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Background: To evaluate the efficacy and safety of intravitreal injections of 4 mg (high dose) of aflibercept in treatment-naive patients with neovascular AMD(nAMD) with treat and extend(TREX) dosing regimens, and to determine the frequency of injections. Methods: In this interventional, retrospective study a total of 15 eyes of 14 patients (eight female and 9 male) with nAMD were included. All patients were examined and OCT imaging was performed at the time of initial presentation, on the day of each injection and at subsequent follow-up visits. Each eye received intravitreal injections of 4 mg/0.1 mL aflibercept at the dose of every 4 weeks for three months (loading phase) after that 4 mg high dose of aflibercept was applied as the TREX regime. The eyes with a minimum follow-up time of 12 months are included. Results: The mean age of the patients was 74.9 ± 7.3(61–85) years and the mean follow-up time was 20.33 ± 8.7(12–34) months. Total number of injections were 9.3 ± 3.0 (5–14) during the follow-up period. A statistically significant increase was found in terms of best-corrected visual acuity and central macular thickness between mean baseline values and at 1, 3, 6, 12 months, and the final examination(p < 0.05 for each comparison). No complication was observed during follow-up. Conclusions: High-dose Aflibercept of 4 mg/0.1 mL application with the TREX regimen was found to be efficient and safe. High-dose may also help to reduce the frequency of injections and visits in the follow-up period in eyes with nAMD. Prospective studies with large series are warranted. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to assess the frequency of smoking cessation and to identify the factors affecting smoking cessation success among individuals seeking assistance at a smoking cessation centre. Methods: This cross-sectional study included 1,570 individuals who applied to the smoking cessation centre in Izmir, Turkey, between 2009 and 2018, and completed three follow-ups. Data were obtained from the centre's records. Factors affecting smoking cessation success were analysed using logistic regression in multivariate analysis. Results: The median age to start smoking was 19 (17-22), and the median number of cigarettes consumed per day was 20 (20-30). Among the participants, 59.9% exhibited a high/very high level of nicotine dependence, and 79.6% had attempted to quit smoking previously. The median number of patient follow-ups was 7 (5-10). Of the patients, 34.0% successfully quit smoking for one year. According to the multivariate analysis results, smoking cessation success increased with being married by 2.26 times (95% CI: 1.51-3.38, p < 0.001), the absence of other smokers in the household by 1.38 times (95% CI: 1.01-1.88, p = 0.04), having a low level of nicotine dependence by 1.75 times (95% CI: 1.23-2.48, p = 0.002), and more patient follow-ups by 1.61 times (95% CI: 1.52-1.72, p < 0.001). Conclusions: Smoking cessation success is increased by the support and follow-up provided by healthcare professionals, the absence of other smokers in the household, and a low level of nicotine dependency. [ABSTRACT FROM AUTHOR]

In this study, 419 Turkish middle school students (203 girls, 216 boys) were surveyed on their exposure to and engagement in bullying, and their level of hopelessness. Our findings suggest that girls were victims of indirect (e.g. gossiping) bullying more than boys. Boys reported being victims of physical (e.g. damaging property) and verbal (e.g. teasing) bullying more than girls. While the level of hopelessness among victims of physical and verbal bullying was higher than non-victims, no difference was found between the victims of indirect bullying and non-victims. Students who never talked to their teachers and parents about bullying reported higher levels of hopelessness than others. The implications of the study for intervention and prevention programs are discussed. (Contains 4 tables.)

