Turkish Journal of Ophthalmology最新文献

{"title":"Real-Life Effectiveness and Safety of Selective Laser Trabeculoplasty as Primary, Adjunctive, and Substitutive Therapy.","authors":"David Oliver-Gutierrez, Osvaldo Guevara-Chavarría, Shirin Djavanmardi, Gloria Segura-Duch, Marta Castany, Stefania Piludu, Carlos A Arciniegas-Perasso, Elena Ávila, Elena Milla, Susana Duch","doi":"10.4274/tjo.galenos.2025.75570","DOIUrl":"10.4274/tjo.galenos.2025.75570","url":null,"abstract":"<p><strong>Objectives: </strong>To assess real-world outcomes of selective laser trabeculoplasty (SLT) in naive patients compared to SLT as adjunctive treatment (AT), investigating SLT's intraocular pressure (IOP) reduction and its potential to decrease topical medication.</p><p><strong>Materials and methods: </strong>Patients undergoing SLT with no prior glaucoma surgery or laser treatment were grouped based on the intended objective: SLT as primary treatment (PT), SLT as AT, and SLT as substitutive treatment (ST). Survival in the PT and AT groups was defined as ≥20% IOP reduction from baseline and IOP ≤21 on two consecutive visits with the same or fewer medications and no additional glaucoma procedure, including repeat SLT. Survival in the ST group was defined as decreasing topical medication while maintaining or reducing IOP.</p><p><strong>Results: </strong>The study included 120 eyes of 120 patients with a mean follow-up of 32.7 months. The PT group showed superior IOP reduction than the AT group at 24-36 months (22.1% vs. 14.5%, p=0.039). Non-responders comprised 28.6% of the PT group and 37.0% of the AT group. The PT group demonstrated better survival rates than the AT group at 12, 24, and 36 months (69.0% vs. 47.1%, 38.8% vs. 31.4%, and 31.1% vs. 23.5%, respectively). In the ST group, 34.2% of patients were successful at 12 months, increasing to 38.3% at 24 months. At 24 months, 50.0% of patients had reduced at least one medication.</p><p><strong>Conclusion: </strong>SLT showed two-thirds effectiveness, with one-third being non-responders. It was more effective as PT, with higher IOP reduction and success rates. SLT reduced topical medication in half of patients.</p>","PeriodicalId":23373,"journal":{"name":"Turkish Journal of Ophthalmology","volume":"55 3","pages":"132-140"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12192229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ab Interno Goniotomy/Goniectomy Techniques","authors":"Zeynep Aktaş, Syril Dorairaj, Mohamed Sayed, Arsham Sheybani, Ahmet Yücel Üçgül, Isabella Wagner, Mohamed Khodeiry","doi":"10.4274/tjo.galenos.2025.29345","DOIUrl":"10.4274/tjo.galenos.2025.29345","url":null,"abstract":"<p><p>Minimally invasive glaucoma surgeries (MIGS), such as Kahook Dual Blade (KDB), bent ab interno needle goniectomy (BANG), gonioscopy-assisted transluminal trabeculotomy (GATT), OMNI, Trabectome, Streamline, and TrabEx+, have significantly advanced the treatment of glaucoma by improving aqueous humor outflow and reducing intraocular pressure (IOP). These innovative procedures target the trabecular meshwork (TM) and Schlemm’s canal, offering effective alternatives to more invasive filtration surgeries. By enhancing the natural drainage pathways, MIGS can achieve notable reductions in IOP and minimize the need for long-term glaucoma medications. Each device has a distinct mechanism of action. The KDB excises a strip of TM, while BANG uses a bent hypodermic needle for controlled goniectomy. GATT performs a 360-degree trabeculotomy using a microcatheter or Prolene (polypropylene) suture to open Schlemm’s canal. OMNI combines canaloplasty and trabeculotomy in a single procedure. The Trabectome ablates TM tissue with electrical energy, whereas Streamline performs viscodilation to expand outflow channels. TrabEx+ facilitates goniectomy with integrated irrigation and aspiration. Clinical studies have shown these MIGS techniques to be both safe and effective, with fewer complications compared to traditional surgeries like trabeculectomy or tube shunt implantation. MIGS procedures are particularly appealing due to their reduced recovery time and lower risk profile. However, further research is essential to establish their long-term efficacy and durability. Continued advancements and comprehensive long-term studies will ensure that MIGS provide sustainable and reliable benefits for glaucoma patients, optimizing treatment strategies in clinical practice.