Tahsin Akçaoğlu

Background: This study aimed to evaluate longitudinal changes in retinal layers, retinal vessel diameters, and choroidal thickness using optical coherence tomography (OCT) in patients with central retinal artery occlusion (CRAO). Methods: This retrospective study included 35 patients (70 eyes) diagnosed with unilateral CRAO between 1 January 2020 and 5 January 2024. Unaffected fellow eyes served as internal controls. OCT-based macular segmentation, retinal arterial and venous diameter measurements, and subfoveal and peripapillary choroidal thickness were assessed in the acute phase (t-tests, Mann–Whitney U, Wilcoxon signed-rank, and chi-square tests. Results: Retinal arterial and venous diameters showed significant narrowing during follow-up (arteries: 77.91 ± 11.77 µm to 70.74 ± 15.12 µm; veins: 130.94 ± 22.54 µm to 118.57 ± 20.61 µm; both p < 0.05). Macular segmentation demonstrated marked thinning of the inner retinal layers, most prominently in the retinal nerve fiber layer and ganglion cell layer (40.09 ± 26.86 to 12.51 ± 4.99 µm and 61.20 ± 25.83 to 24.26 ± 12.11 µm, respectively; both p = 0.001). Subfoveal choroidal thickness progressively decreased over time (from 206.40 ± 34.91 µm to 178.86 ± 28.28 µm, p = 0.009). Peripapillary choroidal thickness increased across all quadrants at 6 months, most consistently in the inferior quadrant (p = 0.001). No significant differences in retinal or choroidal parameters were observed between HBOT-treated and non-treated patients. All cases exhibited persistent vascular occlusion without reperfusion. Conclusions: CRAO is characterized by progressive inner retinal atrophy, retinal vessel narrowing, and distinct temporal changes in choroidal morphology. The relative preservation and subsequent increase in peripapillary choroidal thickness during follow-up suggest dynamic choroidal involvement despite persistent occlusion. OCT-based macular segmentation and retinal vessel analysis provide objective biomarkers for longitudinal structural assessment in CRAO. By jointly quantifying retinal layer, retinal vascular, and choroidal remodeling, these findings may also provide reference data for future studies of structural evolution in non-reperfused CRAO.

Vitreous hemorrhage (VH) is one of the main causes of vision loss in diabetic retinopathy (DRP). Early surgery increases the visibility of the retina, allowing early recognition of DRP complications and additional treatments. One of the most important reasons affecting success after surgery is recurrent vitreous hemorrhage (RVH). We aimed to investigate the risk factors for RVH after early 25G vitrectomy in diabetic VH. Eighty eyes of eighty patients who underwent early 25G PPV surgery with a diagnosis of VH due to proliferative diabetic retinopathy (PDR) were included in this retrospective study. Vision acuity changes and intraocular pressure (IOP) changes were compared. The effect of arterial hypertension (HT), coronary artery disease (CAD), preoperative antiglaucomatous usage, and anticoagulant usage on RVH was investigated. A value of P < .05 was accepted as statistically significant. Postoperative RVH was observed in 18 (22.5%) patients. There was no correlation between the age of the patients and the development of postoperative RVH (r = −0.197, P = .08). The rate of HT and the mean HbA1C levels were found to be higher in the patients who developed RVH than in those who did not (P = .04 and < 0.001, respectively). The presence of CAD, preoperative glaucoma disease, and the use of anticoagulants did not have any effect on RVH (P = .229, 0.843, 0.932, respectively). HT and increased HbA1c were found to be risk factors for RVH in VH patients who underwent 25G vitrectomy in the early period in our study.

Fungal keratitis is a medical emergency that is among the most common causes of blindness in developing countries. The type of the agent may vary depending on the geographical conditions under which the patient lives, trauma exposure, the use of contact lenses and profession. Curvularia spp. is a saprophytic genus that rarely causes systemic disease in humans and has 250 species identified to date. They proliferate in soil and plants and spread to the environment with their spores and the formation of blackish and fluffy colonies is its most well-known morphological feature. There may be difficulties in cultivating brown (dematiaceous) fungi. Due to the similarity between the genera, conventional methods remain inadequate for diagnosis. In this report, a case of fungal keratitis associated with C.lunata was presented. Seventy-five years-old female patient admitted to the hospital with the symptoms of stinging pain, blurred vision, and swelling in the right eye. Her symptoms had begun four days ago after her eye was hit by a plant. The patient who had a history of peripheral neuropathy due to diabetes mellitus (DM) was hospitalized with a preliminary diagnosis of keratitis, and in the cultures of the patient's corneal scraping samples, the filamentous, black pigment-forming colonies of the pathogen growing on 5% sheep blood agar and potato dextrose agar showing an aerial hyphal structure, were stained with lactophenol cotton blue and examined under the microscope. The microscopic examination revealed geniculate conidiophores with brown pigmentation. On top of these structures were tetralocular macroconidia, one of which appeared to be larger than the main axis. The fungus was subjected to molecular identification with the prediagnosis of Curvularia/Bipolaris. DNA extraction of the ITS region polymerase chain reaction amplification and Sanger sequencing were performed for molecular identification. Sanger sequencing identified the agent to be Curvularia lunata with a similarity rate of 99.79% (NCBI-GenBank Nucleotide ID: OR365075). In vitro antifungal susceptibility of C.lunata was evaluated by microdilution method. Itraconazole and amphotericin B showed higher activity against C.lunata compared to other antifungals while fluconazole was the least active antifungal. Intrastromal and subconjunctival voriconazole injection was applied to the patient who was unresponsive to empirically initiated oral moxifloxacin and different topical treatments (vancomycin, ceftazidime, flucanozole, ganciclovir, cyclopentolate hydrochloride, hyaluronic acid and trehalose). After injection, right penetrating keratoplasty was applied due to increased thinning of the ulcerated area. No pathogen was detected in cultures taken after keratoplasty. Rare fungi should be considered in cases of keratitis that are difficult to treat. Fungal keratitis caused by brown fungi are clinically similar to each other and effective treatment protocols cannot be implemented without a species identification. Identification of the pathogen will enable genus-specific treatment. This will also help prevent complications that may occur. This article aims to present a case of fungal keratitis associated with C.lunata.