Publications by authors named "Ali Kal"

24 Publications

  • Page 1 of 1

Comparison of the effects of anti-vascular endothelial growth factor treatments on pigment epithelial detachment in age-related macular degeneration.

Int Ophthalmol 2021 Jan 22. Epub 2021 Jan 22.

Department of Ophthalmology, School of Medicine, Başkent University, Ankara, Turkey.

Purpose: The aim of this study is to compare structural and visual outcomes of naive neovascular age-related macular degeneration patients with significant pigment epithelial detachment (PED), treated with ranibizumab and aflibercept.

Methods: This was a retrospective case series that included 33 naive patients treated with ranibizumab and 25 with aflibercept. The patients were followed with pro re nata (PRN) after first three intravitreal injections. LogMAR visual acuity, PED height and radius on spectral domain optical coherence tomography findings were compared.

Results: Baseline mean PED height was 270.39 ± 114.14 µm and 315.24 ± 115.8 µm (p = 0.14); baseline mean PED radius was 2063.64 ± 942.75 µm and 1958.88 ± 452.22 µm (p = 0.61); and baseline BCVA was 1.16 ± 0.73 and 1.09 ± 0.69 (p = 0.73), for ranibizumab, and aflibercept group, respectively. In aflibercept group, there was statistically significant decrease in PED height at first, third and 12th months. In PED radius, decrease was greater in aflibercept group, however not significant. In addition, in aflibercept group visual acuity was better at all three months; however, none of them were significant.

Conclusion: Although the maximum improvement was seen at third month, final visual acuity and parameters of PED were better in aflibercept group. The efficacy of the both drug to choroidal neovascularization was known; however, in cases with significant PED, aflibercept can be consider for the first-level treatment.
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http://dx.doi.org/10.1007/s10792-021-01695-3DOI Listing
January 2021

Evaluation of the tear parameters of ovulation induction patients in a short time period with anterior segment optical coherence tomography.

Arq Bras Oftalmol 2020 Nov-Dec;83(6):511-516

Obstetrics and Gynaecology Department, Faculty of Medicine, Baskent University, Konya, Turkey.

Purpose: The effects of sex steroid hormones on tearparameters are known. Theaim of this studywas to examine the effects on tear parameters during exposure to high-dose sex steroids in a short period of time.

Methods: Forty patients who were admitted to the infertility clinic of our hospital and planned to undergo ovulation induction with exogenous gonadotropins were included in our study. Prior tothe initiation of ovulation induction, the basal levels of estradiol were measured on day 3 of the menstrual cycle and ophthalmologic examinations were performed by the ophthalmology department of our hospital. The estradiol levels were-measured on the day ofovulation induction usinghuman chorionic gonadotropin and compared with basal estra-diol; eye examinations were also repeated.

Result: Forty women with reproductive period and average age of 33.3 ± 4.2 years were included in this study. Basal levels of estradiol were significantly (p<0.001) higher after ovulation induction than before induction. The scores in the break-up timeand after induction were 6.2 ± 2.8 sn and 8.4 ± 1.4 sn, respectively. The values of Schirmer's test were 14.3 ± 7.1 mm and 20.6 ± 6.2 mm before and after induction, respectively. Both values were significantly higher after ovulation induction (p<0.001; p=0.001, respectively).

Conclusion: We observed impro-vemet in tear function tests following the use of estradiol even for a limited time.The use of estradiol during menopause may improve dry eye symptoms in patients.
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http://dx.doi.org/10.5935/0004-2749.20200095DOI Listing
February 2021

Spectral domain optical coherence tomography findings of patients with ankylosing spondylitis.

Int Ophthalmol 2020 Oct 12;40(10):2727-2734. Epub 2020 Jun 12.

Department of Ophthalmology, School of Medicine, Başkent University, Ankara, Turkey.

Purpose: The aim of this study is to evaluate the possible effects of (ankylosing spondylitis) AS on choroidal thickness (CT) and other retinal layers using spectral domain optical coherence tomography (SD-OCT).

Methods: This cross-sectional study group comprised 41 AS patients and age and sex-matched 46 control subjects. None of our patients had active anterior uveitis during the measurements. We evaluated and compared CT, retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, focal loss volume (FLV) and global loss volume (GLV) of the participants.

Results: The CT of the patients at 1500 µm (286.20 µm ± 65.81), 1000 µm (309.55 µm ± 85.33) nasally to the fovea and subfoveal layer (339.93 µm ± 69.93) were thicker than in controls (p = 0.007, p = 0.037, p = 0.008). Except nasal layer, all RNFL layers were significantly thinner than controls (p < 0.001). GCC and macular thickness were also thinner than controls (p < 0.001).

