Serife Ciloglu Hayat

Background/Objectives: To evaluate the effect of baseline ESASO OCT-based cyst stage on 24-month outcomes in treatment-naïve diabetic cystoid macular oedema (CME) receiving anti-VEGF therapy. Subjects/Methods: Multicentre retrospective cohort of 311 treatment-naïve eyes classified at baseline as ESASO Stage 1 (mild, n=94), 2 (moderate, n=99), or 3 (advanced, n=118). BCVA (logMAR) and central macular thickness (CMT) at baseline and 3, 6, 12, 18 and 24 months were analysed using linear mixed-effects models with a random intercept per eye. A sensitivity analysis adjusted for anti-VEGF agent and cumulative dexamethasone exposure. Results: Stage 3 had worse baseline BCVA (0.744 vs. 0.537 and 0.570 logMAR; p<0.0001) and CMT (516 vs. 335 and 410 μm; p<0.0001). All groups improved significantly. At 12 months, Stage 3 had the highest proportion of ≥3-line gainers (42.4% vs. 21.3% and 25.3%; p=0.012). Between 18 and 24 months, Stage 3 showed a within-stage BCVA deterioration (+0.061 logMAR; 95% CI +0.005 to +0.116; p=0.032), while Stages 1 and 2 remained stable (p=0.41, 0.96). This decline persisted after adjusting for treatment exposure (+0.060 logMAR; p=0.034). Stage 3 required more dexamethasone implants (linear trend p=0.009) and more clinic visits by 24 months (11.7 vs. 9.9; p=0.002). Conclusions: In advanced diabetic CME, anti-VEGF therapy produces substantial mid-term visual gains but is associated with a small, significant late-phase BCVA decline between 18 and 24 months not attributable to treatment heterogeneity. Baseline ESASO cyst staging may serve as a supportive prognostic marker alongside BCVA, identifying eyes warranting closer monitoring; prospective validation is required.

Purpose: To assess the incidence, timing, and predictors of major adverse cardiovascular and cerebrovascular events (MACCE) after retinal artery occlusion (RAO), as well as visual outcomes and the association of hyperbaric oxygen therapy (HBOT) with visual recovery. Methods: In this retrospective cohort study, 190 consecutive patients with central, branch, or cilioretinal RAO and ≥6 months of follow-up were analyzed. Independent predictors of MACCE were assessed using multivariable logistic regression and Cox proportional hazards models. The primary outcome was MACCE, defined as ischemic stroke or myocardial infarction during follow-up. Secondary outcomes included best-corrected visual acuity (BCVA), clinically meaningful visual improvement, and MACCE-free survival. Results: During a median follow-up of 26.5 months, MACCE occurred in 26 (13.7%) patients, with 7 (26.9%) of events occurring within the first month after RAO. Hyperlipidemia was independently associated with MACCE in both logistic regression (adjusted odds ratio [OR], 3.40; 95%CI, 1.37–8.43; p =0.008) and Cox regression (hazard ratio [HR], 3.04; 95%CI, 1.38–6.72; p =0.006). Central retinal artery occlusion (CRAO) was associated with higher MACCE risk compared with branch retinal artery occlusion and cilioretinal artery occlusion (BRAO/CLRAO), reaching significance only in logistic regression.Visual outcomes were primarily determined by baseline BCVA and age. HBOT-treated eyes showed significant within-group visual improvement, although final BCVA did not differ significantly between treated and untreated groups. Conclusions: RAO is associated with substantial MACCE risk, particularly early after diagnosis. Hyperlipidemia emerged as a strong and potentially modifiable predictor of adverse systemic outcomes, supporting urgent systemic evaluation and aggressive secondary prevention following RAO.

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.

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 evaluate the interobserver reproducibility of Goldmann applanation tonometry (GAT) among ophthalmologists with varying levels of experience and to assess the agreement between noncontact tonometry (NCT) and GAT in measuring intraocular pressure (IOP).Methods: This cross-sectional observational study, conducted prospectively at a tertiary care hospital, included 210 patients. IOP measurements were performed on the right eye using NCT followed by GAT. Observer 1 was a senior ophthalmologist, while observers 2 and 3 were a second-year and a first-year resident, respectively. The primary objective was to compare GAT-based IOP measurements between observer 1 and the residents; the secondary objective was to evaluate agreement between NCT and GAT.Results: A statistically significant difference was observed between observers 1 and 2, and between observer 1 and NCT, but not between observers 1 and 3. The mean difference (MD) in IOP between observers 1 and 2 was 0.8 mmHg (95% limits of agreement [LoA], ±5.7 mmHg). Comparisons with observer 3 and NCT yielded MDs of 0.4 mmHg (95% LoA, ±6.5 mmHg) and –0.9 mmHg (95% LoA, ±7.3 mmHg), respectively. A higher percentage of observer 2 readings fell within ±4 mmHg of observer 1 compared to observer 3 and NCT. In the normotensive subgroup, MDs were 0.7, 0.4, and –1.4 mmHg, respectively, with a notably wide LoA for NCT (–8.1 to 5.3 mmHg).Conclusions: There was notable interobserver variability in GAT-based IOP measurements between residents and the senior ophthalmologist, exceeding the ±4 mmHg clinical acceptability benchmark. This variability suggests that less experienced observers may not yet have fully developed skills, impacting measurement accuracy. Over time, this range may narrow as experience and proficiency improve. Additionally, clinicians should interpret NCT results with caution—especially in postoperative assessments or when modifying treatment. Cross-checking with GAT and incorporating structured training protocols may enhance measurement consistency.

