Publications by authors named "Fatih Mehmet Mutlu"

61 Publications

A Case of Multiple Optic Disc Pits: 21-Year Follow-up

Turk J Ophthalmol 2021 04;51(2):123-126

University of Health Sciences Turkey Gülhane Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey

Optic disc pits (ODP) are an uncommon congenital abnormality. Patients remain asymptomatic unless they develop maculopathy. The use of optic coherence tomography has critical benefits in the follow-up of patients who are at the amblyogenic age. The aim of this study is to present a case of double ODP in the right eye and single ODP in the left eye in a partially accommodative esotropia patient followed for 21 years. To our knowledge, multiple ODP has never been described in a patient with partially accommodative esotropia.
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http://dx.doi.org/10.4274/tjo.galenos.2020.66909DOI Listing
April 2021

Ab interno 180-degree trabeculectomy with a dual blade in a patient with refractory primary congenital glaucoma.

Eur J Ophthalmol 2021 Apr 16:11206721211010402. Epub 2021 Apr 16.

Department of Ophthalmology, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey.

A 13-year-old female patient with refractory primary congenital glaucoma (PCG) in the right eye who had a history of multiple glaucoma operations underwent ab interno 180-degree trabeculectomy with the Kahook Dual Blade (KDB) targeting the nasal and inferior angles. On postoperative day 1, the intraocular pressure (IOP) of the right eye reduced from 43 to 15 mmHg while on medical therapy. The patient maintained this IOP level throughout the 6-month follow-up. Ab interno KDB trabeculectomy targeting both nasal and inferior angles may be an effective and safe procedure for the treatment of PCG even in eyes with a history of previously failed glaucoma procedures.
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http://dx.doi.org/10.1177/11206721211010402DOI Listing
April 2021

Evaluation of static and dynamic Pupillometry changes in men using Silodosin for benign prostatic hypertrophy.

BMC Ophthalmol 2021 Mar 8;21(1):125. Epub 2021 Mar 8.

Department of Ophthalmology, University of Health Sciences, Gulhane Education and Research Hospital, Ankara, Turkey.

Background: Intraoperative floppy iris syndrome is a variant of the small pupil syndrome that has been observed during cataract surgery in some patients currently or previously treated with α1 adrenergic blockers. It is important for cataract surgeons to predict the probable complications preoperatively. Our study aims to evaluate the static and dynamic pupil characteristics of patients treated with silodosin-a selective α1 adrenergic blocker-for benign prostate hypertrophy (BPH) and to compare these values with healthy subjects using an automatic quantitative pupillometry system.

Methods: A total of 74 BPH patients treated with silodosin for six months (group 1) and 30 healthy subjects (group 2) were enrolled in this prospective multidisciplinary cross-sectional study. Static and dynamic pupillometric measurements were obtained under optimized conditions, and the results were compared between the two groups.

Results: Seventy-four male patients with a mean age of 63,35 ± 7,21 (46-77) years with BPH treated with silodosin and 30 normal male subjects with a mean age of 63,07 ± 4,73 (52-71) years were analyzed. There were statistically significant differences between the groups with regard to scotopic pupil diameter (PD), high photopic PD, and low photopic PD (p < 0.001, for each one). The patient group had statistically significant higher values of amplitude and velocity of pupil contraction and lower values of duration of pupil contraction and latency as well as duration and velocity of pupil dilation.

Conclusion: The static and dynamic pupil characteristics of subjects treated with silodosin for BPH are different from those of healthy eyes. In addition, our results may have shed light on the risk for intraoperative floppy iris syndrome (IFIS) before cataract surgery; thus, surgeons can be alert and take precautions.
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http://dx.doi.org/10.1186/s12886-021-01894-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938558PMC
March 2021

Alterations in the Retinal Nerve Fiber Layer Thickness Color Map in Non-Glaucomatous Eyes with Myopia.

Turk J Ophthalmol 2021 Feb;51(1):26-31

University of Health Sciences Turkey, Gülhane Faculty of Medicine, Department of Ophthalmology Ankara, Turkey.

Objectives: To determine the normal values for retinal nerve fiber layer thickness (RNFLT) in myopic patients without glaucoma and analyze the changes in their color map.

