Alperen Bahar

Purpose: To evaluate anterior segment changes induced by the Valsalva maneuver in phakic and pseudophakic eyes using Scheimpflug imaging.Materials and methods: This paired-eye cross-sectional observational study included 136 eyes of 68 patients with unilateral pseudophakia, with each participant contributing one pseudophakic eye and the contralateral phakic eye. Intraocular pressure (IOP), central corneal thickness (CCT), corneal volume (CV), anterior chamber depth (ACD), anterior chamber volume (ACV), pupil diameter (PD), iridocorneal angle (ICA), axial length (AL), and the ACD/AL ratio were measured at baseline and during a standardized Valsalva maneuver. Measurements were obtained using non-contact tonometry, Scheimpflug imaging, and optical biometry. Within-eye changes from baseline were analyzed separately for phakic and pseudophakic eyes.Results: During the Valsalva maneuver, IOP and PD increased significantly in both phakic and pseudophakic eyes (all p≤0.003). In phakic eyes, ACD and ACV decreased significantly (both p=0.03), whereas ICA did not change significantly (p=0.58). In pseudophakic eyes, ICA decreased significantly (p=0.002), whereas the changes in ACD and ACV were not statistically significant (p=0.08 and p=0.61, respectively). No statistically significant changes were detected in AL, CV, or the ACD/AL ratio in either group. CCT changes did not reach the predefined threshold for statistical significance.Conclusions: The Valsalva maneuver was associated with transient changes in intraocular pressure, pupil diameter, and selected anterior segment parameters in both phakic and pseudophakic eyes. Within-eye analyses showed significant reductions in ACD and ACV in phakic eyes and significant narrowing of the ICA in pseudophakic eyes. However, direct comparison of these changes between lens-status groups is required before concluding that phakic and pseudophakic eyes exhibit different biomechanical responses. Standardization of respiratory effort may improve the reliability of anterior segment imaging and biometric measurements.

Purpose To evaluate the prelaminary clinical effects of subconjunctival injectable platelet-rich fibrin (i-PRF) in patients with severe dry eye disease (DED). Methods This study included two groups: an i-PRF group consisting of 28 eyes treated with subconjunctival i-PRF injection and a control group of 32 eyes. The ocular surface disease index (OSDI-12), tear break-up time (TBUT), corneal fluorescein staining (CFS), tear meniscus height (TMH), and tear meniscus area (TMA) were assessed at baseline and during follow-up. Changes in clinical parameters were compared between the groups. Results Baseline demographic characteristics and dry eye parameters were comparable between the groups (all p > 0.05). After three injections, the i-PRF group showed a significantly greater reduction in OSDI-12 and CFS scores, as well as a significant increase in TBUT, compared with the control group. Tear meniscus parameters also improved in the i-PRF group, with TMH increasing from 145.9 ± 28.5 (143.0) to 254.3 ± 35.3 (258.5) µm and TMA from 0.015 ± 0.004 (0.016) to 0.043 ± 0.005(0.043) mm². Conclusion Subconjunctival i-PRF injection was associated with improvements in both subjective symptoms and objective ocular surface parameters in patients with severe DED. These preliminary results suggest that i-PRF may be a promising adjunctive treatment option for patients refractory to conventional therapies. Further prospective controlled studies with longer follow-up are needed to confirm its efficacy and durability.

AIM: To investigate the effect of pentagonal conjunctival autograft on reducing graft retraction following pterygium surgery. METHODS: This retrospective comparative study included patients who underwent primary pterygium excision with either pentagonal (created by shaping the junction with the recipient conjunctiva into a wedge) or quadrangular conjunctival autograft transplantation. All patients completed a 6mo postoperative follow-up. The primary outcome measure was the incidence of graft retraction; secondary outcomes included graft displacement requiring re-suturing and pterygium recurrence rate. RESULTS: The study enrolled 58 participants, comprising 26 (15 males, 11 females) in the pentagonal graft group (mean age: 54.9±13.1y), and 32 (17 males, 15 females) in the quadrangular graft group (mean age: 57.6±10.4y). Graft retraction occurred in only 1 eye (3.8%) in the pentagonal autograft group, compared to 9 eyes (28.1%) in the quadrangular autograft group. No cases of graft displacement requiring re-suturing were reported in the pentagonal autograft group. Although graft displacement and recurrence requiring re-suturing were observed less frequently in surgeries with a pentagonal graft, the difference was not statistically significant (P>0.05). CONCLUSION: Designing the conjunctival autograft in a pentagonal shape—mimicking geodesic dome architecture and conforming to the eye’s spherical structure—enhances compatibility with the recipient conjunctiva and improves resistance to physical traction forces. This design effectively reduces the incidence of graft retraction and other related complications, providing a more favorable surgical option for pterygium treatment.

