Publications by authors named "Aysegul Mavi Yildiz"

15 Publications

  • Page 1 of 1

Spectral domain optical coherence tomography assessment of macular and optic nerve alterations in patients recovered from COVID-19: a comparative study.

Can J Ophthalmol 2021 Jul 5. Epub 2021 Jul 5.

Bursa Uludag University School of Medicine, Department of Chest Diseases, Bursa, Turkey.

Objective: To quantify microstructutal alterations in the macula and peripapillary retinal nerve fibre layer (RNFL) in patients recovered from coronavirus disease 2019 (COVID-19) using spectral domain optic coherence tomography (SD-OCT).

Design: Retrospective, observational.

Participants: This comparative, cross-sectional study included patients who recovered from COVID-19 (Group 1) and age- and sex-matched normal controls (Group 2).

Methods: A comprehensive ophthalmic examination, including best-corrected visual acuity and biomicroscopic anterior and posterior segment examination was performed. SD-OCT analysis of the macula and peripapillary RNFL was obtained for each participant. In addition, patient demographics and comorbidities were recorded.

Results: 238 eyes of 122 subjects (Group 1: n = 63; Group 2: n = 59) were included. The incidence of coexisting comorbidity was higher in Group 1 (n = 26/63, 41.3%) compared with Group 2 (n = 12/59, 20.3%) (p = 0.013). The central foveal thickness (CFT) was significantly higher in Group 1 (271.0±26.8 µm) than Group 2 (263.2±22.0 µm) (p = 0.015). The average outer nuclear layer (ONL) thickness at central fovea in Group 1 (85.4±13.3 µm) was significantly thicker than that in Group 2 (81.4±15.2 µm) (p = 0.035). The mean peripapillary RNFL thickness of Group 1 (102.6±8.8 µm) and Group 2 (100.9±8.3 µm) were similar (p = 0.145). The mean choroidal thickness of groups at the fovea and at 1500 µm nasal and temporal to the fovea were not significantly different (p > 0.05 for all).

Conclusion: Significant thickness alterations in individual retinal layers and CFT was detected in post-COVID-19 patients. The increase in CFT and ONL thickness might be attributed to direct infection or viral-induced inflammatory response of retina.
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http://dx.doi.org/10.1016/j.jcjo.2021.06.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255111PMC
July 2021

Foveal Displacement following Temporal Inverted Internal Limiting Membrane Technique for Full Thickness Macular Holes: 12 Months Results.

Curr Eye Res 2021 Jul 12:1-8. Epub 2021 Jul 12.

Retina Department, Bursa Retina Eye Hospital, Bursa, Turkey.

To compare conventional 360° internal limiting membrane (ILM) peeling and temporal inverted ILM flap technique with regard to postoperative foveal displacement. Patients who underwent 23 G vitrectomy with either 360° ILM peeling (Group 1) or temporal inverted ILM technique (Group 2) for idiopathic macular hole with a minimum follow up of 12 months were included. The metamorphopsia rates and distances between fovea and 3 retinal landmarks: the first retinal vascular bifurcation or crossover located superonasal and inferonasal to the fovea and ciliary vessel at the temporal margin of the disc, were compared on MultiColor SLO and near-infrared reflectance images. In addition, papillofoveal distance was measured on B-scan optical coherence tomography (OCT). A total of 57 eyes were recruited (Group 1, n = 25; Group 2, n = 32). The visual acuity at month-1 was significantly higher in Group 2 than Group 1 ( = .007). A significant postoperative foveal displacement towards the disc was observed in Group 1 and Group 2 ( < .001 and = .002 respectively). Shortening of the papillofoveal distance was greater in Group 1 than Group 2 at all postoperative visits ( < .05 for all). Furthermore, significant changes in papillofoveal distance continued until 6 months in Group 1 ( < .05 for all), whereas no significant changes occurred in Group 2 after month-1 ( > .05 for all). The complaints of metamorphopsia was significantly higher in Group 1 (n = 18/25) compared with Group 2 (n = 10/32) ( = .002). Temporal inverted ILM flap appear to be superior to 360° ILM peeling with regard to faster visual rehabilitation, lower rates of subjective metamorphopsia and less foveal displacement.
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http://dx.doi.org/10.1080/02713683.2021.1945110DOI Listing
July 2021

Osseointegrated Implants for Orbito-Facial Prostheses: Common Complications and Solutions.

