Publications by authors named "B Ece Kurtul"

34 Publications

Association of childhood obesity with retinal microvasculature and corneal endothelial cell morphology.

J Pediatr Endocrinol Metab 2021 Feb 14;34(2):171-176. Epub 2020 Dec 14.

Department of Pediatrics, Hatay Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay, Turkey.

Objectives: To investigate the optical coherence tomography angiography (OCTA) and specular microscopy (SM) findings in obese children and compare them with healthy ones.

Methods: In this prospective study, 50 eyes of 25 obese children [body mass index (BMI) ≥95th percentile], 36 eyes of 18 control age- and sex- matched healthy subjects (BMI <85th percentile) were included. Demographic features and ophthalmological examination including OCTA measurements as well as SM findings were assessed. Cellular morphology was observed by noncontact SM and results for corneal endothelial cell density (cells/mm), coefficient of variation of cell size and percentage of hexagonal cells were obtained. The OCTA was performed with 6 × 6 mm sections for macula and 4.5 × 4.5 mm sections for optic disc in all eyes. Foveal retinal thickness (FRT), retinal nerve fiber layer (RNFL) thickness, vessel density in different sections of retina and optic nerve head were analyzed.

Results: All SM parameters, RNFL thickness for average, and all quadrants and optic disc radial peripapillary capillary densities were similar between groups. However, FRT, flow area for choriocapillaris, superficial and deep foveal capillary densities were significantly higher in obese group when compared to controls (242.4 ± 18.2 µm vs. 232.1 ± 16.5 µm, p=0.024, 2.2 ± 0.1 mm vs, 2.2 ± 0.0 mm, p=0.042, 22.4 ± 6.9% vs. 15.6 ± 5.5%, p=0.001, and 38.9 ± 7.5% vs. 31.1 ± 8.6 %, p=0.001, respectively).

Conclusions: Obese children seem to have higher values of FRT, flow area for choriocapillaris, superficial and deep foveal capillary densities. These results may have significant implications for understanding of how childhood obesity could affect retinal microvasculature.
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http://dx.doi.org/10.1515/jpem-2020-0483DOI Listing
February 2021

Plasminogen activator inhibitor-1 4G/5G polymorphism and dyslipidemia with branch retinal artery occlusion in a young lady.

Oman J Ophthalmol 2020 Sep-Dec;13(3):152-154. Epub 2020 Nov 2.

Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Department of Ophthalmology, Hatay/, Turkey.

Branch retinal artery occlusion (BRAO) leads obstruction of blood flow in the distribution of the affected vessel giving rise to ischemia and reorganization of the retinal layers. It is a very rare diagnosis and the etiological risk factors of BRAO are not clean in the young population. Various hypercoagulable states leading to thrombosis appeared to be more responsible. Here, the authors present an interesting case of a 25-year-old female patient with BRAO accompanying with plasminogen activator inhibitor-1(PAI-1) 4G/5G gene polymorphism and dyslipidemia together, for the first time. There was a history of sudden painless blurred vision in her right eye 3 months ago. Her visual acuity was 20/20 in both eyes at the admittion. Fundus photo, red-free photo, optical coherence tomography images of 3 months ago revealed BRAO in the right eye. Fundus exam and images taken at the 3th month confirmed the recovery of retinal edema. Attenuation of inferotemporal retinal artery still mildly appeared. Applied confrontation fields showed a visual field defect corresponding with affected area. Ophthalmologists are advised to be aware of the importance of PAI-1 4G / 5G gene polymorphism and dyslipidemia conditions besides the other genetic mutations and thrombophilic markers regarding BRAO in young patients.
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http://dx.doi.org/10.4103/ojo.OJO_266_2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852414PMC
November 2020

Assessment of platelet-to-lymphocyte ratio in patients with retinal vein occlusion.

Ther Adv Ophthalmol 2020 Jan-Dec;12:2515841420971949. Epub 2020 Nov 18.

Department of Ophthalmology, Tayfur Ata Sökmen Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey.

Purpose: To investigate platelet-to-lymphocyte ratio (PLR) in retinal vein occlusion (RVO) patients.

Methods: In this study, we retrospectively reviewed data of 32 patients with RVO (RVO group) and 32 age- and sex-matched participants without RVO (control group) between January 2017 and March 2019. The PLR was determined by dividing the platelet count by the lymphocyte count.

Results: Age and gender were comparable between the groups ( = 0.204 and  = 0.800, respectively). PLR was significantly elevated in the RVO group compared with the control group (137 (113-164) vs 101 (86-129),  = 0.001)). In the receiver operator characteristics curve analysis, the optimal cut-off value of PLR for predicting RVO was 123, with 69% sensitivity and 72% specificity.

Conclusion: We report that PLR are elevated in RVO, suggesting that PLR may be a useful marker for RVO.
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http://dx.doi.org/10.1177/2515841420971949DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686591PMC
November 2020

Increased Systemic Immune-Inflammation Index Levels in Patients with Dry Eye Disease.

Ocul Immunol Inflamm 2020 Sep 29:1-5. Epub 2020 Sep 29.