Background: Superior sulcus hollowing is a frequent esthetic concern, commonly managed with synthetic fillers or fat grafts; however, these approaches carry potential risks and costs. Injectable platelet‐rich fibrin (i‐PRF), an autologous regenerative biomaterial, has shown promise in dermatologic and dental applications, but its use for periocular volume restoration remains unexplored. Aims: To evaluate the efficacy, safety, and patient satisfaction of i‐PRF injections for the correction of superior sulcus hollowing. Patients/Methods: This single‐center retrospective study included 24 eyes of 12 patients treated with i‐PRF between 2021 and 2024. Sulcus depth was measured at baseline and at 3 and 6 months posttreatment. Subjective satisfaction was assessed using a binary scale. i‐PRF was prepared using a low‐speed centrifugation protocol and injected suborbicularis in three sessions spaced 1 week apart. Results: A significant reduction in superior sulcus depth was observed from baseline to 3 months (13.3 ± 2.8 mm to 9.2 ± 3.7 mm; p = 0.002), followed by mild regression at 6 months (10.5 ± 3.3 mm). Patient satisfaction was high, with 18 out of 24 eyes (75%) reporting favorable outcomes at 3 months. No adverse effects were recorded. Conclusions: This first clinical report of i‐PRF for upper eyelid hollowing suggests that it may serve as a safe, autologous, and minimally invasive alternative for superior sulcus volume restoration. Further prospective studies with standardized outcome measures are warranted to validate these findings.

This study was conducted to investigate the effect of injectable platelet-rich fibrin on the recovery of compromised epithelium due to crosslinking treatment. In this comparative study, the epithelial closure rates and in vivo confocal biomicroscopy results of 26 patients with keratoconus who underwent subconjunctival injection of injectable platelet-rich fibrin near the limbus after epithelium-off corneal crosslinking treatment were compared with those of 25 patients who did not receive the injection of injectable platelet-rich fibrin. The average time to epithelial defect closure in the injectable platelet-rich fibrin group was 2.76 ± 0.90 days compared to 3.56 ± 0.86 days in the non-injectable platelet-rich fibrin group (p=0.003). At the end of the 1st month, the mean subbasal nerve plexus density was 1.26 ± 1.61 nerves/mm2 in the injectable platelet-rich fibrin group, whereas it was 0.72 ± 0.89 nerves/mm2 in the non-injectable platelet-rich fibrin group (p=0.016). By the 3rd month, the density increased to 3.42 ± 1.13 nerves/mm2 in the injectable platelet-rich fibrin group and 2.36 ± 1.15 nerves/mm2 in the non-injectable platelet-rich fibrin group (p=0.002). Similarly, the anterior stromal keratocyte density at the end of the 1st month was 93.6 ± 33.5 cells/mm2 in the injectable platelet-rich fibrin group compared to 67.3 ± 26.4 cells/mm2 in the non-injectable platelet-rich fibrin group (p=0.001). By the end of the 3rd month, the density increased to 255.2 ± 45.7 cells/mm2 in the injectable platelet-rich fibrin group and 222.1 ± 43.6 cells/mm2 in the non-injectable platelet-rich fibrin group (p=0.011). In the non-injectable platelet-rich fibrin group, one patient developed a sterile infiltrate at the end of the 1st week, whereas no complications were observed in the injectable platelet--rich fibrin group. Subconjunctival injectable platelet-rich fibrin application is an effective and safe method for corneal epithelial healing after crosslinking treatment.

Traumatic optic neuropathy (TON) is characterized by optic nerve damage following head or eye trauma, which can lead to severe vision loss. Historically, surgical decompression was the primary treatment approach for this condition until the study by Anderson et al. in 1982, which explored the effectiveness of steroids. Subsequent research, particularly in spinal cord injury cases, sparked debates regarding steroid use in TON treatment, with studies yielding controversial results regarding both effectiveness and side effects. Ongoing research aims to identify more effective treatments for TON. As a result, TON remains a clinical challenge without a clear consensus on treatment approaches, necessitating individualized evaluation for each case.

