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INTRODUCTION: OpenAI recently introduced the ability to create custom generative pre-trained transformers (cGPTs) using text-based instruction and/or external documents using retrieval-augmented generation (RAG) architecture without coding knowledge. This study aimed to analyze the features of ophthalmology-related cGPTs and explore their potential utilities. METHODS: Data collection took place on January 20 and 21, 2024, and custom GPTs were found by entering ophthalmology keywords into the "Explore GPTS" section of the website. General and specific features of cGPTs were recorded, such as knowledge other than GPT-4 training data. The instruction and description sections were analyzed for compatibility using the Likert scale. We analyzed two custom GPTs with the highest Likert score in detail. We attempted to create a convincingly presented yet potentially harmful cGPT to test safety features. RESULTS: We analyzed 22 ophthalmic cGPTs, of which 55% were for general use and the most common subspecialty was glaucoma (18%). Over half (55%) contained knowledge other than GPT-4 training data. The representation of the instructions through the description was between "Moderately representative" and "Very representative" with a median Likert score of 3.5 (IQR 3.0-4.0). The instruction word count was significantly associated with Likert scores (P = 0.03). Tested cGPTs demonstrated potential for specific conversational tone, information, retrieval and combining knowledge from an uploaded source. With these safety settings, creating a malicious GPT was possible. CONCLUSIONS: This is the first study to our knowledge to examine the GPT store for a medical field. Our findings suggest that these cGPTs can be immediately implemented in practice and may offer more targeted and effective solutions compared to the standard GPT-4. However, further research is necessary to evaluate their capabilities and limitations comprehensively. The safety features currently appear to be rather limited. It may be helpful for the user to review the instruction section before using a cGPT.

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PURPOSE: We aimed to evaluate distance stereoacuity (DS) in patients with successfully treated accommodative esotropia (AET) and its association with other clinical factors. METHODS: The medical records of 176 children with refractive AET with a follow-up period ≥ 1 year were reviewed to identify a cohort of patients who achieved a stable alignment within 4 prism diopters (PD) of orthotropia at both distance and near fixation. Age of onset, duration of misalignment, uncorrected near and distance deviation, accommodative convergence/accommodation ratio, refractive error, presence of anisometropia and amblyopia, near stereopsis were evaluated as predictors of outcome. DS was measured using the Distance Randot Stereo test and near stereoacuity by Randot Stereotest. The patient group was compared with 50 age-matched normal controls for DS. RESULTS: Fifty-six patients were included, and 38 patients had DS at the final visit. All patients with DS attained uncontoured near stereopsis (UCNS). UCNS was present only in 11 patients without DS (p = 0.001). Anisometropia (p = 0.997), uncorrected near deviation (p = 0.224), distance deviation with correction (p = 0.255), and high hypermetropia (p = 0.998) were not associated with DS. The multivariable regression model showed a significant positive correlation between UCNS and DS (OR = 31.14 (95% CI 2.25-430.48); p = 0.01). Contoured near stereopsis outcome was significantly different between the patients with and without DS (p = 0.001 for animals and p = 0.003 for circles). Compared with the control group, the patient group yielded lower DS scores (p = 0.001). CONCLUSION: Distance Randot Stereotest can be useful in measuring binocular vision recovery after successful realignment in refractive AET patients. Patients attaining normal scores for near stereopsis tests after optical correction revealed subnormal thresholds for DS.

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A 51-year-old male with a a history of BRAF V600 E mutation-positive, superficial spreading-type cutaneous melanoma on the chest with metastasis to a sentinel lymph node had a 4-week history of redness and swelling of the right temporal bulbar conjunctiva and was referred for evaluation of a choroidal lesion in the right eye. What would you do next?

