By
Kayabasi, M (Kayabasi, Mustafa) ; Mammadov, T (Mammadov, Turhan) ; Köksaldi, S (Koksaldi, Seher) ; Arikan, G (Arikan, Gul) ; Kaynak, S (Kaynak, Suleyman) ; Saatci, AO (Saatci, Ali Osman)
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ARCHIVE OF CLINICAL CASES
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Toxoplasma chorioretinitis (TC) can exhibit atypical features in immunocompromised patients including bilaterality, extensive spread, multifocal presentation, large areas of retinal necrosis without adjacent retinal scarring, and diffuse necrotizing retinitis resembling the viral retinitis that may cause confusion in the differential diagnosis. The aim of this study was to present the clinical features of four eyes of three immunocompromised patients with active toxoplasma chorioretinitis. Two of the patients were female and one, male. Two patients had hematological malignancies and the remaining patient was under adalimumab treatment for ankylosing spondylitis. Visual complaints began 10 days to four months prior to TC diagnosis. All four eyes had mild-to-moderate anterior chamber cells together with severe vitritis on slit-lamp examination while there were solitary chorioretinitis lesions on fundoscopy. Despite all patients were negative for anti-toxoplasma immunoglobulin M, all were positive for immunoglobulin G. All three patients were successfully treated with a combined treatment of systemic and intravitreal anti-toxoplasmic drugs. Clinicians should be cautious for the possible toxoplasma chorioretinitis besides the other infectious entities when a new uveitis episode is detected in an immunosuppressed patient in order to avoid misdiagnosis and thereby wrong treatment.
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Anti-toxoplasmic therapy immunosuppression ocular toxoplasmosis toxoplasma chorioretinitis uveitis
Intravitreal Ranibizumab and Dexamethasone Implant Injections as Primary Treatment of Diabetic Macular Edema: The Month 24 Results from Simultaneously Double Protocol
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Kaya, M (Kaya, Mahmut) ; Atas, F (Atas, Ferdane) ; Kocak, N (Kocak, Nilufer) ; Ozturk, T (Ozturk, Taylan) ; Ayhan, Z (Ayhan, Ziya) ; Kaynak, S (Kaynak, Suleyman)
(provided by Clarivate)
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CURRENT EYE RESEARCH
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PurposeTo compare efficacy of simultaneously administered intravitreal dexamethasone implant (DEX implant) and ranibizumab (simultaneous double protocol) injections with ranibizumab monotherapy for diabetic macular edema (DME) at month 24.MethodsThis is a prospective, consecutive, clinical interventional study. Naive eyes with DME were randomized into two groups: 34 eyes received simultaneous double-protocol therapy and 34 eyes received ranibizumab monotherapy. The primary efficacy endpoint was change in visual acuity in month 24. The secondary efficacy endpoints were to evaluate gain of >= 15 letters, morphological changes and central foveal thickness. Decreased vision from DME (study eye BCVA, 20/40 or worse Snellen equivalent using ETDRS testing), the presence of DME with >= 300 mu m foveal intraretinal cystoid spaces (within 1000 mu m of the centre of the fovea), subfoveal neuroretinal detachment (SND), intraretinal hyperreflective foci (HRF, within 500 mu m of the centre of the fovea) or foveal lipid exudates and external limiting membrane (ELM) and ellipsoid zone (EZ) disruption (within 500 mu m of the centre of the fovea) on SD-OCT were eligible to enrol.ResultsThe mean baseline BCVA was 48 +/- 23 letters in double protocol group and 52 +/- 14 letters ranibizumab monotherapy group (p = 0.416). The mean number of ETDRS letters changed from baseline at 12 months versus change from baseline at month 24 in double protocol group and ranibizumab monotherapy group were +21.6 versus +20.2 and +9.6 versus +9.1, respectively. At the month 24 time point, 65.4% of patients in double protocol group and 26.2% of patients in ranibizumab monotherapy group had gained >= 15 ETDRS letters in BCVA from baseline (p < 0.001). The external limiting membrane (ELM) and ellipsoid zone (EZ) integrity were better in the double protocol group in comparison to ranibizumab monotherapy group at month 24. In addition, there was no statistically significant increase in the proportion of patients with epiretinal membrane in double protocol group at month 24, by the contrast with ranibizumab monotherapy group (p = 0.06 and p = 0.04 in the double protocol and ranibizumab monotherapy groups, respectively). From baseline to month 24, the mean central foveal thickness (CFT) was 672 +/- 293 mu m reduced to 278 +/- 84 mu m in double protocol group and was 631 +/- 279 mu m reduced to 356 +/- 108 mu m in ranibizumab monotherapy group (p < 0.001 and p < 0.001). From baseline to month 24, 38% (13/34) of eyes in double protocol group and 18% (6/34) of eyes in ranibizumab monotherapy group had at least 5 mmHg of IOP elevation (p = 0.012). Two grades or more increased cataract density were detected 27% (6/22) of eyes in the double protocol group and in 12.5% (3/24) of eyes in the ranibizumab monotherapy group from baseline to month 24 (p = 0.032).ConclusionAccording to the improvements in visual acuity and morphological changes achieved at month 24, the simultaneous double protocol therapy can be an effective treatment option for DME with inflammatory biomarkers on OCT or/and decreased visual acuity.
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Author Keywords
Dexamethasone implant diabetic macular edema double protocol optical coherence tomog raphyranibizumab
Ranibizumab or Aflibercept Monotherapies in Treatment-Naive Eyes with Diabetic Macular Edema: A Head-to-Head Comparison in Real-Life Experience
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Kaya, M (Kaya, Mahmut) ; Öztürk, T (Ozturk, Taylan) ; Koçak, N (Kocak, Nilufer) ; Yagci, BA (Yagci, Betul Akbulut) ; Atas, F (Atas, Ferdane) ; Kaynak, S (Kaynak, Suleyman)
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TURK OFTALMOLOJI DERGISI-TURKISH JOURNAL OF OPHTHALMOLOGY
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10.4274/tjo.galenos.2022.38227
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Objectives: To compare the functional and anatomical outcomes of ranibizumab and aflibercept monotherapies given according to a pro re nata (PRN) protocol in treatment-naive eyes with diabetic macular edema (DME) in a real-life clinical setting.
Materials and Methods: The medical charts of treatment-naive patients with center-involved DME retrieved from our institutional database were reviewed in this retrospective cohort study. A total of 512 treatment-naive eyes with DME underwent either ranibizumab (Group I; 308 eyes) or aflibercept (Group II; 204 eyes) monotherapy and 462 patients were included. The primary outcome was visual gain over 12 months.
Results: The mean number of intravitreal injections within the first year was 4.34 +/- 1.83 and 4.39 +/- 2.12 in Group I and II, respectively (p=0.260). The mean best corrected visual acuity (BCVA) improvement at 12 months was +5.7 and +6.5 ETDRS letters in Group I and II, respectively (p=0.321). However, among eyes with a BCVA score less than 69 ETDRS letters (54% of the study population), visual gain was more prominent in Group II (+15.2 vs. +12.1 ETDRS letters; p<0.001). Statistically significant decreases in central foveal thickness were observed with both ranibizumab and aflibercept monotherapy (p<0.001), with no significant difference between the groups (p=0.148).
Conclusion: No statistically significant difference was found in visual outcomes at 12-month follow-up between ranibizumab and aflibercept monotherapies using a PRN protocol, although there was a tendency toward slightly better functional and anatomic prognosis in the aflibercept arm.
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Author Keywords
Aflibercept diabetic macular edema pro re nata protocol ranibizumab
Optical Coherence Tomography Angiography Imaging of Foveal Atrophy Secondary to Commotio Retinae in a Pediatric Patient
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Kefeli, I (Kefeli, Isil) ; Utine, CA (Utine, Canan A.) ; Kaya, M (Kaya, Mahmut) ; Kaynak, S (Kaynak, Suleyman)
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BEYOGLU EYE JOURNAL
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Optical coherence tomography-angiography (OCTA) is a fast, reliable, and non-invasive technique for the diagnosis and follow-up of patients with commotio retinae (CR). Severity of the damage to the retinal and choroidal microvasculature in OCTA imaging and the visual prognosis are directly related to the severity of trauma. There are a few published reports on OCTA in CR that shows alterations of the retinal or superficial choroidal vessels and choriocapillary plexus. OCTA imaging seems to be predictive for visual prognosis. Herein, we present a 6-year-old boy, who had blunt trauma to the right eye with a stick during outdoor playing with visual acuity reduction to 0.1 following resolution of the Berlin's edema. In our case, OCTA revealed damage to the outer layers of the retinae and choriocapillaris and resulting in permanent vision loss. OCTA is a non-invasive, rapid, and safe imaging technique that qualitatively and quantitatively analyzes blood flow from the superficial capillary plexus to the choriocapillaris, which can be predictive in the visual prognosis.
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Berlin's edema blunt trauma commotio retinae microvascular damage optical coherence angiography-angiography
The prevalence and systemic risk factors of diabetic macular edema: a cross-sectional study from Turkey
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Acan, D (Acan, Durgul) ; Calan, M (Calan, Mehmet) ; Er, D (Er, Duygu) ; Arkan, T (Arkan, Tugba) ; Kocak, N (Kocak, Nilufer) ; Bayraktar, F (Bayraktar, Firat) ; Kaynak, S (Kaynak, Suleyman)
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BMC OPHTHALMOLOGY
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Background: The aim of this study was to evaluate the prevalence of diabetic macular edema (DME) utilizing optical coherence tomography (OCT), and to clarify the effects of the systemic findings and risk factors on the development of DME.
Methods: This cross-sectional study was conducted in the departments of ophthalmology and endocrinology at the Dokuz Eylul University School of Medicine in Izmir, Turkey. The demographics, type and duration of diabetes mellitus, treatment modality, smoking and alcohol consumption habits, as well as the systemic blood pressure, renal functional tests, hemoglobulin A1c level, serum lipid profile, and 24-h urine albumin level were noted and statistically analyzed. The relationships between the systemic findings and DME were studied.
Results: Four-hundred and thirteen eyes of 413 diabetic patients who were examined between January 2011 and July 2012 were enrolled in this study. The prevalence of DME was 15.3% among the patients. The males exhibited DME significantly more frequently than the females (p = 0.031), and the duration of diabetes was significantly longer in those patients with DME (p < 0.001). Those patients without DME frequently used antihyperlipidemic drugs and had a higher level of high density lipoprotein cholesterol (p = 0.040 and p = 0.046, respectively). The patient's alcohol consumption, nephropathy, neuropathy, previous cataract surgery, severity of diabetic retinopathy, and insulin usage were statistically significant factors with regard to the DME prevalence.
Conclusions: This study demonstrated the prevalence of DME in Turkey by utilizing OCT. The development of DME can be avoided or limited and the response to treatment may be improved by the regulation of the DME risk factors.
