Osman Parca

Background: In this study, we evaluated whether preoperative foveal morphology assessed using optical coherence tomography is associated with postoperative absolute refractive prediction error after uncomplicated cataract surgery. Methods: This retrospective observational study screened 435 patients and included 91 eyes of 91 patients after exclusions. All included patients underwent phacoemulsification with monofocal intraocular lens implantation. Preoperative spectral-domain optical coherence tomography measurements were used to calculate a foveal steepness index (FSI) as the ratio of the mean inner Early Treatment Diabetic Retinopathy Study (ETDRS) ring thickness to minimum foveal thickness, and foveal depth as the difference between these measurements. The primary outcome was SRK/T-derived absolute prediction error (APE) at one month. A supplementary analysis used Barrett Universal II. Associations were examined using Spearman correlation and univariable and multivariable linear regression analyses. A sensitivity analysis was performed after zeroing the cohort mean signed prediction error. Results: The mean age was 68.2 ± 7.8 years. The mean absolute prediction error was 0.48 ± 0.37 D, with a median of 0.50 D (IQR, 0.25–0.75 D). Overall, 70.3% and 95.6% of eyes had errors within 0.50 and 1.00 D, respectively. FSI and foveal depth were significantly associated with APE in univariable analyses (p = 0.028 and p = 0.013, respectively). The adjusted foveal-depth association was not statistically significant in the primary analysis (p = 0.079) but reached significance after zeroing the mean prediction error (p = 0.032). The supplementary Barrett Universal II analysis did not confirm an adjusted association before or after zeroing the mean signed prediction error. Adding foveal depth did not meaningfully improve leave-one-out cross-validated performance. Conclusions: These exploratory findings suggest a possible association between foveal morphology and SRK/T-derived APE in this study population. Reproducibility across IOL calculation formulas and clinical applicability remain uncertain; validation in a larger prospective cohort is needed.

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: The primary goal in traumatic lacrimal canalicular lacerations is to restore canalicular continuity and prevent permanent epiphora. This study evaluated anatomical and functional outcomes and postoperative complications of Bowman probe-guided repair using a 24-gauge intravenous cannula in urgent cases where commercial canalicular stents were unavailable.Materials and methods: This retrospective single-center case series included patients undergoing primary canalicular repair with this technique between January 2022 and December 2025. Patients with incomplete records or follow-up shorter than 3 months were excluded. Demographics, injury characteristics, surgical details, cannula retention, follow-up, success rates, and complications were recorded. Anatomical success was defined as lacrimal patency on irrigation at final follow-up; functional success as absence of epiphora (Munk score 0).Results: Twenty-one patients (15 male; mean age 36±16 years) were included. The lower canaliculus was most frequently involved. Fifteen patients underwent repair within 24 hours; 19 underwent concurrent eyelid repair. Mean cannula retention and follow-up were 3.8±1.0 and 9.5±2.7 months, respectively. Anatomical and functional success were achieved in 18 (85.7%) and 17 (81.0%) patients, respectively. Complications included corneal abrasion in 3 (14.3%), early cannula loss in 2 (9.5%), and canalicular stenosis in 1 (4.8%). No punctal granuloma or wound infection occurred.Conclusion: Bowman probe-guided canalicular repair using a 24-gauge intravenous cannula achieved favorable early-to-intermediate anatomical and functional outcomes with manageable complications in this limited series. In urgent cases without commercial stents, it may be considered a readily available alternative. These findings should be supported by prospective studies with larger sample sizes.

Background: Demodex-associated blepharitis is a chronic inflammatory eyelid disease characterized by collarettes, eyelid margin inflammation, and the presence of Demodex mites. Comparative data on different tea tree oil (TTO)-based application forms remain limited. This study compared the clinical and microscopic outcomes of TTO-based eyelid wipes and eyelid shampoo in Demodex-positive chronic blepharitis.Methods: In this retrospective, single-center study, 155 adults with clinically and microscopically confirmed Demodex-positive chronic blepharitis were grouped by treatment form: eyelid wipes (n=74) or eyelid shampoo (n=81). Baseline and 3-month assessments included subjective symptoms, Ocular Surface Disease Index (OSDI) scores, collarette severity, eyelid margin erythema, meibum quality, meibomian gland obstruction, and microscopic Demodex status.Results: Baseline demographic and clinical characteristics were similar between groups. At 3 months, symptoms improved in both groups, but burning was less frequent in the wipe group (p=0.048). The OSDI score was lower in the wipe group (24.4±7.5 vs 27.3±8.6; p=0.026). Collarette and meibum quality scores favored the wipe group (p=0.011 and p=0.003, respectively). Meibomian gland obstruction scores were comparable (p=0.87), whereas improvement in eyelid margin erythema (89.2% vs 76.5%; p=0.038) and meibomian gland obstruction (83.8% vs 67.9%; p=0.022) was more frequent in the wipe group. Demodex eradication rates were similar (64.9% vs 60.4%; p=0.570).Conclusion: Both TTO-based formulations were associated with clinical improvement and comparable Demodex eradication. Eyelid wipes may provide additional benefit for ocular surface-related quality of life and selected eyelid margin and meibomian gland outcomes. Prospective randomized studies are needed to confirm these results.