Materials And Methods: A total of 245 eyes without glaucoma were included in the study. According to the degree of myopia, the cases were divided into 4 groups: control group (+1.00/-1.00 D; n=70), Group 1 (-1.00/-3.00 D; n=50), Group 2 (-3.00/-6.00 D; n=75), and Group 3 (>-6.00 D; n=50). Intra-group comparisons were performed in terms of superotemporal, superonasal, nasal, inferonasal, inferotemporal, temporal, and global RNFLT (Heidelberg Spectralis, Optic Coherence Tomography, Germany) and the color coding of these quadrants (green: within normal limits, yellow: borderline, red: outside normal limits).

Results: All groups were similar in age and gender (p>0.05). As the degree of myopia increased, RNFLT became thinner in the upper and lower temporal and upper and lower nasal quadrants (p<0.01). The rate of measurements considered borderline and outside normal limit in at least 1 quadrant was higher in groups with higher myopia for all quadrants (p<0.05). This rate was found to be 8/70 (11.4%) for the control group, 9/50 (18.0%) for Group 1, 21/75 (28.0%) for Group 2, and 33/50 (66.0%) for Group 3 (p<0.01).

Conclusion: The high rate of RNFLT classified as borderline or outside normal limits in myopic patients is a finding to which clinicians should pay attention in order not to make a misdiagnosis, especially in cases of suspected glaucoma.
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http://dx.doi.org/10.4274/tjo.galenos.2020.58726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931659PMC
February 2021

Evaluation of the Cataract Surgery 2018 Survey in Terms of Achieving Refractive Cataract Surgery Targets.

Turk J Ophthalmol 2021 Feb;51(1):7-18

Okan University Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey.

Objectives: The aim of this study was to show at what rate the technological equipment used in cataract surgery by Turkish ophthalmologists and their knowledge are reflected in practice and how up to date they are.

Materials And Methods: A questionnaire conducted using SurveyMonkey was used to evaluate the answers to 17 questions from 823 members of the Turkish Ophthalmological Association. Results were evaluated in subgroups according to the participants' age, occupational status, institutions, and whether they conducted relevant academic activities, and the data were compared as inadequate, standard, and contemporary approaches according to the determined criteria.

Results: Optical biometry devices were used at rates of 77.7% and 67.3% for intraocular lens (IOL) power calculations and keratometric measurements in preparation for cataract surgery, respectively. For IOL power calculation, third-generation formulas, especially the SRK-T, were used most commonly (46.2%), followed by second-generation formulas (21.9%), and fourth/fifth-generation formulas and multiple evaluations for different axial lengths (31.9%). The most common incision size was 2.8 mm (51.6%), while the percentage of 2.2 mm and shorter incisions considered to be neutral in terms of surgically induced astigmatism was 18.8%. When selecting incision location, approaches to reduce corneal astigmatism were reported by 28.9%, neutral approaches by 26.2%, and insensitive approaches by 44.9%. Additionally, 55.6% of participants never implanted toric IOLs and 50.7% did not use presbyopia-correcting IOLs. The proportion of surgeons who have experience with femtosecond laser-assisted cataract surgery was 10.3% and the rate of intracameral antibiotic injection at the end of the operation was 89.4%.

Conclusion: It was seen that Turkish cataract surgeons were able to use high technology for surgical preparation and surgery at high rates, but this was not reflected in practice at same rate in terms of achieving contemporary standards of refractive cataract surgery.
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http://dx.doi.org/10.4274/tjo.galenos.2020.46020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931655PMC
February 2021

Clinical Usefulness of a Computerized Vision Chart for Distance Stereoacuity Assessment in Children with Intermittent Exotropia.

Semin Ophthalmol 2021 Feb 10;36(1-2):41-45. Epub 2021 Feb 10.

Department of Ophthalmology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey.

Introduction: The aim of this study is to evaluate distance stereoacuity in children with intermittent exotropia (IXT) using a computerized vision chart (CVC), to compare the results to the normal subjects, and to determine if any correlation between stereoacuity and IXT severity exits.

Methods: A prospective case-control study was conducted including 24 children with IXT and 25 age-matched normal subjects. The mean age was 8.9 ± 4.5 in IXT group and 9.4 ± 4.2 in control group. The majority of patients (n = 17) had basic type IXT. Full ophthalmic examinations, deviations and stereoacuity tests were evaluated. Stereoacuity was measured with the CVC for distance stereoacuity and Randot stereotest book for near stereoacuity. Level of fusional control in patients with IXT was assessed using Newcastle Control Score (NCS). Seven of the patients with IXT were also reevaluated postoperatively.