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Author Keywords
Diabetic macular edema Optical coherence tomography Prevalence
Intravitreal ranibizumab and dexamethasone implant injections as primary treatment of diabetic macular edema: simultaneously double protocol
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Kaya, M (Kaya, Mahmut) ; Kocak, N (Kocak, Nilufer) ; Ozturk, T (Ozturk, Taylan) ; Bolluk, V (Bolluk, Volkan) ; Ayhan, Z (Ayhan, Ziya) ; Kaynak, S (Kaynak, Suleyman)
(provided by Clarivate)
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EYE
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Purpose To assess the 12-month efficacy and safety of simultaneously administered intravitreal dexamethasone implant (DEX implant) and ranibizumab (simultaneous double protocol) injections in comparison with ranibizumab monotherapy as the first-line treatment of diabetic macular oedema (DMO). Methods Prospective, consecutive, clinical interventional study. Patients were randomized into two groups: 24 naive DMO patients (34 eyes) who received simultaneous double-protocol therapy and 22 DMO patients (34 eyes) who received ranibizumab monotherapy were included. Monthly ranibizumab (0.5 mg) was administered for the first 6 months and later on, an as-needed treatment basis. DEX implant injection was performed at any time during the loading dose of the three consecutive monthly injections of ranibizumab, and with as-needed reinjections of ranibizumab from 6th month onwards. Change in visual acuity was the primary efficacy endpoint. Secondary efficacy endpoints were a gain of >= 15 letters and a change in the central foveal thickness. Results Mean BCVA increased from baseline to month 12 in the simultaneously double-protocol therapy group compared with the ranibizumab monotherapy group (21.6 versus 9.6 letters [P < 0.001]). The corresponding proportions of eyes gaining >= 15 letters were 60% versus 29.4% (P < 0.0001). Moreover, the mean reductions in the central foveal thickness were 413 versus 282 mu m (P = 0.001). At 12 month, the simultaneous double-protocol therapy decreased a significant number of foveal cysts and subfoveal neuroretinal detachment compared with those by ranibizumab monotherapy. Conclusions The simultaneous addition of DEX implant at any time during the three monthly loading doses of ranibizumab in patients with DMO significantly improved the visual outcomes and revealed superior anatomic outcomes than those with the ranibizumab monotherapy.
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BEVACIZUMAB AFLIBERCEPT RETINOPATHY ASSOCIATION EYES
A Novel Biomarker in Diabetic Macular Edema with Serous Retinal Detachment: Serum Chitinase-3-Like Protein 1
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Kaya, M (Kaya, Mahmut) ; Kaya, D (Kaya, Derya) ; Idiman, E (Idiman, Egemen) ; Kocak, N (Kocak, Nilufer) ; Ozturk, T (Ozturk, Taylan) ; Ayhan, Z (Ayhan, Ziya) ; Altun, Z (Altun, Zekiye) ; Kaynak, S (Kaynak, Suleyman)
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OPHTHALMOLOGICA
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Purpose: To determine whether serum chitinase-3-like protein 1 (CHI3L1) and interleukin-6 (IL-6) levels correlate with serous retinal detachment (SRD) in diabetic macular edema (DME) using spectral-domain optical coherence tomography (SD-OCT). Methods: In this cross-sectional case-control study, 394 patients (treatment-naive DME patients, n = 218; diabetic patients without DME, n = 96; nondiabetic controls, n = 80) were included in the study. Eyes were classified according to SD-OCT features of DME: SRD, cystoid macular edema (CMO), and diffuse retinal thickness (DRT). Serum concentrations of CHI3L1 and IL-6 were analyzed using enzyme-linked immunosorbent assay. Results: Serum CHI3L1 and IL-6 levels were significantly higher in DME with SRD compared to patients with CMO and DRT (p < 0.001 for all groups). Multivariate regression analysis showed that CHI3L1 and IL-6 had a stronger influence on the presence of SRD in DME (r = 1.162, p = 0.026, and r = 1.242, p = 0.016, respectively). Serum concentration of CHI3L1 was significantly correlated with that of IL-6 (r = 0.386, p = 0.0015). Conclusions: Our data suggest that serum concentrations of CHI3L1 and IL-6 are involved in the process of SRD in DME. CHI3L1 can be investigated further as a new diagnostic biomarker for DME with SRD. (C) 2018 S. Karger AG, Basel
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Author Keywords
Chitinase-3-like protein 1 Diabetic macular edema Diabetes mellitus ELISA Serum nterleukin-6
Evaluation of systemic risk factors in different optical coherence tomographic patterns of diabetic macular edema
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Acan, D (Acan, Durgul) ; Karahan, E (Karahan, Eyyup) ; Kocak, N (Kocak, Nilufer) ; Kaynak, S (Kaynak, Suleyman)
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INTERNATIONAL JOURNAL OF OPHTHALMOLOGY
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AIM: To elucidate the relationship between systemic risk factors and different patterns of diabetic macular edema (DME) determined with optical coherence tomography (OCT).
METHODS: In this cross-sectional study, DME was classified by OCT as diffuse retinal thickness (DRT), cystoid macular edema (CME) and serous retinal detachment (SRD) and the relationship between the systemic risk factors and DME patterns was evaluated.
RESULTS: Of the 57 patients with DME, 21 (36.8%) had DRT, 24 (42.1%) had CME and 12 (21.0%) had SRD. Micro- or macro-albuminuria was significantly higher in the DRT pattern (61.9%) compared with the SRD (50.0%) and CME patterns (25.0%; P=0.040). Hemoglobin A1c (HbA1c) level was significantly higher and patients were younger in the DRT pattern group (P=0.034, P=0.032). Best corrected visual acuity was the worst and central macular thickness was the thickest in the CME pattern group.
CONCLUSION: Micro- or macro-albuminuria may be more frequent and HbA1c level may be higher in patients with DRT. These patients are also seen to be younger than patients with non-DRT.
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Author Keywords
cystoid macular edema diabetic macular edema diffuse retinal thickness optical coherence tomography serous retinal detachment
Comparison of macular pigment optical density in patients with dry and wet age-related macular degeneration
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Ozyurt, A (Ozyurt, Ayhan) ; Kocak, N (Kocak, Nilufer) ; Akan, P (Akan, Pinar) ; Calan, OG (Calan, Ozlem Gursoy) ; Ozturk, T (Ozturk, Taylan) ; Kaya, M (Kaya, Mahmut) ; Karahan, E (Karahan, Eyup) ; Kaynak, S (Kaynak, Suleyman)
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INDIAN JOURNAL OF OPHTHALMOLOGY
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Aim: The aim of the study was to evaluate the macular pigment optical density (MPOD) levels in patients with wet age-related macular degeneration (AMD), dry AMD, and also in healthy controls. Settings and Design: This study was conducted at Department of Ophthalmology, and the study design was a prospective study. Patients and Methods: Forty-eight patients with wet AMD, 51 patients with dry AMD, and 50 controls were included in the study. All patients were naive to both previous lutein or zeaxanthin administration and any previous intravitreal injections. Fundus reflectance (VISUCAM 500, reflectance of a single 460 nm wavelength) was used to measure the MPOD levels. Three groups were compared regarding age, gender, serum lutein, and zeaxanthin concentrations as well as MPOD levels. Results: Serum lutein and zeaxanthin levels were significantly higher in control group when compared with wet AMD (Group 1) and dry AMD (Group 2) (P = 0.001 and P < 0.001, respectively). Mean MPOD was found to be similar in all of the three study subgroups (P = 0.630). However, maximum MPOD was significantly higher in control group when compared with Group 1 and 2 (P = 0.003). There was no correlation between serum lutein or zeaxanthin concentrations and mean MPOD levels (P = 0.815, r = 0.014 and P = 0.461, r = 0.043, respectively), but there was a weak correlation between serum zeaxanthin concentration and maximum MPOD level (P = 0.042, r = 0.124). Maximum MPOD level was found to be correlated with the level of AMD (Group 1, 2, and 3; r = 0.184, P = 0.041). Conclusion: Maximum MPOD level was found to be lower in patients with AMD when compared with control cases. Mean MPOD and maximum MPOD levels were similar in wet and dry AMD Groups. These results can be applied clinically keeping in mind that MPOD measurements with one wavelength reflectometry may not be completely reliable.
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Author Keywords
Age-related macular degeneration macular pigment optical density serum lutein serum zeaxanthin
Is There a Relationship Between Use of Anti-Vascular Endothelial Growth Factor Agents and Atrophic Changes in Age-Related Macular Degeneration Patients?
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TURK OFTALMOLOJI DERGISI-TURKISH JOURNAL OF OPHTHALMOLOGY
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Choroidal neovascularization due to age-related macular degeneration (AMD) is currently treated successfully with anti-vascular endothelial growth factor (VEGF) intravitreal agents. Emerging evidence suggests that anti-VEGF treatment may potentially increase development of geographic atrophy. However, there is not yet direct proof of a causal relationship between geographic atrophy and use of anti-VEGF agents in nAMD. The aim of this review is to discuss the evidence concerning the association between anti-VEGF therapy and progression of geographic atrophy.
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Author Keywords
Anti-VEGF agents geographic atrophy age-related macular degeneration
Risk factors for multiple retinal tears in patients with acute posterior vitreous detachment
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Karahan, E (Karahan, Eyyup) ; Karti, O (Karti, Omer) ; Er, D (Er, Duygu) ; Cam, D (Cam, Duygu) ; Aydin, R (Aydin, Rukiye) ; Zengin, MO (Zengin, Mehmet Ozgur) ; Kaynak, S (Kaynak, Suleyman)
(provided by Clarivate)
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INTERNATIONAL OPHTHALMOLOGY
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Purpose To evaluate possible risk factors for multiple retinal tears in patients with acute posterior vitreous detachment.
Materials and methods Three hundred and seventy-six consecutive patients presenting with symptoms of floaters and/or flashes were examined. The associations of retinal tears with the duration of symptoms, multiple floaters, flashing, a family history of retinal detachment, peripheral retinal degeneration, lens status, myopia, tobacco dust, and retinal or vitreous hemorrhage were analyzed.
Results Fifty-four (14.4%) of the 376 patients had 71 initial retinal tears. Forty of the 54 eyes had one retinal tear, and 14 eyes had multiple retinal tears. The presence of retinal or vitreous hemorrhage increased the risk of multiple retinal tears 6.1 times using univariate analysis and 7.0 times using multivariate analysis.
Conclusion Unrecognized retinal tears in patients with acute posterior vitreous detachment can cause subsequent retinal detachment. It is therefore important to consider multiple retinal tears, especially in patients with retinal or vitreous hemorrhage.