J Craniofac Surg 2021 Jul-Aug 01;32(5):1770-1774

Sisli Hamidiye Etfal Training and Research Hospital, Istanbul.

Purpose: To evaluate anatomical and functional results of osseointegration with magnetic coupling for oculofacial prosthetic rehabilitation after exenteration.

Methods: This retrospective study included 11 consecutive patients who received orbital reconstruction and oculofacial prosthetic rehabilitation between September 2015 and October 2019. Patient demographics, surgical indications, previous treatment procedures, histopathologic features, and reconstructive procedures were recorded.

Results: The mean age was 37.81 ± 23 years (range 5-78 years). The mean follow-up was 23.81 ± 12 months (range 10-48 months). The principal diagnoses were squamous cell carcinoma of the eyelids (n = 2/11), mucoepidermoid carcinoma of the maxillary sinus (n = 2/11), rhabdomyosarcoma (n = 1/11), mucormycosis (n = 1/11), neurofibromatosis (n = 1/11), basosquamous carcinoma (n = 1/11), malign melanoma (n = 1/11), primitive neuroectodermal tumor (n = 1/11), and retinoblastoma (n = 1/11). Six of the patients were repaired by primary closure. Procedures performed to reconstruct the orbital cavity included split-thickness skin graft (n = 2/11), temporalis muscle flap (n = 2/11), and frontalis muscle flap (n = 1/11). Nine of the 11 patients who received orbital implants were successfully rehabilitated by epithesis. Postoperative complications included implant loss (n = 4/11), periprosthetic local infection (n = 3/11), and soft tissue overgrowth around the orbital prosthesis (n = 2/11). All patients had Straumann bone level implant (Basel, Switzerland) osseointegrated titanium implants (3.5 mm) placed in a 2-stage procedure over a span of 3 to 4 months with subsequent successful prosthesis fitting.

Conclusion: The reconstructive methods following orbital exenteration, should be customized according to the patients' characteristics such as extension of the orbital defect, bone quality, and expectations to achieve satisfactory results.
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http://dx.doi.org/10.1097/SCS.0000000000007360DOI Listing
July 2021

Subretinal Coapplication of Tissue Plasminogen Activator and Bevacizumab with Concurrent Pneumatic Displacement for Submacular Hemorrhages Secondary to Neovascular Age-Related Macular Degeneration.

Turk J Ophthalmol 2021 02;51(1):38-44

Acıbadem University Faculty of Medicine, İstanbul, Turkey.

Objectives: To evaluate the functional and morphological outcomes of vitrectomy in combination with intravitreal 5% C3F8 tamponade and subretinal injections of tissue plasminogen activator (tPA) and anti-vascular endothelial growth factor (anti-VEGF) in patients with submacular hemorrhage (SMH) and to investigate the preoperative prognostic factors.

Materials And Methods: This retrospective study included 30 patients (16 women, 14 men) diagnosed with SMH secondary to neovascular age-related macular degeneration (AMD). Preoperative SMH thickness and area, ellipsoid zone integrity, and postoperative reduction in the amount of subfoveal blood on optical coherence tomography and fundus photographs were assessed. Furthermore, visual acuity (VA), hemorrhage duration, and the need for additional intravitreal anti-VEGF injections were recorded.

Results: The patients' mean age was 73.33±8.23 years. Mean VA improved from logMAR 2.11±0.84 at baseline to logMAR 1.32±0.91, 0.94±0.66, 1.13±0.84, and 1.00±0.70 at postoperative month 1, 2, 3, and 6, respectively. A significant negative correlation was found between hemorrhage duration and postoperative VA at month 2 (p=0.005), month 3 (p=0.019), and month 6 (p=0.012). The mean preoperative SMH duration was significantly shorter in patients who achieved total resolution of the hemorrhage compared with the subtotal resolution group (p<0.001). The mean SMH area was smaller in the patients with continuous ellipsoid zone.

Conclusion: Vitrectomy and submacular tPA and anti-VEGF injections with concurrent C3F8 tamponade appears to provide adequate displacement of the hemorrhage, resulting in significant VA improvement in patients with hemorrhagic neovascular AMD. Timing of the surgery appears to be the most important factor determining the final VA.
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http://dx.doi.org/10.4274/tjo.galenos.2020.72540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931654PMC
February 2021

The predictive value of ectopic inner retinal layer staging scheme for idiopathic epiretinal membrane: surgical results at 12 months.