The Department of Ophthalmology, Hatay Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine , Hatay, Turkey.

Purpose: To evaluate the systemic immune-inflammation index (SII) levels, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in patients with dry eye disease (DED) and to compare with control subjects.

Methods: This prospective study included 47 DED patients and 47 age- and sex-matched healthy controls. Ophthalmological examination, diagnostic DED tests, and routine complete blood cell count parameters were analyzed. The SII value was calculated as follows: platelet count × (neutrophil/lymphocyte).

Results: The mean SII, NLR, and PLR levels were significantly higher in DED patients compared to controls ( < .001, < .001 and = .009, respectively). Using the receiver operating characteristics (ROC) curve analysis to predict patients with DED, the highest area under the curve (AUC) was determined SII (0.761 for SII, 0.727 for NLR, and 0.653 for PLR).

Conclusions: As a novel tool superior to other inflammatory markers, SII may be a cheap and reliable indicator of inflammatory status in DED patients.
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http://dx.doi.org/10.1080/09273948.2020.1821899DOI Listing
September 2020

Schnyder Corneal Dystrophy: A Rare Case Report.

Nepal J Ophthalmol 2020 Jan;12(23):110-113

Department of Ophthalmology, Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay, Turkey.

Introduction: Schnyder corneal dystrophy (SCD) is a rare, autosomal dominant, anterior stromal dystrophy described as progressive bilateral corneal opacification due to abnormal accumulation of cholesterol and phospholipids in the cornea. The clinical signs can change as the patient ages. SCD with different presentations may actually be misdiagnosed. Early diagnosis would help to rule out other potentially sight threatening or treatable conditions like infectious keratitis or drug toxicity.

Case: We present a case of a 34-year-old Syrian male patient, came to our clinic for bilateral decreased visual acuity for 5 years. His visual acuity was 0.15 in both eyes. Slitlamp examination revealed corneal arcus or disk-like lesion and polychromatic crystalline depositions in both eyes in subepithelial and the anterior 1/3 of the stroma. The mild onset of arcus lipoides was also seen. Central corneal thickness results were 507 μm in the right eye and 503 μm in the left eye. A diagnosis of Schnyder corneal dystrophy was thought based on clinical presentation and coexistence dyslipidemia of the patient.

Conclusion: Ophthalmologists should keep in mind SCD and its associated systemic findings that need to be evaluated and managed properly.
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http://dx.doi.org/10.3126/nepjoph.v12i1.26185DOI Listing
January 2020

Evaluation of microvascular changes in optic disc and retina by optical coherence tomography angiography during Valsalva maneuver.

Int Ophthalmol 2020 Oct 12;40(10):2743-2749. Epub 2020 Jun 12.

Department of Ophthalmology, Hatay Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Antakya, Hatay, Turkey.

Purpose: Optical coherence tomography angiography (OCTA) is an increasingly widespread imaging tool that allows the visualization of the microvascular structures of the eye. It should be kept in mind in clinical practice, Valsalva maneuver (VM) may have an effect on OCTA findings. We aimed to evaluate the effect of VM on the optic nerve and retinal blood flow parameters measured by OCTA.

Methods: Sixty age- and sex-matched healthy volunteers were included into this prospective study. Optic disc status for radial peripapillary capillary (RPC) network [whole image, inside disc and peripapillary capillary densities], superficial and deep capillary plexus whole, foveal, parafoveal and perifoveal densities and foveal avascular zone (FAZ) densities of volunteers were examined by OCTA both at rest and during VM.

Results: The mean age of the subjects was 31.48 ± 7.49 (18-50) years and 51.7% were male. Superficial whole, parafoveal and perifoveal vessel densities were found to be significantly decreased during VM (p = 0.008, p= 0.015, p = 0.017, respectively). Lower levels of deep whole, parafoveal and perifoveal vessel densities were also detected while VM (p < 0.001 for all). However, there were no significant differences in terms of foveal vessel and FAZ densities. Additionally, VM significantly decreased RPC densities for whole image, inside and peripapillary capillary (p = 0.005, p < 0.001, p = 0.039, respectively).

Conclusion: VM may cause a significant decrease in optic nerve and para-perifoveal blood flow. Therefore, patient instruction about not holding breath is required before OCTA scanning.
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http://dx.doi.org/10.1007/s10792-020-01461-xDOI Listing
October 2020

Bilateral Double-headed Recurrent Pterygium: A Case Presentation and Literature Review.

Med Hypothesis Discov Innov Ophthalmol 2020 15;9(2):85-90. Epub 2020 Mar 15.

Department of Ophthalmology, Mustafa Kemal University Tayfur Ata Sokmen Faculty of Medicine, Hatay, Turkey.

