Publications by authors named "Caner Kara"

14 Publications

  • Page 1 of 1

Bevacizumab and neurodevelopmental outcomes of preterm infants with retinopathy of prematurity: should we still worry?

J Matern Fetal Neonatal Med 2021 Feb 22:1-8. Epub 2021 Feb 22.

Department of Neonatology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey.

Aim: Bevacizumab may affect preterm infants' ongoing organogenesis with its antiangiogenic effects. We aimed to compare neurodevelopmental outcomes (NDO) of preterm infants treated for retinopathy of prematurity (ROP) with laser photocoagulation (LP), intravitreal bevacizumab (IVB) or both treatments, and to find out the effects of IVB on NDO.

Methods: Medical records of preterm infants with ROP treatment and evaluation for NDO were retrospectively collected between 1 January 2017 and 31 June 2019. Primary outcome was Bayley Scales of Infant and Toddler Development 3rd Edition (Bayley-III) scores including cognitive, language, and motor scores. Secondary outcomes were neurodevelopmental impairments (NDIs) classified as the presence of any of cerebral palsy (CP), sensorineural/mixed hearing loss, visual impairment, and developmental delay with any Bayley-III score <85. Severe NDI (sNDI) was defined as presence of any of CP with a Gross Motor Function Classification Scale of 3, 4, or 5, requirement for hearing aids or cochlear implants, bilateral visual impairment or severe developmental delay with any Bayley-III score <70.

Results: LP, IVB, and IVB + LP groups included 32, 12, and 10 patients, respectively. Patent ductus arteriosus treatment rates were as 68.7, 75, and 90% in groups, respectively (<.05 between LP and IVB + LP groups). Grades 3 and 4 intraventricular hemorrhage (IVH) was lower in LP group than IVB group (9.4% vs. 33.4%, <.05) while IVB + LP group had no grades 3 and 4 IVH. Other neonatal characteristics were similar ( > .05). CP was in 50%, 28%, and 0% of LP, IVB, and IVB + LP groups (<.05). There was no difference in median Bayley-III cognitive, language, and motor scores between groups ( > .05). Moderate and severe developmental delays were similar between groups ( > .05) whereas IVB group had more moderate cognitive delay; and more severe cognitive, language, and motor delay. NDI rate was not different (59.3%, 50%, and 40% in groups,  > .05). sNDI was highest in IVB group but not statistically significant (31.2, 41.7, and 10% in groups,  > .05). Multiple logistic regression analysis showed that ROP treatment type and grades 3 and 4 IVH did not have any significant effect on NDO ( > .05). Odds of NDI was not effected by ROP treatment type ( > .05).

Conclusions: Patients treated with bevacizumab should be carefully monitored for neurodevelopmental problems, although the frequency of grades 3 and 4 IVH in the bevacizumab group is thought to contribute to higher rates of sNDI and Bayley-III score <70.
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http://dx.doi.org/10.1080/14767058.2021.1888913DOI Listing
February 2021

Is being small for gestational age a risk factor for strabismus and refractive errors at 3 years of age?

Turk J Pediatr 2020 ;62(6):1049-1057

Department of Ophthalmology, Bilkent City Hospital, Ankara, Turkey.

Background: Visual problems, cerebral visual impairment, refractive errors and strabismus are commonly found in preterm infants in long-term follow-ups. The aim of this study was to determine the factors that lead to the development of amblyogenic risk factors, such as high refractive errors, anisometropia and strabismus, in the long-term evaluation of preterm infants.

Methods: We retrospectively evaluated children who were screened for retinopathy of prematurity (ROP) and who had a 3rd year ophthalmologic examination. The impacts of sex, gestational age (GA), birth weight (BW), BW for GA, being small for gestational age (SGA), being appropriate for gestational age (AGA), multiple pregnancies and the results of ROP screening on refractive errors and the development of strabismus were evaluated by logistic regression analysis. The SGA and AGA groups were compared in terms of refractive errors and presence of strabismus.