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Background: Our purpose was to demonstrate if measuring lens autofluorescence (AF) with a scanning confocal biomicroscope may be used to identify subjects with undiagnosed type II diabetes mellitus (DM), and hence, for it to be used as a marker for the severity of diabetic retinopathy in diabetic patients. Patients and methods: In this cross-sectional, comparative study, lens AF was measured with scanning confocal lens fluorescence biomicroscope in diabetic and healthy groups. Full ophthalmological examination was performed. Blood tests of fasting plasma glucose, and glycosylated hemoglobin were also analyzed. The correlation between lens AF results and blood tests was evaluated in both groups. The cutoff value for the diagnosis of DM using lens AF was investigated. Results: The study included 191 subjects with a mean age of 52.09±6.75 years. One hundred and seven (56.0%) subjects were female, and 84 (44.0%) were male. Eighty-two (42.9%) patients had type II DM, and 109 (57.1%) subjects self-reported as normal. The fluorescence ratio (FR) values ranged from 0.09 to 0.46 (0.23±0.06) in the total group. Mean FR measurements of diabetic subjects were significantly higher (0.27±0.06) than those without DM (0.20±0.05), (p=0.001). A statistically significant correlation was found between glycosylated hemoglobin, fasting plasma glucose, and FR. The cutoff point for the FR according to the presence of DM was found to be 0.24 and above (p=0.001), with a sensitivity of 71.95% and a specificity of 80.73%. Conclusion: Measuring AF of human lens as an indirect evidence of increased advanced glycaton end products may helpful in detecting impaired glucose metabolism. Our results show highly significant correlation between possibility of DM and FR. [ABSTRACT FROM AUTHOR]

Proliferative vitreoretinopathy (PVR) is a wound healing process, which is characterized by membrane formation on both surfaces of the retina and in the vitreus as a result of migration and proliferation of cells in these areas. Contraction of formed membranes causes traction retinal detachment (RD) in the first stage, which in time may result in reopening of preexisting breaks; or new breaks form and rhegmatogenous RD component may be added to the scene. PVR is the most frequent cause of failure after RD surgery. Stages in the pathogenesis of PVR in order are, inflammation with activation and proliferation of cells, extracellular matrix formation and remodeling, and contraction. Each stage is a complicated process, in which various molecules and cells play roles. Although, the primary treatment of PVR is a well-performed surgery; multiple phamacological agents can be use to prevent PVR formation or prevent its recurrence as adjuvants to surgery. Antiinflammatory, antiproliferative drugs, and agents that inhibit formation and contraction of extracellular matrix are some of them. As the importance of molecules that play roles in every step of PVR ptahogenesis and genetic predispositions get clear, and as the drugs can be given more efficiently and for longer time, the efficiency of pharmacotherapy of PVR will be more effective. Investigative studies to develop effective drugs for the prophylaxis and treatment PVR without side effects, that will be easily used for long times are currently ongoing. Especially, the prophylaxis of PVR seems to be possible with the current pharmacotherapy options available. It is demonstrated that postoperative inflammation is decreased with the use of antiinflammatory agents. Intraoperative infusion of low molecular weight heparin and 5-fluorouracil is clinically found effective in the prevention of PVR in eyes with high risk for PVR development. The studies that will show the efficacy of isotretinoin in the prophylaxis and treatment of PVR will be announced in the near future, which seem to be hopeful. Because the pathogenesis of PVR is complicated, combined therapies which are effective for its every stage are expected to be more successful for the effective pharmacotherapy of PVR. [ABSTRACT FROM AUTHOR]

The article presents two case studies of a 9-year-old boy who had an open-globe injury to the right eye caused by an air gun pellet and a 9-year-old who had undergone primary corneal suturing because of a left eye wound caused by a tree branch. Both patients manifest posttraumatic retinal detachment and one has endophthalmitis. Intraocular foreign bodies (IFOB) were extracted from the eye using a suture loop and intraocular forceps.