Results: Near stereoacuity was good in both IXT and control groups, and there was no significant difference between groups. There was a poor correlation between near stereoacuity and NCS (r = 0.15, = .48). Distance stereoacuity in the IXT group was significantly reduced compared to controls ( = .004). There was a positive correlation between distance stereoacuity values and NCS in patients with IXT (r = 0.73, < .001).

Conclusion: Diminished distance stereoacuity in children with IXT can be detected with the CVC and this test may be useful for deciding the timing of surgical intervention and postoperative evaluation.
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http://dx.doi.org/10.1080/08820538.2021.1884271DOI Listing
February 2021

Comparative study of retinal nerve fibre layer thickness and retinal peripapillary capillary plexus microvascular vessel density: structure-function relationship analysis in glaucoma.

Eye (Lond) 2021 Jan 19. Epub 2021 Jan 19.

Department of Ophthalmology, Gulhane Medical Faculty, Health Sciences University, Ankara, Turkey.

Background: To investigate whether the retinal peripapillary capillary plexus vessel density (RPCP VD) or the retinal nerve fibre layer thickness (RNFLT) is better in showing the structure-function relationship in glaucoma.

Methods: Sixty-seven patients with primary open-angle glaucoma (POAG) in one eye and no visual field loss in fellow eye were included in this study. The scans of RPCP VD and RNFLT, and the standard automated perimetry data [including mean deviation (MD), pattern standard deviation (PSD), sector-based pattern deviation (PD) values] were analysed and compared.

Results: The global RNFLT was associated with MD (P = 0.035). RNFLTs of the superotemporal, superonasal, inferotemporal and inferonasal quadrants were associated with the corresponding PD (P = 0.004, <0.001, 0.002 and 0.012). The global RPCP VD was found to be associated with MD and PSD (P = 0.030 and 0.049, respectively). RPCP VD of the superotemporal quadrant was associated with PD of the corresponding quadrant, as well as with PSD (P = 0.003 and 0.043, respectively). Remaining RPCP VD values were only associated with the PD values of the corresponding quadrants (P < 0.05). The associations of the RPCP VD with PD were stronger than those of the RNFLT with PD [RPCP VD vs RNFLT: R = 0.624 vs 0.558 (P < 0.001 for both) for the superotemporal, 0.649 vs 0.552 for the superonasal (P < 0.001 for both), 0.598 vs 0.427 for the inferotemporal (P < 0.001 for both), 0.581 vs 0.408 for the inferonasal (P < 0.001 for both), 0.594 vs 0.068 (P < 0.001 vs 0.098) for the temporal, and 0.338 vs 0.195 (P < 0.001 vs 0.004) for the nasal quadrants].

Conclusion: In conclusion, the VD of RPCP was more informative in terms of the structure-function relationship in POAG. Future prospective follow-up studies with larger sample sizes are required to confirm the findings.
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http://dx.doi.org/10.1038/s41433-020-01367-zDOI Listing
January 2021

Surgical management of consecutive exotropia: Long-term outcomes.

Eur J Ophthalmol 2021 Jan 9:1120672120983199. Epub 2021 Jan 9.

Department of Ophthalmology, University of Health Science, Gulhane School of Medicine, Ankara, Turkey.

Purpose: To compare lateral rectus recession (LRc) and medial rectus advancement (MRadv) for correction of consecutive exotropia (CXT).

Methods: Of the 43 exotropic patients 20 of them underwent LRc (group 1) and 23 of them underwent MRadv (group 2). Postoperative exodrift, strabismic angle, dose effect relationship were compared with minimum 2 years follow‑up.

Results: An average dose-effect in group 2 is higher than group 1 in the early postoperative period, however there was no significant difference at the second year follow-up (p=0,109). An average exodrift after 2 year follow-up was 6,6±7,12 PD in group 1, and 8,13±7,45 PD in group 2. Postoperative overall success rate was 50% in group 1 and 65% in group 2 at the last follow-up. The success rates were not significantly different between the groups (chi-square, p =0.31).

