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Objectives: To compare the 36-month outcomes of trabeculectomy alone versus combined phacotrabeculectomy in patients with non-granulomatous uveitic glaucoma (UG), focusing on intraocular pressure (IOP) control, surgical success, and postoperative intervention requirements. Methods: In this retrospective cohort study, 62 eyes with medically uncontrolled non-granulomatous UG were included. Patients were divided into two groups: Group 1 underwent combined phacoemulsification and trabeculectomy, while Group 2 underwent trabeculectomy alone. Preoperative and postoperative IOP measurements were evaluated over 36 months. Surgical success was defined as IOP between 5 and 21 mmHg, without additional glaucoma procedures or significant vision loss. Postoperative complications, medication requirements, and needling rates were also assessed. Results: The mean follow-up period was 36 months. The cumulative surgical success rate was higher in the combined group (88.2%) than in the trabeculectomy-alone group (71.1%), although the difference was not statistically significant (p > 0.05). Needling was significantly more frequent in Group 2 (p < 0.05), and more patients in Group 2 required antiglaucomatous medications postoperatively. No significant differences in complication rates or visual outcomes were observed between the groups. Conclusion: Both surgical approaches provide effective IOP control in uveitic glaucoma; however, combined surgery may result in fewer postoperative interventions and a trend toward improved 36-month surgical success. Careful patient selection and inflammation control remain crucial in optimizing outcomes.

Keratoconus had traditionally been considered a rare disease at a time when the imaging technology was inept in detecting subtle manifestations, resulting in more severe disease at presentation. The increased demand for refractive surgery in recent years also made it essential to more effectively detect keratoconus before attempting any ablative procedure. Consequently, the armamentarium of tools that can be used to diagnose and treat keratoconus has significantly expanded. The advances in imaging technology have allowed clinicians and researchers alike to visualize the cornea layer by layer looking for any early changes that might be indicative of keratoconus. In addition to the conventional geometrical evaluation, efforts are also underway to enable spatially resolved corneal biomechanical evaluation. Artificial intelligence has been exploited in a multitude of ways to enhance diagnostic efficiency and to guide treatment. As for treatment, corneal cross-linking treatment remains the mainstay preventive approach, yet the current main focus of research is on increasing oxygen availability and developing new strategies to improve riboflavin permeability during the procedure. Some new combined protocols are being proposed to simultaneously halt keratoconus progression and correct refractive error. Bowman layer transplantation and additive keratoplasty are newly emerging alternatives to conventional keratoplasty techniques that are used in keratoconus surgery. Advances in tissue engineering and regenerative therapy might bring new perspectives for treatment at the cellular level and hence obviate the need for invasive surgeries. In this review, we describe the advances in the diagnosis and treatment of keratoconus primarily focusing on newly emerging approaches and strategies.

Amaç: İnvaziv meme kanseri, farklı biyolojik ve patolojik özellikleri olan, farklı klinik davranış, tedaviye yanıt ve sonuç ile karakterize heterojen bir hastalık grubudur. Spesifik neoplazilerin çoğunun nadir olması, optimal tedaviyi de tanımlamak için büyük veya randomize çalışmalara izin vermez. Biz de bu çalışmada kliniğimizde takip ve tedavi edilen nadir meme karsinomlarının klinik ve patolojik özelliklerini tedavi şekillerini ve sonuçlarını değerlendirmeyi amaçladık. Yöntemler: 2000-2016 yılları arasında merkezimize meme kanseri nedeniyle başvuran 1280 hastanın dosyası incelendi. Bu çalışmaya patolojik tanısı invaziv duktal karsinoma ve invaziv lobüler karsinoma olarak tanı konan hastalar dışındaki diğer nadir meme karsinomu alt tipine sahip tüm hastalar dahil edildi. Çalışmaya dahil edilen 73 hasta; yaş, menopozal durum, aile öyküsü, tümör-lenf nodu-metastaz evresi, histolojik grade’i, hormon reseptör düzeyi, HER2 ekspresyonu, uygulanan cerrahi şekli ve ortalama sağkalım (OS) süresi açısından retrospektif olarak analiz edildi. Bulgular: Sekiz histolojik tipte meme tümörü değerlendirildi. Gruplar arasında hastaların ortalama yaşları anlamlı farklı değildi. Histolojik tip olarak en yaşlı hastalar papiller grupta, en genç hastalar tübüler gruptaydı. Gruplar arasında ortalama tümör çapı belirgin olarak farklıydı (p=0,02). Tubüler ve müsinöz tip meme karsinomlarında hastaların ortalama yaşı literatürden daha gençti ve bu tümörlerde ortalama tümör çapı da daha büyüktü. İleri evrede tanı konan hasta oranı yüksekti (%43). En iyi prognozlu histolojik tipler müsinöz ve tubüler karsinom iken en kısa OS süresi primer meme sarkomu ve nöroendokrin karsinom grubundaydı. Sonuç: Nadir meme kanserleri, farklı davranış ve prognozları olan heterojen bir malignite grubudur. Sonuçlarımız bazı olgular haricinde diğer çalışmalardan elde edilen verilerle genellikle uyumluydu. Bu istisnalar ırk, bölgesel faktörler, farklı patolojik değerlendirme ve çevresel faktörlerle ilişkili olabilir. Bununla birlikte bu tümörlerin az görülmesinden dolayı kapsamlı klinik çalışmalara ihtiyaç vardır.