Conclusion: In conclusion, present findings may suggest that the AS disease may affect the choroidal, RNFL and GCC thickness by disease's own inflammatory effect, independently from the uveitis history.
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http://dx.doi.org/10.1007/s10792-020-01458-6DOI Listing
October 2020

Evaluation of Iridocorneal Angle, Choroidal Thickness, and Retinal Nerve Fiber Layer Thickness in Children With a History of Retinopathy of Prematurity.

J Glaucoma 2020 Feb;29(2):112-116

Department of Ophthalmology, Başkent University School of Medicine, Konya Research Hospital, Konya.

Purpose: Retinopathy of prematurity (ROP) is proliferative retinopathy affecting premature infants associated with abnormal maturation of the retinal vasculature. We sought to evaluate iridocorneal angle, choroidal thickness, and retinal nerve fiber layer thickness (RNFLT) of the children that have a history of ROP using spectral-domain optical coherence tomography.

Patients And Methods: Fifty eyes of 28 children with a history of ROP and 46 eyes of 23 healthy school-aged children were included in this study. RNFLT, choroidal thickness, and iridocorneal angle parameters [trabecular iris angle, angle opening distance (AOD500), and trabecular iris space area (TISA500) 500 μm from the scleral spur] were evaluated using spectral-domain optical coherence tomography. Student t test was used to compare the mean of the parameters. Correlations between the variables were investigated based on the Pearson or Spearman correlation coefficient.

Results: Subfoveal (ROP: 253.98±42.5; control: 286.2±71.9; P=0.045), 500 µm (ROP: 242.04±41.8; control: 276.7±45.3; P=0.003), 1000 µm (ROP: 237±39.7; control: 270.15±55.93; P=0.007), and 1500 µm (ROP: 224.16±37.5; control: 259.75±55.2; P=0.003) temporal choroidal thicknesses were significantly thinner in ROP history children. None of the RNFLT parameters and ganglion cell complex thickness were different between groups. Iridocorneal angle parameters were significantly lower in children with ROP history. (trabecular iris angle: ROP=31.35±3.9 degrees, control=35.4±4.5 degrees, P<0.001; TISA500: ROP=0.167±0.05 mm, control=0.21±0.05 mm, P=0.003; AOD500: ROP=480.96±160.4 µm, control=542.95±161.2 µm, P=0.035).

Conclusions: ROP is associated with differences in the iridocorneal angle. Possible iridocorneal angle pathology should be a consideration in children with a history of ROP.
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http://dx.doi.org/10.1097/IJG.0000000000001413DOI Listing
February 2020

Retinal vascular density evaluation of migraine patients with and without aura and association with white matter hyperintensities.

Acta Neurol Belg 2019 Sep 14;119(3):411-417. Epub 2019 Feb 14.

Department of Ophthalmology, Faculty of Medicine, Konya Research Hospital, Başkent University, 42000, Konya, Turkey.

Underlying pathophysiological mechanism of migraine is not all clear; however, recent reports suggested that neurovascular system is involved. We aimed to evaluate the retinal vessel densities of migraine patients with and without aura and the associations with white matter hyperintensities (WMH), using optical coherence tomography angiography (OCTA). We recruited 28 migraine with aura (MWA) patients, 26 migraine without aura (MWO) and age and sex-matched 34 healthy controls in our study. All participants were evaluated with optical coherence tomography (OCT) and OCTA for optic nerve parameters and retinal vessel densities with RTVue XR AVANTI. On macular OCTA, superficial and deeper retinal foveal vessel density (VD) were significantly lesser in MWA and MWO than controls. On optic nerve OCTA, whole optic disc, peripapillary, superior hemisphere, superior layer and temporal layer VD were significantly lesser in MWA and MWO. In group of MWA with the WMH, deeper foveal VD and superior hemisphere VD, average RNFL, superior hemisphere and superior layer were significantly lesser and also foveal avascular zone was significantly larger than the group of without WMH. Alterations of VD in patients with migraine are showed in our study. In addition, in group of MWA these alterations have associations with WMH. Supporting these findings with further reports can be useful to understand the pathophysiology of this disease.
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http://dx.doi.org/10.1007/s13760-019-01094-7DOI Listing
September 2019

Retinal detachment in albinism.

Clin Ophthalmol 2018 5;12:651-656. Epub 2018 Apr 5.

Department of Ophthalmology, Baskent University, Konya, Turkey.

Purpose: To report the visual and anatomic outcomes of albino retinal detachment (ARD) repair.

Methods: Collaborative retrospective analysis of ARD. Outcome measures were number of surgical interventions, final retinal reattachment, and best corrected visual acuity (BCVA) at last follow-up.