Results: Six hundred and eight children, including 317 (52.1%) males and 291 (47.9%) females, were included in the study. The mean GA was 31 ± 3 weeks (24-36), and the mean BW was 1505 ± 435 g (600-2460). The number of SGA-born children was 101 (16.6%). Manifest deviation was detected in 42 (5.6%) children, and optical correction was required in 101 (16.6%) children. Being an SGA infant and multiple pregnancies were risk factors for refractive errors requiring optical correction, and hyperopia (≥3.00 D) was found to be a risk factor for the development of strabismus in the multivariate regression analysis. Additionally, the SGA group was at high risk for strabismus, hyperopia, high astigmatism and the need for optical correction.

Conclusions: We concluded that SGA seems to be associated with an increased risk of strabismus and a high refractive error. It should be taken into consideration during follow-up examinations of SGA infants.
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http://dx.doi.org/10.24953/turkjped.2020.06.017DOI Listing
January 2020

Comparison of photoscreening and autorefractive screening for the detection of amblyopia risk factors in children under 3 years of age.

J AAPOS 2020 02 8;24(1):20.e1-20.e8. Epub 2020 Jan 8.

Department of Ophthalmology, Etlik Zübeyde Hanim Women's Health Education and Research Hospital, Ankara, Turkey.

Purpose: To evaluate the effectiveness of photoscreening and autorefractive screening for the detection of amblyopia risk factors (ARFs) in a cohort of preterm and term-born children <3 years of age.

Methods: In this cross-sectional study, the Spot Vision photoscreener and the SureSight autorefractor were used to screen participants. The diagnostic and predictive values of the devices in detecting ARF based on American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 2013 referral criteria was calculated using manufacturer criteria, the VIP 90 (90% specificity) and VIP 94 (94% specificity) criteria from the Vision in Preschool (VIP) study, and criteria recommended by Rowatt and colleagues. Results were evaluated using receiver operating characteristic (ROC) curves.

Results: A total of 368 patients (mean age, 14.4 ± 10.4 months) were included. The ARF rate was 25% according to the 2013 AAPOS criteria. The highest specificity and positive predictive values (PPV) were obtained with Spot Vision manufacturer criteria (specificity, 0.91; PPV, 0.69). SureSight manufacturer criteria showed very low specificity and PPV values (specificity, 0.43; PPV, 0.35) and a high false positive rate (57%). The highest specificity and PPV values for SureSight were obtained with the Rowatt criteria (specificity, 0.86; PPV, 0.62).

Conclusions: In our study cohort, photoscreening with the Spot Vision manufacturer criteria seemed sufficient for vision screening in the 0-3 years age group, with high specificity values. The Rowatt criteria may increase performance of the SureSight in this age group.
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http://dx.doi.org/10.1016/j.jaapos.2019.09.020DOI Listing
February 2020

Relationships between corneal biomechanics and the structural and functional parameters of glaucoma damage.

Arq Bras Oftalmol 2020 Mar-Apr;83(2):132-140

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

Purpose: To investigate the relationships between (i) thickness of the retinal nerve fiber layer, optic nerve head topography, and visual field parameters and (ii) corneal biomechanical properties in normal controls and patients with ocular hypertension and primary open-angle glaucoma.

Methods: This observational, cross-sectional study included 68 eyes with primary open-angle glaucoma, 99 eyes with ocular hypertension and 133 control eyes. Corneal biomechanical properties, optic nerve head topographic features, retinal nerve fiber layer thickness, and visual fields were assessed in all cases. Corneal biomechanical properties, retinal nerve fiber layer thicknesses, and optic nerve head topographic features were compared among the groups. The associations between structural and functional measures of glaucomatous damage and corneal biomechanical factors were also evaluated.