[LANGUAGE=”English”]ObjectivesThis study aimed to evaluate the long-term outcomes of limbal stem cell deficiency (LSCD) treated with various limbal stem cell transplantation (LSCT) techniques.Materials and MethodsThis retrospective study included 32 eyes of 29 patients who underwent LSCT. Clinical evaluation was performed based on preoperative and postoperative best corrected visual acuity (BCVA, logarithm of the minimum angle of resolution [logMAR]), degree of corneal neovascularization, extent of corneal involvement, and clarity of the central visual axis. Human leukocyte antigen (HLA) compatibility in allograft recipients was assessed via HLA tissue typing. The Kruskal-Wallis and Wilcoxon tests were used to compare variables between groups.ResultsA total of 84.4% (n=27) of the eyes had LSCD secondary to chemical injury. Median preoperative and postoperative BCVA (logMAR) values were 2.1 and 1.8 (p=0.01) in the conjunctival limbal allograft (CLAL) group (n=22; 18 living-related, 4 deceased donors), 0.9 and 0.7 (p=0.11) in the conjunctival limbal autograft (CLAU) group (n=4), and 2.1 and 1.3 (p=0.04) in the simple limbal epithelial transplantation (SLET) group (n=6; 3 autografts, 3 allografts), respectively. There was no statistically significant difference in BCVA improvement between groups. Median clinical scores improved from 10 to 6 in the CLAL group (p<0.001), from 7 to 4 in the CLAU group (p=0.11), and from 10 to 3 in the SLET group (p=0.03). Preoperatively, a statistically significant difference in clinical scores was observed only between the CLAU and SLET groups (p=0.029); however, no significant difference was found between groups postoperatively. HLA compatibility was 75% in 15 eyes that received living-related CLAL, and 100% in all 3 eyes that underwent allogeneic SLET.ConclusionDifferent LSCT techniques may be applied in LSCD depending on the underlying etiology and extent of involvement. Favorable outcomes can also be achieved with allogeneic approaches when HLA compatibility is ensured.[LANGUAGE=”Turkish”]AmaçFarklı limbal kök hücre transplantasyon (LKHT) cerrahisi uygulanan limbal kök hücre yetmezlikli (LKHY) olguların uzun dönem klinik sonuçlarını değerlendirmek.Gereç ve YöntemLKHT yapılan 29 hastanın 32 gözü retrospektif olarak değerlendirildi. Tüm hastaların ameliyat öncesi ve sonrası en iyi düzeltilmiş görme keskinliği (minimum rezolüsyon açısı logaritması [logMAR]), korneanın vaskülarizasyon derecesi, kornea tutulum alanı ve merkezi görme ekseninin şeffaflığına bakılarak klinik skorlaması yapıldı. Allogreft nakil olgularında alıcı-donör insan lökosit antijeni (HLA) uyumu değerlendirildi. İstatistiksel analiz olarak gruplar arası değişkenleri karşılaştırmada Kruskal-Wallis ve Wilcoxon testleri kullanıldı.BulgularGözlerin %84,4’ünde (n=27) kimyasal yaralanmaya bağlı LKHY vardı. Cerrahi öncesi ve sonrası ortanca görme keskinliği değerleri konjonktival limbal allogreft (KLAL, n=22, 18’i canlı, 4’ü kadaverik) için 2,1 ve 1,8 logMAR (p=0,01), konjonktival limbal otogreft (KLO, n=4) için 0,9 ve 0,7 logMAR (p=0,11), ve basit limbal epitelyal transplantasyon (BLET, n=6, 3’ü otogreft, 3’ü allogreft) için 2,1 ve 1,3 logMAR (p=0,04) idi. Gruplar arasında cerrahi öncesi ve sonrası görme keskinliklerinde anlamlı bir farklılık yoktu. Ortanca klinik skorların; KLAL grubunda 10’dan 6’ya (p<0,001), KLO grubunda 7’den 4’e (p=0,11) ve BLET grubunda 10’dan 3’e (p=0,03) gerilediği izlendi. Klinik skorlamada cerrahi öncesi sadece KLO ve BLET grubu arasında anlamlı farklılık (p=0,029) mevcutken; cerrahi sonrası gruplar arasında anlamlı bir farklılık saptanmadı. HLA uyumu canlı KLAL uygulanan 15 gözde %75 iken, allogreft BLET uygulanmış 3 gözde %100 idi.SonuçLKHY’de etiyolojiye ve korneal tutuluma bağlı olarak farklı LKHT teknikleri uygulanabilmektedir. HLA doku uyumunun olduğu allojenik kök hücre uygulamalarında da başarılı sonuçlar elde edilmektedir.