Objective: To investigate whether residual optical coherence tomography (OCT) findings in the neurosensory retina and quantitative choroidal parameters are associated with best-corrected visual acuity (BCVA) after center-involved diabetic macular edema (DME) has resolved following anti–vascular endothelial growth factor (anti-VEGF) treatment. Methods: Medical records of 44 patients comprising 49 treated eyes were reviewed retrospectively. All eyes had received at least 3 initial intravitreal anti-VEGF injections before the postresolution assessment. Central 1 mm spectral-domain OCT B-scans were examined for disorganization of the retinal inner layers (DRIL), ellipsoid zone (EZ) disruption, and external limiting membrane (ELM) disruption. Enhanced-depth imaging OCT was used to measure subfoveal choroidal thickness (SFCT) and calculate the choroidal vascularity index (CVI) after Otsu-based binarization of a manually selected subfoveal choroidal area. Generalized estimating equation (GEE) models were used to account for inter-eye correlation. Results: Mean (SD) BCVA was 0.48 (0.45) logMAR. Mean (SD) SFCT and CVI were 241 (60) μm and 0.65 (0.08), respectively. BCVA was poorer in eyes with DRIL (P = .008), ELM disruption (P < .001), and EZ disruption (P = .001). DRIL was also associated with a higher frequency of ELM and EZ disruption (P < .001 and P = .001, respectively). Hard exudates were not significantly associated with BCVA after GEE analysis (P = .055). Choroidal thickness and CVI did not differ significantly across retinal biomarker subgroups. CVI showed a modest inverse association with age (r = −0.324, P = .023) but was not significantly associated with BCVA. Conclusion: In eyes evaluated after resolution of center-involved DME, poorer BCVA was associated with persistent inner and outer retinal microstructural abnormalities, particularly DRIL and ELM/EZ disruption. In contrast, posttreatment SFCT and CVI were not significantly associated with BCVA or retinal biomarker status.

Background/Objectives: To evaluate interocular retinal and choroidal microvascular alterations associated with compensatory head tilt in unilateral congenital superior oblique palsy (SOP) and to investigate their relationship with head tilt degree using optical coherence tomography angiography (OCTA). Methods: This retrospective cross-sectional study included 34 patients with congenital SOP and head tilt–dominant abnormal head posture. A paired-eye design compared the tilt-side eye with the opposite-side eye. Superficial and deep capillary plexus (SCP, DCP) vessel density, foveal avascular zone (FAZ) parameters, choroidal vascularity index (CVI), and subfoveal choroidal thickness (SFCT) were assessed. Interocular differences were defined as Δ = opposite-side eye − tilt-side eye. Correlation and multivariable regression analyses were performed to assess associations with head tilt degree. The interocular difference in CVI (ΔCVI) and its association with head tilt degree were defined as the primary outcomes, whereas retinal OCTA parameters, FAZ metrics, and SFCT were considered exploratory secondary outcomes. Results: CVI showed the most prominent interocular difference, being higher in the opposite-side eye than in the tilt-side eye (0.71 ± 0.04 vs. 0.68 ± 0.04; p < 0.001), whereas SFCT did not differ significantly (p = 0.395). SCP foveal vessel density and DCP inferior vessel density showed nominal differences in the unadjusted analyses but did not remain statistically significant after Benjamini–Hochberg false discovery rate correction. ΔCVI correlated positively with head tilt degree (ρ = +0.533, p = 0.001) and remained independently associated in multivariable analysis (p = 0.001). Conclusions: Compensatory head tilt in congenital SOP is associated with measurable interocular microvascular asymmetry, predominantly at the choroidal level. CVI demonstrated the strongest association with head tilt severity, whereas retinal OCTA findings were exploratory, suggesting that OCTA may provide objective insight into posture-related choroidal microvascular alterations.