Pterygium is a frequent corneal disease characterized by growing of fibrovascular tissue from the bulbar conjunctiva onto the cornea. Although the causes of pterygium are not obvious, sun exposure is closely correlated with its development. Pterygium, especially double-headed pterygium is mostly seen in warm climate and in individuals who work outdoors. A minority of pterygium is double-headed (both temporal and nasal origins). Bilateral recurrent double-headed pterygium is a very rare condition. Here, we reported a 35-year-old male patient with bilateral recurrent double-headed pterygium. A brief review about the recent literature concerning the etiology, associated risk factors, operation types and management of patients with recurrent pterygium was also discussed. The patient was a field worker, smoker and had a family history of pterygium. There was no ocular surgery history except pterygium surgery 15 years ago in both eyes. A successful pterygium excision was performed under local anesthesia with the vertical split conjunctival autograft transplantation (CAT) in both temporal and nasal parts of the right eye (randomly) for cosmetic disfigurement and avoidance of recurrence. The pathological report was consistent with pterygium. At postoperative first week, first and 1.5 month visits, conjunctival autografts were in place and stable. No complications such as infection, corneal thinning or graft dislocation were seen. The patient was satisfied with his right eye and demanded the same surgery for his left eye. We suggest vertical split simultaneous CAT as a safe and useful surgical method for the treatment of recurrent double-headed pterygium; however, longer follow-up is required to confirm the outcome.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7134241PMC
March 2020

Neutrophil-to-lymphocyte ratio in ocular diseases: a systematic review.

Int J Ophthalmol 2019 18;12(12):1951-1958. Epub 2019 Dec 18.

Department of Ophthalmology, Ufuk University Faculty of Medicine, Ankara 06830, Turkey.

Aim: To summarize the results of studies investigating neutrophil-to-lymphocyte ratio (NLR) and to identify the role of NLR in ocular diseases.

Methods: With the aim of identifying the studies related to NLR, a search was conducted on http://www.ncbi.nlm.nih.gov/pubmed by utilizing the key words "neutrophil lymphocyte ratio, ocular diseases, and eye diseases" up to February 2018. All of the original articles were assessed according to date of publications, countries, clinics and topics. Studies about ocular inflammatory diseases were evaluated according to their qualifications, review methods and results.

Results: A total of 4473 publications, including original research articles and reviews were screened. The number of publications was shown a regular logarithmic increase over the years. The majority of studies were performed by clinics in Turkey and many of these publications were performed by oncology and cardiology clinics. A total of 75 publications were identified to be about ocular diseases.

Conclusion: Elevated NLR as a cheap, reproducible, and readily available marker could be used as a diagnostic and/or prognostic marker in ocular diseases.
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http://dx.doi.org/10.18240/ijo.2019.12.18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901879PMC
December 2019

Advanced recurrent pterygium leading to significant visual impairment.

Clin Exp Optom 2020 07 6;103(4):544-545. Epub 2019 Aug 6.

Department of Ophthalmology, Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay, Turkey.

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http://dx.doi.org/10.1111/cxo.12949DOI Listing
July 2020

The correlation of routine hematological indices with pterygium.

Ther Adv Ophthalmol 2019 Jan-Dec;11:2515841419848922. Epub 2019 Jul 9.

Department of Ophthalmology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.

Purpose: Increased systemic/local inflammation and oxidative stress play a key role in the pathophysiology of pterygium, but there is limited information regarding routine hematological indices' levels in patients with pterygium. In this study, we aimed to evaluate the levels of complete blood count parameters in patients with pterygium.

Material And Method: In all, 61 patients with pterygium (pterygium group; mean age = 51.4 ± 13.8 years) and 55 healthy individuals (control group; mean age = 50.2 ± 13.1 years) were included in the study. Participants were given routine ophthalmic examinations; complete blood count parameters were assayed.

Results: Compared to the control group, red cell distribution width level was significantly higher in patients with pterygium ( = 0.009), but the difference between the groups in terms of the other complete blood count parameters was not statistically significant. However, high-density lipoprotein cholesterol level was significantly lower in the pterygium group than control group ( = 0.015). In the pterygium group, low-density lipoprotein cholesterol levels were lower, but this difference was not statistically significant ( = 0.079).

Conclusion: Red cell distribution width levels were significantly increased in patients with pterygium. Our data support the idea that inflammation cytokines and oxidative stress may play an important role in the pathogenesis of this disorder.
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http://dx.doi.org/10.1177/2515841419848922DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6620725PMC
July 2019

Implantation of a double iris-claw intraocular lens in an aphakic nanophthalmic eye.

Indian J Ophthalmol 2017 Dec;65(12):1490-1492

Private Maya Eye Diseases Center, Ankara, Turkey.

A 55-year-old female with an aphakic nanophthalmic eye underwent a secondary intraocular lens implantation (IOL) with double Artisan aphakia iris claw IOLs (ICIOLs) and was evaluated in this research. The patient's preoperative best-corrected visual acuity (BCVA) of the right eye was 0.4 (0.4 logMAR) (with + 21.00 D), postoperative 1st and 3rd month, 1st year, and 3 years BCVAs were 0.4 (0.4 logMAR). The intraocular pressure was 15 mmHg preoperatively, and 14, 12, 12, and 15 mmHg postoperatively at 1st and 3rd month, 1st year, and 3 years, respectively. The preoperative endothelial cell density (ECD) was 2372 cells/mm2, and postoperative ECDs were 2352, 2391, 2246, and 2240 cells/mm2 at 1st and 3rd months, at 1st year, and 3 years respectively. In aphakic nanophthalmic eyes with inadequate capsular support, which require high IOL dioptry, the implantation of double ICIOLs (one in front of the iris and the other behind the iris) seems to be safe and provides good visual rehabilitation.
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http://dx.doi.org/10.4103/ijo.IJO_441_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742990PMC
December 2017

Increased red cell distribution width levels in children with seasonal allergic conjunctivitis.