Results: Significantly lower corneal hysteresis and corneal resistance factor values were observed in the primary open-angle glaucoma and ocular hypertension groups as compared with the control group, but there were no significant differences between the primary open-angle glaucoma and ocular hypertension groups. In the ocular hypertension group, no associations were observed between the corneal hysteresis and corneal resistance factor with values and the structural and functional parameters. In the primary open-angle glaucoma group, positive correlations were observed between the corneal hysteresis values and the global retinal nerve fiber layer thickness (p<0.01, r=0.27), mean retinal nerve fiber layer thickness (p<0.01, r=0.33), and mean deviation (p<0.01, r=0.26), and negative correlations were observed between the corneal resistance factor values, and the cup area (p<0.01, r=-0.39), cup-to-disk ratio (p=0.02, r=-0.28), linear cup-to-disk ratio (p=0.02, r=-0.28), and cup shape (p=0.03, r=-0.26). In the control group, weak correlations were detected between the corneal hysteresis and the cup area (p=0.03, r=0.19), cup-to-disk ratio (p=0.01, r=0.21), and linear cup-to-disk ratio (p=0.01, r=0.22).

Conclusions: Distinct correlations were identified between the corneal hysteresis and corneal resistance factor values and the functional and structural parameters in the primary open-angle glaucoma and control groups. Corneal hysteresis and corneal resistance factor may have different roles in the pathophysiology of glaucoma.
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http://dx.doi.org/10.5935/0004-2749.20200019DOI Listing
May 2020

Effect of birth weight on retinopathy of prematurity in discordant twin pairs.

Indian J Ophthalmol 2019 06;67(6):806-810

Department of Neonatology, Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey.

Purpose: Since twin pairs with discordance have equal gestational age (GA), discordant twins may constitute an appropriate group to investigate the specific effect that birth weight (BW) has on the development of retinopathy of prematurity (ROP). The present study aims to investigate the effect of BW on any and severe stages of ROP development in twin pairs.

Methods: Fifty-two discordant twin pairs (104 preterms) born ≤32 gestational weeks, who were diagnosed with a minimum of 18% discordance between their BWs, were retrospectively analyzed. Twin pairs were separated into two groups based on the BW of each pair. The rate of any stage of ROP, Type 1 ROP, and perinatal risk factors were compared statistically among twin pairs.

Results: The rate of any stage of ROP and Type 1 ROP was 24.0% and 4.8% in the whole group, respectively. A statistically significant difference was shown between lower and higher BW groups at any stage of ROP development (34.6% vs. 13.4%, P = 0.02). However, no difference was observed in Type 1 ROP development (7.7% vs. 1.9%, P = 0.17). No significant differences were found between twin pairs regarding neonatal morbidities. The number of small GA (SGA) infants in the smaller twin group was statistically higher than larger group and regression analysis showed that being SGA had significant correlation with any stage of ROP (odds ratio: 4.98, P = 0.02).

Conclusion: This study showed that BW serves an effective role at any stage of ROP development in discordant twin pairs; however, no significant difference in terms of Type 1 ROP.
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http://dx.doi.org/10.4103/ijo.IJO_1197_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552611PMC
June 2019

Evaluation of a birth-related foveal hemorrhage in an infant using optical coherence tomography.

Arq Bras Oftalmol 2018 04;81(2):157-160

Department of Ophthalmology, Etlik Zübeyde Hanim Women's Health Education and Research Hospital, Research Hospital, Ankara, Turkey.

During the routine ophthalmologic examination of a 38-day old female infant, indirect ophthalmoscopy revealed a dense hemorrhage on the fovea and a couple of superficial hemorrhages in the nasal retina of the left eye. No hemorrhage was observed in the right eye. A hand-held spectral domain optical coherence tomography (SD-OCT) was used at the time of diagnosis. The hemorrhage at the nasal retina resolved in the first week of follow-up, and the foveal hemorrhage resolved 12 weeks after birth. Spectral domain optical coherence tomography was repeated once the foveal hemorrhage had resorbed, and it showed that the foveal contour had reformed without any sequelae. This case suggests that birth-related foveal hemorrhages do not cause any disturbance in the foveal architecture.
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http://dx.doi.org/10.5935/0004-2749.20180034DOI Listing
April 2018

Intravitreal bevacizumab as rescue therapy following treatment failure with laser photocoagulation in retinopathy of prematurity.