Results: Seventeen eyes of 16 patients (12 males; mean age =37.8 years) had the following complications at presentation: macula off (14), total (7) or inferior detachment (5), proliferative vitreoretinopathy (5), detectable break (16), lattice (5), horseshoe tears (9), and giant tear or dialysis (4). Mean number of interventions was 1.8 (range =1-5) and included cryopexy (15) with scleral buckle (11), and/or vitrectomy (8). Mean initial BCVA was counting finger (CF) 1 m and at last follow-up (mean 77 months) CF4m with mean improvement of 4.5 lines (early treatment diabetic retinopathy study) (=0.05). Intraoperative choroidal hemorrhage occurred in three eyes. The retina was finally attached in 14 eyes, with residual inferior detachment in three eyes with silicone oil in situ. Silicone oil was kept in six of seven eyes because of residual inferior detachment (3) and removal of silicone oil, which led to redetachment (1) or fear of redetachment (2).

Conclusion: Repair of ARD may require several interventions, with the need to keep silicone oil in several cases due to nystagmus and reduced melanin pigment.
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http://dx.doi.org/10.2147/OPTH.S158785DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5896647PMC
April 2018

Choroidal thickness in patients with fibromyalgia and correlation with disease severity.

Indian J Ophthalmol 2018 Mar;66(3):428-432

Department of Internal Medicine, Nephrology, School of Medicine, Baskent University, Konya Research Hospital, Konya, Turkey.

Purpose: To evaluate and compare choroidal thickness in patients with fibromyalgia (FM) and healthy controls.

Methods: In this prospective, cross-sectional study, forty eyes of 40 patients with FM and 40 eyes of 40 age- and sex-matched healthy subjects were enrolled. FM was diagnosed according to the American College of Rheumatology criteria. The choroidal thickness measurements of the subjects were obtained using spectral-domain optical coherence tomography (RTVue-100, Optovue). Widespread pain index (WPI), symptom severity scale (SSS), and fibromyalgia impact questionnaire (FIQ) scores were recorded. The choroidal thickness measurements of the groups were compared, and correlations among the WPI, SSS, and FIQ scores and these measurements were calculated.

Results: Choroidal thicknesses at 1500 μm nasally were 198.5 ± 46.7 μm and 306.3 ± 85.4 μm; at 1000 μm nasally were 211.7 ± 50.2 μm and 310.05 ± 87.26 μm; at 500 μm nasally were 216 ± 55.05 μm and 311.5 ± 83.4 μm; at subfoveal region were 230.9 ± 58.4 μm and 332.4 ± 91.3 μm; at 500 μm temporally 227.5 ± 58.1 μm and 318.15 ± 92.3 μm; at 1000 μm temporally 224.5 ± 57.07 μm and 315.1 ± 84.2 μm; at 1500 μm temporally 212.5 ± 56.08 μm and 312.9 ± 87.8 μm in the FM and control groups, respectively (P < 0.001). Choroidal thicknesses were thinner at all measurement location, except temporal 1000 and 1500 in patients with FIQ score ≥50 than in FIQ score <50.

Conclusion: The results of this study demonstrated that choroidal thickness decreases in patients with FM and correlated with disease activity. This choroidal changes might be related with the alterations in autonomic nervous system functioning. Further studies are needed to evaluate the etiopathologic relationship between choroidal thickness and FM.
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http://dx.doi.org/10.4103/ijo.IJO_877_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859601PMC
March 2018

Evaluation of Dry Eye Using Anterior Segment Optical Coherence Tomography in Patients With End-Stage Renal Disease Undergoing Hemodialysis.

Ther Apher Dial 2018 Apr 4;22(2):104-108. Epub 2017 Dec 4.

Ophthalmology Department, Başkent University, School of Medicine, Ankara, Turkey.

The aim of the present study was to evaluate dry eye parameters with conventional tests and tear meniscus with Anterior Segment Optical Coherence Tomography (AS-OCT) in patients with end-stage renal disease (ESRD). Thirty-eight ESRD patients undergoing hemodialysis, and 40 healthy individuals were enrolled. An ocular surface disease index questionnaire (OSDI) was administered. Before conventional dry eye tests, tear meniscus were evaluated using AS-OCT. After a complete ocular examination, Schirmer and break-up time (BUT) tests were performed and probable corneal staining was investigated. Schirmer test and BUT values were significantly lower in ESRD patients (P < 0.05). OSDI scores and corneal staining scores were significantly higher in ESRD patients (P < 0.05). Tear meniscus height, tear meniscus depth, and tear meniscus area, which were obtained by AS-OCT were significantly lower in patients with ESRD (P < 0.05). Tear meniscus evaluation using AS-OCT is an effective and non-invasive method to assess tear meniscus in patients with ESRD. Patients with ESRD undergoing hemodialysis should obtain regular ophthalmic examination, especially for dry eye.
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http://dx.doi.org/10.1111/1744-9987.12612DOI Listing
April 2018

Evaluation of retrobulbar blood flow and choroidal thickness in patients with rheumatoid arthritis.

Int Ophthalmol 2018 Oct 20;38(5):1825-1831. Epub 2017 Jul 20.