Int Ophthalmol 2018 Jun 18;38(3):1079-1084. Epub 2017 May 18.

Department of Ophthalmology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.

Purpose: Seasonal allergic conjunctivitis (SAC) is an inflammatory disease of the conjunctiva. Red cell distribution width (RDW) is a widely accepted inflammatory marker. We aimed to investigate whether RDW level is associated with the development of SAC in pediatric population.

Methods: The present study consisted of 90 subjects (45 children with SAC and 45 age- and sex-matched healthy children). The demographic findings, complete blood count parameters including RDW and laboratory parameters, were evaluated.

Results: The mean RDW levels were significantly higher in children with SAC compared to the control group (14.02 ± 0.82 vs. 13.26 ± 0.64%, respectively, p < 0.001). In receiver operating characteristic analysis, the area under the curve for RDW for predicting SAC was 0.786, and a RDW value of 13.45 or higher predicted SAC with a sensitivity of 75.6% and specificity of 65%.

Conclusion: Our study suggests that elevated RDW levels are significantly associated with SAC in pediatric population, which may imply a possible role of increased inflammatory status and oxidative stress in the pathogenesis of SAC.
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http://dx.doi.org/10.1007/s10792-017-0563-xDOI Listing
June 2018

Comparison of Intravitreal Bevacizumab, Intravitreal Ranibizumab and Laser Photocoagulation for Treatment of Type 1 Retinopathy of Prematurity in Turkish Preterm Children.

Curr Eye Res 2017 07 27;42(7):1054-1058. Epub 2017 Jan 27.

b Department of Ophtalmology , Dışkapı Yıldırım Beyazıt Research and Education Hospital , Dışkapı/Ankara , Turkey.

Purpose: To evaluate effectiveness of treatment modalities, major complications and refractive errors in children who were treated with intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR) or laser photocoagulation (LP) for type 1 retinopathy of prematurity (ROP).

Methods: Premature infants who underwent IVB monotherapy (Group 1), IVR monotherapy (Group 2) or LP (Group 3) for type 1 ROP and infants with spontaneously regressed ROP (Group 4) were included for the study. Major complications, recurrence rate, recurrence time, total retinal vascularization time and refractive errors at 18 months of corrected age (CA) were determined.

Results: Groups 1, 2, 3 and 4 included 24 eyes of 12 patients, 12 eyes of six patients, 72 eyes of 36 patients and 148 eyes of 74 patients, respectively. Recurrence of the disease occurred in two eyes of one patient in Group 1 at 52 weeks of postmenstrual age (PMA) and two eyes of one patient at 48 weeks of PMA in Group 2. In Group 3, disease did not regress after the first treatment in 10 eyes of five patients. The mean vascularization time in Group 1 was 73 ± 10.1 weeks of PMA and 61.8 ± 6.6 weeks of PMA in Group 2 (p = 0.027). Macular ectopia was seen in two eyes of one patient and exudative retinal detachment (ERD) occurred in two eyes of one patient in Group 3. Mean spherical equivalent was 1.49 ± 3.04 diopters (D) in Group 1, -1.79 ± 2.87D in Group 2, -1.27 ± 2.8 D in Group 3 and 1.52 ± 1.07 D in Group 4 at 18 months of CA. There was no significant difference in astigmatism values in all groups.

Conclusion: IVB, IVR and LP are options that can successfully treat ROP. Myopia was observed to be the main refractive error in all treatment groups. Vascularization of the retina was completed later in the IVB group than in the IVR group.
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http://dx.doi.org/10.1080/02713683.2016.1264607DOI Listing
July 2017

Impact of oral contraceptive pills on central corneal thickness in young women.

Indian J Pharmacol 2016 Nov-Dec;48(6):665-668

Department of Ophthalmology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.

Objectives: Hormonal changes during oral contraceptive pill (OCP) use may affect central corneal thickness (CCT) values. We aimed to evaluate the impact of OCP use on CCT values in healthy young women.

Materials And Methods: Fifty women subjects who use OCP for contraception (Group 1) and forty control subjects (Group 2) who do not use OCP were included in this prospective study. None of the patients had any history of systemic or ocular diseases. The CCT values measured by ultrasonic pachymeter (Nidek US-4000 Echoscan, Japan) and the intraocular pressure (IOP) values were measured by noncontact tonometer (Reichert 7 CR Corneal Response Technology, USA) at the time of admission to our clinic. The demographic findings and body mass index (BMI) scores of participants were also recorded.