J Curr Ophthalmol 2018 Mar 24;30(1):80-84. Epub 2017 Aug 24.

Nevsehir State Hospital, Department of Ophthalmology, Nevsehir, Turkey.

Purpose: To evaluate the efficacy of intravitreal bevacizumab (IVB) in case of treatment failure with laser photocoagulation in retinopathy of prematurity (ROP).

Methods: A retrospective review of infants treated with IVB injection due to treatment failure with laser photocoagulation was performed. The anatomical results and complications were evaluated after treatment.

Results: 9 eyes of 6 premature infants with a mean gestational age of 26.8 ± 3.0 weeks (range, 23-32 w) and mean birth weight of 958 ± 319 g (range, 600-1400 g) were identified. Six of the eyes had zone 1 disease, and all of these eyes were classified as aggressive posterior ROP (APROP). Three of the eyes had zone 2 disease, and one of these eyes was classified as APROP, and the other two eyes were classified as high-risk pre-threshold disease. All of the eyes showed regression of the disease except one patient, both eyes of whom progressed to stage 4A. None of the patients developed ocular and systemic complications at the end of the six-month follow-up period.

Conclusion: IVB could be an option in patients with ROP in whom laser photocoagulation failed.
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http://dx.doi.org/10.1016/j.joco.2017.08.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859210PMC
March 2018

Retinopathy of prematurity in extremely premature infants: multiple births versus single births

Turk J Med Sci 2018 Feb 23;48(1):131-135. Epub 2018 Feb 23.

Background/aim: This study aimed to compare the incidence of any stage of retinopathy of prematurity (ROP) and type 1 ROP between extremely preterm multiple- and single-birth infants. Materials and methods: In this retrospective study, we included extremely preterm infants who were ≤27 weeks of gestational age at birth. The screened infants were divided into two groups: single and multiple births. The incidence of any stage of ROP and type 1 ROP was compared between the groups. Results: This study included 301 infants; 225 were in the single-birth group and 76 were in multiple-birth group. The incidences of any stage of ROP and type 1 ROP among all infants were 70.7% (213 of 301) and 16.6% (50 of 301), respectively. Regression analysis showed that lower birth weight (OR = 0.99, P = 0.004) and longer length of stay in hospital (OR = 1.02, P = 0.002) were significantly correlated with any stage of ROP. Compared to single-birth infants, the risk of any stage of ROP and type 1 ROP did not statistically increase for multiple-birth infants (P > 0.05). Conclusion: This study showed that multiple birth had no significant correlation with ROP development in extremely preterm infants.
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http://dx.doi.org/10.3906/sag-1706-52DOI Listing
February 2018

Torpedo Maculopathy in a 6-Month-Old Infant: Early Clinical and Optical Coherence Tomography Findings.

J Pediatr Ophthalmol Strabismus 2017 Aug 24;54:e54-e57. Epub 2017 Aug 24.

A 6-month-old male infant presented for routine ophthalmologic examination. Indirect ophthalmoscopy revealed a flat, oval, hypopigmented lesion located in the temporal macula in the right eye with the tip pointing toward the fovea, which was compatible with torpedo maculopathy. Optical coherence tomography (OCT) was performed at the time of diagnosis. OCT scans of the lesion revealed slight retinal pigment epithelium hyperreflectivity. This case serves as the earliest OCT finding of the youngest patient diagnosed as having torpedo maculopathy in the literature. [J Pediatr Ophthalmol Strabismus. 2017;54:e54-e57.].
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http://dx.doi.org/10.3928/01913913-20170531-04DOI Listing
August 2017

Increased levels of circulating CD34+ cells in neovascular age-related macular degeneration: relation with clinical and OCT features.

Eur J Ophthalmol 2018 Jan 19;28(1):80-86. Epub 2018 Feb 19.

6 Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Ankara - Turkey.

Purpose: To investigate the levels of circulating CD34+ stem cells in patients with neovascular type age-related macular degeneration (AMD) and its relation with clinical and optical coherence tomography (OCT) findings.