Department of Nephrology, Baskent University, Konya, Turkey.

Purpose: To evaluate whether retrobulbar blood flow and choroidal thickness (CT) are affected in patients with rheumatoid arthritis (RA), and the relationship between these values.

Methods: We evaluated 40 eyes of 20 RA patients and 40 eyes of 20 healthy controls. The enhanced depth imaging optical coherence tomography, color Doppler imaging, was held. Statistical analysis was performed.

Results: Peak systolic velocity (PSV) of ophthalmic (OA) and central retinal artery (CRA) were significantly higher in RA. No significant difference was observed when end-diastolic velocity (EDV) of OA and CRA was compared between the groups. The resistivity index (RI) of OA and CRA was higher in RA. Perifoveal/subfoveal CT was lower in RA. Negative correlation was detected between the RI of OA and the perifoveal CT, and a positive correlation was detected between RI of CRA and CT.

Conclusions: Ocular hemodynamics is effected by RA and can exaggerate ocular complications of various vascular diseases such as diabetes mellitus, hypertension, retinal vascular occlusions.
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http://dx.doi.org/10.1007/s10792-017-0656-6DOI Listing
October 2018

Effect of fingolimod (FTY720) on choroidal thickness in patients with multiple sclerosis.

Mult Scler Relat Disord 2017 May 16;14:4-7. Epub 2017 Mar 16.

Department of Nephrology, Başkent University Hospital, Konya, Turkey. Electronic address:

Objective: Using spectral domain optical coherence tomography (SD-OCT), to compare the choroidal thickness in a healthy population (group 1), with newly diagnosed multiple sclerosis (MS) patients (group 2), with MS patients who underwent β-interferon monotherapy (group 3) and MS patients who underwent fingolimod therapy for 1 year (group 4) METHODS: Twenty-five control subjects (25 eyes), 24 newly diagnosed (24 eyes) MS patients, 22 MS patients who underwent fingolimod monotherapy for 1 year (22 eyes), and 24 MS patients who underwent β-interferon monotherapy for 1 year (24 eyes) were included in this study. The control group consisted of age- and gender-matched healthy individuals. The choroidal thickness measurements were performed using a high-speed and high-resolution SD-OCT device. The choroidal thickness measurements were compared using a One Way Anova and Post-Hoc Tukey test.

Results: Ninety-five eyes of 95 participants were included in this study. The mean age of the control group was 27.83±4.60, and it was 26.83±6.79, 27.87±6. 46 and 27.58±6.65 in the newly diagnosed MS group, fingolimod group and β-interferon group, respectively. In fingolimod group N-1000, N-1500 and T-1500 was significantly lower than control group. (p=0.026, p=0.06 p=0.13) CONCLUSION: Choroidal thickness values at N-1000, N-1500 and T-1500 levels in fingolimod group were found lower than in control but higher than in newly diagnosed MS group. This result can be explained with the therapeutic effect of the fingolimod on MS.
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http://dx.doi.org/10.1016/j.msard.2017.03.005DOI Listing
May 2017

The comparison of antimicrobial effectiveness of contact lens solutions.

Int Ophthalmol 2017 Oct 13;37(5):1103-1114. Epub 2016 Oct 13.

Department of Microbiology, Çekirge Public Hospital, Bursa, Turkey.

Purpose: The aim of this study was to compare the effects of widely used multipurpose contact lens solutions against Staphylococcus aureus and Pseudomonas aeruginosa, in addition to cystic and trophozoite forms of Acanthamoeba castellanii and A. polyphaga, that cause microbial keratitis.

Methods: Three multipurpose solutions were tested: SOLO-care, ReNu, and Opti-Free Express. The test solutions were challenged with P. aeruginosa (ATCC 27853) and S. aureus (ATCC 2913) based on the ISO stand-alone and regiment test procedure for disinfecting products, A. polyphaga (ATCC 30871) and A. castellanii (1501/1A) cystic and trophozoite forms. Multipurpose solutions were sampled for surviving microorganisms at manufacturer's minimum recommended disinfection time. The number of viable organisms was determined, and log reductions were calculated.

Results: ReNu and SOLO-care resulted in a reduction greater than the required mean 3.0 logarithmic reduction against S. aureus, and SOLO-care and Opti-Free Express resulted in a reduction more than the required mean 3.0 logarithmic reduction against P. aeruginosa. Against the cystic and trophozoite forms of A. castellanii, the log reduction provided by SOLO-care was 1.01 and 1.31 log, respectively. ReNu provided a 0.83 log reduction of the cystic form and a 1.21 log reduction of the trophozoite form. Using Opti-Free Express, the log reduction for both forms was 1.31. SOLO-care led to a 0.61 log reduction of the cystic form of A. polyphaga and a 1.01 log reduction of the trophozoite form. ReNu provided a 0.41 log reduction of the cystic form and a 4.99 log reduction of the trophozoite form. Opti-free Express resulted in a 0.89 log reduction of the cystic form and a 3.11 log reduction of the trophozoite form.