Purpose: To evaluate the anatomical and functional outcomes of combined 25 gauge and 20 gauge pars plana vitrectomy (PPV) in the treatment of a variety of vitreoretinal diseases. Materials and Methods: In this retrospective interventional case series combined 25 gauge and 20 gauge PPV was performed in 41 eyes. In the combined technique, two 25 g sutureless sclerotomies and one 20 g (for the active hand) sclerotomy were performed. Eyes with a minimum followup of 6 months were evaluated. Main outcome measures were the number of sutures in 25 gauge sclerotomies, changes in visual acuity, intraocular pressure (IOP), and rates of complications. Results: Mean follow-up was 9.34±2.27 months. No suture was necessary for the 25g sclerotomies. Mean visual acuity improved at postoperative month 1 (p=0.002) and at the last visit (p<0.001). A significant decrease in mean IOP was detected after 2 hours (p<0.001) and by day 1 (p=0.001) postoperatively. In one (2.43%) eye transient severe hypotony was observed. In two eyes operated on with a diagnosis of a macular hole, the holes were sealed after a second surgical procedure. Conclusion: Combined 25 g and 20 g PPV for treatment of a variety of vitreoretinal diseases yielded anatomic and functional recovery without significant complications. This technique combines the advantages of both systems, expands the indications of 25 g sutureless vitrectomy, and obviates the need for a variety of 25 g instruments. [ABSTRACT FROM AUTHOR]

Purpose: To compare anatomical and functional outcomes of 25 gauge sutureless pars plana vitrectomy (PPV) and 20 gauge PPV in eyes with diabetic vitreous hemorrhage (VH). Materials and Methods: IIn this interventional case series 15 eyes (Group 1) underwent 20-gauge PPV, and 29 eyes (Group 2) underwent 25 gauge sutureless PPV with oblique sclerotomies due to diabetic VH. Eyes with a minimum follow-up of 6 months were evaluated. The main outcome measures were changes in visual acuity (VA), intraocular pressure (IOP), and rates of complications. Results: In all eyes PPV was performed without complication. The mean follow-up period was 14±9.14 months. Mean VA in Group 1 increased significantly at postoperative week 1 and thereafter, whereas it increased in Group 2 at postoperative month 1 and thereafter (p<0.05). Mean log- MAR change, mean IOP levels, and rates of complications did not differ significantly between the two groups during follow-up (p>0.05). Transient hypotony was detected in 3 eyes in Group 2 only (p>0.05). Revitrectomy was performed in 1 (6.66%) and 3 (10.34%) eyes due to postoperative rehemorrhage in the two groups, respectively (p>0.05). Conclusions: In this study 25 gauge sutureless pars plana vitrectomy with oblique sclerotomies and 20 gauge vitrectomy were similarly effective and safe in the treatment of diabetic VH. Further prospective randomized and controlled studies with larger series and with longer follow-up are warranted. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical features, surgical methods and results of surgery in retinal detachments (RD) developing after refractive lens excange (RLE) and phacic intraocular lens (PIL) implantation in highly myopic eyes. Materials and Methods: Nine eyes of 7 patients who had rhegmatogenous retinal detachment after RLE and PIL implantation for high myopia were included in the study. Best corrected visual acuities (BCVA), duration between the refractive surgery (RS) and retinal detachment (RD), vitreoretinal findings, anatomic and functional success (at least 2 lines increase in visual acuity) were evaluated. Results: Of the patients 4 were female, 3 were male. The mean age of 7 patients was 38.14±9.42. Posterior chamber phacic intraocular lens was implanted in 3 (33.3%) eyes, anterior chamber phacic intraocular lens was implanted in 1 (11.1%) eye and RLE was performed in 5 (55.5%) eyes. Mean interval between RS and RD was 63.66±42.3 months. Preoperative mean BCVA was 20/25000 (0.001) median proliferative vitreoretinopathy grade was B (A-D2). Eight (88.8%) eyes had macular detachment. Scleral buckling was performed in 1 eye, pars plana vitrectomy±scleral buckling was performed in 8 eyes. The mean follow up was 13.77±5.58 months after surgery. Retinal attachment was achieved with single operation in 6 (66.6%) eyes, with two surgeries in 2 (22.2%) eyes, and with three operations 1 (11.1%) eye. Final anatomical success rate was 100%. Functional successs was achieved in 7 (77.7%) eyes. Conclusion: Retinal detachments following refractive surgery represent a complicated group of retinal diseases. However, successful anatomical and functional results can be obtained if appropriate treatment methods are prefered. [ABSTRACT FROM AUTHOR]