Methods: The study consisted of 55 patients: 28 patients (18 male and 10 female) with neovascular type AMD as a study group and 27 patients (12 male and 15 female) scheduled for cataract surgery as a control group. The level of CD34+ stem cells was measured by flow cytometry. Demographic and clinical data were recorded.

Results: The mean ages of patients in the study and control groups were 71 ± 8 and 68 ± 6 years, respectively. There was no statistically significant difference in terms of age, sex, or systemic disease association between study and control groups. However, smoking status was significantly higher in the study group (67.9% vs 37.0%; p = 0.02). Stem cell levels were significantly higher in the study group (1.5 ± 0.9 vs 0.5 ± 0.3; p<0.001), but there was no relation between stem cell levels and clinical and OCT findings.

Conclusions: Increased circulating CD34+ stem cell levels were observed in patients with choroidal neovascular membrane associated with AMD, but no significant relation was found between cell levels and clinical and OCT findings.
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http://dx.doi.org/10.5301/ejo.5001012DOI Listing
January 2018

Inability of Open-Field Autorefraction to Eliminate Accommodation in Preschoolers.

J Pediatr Ophthalmol Strabismus 2017 Sep 17;54(5):311-318. Epub 2017 May 17.

Purpose: To evaluate the effectiveness of the Shin-Nippon NVision-K 5001 autorefractometer (Rexxam Co. Ltd., Osaka, Japan) (also branded as the Grand Seiko WR-5100K; Grand Seiko Co. Ltd., Hiroshima, Japan) based on the open-field refractometry principle in refractive measurements of preschool children and to determine its ability to eliminate accommodation adequately.

Methods: The refractive results of 114 preschool children who presented to the ophthalmology outpatient department for screening were evaluated. The measurements were obtained before and after cycloplegia with the Shin-Nippon NVision-K 5001 autorefractometer and after cycloplegia with retinoscopy, which is the gold standard. The results underwent vectorial transformation to produce the spherical equivalent (M) and two Jackson cross-cylinder (J0 and J45) values. All results were then subjected to statistical analysis. The difference between the measurements was evaluated with repeated measures analysis of variance.

Results: Included in the study were 106 preschool children (51 boys and 55 girls). The mean age was 5.3 ± 0.9 years (range: 3 to 6 years). Although statistically significantly more myopic results were obtained with non-cycloplegic measurements using the Shin-Nippon NVision-K 5001 autorefractometer (P < .001), no difference was observed in cylindrical values (P > .05). Cycloplegic J0 measurements were significantly lower (P < .001), but no difference was found between J45 values before and after cycloplegia (P > .05).

Conclusions: The Shin-Nippon NVision-K 5001/Grand Seiko WR-5100K open-field autorefractometer seems to be inadequate in eliminating accommodation in childhood. Measurements under cycloplegia continue to be the best method to ensure accurate results. [J Pediatr Ophthalmol Strabismus. 2017;54(5):311-318.].
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http://dx.doi.org/10.3928/01913913-20170329-01DOI Listing
September 2017

Does the intraocular pressure-lowering effect of prostaglandin analogues continue over the long term?

Int Ophthalmol 2017 Jun 9;37(3):619-626. Epub 2016 Aug 9.

Ulucanlar Eye Research and Training Hospital, Ankara, Turkey.

The purpose of the study is to assess the changes in the long-term effects of prostaglandin analogues (PGAs) on intraocular pressure (IOP) reduction in patients with primary open-angle glaucoma (POAG). Data of POAG patients treated with latanoprost (0.005 %), travoprost (0.004 %), or bimatoprost (0.03 %) as the first line treatment for 5 years or more were retrospectively evaluated. Baseline ophthalmic assessment values were recorded together with the IOP at the 6th month, 1st year, and then annually. The 79 patients included 33 (41.8 %) men and 46 (58.2 %) women. There were 34 (43.0 %) patients using latanoprost (0.005 %), 23 (29.1 %) patients using bimatoprost (0.03 %), and 22 (27.8 %) patients using travoprost (0.004 %). There was no difference between the groups in terms of age, gender, or baseline IOP levels. IOP levels at the 6th month were significantly lower than baseline IOP levels in all groups (p < 0.01, Friedman test). The IOP decrease was maintained after the 6th month in all three group with no statistically significant difference compared to the 6th month IOP value (p > 0.05, Friedman test) and no statistically significant difference between the groups during follow-up (Kruskal-Wallis test, p > 0.05). IOP reductions with PGAs were adequate and stable in the 5-year follow-up period with no decrease in effectiveness over time.
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http://dx.doi.org/10.1007/s10792-016-0315-3DOI Listing
June 2017