Results: The mean ages were 32.8 ± 5.6 for OCP + patients (Group 1) and 31.3 ± 6.9 for OCP-patients (Group 2) ( = 0.28). The mean CCT values were significantly higher in Group 1 when compared to that of the Group 2 (540.9 ± 30.4 μm and 519.6 ± 35.6 μm, respectively) ( = 0.003). The mean IOP value was 14.3 ± 2.5 mmHg in Group 1 and 14.4 ± 2.7 mmHg in Group 2 ( = 0.96). The mean BMI scores were 24.4 ± 5.8 kg/m in Group 1 and 24.6 ± 3.5 kg/m in Group 2 ( = 0.83).

Conclusion: Our findings revealed that CCT values were significantly higher in patients with OCP use. Ophthalmologists should be aware of potential elevated CCT levels in these patients.
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http://dx.doi.org/10.4103/0253-7613.194860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5155467PMC
June 2017

Bilateral congenital mydriasis in a child case.

Turk Pediatri Ars 2016 Sep 1;51(3):176-177. Epub 2016 Sep 1.

Clinic of Ophtalmology, Dr. Sami Ulus Training and Research Hospital, Ankara, Turkey.

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http://dx.doi.org/10.5152/TurkPediatriArs.2016.4194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047370PMC
September 2016

The Relationship between Neutrophil-to-lymphocyte Ratio and Age-related Macular Degeneration.

Korean J Ophthalmol 2016 Oct 29;30(5):377-381. Epub 2016 Sep 29.

Department of Ophthalmology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.

Purpose: To investigate the possible associations of neutrophil-to-lymphocyte ratio (NLR) and high sensitivity C-reactive protein (hs-CRP) level with age-related macular degeneration (ARMD).

Methods: Patients were divided to three groups of 40 patients with non-neovascular ARMD (group 1), 40 patients with neovascular ARMD (group 2), and 40 healthy control subjects (group 3). The neutrophil and lymphocyte counts were evaluated using an ABX Pentra DF120/USA biochemical analyzer, and hs-CRP levels were measured using a Beckman Coulter Immage 800. The NLR was measured by dividing neutrophil count by lymphocyte count.

Results: The patients in group 2 were older and more often diabetic than the patients in groups 1 and 3 ( < 0.001 and < 0.001, respectively). The NLR level was 1.65 ± 0.71 in group 1, 1.98 ± 0.84 in group 2, and 1.46 ± 0.44 in group 3. The hs-CRP value was 1.98 ± 0.251 mg/L in group 1, 3.242 ± 0.211 mg/L in group 2, and 1.145 ± 0.193 mg/L in group 3. Both NLR and hs-CRP values were significantly higher in group 2 compared to group 3 ( = 0.002 and = 0.002, respectively). In multivariate analysis, NLR remained an independent predictor of neovascular ARMD (odds ratio, 3.882; 95% confidence interval, 1.574 to 9.576; = 0.003) together with age ( < 0.001), diabetes mellitus ( = 0.041), and hs-CRP ( = 0.018).

Conclusions: Our study suggests that increased NLR value is independently associated with neovascular ARMD.
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http://dx.doi.org/10.3341/kjo.2016.30.5.377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5057014PMC
October 2016

Ocular Disorders in Turkish Children with Sensorineural Hearıng Loss: A Cross-Sectional Study and Literature Review.

Semin Ophthalmol 2018 14;33(2):155-160. Epub 2016 Sep 14.

a Ministry of Health, Dr. Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey.

Purpose: To investigate types and frequencies of ocular disorders in children with sensorineural hearing loss (SNHL), and to emphasize the importance of ophthalmological examination in these children.

Methods: A retrospective analysis of the examination records of children examined in our instutititon between January 2011 and September 2014 was performed. Ocular disorders of children with SHNL were selectively reviewed.

Results: Among 55340 patients, SNHL was present in 110 (0.2%). SNHL was bilateral in 104 patients (94.5%) and unilateral in 6 (5.5%). Ninety-one cases had congenital hearing loss (83%), and 19 (17%) had acquired SNHL. Forty cases (36%) had an ocular disorder, either refractive or non-refractive or both. Seventy cases (64%) had normal ocular examination. No difference was found between congenital or acquired SNHL cases in terms of possessing an ocular disorder (p=0.0962). The most common ocular abnormality was refractive error, mainly hypermetropia (21%). There was no significant difference between the prevalences of ocular abnormalities among cases with different lateralites or severities of SNHL (p=0.051, p=0.874, respectively). Twenty-six cases (23.6%) had SNHL as a component of a genetically defined syndrome. All of them had coexisting refractive or non-refractive ocular abnormalities. Some genetic, non-syndromic abnormalities, including Achondroplasia, Celiac disease, and focal segmental glomerulosclerosis, were diagnosed in four cases, among whom refractive errors and/or strabismus were detected.

Conclusions: Due to the common coexistence of ocular problems and SNHL in children, ophthalmological screening is crucial. Families and healthcare providers should be informed about the critical role of ophthalmic assesment in these children for their future quality of life.
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http://dx.doi.org/10.1080/08820538.2016.1182560DOI Listing
April 2018

Does Correction of Strabismus Improve Quality of Life in Children with Autism Spectrum Disorder: Results of a Parent Survey by Ophthalmologists.