Conclusion: Although there was no statistically significant difference at the last follow-up, better results were obtained with MRadv than LRc in the treatment of CXT.
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http://dx.doi.org/10.1177/1120672120983199DOI Listing
January 2021

Uveitis as a Confounding Factor in Retinal Nerve Fiber Layer Analysis Using Optical Coherence Tomography.

Ocul Immunol Inflamm 2020 Sep 18:1-6. Epub 2020 Sep 18.

Gulhane Medical Faculty, Department of Ophthalmology, Health Sciences University , Ankara, Turkey.

Purpose: To investigate the retinal nerve fiber layer thickness (RNFLT) in uveitic eyes and search for the associations with uveitis activity, etiology and location.

Methods: The files of 76 patients with uveitis and 76 controls were scanned. Associations of RNFLT were analyzed using generalized linear models.

Results: The RNFLT was significantly higher in patients with uveitis ( < .001). Active uveitis patients had a thicker RNFL than the controls and the patients with quiescent uveitis ( < .001). Anterior uveitis was associated with thinner RNFL in global and inferotemporal quadrant ( = .011 and 0.013, respectively). Thickening of RNFL was associated with posterior uveitis and Behçet's disease in all quadrants ( < .001) and idiopathic uveitis in the superonasal and nasal quadrants ( = .001).

Conclusion: Active uveitis, as well as posterior uveitis and Behcet's disease-associated uveitis, is a major confounding factor in RNFL analysis and therefore detection of glaucoma.
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http://dx.doi.org/10.1080/09273948.2020.1811353DOI Listing
September 2020

Late Surgical Correction of Longstanding Constant Strabismus in Adults: Is Fusion Possible in All Successfully Aligned Patients?

J Binocul Vis Ocul Motil 2020 Jul-Sep;70(3):109-114. Epub 2020 Jul 16.

Ophthalmology, Dünya Eye Hospital , İstanbul, Turkey.

Purpose: To determine whether late surgical correction provides fusion in adults who have constant strabismus beginning in early childhood.

Materials And Methods: This was a prospective study that included 34 consecutive adults with a history of early onset strabismus who had not previously undergone surgery. They were tested with the Bagolini striated glasses (BSG), Worth four-dot (W4D) test, cover test, and four-prism diopter (4-PD) test, preoperatively, and 6 weeks after surgery.

Results: The mean age was 23.8 years, 17 patients had esotropia and 17 patients had exotropia. Preoperatively, all patients demonstrated a manifest horizontal deviation ranging from 30 to 60 and had suppression. At 6 weeks postoperatively, 33 patients had a horizontal manifest deviation of <15 (range, 2-14; median, 6), and none were orthotropic as determined by the cover test together with the 4-PD test. All of these 33 patients achieved anomalous retinal correspondence (ARC) with the BSG at near, and 25 (75%) had ARC with the W4D test at near.

Conclusions: Although our study has limited number of patients its findings suggest it is possible to develop ARC after surgery in almost all adult patients with childhood-onset strabismus associated with suppression, and who have not previously been operated upon, if satisfactory alignment is achieved in adulthood.
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http://dx.doi.org/10.1080/2576117X.2020.1787017DOI Listing
July 2020

Bupivacaine injection for comitant horizontal strabismus: clinical and radiological results.

Arq Bras Oftalmol 2020 06 10;83(3):180-184. Epub 2020 Feb 10.

Department of Ophthalmology, Gulhane Military Medical Academy, Ankara, Turkey.

Purpose: To report the outcomes of bupivacaine injection for the treatment of comitant horizontal strabismus and evaluate clinical effectiveness and associated radiological changes.

Methods: This prospective observational clinical study was conducted on 10 patients with comitant horizontal strabismus of up to 40 prism diopters. Ophthalmologic examinations and three-dimensional orbital magnetic resonance imaging were performed pre and post-injection (at first, third, and 12th months). A 4.5 ml of 0.5% bupivacaine was injected into the extraocular muscle under topical anesthesia using an electromyography in all patients.

Results: The mean follow-up time at post bupivacaine injection and mean deviation at primary position were was 17 ± 2 months and 21.3 prism diopters, respectively. The mean changes in ocular alignment, enlargement of the cross-sectional area in the injected muscle, and volumetric enlargement were 7.7 PD, 12%, and 17% at the first year post-injection, respectively. No severe or persistent complication was observed. Ptosis and mydriasis were noted post-injection due to the anesthetic effects of bupivacaine but disappeared within 2 h post-injection.