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Author Keywords
Posterior vitreous detachment Retinal tears Vitreous hemorrhage
Expert recommendations for the management of diabetic macular edema with intravitreal dexamethasone implant: A Turkish Delphi study
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Batioglu, F (Batioglu, Figen) ; Yanik, Ö (Yanik, Ozge) ; Saatçi, AO (Saatci, Ali Osman) ; Eldem, B (Eldem, Bora) ; Akkin, C (Akkin, Cezmi) ; Afrashi, F (Afrashi, Filiz) ; Özdemir, H (Ozdemir, Hakan) ; Mentes, J (Mentes, Jale) ; Güngör, K (Gungor, Kivanc) ; Karabas, L (Karabas, Levent) ;
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EUROPEAN JOURNAL OF OPHTHALMOLOGY
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Purpose To provide consensus on the clinical use of intravitreal dexamethasone (DEX) implant for the treatment of diabetic macular edema (DME) in Turkey. Methods A panel of 22 retina experts prepared 77 statements of recommendation, and 80 retinal specialists practicing in Turkey were chosen to vote either in support or against each one. A Delphi-based method was used through which the ophthalmologists were able to view all of the results anonymously after two rounds and modify their subsequent answers. The survey was conducted via a mini website, and statements without consensus were resent to the specialists with the latest vote results a week later. Results A total of 72 ophthalmologists answered the first and second round questions. After the first stage, consensus was achieved on 55 of the statements, leaving 22 without agreement. After the second stage, consensus was reached on 11 of the remaining statements. Strong consensus was achieved on statements regarding the etiopathogenesis of DME and the first-line indications and safety of the DEX implant procedure. The panel recommended the use of DEX implant for patients with an arterial thromboembolic event in the last three months and also agreed that pro re nata DEX implant treatment not only provides better outcomes for DME patients but also reduces the treatment burden for those who could not receive an adequate number of anti-vascular endothelial growth factor (VEGF) injections. Conclusion This study provides clinical consensus and recommendations about the use of DEX implant in the clinical practice of DME management in Turkey.
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Author Keywords
Delphi consensus dexamethasone implant diabetic macular edema
Rapid response to systemic steroid in macular alexandrite laser exposure: Multimodal imaging
By
Balikoglu-Yilmaz, M (Balikoglu-Yilmaz, Melike) ; Kaya, M (Kaya, Mahmut) ; Erbezci, M (Erbezci, Murat) ; Kaynak, S (Kaynak, Suleyman)
(provided by Clarivate)
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EUROPEAN JOURNAL OF OPHTHALMOLOGY
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To report the management of accidental macular photocoagulation during a 750-nm Alexandrite laser hair removal procedure.
Methods
Single case report with images.
Results
A 23-year-old girl presented with an immediate visual field defect in her right eye after direct inadvertent exposure to a single discharge from a 750-nm Alexandrite laser used for laser hair removal. Baseline Snellen visual acuity was 20/20 in the involved right eye but the patient reported a subjective visual field defect. She was treated with oral methylprednisolone that was started at a dose of 1 mg/kg/day and then gradually reduced. Six months after the initial exposure, the final visual acuity was 20/20 and there was a significant improvement in the macular lesion. However, the subjective visual field defect continued. She underwent multimodal retinal imaging with optical coherence tomography, fundus fluorescence angiography, and optical coherence tomography angiography in addition to a visual field test and microperimety.
Conclusion
The present case documents a gradual visual and anatomical improvement following macular photic damage after accidental occupational exposure to a 750-nm Alexandrite laser. The treatment should be arranged according to the localization of the laser damage. Optical coherence tomography angiography also has the potential to help noninvasively detect choriocapillaris damage.
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Author Keywords
750-nm Alexandrite laser macular laser injury optical coherence tomography angiography steroids visual field defect
Correlation of choroidal thickness with serum cortisol level
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Karahan, E (Karahan, Eyyup) ; Zengin, MO (Zengin, Mehmet Ozgur) ; Aydin, R (Aydin, Rukiye) ; Ozturk, T (Ozturk, Taylan) ; Kaya, M (Kaya, Mahmut) ; Kocak, N (Kocak, Nilufer) ; Kaynak, S (Kaynak, Suleyman)
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CLINICAL AND EXPERIMENTAL OPTOMETRY
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Background: The aim was to investigate the correlation of serum cortisol level with choroidal thickness.
Methods: Sixty-six healthy volunteers had no visual complaints or history of ocular disease. Subfoveal choroidal thickness at the foveal centre was measured with spectral domain optical coherence tomography (SD-OCT). Morning serum cortisol levels were obtained at 8: 00 am immediately following the SD-OCT measurement. Measurements of only the right eyes were included in the study. Age, gender, axial length and spherical equivalent were noted. Correlation of choroidal thickness with age, gender, axial length, spherical equivalent and serum cortisol level were investigated with linear and multiple regression analysis.
Results: Sixty-six eyes of 66 patients were evaluated. Mean age was 43.4 +/- 3.6 years (range: 40 to 53 years), mean spherical equivalent was -0.15 D (range: -1.25 to +1.50 D), mean axial length was 23.2 mm(range; 22.0 to 23.7 mm), mean choroidal thickness was 317.9 +/- 45.1 mu m (range: 206 to 394 mu m). Age and spherical equivalent were not significantly correlated with choroidal thickness. Axial length had a strong negative correlation with choroidal thickness (R-2: 0.488, p = 0.000). There was no significant correlation between serum cortisol level and choroidal thickness (R-2: 0.034, p = 0.139).
Conclusion: Our results did not reveal any correlation between serum cortisol level and choroidal thickness. We believe that more prospective studies are needed to determine the relationship of cortisol and other hormones with choroidal thickness.
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Author Keywords
choroidal thickness serum cortisol spectral domain optical coherence tomography
Demarcation Laser Photocoagulation for Subclinical Retinal Detachment: Can Progression to Retinal Detachment Be Prevented?
By
Koçak, N (Kocak, Nilufer) ; Kaya, M (Kaya, Mahmut) ; Öztürk, T (Ozturk, Taylan) ; Bolluk, V (Bolluk, Volkan) ; Kaynak, S (Kaynak, Suleyman)
(provided by Clarivate)
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TURK OFTALMOLOJI DERGISI-TURKISH JOURNAL OF OPHTHALMOLOGY
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10.4274/tjo.galenos.2019.22844
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Objectives: To describe results of demarcation laser photocoagulation in preventing progression of subclinical retinal detachment (SCRD).
Materials and Methods: Twenty-one eyes of 20 patients with SCRD were included. All patients underwent a complete ophthalmological examination, spectral-domain optical coherence tomography, and color fundus photography. Ages at initial diagnosis ranged between 18 and 75 years (mean: 57.3 +/- 16.2 years). Patients followed for at least 6 months were included in the study. Periodic retinal examinations were performed over follow-up periods of 6-55 months using Goldmann three-mirror contact lens and sometimes semilunar mirror lens with scleral indentation.
Results: Twelve patients (60%) were female, eight (40%) were male. The mean follow-up period was 24.3 +/- 15.2 months (6-55 months). Three (14.3%) eyes were pseudophakic. One patient was affected bilaterally, with both eyes each containing two separate areas of involvement. The SCRD was in the upper quadrant of 18 eyes (85.7%) and the lower quadrant in 3 eyes (14.3%), and was located in the temporal region 10 eyes (47.6%), the nasal quadrant in 4 eyes (19.1%), and in the upper quadrant (temporal-nasal) in 7 eyes (33.3%). Six eyes (28.6%) were found to have myopia greater than -3.0 diopters. Progression to clinical retinal detachment was observed in 4/21 SCRD eyes (19%). All eyes showing progression to clinical retinal detachment had >-3.0 diopter myopia and multiple retinal tears located in the upper quadrant.
Conclusion: Demarcation laser photocoagulation should be kept in mind as a first-line treatment for eyes with SCRD. Laser photocoagulation is vital in preventing progression to rhegmatogenous retinal detachment in most patients. After this treatment, these patients should be followed closely.
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Author Keywords
Clinical retinal detachment first-line treatment laser photocoagulation subclinical retinal detachment
Spontaneous resolution of macular edema after silicone oil removal
By
Kgrahan, E (Kgrahan, Eyyup) ; Tuncer, I (Tuncer, Ibrahim) ; Zengin, MO (Zengin, Mehmet Ozgar) ; Kacukerdonmez, C (Kacukerdonmez, Cen) ; Kaynak, S (Kaynak, Suleyman)
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INTERNATIONAL JOURNAL OF OPHTHALMOLOGY
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10.3980/j.issn.2222-3959.2014.06.17
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AIM: To investigate the macular changes in eyes filled with silicone oil (SO) and course of these changes after SO removal.
METHODS: A retrospective optical coherence tomography scan review was conducted for twenty-four patients who underwent uncomplicated pars plana vitrectomy with SO tamponade for complex retinal detachments were detected with optical coherence tomography before, and one week, one month and three months after SO removal.
RESULTS: Mean duration of SO tamponade was 3.6 +/- 1.0mo (range 3-7mo). Cystoid macular edema (CME) was detected in 3 eyes before SO removal. Submacular fluid was represented in 1 eye before silicone SO removal. Resolution of CME and submacular fluid was achieved 1mo after SO removal in all eyes. Mean best corrected visual acuity (BCVA) was 1.15 t0.65 (range, hand movement to 0.2) before SO removal in the eyes without macular changes. After SO removal, the mean BCVA values at 1wk and 1 and 3mo, and 0.82 +/- 0.23, 0.76 +/- 0.21, and 0.70 +/- 0.19, all of which were significantly better than baseline (P =0.030, 0.017, 0.006 respectively). In the eyes with macular CME and subretinal fluid the mean BCVA was significantly improved at 3mo after SO removal compared with baseline (P=0.037).
CONCLUSION: Decreased visual acuity in eyes filled with SO could be caused by macular complications due to SO. CME and subretinal fluid may resolve without any additional macular surgery after SO removal.
Intravitreal application of Ozurdex (R) (Allergan, Inc., Irvine, CA, USA) which is a biodegradable, sustained-release dexamethasone implant has been reported to be effective in the treatment of macular edema. Migration of such implant into the anterior chamber has been recently described in cases without perfect zonular or the posterior capsular integrity. Herein, we report the first case with anterior migration of Ozurdex (R) implant that mislocated just behind the intraocular lens (IOL) in an intact capsular bag. It is thought that such implant migrated anteriorly towards into the posterior chamber through weak zonules as the present case had a medical history of uneventful phacoemulsification surgery with the implantation of posterior chamber IOL. However, the migrated implant was well tolerated since there was no sign of the corneal complication, rise in intraocular pressure, and anterior chamber reaction. Close follow-up was scheduled to find out any signs of anterior segment pathology. Meanwhile dexamethasone implant completely degraded at the 4th month of postoperative follow-up.
Keywords
Author Keywords
Anterior migrationOzurdexposterior chamber
Author Keywords
retinal detachment silicone oil macula
Anterior migration of dexamethasone implant in a pseudophakic patient with intact posterior capsule
By
Kocak, N (Kocak, Nilufer) ; Ozturk, T (Ozturk, Taylan) ; Karahan, E (Karahan, Eyyup) ; Kaynak, S (Kaynak, Suleyman)
(provided by Clarivate)
Source
INDIAN JOURNAL OF OPHTHALMOLOGY
Volume
Issue
Page
DOI
Published
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Document Type
Abstract
Intravitreal application of Ozurdex (R) (Allergan, Inc., Irvine, CA, USA) which is a biodegradable, sustained-release dexamethasone implant has been reported to be effective in the treatment of macular edema. Migration of such implant into the anterior chamber has been recently described in cases without perfect zonular or the posterior capsular integrity. Herein, we report the first case with anterior migration of Ozurdex (R) implant that mislocated just behind the intraocular lens (IOL) in an intact capsular bag. It is thought that such implant migrated anteriorly towards into the posterior chamber through weak zonules as the present case had a medical history of uneventful phacoemulsification surgery with the implantation of posterior chamber IOL. However, the migrated implant was well tolerated since there was no sign of the corneal complication, rise in intraocular pressure, and anterior chamber reaction. Close follow-up was scheduled to find out any signs of anterior segment pathology. Meanwhile dexamethasone implant completely degraded at the 4th month of postoperative follow-up.