A patient who had subfoveal fluid associated with sympathetic ophthalmia following scleral buckling and subretinal fluid drainage surgery is evaluated. The subfoveal fluid was demonstrated with optical coherence tomography. The patient received oral corticosteroid and cyclosporine A combination. He is followed with regular examinations, fluorescein angiography and OCT. Visual acuity increased from 20/25 to 20/20 and the subfoveal fluid resolved in the sympathizing eye with therapy. OCT may be a valuable tool in monitoring the response to the systemic therapy of sympathetic ophthalmia with subfoveal exudation. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy of radial optic neurotomy (RON) with or without intravitreal triamcinolone in improving visual acuity in central retinal vein occlusion (CRVO). Materials and Methods: We performed vitrectomy and RON to 16 eyes of 16 patients with CRVO with a best corrected visual acuity (BCVA) of 20/200 or less. Eight of them received an injection of 4mg intravitreal triamcinolone (IVTA) at the completion of the surgery. The major outcome parameter was defined as an improvement of BCVA of 2 or more lines and final BCVA better than 20/200. Decrease in central macular thickness was our secondary outcome parameter. Intraoperative and postoperative complications were also evaluated. Results: Eleven (68.8%) of the eyes were evaluated as ischemic based on fluorescein angiography and presence of relative afferent pupillary defect. Only 2 (12.5%) patients had BCVA of better than 20/200 postoperatively. Central macular thickness was significantly reduced from 811±303 μ to 444±276 μ (p<0.01). Preoperative visual acuity and age were significant factors in affecting final BCVA of better than 20/200 (p=0.02 and p=0.05, respectively). One patient underwent trabeculectomy because of intractable open angle glaucoma. One additional patient developed neovascular glaucoma and was treated with diod laser cyclophotocoagulation. Conclusions: RON surgery with or without peroperative IVTA led to a significant decrease in central macular thickness but its functional success is very limited in eyes with preoperative BCVA of less than 20/200 and probably is not better than the natural history. [ABSTRACT FROM AUTHOR]

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by vascular thrombosis or pregnancy morbidity. Ocular involvement in APS includes a broad spectrum of manifestations involving anterior and posterior segment or the presence of neuroophthalmologic features. Nonarteritic anterior ischemic optic neuropathy (NAION) is a very rare finding, and in this report a case having NAION as the prevailing sign of APS is presented. A middle-aged women who presented with visual disturbances in her left eye (LE) and turned out to have the diagnosis of primary APS with the help of rheumatological investigations is discussed. She was treated with oral steroids for NAION in her LE. With systemic and rheumatological work-up, primary APS was diagnosed, and hydroxychloroquine, coumadin, and aspirin were started, after which she remained stable under control. Due to the important diagnostic and therapeutic implications of APS, it should be considered in the differential diagnosis of NAION, particularly when the etiology is uncertain. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 2.5-year-old girl with type I osteogenesis imperfecta who underwent 25-gauge sutureless vitrectomy after being presented with intravitreal opacities. After nine months, the patient exhibited a healthy optic nerve and retina without detachment in her funduscopic examination. The study showed that 25-gauge sutureless vitrectomy can be used for pediatric patients with associated thin sclera to allow less surgical trauma and to avoid scleral suturing.