Conclusions: Bupivacaine injection improved eye alignment in small-angle horizontal comitant strabismus, effectively diagnosed with orbital magnetic resonance imaging to evaluate volumetric changes of the extraocular muscles. Further clinical studies with larger numbers of patients should be performed to define optimal dosages, concentration, and application method and dose-response relationship.
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http://dx.doi.org/10.5935/0004-2749.20200032DOI Listing
June 2020

Clinical Features and Surgical Results in Harada-Ito Surgery Patients.

Turk J Ophthalmol 2018 Oct 31;48(5):267-273. Epub 2018 Oct 31.

Batıgöz Hospital, Ophthalmology Clinic, İstanbul, Turkey.

Symptomatic excyclotorsion is an important clinical problem, especially in acquired superior oblique muscle palsy. Excyclotorsion can disrupt the fusion and cause torsional diplopia. Harada-Ito surgery (HI) is a widely used method for treating excyclotorsions. This method relieves the torsional diplopia by increasing the effect of the incyclotorsion. In this study, we aimed to report the clinical features of patients with torsional diplopia due to acquired trochlear nerve palsy and the results of HI surgery in these patients.
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http://dx.doi.org/10.4274/tjo.31643DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6216535PMC
October 2018

A study on the validity and reliability of the Amblyopia andStrabismus Questionnaire (A&SQ) in Turkish.

Turk J Med Sci 2017 Apr 18;47(2):483-489. Epub 2017 Apr 18.

Department of Ophthalmology, Gülhane Training and Research Hospital, Healt Sciences University, Ankara, Turkey.

Background/aim: This study aims to evaluate the reliability and validity of the Amblyopia and Strabismus Questionnaire (AandSQ) that is translated into Turkish.

Materials And Methods: This is a methodological study. A total of 149 patients took part in the survey research between December 2012 and June 2014 in an university hospital, and 37 were retested. Cronbach's alpha coefficient was used for the questionnaire's reliability analysis.

Results: Cronbach's alpha coefficients for the subscales of fear of losing the better eye, distance estimation, visual disorientation, double vision, and social contact and appearance were found to be 0.80, 0.88, 0.95, 0.80, and 0.81, respectively. Five factors determined by the exploratory factor analysis explained 69.87% of the total variance.

Conclusion: The Turkish version of the AandSQ is found as a reliable and valid scale for analyzing Turkish society. The AandSQ might be helpful for measuring quality of life in patients with strabismus.
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http://dx.doi.org/10.3906/sag-1512-86DOI Listing
April 2017

Is there a relationship between outer retinal destruction and choroidal changes in cone dystrophy?

Arq Bras Oftalmol 2016 Sep-Oct;79(5):315-318

Department of Ophthalmology, GATA Medical School, Ankara, Turkey.

Purpose:: The aim of the present study was to use enhanced depth imaging optical coherence tomography (EDI-OCT) to investigate choroidal changes in patients with cone dystrophy (CD) and to correlate these findings with clinical and electroretinography (ERG) findings.

Methods:: This case-control study included 40 eyes of 20 patients with CD and 40 eyes of 40 age- and refraction-matched healthy individuals. Choroidal thickness (CT) measurements were obtained under the foveal center and at 500 and 1,500 μm from the nasal and temporal regions to the center of the fovea, respectively. EDI-OCT and ERG data were analyzed, and the correlations of CT with the best-corrected visual acuity (BCVA) and the central foveal thickness (CFT) were evaluated.

Results:: The mean subfoveal CTs in the CD and control groups were 240.70 ± 70.78 and 356.18 ± 48.55 μm, respectively. The subfoveal CT was significantly thinner in patients with CD than in the controls (p<0.001). The patients with CD also had significantly thinner choroids than the controls at each measurement location relative to the fovea (p<0.001). The subfoveal CT in the CD group correlated with CFT (p=0.012), but no significant correlation was found between the subfoveal CT and BCVA or photopic ERG responses.