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PURPOSE: Optical properties of commonly used multifocal and extended-depth-of-focus (EDOF) intraocular lenses (IOLs) can induce artifacts or changes in optical coherence tomography (OCT) measurements. Our purpose was to investigate the possible effects of different IOLs on peripapillary and macular OCT parameters. METHODS: The preoperative and postoperative third-month peripapillary OCT and ganglion cell analysis (GCA) parameters of patients having monofocal (Alcon IQ), multifocal (PanOptix), or EDOF (Vivity) IOL implanted during cataract surgery were compared. RESULTS: Sixty-four eyes of 64 patients were included (21 monofocal, 24 multifocal, and 19 EDOF). Although all OCT image qualities increased postoperatively, only GCA image quality changes in the monofocal and multifocal groups reached statistical significance. Most peripapillary retinal nerve fiber layer (RNFL) and GCA parameters were similar preoperatively and postoperatively. The superior RNFL thickness in the monofocal group and the temporal RNFL thickness in the EDOF group were higher postoperatively ( P = 0.04 and P = 0.02, respectively). Most GCA and RNFL value changes between preoperative and postoperative measurements were similar between groups. In the parameters that changed, postoperative values were higher in the monofocal group ( P = 0.02 for minimum ganglion cell layer and inner plexiform layer, P = 0.04 for average RNFL). CONCLUSION: Trifocal and EDOF IOLs do not seem to have a negative effect on OCT parameters.

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AIM: To investigate vascular changes in different stages of glaucoma and to evaluate the role of optical coherence tomography angiography (OCTA) in the early diagnosis of glaucoma. METHODS: Glaucoma patients and healthy controls (n=29 eyes) were investigated in this cross-sectional comparative study. Glaucoma patients were grouped as ocular hypertension (n=44 eyes), preperimetric glaucoma (PPG; n=32 eyes), early glaucoma (EG; n=35 eyes), moderate stage glaucoma (MG; n=36 eyes), and advanced glaucoma (AG; n=35 eyes). Peripapillary and macular vascular densities (VDs) of all participants were compared and correlations of VDs and retinal nerve fiber layer thickness (RNFLT), ganglion cell analysis (GCA), and visual field (VF) tests were evaluated. Area under the receiver operation characteristic curves (AUC) of the peripapillary and macular VD parameters were obtained. RESULTS: VD values decreased with the progression of glaucoma. Most peripapillary and macular VD parameters of PPG and EG groups were lower than healthy controls (P<0.001). There was no significant difference in RNFLT between the PPG and EG groups, but most peripapillary and macular VDs were found to be lower in EG group than in PPG group (P<0.05). In most disease group, VDs were significantly correlated with OCT parameters (P<0.001) and VF index (P<0.05). There were no significant correlations between VF and RNFLT indices in the AG group, but significant correlations were found between VF and VD values (P<0.05). AUC for discriminating between healthy and glaucomatous eyes were highest in whole image peripapillary VD (AUC: 0.865, 0.929, and 0.986, respectively in EG, MG, and AG groups). CONCLUSION: OCTA can be used in the early diagnosis of glaucoma and can be useful in follow-up of the advanced disease. In cases where limitations or suspicions in structural and functional tests are present, OCTA can be used as a supportive diagnostic test, both in EG and AG.

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Purpose: To evaluate the macular microvascular changes in patients with intermediate uveitis (IU) using optical coherence tomography angiography (OCT-A) and to determine the relationship of OCT-A measurements with disease duration and activity. Methods: This cross-sectional study was performed at the uvea department of a tertiary hospital. Patients with IU (8 women, 8 men; mean age: 28.80 ± 12.80 years) were included in the study. The macular thickness measurements obtained by optical coherence tomography (OCT) (Heidelberg Spectralis, Heidelberg Engineering, Heidelberg, Germany) and macular superficial and deep vessel density (VD) parameters obtained by OCT-A (Avanti RTVue-XR; Optovue, Fremont, CA, USA) were compared with healthy subjects (12 men, 22 women; mean age: 28.40 ± 8.32 years). Eyes with pathology including marked obvious edema in the macula were not included in the study. Results: The macular thickness was found to be higher in the patient group (p < 0.001). The deep and superficial VD measurements in almost all quadrants in both superficial and deep layers were significantly lower in the IU patient group (p < 0.05). Macular thickness was increased in the active state of IU (p = 0.03), however, none of the OCT-A parameters showed a significant difference between active and inactive IU patients (p > 0.05). No correlation was observed between OCT-A parameters and total IU disease duration. Conclusion: Quantitative analyses of macular vascular structures demonstrate significantly reduced VD in both superficial and deep retinal layers in IU patients. Considering the importance of the macula in visual prognosis, OCT-A can provide crucial data for the monitoring and follow-up of IU patients.