Objectives To investigate the effects of subconjunctival injectable platelet-rich fibrin (i-PRF) injection on healing and complication rates after pterygium surgery with conjunctival autograft. Methods This retrospective and comparative study evaluated 31 eyes that received i-PRF injections under the donor and graft conjunctiva following pterygium surgery, while 34 eyes did not receive i-PRF after the pterygium surgery. The patients’ follow-up period was for 12 months. Postoperative recurrence, epithelial healing time, postoperative pain score, graft edema, and sliding of the graft (need for re-suturation) data were evaluated. Results For the 12 months after surgery, one eye (3.2%) in the i-PRF group had developed corneal recurrence, and five eyes (14.7%) in the non-i-PRF group had developed recurrence. The mean corneal epithelial healing time was 2.96 ± 0.70 days in the i-PRF group and 3.58 ± 0.70 days in the non-i-PRF group (p = 0.001). The mean healing time of the donor conjunctiva epithelium was 3.84 ± 0.70 days in the i-PRF group, whereas it was 4.44 ± 0.74 days in the non-i-PRF group (p = 0.006). The mean postoperative pain score was 4.45 ± 1.52 in the i-PRF group and 5.08 ± 1.40 in the non-i-PRF group. In the non-i-PRF group, three cases (8.8%) required re-suturation, whereas, in the i-PRF group, no one required re-suturation. Conclusions Thanks to its platelets-derived growth factors, i-PRF can be a safe and effective adjuvant therapy for faster healing of conjunctival autograft and in the prevention of recurrence.

Pupil Boyutu Scheimpflug Tomografi ile Ölçülen Lens ve Kornea Dansitometri Ölçümünü Nasıl Etkiler?

Purpose: To compare the surgical outcomes of Muller muscle conjunctival resection (MMCR) and levator advancement (LA) in patients with mild to moderate blepharoptosis.

Amaç: Kontakt lens kullanım alışkanlıklarının, bakım önerilerine uyumun ve hijyen alışkanlıklarının sorgulanması ve bunların oküler yüzey ve mikrobiyal kontaminasyon üzerindeki etkilerini incelemek Hastalar ve Yöntem: Bu prospektif çalışmada 2021-2022 yıllarında kontakt lens bölümümüze başvuran, takipli 108 yumuşak kontakt lens kullanıcısına, kontakt lens kullanımı için riskli kabul edilen davranış ve kullanım alışkanlıkları soruldu. Hastaların son kullandıkları kontakt lensler saklama kapları ile beraber mikrobiyolojik çalışma için laboratuvara gönderildi. Oküler yüzey analizi için oküler yüzey boyanması, göz yaşı kırılma zamanı ve oküler yüzey hastalık indeksi skorlaması yapıldı. Mikrobiyal kontaminasyon ve oküler yüzey analizi ile kontakt lens kullanım alışkanlıkları arasındaki ilişki analiz edildi. Bulgular: Kliniğimize başvuran kontakt lens kullanıcılarından sadece %6.4 ü tüm kontakt lens kullanım önerilerine uyduğunu bildirdi. Kullanıcıların 72 sinde (%66.7) kültürlerde en az bir üreme olurken, oküler yüzey bozukluğu görülen kullanıcı sayısı ise 60 (%55.6) idi. Kontakt lens ile uyuma (p=0.003) ve lensi belirtilen süreden uzun süre kullanma (p=0.016) oküler yüzey problemlerini arttırıyorken; el hijyenine uymama (p ≤0.001), lens kabı ve solüsyonu belirtilenden uzun süre kullanma (p=0.038) ve solüsyon yerine su kullanmanın (p=0.001) mikrobiyolojik kontaminasyonu arttırdığı gösterilmiştir. Sonuç: Bu ve bundan önceki çalışmalar göstermiştir ki riskli lens kullanım davranışları oküler yüzey- gözyaşı bozuklukları ve mikrobiyal kontaminasyonu arttıran önemli bir problemdir. Toplumda artan lens kullanımıyla beraber yüksek riskli lens kullanım oranları ciddi oküler patolojileri beraberinde getirebilir.