Keywords
Author Keywords
Anterior migration Ozurdex posterior chamber
Effect of macular hole volume on postoperative central macular thickness
By
Ozturk, T (Ozturk, Taylan) ; Karahan, E (Karahan, Eyyup) ; Er, D (Er, Duygu) ; Kaya, M (Kaya, Mahmut) ; Kocak, N (Kocak, Nilufer) ; Kaynak, S (Kaynak, Suleyman)
(provided by Clarivate)
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ARQUIVOS BRASILEIROS DE OFTALMOLOGIA
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Purpose: To evaluate the association between macular hole volume (MHV) and postoperative central macular thickness (CMT) using spectral-domain optical coherence tomography (SD-OCT).
Methods: Thirty-three eyes of 30 patients with a large full-thickness idiopathic macular hole with or without vitreomacular traction who underwent surgical intervention were included in this cross-sectional study. Complete ophthalmological examination, including SD-OCT, was performed for all participants during the pre- and postoperative visits. MHV was preoperatively measured using SD-OCT, which captured the widest cross-sectional image of the hole. For normal distribution analysis of the data, the Kolmogorov-Smirnov test was performed, and for statistical analyses, chi-square, Student's t-test, Mann-Whitney U test, and Pearson's correlation coefficient test were performed.
Results: Mean preoperative best-corrected visual acuity (BCVA) and MHV were found to be 0.99 +/- 0.36 (range, 0.3-2.0) logMAR and 0.139 +/- 0.076 (range, 0.004-0.318) mm(3), respectively. Mean follow-up was 16.3 +/- 14.3 (range, 3-50) months. No statistical correlations were found between MHV and postoperative BCVA (p=0.588) and between MHV and disease recurrence (p=0.544). A weak negative correlation existed between MHV and final CMT scores (p=0.04, r=-0.383).
Conclusions: Greater MHV was found to be weakly associated with lower postoperative CMT scores.
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Author Keywords
Retinal perforations/surgery Tomography, optical coherence Vitrectomy Macula lutea Postoperative period
Rare Clinical Sign of Hodgkin's Lymphoma: Ocular Involvement
By
Ayhan, Z (Ayhan, Ziya) ; Karabag, RY (Karabag, Revan Yildirim) ; Alacacioglu, I (Alacacioglu, Inci) ; Kaynak, S (Kaynak, Suleyman) ; Koçak, N (Kocak, Nilufer)
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Source
TURK OFTALMOLOJI DERGISI-TURKISH JOURNAL OF OPHTHALMOLOGY
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Bilateral non-granulomatous anterior uveitis with left vitritis and macular edema were detected in a 19-year-old woman presenting with blurred vision in her left eye. Light microscopic study of the pathologic mediastinal lymph node that was detected via contrast computed tomography imaging during etiologic study revealed nodular sclerosing and mixed cellularity Hodgkin's lymphoma (HL). Ocular findings completely resolved with adriablastin, bleomycin, vinblastine, dacarbazine chemotherapy treatment. Herein, it is emphasized that HL should be remembered as one of the differential diagnoses in patients with ocular inflammatory pathologies such as uveitis and vasculitis. The ocular findings of HL are discussed.
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Author Keywords
Anterior uveitis Hodgkin's lympho mamacular edema posterior uveitis
Comparision of Optical Low Coherence Reflectometry Versus Ultrasonic Biometry in High Hypermetropia
By
Aydin, R (Aydin, Rukiye) ; Erdur, SK (Erdur, Sevil Karaman) ; Cabuk, KS (Cabuk, Kubra Serefoglu) ; Karahan, E (Karahan, Eyyup) ; Kaynak, S (Kaynak, Suleyman)
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Source
EYE & CONTACT LENS-SCIENCE AND CLINICAL PRACTICE
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Purpose: To compare anterior chamber depth (ACD), axial length (AL), and lens thickness (LT) measurements obtained by the Lenstar LS 900 (Haag-Streit AG) optical low-coherence reflectometry with those obtained by the A-scan contact ultrasound among patients with moderate and high hypermetropia.
Methods: Fifty-two eyes of 52 patients with moderate and high hypermetropia (spherical equivalent of +4 D or more) were examined in this study measurements of ACD, AL, and LT obtained by Lenstar were compared with those obtained by applanation A-scan ultrasound. All measurements were obtained by two independent examiners. The interdevice agreements were evaluated with Bland-Altman analyses.
Results: The mean age of the patients was 54.78 +/- 12.77 years (range 18-74 years). The mean spherical equivalent refractive power was +5.16 +/- 1.12 D (+4.0 to +8.75). The mean values of ACD, AL, and LT with A-scan were 3.05 +/- 0.34, 21.55 +/- 0.75, and 4.33 +/- 0.49 mm, respectively, whereas these values were 2.99 +/- 0.45, 21.58 +/- 0.78, and 4.20 +/- 0.44 mm, respectively, with Lenstar. There was statistically significant difference of LT between the two methods (P=0.02). The mean differences (lower/upper limit of agreement) of the ACD, AL, and LT values for A-scan ultrasound and Lenstar were -0.06 (-0.594/0.474), 0.04 (-0.380/0.459), and -0.12 (-0.739/0.502), respectively.
Conclusion: Among patients with moderate and high hypermetropia, the biometric measurements of ACD, AL, and LT by ultrasound and optical biometry were determined to be correlated and there was a high degree of agreement between contact A-scan ultrasonic biometry and Lenstar.
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Author Keywords
Hypermetropia A-scan ultrasound Optical low coherence reflectometry Biometry
Cilioretinal Artery Occlusion Combined with Central Retinal Vein Occlusion: What Is the Best Imaging Modality for the Follow-Up?
By
Kaya, M (Kaya, Mahmut) ; Ozturk, T (Ozturk, Taylan) ; Ayhan, Z (Ayhan, Ziya) ; Kocak, N (Kocak, Nilufer) ; Kaynak, S (Kaynak, Suleyman)
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Source
CASE REPORTS IN OPHTHALMOLOGICAL MEDICINE
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We report retinal structural changes of a 37-year-old man diagnosed with the concomitant occlusion of cilioretinal artery and central retinal vein. Comprehensive ophthalmological evaluation was performed, followed by spectral-domain optical coherence tomography (SD-OCT, Heidelberg), optical coherence tomography angiography (OCT angiography, Optovue Inc., Fremont, California, USA), fluorescein angiography, and color fundus photography. The use of OCT angiography and en face SD-OCT imaging as an adjunct test to map out correlative paracentral scotomas during follow-up allowed us to evaluate cilioretinal artery occlusion in the best way due to obtaining satisfactory images of the normal retinal vascular networks and areas of nonperfusion and congestion at various retinal levels.
Keywords
Keywords Plus
SPECTRUM
Evaluation of inner segment/outer segment junctions in different types of epiretinal membranes
By
Aydin, R (Aydin, Rukiye) ; Karahan, E (Karahan, Eyyup) ; Kaya, M (Kaya, Mahmut) ; Ozturk, T (Ozturk, Taylan) ; Cabuk, KS (Cabuk, Kubra Serefoglu) ; Kocak, N (Kocak, Nilufer) ; Kaynak, S (Kaynak, Suleyman)
(provided by Clarivate)
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ARQUIVOS BRASILEIROS DE OFTALMOLOGIA
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Purpose: This study was conducted to evaluate the relationships of inner/outer segment (IS/OS) junction disruption, macular thickness, and epiretinal membrane (ERM) grade with best-corrected visual acuity (BCVA), as well as the relationship between IS/OS junction disruption and ERM grade.
Methods: Fifty-four eyes of 54 patients with different grades of ERM were retrospectively reviewed. Patients were classified into three groups by ERM grade according to retinal striae and vessel distortion: grade/group 1, visible membranes without retinal striae or vessel distortion; grade/group 2, mild to moderate macular striae or vessel straightening; and grade/group 3, moderate to severe striae and vascular straightening. Correlations of BCVA with age, central retinal thickness, ERM grade, and IS/OS disruption as well as of IS/OS disruption, central macular thickness, and BCVA with ERM grade were evaluated.
Results: Twenty-nine (53.7%) eyes exhibited IS/OS junction disruption. Groups 1 and 2 differed significantly with respect to BCVA (p = 0.038), but groups 2 and 3 did not (p = 0.070). Central macular thickness was significantly greater in group 2 than in group 1 (p = 0.031) and in group 3 than in group 2 (p = 0.033). Groups 1 and 2 differed significantly in terms of IS/OS disruption (p = 0.000), but groups 2 and 3 did not (p = 0.310).
Conclusions: The IS/OS junction appears to be disrupted during the early stages of ERM. Grade 3 ERM is associated with a significantly higher incidence of IS/OS disruption.
Keywords
Author Keywords
Epiretinal membrane Retinal photoreceptor cell inner segment Diagnostic techniques ophthalmologic Tomography optical coherence/methods
Active Silicone Oil Removal with a Transconjunctival Sutureless System: Is the 23-Gauge System Safe and Effective?
By
Kaya, M (Kaya, Mahmut) ; Özyurt, A (Ozyurt, Ayhan) ; Öztürk, AT (Ozturk, Arif Taylan) ; Er, D (Er, Duygu) ; Kaynak, S (Kaynak, Suleyman) ; Koçak, N (Kocak, Nilufer)
(provided by Clarivate)
Source
TURK OFTALMOLOJI DERGISI-TURKISH JOURNAL OF OPHTHALMOLOGY
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Objectives: To evaluate the safety and efficacy of active silicone oil removal with a 23-gauge (G) transconjunctival sutureless system.
Materials and Methods: One hundred sixteen eyes of 113 patients who had previous retinal detachment surgery with pars plana vitrectomy and silicone oil injection surgery, and underwent silicone oil removal surgery with 23-G transconjonctival sutureless technique in our clinic between January 2009 and April 2014 were reviewed retrospectively. The patients were evaluated with regard to postoperative changes in best corrected visual acuity and intraocular pressure (IOP), and complications that occurred during and after surgery.
Results: Of the 113 patients with mean age of 61.1 +/- 9.7 years (29-88 years), 62 (54.8%) were males and 51 (45.2%) were females. Silicone oil removal was performed 8.43 +/- 5.24 months after the initial surgery. Mean follow-up was 13.38 +/- 4.35 months. Visual acuity improved in 69 eyes (59.48%). Anatomic success was achieved in 113 eyes (97.41%). Mean IOP was 16.2 +/- 7.2 mmHg at baseline and 14.4 +/- 2.6 mmHg at postoperative day 1 (p=0.643). Eight eyes needed suturation of at least one sclerotomy. Retinal redetachment occurred in 3 eyes (2.5%) resulting in a decrease in vision. There were no cases of choroidal detachment, endophthalmitis, clinically significant corneal endothelial decompensation, or macular edema.
Conclusion: Active removal of 1,300-centistoke silicone oil with a 23-G transconjunctival sutureless system is a simple, sutureless technique causing minor surgical trauma. Active removal of silicone oil with the 23-G transconjunctival sutureless technique was found to be effective and safe in both phakic and pseudophakic eyes.