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Incisional surgeries such as trabeculectomy reduce the resistance of the eye to trauma. Trabeculectomy is often performed together with mitomycin C, and late onset hypotony is already an expected complication in these eyes. This case report presents a patient who developed dehiscence of the scleral flap and hypotony maculopathy after Valsalva maneuver after 5.5 years of trabeculectomy. In a 6-month period, the patient's hypotonic maculopathy became evident, and vision was affected after this period. Thereupon, the wound site was explored, and dehiscence of the scleral flap at the temporal wound site and increased aqueous outflow were detected. Repair was done with sterile pericardium patch. Post-operative vision, intraocular pressure, and hypotony maculopathy recovered very quickly. After incisional surgeries, patients should be warned against both external trauma and minor traumas such as eye rubbing and Valsalva maneuver.

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Objectives: The objectives of the study were to investigate the inter and intraocular differences in posterior pole asymmetry analysis (PPAA) with optical coherence tomography (OCT) in anisometropia, to examine the relationship between the presence of anisometropia and amblyopia and retinal thickness. Methods: Patients between ages of 5 and 16 years with anisometropia who applied to our clinic were included in the study. Macular retinal thickness measurements were evaluated by PPAA using the posterior pole algorithm of the spectral domain-OCT device. Asymmetry was analyzed both as the difference between the right and left eyes and the difference between the superior, inferior, and mean retinal thicknesses of 64 separate quadrants in the same eye. Hemispheric and right-left eye asymmetry differences analyses were performed. Results: 118 patients were included in the study(65 females and 53 males). Group 1 consisted of anisometropic patients (n=46), Group 2 consisted of anisometropic amblyopia patients (n=40), and Group 3 consisted of control group (n=32). The mean age of the patients was 9.72±5.6 years. The mean spherical equivalent difference between the two eyes of the patients was 1.7±0.6 D. When anisometropic eyes were compared with normal eyes, there was no significant difference between mean superior, inferior and total retinal thickness, and right-left eye asymmetry values (for all, p>0.05). In the asymmetry evaluation performed by counting the black boxes in the PPAA, a significant difference was found in the right-left asymmetry evaluation in anisometropic amblyopic eyes, in some quadrants and in the right-left asymmetry analysis (p<0.05). Conclusion: While no difference was found between anisometropic and normal eyes in the PPAA, there was differences in some quadrants in the anisometropic amblyopic group compared to the control group suggesting that there is an involvement in the peripheral quadrants of the macula, especially in treatment resistant amblyopic patients.

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PURPOSE: To evaluate whether retrobulbar blood flow and choroidal thickness (CT) are affected in patients with rheumatoid arthritis (RA), and the relationship between these values. METHODS: We evaluated 40 eyes of 20 RA patients and 40 eyes of 20 healthy controls. The enhanced depth imaging optical coherence tomography, color Doppler imaging, was held. Statistical analysis was performed. RESULTS: Peak systolic velocity (PSV) of ophthalmic (OA) and central retinal artery (CRA) were significantly higher in RA. No significant difference was observed when end-diastolic velocity (EDV) of OA and CRA was compared between the groups. The resistivity index (RI) of OA and CRA was higher in RA. Perifoveal/subfoveal CT was lower in RA. Negative correlation was detected between the RI of OA and the perifoveal CT, and a positive correlation was detected between RI of CRA and CT. CONCLUSIONS: Ocular hemodynamics is effected by RA and can exaggerate ocular complications of various vascular diseases such as diabetes mellitus, hypertension, retinal vascular occlusions.

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We report the case of a 15-month-old boy who presented with a mass lesion of the right upper eyelid that had been present since birth and had slowly enlarged over the last 3 months. The lesion had minimal surrounding erythema simulating the appearance of a chalazion. Intraoperatively the lesion was noted to be firmly adherent to the underlying tarsus. The lesion was excised completely through an eyelid crease approach leaving the tarsus intact. The histopathology was consistent with dermoid cyst. To our knowledge, this is the third case of a tarsal dermoid cyst reported in the literature. Dermoid cyst should be included in the differential diagnosis of eyelid mass lesions, and particulary differentiated from a chalazion to avoid mismanagement that may lead to scarring, recurrence and inflammation. The excision of these lesions sparing the underlying tarsus can be possible.