Tunahan Akyol

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.

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.

Purpose: To present a rare case of transient esodeviation and binocular diplopia caused by unintended medial rectus involvement following periocular botulinum toxin type A (BoNT‐A) injection performed in a non‐medical setting. Case Report: A 39‐year‐old female with no systemic disease presented with a 1‐day history of painless horizontal binocular diplopia. Five days before symptom onset, she had received a cosmetic BoNT‐A injection into the glabellar, forehead, and lateral canthal regions at a non‐medical beauty center. Ophthalmic examination revealed a visual acuity of 0.0 logMAR bilaterally, normal anterior and posterior segment findings, and a 10‐prism‐diopter esodeviation in primary gaze. Extraocular motility demonstrated full ductions without restrictive patterns. Worth four‐dot testing showed right‐eye suppression, and stereopsis was markedly reduced. Cranial nerve and neurological examinations were normal. Orbital–cranial CT and MRI were unremarkable. The clinical picture was consistent with unintended diffusion of the toxin, leading to transient medial rectus overaction. The patient was managed conservatively with prism correction. Prism strength was gradually reduced over follow‐up (8 PD → 6 PD → 2 PD), and prisms were discontinued by month four. Full resolution of diplopia occurred at month six, consistent with the expected timeframe of neuromuscular recovery after BoNT‐A exposure. Conclusion: Medial rectus involvement following cosmetic BoNT‐A injection is extremely rare but may result in symptomatic diplopia and functional visual impairment. This case emphasizes that botulinum toxin injections must be performed exclusively by trained medical professionals with appropriate anatomical knowledge. Early recognition of cosmetic injection–related strabismus is essential to avoid unnecessary neurological workup and to ensure timely conservative management.

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.

To compare the effects of single clear corneal incision (CCI) and opposite clear corneal incision (OCCI) techniques on corneal and total astigmatism in pat

Objective: To evaluate the impact of cataract surgery on sexual quality of life in female patients using the Sexual Quality of Life–Female (SQOL-F) questionnaire. Methods: This prospective observational study included 67 female patients who underwent cataract surgery. Sexual quality of life was assessed preoperatively and again at 3 months postoperatively using the Sexual Quality of Life–Female (SQOL-F) scale. This is a validated 18-item Likert-type instrument that assesses emotional, psychological, and relational aspects of sexual life. Scores were transformed to a 0–100 scale, with higher scores indicating better sexual quality of life. Demographic variables included age, education level, employment status, and economic status. Statistical comparisons between preoperative and postoperative scores were performed. Results: Sixty-seven women participated. Sexual quality-of-life scores improved after cataract surgery. For patients over 60 years, SQOL-F scores rose from 58.7 ± 7.2 to 76.9 ± 11.3 (p < 0.05). Patients under 60 showed no significant improvement. Those with lower education and those with low or high economic status showed significant gains (p < 0.05), whereas university-educated or employed patients did not. These results show that cataract surgery’s impact on sexual quality of life differs by sociodemographic group. Conclusion: Cataract surgery can improve sexual quality of life in women, especially older patients and those with lower socioeconomic status. This suggests cataract surgery offers psychosocial benefits beyond vision improvement. Larger studies are needed to confirm these findings.

Objective: To evaluate postoperative changes in male sexual function after cataract surgery and to examine the association between improvements in visual acuity and sexual performance using the International Index of Erectile Function (IIEF). Material and Methods: This prospective observational study included 52 men with age-related cataract who underwent uncomplicated phacoemulsification and intraocular lens implantation. Sexual function was assessed using the IIEF, encompassing erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. Assessments were conducted preoperatively and one month postoperatively. Best-corrected visual acuity (BCVA) and demographic data were also recorded. Paired Student’s t-test was used to compare pre- and postoperative results. Results: The mean BCVA improved significantly from 0.58 ± 0.21 logMAR preoperatively to 0.14 ± 0.09 logMAR at one month (p < 0.001). Total IIEF scores increased from 35 ± 1.6 to 43 ± 1.7 (p < 0.005), indicating overall enhancement in sexual function. Significant improvements were observed in orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction (p < 0.005 for all), while changes in erectile function were not statistically significant (p > 0.05). Visual improvement correlated positively with changes in total IIEF score (r = 0.52, p = 0.001). Conclusion: Cataract surgery not only restores vision but also positively influences sexual and psychosocial well-being. Improvements in sexual satisfaction, desire, and orgasmic function highlight the broader quality-of-life benefits of visual rehabilitation. Further large-scale studies are needed to clarify the mechanisms underlying this association.