Eye (Lond) 2021 Aug 9;35(8):2164-2172. Epub 2021 Feb 9.

Bursa Retina Eye Hospital, Bursa, Turkey.

Background/objectives: To assess the effect of ectopic inner foveal layers (EIFL) based staging scheme, foveal avascular zone (FAZ) alterations and other microstructural optical coherence tomography (OCT) findings on visual function for patients undergoing idiopathic epiretinal membrane (iERM) surgery.

Subjects/methods: In this retrospective study, patients who underwent 27 G pars plana vitrectomy (PPV) for idiopathic ERM with a minimum follow-up of 12 months were included. Preoperative and postoperative OCT scans, FAZ area measurements on en face OCT angiography images and mean retinal sensitivity (MRS) using microperimetry were recorded in all cases. The correlation of FAZ area, EIFL and other OCT parameters with preoperative and postoperative best-corrected visual acuity (BCVA) was analysed.

Results: In all, 112 eyes of 112 patients were included. Visual acuity improvement was statistically significant in all four stages; however, differences between Stages 2, 3 and 4 ERMs remained significant (p < 0.05). The presence and thickness of the EIFL was associated with worse baseline (p = 0.013; p = 0.005, respectively) and final (p < 0.001 for both) BCVA. The presence of cystoid macular oedema was associated with worse BCVA at baseline (p = 0.027) and postoperative month-6 (p = 0.04). The mean FAZ area was significantly reduced in all stages of ERM compared with the fellow eyes (p < 0.05 for all). Postoperative retinal sensitivity improvement was statistically significant in Stage 1 and Stage 2.

Conclusion: The presence of EIFL is an independent predictor of worse postoperative BCVA. Accordingly, despite significant BCVA improvements in all stages of ERM, visual acuity gain remains limited in eyes with Stage 3 and Stage 4 ERM.
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http://dx.doi.org/10.1038/s41433-021-01429-wDOI Listing
August 2021

The Influence of Crescent-Shaped Selective Internal Limiting Membrane Staining on Vital Dye Toxicity in Temporal Inverted Flap Technique.

Curr Eye Res 2021 Jan 26:1-7. Epub 2021 Jan 26.

Ophthalmology Department, Bursa Retina Eye Hospital, Bursa, Turkey.

: To investigate the macular function and morphology after temporal inverted internal limiting membrane (ILM) flap technique with and without staining of the ILM flap in contact with the retinal pigment epithelium (RPE).: This retrospective study included 30 patients with idiopathic macular hole (MH), who underwent 27 G vitrectomy and temporal inverted ILM flap technique with brillant blue G (BBG) assisted ILM staining. In Group 1 (n = 16), a large bubble of perfluorocarbon liquid (PFCL) measuring approximately 6-disc diameters was used to cover the hole and central part of the ILM flap whereas in Group 2 (n = 14), only a small drop of PFCL to merely cover the MH was used. Complete ophthalmic examination including microperimetry (MP), optical coherence tomography (OCT) was performed preoperatively, 6 months after surgery.: MH closure was achieved in all the eyes in both groups. The sizes of ellipsoid zone (EZ) and external limiting membrane (ELM) defect significantly decreased after surgery relative to the baseline width in both groups ( < .05 for all). The mean improvement in visual acuity ( = .896) and retinal sensitivity was similiar between groups ( = .409). Accordingly, the postoperative mean lengths of the EZ ( = .254) and ELM disruption ( = .406) on OCT scans were similiar between groups. However, 3 of the eyes in Group 2 developed cystoid macular edema between postoperative month-1 and month-6.: The crescent-shaped selective staining of the ILM flap could prevent prolonged retinal toxicity of vital dyes in inverted ILM flap technique. Further studies involving larger number of patients with longer follow up are needed to determine the impact of this technique in the management of vital dye toxicity.
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http://dx.doi.org/10.1080/02713683.2021.1877312DOI Listing
January 2021

Giant osteomas: Clinical results and surgical approach from ophthalmic point of view.

Eur J Ophthalmol 2021 Mar 2;31(2):766-773. Epub 2020 Oct 2.

Medicabil Private Hospital, Eye Clinic, Bursa, Turkey.