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Author Keywords
23-gauge transconjunctival sutureless technique silicone oil removal
Comparative study of photodynamic therapy monotherapy versus triple management in age-related macular degeneration
By
Selim, A (Selim, Ahmet) ; Koçak, N (Kocak, Nilufer) ; Aslankara, H (Aslankara, Huseyin) ; Kaynak, S (Kaynak, Suleyman)
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TURKISH JOURNAL OF MEDICAL SCIENCES
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Aim: To compare the effectiveness of photodynamic therapy (PDT) and PDT combined with intravitreal triamcinolone (IVTA) and vascular endothelial growth factor inhibition (anti-VEGF) in age-related macular degeneration (AMD).
Materials and methods: Eighty eyes of 80 patients diagnosed with choroidal neovascularization (CNV) caused by AMD were included in the study. PDT was carried out on 40 eyes in group I, and PDT combined with 4 mg IVTA and anti-VEGF (1.25 mg bevacizumab in 20 eyes, 0.3 mg pegaptanib sodium in 20 eyes) was carried out in group II. The primary efficacy endpoint was the mean change from baseline visual acuity at month 12.
Results: Mean follow-up was 14.2 +/- 2.18 months in group I and 12.45 +/- 2.82 months in group II. In group I there was a 2.88 logMAR line decrease and 1.95 logMAR line increase in group II in vision between pretreatment and 12th month measurements (P < 0.05). Mean PDT session was 2.00 in group I and the mean combined treatment session was 1.15 in group II in the 12th month.
Conclusion: Combination of IVTA and anti-VEGF with PDT is more effective and safer than PDT monotherapy in the treatment of CNV secondary to AMD. Combination treatment decreases the frequency and number of treatment sessions for an improved visual prognosis.
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Author Keywords
Age-related macular degeneration bevacizumab choroidal neovascularization pegaptanib sodium photodynamic therapy
The Effects of Glaucoma and Age-Related Macular Degeneration on Quality of Life
By
Koçak, N (Kocak, Nilufer) ; Onur, BE (Onur, Behice Elif) ; Kaya, M (Kaya, Mahmut) ; Aslankara, H (Aslankara, Huseyin) ; Cimilli, HC (Cimilli, Hasan Can) ; Kaynak, S (Kaynak, Suleyman)
(provided by Clarivate)
Source
TURK OFTALMOLOJI DERGISI-TURKISH JOURNAL OF OPHTHALMOLOGY
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Objectives: The aim of the study was to assess the depressive and anxiety symptoms and the quality of life (QofL) in patients treated for glaucoma and age-related macular degeneration (AMD).
Materials and Methods: Between March 1 and June 30, 2008, 60 outpatients with glaucoma and AMD were included into the study. As controls, sixty patients with similar sociodemographic features and who applied to the Ophthalmology Clinics with refractive errors only were taken. All patients and controls were applied the 17-item Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), the World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF) Turkish version.
Results: The mean HDRS and HARS scores of the glaucoma and AMD patients were significantly higher than those of the controls (p<0.05). The mean HDRS and HARS scores did not show a significant difference between the patients with glaucoma and AMD (p>0.05). In the glaucoma and AMD groups, WHOQOL-BREF scores in the physical, social, environmental, and psychological domains were significantly lower than in the controls (p<0.05). The WHOQOL-BREF scores in the physical, social, environmental, and psychological domains did not show a significant difference between the patients with glaucoma and AMD (p>0.05).
Conclusion: It was shown that the QofL was impaired in patients with glaucoma and AMD who were more depressive and anxious. So that, we believe that it is very important to keep under observation the psychiatric symptoms of patients who have chronic eye diseases like glaucoma and AMD to increase the quality of their lives and to improve the prognosis.
Keywords
Author Keywords
AMD anxiety depression glaucoma quality of life
Bilateral foveal retinoschisis accompanying unilateral peripheral retinoschisis
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Source
INDIAN JOURNAL OF OPHTHALMOLOGY
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X-linked juvenile retinoschisis is a rare hereditary retinal disease characterized by a tangential splitting of the neurosensory retina which may cause early-onset visual impairment. Existence of the retinal neurosensory layer splitting on cross-sectional images of optical coherance tomography (OCT) and the absence of leakage on fluorescein angiography (FA) help confirming the diagnosis. Such diagnostic tests are also helpful in determining the management of the disease. However, most of the retinoschisis cavities remain stable and rarely extend to the posterior pole, many authors suggest laser prophylaxis to avoid the potential risk of retinal detachment due to holes in the outer retinal layer. Herein, we report a case with bilateral foveal retinoschisis accompanying unilateral peripheral retinoschisis who was evaluated with detailed ophthalmologic examination. Visual acuity, fundoscopy, OCT, and FA remained stable in the second year of follow-up after prophylactic argon laser treatment.
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Author Keywords
Fluorescein angiography optical coherance tomography prophylactic argon laser treatment retinoschisis
Outcomes of Cataract Surgery in Vitrectomized Eyes
By
Türüthan, D (Turuthan, Durgul) ; Koçak, N (Kocak, Nilufer) ; Eren, S (Eren, Sitki) ; Kaynak, S (Kaynak, Suleyman)
Source
TURK OFTALMOLOJI DERGISI-TURKISH JOURNAL OF OPHTHALMOLOGY
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Purpose: To evaluate the intraoperative complications and postoperative visual outcomes of phacoemulsification surgery for the secondary cataract in vitrectomized eyes.
Material and Method: We retrospectively evaluated 51 previously vitrectomized eyes of 51 patients who had undergone phacoemulsification and intraocular lens (PHACO(+) IOL) implantation surgery. PHACO+ IOL surgery was performed in our clinic between October 2008 and May 2011. Intraoperative complications and postoperative best-corrected visual acuity (BCVA) outcomes were analyzed.
Results: In this study, 31 out of 51 eyes had posterior subcapsular cataract. Cataract surgery was performed after a mean of 21.39 +/- 26.4 ( 6120, median 10.75) months following PPV. Mean preoperative and postoperative BCVA was measured to be 1.52 +/- 0.88 logMAR and 0.74 +/- 0.73 logMAR, respectively. In 25 eyes which had been filled with silicon oil, mean BCVA was 1.95 +/- 0.91 logMAR preoperatively and 1.15 +/- 0.84 logMAR postoperatively. In 18 (35.3%) eyes which had been filled with sulfur hexafluoride tamponade, mean BCVA was 1.17 +/- 0.47 logMAR preoperatively and 0.38 +/- 3.6 logMAR postoperatively. Peroperative zonular dialysis with instable deep anterior chamber occurred in two eyes, and posterior capsular tear occurred in one eye. Four eyes had Nd:YAG capsulotomy due to the posterior capsular opacity during the follow-up period.
Discussion: Despite the well-known difficulties encountered in vitrectomized eyes such as zonular weakness, increased mobility of the lens-iris diaphragm, posterior capsular instability and posterior capsular plaques, phacoemulsification in vitrectomized eyes proved to be a safe surgery, and increase in visual acuity can be achieved.
Keywords
Author Keywords
Complication phacoemulsification pars plana vitrectomy
Ocular Toxoplasmosis Developed After Liver Transplantation
By
Oguz, VA (Oguz, Vildan Avkan) ; Koçak, N (Kocak, Nilufer) ; Köse, H (Kose, Hatice) ; Ünek, T (Unek, Tarkan) ; Özbilgin, M (Ozbilgin, Mucahit) ; Karademir, S (Karademir, Sedat) ; Kaynak, S (Kaynak, Suleyman)
(provided by Clarivate)
Source
MIKROBIYOLOJI BULTENI
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Ocular toxoplasmosis after solid organ transplantation occurs usually within the first three months of primary infection or reactivation of latent infection. There are a few reports of ocular toxoplasmosis following liver transplantation in the literature, however, no reports were detected in the national data. In this report a 35-year-old female patient diagnosed as ocular toxoplasmosis following reactivation in the second year after liver transplantation, was presented. The case was successfully treated with trimet-hoprim/sulfamethoxazole and clindamycin. This case was presented to emphasize late presentation of toxoplasmosis in transplantation patients and to withdraw attention to the importance of serological investigations done before transplantation.
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Author Keywords
Toxoplasma gondii toxoplasmosis ocularl iver transplantation
Low-fluence photodynamic therapy combinations in the treatment of exudative age -related macular degeneration
By
Ozturk, T (Ozturk, Taylan) ; Oner, H (Oner, Hakan) ; Saatci, AO (Saatci, Ali Osman) ; Kaynak, S (Kaynak, Suleyman)
(provided by Clarivate)
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INTERNATIONAL JOURNAL OF OPHTHALMOLOGY
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10.3980/j.issn.2222-3959.2012.03.25
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AIM: To compare the efficacy of low-fluence photodynamic therapy (PDT) combinations in the treatment of age-related macular degeneration (AMD).
METHODS: Forty-five previously untreated eyes of 45 patients with exudative AMD whose best-corrected visual acuity (BCVA) was >= 0.3 (Snellen) were enrolled. 15 patients in Group I underwent low-fluence PDT (25J/cm(2)-300mW/cm(2) -83sec) and intravitreal pegaptanib combination, 15 patients in Group II underwent PDT (50J/cm(2)-600mW/cm(2)-83sec) and intravitreal pegaptanib combination while, 15 patients in Group III underwent intavitreal pegaptanib monotherapy. Complete ophthalmologic examinations were performed in pre and post treatment visits, and the results were statistically analised. A clinical activity score (CAS) was calculated by using changes in lesion size, amount of hemorrhage, staining pattern in FA and OCT measurement of intra/subretinal fluid. <= 3 logMAR lines of decrease in BCVA and decrease in CAS were considered as successful treatment.
RESULTS: The mean age of 19 female (42.2%) and 26 male (57.8%) patients was (72.82 +/- 8.02) years. Mean follow-up was (13.93 +/- 5.87) months. Lesion type was occult in 28 eyes (62.2%). Treatment success rates according to BCVA assessments were 86.7%, 80%, 60% and mean BCVA decrease were 0.3, 1.0, 2.2 logMAR lines in Group I, II and III, respectively (P >0.05). According to the changes in central macular thickness and CAS, no difference was found among the study groups(P=0.850 and P=0.811, respectively). Patients treated with combination regimens had lower intravitreal injection frequencies (P=0.015).
CONCLUSION: Combination regimen with intraviteal pegaptanib and low-fluence PDT seems to be safe and effective in stabilizing the clinical activity and BCVA in exudative AMD.
Keywords
Author Keywords
age-related macular degeneration photodynamic therapy low-fluence photodynamic therapy anti-VEGF
Keywords Plus
CHOROIDAL NEOVASCULARIZATION SECONDARY INTRAVITREAL BEVACIZUMAB VERTEPORFIN RANIBIZUMAB TRIAMCINOLONE PEGAPTANIB
Comparison Between Scleral Buckling Surgery with and without use of Operating Microscope in Cases of Rhegmatogenous Retinal Detachment
By
Tuncer, I (Tuncer, Ibrahim) ; Kaynak, S (Kaynak, Suleyman) ; Karahan, E (Karahan, Eyyup) ; Zengin, MÖ (Zengin, Mehmet Ozgur)
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Source
TURK OFTALMOLOJI DERGISI-TURKISH JOURNAL OF OPHTHALMOLOGY
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Objectives: To compare the results of scleral buckling surgery with and without use of operating microscope for primary rhegmatogenous retinal detachment (RRD).
