PURPOSE: In patients with retinal vein occlusion (RVO), the presence of pearl necklace sign is often overlooked; however, this sign should be sought among optical coherence tomography (OCT) findings. Our aim is to evaluate retrospectively the presence of pearl necklace sign and other OCT (findings in patients with RVO at their first visit. Furthermore, to reveal any association between pearl necklace sign and other OCT findings.
METHODS: In this retrospective cross-sectional study, OCT features of the patients with RVO who were examined between 2009 and 2019 were analyzed. Only the OCT findings at the first visit were taken into consideration. Both treatment-naïve patients and patients previously treated elsewhere were included in the study. OCT findings, particularly the pearl necklace sign (circular localization of the hyperreflective dots (HRDs) around the inner retinal cyst wall or the sensory retinal detach-ment wall) were looked for.
RESULTS: The study population was 100 eyes of 100 patients with RVO. The pearl necklace sign was found in 20 of 100 eyes with RVO (20%). The presence of the pearl necklace sign and serous retinal detachment had a statistically significant con-nection (P = 0.026). Moreover, the pearl necklace sign group was shown to have statistically higher HRDs than the other groups (P = 0.002).
CONCLUSION: Even though the common OCT findings were meticulously elaborated in many of the previous studies, pearl necklace sign has not been particularly looked for in eyes with RVO. Overall, pearl necklace sign was present in 20% of 100 patients with RVO in this single-visit OCT study. This ratio makes us think that the pearl necklace sign actually accompanies RVO more often than previously thought.

PURPOSE: To investigate the effect of the therapeutic doses of bevacizumab, recombinant humanized anti-vascular endothe-lial growth factor monoclonal antibody, on the silicone oil (SiO) using nuclear magnetic resonance (NMR) and Fourier trans-form infrared (FT-IR) spectroscopies.
METHODS: Freshly opened 1000-centistoke SiO (polydimethylsiloxane, Micromed s.r.l. Fonte Nuova, Italy) was mixed with three different therapeutic doses of bevacizumab/Avastin (US Biotech unit of Roche Registration GmbH, Grenzach-Wyhlen, Germany), respectively as 1.25 mg/0.05 mL, 2.5 mg/0.1 mL, and 5 mg/0.2 mL. Coupled spectroscopic methods were em-ployed to determine potential chemical shifts in the SiO: In the proton hydrogen-1 NMR (1H-NMR) spectroscopy, the internal standard and the solvent were tetramethylsilane and chloroform, respectively. The 1H spectrum was recorded at a frequency of 500 MHz. In the FT-IR spectroscopy, the attenuated total reflectance method was used for sampling, and spectral band-width was 4000 to 400 cm-1 at 4 cm-1 resolution.
RESULTS: 1H-NMR spectroscopy revealed a minor change in the functional groups of SiO after the interaction of the dose of Avastin at 1.25 mg/0.05 mL with no chemical shifts. In contrast, the high therapeutic doses caused remarkable changes in the Si-CH3 functional groups. FT-IR spectroscopy identified decreasing the absorption peaks intensity of Si-O-Si bending at 1008 cm-1 in the high therapeutic doses. The spectral findings showed the breakdown potential of the SiO due to hydrolytic degradation in the aqueous environment of Avastin (at 2.5 mg/0.1 mL, and 5 mg/0.2 mL doses).
CONCLUSION: SiO could undergo structural change due to the interaction of aqueous Avastin, especially at high-therapeutic doses. In case of Avastin® is required, the quantity of 1.25 mg/0.05 mL of Avastin should be used in SiO-filled eyes to minimize its unknown chemical effect.