Purpose: To present clinical ocular manifestations, radiological features and surgical results of giant paranasal osteomas involving the orbit.

Design: Retrospective, interventional, case series.

Methods: The study included patients treated for giant paranasal osteoma involving the orbit. Total or subtotal excision of the tumor was performed via external approach. Clinical characteristics including presenting symptoms, radiologic investigation, histopathology and details of the surgery were recorded.

Results: Of the six patients included; four were male and two were female. Mean age was 46.8 years (range 12-70 years). Five patients had unilateral, one patient had bileteral disease. The presenting complaints included complete ( = 2/6) or partial ( = 4/6) limitation of eye movements depending on the location and size of the tumor, diplopia ( = 5/6), vision loss ( = 2/6) exophthalmos ( = 6/6) and reduced pupillary light reflex ( = 2/6). The presumed origin of the tumor was frontoethmoidal region ( = 2/6), frontal sinus ( = 3/6) and ethmoid sinus ( = 1/6). Total resection was achieved in three of the patients whereas partial resection was achieved in remaining three patients due to risk of incremental neurological damage. Mild ptosis was observed in all patients during the postoperative period (temporary,  = 4; permanent,  = 2).

Conclusion: Despite the benign nature of osteomas, severe functional impairment including vision loss due to compression of the optic nerve and diplopia might occur in case of orbital involvement. Osteomas with an orbital extension > %50 of the bony orbit volume are more prone to cause irreversible visual loss. Surgical resection is still the mainstay of therapy.
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http://dx.doi.org/10.1177/1120672120962041DOI Listing
March 2021

Evaluation of Lacrimal Drainage Function in the Anophthalmic Socket by Dacryoscintigraphy.

J Craniofac Surg 2020 Oct;31(7):1991-1994

Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital.

Purpose: To investigate whether impaired lacrimal pump function is a possible cause of discharge in patients wearing an artificial eye compared with the remaining healthy eye.

Methods: Consecutive patients wearing unilateral ocular prosthesis for ≥6 months were included in this retrospective study. Excluded were any deformities of eyelids or nasal passage, socket complications such as entropion, ectropion, ptosis, infection, pyogenic granuloma, contracted socket, obstruction of nasolacrimal duct diagnosed with lacrimal irrigation and a difference greater than 2 mm in terms of protrusion between two eyes detected by Hertel exophthalmometry. Patients were asked to score the levels of tearing and mucopurulent discharge between 0 and 5 to assess lacrimal drainage function subjectively. Furthermore, dacryoscintigraphy was performed to assess the functional status of the lacrimal system objectively.

Results: Included were 32 subjects (12 females, 20 males; aged 32.94 ± 17.62, range 13-78). Mean duration of prosthetic wearing 26.41 ± 21.30 (6-72) months. The mean subjective scores of tearing and mucopurulent discharge were 1.56 ± 1.67 and 1.94 ± 1.63, respectively. The rate of functional stenosis was significantly higher in the anophthalmic socket side as compared to the healthy side (P = 0.002). The rates of a presac, preduct, and intraduct obstruction was notes as n = 9, n = 10, n = 1 and n = 0, n = 6, n = 2 in the anophthalmic side and the companion eye, respectively (P = 0.021).

Conclusion: Compared to paired healthy eyes, the ocular prosthesis exhibited significantly higher rates of functional lacrimal duct obstruction, especially at the presac level. The alterations in orbital volume and tear film composition in addition to reduced corneal reflex blinking may lead to the failure of lacrimal pump function in artificial eyes.
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http://dx.doi.org/10.1097/SCS.0000000000006669DOI Listing
October 2020

Evaluation of inner retinal dimples and internal limiting membrane flap configuration after temporal inverted ILM flap technique.

Eur J Ophthalmol 2021 Mar 6;31(2):649-655. Epub 2020 Jul 6.

Bursa Retina Eye Hospital, Bursa, Turkey.

Purpose: To quantitatively evaluate structural changes associated with inner retinal dimples (IRDs) and qualitatively classify the internal limiting membrane (ILM) flap configuration after temporal inverted ILM flap technique using spectral domain optical coherence tomography (SD-OCT).