Materials and Methods: This comparative study consisted of 74 eyes of 74 patients who underwent scleral buckling for primary RRD. Group 1 consisted of 35 patients (17 male and 18 female) who were operated using operating microscope and Group 2 consisted of 39 patients (19 male and 20 female) who were operated without operating microscope. Patients with post-equatorial breaks, retinal breaks greater than 90 degrees, proliferative vitreoretinopathy (>= C2), and those with follow-up period of less than six months were excluded from the study. The two groups were compared based on age, sex, etiology, anatomic success, and surgical complications (scleral perforation, iatrogenic retinal breaks, vitreous hemorrhage, buckle malposition, and vortex vein damage).
Results: Mean age was 64.11 +/- 7.91 years (range, 55-79 years) in Group 1 and 65.20 +/- 6.15 years (range, 56-80 years,) in Group 2. Mean age and gender were not statistically significantly different between the groups (p=0.508 and p=0.990, respectively). Etiological causes were revealed as myopia, peripheral retinal degeneration, pseudophakia, aphakia, trauma, and idiopathic. Etiological causes were not significantly different between the two groups (p>0.05, for all). Surgical complication rates were higher in Group 2, however, the differences were not statistically significant (p>0.05, for all). Anatomical success rates was similar between the two groups (80% in Group 1 and 79.5% in Group 2, p=0.956).
Conclusion: The results of scleral buckling surgery with and without use of operating microscope were not significantly different; However, operating microscope should be used especially in presence of risk factors for scleral complications.
Keywords
Author Keywords
Operating microscope retinal detachment scleral buckling
Comparison of Ranibizumab and Pegabtanib Sodium Monotherapies in Terms of Rates of Stabilization After the First Three Doses
By
Koçak, N (Kocak, Nilufer) ; Aslankara, H (Aslankara, Huseyin) ; Türüthan, D (Turuthan, Durgul) ; Kaynak, S (Kaynak, Suleyman)
Source
TURK OFTALMOLOJI DERGISI-TURKISH JOURNAL OF OPHTHALMOLOGY
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Purpose: To evaluate the short-term efficacy of intravitreal ranibizumab and pegaptanib Na injection in the treatment of wet type of age related macular degeneration (AMD).
Material and Method: We retrospectively reviewed the records of 30 patients (30 eyes) who were treated with monthly injections of intravitreal ranibizumab for three months and 30 patients (30 eyes) who were treated with intravitreal pegaptanib Na at 6-week intervals for a period of 18 weeks for wet-type AMD. Baseline clinical findings and demographic data, visual acuity (VA) and central macular thickness (CMT) before and after treatment, and stabilization of VA rate after treatment were evaluated.
Results: There were no statistically significant differences in age, sex and in terms of baseline types of angiographic lesions between the groups. Following ranibizumab treatment, VA with logMAR changed from 0.83 +/- 0.60 to 0.58 +/- 0.48. Stabilization of VA was achieved in 96.7% of patients (fewer than 15 letters lost). Mean CMT decreased from 487.23 +/- 72.03 mu m to 338.70 +/- 91.56 mu m. There were statistically significant changes in VA and CMT after ranibizumab treatment (p<0.001). Mean VA was 0.78 +/- 0.39 logMAR at initial examination and 0.83 +/- 0.47 logMAR at the last examination in pegaptanib Na group. Stabilization of VA was achieved in 83.3% of patients. The mean CMT decreased from 483.20 +/- 104.48 mu m to 454.03 +/- 80.47 mu M. There were no statistically significant changes in VA (p = 0.39) and CMT (p = 0.87) after pegabtanib Na treatment. At the end of follow-up, there were no ocular complications such as uveitis, endophthalmitis and glaucoma.
Discussion: Ranibizumab therapy led to significant improvements in both mean VA and CMT. Patients who received pegaptanib Na treatment had stability of VA, but no improvement in short-term period.
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Author Keywords
Age-related macular degeneration pegaptanib Na ranibizumab
Early Results of Ranibizumab Monotherapy in Patients with Choroidal Neovascularization
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Koçak, N (Kocak, Nilufer) ; Kaya, M (Kaya, Mahmut) ; Selver, ÖB (Selver, Ozlem Barut) ; Ayhan, Z (Ayhan, Ziya) ; Kaynak, S (Kaynak, Suleyman)
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TURK OFTALMOLOJI DERGISI-TURKISH JOURNAL OF OPHTHALMOLOGY
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Purpose: To evaluate the efficacy and safety of intravitreal ranibizumab monotherapy in patients with choroidal neovascularization (CNV) secondary to age-related macular degeneration.
Material and Method: This was a non-randomized, observational, retrospective trial during the period from April 2008 to January 2010 with data collection of 73 eyes from 65 consecutive CNV patients who underwent ranibizumab injection. Data collection at all visits included best-corrected visual acuity (BCVA), detailed ophthalmological examination, optical coherence tomography measurements, fluorescein angiography (FA) and retinal photography. All patients were treated with intravitreal ranibizumab, three times monthly. Additional ranibizumab was performed if one of the following changes was observed: spread of the lesion, increased central macular thickness (>300 mu m ), signs of active CNV leakage on FA, new hemorrhage, or loss of BCVA >= 5 letters on the ETDRS chart. The patients were followed up monthly.
Results: 33 patients were female and 32 were male with a mean age of 71.3 +/- 9.4 (range: 40-90) years. The mean follow-up period was 6.8 +/- 4.9 (range: 4-20) months. 21 patients (28.8%) were pseudophakic. Occult CNV was present in 45 eyes (61.4%), classic CNV in 23 (31.8%) eyes, and fibrovascular pigment epithelial detachment was present in 5 (6.8%) eyes. The mean BCVA was 0.8 +/- 0.5 logMAR before the injection and 0.6 +/- 0.4 logMAR at the last visit. The mean BCVA significantly improved (p=0.001) in all eyes, but there was no statistical difference between the subgroups (p>0.05). There was no major complication related to the injections.
Discussion: Intravitreal ranibizumab monotherapy was effective in increasing significantly and stabilizing BCVA in patients with CNV secondary to age-related macular degeneration. After ranibizumab treatment, regression of neovascularization was observed and no side effects were recorded.
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Author Keywords
Choroidal neovascularization complication ranibizumab monotherapy visual acuity
Transluminal Nd: YAG Laser Embolysis for Branch Retinal Artery Occlusion: A case Report
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Koçak, N (Kocak, Nilufer) ; Kaynak, S (Kaynak, Suleyman) ; Biçer, I (Bicer, Ilker) ; Kaynak, T (Kaynak, Tulin) ; Yucad, G (Yucad, Gul)
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TURK OFTALMOLOJI DERGISI-TURKISH JOURNAL OF OPHTHALMOLOGY
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A 57-year-old, male, type 2 diabetic patient with the diagnosis of acute form of right eye inferotemporal branch retinal artery occlusion which occurred three days ago was reported. The patient complained of right eye visual field deficit (horizontal upper quadrant) with decreased visual acuity of finger counting from two meters. On fundus examination, calcific embolus was noted with inferotemporal branch artery occlusion and macular edema. The embolus was fragmented (embolysis) with the Nd:YAG laser technique. Subhyaloid hemorrhage developed and was drained by posterior hyaloidotomy with Nd:YAG laser at the same session. Visual acuity increased and hemorrhage gradually absorbed on follow-up period. Final visual acuity was 8/10 with eccentric fixation. Recovery of blood flow in the occluded arteriole both in fundus examination and fluorescein angiography were noted.
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Author Keywords
Calcific embolus branch retinal artery occlusion Nd:YAG laser embolysis
Histological changes in the healing process of sclerotomy sites after 20-gauge and transconjunctival 23-and 25-gauge incisions in experimental model
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Koçak, N (Kocak, Nilufer) ; Lebe, B (Lebe, Banu) ; Selver, ÖB (Selver, Ozlem Barut) ; Zengin, MÖ (Zengin, Mehmet Ozgur) ; Kaynak, S (Kaynak, Suleyman)
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TURKISH JOURNAL OF MEDICAL SCIENCES
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Aim: To evaluate the healing mechanism and histological changes of the 20-gauge standard, and 23- and 25-gauge transconjunctival sutureless vitrectomy (TSV) incisions in rabbits.
Materials and methods: Twelve of 16 albino rabbits' right eyes underwent sclerotomy of either 20-gauge standard, or 23-gauge or 25-gauge TSV incisions. Four rabbits were tested as controls. The study eyes were examined clinically on the first postoperative day and in 3-day periods for 2 weeks. After 2 weeks, rabbits were euthanized; globes were enucleated and underwent histological examination. The sclerotomy sites were investigated histopathologically under light microscope for wound healing semicantitatively.
Results: Pathological sections were examined to monitor the healing course of the sclerotomy sites. Edema, mononuclear inflammatory cell infiltration, fibroplasia, foreign body reaction, neovascularization, and reactive-regenerative changes on ciliary body were evaluated and scored. Fibroplasia and reactive-regenerative changes on ciliary body were statistically significant in eyes treated with 20-gauge standard sclerotomy (P < 0.05). For foreign body reaction results, there was no statistically significant difference between all groups (P > 0.05).
Conclusion: Conventional 20-gauge sclerotomies required conjunctival peritomy and suturing. Transconjunctival 23-gauge and 25-gauge sclerotomy incision procedures without sutures and peritomy decrease overall surgical time, avoid the local inflammatory reaction to the suture materials, decrease postoperative inflammation, and support rapid healing recovery.
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Author Keywords
Sclerotomy transconjunctival sutureless vitrectomy incision wound healing
Analysis of Macular Pigment Optical Density Change with Age
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TURK OFTALMOLOJI DERGISI-TURKISH JOURNAL OF OPHTHALMOLOGY
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Purpose: To evaluate the macular pigment optical density (MPOD) changes with age and other risk factors.
Material and Method: Eighty-seven normally sighted healthy subjects (34 men, 53 women) ranging in age from 20 to 50 years were evaluated for MPOD. All subjects underwent detailed ophthalmological examination. Iris colors, smoking history and serum lipid profile were recorded. Heterochromatic flickering photometer (MacuScopeTM) was used for the measurements. The subjects were divided into two groups according to their age (Group 1: 20-35 years and Group 2: 36-50 years).
Result: The mean age was 29.1 +/- 4.1years in Group 1 and 43.4 +/- 4.5 years in Group 2. Iris color was green-blue in 31% of Group 1 subjects and 24% of Group 2 subjects (p>0.05). The overall mean MPOD was 0.685 +/- 0.253 for Group 1 and 0.508 +/- 0.203 for Group 2. There was a significant negative correlation between MacuScopeTM readings and age (p=0.001). The MPOD was measured low in 2.6% of Group 1 and in 12.2% of Group 2; high in 34.2% of Group 1 and in 16.3% of Group 2. Smoking history was present in 28.9% of Group 1 and in 28.6% of Group 2 subjects. High serum lipid levels were found in 4.1% of Group 2.