PURPOSE: The objective is to determine the effect of ectopic inner foveal layer (EIFL) thickness on preoperative and postoper-ative best-corrected visual acuity (BCVA) and metamorphopsia scores in stage 3 epiretinal membranes (ERM).
METHODS: Thirty eyes of 28 patients were included in the study. All patients underwent uncomplicated vitrectomy and membrane peeling. EIFL, central foveal thickness (CFT), outer nuclear layer (ONL), inner nuclear layer (INL), inner plexiform layer (IPL) thicknesses were measured preoperatively and postoperatively at 3 months using Spectralis spectral-domain optical cohorence tomography. Horizontal line (MH) and vertical line (MV) metamorphopsia scores were calculated using M-CHARTS. Postoperative changes in OCT parameters and visual functions and the correlations between them were analyzed.
RESULTS: EIFL thickness, ONL thickness, and CFT were 143.1 ± 19.1 μm, 189.3 ± 48 μm, and 431.7 ± 58 μm preoperatively, respectively. In the postoperative 3rd month, they were 131.2 ± 17.3 μm, 163.5 ± 45.1 μm, and 388.2 ± 52.6 μm (P = 0.004, P = 0.001, P = 0.001 respectively). BCVA (logMAR: Logarithm of the minimal angle of resolution), MH, and MV scores at the postoperative 3rd month were significantly lower than their preoperative values (P < 0.001 in all three). Preoperative CFT was found to be correlated with preoperative MH and MV (P = 0.031, P = 0.02, respectively). Preoperative ONL thickness was correlated with MH and MV scores (P = 0.049, P = 0.014, respectively). Preoperative INL thickness was only positively correlated with the MH score (P = 0.004). There was no correlation between preoperative - postoperative OCT parameters and postoperative visual functions.
CONCLUSION: EIFL thickness had no effect on metamorphopsia and BCVA in stage 3 ERM patients. It was thought that the formation of metamorphopsia in these patients might be due to changes in the outer retinal layers.

PURPOSE: The study aims to determine the opinions of ophthalmologists about the use of telemedicine applications in the field of ophthalmology.
METHODS: A standardized questionnaire consisting of 20 questions about demographic information and the use of telemedicine applications in ophthalmology was sent electronically to 110 ophthalmologists. The physicians were asked to answer the questionnaire, and the data were analyzed.
RESULTS: Of the 110 physicians who received the questionnaire, 87 answered all the questions in the questionnaire, and the results were evaluated based on the answers of 87 physicians. Only 9 (11%) of the physicians stated that they had sufficient knowledge about telemedicine, and it was observed that all of these physicians were between the ages of 24–34. Fifty-eight (67%) of the physicians stated that telemedicine applications could be used, and 60 (69%) stated that the patients would also benefit from these applications. It has been observed that the rate of physicians who think that the patient-physician re-lationship will be affected by these practices is only 29 (33%). Sixty-two (74%) of the physicians stated that the telemedicine services to be provided through voice communication and video transmission in the field of ophthalmology would be insufficient, and they stated that video conversation would be appropriate.
CONCLUSION: The necessity of keeping up with the speed of technology development in health services will include telemedicine applications more in our lives. As a result of our study, we can predict that ophthalmologists will support this field if deficiencies are eliminated, and medicolegal regulations are made.

PURPOSE: The aim of this study was to investigate the effect of obesity on various ocular examination parameters in a com-parative analysis between normal-weight and obese adul
METHODS: Thirty-two normal-weight and 64 obese adults were included in the study. Detailed ophthalmologic examination, in-cluding intraocular pressure (IOP), central corneal thickness (CCT), keratometry, anterior chamber depth (ACD), lens thickness (LT), and axial length (AL) by A-mode ocular ultrasonography; and macular and retinal nerve fiber layer thickness (RNFL) by spectral domain optical coherence tomography were compared between normal-weight and obese adults. Obese individuals were fur-ther stratified into Class I-II and Class III obesity categories, and the ocular parameters were compared between these three groups.
RESULTS: IOP was significantly higher in the obese group than in the healthy controls (16.7±2.4 vs. 15.1±2.2 mmHg, p=0.002), whereas CCT, keratometry values, ACD, LT, AL, and RNFL thicknesses did not differ between the groups. The mean retinal thicknesses in the inner retinal ring (3 mm) at superior (p=010), nasal (p=0.04), and temporal (p=0.002) quadrants were lower in the class III obese group compared to class I obese individuals. ACD was significantly narrower in class III obese group (p=0.01). Body mass index was significantly correlated with IOP (p<0.001).
CONCLUSION: Obesity is associated with elevated IOP and signs of retinopathy. An increase in the severity of obesity was found to be associated with a decrease in macular thickness and a narrowing of the anterior chamber.

PURPOSE: The purpose of the study is to determine how male and female authors are represented in academic ophthalmol-ogy publications in Turkey, as well as how publishing types have evolved over time.
METHODS: Online available Turkish articles (6416 articles from 40 journals) published by the Scientific and Technological Research Council of Turkiye, Turkish Academic and Information Center, between 1995 and 2022 were retrospectively assessed. The following parameters were retrieved and recorded: Article type, publication year, gender of the first and last author, gender of the corresponding author, and total female and male authors.
RESULTS: The publications were grouped over a 5-year period, from 1995 to 2022, and there was a statistically significant rise in female authors per publication over time (P = 0.023). The majority of publications were research articles (75%), followed by case reports (18.3%) and reviews (3.1%). Gender disparities in publication types were statistically non-significant (P > 0.005). Compared to males, females made up 42.6% and 34.2% of the first and last authors, respectively. Moreover, 42.4% of the corresponding authors were female.
CONCLUSION: Gender imbalance appears to be diminishing among Turkish Ophthalmology academics, and a surge in female academic productivity is encouraging.