Methods: Twenty-three eyes of 23 patients with successfully closed idiopathic, large (>400 μm) macular hole were enrolled. Patients were treated with pars plana vitrectomy followed by temporal inverted ILM flap technique. A complete ophthalmologic examination including cross sectional and en face OCT in addition to multicolor blue reflectance imaging of confocal scanning laser ophthalmoscopy (cSLO) was performed preoperatively and at postoperative month-12. The location, number, depth, and width of the IRDs were analyzed using blue reflectance images of multicolor cSLO and en face OCT. The ILM flap is also classified as smooth, wrinkled, and folded with en face OCT.

Results: The mean number of IRDs visualized on en face OCT ( = 23.08 ± 22.05) was statistically significantly higher compared with multicolor cSLO blue reflectance module (5.91 ± 10.58;  < 0.001). The mean depth of IRDs measured on en face OCT was 8.08 ± 3.1 μm (3-14 μm) which referred to the nerve fiber layer. The final visual acuity was associated with neither ILM flap configuration ( = 0.408), nor number of the IRDs on en face OCT ( = 0.112).

Conclusion: En face OCT is a novel imaging modality that offers improved visualization and accuracy in identifying the features of the IRDs and the ILM flap. Additionally, it provides clear visualization of the vitreoretinal interface to distinguish whether ILM was peeled or not in the initial surgery.
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http://dx.doi.org/10.1177/1120672120940980DOI Listing
March 2021

XEN Gel Stent versus trabeculectomy: Short-term effects on corneal endothelial cells.

Eur J Ophthalmol 2021 Mar 26;31(2):346-353. Epub 2020 May 26.

Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Purpose: To compare the short-term changes in corneal endothelial cells after trabeculectomy or XEN Gel Stent implantation.

Design: Prospective, interventional, comparative study.

Methods: Changes in corneal endothelium in patients that underwent XEN Gel Stent implantation or trabeculectomy were prospectively evaluated. Eighty eyes of 62 diagnosed with open-angle glaucoma were divided into two the trabeculectomy and XEN Gel Stent groups. Corneal specular microscopy was performed at the central cornea using a noncontact specular microscope preoperatively and 3 months after surgery.

Results: The baseline mean corneal endothelial cell density in the trabeculectomy group was 2390.3 ± 324.8 cells/mm, and this was significantly reduced to 2148 ± 352.5 cells/mm 3 months after surgery, representing a cell loss of 10.0% (p < 0.001). The baseline mean corneal endothelial cell density in the XEN Gel Stent group was 2156.2 ±559.7 cells/mm, and this was significantly reduced to 2098.4 ± 556.2 cells/mm 3 months after surgery, representing a cell loss of 2.1% (p = 0.002). The corneal endothelial cell density change rate of the trabeculectomy group (-10.0% ± 9.7%) was statistically higher than the XEN Gel Stent group (-2.1% ± 13.8%) (p = 0.002). A statistically significant difference was observed in the trabeculectomy group between the baseline and postoperative values in the coefficient of variation (p = 0.029).

Conclusion: Trabeculectomy caused more endothelial cell damage than XEN Gel Stent implantation in the short-term follow-up period. The XEN Gel Stent may be the treatment of choice in patients with a significantly low preoperative corneal endothelial cell density.
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http://dx.doi.org/10.1177/1120672120924339DOI Listing
March 2021

Combined Femtosecond Laser-Assisted Cataract Surgery and 27-Gauge Transconjunctival Sutureless Vitrectomy.

J Ophthalmol 2020 23;2020:7651941. Epub 2020 Mar 23.

Bursa Retina Eye Hospital, Bursa, Turkey.

Purpose: To report the outcomes of combined surgery using femtosecond laser-assisted cataract surgery (FLACS) and sutureless 27-gauge pars plana vitrectomy with intravitreal tamponade.

Methods: This retrospective clinical study involved 23 eyes of 23 patients on whom combined vitreoretinal surgery was performed. Patients were initially given the femtosecond laser treatment that was performed after selection of capsulotomy and lens fragmentation patterns. The capsulotomy diameter was chosen as 4.9 mm in all patients. After the femtosecond laser, the sutureless phacovitrectomy procedure was performed. At the end of surgery, perfluoropropane or sterile air tamponade was applied.