Çin’in 21. yüzyıldaki en büyük altyapı yatırım girişimi olan Kuşak ve Yol Girişimi (KYG), Çin devlet kapitalizmi modelinin uluslararasında bir yatırım modeline dönüştürülmesinin ilk nüvesidir. Girişimin devlet-destekli yatırım girişimi olarak adlandırılmasına yol açan en önemli sebep, girişimdeki projelerin finansmanının Çin devlet ticari ve politika bankaları ve ulusal varlık fonları tarafından sağlanmasıdır. Fakat altyapı finansmanının ülke garantili tercihli krediler yoluyla sağlanması özellikle az gelişmiş ve gelişmekte olan ülkelerin borçlarını ödeyememeleri durumunda Çin kamu teşebbüsleriyle borç-öz sermaye takası anlaşmaları yapmalarına yol açmaktadır. Çin’in stratejik noktaları ele geçirmek için küçük ekonomileri bilinçli bir şekilde aşırı KYG borçlanmasına itmesi olarak tanımlanan borç tuzağı, KYG’nin aslında siyasi bir proje olduğu tartışmalarının merkezinde yer almaktadır. Bu çalışmada, öncelikle bankalar ve ulusal varlık fonlarının analiziyle Çin’in devlet sermayesini KYG finansmanına nasıl aktardığı ele alınacaktır. Ardından borç sıkıntına düşen ülkelerdeki projelerin Çin için stratejik bir önem arz edip etmediği analiz edilecektir.

Purpose In this study, it was aimed to determine the predictors of clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD) and clinical significance of mean platelet volume (MPV)/total platelet count ratio (MPR) as a new predictor for CR-POPF. Methods A total of 105 patients who underwent PD consecutively due to periampullary located diseases were included in the study. Patients were divided into two groups as CR-POPF and no postoperative pancreatic fistula (No-POPF). Demographic parameters, preoperative serum-based inflammatory indicators, surgical procedures, intraoperative findings, and histopathological parameters were recorded retrospectively from prospectively recorded patient files and compared between the groups. Results CR-POPF occurred in 16 (15.2%) patients: 8 (7.6%) were grade B and 8 (7.6%) were grade C according to the ISGPF classification. In univariate analysis, intraoperative blood loss > 580 mL (OR: 5.25, p  = 0.001), intraoperative blood transfusion (OR: 5.96, p  = 0.002), intraoperative vasoconstrictor medication (OR: 4.17, p  = 0.014), benign histopathology (OR: 3.51, p  = 0.036), and poor differentiation in malignant tumors (OR: 4.07, p  = 0.044) were significantly higher in the CR-POPF group, but not significant in multivariate analysis. Soft pancreatic consistency (OR: 6.08, p  = 0.013), pancreatic duct diameter < 2.5 mm (OR: 17.15, p  < 0.001), and MPR < 28.9 (OR: 13.91, p  < 0.001) were the independent predictors of CR-POPF according to multivariate analysis. Neoadjuvant treatment history and simultaneous vascular resection were less likely to cause CR-POPF development; however, they were insignificant. Conclusion Soft pancreatic consistency, pancreatic duct diameter, and preoperative MPR were the independent predictors of CR-POPF following PD. Decreased MPR is a strong predictor for CR-POPF and should be considered when deciding treatment strategies.