Background/Objectives: To evaluate early postoperative changes in scleral and iris thicknesses together with corneal layer thicknesses and tomographic parameters following corneal collagen cross-linking (CXL) in eyes with progressive keratoconus. Methods: This retrospective study included 94 eyes of 94 patients with progressive keratoconus who underwent standard epithelium-off CXL using the Dresden protocol. Corneal tomography (Pentacam) and anterior segment optical coherence tomography (AS-OCT) measurements were obtained preoperatively and at the early postoperative follow-up (3 months ± 2 weeks). Thickness measurements of the tear film, corneal epithelium, Bowman layer, stroma, Descemet–endothelium complex, sclera (1–3 mm from the limbus), and iris (1–2 mm from the pupillary margin) were analyzed. Pre- and post-CXL values were compared using paired statistical tests, and effect sizes were calculated. Results: In the early postoperative period, scleral thickness showed a significant increase at all measured distances from the limbus, with medium effect sizes, while iris thickness demonstrated a significant decrease at all measurement points with large effect sizes (p < 0.001). Tear film, epithelial, and stromal thicknesses decreased significantly after CXL, whereas Bowman layer and Descemet–endothelium complex thicknesses remained unchanged. Pachymetric measurements revealed significant thinning at the pupil center, corneal apex, and thinnest point. No significant changes were observed in Kmax or anterior chamber depth, indicating stabilization rather than progression in the early postoperative period. Conclusions: Corneal collagen cross-linking was associated with measurable early structural changes in corneal layers and extra-corneal anterior segment tissues during the postoperative period. The observed increase in scleral thickness and decrease in iris thickness suggest that structural alterations may occur in extra-corneal anterior segment tissues following CXL. These findings support the concept that CXL influences anterior segment biomechanics in a tissue-specific manner and that extra-corneal parameters may serve as complementary markers for early postoperative assessment.

This study evaluates the clinical outcomes of adjunctive amniotic membrane transplantation (AMT) in the surgical management of fat adherence syndrome (FAS), a rare but challenging cause of restrictive strabismus following inferior oblique surgery. This retrospective clinical series included patients diagnosed with FAS between 2016 and 2022 who presented with hypotropia, supraduction limitation, and a positive forced duction test after prior inferior oblique surgery. All patients underwent meticulous adhesiolysis, conjunctival recession, and, when indicated, inferior rectus recession, with adjunctive AMT. Surgical success was predefined as postoperative deviation ≤10 prism diopters, improved supraduction without mechanical restriction, and resolution of abnormal head posture. Seven patients (mean age: 17.7 years) met the inclusion criteria. Intraoperatively, dense adhesions involving the inferior rectus muscle, Tenon capsule, and prolapsed fat were identified and successfully released in all cases. Postoperatively, all patients demonstrated improvement in both alignment and motility, and 6 of 7 met the predefined surgical success criterion of ≤10 prism diopters. Diplopia and abnormal head posture resolved in affected patients. No cases of anterior segment ischemia, recurrent restriction, or other complications were observed during 6 to 36 months of follow-up. Adjunctive AMT may help improve postoperative healing and reduce recurrent fibrosis in patients undergoing surgery for FAS. In this retrospective series, favorable functional and cosmetic outcomes were observed following combined surgical management with AMT. Larger prospective controlled studies are required to further clarify its therapeutic contribution.

Purpose: Childhood myopia is increasing globally, yet limited evidence exists on how parental knowledge, attitudes, and practices (KAP) relate to children’s myopia status. This study aimed to evaluate parental KAP regarding childhood myopia and examine their associations with refractive outcomes. Methods: This cross-sectional study included parents of myopic children aged 6–18 years presenting to an ophthalmology clinic between July and November 2025. A structured KAP questionnaire assessed parental knowledge of risk factors and control methods, attitudes toward myopia severity and management, and daily preventive practices. KAP scores were analyzed as continuous variables. Annual myopia progression was categorized according to refractive change (< − 0.50 D, 0.50–1.00 D, > 1.00 D). Results: A total of 303 parents were enrolled. The mean knowledge, attitude, and practice scores were 4.68 ± 2.44, 8.12 ± 3.37, and 3.59 ± 1.52, respectively. Higher educational level, urban residence, and a family history of myopia were consistently associated with higher KAP scores. Parental KAP also varied by the child’s myopia severity: parents of children with high myopia demonstrated markedly higher knowledge and attitude scores than those of children with mild or moderate myopia. Correlation analysis showed a moderate positive association between knowledge and attitude scores ( r = 0.360, p < 0.001). Annual myopia progression was negatively correlated with knowledge ( r = − 0.263, p < 0.001), attitude ( r = − 0.127, p = 0.027), and practice scores ( r = − 0.123, p = 0.033), indicating that children of parents with higher KAP scores tended to show less refractive progression. Conclusions: Parental KAP profiles were associated with clinically relevant patterns of refractive progression in childhood myopia. Despite generally positive attitudes, substantial gaps persisted in parental knowledge and daily implementation of protective practices. Strengthening parental education and improving access to evidence-based interventions may support better behavioral engagement in myopia management.