Purpose: To assess ocular findings in treatment-naïve people living with HIV (PLWH), focusing on posterior segment involvement, and to identify key virologic and immunologic predictors, including cytomegalovirus (CMV) retinitis and HIV-related retinopathy. Design: Prospective cross-sectional study. Methods: This study included 124 treatment-naïve PLWH who were referred for ophthalmologic screening at the time of HIV diagnosis. All participants underwent a comprehensive ophthalmic examination. Demographic and clinical data were collected, along with key immunologic and virologic markers: CD4+ and CD8+ T-cell counts, CD4/CD8 ratio, and plasma viral loads for both HIV and CMV, all measured prior to initiation of antiretroviral therapy. The primary outcome was the identification of posterior segment involvement, specifically CMV retinitis and HIV-related retinopathy, in relation to CD4 count, CD4/CD8 ratio, and CMV plasma load. Results: Posterior segment involvement was observed in 29% of patients, most commonly CMV retinitis. Univariate analysis showed significant associations with age, CD4 count, CD4/CD8 ratio, log₁₀HIV plasma load, and log₁₀CMV plasma load. Multivariate analysis revealed that log₁₀CMV plasma load remained the strongest independent predictor of posterior segment involvement (OR: 1.630, P = 0.003). CMV retinitis was significantly associated with log₁₀CMV plasma load ( P < 0.001), with a threshold of 44.5 IU/mL (log₁₀ = 1.6470) demonstrating high sensitivity (85.7%) and negative predictive value (97.8%). For a higher threshold of 1370 IU/mL (log₁₀ = 3.1294), specificity was higher (90.0%) with a positive predictive value of 47.6%. HIV-related retinopathy correlated inversely with CD4/CD8 ratio ( P = 0.030). Conclusions: Early ophthalmologic screening is essential in PLWH with advanced immunosuppression. CMV DNA plasma load, CD4 count, and CD4/CD8 ratio are useful markers to identify patients at risk of vision-threatening complications.

Panretinal photocoagulation (PRP) is the standard treatment for proliferative diabetic retinopathy (PDR), but it may alter corneal sensitivity and tear fil

To characterize ocular findings, management strategies, and factors associated with visual outcomes following blunt ocular trauma, with particular emphasis on the prognostic relevance of macular commotio retinae. This retrospective study included 288 patients with BOT who presented to a tertiary referral center between January 2021 and July 2025. Demographic characteristics, injury mechanisms, ocular findings, and treatment modalities were reviewed. Visual acuity (VA) was recorded at presentation and at final follow-up; poor visual outcome was defined as a final VA ≥ 1.0 LogMAR. Macular commotio retinae was graded based on the extent of foveal involvement, and its association with visual outcomes was analyzed. The median patient age was 36 years (IQR 27-48), and 51.4% were male. Falls (28.8%) and assaults (27.8%) were the most common mechanisms of injury. Traumatic cataract (24.0%) and hyphema (15.6%) were the most frequent anterior segment findings, while commotio retinae (25.7%) was the most common posterior segment lesion. Median VA improved significantly from 0.7 (IQR 0.4-1.3) LogMAR at presentation to 0.4 (IQR 0.22-0.7) LogMAR at final follow-up (p < 0.001); however, 14.2% of eyes had poor final visual outcomes. Higher grades of macular commotio retinae were strongly associated with poor visual outcome (p < 0.001). In contrast, anterior segment findings such as hyphema and traumatic cataract were not predictive in this cohort. Half of the patients (n = 144) were managed conservatively, while phacoemulsification and pars plana vitrectomy were the most commonly performed interventions. Blunt ocular trauma results in a broad spectrum of anterior and posterior segment injuries with variable visual prognosis. Grading the severity of macular commotio retinae provides clinically meaningful prognostic information, as higher grades are associated with persistent visual impairment. In contrast, many anterior segment injuries are potentially reversible with appropriate treatment. Comprehensive posterior segment evaluation and individualized management are essential to optimize visual outcomes after blunt ocular trauma.

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.