PURPOSE: To present the surgical options and surgical outcomes of juvenile open-angle glaucoma (JOAG).


METHODS: A retrospective review of the case series with JOAG that had undergone surgical treatment was undertaken. Sur-gical techniques, patient characteristics, and surgical outcomes were analyzed.
RESULTS: Thirteen eyes from eight patients with the diagnosis of JOAG were included in the study. The mean age was 26.77 ± 9.83 years. Five (62.5%) of the patients were male. The distribution of the operations was as follows: deep sclerectomy and external suture trabeculotomy in one eye (8%); Ahmed glaucoma valve implantation in one eye (8%); trabeculectomy with antimetabolite augmentation in five eyes (38%); and gonioscopy-assisted transluminal trabeculotomy (GATT) in six eyes (46%). The preoperative mean intraocular pressure (IOP) was 27.62 ± 7.17 mmHg, which decreased to 17.62 ± 13.06 mmHg at the last follow-up visit (36.21% decrease, P = 0.023, Wilcoxon rank test). IOP control was achieved without any additional surgical intervention in 10 (76.9%) eyes over the mean of 15.62 ± 12.17 months of the follow-up period. Further glaucoma surgery was required in three eyes, of which two had undergone GATT and one had undergone trabeculectomy as the primary surgery.
CONCLUSION: The surgical treatment of JOAG results in IOP reduction, and more than one surgery may be required in some cases.

PURPOSE: The aim of the study was to evaluate and compare the effectiveness of a single-session of 180° selective laser trabeculoplasty (SLT) as primary treatment in newly diagnosed cases with pseudoexfoliation glaucoma (PEG) and ocular hypertension (OHT).
METHODS: Thirty-six eyes of 36 PEG cases (PEG-group) and 32 eyes of 32 OHT cases (OHT-group) were included in the study. Intraocular pressure (IOP), central corneal thickness (CCT), and endothelial cell count (ECC) were noted at baseline and post-SLT 3rd month. IOP reduction and success rates were detected. Inter and intragroup comparisons were made.
RESULTS: At baseline, age and gender distributions of groups were similar (P > 0.05). Baseline IOP was 26.7 ± 1.6 in PEG-group and 27.2 ± 1.2 mmHg in OHT-group (P = 0.648). In both groups, there was a significant decrease in IOP at 3rd month com-pared to baseline (P < 0.001). IOP at 3rd month was 18.9 ± 1.1 in PEG-group and 19.6 ± 0.6 mmHg in OHT-group (P = 0.507). IOP reduction rate (29.2% vs. 27.9%, P = 0.807) and success rate (69.4% vs. 75%, P = 0.846) were similar in PEG-group and OHT-group. Baseline CCT was 541.4 ± 25.3 in PEG-group and 543.3 ± 22.1 µm in OHT-group (P = 0.581), while baseline ECC was 2496.5 ± 231.8 and 2512.3 ± 242.7 cells/mm2, respectively (P = 0.324). In groups, no significant change was detected in CCT and ECC values at 3rd month compared to baseline (P > 0.05). IOP, CCT, and ECC values of groups were similar at 3rd month (P > 0.05).
CONCLUSION: We found that single-session of 180° SLT was similarly effective in reducing the IOP in newly diagnosed PEG and OHT cases. We also detected that it was safe for cornea and could be used as primary treatment in newly diagnosed cases.

PURPOSE: The aim of this study is to evaluate the effectiveness of Teachable Machine (TM), a code-free web-based artificial intelligence (AI) platform, in the detection and classification of vitreomacular interface diseases (VMIDs) in optical coherence tomography (OCT) images.
METHODS: A dataset of 445 cross-sectional OCT images from patients with VMID, along with 200 images from healthy individ-uals, was retrospectively prepared at a tertiary health-care institution. The OCT images were categorized into three groups: Epiretinal membrane (ERM), macular hole (MH), and vitreomacular traction (VMT). Subsequently, a deep learning (DL) model for VMID classification was developed using TM, a code-free web-based AI platform. The model underwent training on 160 ERM, 96 MH, 100 VMT, and 160 normal images, followed by testing on 40 ERM, 25 VMT, 24 MH, and 40 normal images. Sensi-tivity, specificity, and receiver operating characteristic curve were calculated to evaluate the effectiveness of the developed model.
RESULTS: The DL model showed 100% sensitivity and specificity in detecting any VMID compared to normal eyes. For detecting VMT, TM had 100% sensitivity, 98.08% specificity, and an AUC of 0.99. In ERM detection, sensitivity and specificity were both 100%, with an AUC of 1.00. MH detection had 91.67% sensitivity, 100% specificity, and AUC of 0.958.
CONCLUSION: This study demonstrates that TM can be used with high efficiency in detecting and classifying VMID. TM appli-cation, which performs image classification with DL, can be considered an effective alternative, especially for physicians who do not have coding knowledge to develop AI models.