Conclusions:: The present study demonstrated a significant thinning of the choroid in patients with CD. EDI-OCT is a useful technique for describing the choroidal changes occurring in CD. Future studies investigating the association between choroidal changes and outer retinal destruction or the disease stage may provide a better understanding of the pathophysiology of CD.
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http://dx.doi.org/10.5935/0004-2749.20160090DOI Listing
July 2017

Comment on survival analysis following early surgical success in intermittent exotropia surgery.

Int J Ophthalmol 2016 18;9(10):1532-1534. Epub 2016 Oct 18.

Department of Ophthalmology, Gulhane Military Medical School, Ankara 06010, Turkey.

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http://dx.doi.org/10.18240/ijo.2016.10.28DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5075675PMC
October 2016

Outcomes of Unilateral Inferior Oblique Myectomy Surgery in Inferior Oblique Overaction Due to Superior Oblique Palsy.

Turk J Ophthalmol 2016 Jan 5;46(1):21-24. Epub 2016 Jan 5.

Gülhane Military Medical Academy, Department of Ophthalmology, Ankara, Turkey.

Objectives: To present the outcomes of unilateral inferior oblique myectomy performed in patients with inferior oblique overaction due to superior oblique palsy.

Materials And Methods: Twenty-seven eyes of 27 patients that underwent inferior oblique myectomy surgery for superior oblique palsy between 2002 and 2008 were included. Inferior oblique overaction scores (between 0-4) at preoperative, early postoperative (within 1 week after surgery) and late postoperative (earliest 6 months) visits were reviewed.

Results: There were 12 male and 15 female patients. Eighteen were operated on the right eye, and 9 were operated on the left eye. The mean age was 15.62±13.31 years, and the mean follow-up was 17±11.28 months (range, 6-60 months). Patients who had horizontal component and V-pattern deviation were excluded. Preoperative and early postoperative inferior oblique overaction scores were 2.55±0.75 and 0.14±0.36, respectively, and the difference was statistically significant (p<0.01). This improvement was maintained up to the late postoperative period.

Conclusion: Due to its promising short-term and long-term results, inferior oblique myectomy can be the first choice of surgery for inferior oblique overaction due to superior oblique palsy.
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http://dx.doi.org/10.4274/tjo.02170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5076305PMC
January 2016

Keratoacanthoma of the conjunctiva in a young patient.

Arq Bras Oftalmol 2016 May-Jun;79(3):195-6

Department of Ophthalmology, Gulhane Military Medical Academy and Faculty of Medicine, Ankara, Turkey.

Keratoacanthomas rarely occur in the conjunctiva. We report a case of a 24-year-old man with a rapidly growing conjunctival mass. The tumor was excised with a safety margin to exclude squamous cell carcinoma and was histopathologically diagnosed as a keratoacanthoma. There has been no recurrence over 2 years of follow-up. To the best of our knowledge, he is the youngest patient to be diagnosed with conjunctival keratoacanthoma who had no known risk factors such as skin disorders, trauma, surgery, or infection. In similar cases, we recommend complete early surgical excision and careful follow-up to exclude malignancy.
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http://dx.doi.org/10.5935/0004-2749.20160056DOI Listing
April 2017

Long-term motor and sensory outcomes after surgery for infantile esotropia.

Vojnosanit Pregl 2016 May;73(5):463-8

Background/aim: Infantile esotropia (ET), entitled as congenital ET, is defined as an alternating, cross-fixational ET that occurs within the first 6 months of life. The aim of this study was to determine the long-term motor and sensory outcomes after surgical correction of patients with infantile ET.

Methods: Medical records of 108 consecutive children who had bimedial rectus recession (BMR) initially for ET were reviewed retrospectively. The patients were divided into 3 groups: the group I, surgery before one-year old; the group II, surgery between one and two-year old; the group III, surgery after two-year old.

Results: No significant differences were determined among the groups for preoperative mean angle of deviation and refractive error (p > 0.05, for both). Development rate of dissociated vertical deviation (DVD) was greater (40%) in the group I, and the relationship between the rate of DVD and the timing of the initial surgery was statistically significant (p = 0.03). Risk for additional surgery was significantly greater in patients with a younger mean age at initial surgery (p = 0.01). Although measurable stereopsis rate was higher in the group I (35%, 32.4%, 27.8%, respectively) the difference among the groups was insignificant (p = 0.80).