</p>","PeriodicalId":23373,"journal":{"name":"Turkish Journal of Ophthalmology","volume":" ","pages":"159-170"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12192231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Automated vs. Expert-Designed Machine Learning Models in Age-Related Macular Degeneration Detection and Classification.","authors":"Ceren Durmaz Engin, Ufuk Beşenk, Denizcan Özizmirliler, Mustafa Alper Selver","doi":"10.4274/tjo.galenos.2025.74780","DOIUrl":"10.4274/tjo.galenos.2025.74780","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the effectiveness of expert-designed machine learning models and code-free automated machine learning (AutoML) models in classifying optical coherence tomography (OCT) images for detecting age-related macular degeneration (AMD) and distinguishing between its dry and wet forms.</p><p><strong>Materials and methods: </strong>Custom models were developed by an artificial intelligence expert using the EfficientNet V2 architecture, while AutoML models were created by an ophthalmologist utilizing LobeAI with transfer learning via ResNet-50 V2. Both models were designed to differentiate normal OCT images from AMD and to also distinguish between dry and wet AMD. The models were trained and tested using an 80:20 split, with each diagnostic group containing 500 OCT images. Performance metrics, including sensitivity, specificity, accuracy, and F1 scores, were calculated and compared.</p><p><strong>Results: </strong>The expert-designed model achieved an overall accuracy of 99.67% for classifying all images, with F1 scores of 0.99 or higher across all binary class comparisons. In contrast, the AutoML model achieved an overall accuracy of 89.00%, with F1 scores ranging from 0.86 to 0.90 in binary comparisons. Notably lower recall was observed for dry AMD vs. normal (0.85) in the AutoML model, indicating challenges in correctly identifying dry AMD.</p><p><strong>Conclusion: </strong>While the AutoML models demonstrated acceptable performance in identifying and classifying AMD cases, the expert-designed models significantly outperformed them. The use of advanced neural network architectures and rigorous optimization in the expert-developed models underscores the continued necessity of expert involvement in the development of high-precision diagnostic tools for medical image classification.</p>","PeriodicalId":23373,"journal":{"name":"Turkish Journal of Ophthalmology","volume":"55 3","pages":"120-126"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12192190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of 20% Autologous Platelet-Rich Plasma Versus Conventional Treatment in Moderate to Severe Dry Eye Patients.","authors":"Shubhi Sachan, Kshama Dwivedi, Satya Prakash Singh, Santosh Kumar, Vinod Kumar Singh","doi":"10.4274/tjo.galenos.2025.47717","DOIUrl":"10.4274/tjo.galenos.2025.47717","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effectiveness of conventional therapy and 20% autologous platelet-rich plasma (aPRP) eye drops for moderate to severe dry eye disease (DED).</p><p><strong>Materials and methods: </strong>In this prospective interventional study, 40 individuals (80 eyes) with moderate to severe DED were analyzed. Twenty patients each were randomly assigned to the study and control groups. The study group was given 20% aPRP eye drops; the control group was given artificial tears as per conventional treatment. Comprehensive eye examinations including evaluation of best corrected visual acuity (BCVA), tear meniscus height, tear break-up time (TBUT), Schirmer's test, corneal fluorescein staining, conjunctival impression cytology, and Ocular Surface Disease Index (OSDI) were conducted in both groups for 3 months. Pre- and posttreatment results were compared.</p><p><strong>Results: </strong>The average age of patients in the study group was 51±14 years (range, 37-65 years), whereas that of the control group was 50±17 years (range, 33-67 years). After 3 months, there was a more significant decrease in OSDI score in the study group than in the control group (p<0.01). The BCVA data demonstrated no statistically significant difference (p>0.05). Measurements of tear meniscus height, Schirmer's value, and TBUT at 3 months showed statistically significant differences (p<0.01). The posttreatment improvements in fluorescein staining and impression cytology scores in the study group were markedly superior to those in the control group (p<0.01).</p><p><strong>Conclusion: </strong>aPRP is both safe and more effective than conventional treatments for moderate to severe symptomatic DED.</p>","PeriodicalId":23373,"journal":{"name":"Turkish Journal of Ophthalmology","volume":"55 3","pages":"112-119"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12192197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gonioscopy-Assisted Transluminal Trabeculotomy versus Bent Ab Interno Needle Goniectomy in Patients with Open-Angle Glaucoma.","authors":"Ahmet Yücel Üçgül, Rukiye Kılıç Üçgül, Zeynep Aktaş","doi":"10.4274/tjo.galenos.2025.44773","DOIUrl":"10.4274/tjo.galenos.2025.44773","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) and bent ab interno needle goniectomy (BANG) in patients with open-angle glaucoma (OAG).