PURPOSE: At present, drug treatments are composing the majority of dry eye therapies. However, considering the side effects of drugs, there has been increasing interest in novel non-drug treatment options, and these new treatments have been researching ways of tear production. Therefore, we aimed to investigate the role of chewing gum on tear-meniscus param-eters and blinking rate with objective and quantitative methods.
METHODS: Sixty eyes of 30 healthy volunteers’ tear-meniscus height (TMH), tear-meniscus depth (TMD), and tear-menis-cus area (TMA) were acquired with anterior segment-optical coherence tomography. Tear-meniscus measurements were performed before and during chewing gum; at 15 and 30 min. Blinking rates were also recorded both before and during chewing gum for 5 min.
RESULTS: TMH, TMD, and TMA values at 15 and 30 min of chewing gum were significantly higher than those values before chewing gum (p<0.001). TMH, TMD, and TMA values at 15 min of chewing gum were similar to those values at 30 min of chewing gum (p>0.05). Blinking rate during chewing gum was significantly higher than that value before chewing gum (p<0.001).
CONCLUSION: To the best of our knowledge, this was the first study demonstrating that chewing gum increased tear-meniscus parameters and blinking rate at acute phase of chewing with objective, quantitative, and non-invasive methods. Chewing gum is cheap, sustainable, and easy to reach. In addition, it is not a drug, and there is no risk of drug-related side effects. According to our outcomes, we thought that chewing gum might improve dry eye-related complaints by increasing tear production and blinking rate.

PURPOSE: This study aimed to investigate tear tests and corneal parameters in individuals who wear face masks.
METHODS: A prospective study included 75 participants, all using surgical face masks due to new regulations during the COVID-19 pandemic. They were divided into groups according to the duration of face mask wear (<3 [Group 1], from 3 to 6 [Group 2], over 6 h/day [Group 3]). All participants underwent a detailed ophthalmological evaluation. The Schirmer test and tear break-up time (TBUT) scores were assessed. In addition, corneal parameters were measured using a Pentacam Scheimpflug camera.
RESULTS: The values of TBUT and Schirmer test scores were significantly lower in Group 3 than in Groups 1 and 2 (p<0.001 for all). There was a statistically significant difference between the groups in the pachymetric measurements at the pupil center (p<0.001), and the finest point was significantly less in Group 3 than in Groups 1 and 2 (p<0.001). The scores of the TBUT and Schirmer tests were significantly positively correlated with the pachymetric measurements (p<0.001 for all).
CONCLUSION: We have determined that the cornea is affected by individuals who wear face masks. To be protected from the undesirable effects of mask use, the exposed upper parts of the mask can be taped with a flexible tape, and artificial tears can be used prophylactically.

PURPOSE: The purpose of the study is to evaluate the relationship between medical supervisors and residents which is piv-otal for effective medical training programs. Deficiencies in resident performance can jeopardize patient care and trigger grievances from supervisors. This study delves into grievances expressed by medical supervisors against residents, identifying underlying performance deficiencies. Conducted at Lahore General Hospital, the research focuses on seven categories: Inadequate Clinical Skills and Knowledge, Unsatisfactory Humanistic Qualities and Professionalism, Quality of Medical Care, Professional Attitudes and Behaviors, Teamwork and Collaboration, Unexplained Absenteeism and Workload Management, and Attitude and Work Ethic.
METHODS: A 16-item questionnaire was administered to 24 supervisors (92.3% response rate) to gauge deficiencies. Promi-nent issues included deficient Professional Attitudes and Behaviors (91.7%), Clinical Skills and Knowledge (66.7%), and Humanistic Qualities and Professionalism (66.7%). Concerns were also noted regarding attitude and work ethic (58.35%), absenteeism and workload management (50.05%), teamwork and collaboration (50.05%), and quality of medical care (49.95%).
RESULTS: The study underscores the need for targeted interventions in training to rectify these deficiencies. Incorporating focused training modules could foster well-rounded skill development among residents while promoting teamwork and work ethic.
CONCLUSION: Addressing deficiencies identified in this study can cultivate patient-centered physicians and elevate medical training programs. However, the study’s single-institution focus and supervisor-centric perspective warrant further exploration involving resident feedback for comprehensive insights.