Conclusions: Multipurpose contact lens solutions using similar regimens can show different disinfection abilities.
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http://dx.doi.org/10.1007/s10792-016-0375-4DOI Listing
October 2017

Evaluation of choroidal and retinal thickness measurements in adult hemodialysis patients using spectral-domain optical coherence tomography.

Arq Bras Oftalmol 2016 Jul-Aug;79(4):229-32

Department of Ophthalmology, School of Medicine, Baskent University, Ankara, Turkey.

Purpose: To assess the effect of hemodialysis on retinal and choroidal thicknesses using spectral-domain optical coherence tomography (SD-OCT).

Methods: In this prospective interventional study, 25 hemodialysis patients (17 male, 8 female) were enrolled. All participants underwent high-speed, high-resolution SD-OCT (λ=840 mm; 26.000 A-scans/s; 5 µm resolution) before and after hemodialysis. Choroidal thickness was measured perpendicularly from the outer edge of the retinal pigment epithelium to the choroid-sclera boundary at the fovea and at five additional points: 500 µm and 1000 µm nasal to the fovea and 500 µm, 1000 µm, and 1500 µm temporal to the fovea. Two masked physicians performed the measurements. Choroidal and retinal thicknesses before and after hemodialysis were compared.

Results: The median choroidal thicknesses before and after hemodialysis were 182 µm (range, 103-374 µm) and 161 µm (range, 90-353 µm), respectively (P<0.001). The median retinal thicknesses were 246 µm (range, 179-296 µm) before and 248 µm (range, 141-299 µm) after hemodialysis (P>0.05). Systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, heart rate, and ocular perfusion pressure significantly decreased after hemodialysis (P<0.001). Intraocular pressure did not vary significantly (P=0.540).

Conclusion: Hemodialysis seems to cause a significant decrease in choroidal thickness, whereas it has no effect on retinal thickness. This significant decrease in choroidal thickness might be due to the extensive fluid absorption in hemodialysis, which could result in decreased ocular blood flow.
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http://dx.doi.org/10.5935/0004-2749.20160066DOI Listing
April 2017

The protective effect of prophylactic ozone administration against retinal ischemia-reperfusion injury.

Cutan Ocul Toxicol 2017 Mar 30;36(1):39-47. Epub 2016 Mar 30.

h Department of Anesthesiology and Reanimation , Medical Faculty, Selcuk University , Konya , Turkey.

Introduction: Retinal ischemia-reperfusion (IR) injury is associated with many ocular diseases. Retinal IR injury leads to the death of retinal ganglion cells (RGCs), loss of retinal function and ultimately vision loss. The aim of this study was to show the protective effects of prophylactic ozone administration against retinal IR injury.

Materials And Methods: A sham group (S) (n = 7) was administered physiological saline (PS) intraperitoneally (i.p.) for 7 d. An ischemia reperfusion (IR) group (n = 7) was subjected to retinal ischemia followed by reperfusion for 2 h. An ozone group (O) (n = 7) was administered 1 mg/kg of ozone i.p. for 7 d. In the ozone + IR (O + IR) group (n = 7), 1 mg/kg of ozone was administered i.p. for 7 d before the IR procedure and at 8 d, the IR injury was created (as in IR group). The rats were anesthetized after second hour of reperfusion and their intracardiac blood was drawn completely and they were sacrificed. Blood samples were sent to a laboratory for analysis of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), malondialdehyde (MDA), total oxidant score (TOS) and total antioxidant capacity (TAC). The degree of retinal injury was evaluated according to changes in retinal cells and necrotic and apoptotic cells using the TUNEL method. Data were evaluated statistically with the Kruskal-Wallis test.

Results: The number of RGCs and the inner retinal thickness were significantly decreased after ischemia, and treatment with ozone significantly inhibited retinal ischemic injury. In the IR group, the degree of retinal injury was found to be the highest. In the O + IR group, retinal injury was found to be decreased in comparison to the IR group. In the ozone group without retinal IR injury, the retinal injury score was the lowest. The differences in the antioxidant parameters SOD, GSH-Px and TAC were increased in the ozone group and the lowest in the IR group. The oxidant parameters MDA and TOS were found to be the highest in the IR group and decreased in the ozone group.

Discussion: IR injury is also positively correlated with the degree of early apoptosis. This study demonstrated that ozone can attenuate subsequent ischemic damage in the rat retina through triggering the increase of the antioxidant capacity.
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http://dx.doi.org/10.3109/15569527.2016.1156120DOI Listing
March 2017

Abducens Nerve Palsy and Ipsilateral Horner Syndrome in a Patient With Carotid-Cavernous Fistula.