Semin Ophthalmol 2018 6;33(2):149-154. Epub 2016 Sep 6.

a Department of Ophthalmology, Ministry of Health , Dr. Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey.

Purpose: Ophthalmic problems are reported to be common in children with autism spectrum disorder (ASD), and strabismus is of particular importance. We aimed to investigate the outcomes of strabismus management in cases with ASD and identify the impact of optical or surgical correction of the strabismus on the child using a questionnaire for parents.

Methods: A survey was designed to assess parents' perceptions of pre-management and post-management quality of life in 41 children aged 5-17 years with ASD and strabismus using a questionnaire with 10 questions, including three subscales.

Results: Significant improvements were noted after management in functional limitations (P < 0.01), psychosocial interactions (P < 0.01), and ocular alignment (P < 0.01) subscales.

Conclusion: This is the first study of the literature that investigated the impact of ocular re-alignment on behavioral patterns and social interactions of children with ASD and strabismus.
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http://dx.doi.org/10.1080/08820538.2016.1182559DOI Listing
April 2018

A Rare Cause of Retinal Artery Occlusion in Severe Hypernatremic Dehydration in Newborns.

Ophthalmic Surg Lasers Imaging Retina 2016 05;47(5):482-5

Neonatal hypernatremia is an important electrolyte disorder that may have serious complications. It may be a rare and underdiagnosed cause of venous and arterial thrombosis, leading to severe brain damage by cerebral edema and intracranial hemorrhage. Here, the authors present a case of bilateral central retinal artery occlusion in a newborn with severe hypernatremic dehydration who is found to be normal in terms of other causes of retinal arterial thromboembolization. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:482-485.].
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http://dx.doi.org/10.3928/23258160-20160419-14DOI Listing
May 2016

Comparative Clinical Outcomes of Pediatric Patients Presenting With Eyelid Nodules of Idiopathic Facial Aseptic Granuloma, Hordeola, and Chalazia.

J Pediatr Ophthalmol Strabismus 2016 Jul 17;53(4):206-11. Epub 2016 May 17.

Purpose: To present the clinical features of the eyelid nodules observed in a newly determined dermatologic disorder, idiopathic facial aseptic granuloma (IFAG), and to compare them with children having acute hordeolum and chalazion.

Methods: Duration of the lesion, localization, presence of coexisting facial nodules, management strategies, and response time to topical/oral antibiotics were retrospectively reviewed in 50 children with IFAG, acute hordeolum, or chalazion.

Results: Fourteen children with one or more IFAG nodules on their eyelids, 28 children with one or more acute hordeolum, and 8 children with one or more chalazion were examined. Children with IFAG on their eyelids and face presented earlier than children with acute hordeolum (P = .006). The duration of this lesion was similar among patients with IFAG on their eyelids and acute hordeolum (P = .53). Duration of the lesion and treatment response time were shorter in children with IFAG on their eyelids and face (P = .004) than in those with IFAG on their eyelids (P = .013). The lesions of patients with chalazion had a longer duration compared to those with IFAG on their eyelids (P = .005), IFAG on their eyelids and face (P < .001), and acute hordeolum (P = .04). Twenty patients with acute hordeolum recovered after topical antibiotics and had a similar treatment response time to those with IFAG on their eyelids and face (P = .06) and those with IFAG on their eyelids (P = .16).

Conclusions: IFAG should be considered in the differential diagnosis of painless eyelid nodules in children. Because IFAG on the eyelids has many overlapping features with hordeola/chalazia, its differentiation may be difficult in the absence of accompanying facial granulomas. Chronic subepidermal eyelid nodules resembling skin abscess should alert clinicians for IFAG. Because IFAG responds well to oral clarithromycin, unnecessary surgical interventions should be avoided in these cases. [J Pediatr Ophthalmol Strabismus. 2016;53(4):206-211.].
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http://dx.doi.org/10.3928/01913913-20160511-03DOI Listing
July 2016

Elevated neutrophil-to-lymphocyte ratio in pseudoexfoliation syndrome.

Eye (Lond) 2016 Aug 6;30(8):1045-8. Epub 2016 May 6.

Department of Ophthalmology, Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.

PurposeTo investigate the relationship between serum neutrophil/lymphocyte ratio and pseudoexfoliation syndrome.Materials and methodsThis study was designed as a retrospective analysis. Patients were divided into three groups: 55 patients with pseudoexfoliation syndrome (group 1), 19 patients with pseudoexfoliation glaucoma (group 2), and 48 control subjects without pseudoexfoliation syndrome or pseudoexfoliation glaucoma (group 3). The levels of neutrophils and lymphocytes were measured by ABX Pentra DF120/USA biochemical analyzer. The neutrophil/lymphocyte ratio was measured by dividing neutrophil count by lymphocyte count.ResultsThe mean ages of patients were 67.9±8.1 in group 1, 70.6±7.4 in group 2, and 67.3±7.6 in group 3 (P=0.172). Baseline clinical characteristics, such as diabetes and hypertension, were similar among groups. The mean neutrophil/lymphocyte ratio values were 2.08±0.61 in group 1, 2.20±0.58 in group 2, and 1.51±0.57 in group 3. The neutrophil/lymphocyte ratio was significantly higher in group 1 and 2 than the group 3 (P<0.001). In receiver operating characteristics analysis, the area under the curve for neutrophil/lymphocyte ratio was 0.776, and a neutrophil/lymphocyte ratio of >1.72 predicted pseudoexfoliation syndrome with a sensitivity of 77% and specificity of 71%.ConclusionThe elevated neutrophil/lymphocyte ratio is significantly associated with pseudoexfoliation syndrome. This novel and low-cost parameter can provide useful information for the relevant risk evaluation in these patients.
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http://dx.doi.org/10.1038/eye.2016.89DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985684PMC
August 2016