Discussion: There was a significant negative correlation between MacuScopeTM readings and age in healthy subjects. In our study, there was no correlation between serum lipid profile and smoking history with MPOD. Future controlled trials with larger sample size are needed to investigate the relationship between MPOD and risk factors other than age.
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Author Keywords
MacuScope TM macula pigment optical density macular pigment
Approach to Rhegmatogenous Retinal Detachment Combined with Dislocated Crystalline Lens
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Yilmaz, O (Yilmaz, Orhan) ; Koçak, N (Kocak, Nilufer) ; Kaya, M (Kaya, Mahmut) ; Aydin, R (Aydin, Rukiye) ; Kaynak, S (Kaynak, Suleyman)
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TURK OFTALMOLOJI DERGISI-TURKISH JOURNAL OF OPHTHALMOLOGY
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Purpose: To assess the rhegmatogenous retinal detachment with crystalline lens dislocation and discuss appropriate surgical techniques.
Material and Method: The surgical technique and clinical approach in five patients with rhegmatogenous retinal detachment and crystalline lens dislocation were assessed. Four patients were male and one was female. Encircling scleral buckling surgery was performed 12 mm from the limbus in all cases. In order to visualize the vitreous body, triamcinolone acetonide was injected into the vitreous cavity and then vitrectomy was carried out. Perfluorodecaline (DK Line) was injected to elevate the dislocated lens to the iris level. The lens material was aspirated by pars plana phacofragmentation and cortex remnants were cleaned by vitrectomy. Laser endophotocoagulation was performed 360 degree on the peripheral retina through the perfluorodecaline. Six o'clock peripheral iridectomy was done and dispersive viscoelastic material was injected into the anterior chamber. Then perfluorodecaline was exchanged with 1300 cs silicone oil.
Result: The mean age of the subjects was 29 years (range, 26-33 years). The patients were followed for a mean period of 68 months (range, 56-86 months). The cause of crystalline lens dislocation was trauma in two cases and Marfan syndrome in three cases. The mean preoperative best-corrected visual acuity was less than 1/10. Visual acuity increased postoperatively in all eyes; the mean visual acuity was 1/10. In the follow-up period, retina was attached in all cases. As silicone oil was injected in all cases, intraocular lens insertion was not performed.
Discussion: Perfluorocarbon liquids used in the crystalline lens dislocation with rhegmatogenous retinal detachment can either flatten the retina or lift the dislocated lens to the iris plane and decrease endophacoemulsification- related complications.
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Author Keywords
Crystalline lens dislocation pars plana vitrectomy phacofragmentation retinal detachment
Microincisional cataract surgery and Thinoptx rollable intraocular lens implantation
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Cinhuseyinoglu, N (Cinhuseyinoglu, Necdet) ; Celik, L (Celik, Lider) ; Yaman, A (Yaman, Aylin) ; Arikan, G (Arikan, Gul) ; Kaynak, T (Kaynak, Tulin) ; Kaynak, S (Kaynak, Suleyman)
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GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY
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Microincisional cataract surgery is a safe procedure with a very short learning period for an experienced cataract surgeon and rollable ultrathin intraocular lenses eliminate the need for enlargement of corneal incision. The purpose of the study was to evaluate the safety and efficacy of cataract surgery through a corneal microincision and implantation of rollable ultrathin intraocular lenses. The setting was Dokuz Eylul University Medical Faculty, Ophthalmology Department, Izmir, Turkey and SSK Okmeydani Hospital, Ophthalmology Clinic, Istanbul, Turkey.
Ninety eyes in 85 patients were operated on through clear corneal microincisions with sleeveless phacoemulsification and rollable intraocular lenses were implanted. Forty-six of the patients were men and 39 were women between the ages of 27 and 83, with a mean of 51 years. Two eyes had atrophic senile macular degeneration, 4 eyes had nonspecific retinal pigment epithelial changes with chorioretinal atrophy, and 4 patients had diabetes mellitus without retinopathy. Three eyes had posterior capsular opacifications of unknown etiology. Two eyes had primary open angle glaucoma (PAAG) with cup to disc ratios of about 0.5. Three eyes had dense nuclear sclerosis of grade 4 with very low visibility of retinal structures. Other patients had no ocular or systemic pathology other than nuclear/corticonuclear cataract of grade 2-3. Uncorrected and best spectacle-corrected distance and near visual acuities, keratometric values, and refractive status were noted preoperatively and 1 week, 1 month, and 6 months postoperatively. Statistical analysis of keratometric changes between preoperative and postoperative findings was performed using the paired samples t test.
At 6 months postoperatively, 1 patient had a best spectacle-corrected visual acuity (BSCVA) of 0.2, the patient with atrophic senile macular degeneration. The rest of the eyes achieved a BSCVA of 0.63 or better. At 6 months postoperatively, 55 (61.11%) eyes had uncorrected visual acuities (UCVA) equal to or better than 0.8 and 83 (92.22%) eyes had BSCVA equal to or better than 0.8 according to the Snellen chart. The mean postoperative corneal astigmatisms at 1 week, 1 month, and 6 months were 0.69 +/- 0.43 D, 0.66 +/- 0.46 D and 0.65 +/- 0.48 D respectively. Statistical analysis revealed a significant change in corneal astigmatisms at the 1st week visit (p < 0.05), but not at the 1st and 6th month visits (p > 0.05) compared with preoperative findings.
Based on the limited data in the literature and in this study, it is not possible to make concrete decisions about the benefits and disadvantages of the ThinOptx IOL for longer durations. Intraoperatively, this IOL apparently eliminates the need for enlargement of the corneal incision during implantation. However, the statistical insignificance of induced astigmatisms after microincisions and classical phacoincisions should also be taken into consideration. We conclude that ThinOptx IOL is a pioneering intraocular lens implant that will contribute to the exciting future of cataract refractive surgical procedures. However, both clinical and laboratory investigations are needed to clearly describe the long-term effectiveness of this new rollable IOL.
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Author Keywords
microincisional cataract surgery Thinoptx rollable IOL
The effects of intravitreally injected bevacizumab on the retina and retina pigment epithelium: experimental in-vivo electron microscopic study in intact versus vitrectomized eyes
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Kocak, N (Kocak, Nilufer) ; Ozogul, C (Ozogul, Candan) ; Kaynak, S (Kaynak, Suleyman) ; Sonmez, U (Sonmez, Ulker) ; Zengin, MO (Zengin, Mehmet Ozgur) ; Karti, O (Karti, Omer) ; Ozturk, T (Ozturk, Taylan) ; Ergin, MH (Ergin, Mehmet Hilmi)
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CENTRAL EUROPEAN JOURNAL OF MEDICINE
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To analyze the retinal toxicity of bevacizumab at various doses both in vitrectomized and non-vitrectomized rabbit models. Twenty-eight rabbits were included in the study. Twenty-four rabbits were assigned to six groups, with 4 of the rabbits in the control group. The animals in Groups 1, 2 and 3 received bevacizumab at a dose of 0.3 mg, 0.5 mg and 1.5 mg/eye, respectively. The rabbits in Groups 4, 5 and 6 received intravitreal bevacizumab of 0.3 mg, 0.5 mg and 1.5mg/eye, respectively, after gas compression vitrectomy. Two weeks after the procedure, the rabbits were euthanized. Retina tissue samples were then obtained and examined with both light and electron microscopes. In Groups 1, 2 and 3 after bevacizumab injection, toxic degeneration in the photoreceptor and retinal pigment epithelium cells was observed via electron microscopic examination. The findings in Groups 4 and 5 were normal as compared to the control group. In Group 6, toxicity in the bipolar neurons and photoreceptor cells was noticed. Increased toxicity and retinal penetration were noticed in all administered doses of bevacizumab in the presence of vitreous. In addition, ocular toxicity occurred through the injection of the highest dose of bevacizumab after vitrectomy. It is possible that the bevacizumab dose and the, vitreous are as important as the drug half-life in the vitreous.
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Author Keywords
Anti-VEGFB Bevacizumab Electron microscopy
Side effects during photodynamic therapy with verteporfin
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Örel, T (Orel, Talip) ; Koçak, N (Kocak, Nilufer) ; Selim, A (Selim, Ahmet) ; Öner, FH (Oner, Ferit Hakan) ; Kaynak, S (Kaynak, Suleyman) ; Ergin, M (Ergin, Mehmet)
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TURK OFTALMOLOJI DERGISI-TURKISH JOURNAL OF OPHTHALMOLOGY
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PURPOSE: To evaluate the side effects of ocular photodynamic therapy (PDT) with verteporfin at the time of therapy and early post-treatment period.
MATERIAL-METHODS: 283 patients who had been performed PDT with verteporfin between October 2003 May 2007 were evaluated retrospectively in this study. Therapies were performed at Dokuz Eylul University Outpatient Hospital at which intensive care unit can be used whenever necessary. Pain, edema, extravasation at injection site, back pain related to infusion, photosensitivity reaction, nausea, vomiting and allergic reactions were evaluated. Transient visual abnormalities (cloudy vision, flashing lights), severe decrease in visual acuity (at first week, ? 4 lines), lacrimation disorders, subretinal and intravitreal hemorrhage were evaluated as ocular side effects either during or immediately after the therapy.
RESULTS: Among 283 patients included to study; two patients (%0.7) complained about tenderness of antecubital vein line, 12 patients (%4) complained about back pain and one patient ( % 0,3) complained about nausea at the time of infusion, one patient ( 0,3) complained about blurring in visual acuity (? 4 lines) and in four patients (%1,4) subretinal hemorrhages were detected within the first week. Photosensitivity reaction, allergic reaction, lacrimation disorders and intravitreal hemorrhage were not detected in any patients.
CONCLUSION: Side effects of PDT with verteporfin at the time of management and soon after the therapy are generally temporary and do not effect the quality of life. Given detailed information is very important to the patients and their relatives before the management for controlling the side effects of PDT with verteporfin.
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Author Keywords
Age related macular degeneration photodynamic therapy side effects of photodynamic therapy verteporfin
Transscleral fixation of a black diaphragm intraocular lens in severely traumatized eyes requiring vitreoretinal surgery
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JOURNAL OF CATARACT AND REFRACTIVE SURGERY
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7th Congress of the Mediterranean-Ophthalmological-Society
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The records of 4 eyes of 4 patients who had transscleral fixation of black diaphragm intraocular lenses (IOLs) after vitreoretinal surgery due to complications of severe perforating trauma were retrospectively reviewed. The transscleral fixation was performed 4 to 13 months after the vitreoretinal surgery. All patients reported a subjective decrease in glare and photophobia, with improved visual acuity in 2 eyes during a mean follow-up of 3 years. Cystoid macular edema was noted in 1 eye and transitory intraocular pressure elevation due to intraocular silicone oil in 1 eye. Severe perforating eye injury is frequently associated with extensive iris defects and lenticular and vitreoretinal complications. Although visual acuity may not be the primary concern in these eyes, favorable visual rehabilitation can be achieved following proper management of the retinal complications and transscleral fixation of black diaphragm IOLs to overcome glare and photophobia.