</p><p><strong>Materials and methods: </strong>This retrospective comparative study included 65 eyes diagnosed with OAG that underwent GATT (34 eyes) or BANG (31 eyes). Intraocular pressure (IOP) was measured using Goldmann applanation tonometry at baseline and during follow-up visits. Success was categorized as qualified (IOP ≤21 mmHg with ≥20% reduction) and complete (same criteria without medication). Complications and the need for further surgery were recorded.</p><p><strong>Results: </strong>Preoperative mean IOP was 32.9±6.1 mmHg for GATT and 31.8±5.4 mmHg for BANG. At the final visit, mean IOP was reduced to 15.8±4.5 mmHg in the GATT group (51.9% reduction) and 17.9±5.7 mmHg in the BANG group (43.7% reduction). The complete success rate was 88.2% for GATT and 61.3% for BANG. Early failures were more frequent in BANG, while GATT showed fewer but later failures. Both procedures had minimal complications, with transient hyphema being the most common.</p><p><strong>Conclusion: </strong>In this study, GATT provided greater and more sustained IOP reduction and higher long-term success rates compared to BANG, making it a more reliable option for managing OAG.</p>","PeriodicalId":23373,"journal":{"name":"Turkish Journal of Ophthalmology","volume":"55 3","pages":"141-147"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12192189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Binocular Approaches in Amblyopia Treatment Based on Dichoptic Stimulation","authors":"Demet Yabanoğlu, Hande Taylan Şekeroğlu","doi":"10.4274/tjo.galenos.2025.06626","DOIUrl":"10.4274/tjo.galenos.2025.06626","url":null,"abstract":"<p><p>The discovery that binocular dysfunction may play a critical role in the development of amblyopia has led to the development of a novel approach based on contrast-rebalanced binocular stimulation of both eyes. This approach, known as dichoptic stimulation, enables the treatment of amblyopia by facilitating the cooperation of both eyes. Dichoptic treatment approaches are founded on the theoretical premise that binocular imbalance plays a significant role in both monocular and binocular impairments in amblyopia, and that preserving binocular function capacity is essential. Therefore, these approaches are designed to promote the collaborative functioning of the eyes, enhance stereopsis, and improve binocular fusion. This review systematically examines and synthesizes the existing literature on dichoptic stimulation techniques aimed at improving binocular function in the treatment of amblyopia. Based on various studies in the literature, the fundamental principles of these treatment methods are outlined, and the results obtained in comparison to traditional monocular treatments are highlighted. The clinical efficacy of dichoptic treatment methods is evaluated in terms of their contribution to enhancing binocular function in amblyopia. Additionally, information is provided regarding the outcomes, treatment durations, efficacy levels, and potential side effects of these treatment approaches in different patient groups. This review offers a comprehensive assessment of the integration of dichoptic treatment approaches into clinical practice, highlighting both their advantages and disadvantages, and aims to provide a guiding perspective on their future use.</p>","PeriodicalId":23373,"journal":{"name":"Turkish Journal of Ophthalmology","volume":" ","pages":"148-158"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12192222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pattern of RNFL Damage in Early- and Late-Stage Primary Open-Angle Glaucoma Using the Disc Damage Likelihood Scale and Optical Coherence Tomography.","authors":"Noor UlAin, Rehan Moinuddin Shaikh, Tayyaba Gul Malik","doi":"10.4274/tjo.galenos.2025.88834","DOIUrl":"10.4274/tjo.galenos.2025.88834","url":null,"abstract":"<p><strong>Objectives: </strong>To determine patterns of peripapillary retinal nerve fiber layer (RNFL) damage in early- and late-stage glaucoma based on the Disc Damage Likelihood Scale (DDLS).</p><p><strong>Materials and methods: </strong>This cross-sectional, multi-center study involved 267 eyes of 135 patients aged 18 years or older with suspected or diagnosed glaucoma. Exclusion criteria were high refractive errors, media opacities, trauma history, and systemic conditions affecting the optic disc. After a comprehensive ocular examination, the DDLS was used for glaucoma staging. Disease severity was classified into three zones: green, orange, and red. RNFL thickness was measured in four quadrants using optical coherence tomography. Patterns of RNFL damage were analyzed, especially in terms of the ISNT (inferior>superior>nasal>temporal) rule, and compared between the three groups.