J Craniofac Surg 2015 Oct;26(7):e653-5

*Department of Ophthalmology, Baskent University, Konya †Department of Ophthalmology, Baskent University, Ankara ‡Department of Radiology §Department of Plastic and Reconstructive Surgery, Baskent University, Konya, Turkey.

The combination of abducens nerve palsy and ipsilateral Horner syndrome was first described by Parkinson and considered as a localizing sign of posterior cavernous sinus lesions. The authors present a case with right abducens nerve palsy with ipsilateral Horner syndrome in a patient with carotid-cavernous fistula because of head trauma. The patient was referred to the ophthalmology clinic with diplopia complaint after suffering a head trauma during a motorcycle accident. Cerebral angiography showed low-flow carotid-cavernous fistula.
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http://dx.doi.org/10.1097/SCS.0000000000002131DOI Listing
October 2015

Retinal and choroidal thickness changes after single anti-VEGF injection in neovascular age-related macular degeneration: ranibizumab vs bevacizumab.

Eur J Ophthalmol 2014 Nov-Dec;24(6):904-10. Epub 2014 May 5.

Department of Ophthalmology, Cukurova University School of Medicine, Adana - Turkey.

Purpose: To evaluate and compare the effects of single intravitreal injection of ranibizumab and bevacizumab on central retinal and choroidal thickness in patients with neovascular age-related macular degeneration (AMD).

Methods: Forty eyes of 40 patients with neovascular AMD that underwent intravitreal injection of vascular endothelial growth factor inhibitors (anti-VEGFs) were included. Patients were randomized into 2 groups: 20 eyes received ranibizumab and 20 eyes received bevacizumab injection. Central retinal and choroidal thicknesses of all eyes at baseline and 1 month postinjection scans were measured with Fourier-domain optical coherence tomography (OCT). Student t test and Mann-Whitney U test were used to compare the data.

Results: The mean central retinal thickness (CRT) showed significant decrease after single injection of ranibizumab (from 345.0 µm to 253.5 µm, p<0.01) and bevacizumab (from 329.5 µm to 251.0 µm, p<0.01) at the first month, respectively. There was no significant difference regarding the CRT change between groups (p = 0.39). The mean choroidal thickness decreased from 158.6 µm (115-317) to 155.5 µm (111-322) in the ranibizumab group and from 211.5 µm (143-284) to 201.5 µm (93-338) in bevacizumab group. The decrease was not significant between groups (p = 0.35).

Conclusions: Intravitreal injection of both ranibizumab and bevacizumab provided a significant decrease in CRT; however, the agents caused no significant change in choroidal thickness. Additionally, no difference between ranibizumab versus bevacizumab was observed related to macular edema inhibition.
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http://dx.doi.org/10.5301/ejo.5000478DOI Listing
December 2014

Unusual presentation of an intraocular foreign body retained for sixty years.

Cont Lens Anterior Eye 2014 Jun 12;37(3):234-5. Epub 2013 Dec 12.

Department of Ophthalmology, Baskent University, Faculty of Medicine, Ankara, Turkey.

Intraocular foreign bodies may remain quiescent for many years particularly if they are not metallic. We report a case of a missed intraocular stone foreign body that had remained asymptomatic underneath the iris for 60 years and appeared during cataract surgery.
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http://dx.doi.org/10.1016/j.clae.2013.11.004DOI Listing
June 2014

Dry eyes and migraines: is there really a correlation?

Cornea 2012 Dec;31(12):1414-6

Department of Ophthalmology, Faculty of Medicine, Selçuk University, Konya, Turkey.

Purpose: The purpose of this study was to evaluate the tear film functions and clinical symptoms of patients with migraines.

Methods: This observational comparative study consisted of 33 migraine (26 women and 7 men) patients referred from neurology clinics and 33 (22 women and 11 men) control subjects referred from ophthalmology outpatient clinics. The control subjects had neither systemic nor ocular disease nor any type of headache. All 66 patients underwent a complete ophthalmic examination and diagnostic tests for dry eye, including tear break-up time, Schirmer test with topical anesthesia, lissamine green staining, and an ocular surface disease score. Patients with migraine were classified as migraine with an aura, migraine without an aura, and basilar migraine; a pain score from 1 to 4 was determined for each patient, based on the American Headache Society's Migraine Disability Assessment Test.

Results: Of the 33 patients who participated in the migraine group, 17 (51%) suffered from migraine with aura, 11 (33%) suffered from migraine without aura, and 5 (15%) suffered from basilar migraine. Significant differences in dry eye scores were found between the patients with migraine and the control subjects. In the migraine group, the mean tear break-up time was 7.75±2.37 seconds, whereas in the control group it was 9.15±1.93 seconds. For the Schirmer test, the migraine group had a mean value of 12.09±4.95 mm/5 minutes, whereas the control group had a mean value of 14.90±4.26 mm/5 minutes. Testing with lissamine green staining resulted in a mean value of 1.00±0.16 in the migraine group and 0.30±0.46 in the control group. In the migraine group, the mean for the ocular surface disease index scoring was 36.27±17.54. In the control group, it was 28.42±9.0. A significant difference (P<0.05) was found in the dry eye syndrome testing results between the 2 groups in this study.