Results: The mean age of patients was 66.43 ± 7.61 (range, 54-83) years. Fifteen patients were females (65.2%). The mean follow-up was 16.09 ± 4.71 (range, 9-25) months. The most common surgical indication was epiretinal membrane (65.3%). The mean preoperative best-corrected visual acuity (BCVA) was 0.71 ± 0.44 (range, 1.7-0.3) logMAR, and the mean postoperative BCVA at 6 months was 0.16 ± 0.14 (range, 0.4-0) logMAR ( < 0.001). The mean target sphere refractive error was -0.24 ± 0.16 (range, -0.50-0.11) D, and the mean postoperative spherical equivalent refractive error was -0.14 ± 0.39 (range, -1.00-0.50) D at 6 months (=0.196). All intraocular lenses (IOLs) remained well centered in the capsular bag during surgery and follow-up. There was no iris capture, posterior synechiae, capsular opacification, or pseudophakic cystoid macular edema. The only complication related to femtosecond laser was two cases of subconjunctival haemorrhage related with suction.

Conclusions: FLACS is a safe and effective technique providing the advantage of repeatable, precise capsulorhexis shape and size to achieve a well-centered and stable IOL postoperatively. These advantages can certainly improve the results of vitrectomy, especially in gas-filled eyes. FLACS and 27-gauge sutureless combined surgery may be a future trend in appropriate cases.
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http://dx.doi.org/10.1155/2020/7651941DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7125466PMC
March 2020

Foveal avascular zone and vessel density in children with attention deficit hyperactivity disorder.

Int Ophthalmol 2020 May 7;40(5):1155-1162. Epub 2020 Jan 7.

Department of Ophthalmology, Memorial Sisli Hospital, Okmeydani, Sisli, 34000, Istanbul, Turkey.

Purpose: To compare the retinal and choroidal microvasculature quantitatively via optical coherence angiography (OCTA) in children with attention deficit hyperactivity disorder (ADHD) who were under methylphenidate (MFD) treatment or newly diagnosed as ADHD and were not taking any medication.

Methods: This was a cross-sectional, comparative, and observational study. The children who were between 6 and 17 years old and previously diagnosed as ADHD and were under MFD treatment or who were newly diagnosed as ADHD were included in the study. Optical coherence tomography angiography imaging was performed via OCT RT XR Avanti with AngioVue software (Optivue Inc, Freemont, CA). The main outcome measure of the study was OCTA parameters of the children with ADHD.

Results: A total of 186 eyes of 186 patients were included in the study. There were 80 eyes in the control group (newly diagnosed) and 106 eyes in the treatment group (under MFD treatment). The mean duration of methylphenidate use in the treatment group was 33.9 ± 20.1 months (between 6 and 84 months). The choriocapillary flow area (p = 0.03), superficial parafoveal thickness (p = 0.01), and deep parafoveal thickness (p = 0.01) were statistically greater in the treatment group than the control group.

Conclusion: Most of the important OCTA parameters especially foveal avascular zone (FAZ) area and FAZ perimeter were similar in the two groups. There was a significant difference between the two groups in parafoveal thickness values which might point to a slight effect of MFD on retinal circulation.
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http://dx.doi.org/10.1007/s10792-019-01281-8DOI Listing
May 2020

The Effect of Two Different Frontalis Sling Approaches on Postoperative Eyelid Contour: A Comparative Study.

Aesthetic Plast Surg 2020 04 16;44(2):381-389. Epub 2019 Dec 16.

Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Etfal Street, 34280, Sisli, Istanbul, Turkey.

Purpose: To compare two different frontalis sling approaches, tarsal fixation and orbicular muscle fixation, using silicone rod (FCI Ophthalmics, Marshfield Hills, MA, USA) in terms of postoperative upper eyelid contour in patients with poor levator muscle function.

Design: Retrospective, comparative, case series.

Methods: Ten eyes of seven patients who received frontalis sling surgery with orbicularis muscle fixation (group 1), eight eyes of seven patients who received frontalis sling surgery with tarsal fixation (group 2) and 30 eyes of 15 age and sex-matched healthy controls (control group) were included. Postoperative photographs of all the participants were taken in the primary gaze, and each photograph was viewed on a computer. The distance between the upper lid margin and pupillary center (MCD), nasal limbus (MND), and temporal limbus (MTD) was measured, respectively, using the ruler in Microsoft Paint Software and compared with each other for each participant.