Agenesis of retinal vessels in a newborn with central nervous system developmental abnormality.

Int Ophthalmol 2017 Feb 28;37(1):259-261. Epub 2016 Mar 28.

Department of Pediatric Metabolism, Ministry of Health, Dr. Sami Ulus Maternity and Children Research and Training Hospital, 06080, Ankara, Turkey.

A full-term infant with neonatal seizures was diagnosed to have corpus callosum agenesis with congenital agyria. His indirect ophthalmoscopical evaluation revealed bilateral complete absence of retinal vessels with normal optic discs and macula. Bilateral lamellar cataracts developed in the second month of follow-up, and his muscle biopsy was consistent with a mitochondrial disorder. Confirmation by molecular analysis could not be performed since parents did not give their consent for further investigation.
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http://dx.doi.org/10.1007/s10792-016-0224-5DOI Listing
February 2017

Response to "Recurrent Aphthous Stomatitis As a Marker of Celiac Disease in Children".

Pediatr Dermatol 2016 Mar-Apr;33(2):242. Epub 2016 Feb 9.

Department of Child Health and Diseases, Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey.

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http://dx.doi.org/10.1111/pde.12801DOI Listing
July 2016

Ophthalmic Manifestations in Children With Congenital Hypothyroidism.

J Pediatr Ophthalmol Strabismus 2016 Jan-Feb;53(1):29-34

Purpose: To evaluate the frequencies of ophthalmic abnormalities in children with congenital hypothyroidism.

Methods: A total of 121 patients with a history of congenital hypothyroidism, aged 1 to 216 months, were included in the study. The initial ophthalmological examinations and demographic data of patients who were examined between April 2013 and April 2015 were retrospectively reviewed. Accompanying systemic abnormalities were also noted.

Results: Ophthalmic pathology was determined in 40.4% (49 of 121) of patients with congenital hypothyroidism, of which 79.5% (39 of 49) had significant refractive errors and 32.6% (16 of 49) had strabismus. Systemic abnormalities were observed in 74.3% (90 of 121) of the children, among which 47.1% (57 of 121) were congenital heart defects and 38.0% (46 of 121) were neurologic abnormalities. A high prevalence of Down syndrome (17.3%; 21 of 121) and atopic dermatitis (8.2%; 10 of 121) was detected among patients with congenital hypothyroidism.

Conclusions: In addition to many associated systemic abnormalities, ophthalmic pathologies may also occur in children with congenital hypothyroidism. Thus, routine ophthalmological examination is recommended for these children, starting from the time of initial diagnosis.
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http://dx.doi.org/10.3928/01913913-20160113-06DOI Listing
October 2016

Treatment of Phthiriasis Palpebrarum Mimicking Conjunctivitis in a Newborn.

Indian J Pediatr 2016 Jul 17;83(7):730-1. Epub 2015 Dec 17.

Department of Ophthalmology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.

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http://dx.doi.org/10.1007/s12098-015-1983-0DOI Listing
July 2016

Rapid Development of Corneal Hydrops in a Septic Infant who Received Diode Laser for Aggressive Posterior Retinopathy of Prematurity.

Ophthalmic Surg Lasers Imaging Retina 2015 Oct;46(9):984-5

A premature baby who was hospitalized with the diagnosis of sepsis was treated with diode laser photocoagulation for aggressive posterior retinopathy of prematurity. Diffuse corneal ectasia and corneal hydrops developed in the right eye, and hyphema and corneal hydrops developed on the left eye on postoperative day 12. The patient died because of cardiovascular collapse and hemodynamic instability. Sepsis may be a contributory factor to the clinical susceptibility of the patient for the postoperative corneal effects of the laser. This situation has not been previously reported in the literature.
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http://dx.doi.org/10.3928/23258160-20151008-15DOI Listing
October 2015

Serum Lipid Levels in Pseudoexfoliation Syndrome.

Semin Ophthalmol 2017 4;32(3):281-284. Epub 2015 Sep 4.

a Department of Ophthalmology , Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey.

Purpose: To investigate the serum lipid levels in pseudoexfoliation (PEX) syndrome and its association with systemic vascular disorders.