PurposeTo investigate the risk factors and the clinical characteristics of the hypertensive phase (HP) after Ahmed glaucoma valve (AGV) implantation.MethodsThis retrospective study included 60 eyes of 57 patients who underwent AGV implantation and with at least 1-year follow-up. HP was defined as intraocular pressure (IOP) > 21 mmHg in the first 3 months after the surgery. Independent samples t-test and Chi-square test were used to compare differences in patients with the HP and the non-HP groups. Univariable and multivariable logistic regression analyses were used to determine the risk factors for the development of the HP. Statistical significance was assumed at p < 0.05 level.ResultsHP was observed in 31 eyes (51.7%) with an average peak IOP of 27.6 ± 4.5 mmHg (range 22–40 mmHg). The resolution of HP was noted in 27 eyes (87.1%) at the 3rd month postoperative visit. The number of glaucoma medications at the last postoperative visit and IOP values from 1 month to 1 year were significantly higher in the HP group (all p < 0.05). Patients with traumatic glaucoma showed the highest rate (83.3%) of HP development. In the multivariable analysis, a preoperative IOP > 30 mmHg (p = 0.03, OR:5.82; reference: ≤ 25 mmHg) and younger age (41–64 years, p = 0.02, OR:8.49; ≤ 40 years, p = 0.001, OR:19.62; reference: ≥ 65 years) were independently associated with the occurrence of HP.ConclusionHypertensive phase was observed in half of the patients undergoing AGV implantation. A higher mean preoperative IOP and younger age were risk factors for HP development. Although the majority resolved at the 3-month visit, eyes with HP had higher mean IOPs and required more IOP lowering medications.

Objectives: This study aimed to evaluate the long-term outcomes of limbal stem cell deficiency (LSCD) treated with various limbal stem cell transplantation (LSCT) techniques. Materials and Methods: This retrospective study included 32 eyes of 29 patients who underwent LSCT. Clinical evaluation was performed based on preoperative and postoperative best corrected visual acuity (BCVA, logarithm of the minimum angle of resolution [logMAR]), degree of corneal neovascularization, extent of corneal involvement, and clarity of the central visual axis. Human leukocyte antigen (HLA) compatibility in allograft recipients was assessed via HLA tissue typing. The Kruskal-Wallis and Wilcoxon tests were used to compare variables between groups. Results: A total of 84.4% (n = 27) of the eyes had LSCD secondary to chemical injury. Median preoperative and postoperative BCVA (logMAR) values were 2.1 and 1.8 (p = 0.01) in the conjunctival limbal allograft (CLAL) group (n = 22; 18 living-related, 4 deceased donors), 0.9 and 0.7 (p=0.11) in the conjunctival limbal autograft (CLAU) group (n=4), and 2.1 and 1.3 (p=0.04) in the simple limbal epithelial transplantation (SLET) group (n=6; 3 autografts, 3 allografts), respectively. There was no statistically significant difference in BCVA improvement between groups. Median clinical scores improved from 10 to 6 in the CLAL group (p<0.001), from 7 to 4 in the CLAU group (p = 0.11), and from 10 to 3 in the SLET group (p = 0.03). Preoperatively, a statistically significant difference in clinical scores was observed only between the CLAU and SLET groups (p=0.029); however, no significant difference was found between groups postoperatively. HLA compatibility was 75% in 15 eyes that received living-related CLAL, and 100% in all 3 eyes that underwent allogeneic SLET. Conclusion: Different LSCT techniques may be applied in LSCD depending on the underlying etiology and extent of involvement. Favorable outcomes can also be achieved with allogeneic approaches when HLA compatibility is ensured. Keywords: Limbal stem cell deficiency, limbal stem cell transplantation, simple limbal epithelial transplantation, conjunctival limbal allograft, conjunctival limbal autograft