Conclusion: Patients with ET have limited potential of high grade stereoacuity despite the early alignment of eyes. Early surgery also has potential effects for the development of both inferior oblique overaction and DVD earlier.
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http://dx.doi.org/10.2298/vsp140915034aDOI Listing
May 2016

A Novel Capsulorhexis Technique in White Cataract Surgery.

Semin Ophthalmol 2017 18;32(5):661. Epub 2016 May 18.

a Department of Ophthalmology , Gulhane Military Medical School , Ankara , Turkey.

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http://dx.doi.org/10.3109/08820538.2015.1123736DOI Listing
June 2018

Fixation Characteristics of Severe Amblyopia Subtypes: Which One is Worse?

Semin Ophthalmol 2017 18;32(5):553-558. Epub 2016 May 18.

b Department of Ophthalmology , Gulhane Military Medical School , Ankara , Turkey.

Purpose: To determine differences in macular sensitivity and fixation patterns in different subtypes of severe amblyopia.

Methods: This case-control study enrolled a total of 73 male adults, including 18 with pure strabismic severe amblyopia, 19 with pure anisometropic severe amblyopia, 18 with mixed (strabismic plus anizometropic) severe amblyopia, and 18 healthy controls. MP-1 microperimetry was used to evaluate macular sensitivity, location of fixation, and stability of fixation.

Results: Mean macular sensitivity, stability of fixation, and location of fixation were significantly worse in all amblyopia subtypes when compared with healthy controls. Intergroup comparisons between amblyopia subtypes revealed that mean macular sensitivity, stability of fixation, and location of fixation were significantly worse in pure strabismic and mixed amblyopic eyes when compared with pure anisometropic amblyopic eyes.

Conclusions: Strabismus seems to be a worse prognostic factor in severe amblyopia than anisometropia in terms of fixation characteristics and retinal sensitivity.
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http://dx.doi.org/10.3109/08820538.2015.1123739DOI Listing
December 2017

Comparison of peripapillary choroidal thickness measurements via spectral domain optical coherence tomography with and without enhanced depth imaging.

Postgrad Med 2016 May 8;128(4):439-43. Epub 2016 Apr 8.

a Department of Ophthalmology , GATA Medical School , Ankara , Turkey.

Objectives: To compare peripapillary choroidal thickness (PP-CT) measurements using a spectral domain optical coherence tomography (SD-OCT) device with and without enhanced depth imaging (EDI).

Methods: Sixty healthy subjects aged from 18 to 40 years were included in this study. PP-CTs were measured in the right eyes by manual segmentation via SD-OCT both with and without EDI. The intraclass correlation coefficient (ICC) for each technique and comparison of PP-CT measurements between two techniques were evaluated. The correlation between retinal nerve fiber layer (RNFL) thickness and PP-CT was also explored on images of SD-OCT without EDI.

Results: The PP-CT measurements of 55 subjects were evaluated. The ICC was 0.999 (95% CI: 0.998-1.0, p < 0.001) for SD-OCT with EDI and 0.996 (95% CI: 0.995-0.997, p < 0.001) for SD-OCT without EDI. The mean PP-CT measurements in all regions and the overall mean PP-CT measurements between the two techniques were not different (p > 0.05). Additionally, there was no correlation between RNFL thickness and PP-CT (r = -0.109; p = 0.335).

Conclusions: The PP-CT measurements via SD-OCT without EDI were consistent with the measurements via SD-OCT with EDI. Ophthalmologists who do not have access to EDI technology can use images of SD-OCT without EDI to measure the peripapillary choroid for research purposes. However, thicker peripapillary choroids cannot be measured using this technique and require further modifications or newer technologies, such as SD-OCT with EDI.
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http://dx.doi.org/10.1080/00325481.2016.1171119DOI Listing
May 2016

Retina nerve fiber layer and choroidal thickness changes in obstructive sleep apnea syndrome.

Postgrad Med 2016 11;128(3):317-22. Epub 2016 Mar 11.

a Department of Ophthalmology , Gulhane Military Medical Academy , Ankara , Turkey.

Objectives: The purpose of this study was to determine the effects of obstructive sleep apnea syndrome (OSAS) on the submacular and peripapillary retinal nerve fiber layer (RNFL) and choroidal thickness (ChT).