Treatment success of laser therapy for retinopathy of prematurity in referred and non-referred patients.

Arq Bras Oftalmol 2016 Apr;79(2):96-9

Department of Ophthalmology, Samsun Training and Research Hospital, Samsun, Turkey.

Purpose: Comparison of laser therapy (LT) outcomes in patients with retinopathy of prematurity (ROP) followed up in our clinic and referred from other centers.

Methods: Medical records of 1,856 ROP patients were retrospectively evaluated, and a total of 128 patients who underwent LT were included in the study. The study population was divided into the following two groups: patients who were followed up and treated in our clinic (group 1, N=45) and patients who were referred to our clinic from other centers (group 2, N=83). Data regarding birth weight, sex, gestational age, postnatal treatment time, disease localization, and stage were analyzed and compared between the two groups. Treatment success was defined by anatomic success 6 months after treatment.

Results: Patients in the referred group presented with a more advanced disease (p<0.01), a lower treatment success rate (p=0.01), and a longer time interval between diagnosis and LT (p=0.04).

Conclusions: The treatment success rate of ROP was significantly lower in referred patients because of the potential delay in LT and more advanced disease at the time of treatment initiation.
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http://dx.doi.org/10.5935/0004-2749.20160029DOI Listing
April 2016

Presumed herpetic anterior uveitis: a study with retrospective analysis of 79 cases.

Eur J Ophthalmol 2014 Jan-Feb;24(1):14-20. Epub 2013 Jun 24.

1 Ulucanlar Eye Training and Research Hospital, Ankara - Turkey.

Purpose: To describe the clinical features, visual outcome, medical treatment, and complications of presumed herpetic anterior uveitis.

Methods: We retrospectively analyzed the clinical data related to 79 eyes of 77 patients with presumed herpetic anterior uveitis seen at the Uveitis Unit of the Ulucanlar Eye Training and Research Hospital from 1996 to 2011. Age at onset of disease, sex, follow-up duration, existence of corneal involvement, posterior synechiae, distorted pupil, iris atrophy, characteristic of keratic precipitates, elevated intraocular pressure (IOP), medical treatment, recurrence rate, complications, visual acuities (VA), and surgery for complications were recorded. The complication rates in patients with and without corneal involvement were compared.

Results: There were 38 (49.4%) female and 39 (50.6%) male patients. The mean age at presentation was 48.5 ± 14.8 (20-82) years. The follow-up period was 26.5 (2-127) months. Two patients had bilateral involvement. Ocular findings were a corneal scar or active keratitis in 37 (46.8%) eyes, secondary glaucoma in 14 (17.7%), iris atrophy in 39 (49.4%), distorted pupil in 16 (20.3%), posterior synechiae in 23 (29.1%), and granulomatous anterior uveitis in 30 (40%) eyes. Eight (10.1%) eyes had a posterior subcapsular cataract. Glaucoma surgery was required for uncontrolled IOP with maximum medical treatment in 2 (2.4%) eyes. Long-term oral acyclovir was used in 9 (11.3%) patients. Final VA was ≤ 0.1 in 8 (10.1%) eyes; of these, 6 had either corneal scarring or cataract and 2 preexisting amblyopia.

Conclusions: Presumed herpetic anterior uveitis with or without keratitis has characteristic clinical findings that enable the diagnosis. Long-term prophylactic antiviral therapy should be considered especially in patients <50 years old.
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http://dx.doi.org/10.5301/ejo.5000331DOI Listing
February 2014