PURPOSE: This study aimed to evaluate the impact of clear corneal incisions on astigmatism in patients undergoing cataract surgery. The values of corneal astigmatism before and after surgery were compared, and the difference was analyzed.
METHODS: A total of 50 patients (50 eyes) with regular astigmatism who underwent phacoemulsification due to cataracts were included in this study. The patient’s pre-operative corneal astigmatism, keratometry values, and steep axis were cal-culated. The operation was performed by the same surgeon, and the phacoemulsification clear corneal incision was keratometrically placed on the steep axis. The results of the pre- and post-operative examinations of patients who underwent cataract surgery were retrospectively analyzed at the 1st month of astigmatism. The values of corneal astigmatism before and after surgery were compared, and the difference was examined.
RESULTS: The mean age of the patients was 67.9±6.7 years. Of them, 26 (52%) were women and 24 were men (48%). After surgery, the patient’s best-corrected visual acuity was 20/20. Furthermore, their mean keratometric steep axis was 108.6°±34.9°. It was observed that the patients’ pre- and post-operative corneal astigmatism were 1.24±0.7 diopter (D) and 0.83±0.58 D, respectively. When the values were compared, a difference of 0.41±0.25 D was observed, which was statistically significant (p<0.001). The mean pre-operative flat keratometry was 42.98±0.78 D, and the mean pre-operative steep keratometry was 44.24±0.78 D. On the other hand, the mean post-operative flat keratometry was 42.99±0.79 D, and the mean post-operative steep keratometry was 43.84±0.74 D.
CONCLUSION: Clear corneal incision during cataract surgery flattens the cornea in the meridian of the incision, which poten-tially lessens pre-existing astigmatism. This method can reduce glass dependence among patients in secondary hospitals with no available toric intraocular lenses.

PURPOSE: Antivascular endothelial growth factor (anti-VEGF) medications find extensive utilization in addressing diabetic macular edema (DME). In December 2018, the Social Security Institution of Türkiye introduced the requirement of a loading dose of bevacizumab and subsequent unresponsiveness criteria for the application of other intravitreal drugs in retinal diseases. The aim of this study is to perform a cost analysis of bevacizumab use in the loading dose for DME treatment com-pared to the use of aflibercept and ranibizumab.
METHODS: Patients diagnosed with DME between 2019 and 2022, who received three consecutive doses of bevacizumab at 4–6 week intervals, were included in the study. The prices of anti-VEGF drugs were calculated in US dollars (USD) by taking the average of prices for the respective years. The average prices for the bevacizumab vials were 178.28 USD, 153.12 USD, 149.08 USD, and 138.83 USD for the years 2019, 2020, 2021, and 2022, respectively.
RESULTS: A total of 671 eyes were included in the study. The mean age of the patients was 67.8±10.2 (range 42–86) years. The mean best-corrected visual acuity improved from 0.21±0.13 (range 0.05–0.4) before injections to 0.45±0.11 (range 0.2–0.7) after three doses. No cases of retinal tear/detachment or endophthalmitis were observed. The total cost of 2013 doses of bevacizumab administered intravitreally to 671 eyes was 322.894,50 USD. The cost would be 791,640.96 USD if ranibizumab was used and 800,491.53 USD if aflibercept was used.
CONCLUSION: In the study, it was determined that bevacizumab is more affordable than other anti-VEGF drugs in the treat-ment of DME. Health-care systems may prefer less costly drugs to use their resources more effectively. However, the final decision in drug selection should always be made by doctors based on effectiveness for the benefit of the patient.

Local and regional anesthesia are commonly employed methods in eye surgery, there are situations in which general anes-thesia becomes necessary. Some patients may decline local or regional anesthesia, be unable to maintain a steady position, or lie flat during the procedure. This is particularly pertinent for pediatric patients and individuals with allergies to local anesthetics, who may require general anesthesia. In all cases, meticulous patient preparation is paramount in eye surgery. A thorough evaluation is essential before administering anesthesia, with the choice of anesthesia method dependent on fac-tors such as the patient’s overall health, the specific surgical procedure, and the surgeon’s expertise. In this review, necessary anesthesia methods in ophthalmic surgeries and perioperative patient management will be discussed.