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Keywords Plus
PARS-PLANA VITRECTOMY ARTIFICIAL IRIS ANIRIDIA IMPLANTATION MANAGEMENT CATARACT DEFECTS DEVICES
Intraocular pressure elevation after intravitreal triamcinolone acetonide injection and predictive factors
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Koç, T (Koc, Tulin) ; Koçak, N (Kocak, Nilufer) ; Kaynak, S (Kaynak, Suleyman) ; Kaya, M (Kaya, Mahmut) ; Arikan, G (Arikan, Gul) ; Günenç, U (Gunenc, Uzeyir) ; Ergin, M (Ergin, Mehmet)
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TURK OFTALMOLOJI DERGISI-TURKISH JOURNAL OF OPHTHALMOLOGY
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PURPOSE: To analyze the incidence of intraocular pressure (IOP) elevation following intravitreal triamcinolone acetonide (IVTA) injection and predictive factors for IOP elevation.
METHODS: Charts of 179 patients of 217 eyes who underwent IVTA injection between January 2005- May 2007 were retrospectively reviewed. All cases underwent full ophthalmological examination before IVTA injection. Indications of IVTA injection, IVTA doses, injection times, systemic disease, history of glaucoma were noted.
RESULTS: Mean follow-up was 8.85 +/- 7.125 months (1-41 months). Mean age of the patients was 62,7 +/- 12,7 years (21-88 years). 173 (80 %) eyes received 4 mg /0.1 ml of TA, 44 (20 %) eyes received 2 mg /0.1 ml of TA. The mean baseline of IOP was 14.54 +/- 1.86 mmHg (10-21 mmHg). Fifty -three eyes (%24.4) showed IOP elevation of five mmHg or higher after the IVTA injection. Fourty-eight out of 53 eyes (%90.5) received 4 mg /0.1 ml of single dose of TA. IOP was higher than 15 mmHg before the IVTA injection in 36 (68 %) out of 53 eyes. Twenty-seven (51 %) of these eyes received topical medication. Viscocanolostomy was performed in two patients. The mean age of the patients with high IOP after the injection was significantly lower than the mean age of the study group (p<0.05). The mean IOP elevation time after the injection was 51.3 +/- 46 days.
CONCLUSION: Young age, IVTA dose and baseline IOP higher than 15 mmHg before the IVTA injection were found as a risk factors for IOP elevation after the IVTA injection. IOP elevation after the IVTA injection within six months should be kept in mind.
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Author Keywords
Glaucoma intravitreal triamcinolone acetonide intraocular pressure
Pediatric silicone oil surgery
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Kocak, N (Kocak, Nilufer) ; Saatci, AO (Saatci, Ali Osman) ; Ilhan, HD (Ilhan, Hatice Deniz) ; Yaman, A (Yaman, Aylin) ; Oner, FH (Oner, Ferit Hakan) ; Kaynak, S (Kaynak, Suleyman) ; Ergin, MH (Ergin, Mehmet Hilmi)
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JOURNAL OF PEDIATRIC OPHTHALMOLOGY & STRABISMUS
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Purpose: To evaluate clinical characteristics, surgical aspects, and visual outcomes of pediatric patients who underwent pars plana vitrectomy and silicone oil injection for complicated retinal detachment.
Patients and Methods: The records of 24 patients (25 eyes) younger than 18 years were retrospectively reviewed. All patients underwent pars plana vitrectomy and silicone oil injection for complicated retinal detachment between January 1995 and June 2004 in the Ophthalmology Department of Dokuz Eylul University, Izmir, Turkey. All patients had follow-up at or beyond 6 months.
Results: Nineteen (79.2%) boys and 5 (20.8%) girls were included. Mean age was 12.6 years (standard deviation, +/- 3.5; range, 5 to 17). Five eyes (20%) had blunt ocular trauma. Eleven eyes (44%) had penetrating trauma. Three eyes (12%) had high myopia. Four eyes (16%) had congenital cataract surgery. One eye (4%) had redetachment 1 month after vitreoretinal surgery performed at another clinic. One case had bilateral proliferative vitreoretinopathy with an undefined cause. The retina remained attached in 18 (72%) of 25 eyes at the final examination (17 were totally attached; 1 was partially attached). Mean follow-up was 23.4 months (standard deviation, +/- 20.5; range, 6 to 108). Postoperative visual acuity improved to 1/10 or better only in 6 eyes (24%) at the last examination.
Conclusion: In pediatric patients with complicated retinal detachment, silicone oil injection for intraocular tamponade is an option for treatment, but visual outcome is poorer than for adults.
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SEVERE PROLIFERATIVE VITREORETINOPATHY COMPLICATED RETINAL DETACHMENTS RANDOMIZED CLINICAL-TRIAL VITRECTOMY INJECTION CHILDREN EYES GAS
Effect of ultraviolet B radiation on the absorption characteristics of various intraocular lenses
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Kocak, N (Kocak, Nilufer) ; Kaynak, S (Kaynak, Suleyman) ; Ilknur, T (Ilknur, Turna) ; Ozkan, S (Ozkan, Sebnem) ; Erdogan, G (Erdogan, Gokhan) ; Cingil, G (Cingil, Guray)
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OPHTHALMOLOGICA
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Background: The aim of this study was to determine the effect of ultraviolet B (UVB) exposure on UV filters of various intraocular lenses (IOLs). Methods: Eight samples each of the hydrophobic acrylic, hydrophilic acrylic and silicone IOLs were used. Four IOLs of each type was selected randomly as the control group while the remaining four IOLs of each type were exposed to a UVB dose of 1.4 J/cm(2) (2.40 mW/cm(2)) for 9.45 min, two times with a 4-week interval. IOLs were evaluated for any sign of opacification under microscope weekly. After a follow-up period of 16 weeks, spectrometry for UV filter absorption rates, scanning electron microscopy for deposit formation and energy dispersive X-ray analysis for elemental composition were performed for all IOLs, and findings of the control group IOLs were compared with those of the UVB-exposed IOLs. All these procedures were done at the Department of Ophthalmology, Faculty of Medicine, Dokuz Eylul University. Results: All the IOLs were free of any opacification during the follow-up period. Spectrometric analysis of their UV filters revealed a change in absorption rates in the hydrophilic acrylic and silicone IOLs compared to the control IOLs of the same type. Only the hydrophobic acrylic IOLs preserved the same UV absorption curve after UVB exposure. Conclusion: The pathogenesis of IOL opacification is still undetermined. Some reports claimed that the UV light was the responsible factor. Our experimental study revealed that high doses of UVB did not cause any opacification though they impaired the function of UV filters of the hydrophilic acrylic and silicone IOLs. Copyright (c) 2007 S. Karger AG, Basel
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Author Keywords
intraocular lens opacification intraocular lensultraviolet B ultraviolet filter
Intraoperative Floppy Ins Syndrome in Cataract Patients on Tamsulosin
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Koçak, N (Kocak, Nilufer) ; Kaynak, S (Kaynak, Suleyman) ; Koç, T (Koc, Tulin) ; Aslankara, H (Aslankara, Huseyin)
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TURK OFTALMOLOJI DERGISI-TURKISH JOURNAL OF OPHTHALMOLOGY
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Purpose: To assess the intraoperative floppy iris syndrome (FIS) in cataract patients.
Methods: Patients who had cataract surgery between November 2005-February 2006 at Ophthalmology Department of Dokuz Eylul University were evaluated in terms of intraoperative FIS and the percentage of cataract patients on systemic sympathetic a-1 antagonist tamsulosin (Flomax r) medication.
Results: Seven out of 147 (4.7%) patients were taking tamsulosin (Fiomax r) for benign prostatic hypertrophy. Nine eyes of seven patients underwent cataract surgery. The intraoperative FIS was noted in four out of nine (44.4%) eyes.
Conclusion: Intraoperative floppy iris syndrome should be taken into account in patients who are on the drug tamsulosin (Flomax r) for benign prostatic hypertrophy to avoid possible complications during cataract surgery.
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Floppy iris syndrome cataract tamsulosin
Myopia and Ciliochoroidal Effusion After a Minor Blunt Trauma in juvenile Glaucoma
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Altintas, O (Altintas, Ozgul) ; Yüksel, N (Yuksel, Nursen) ; Kaynak, S (Kaynak, Suleyman) ; Karabas, VL (Karabas, V. Levent)
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TURK OFTALMOLOJI DERGISI-TURKISH JOURNAL OF OPHTHALMOLOGY
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10-year-old boy was hit on his left eye by a small toy one day ago he was admitted to our clinic with the complain of visual loss in his left eye, The visual acuity at this time was finger counting at 5-10 cm in the left eye. Slit lamp examination of the left eye revealed a sligtly shallower anterior chamber and 2mm hyphema. Intraocular pressure(IOP) was 4 mmHg. Dilated ophthalmoscopy showed commotio retinae and dilatation and engorgement of both arteries and veins, and c/d ratio was 0.4. The spherical equivalent of the refraction measured by autorefractometer was -8.60 D(-7.50 (116-2.25) D) in the left eye. The visual acuity at this time was 0.7 in the right eye and IOP was 44 mmHg. Dilated ophthalmoscopy showed nearly total glaucomatous optic atrophy while the arteries and veins in normal configuration. In the 4th day of treatment, the visual acuity improved to the level 0.2 and the IOP elevated to 47 mmHg in the left eye. At this time, the c/d ratio was nearly totally glaupomatous optic atrophy in the left eye, refraction and the configuration of arteries and veins were returned to normal. The TOP in the right eye was 35 mmHg in spite of three topical antiglaucomatous agents. Bilateral trabeculectomy was suggested to the patient with the diagnosis of bilateral juvenile glaucoma. The ciliochoroidal effusion and traumatic myopia after a minor blunt trauma is presented in accordance to the literature.
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Author Keywords
Trauma myopia ciliochoroidal effusion juvenile glaucoma
A Renal Transplant Recipient With Orbital Apex Syndrome Due to Invasive Aspergillosis
By
Yener, S (Yener, Serkan) ; Çelik, A (Celik, Ali) ; Tekis, D (Tekis, Dilek) ; Sütay, S (Sutay, Semih) ; Kaynak, S (Kaynak, Suleyman) ; Yilmaz, N (Yilmaz, Nusret) ; Çavdar, C (Cavdar, Caner) ; Çamsari, T (Camsari, Taner)
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TURKISH NEPHROLOGY DIALYSIS AND TRANSPLANTATION JOURNAL
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Abstract
A Turkish patient was evaluated because of loss of vision of the left eye at the second month after renal transplantation. The ophtalmologic examination showed the involvement of IIIrd, IVth and VIth cranial nerves and orbital apex syndrome was diagnosed. Further investigations showed the presence of acute inflammation in left ethmoid and sphenoid paranasal sinuses. The results of the paranasal sinus endoscopy and pathological examination of the punch biopsies were consistent with invasive aspergillosis sinusitis. Cranial and orbital magnetic resonance images showed orbital sellulitis with the involvement of orbital apex. There was also cavernous sinus thrombosis and thrombosis of internal carotid arteria. The patient was treated with liposomal amphothericin B for 56 days and with itraconazole 200 mg/day for the maintenance therapy. A significant regression of the invasive sinusitis was achieved with this therapy. The patient is now on haemodialysis with good health.
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Author Keywords
Transplant orbital apex syndrome aspergillosis