Conclusions: An increased frequency of dry eye disease was found to occur in patients with migraine, which might suggest that migraine headaches are related to dry eye disease. Some migraine attacks may be aggravated in the presence of dry eye syndrome.
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http://dx.doi.org/10.1097/ICO.0b013e318247ec2aDOI Listing
December 2012

Intraorbital epidermoid cyst: a 5-year-old with exophthalmos and strabismus.

J Craniofac Surg 2012 Mar;23(2):e93-5

Department of Ophthalmology, Selcuk University, Konya, Turkey.

A 5-year-old girl with right exophthalmos and esotropia presented to ophthalmology outpatient clinics. Orbital computed tomography revealed a 20- to 30-mm oval soft tissue mass lying superolateral to the right lateral rectus muscle in the orbit. The patient was operated on by a neurosurgical team, the csyt was removed totally, and examination of the pathologic specimen, which reveals the epidermoid cyst, was performed. After the operation, exophthalmos and esotropia were improved, and visual acuity was increased. Although itis seen as a rare entity in the orbit, epidermoid cyst must be considered during the investigation of exophthalmos.
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http://dx.doi.org/10.1097/SCS.0b013e31824683baDOI Listing
March 2012

Proptosis, congestion, and secondary glaucoma due to carotid-cavernous fistula after embolization.

J Craniofac Surg 2011 Sep;22(5):1963-5

Ophthalmology Department, and the †Neurosurgery Department, Selcuklu Faculty of Medicine, Selcuk University, Konya, Turkey.

Carotid-cavernous fistulas (CCFs) are traumatic or spontaneously occurring communications between the carotid artery and the cavernous sinus. Carotid-cavernous fistulas can be due to a direct connection or indirect connections between the carotid artery system and the cavernous sinus. According to the etiologic classification, they may be of traumatic or spontaneous origin, and according to the angiography classification, they may be of direct or dural. Most CCFs are of spontaneous origin, and these are reported as frequently self-healing lesions. Spontaneous CCFs are mostly secondary to arteriosclerotic changes, which explains the increased ratio of elderly patients. Traumatic CCFs are usually of high-flow type and need intervention. The symptoms are various usually correlated to the size and type of venous drainage. The most frequent symptoms on presentation are proptosis, conjunctivitis, and chemosis; however, this picture may be complicated by optic nerve edema, cranial nerve palsies, and intracranial hemorrhage. We report a case with right low-flow dural CCF, which has worsened after angiography and recovered totally soon after endovascular embolization process.
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http://dx.doi.org/10.1097/SCS.0b013e31822ea840DOI Listing
September 2011

Pediatric endocanalicular diode laser dacryocystorhinostomy: results of a minimally invasive surgical technique.

Eur Arch Otorhinolaryngol 2011 Sep 27;268(9):1283-8. Epub 2011 Mar 27.

Department of Otolaryngology, Cumhuriyet University School of Medicine, Turkey.

The purpose of this study was to evaluate the effectiveness of endocanalicular diode laser dacryocystorhinostomy (DCR), which is a minimally invasive surgical technique, in pediatric patients with congenital nasolacrimal duct obstruction (NLDO). A retrospective study was carried out on patients treated between October 2008 and August 2009 for nasolacrimal duct obstruction with an endocanalicular diode laser procedure. Patients diagnosed as having nasolacrimal duct obstruction were included in this study and an endocanalicular diode laser procedure was performed. The main outcome measures were patients' previous treatments, clinical presentation, operative and postoperative complications, postoperative follow-up and resolution of epiphora. Eighteen children (10 girls, 8 boys) with a mean age of 6.11 ± 2.08 years (range, 4-10) underwent 20 endocanalicular laser DCR operations for congenital NLDO. In all eyes (100%), there was a history of epiphora and chronic dacryocystitis; two (10%) presented with acute dacryocystitis. Previous procedures included probing and irrigation of all eyes (100%) and silicone tube intubation in nine eyes (45%). None of the patients underwent any previous DCR operations. During a mean postoperative follow-up period of 20.50 ± 3.24 months (range, 14-24 months), the anatomical success rate (patency of ostium on nasal endoscopy) was 100%, and the clinical success rate (resolution of epiphora) was 85%. Endocanalicular diode laser DCR is an effective treatment modality for pediatric patients with congenital NLDO that compares favorably with the reported success rates of external and endoscopic endonasal DCR. Moreover, it has an added advantage of shorter operative time, less morbidity and avoidance of overnight admission.
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http://dx.doi.org/10.1007/s00405-011-1585-zDOI Listing
September 2011

Endocanalicular diode laser dacryocystorhinostomy for nasolacrimal duct obstruction: short-term results of a new minimally invasive surgical technique.