</p><p><strong>Results: </strong>The male-to-female ratio was 1.59:1 and the mean age was 45.12±15.76 years. There were statistically significant differences among the groups for average, inferior, superior, and temporal RNFL thickness (p<0.00001). However, the difference in nasal RNFL was insignificant. The ISNT rule was the commonest pattern in the study participants (64.4%) and progressive loss of pattern was observed with increased disease severity.</p><p><strong>Conclusion: </strong>This study revealed an association between disease severity and RNFL thinning in the inferior, superior, and temporal quadrants, while nasal RNFL showed no significant association with disease severity. The ISNT rule was more frequently observed in the early stages and diminished with advanced glaucoma. These results highlight RNFL thinning based on the DDLS as an important marker for glaucoma monitoring.</p>","PeriodicalId":23373,"journal":{"name":"Turkish Journal of Ophthalmology","volume":"55 3","pages":"127-133"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12192247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ptosis Repair by \"PEANUTS\" MMCR: \"Pelin's Easy and Needle Up To Stretch\" Müller's Muscle Conjunctival Resection Without the Putterman Clamp.","authors":"Pelin Kaynak, Gözde Derin Şengün, Can Öztürker, Eda Akgöz","doi":"10.4274/tjo.galenos.2025.61697","DOIUrl":"10.4274/tjo.galenos.2025.61697","url":null,"abstract":"","PeriodicalId":23373,"journal":{"name":"Turkish Journal of Ophthalmology","volume":"55 3","pages":"174-176"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12192220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Promising Outcome of the Augmented Modified Hummelsheim Procedure in a Challenging Case of Inferior Rectus Hypoplasia.","authors":"Florentina Priscilia, Anna Puspitasari Bani","doi":"10.4274/tjo.galenos.2025.46735","DOIUrl":"10.4274/tjo.galenos.2025.46735","url":null,"abstract":"","PeriodicalId":23373,"journal":{"name":"Turkish Journal of Ophthalmology","volume":"55 3","pages":"171-173"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12192200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microvascular and Ultrastructural Changes of the Retina and Choroid in Patients with Sickle Cell Anemia.","authors":"Oğuzhan Oruz, Süheyl Asma, Aysel Pelit, Çiğdem Gereklioğlu, Selçuk Sızmaz, Astan İbayev, Handan Canan, Osman Şahin, Mutlu Kasar, Can Boğa, Caner İncekaş","doi":"10.4274/tjo.galenos.2025.97792","DOIUrl":"https://doi.org/10.4274/tjo.galenos.2025.97792","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the microvascular changes of the retina and choroid in sickle cell anemia (SCA) patients and to investigate the relationship between the severity of sickle cell retinopathy and sickle cell maculopathy (SCM).</p><p><strong>Materials and methods: </strong>In this cross-sectional study, 78 eyes of 39 patients with SCA were included in the patient group and 68 eyes of 34 healthy participants were included in the control group. Differences in foveal avascular zone (FAZ), retinal and subfoveal choroidal thickness (SFCT), and choroidal vascularity index (CVI) between the patient group and the control group were evaluated by swept source optical coherence tomography (OCT) and OCT angiography (OCTA) imaging. In addition, systemic and biological parameters were compared in patients with and without SCM.</p><p><strong>Results: </strong>SCM was detected in 16 eyes of 8 patients. Proliferative sickle cell retinopathy (PSCR) was present in 10 patients. In logistic regression analysis, PSCR was found to be a risk factor for the development of SCM (p=0.015, odds ratio: 17.25, 95% confidence interval: 1.73-172.02). The temporal inner retinal layers were significantly thinner in the patient group compared to the control group. The patient group also exhibited significantly greater FAZ enlargement in both the superficial and deep capillary plexus when compared with the control group (p<0.001 for both). CVI was higher in the control group than in the patient group (p<0.001). SFCT was significantly thinner in the patient group (p=0.013). There was no significant difference between patients with and without SCM in terms of FAZ enlargement, CVI values, or systemic and biological factors.</p><p><strong>Conclusion: </strong>In our study, PSCR was found to be a risk factor for the development of SCM. OCT and OCTA provide valuable information about microvascular changes in the retina and choroid in patients with SCM. Structural changes demonstrated by OCTA before the development of SCM are very important for follow-up and treatment in terms of visual prognosis of patients.</p>","PeriodicalId":23373,"journal":{"name":"Turkish Journal of Ophthalmology","volume":"55 2","pages":"74-81"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}