KC patients ( p < 0.05). LCT was significantly lower, whereas LCCI was significantly higher in KC patients compared with controls ( p < 0.001 for both). Significant correlations were observed between LCT and minimum central corneal thickness ( r = 0.26, p = 0.04) and maximum keratometry ( r = −0.28, p = 0.03). However, no significant correlations existed between LCCI and biomechanical parameters. Conclusion: This study suggests that corneal biomechanical changes in KC are associated with structural alterations in the LC, indicating that KC may not be limited to the cornea alone, but may be related to broader ocular collagen involvement.