A 52-year-old woman presented with diminishing vision who had been followed-up with the diagnosis of macular hole by another clinic. Best corrected visual acuity (BCVA) was 20/800 and 20/100, in the right and left eye, respectively. Fundus examination in both eyes revealed macular hole-like image and gray reflection in the fovea. Internal limiting membrane (ILM) drape was detected via optical coherence tomography (OCT) in the fovea in both eyes. Fundus fluorescein angiography (FA) showed telangiectasis in both eyes. Fundus autofluorescence (FOF) imaging revealed hyperautofluorescence in both eyes. A 65-year-old male patient was admitted because of low vision who had been followed-up with a diagnosis of age-related macular degeneration by another clinic. BCVA was 20/400 and 20/800 in the right and left eye, respectively. In both eyes, the fundus examination revealed retina pigment epithelium abnormalities and gray reflection at the fovea. ILM drape, and inner and outer cystic changes were detected in the right eye and inner and outer cystic changes were detected in the left eye via OCT. FFA showed telangiectasis and FOF imaging showed hyperautofluoresence in both eyes. In the light of these findings the patients were assessed as type 2 JFT and taken under observation. JFTs, despite having been described as telangiectasis, are a heterogeneous group of disorders. Type 1 JFT consists of real telangiectatic changes, type 2 JFT represents foveal atrophy, and type 3 remains with foveal ischemia. As in these patients, appropriate examination and differential diagnosis by using imaging techniques can differentiate JFT from other macular diseases and will help us to avoid unnecessary treatment. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy and results of photodynamic therapy (PDT) in the treatment of chronic central serous chorioretinopathy (CSC) which persists longer than six months. Material and Methods: Fifteen eyes of 14 patients with subfoveal fluid which persisted longer than 6 months were included in the study. Visual acuities and contrast sensitivities of the patients were measured before and after the treatment. Infrared fundus photographies, fundus fluorescein and indocyanine green angiographies were performed. Central macular thickness and macular volume values were obtained with optical coherence tomography. Results: The mean age of the patients was 49±6.3 years. Mean follow-up period was 15.3±13.6 months. Visual acuity (VA) increased more than 2 lines in 12 (80%) eyes after PDT. Visual acuity decreased 1 line in 1 (6.6%) eye; remained unchanged in 1 (6.6%) eye and increased 1 line in 1 (6.6%) eye. The mean contrast sensitivity did not change significantly after PDT. A statistically significant decrease in the mean central macular thickness and total macular volume was observed after the treatment compared to pretreatment (p=0.001). Eleven (73.3%) eyes had complete resolution and 4 (26.7%) eyes had partial resolution of subretinal fluid in OCT. No complication was observed due to PDT. Conclusion: Photodynamic therapy reduced subretinal fluid and improved visual acuity in patients with chronic CSC of longer than six moths duration. Photodynamic therapy was considered as a safe and effective method in the treatment of chronic CSC. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the incidence and related factors of retinopathy of prematurity (ROP) in low-birth-weight infants screened in neonatal intensive care units. Materials and Methods: Medical records of 150 infants who had a gestational age of less than 35 weeks, or 35 to 37 weeks with a low-birth-weight between January 2005-October 2006 were reviewed. Gestational age, birth weight, phototherapy, oxygen therapy, blood transfusion and other pathologies were recorded. ROP were graded due to International Classification of Retinopathy of Prematurity (ICROP). Results: Mean gestational age of the infants in this study was 30.5±2.6 (26-37) weeks, and mean birth weight was 1226±283 (700- 2200) grams. Postnatal fundus examination was done at postnatal 4 weeks. Follow-up was 1 week apart with a mean number of 4 (2-9). At follow-up, various grades (grade 1 to 3) of ROP was detected in 46.7% of 150 infants. High risk, prethreshold ROP (Type 1) was detected in 37 (24.7%) infants and referred to another clinic for treatment. Type 1 ROP was found to have a statistically significant relationship between gestational age (p<0.001), and birth-weight (p<0.001). Discussion: Low-birth-weight and gestational age were found to be related for develeping high risk pretreshold ROP. Screening of all premature infants in neonatal intensive care units and early referral of infants at risk to the limited number of clinics is extremely important for preventing blindness in our country. [ABSTRACT FROM AUTHOR]