Methods: Eighty-four eyes of 42 male patients with OSAS and 112 eyes of 56 aged-matched and body mass index-matched healthy male subjects were enrolled in this case-control study. The ChT and peripapillary RNFL thickness was measured using enhanced depth imaging optical coherence tomography. The ChT and RNFL thickness measurements of the groups were compared, and correlations among the Apnea Hypopnea Index (AHI) values and these measurements were calculated. Right and left eyes were separately evaluated.

Results: There were no significant differences in the subfoveal and temporal ChT between the groups (p > 0.05). The OSAS group had significantly thicker ChT at 0.5 and 1.5 mm nasal to the fovea in both eyes than the control group (p < 0.05). The peripapillary ChT were significantly thicker in the OSAS group at all segments except for the temporal and superotemporal segments when compared with the control group (p < 0.05 for all quadrants except temporal and superotemporal). When compared with controls, the OSAS group had significantly thinner nasal RNFL thickness in the right eye (p = 0.01) and thinner mean RNFL thickness in both eyes (p < 0.001). Other RNFL thickness measurements were similar between groups (p > 0.05). Between AHI and mean RNFL thickness showed a median negative correlation (r = - 0.411, p = 0.001).

Conclusion: The choroidal thickening in patients with OSAS may be associated with the pathophysiology of the neurodegeneration process of the disease.
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http://dx.doi.org/10.1080/00325481.2016.1159118DOI Listing
August 2016

An Unusual Cause of Pseudopapillary Oedema: Hyperphosphatemic Hyperostosis Syndrome.

Ophthalmic Genet 2016 06 12;37(2):238-41. Epub 2016 Jan 12.

c Department of Paediatry , Gulhane Military Medical Academy , Ankara , Turkey.

For the first time, we report hyperphosphatemic hyperostosis syndrome as a cause for pseudopapillary oedema in a pediatric case. Clinical findings are presented and discussed with tomographic evaluation (optical coherence tomography and Heidelberg retinal tomography) of optic discs, visual-evoked potentials, and visual fields.
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http://dx.doi.org/10.3109/13816810.2015.1033559DOI Listing
June 2016

Ocular morbidities of premature children with mild or no retinopathy of prematurity.

Turk J Pediatr 2015 Mar-Apr;57(2):129-35

Department of Ophthalmology, Gulhane Military Medical Academy Ufuk University Faculty of Medicine, Ankara, Turkey.

This study reports the ocular and neurologic outcomes at 3 years of age of preterm children with mild or no retinopathy of prematurity (ROP). We were able to compile data from the medical records of 119 out of 585 (20.3%) children with mild and no ROP, who were screened between March 1999 and March 2012. There were 52 children with mild ROP and 67 with no ROP. In terms of ROP-related risk factors, the mild ROP and no ROP groups showed significant differences in birth weight (p<0.001) and gestational age (p<0.001), as well as in the presence of mechanical ventilation (p=0.04), respiratory distress syndrome (p=0.003), blood transfusion (p=0.006) and sepsis (p=0.024). However, both groups seemed identical in terms of the distribution of refractive errors, presence of strabismus, presence of unfavorable structural or functional outcome, and presence of neurologic sequelae. In particular, the high incidence of neurologic morbidity (100%) in subjects with very poor vision suggested a clear correlation.
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August 2016

Bidirectional Synergistic Vergence.

Neuroophthalmology 2015 Oct 26;39(5):234-235. Epub 2015 Aug 26.

Department of Ophthalmology, Gulhane Military Medical Academy , Ankara, Turkey.

A 14-year-old boy presented with left ptosis and squint since his childhood. In primary position he had left hypotropia with ptosis (levator function 2 mm). With elevation of the right eye, the left eye depresses and adducts; with depression of the right eye, the left eye elevates and abducts. Forced duction test revealed no restrictive pattern. The synergistic divergence described in the literature was unidirectional and wholly compatible with inferior rectus co-contraction. But this case is bidirectional, and the aberrant upward movement cannot be explained by rectus muscle co-contraction. The two vertical rectus muscles show reciprocal misinnervation, or this effect could be coming from co-contraction of one of the oblique muscles for the movement in one direction.
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http://dx.doi.org/10.3109/01658107.2015.1056379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5123172PMC
October 2015