Materials And Methods: Patients were divided into three groups: 52 patients with PEX syndrome (group 1), 20 patients with PEX glaucoma (group 2), and 47 control subjects without PEX syndrome or glaucoma (group 3). The fasting serum total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglyceride levels were evaluated by Beckman Coulter DXC 800/USA biochemical analyzer.

Results: The mean LDL values were 138 ± 33 mg/dl in group 1, 150 ± 37 mg/dl in group 2, and 127 ± 36 mg/dl in group 3. The mean LDL values in groups 1 and 2 were found to be significantly higher than that of group 3 (p = 0.04). The patients in groups 1 and 2 were more often diabetic and hypertensive than group 3 (p < 0.008, p < 0.005, respectively).

Conclusion: Increased LDL values are significantly associated with PEX.
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http://dx.doi.org/10.3109/08820538.2015.1068341DOI Listing
June 2017

Serum neutrophil-to-lymphocyte ratio in retinopathy of prematurity.

J AAPOS 2015 Aug 31;19(4):327-31. Epub 2015 Jul 31.

Department of Neonatology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.

Purpose: To evaluate the relationship between serum neutrophil-to-lymphocyte ratio (NLR) and development of retinopathy of prematurity (ROP).

Methods: Infants with a gestational age of ≤32 week were screened for ROP. Complete blood cell, high-sensitivity C-reactive protein, and interleukin 6 levels of subjects were measured within the first 24 hours of life. The NLR was calculated by dividing neutrophil count by lymphocyte count. The association between other risk factors and the development of ROP were analyzed using univariate analysis and multivariate logistic regression analysis.

Results: A total of 100 infants were included: 80 with ROP and 20 without ROP. The NLR values differed significantly between the ROP group (median, 0.67; interquartile range, 0.38-1.09) and non-ROP group (median, 0.32; interquartile range, 0.22-0.79; P = 0.02). The lymphocyte count in the ROP group (4.01 ± 1.89) compared to that of the non-ROP group (5.69 ± 2.16) was significantly lower (P = 0.001). In multivariate analysis, lymphocyte count remained an independent predictor of ROP (OR = 0.599; 95% CI, 0.430-0.836; P = 0.003).

Conclusions: The NLR seems not to be an independent predictor of development of ROP. Lymphocyte count is inversely associated with ROP.
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http://dx.doi.org/10.1016/j.jaapos.2015.04.008DOI Listing
August 2015

Ophthalmological Findings of Turkish Children With Muscular Dystrophies.

J Pediatr Ophthalmol Strabismus 2015 Sep-Oct;52(5):311-6. Epub 2015 Jul 16.

Purpose: To present the results of ophthalmological examinations in children with muscular dystrophies and highlight the importance of their ophthalmological evaluation.

Methods: Retrospective analysis of the ophthalmological examination records in 74 children with a type of muscular dystrophy, examined between January 2011 and January 2015, was performed.

Results: The most common type of muscular dystrophy observed in our patients was Duchenne muscular dystrophy (67.5%), followed by Becker muscular dystrophy (9.4%), myotonic dystrophy (8%), limb-girdle muscular dystrophy (6.7%), merosin-negative muscular dystrophy (4%), and Ullrich muscular dystrophy (4%). Ten cases of Duchenne muscular dystrophy had both macular and retinal pigmentary changes (20%) and 9 had abnormal electroretinographies with decreased photopic and scotopic responses. Ptosis was the most common finding (83.3%). No abnormalities of light reflexes, pupil size, or saccadic and smooth pursuit movements were seen among cases with myotonic dystrophy.

Conclusions: Ophthalmological problems are commonly seen in children with muscular dystrophies. Simple ophthalmological screening and early intervention can improve their communication skills by way of increasing their visual talents.
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http://dx.doi.org/10.3928/01913913-20150714-01DOI Listing
May 2016

The association of vitamin D deficiency with tear break-up time and Schirmer testing in non-Sjögren dry eye.

Eye (Lond) 2015 Aug 12;29(8):1081-4. Epub 2015 Jun 12.

Department of Family Medicine, Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.

Purpose: To investigate the effect of vitamin D deficiency on tear break-up time (TBUT) and Schirmer test scores and to assess their relationship in non-Sjögren dry-eye patients.

Methods: Thirty-four patients with serum vitamin D deficiency and 21 control subjects with normal vitamin D levels were included in this study. The TBUT and Schirmer-1 test without topical anesthesia were performed to all patients.

Results: The mean TBUT were 5.18±2.15 and 7.36±3.10 s and Schirmer scores were 12.18±6.44 and 18.57±8.99 mm in the study and control groups, respectively. TBUT scores and Schirmer-1 results of the study group were significantly lower than the control group (P=0.01 and 0.007, respectively). The mean vitamin D levels were 11.50±1.8 ng/ml in the study group and 32.8±8.72 ng/ml in control group (P=0.001). Dry-eye symptoms were detected in all patients in the study group and 15% of the patients in the control group.

Conclusions: We demonstrated that vitamin D deficiency decreases the TBUT and Schirmer test values and may be associated with dry-eye symptoms in non-Sjögren syndrome.
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http://dx.doi.org/10.1038/eye.2015.96DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541362PMC
August 2015