Results: Both nasal, central and temporal margin distance values in group 1 and group 2 were significantly lower than those of the control group (p < 0.05 for all values). The ratio of MTD/MCD in the control group was significantly higher than group 1 (p = 0.04) besides the ratio of MND/MTD in the control group was significantly lower than group 1 (p = 0.01).

Discussion: Frontalis sling approach with tarsal fixation using silicone rod might provide improved cosmetic results including more symmetrical upper eyelid contour compared with orbicularis muscle fixation approach. Moreover, the novel measuring technique presented in the current study provides a simple and effective assessment of the upper lid contour in daily practice setting.

Level Of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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http://dx.doi.org/10.1007/s00266-019-01574-4DOI Listing
April 2020

Conventional internal limiting membrane peeling versus temporal inverted internal limiting membrane flap for large macular holes.

Eur J Ophthalmol 2021 Mar 4;31(2):679-687. Epub 2019 Dec 4.

Bursa Retina Eye Hospital, Bursa, Turkey.

Purpose: To compare the functional, anatomical, and morphological results of conventional internal limiting membrane peeling versus temporal inverted internal limiting membrane flap technique for the treatment of macular holes larger than 400 μm.

Design: Retrospective, comparative case series.

Methods: A total of 33 patients were included, of whom 18 were treated with internal limiting membrane peeling (Group 1) and 15 were treated with temporal inverted internal limiting membrane flap technique (Group 2). Complete ophthalmic examination, such as microperimetry and optical coherence tomography, was performed preoperatively and at 12 months after surgery.

Results: The closure rates accomplished in Groups 1 and 2 were 72.2% and 100%, respectively (p = 0.036). The mean improvement in best-corrected visual acuity was logMAR 0.49 ± 0.17 in Group 1 and logMAR 0.91 ± 0.15 in Group 2 (p = 0.037). U-shaped closure was achieved in one eye in Group 1 and 12 eyes in Group 2 (p < 0.001). Complete restoration of external limiting membrane and ellipsoid zone rates were significantly higher in Group 2 (p = 0.027 and p = 0.001, respectively).

Conclusion: The single-layered temporal inverted internal limiting membrane flap technique improves not only anatomical and morphological but also functional outcomes of surgery for large macular holes. Furthermore, this technique seems to minimize the risk of iatrogenic trauma to the nasal part of the fovea and the corresponding papillomacular bundle fibers.
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http://dx.doi.org/10.1177/1120672119892427DOI Listing
March 2021

Comparison of Three Different Techniques on the Movement of Implants After Evisceration.

J Craniofac Surg 2019 Oct;30(7):e590-e593

Sisli Hamidiye Etfal Training and Research Hospital, Department of Ophthalmology.

Purpose: To compare the results of 3 evisceration techniques involving placement of an acrylic implant within the scleral shell without posterior sclerotomy (Group 1), posterior sclerotomy with placement of a porous implant within the intraconal space (Group 2) and posterior sclerotomy with placement of a acrylic implant within the intraconal space (Group 3) with respect to ocular mobility, implant complications and patient satisfaction.

Methods: Single-center, retrospective, interventional case series. A chart review of 72 patients undergoing evisceration between February 2013 and January 2018 was carried out. Thirty-five patients met the inclusion criteria having a normal or near normal size eye and at least 6 months follow-up. The horizontal movements of the implant and the artificial eye was measured by using a ruler. Data analyses were conducted using the Mann-Whitney U test for 2 independent samples.

Results: Neither infection nor prolapse of the implant had occurred in any of the patients. The mean implant sizes were 18 mm in Group 1, 20 mm in Group 2 and 20 mm in Group 3. Statistically, a significant difference was assessed between Group 1 and Group 2 in both nasal and temporal movement of the socket; nasal and temporal movement of the prosthesis. Statistically, a significant difference was assessed between Group 1 and Group 3 in both nasal and temporal movement of the socket; nasal and temporal movement of the prosthesis. However, there was no statistically significant difference between Group 2 and Group 3 in neither nasal and temporal movement of the socket nor nasal and temporal movement of the artificial eye.

Conclusion: Group 1 showed the significantly better movement of both prosthesis and socket in adduction and abduction than Group 2 and 3. The likely explanation for this may be that preserving the scleral shell integrity allows more efficient transmission of muscle contraction to the socket and prosthesis.
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http://dx.doi.org/10.1097/SCS.0000000000005584DOI Listing
October 2019
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