J Craniofac Surg 2010 Nov;21(6):1932-4

Aknet Center of Ophthalmology, Konya, Turkey.

Aim: To evaluate the results, complications, effectiveness, and operative results of the endocanalicular laser dacryocystorhinostomy (ECL DCR) in the distal obstructions of the lacrimal drainage system.

Methods: Sixty eyes of 57 patients who had a diagnosis of distal obstruction of the lacrimal drainage system were evaluated retrospectively in this study. All patients underwent ECL DCR by diode laser between October 2008 and July 2009. Forty-nine patients (86%) were females, 8 patients (14%) were males, and age distribution was between 3 and 84 years old (median, 40 y). The canaliculi were intubated by a silicone tube. The patency of the nasolacrimal system was controlled by lacrimal lavage, loss of epiphora, and endoscopic evaluation of the endonasal rhinostomy site with routine follow-up scheduled at first day and 1-week, 1-month, and 3-month postoperative intervals.

Results: After the 60 ECL DCRs, 10 patients underwent revision ECL DCR because of the persistent epiphora. The patency of the nasolacrimal duct or the decrease of the symptoms was assigned as success. There were no symptoms at all in 83.3% of the patients.

Conclusions: The ECL DCR in the treatment of the distal obstructions of the lacrimal drainage system was easily tolerated by the patients, cosmetically preferred because there was no incision and scar formation with high success rates, and a minimally invasive alternative technique.
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http://dx.doi.org/10.1097/SCS.0b013e3181f4eeb6DOI Listing
November 2010

Comparison of surgical outcomes of endonasal dacryocystorhinostomy with or without mucosal flaps.

Auris Nasus Larynx 2009 Oct 17;36(5):555-9. Epub 2009 Mar 17.

Department of Otolaryngology-Head and Neck Surgery, Baskent University, Ankara, Turkey.

Objective: The goals of this study were to evaluate the long-term results of endoscopic endonasal dacryocystorhinostomy (DCR) with or without a posterior mucosal flap and to compare the surgical success rates of that procedure in patients with a nasolacrimal duct obstruction.

Patients And Methods: We retrospectively investigated the results of 78 endoscopic endonasal DCRs performed at the Baskent University, Department of Otolaryngology between December 2000 and March 2007 on 74 patients with a lacrimal obstruction. The patients were divided into two groups. During surgery, the posterior mucosal flap was preserved in 27 patients (group A) and removed in 47 patients (group B). All patients underwent intubation with a silicone tube at the conclusion of surgery. The silicone tube was removed within 6 months after surgery. The mean follow-up period was 36 months (range, 2-78 months). The results obtained were then compared.

Results: Granulation tissue and synechia developed between the lateral nasal wall and the middle turbinate in one patient in group A (revision surgery was not required). In group B, granulation tissue at the rhinostomy opening was found in seven patients, and in four of those subjects, the granulation tissue obstructed the neo-ostium. These four patients underwent a second operation. In group B, synechia was noted between the middle turbinate and the lateral nasal wall in two of 47 patients. In group A, the procedure was successful for all patients except one in whom granulation tissue developed, and in group B, the surgical success rate was 88.3%.

Conclusion: In endoscopic endonasal DCR, the closure of bare bone with a posteriorly based nasal mucosal flap that creates an anastomosis between the lacrimal sac mucosa and the nasal mucosa decreases the formation of granulation tissue. But, there is no significant difference of success rate between two groups.
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http://dx.doi.org/10.1016/j.anl.2009.01.005DOI Listing
October 2009

Bilateral -14.0 diopters index myopia successfully treated with cataract surgery: a case report.

Ann Ophthalmol (Skokie) 2006 ;38(1):81-2

Department of Ophthalmology, Cumhuriyet University School of Medicine, Sivas, Turkey.

We report a 60-year-old man with bilateral nuclear cataract and -14.0 diopters index myopia. Following uncomplicated phacoemulsifications and posterior chamber intraocular lens implantations on both eyes, right and left axial lengths were 22.58 and 22.60 mm with otobiomeric A-scan ultrasound, respectively. Three-month corrected visual acuity was 20/20 in the right eye with a -1.00 x 130 degrees cylinder and 20/20 in the left eye with -0.50 spheres and -1.00 x 100 degrees cylinders.
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http://dx.doi.org/10.1385/ao:38:1:81DOI Listing
January 2007

The relation between anticardiolipin antibodies and complications of type 2 diabetes mellitus.

Saudi Med J 2006 Jun;27(6):902-4

Department of Internal Medicine, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.

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June 2006