Publications by authors named "Gokhan Demir"

81 Publications

Assessment of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume in patients with idiopathic epiretinal membrane.

Ther Adv Ophthalmol 2021 Jan-Dec;13:25158414211010546. Epub 2021 Apr 23.

Dunya Goz Hospital, Istanbul, Turkey.

Purpose: To assess the role of inflammation in the pathogenesis of idiopathic epiretinal membrane (iERM) using the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) as indicators of inflammation and to compare these parameter levels between iERM and control subjects.

Methods: We retrospectively analyzed the medical records of 36 patients who underwent vitrectomy-ERM peeling and 39 patients who had cataract surgery. We obtained blood samples from all individuals who participated in the study to investigate these parameters.

Results: Seventy-five subjects were included in this study: 36 in the iERM group and 39 in the control group. The mean neutrophil and MPV levels were significantly higher in iERM subjects than in control subjects. The mean lymphocyte level was lower in the iERM group. The mean NLR, PLR, and MPV levels were higher in iERM subjects than in control subjects.

Conclusion: The higher NLR, PLR, and MPV levels found in patients with iERM may indicate that subclinical systemic inflammation may associate with iERM.
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http://dx.doi.org/10.1177/25158414211010546DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8072817PMC
April 2021

Prognostic factors affecting macular hole closure types.

Ther Adv Ophthalmol 2021 Jan-Dec;13:25158414211009007. Epub 2021 Apr 22.

Biostatistics Department, Mersin University, Mersin, Turkey.

Purpose: In this study, we aimed to evaluate the relationship between macular hole closure types assessed by optical coherence tomography (OCT) and the preoperative prognostic factors.

Materials And Methods: In total, 183 patients who underwent pars plana vitrectomy and internal limiting membrane peeling for idiopathic macular hole between August 2014 and August 2019 were reviewed retrospectively. The preoperative measurements of the macular hole including minimum linear diameter (MLD), basal hole diameter (BHD) and hole height (HH) were measured on OCT images. The patients were divided into two closure types on the basis of postoperative OCT findings (type 1 closure: retinal edges were flat and there was no defect of the neurosensory retina on the fovea; type 2 closure: retinal edges were flat and there was a defect of the neurosensory retina on the fovea). The difference of prognostic factors such as age; duration of symptoms; preoperative best-corrected visual acuity (BCVA); preoperative macular hole measurements, including MLD, BHD and HH; and rate of reopening between two types were statistically analysed.

Results: The mean age of patients was 66.33 ± 8.09 years (range: 48-88 years). According to OCT imaging, 117 eyes (63.9%) were classified into the type 1 closure group, and 66 eyes (36.1%) were classified into the type 2 closure group. There were no significant differences between two groups in age, duration of symptoms and preoperative BCVA ( = 0.694,  = 0.092 and  = 0.15). MLD and BHD were significantly larger, and reopening was significantly more common in type 2 group ( < 0.05,  = 0.04 and  < 0.005); however, there was no significant difference in HH between two groups ( = 0.239).

Conclusion: Preoperative horizontal measurements of macular hole may help to determine postoperative visual expectations and anatomical success, and predict the possibility of reopening.
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http://dx.doi.org/10.1177/25158414211009007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8072917PMC
April 2021

Three Cases of Breast Metastases from Lung Cancer and Systematic Review of the Literature.

Eur J Breast Health 2021 Apr 31;17(2):200-205. Epub 2021 Mar 31.

Institude of Senology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey.

Despite the high prevalence of lung cancer among other primary tumors, metastasis of this particular malignancy in the breast is very rare. We report three new cases of lung cancer with breast metastases and discuss radiological and clinical findings. Radiologically, each case displayed different characteristics. First, one of them had bilateral superficially and deeply located irregular lesions. Second, the patient presented with findings similar to inflammatory breast cancer. The third case had a circumscribed mass, resembling a benign complicated cyst. To guide clinicians for proper patient management, radiologists should be aware of the scope of typical and atypical imaging findings of metastatic involvement of the breast.
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http://dx.doi.org/10.4274/ejbh.galenos.2020.5703DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8025728PMC
April 2021

Efficacy and safety of iris-supported phakic lenses (Verisyse) for the treatment of high myopia: 5-year results.

Int Ophthalmol 2021 Apr 16. Epub 2021 Apr 16.

University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Street Number:2, Beyoglu, Istanbul, Turkey.

Purpose: Evaluating efficacy and safety of iris-supported phakic lenses (Verisyse) for high myopia treatment.

Methods: Patients treated with Verisyse (Abbott Medical Optics, Santa Ana, CA, USA) intraocular lens (IOL) implants were evaluated retrospectively. Patients with follow-up periods of more than 5 years were included in the study. Pre- and postoperative fifth-year spheric equivalent (SE) of manifest refraction values, uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively), and endothelial cell density (ECD) values were recorded. Complications were evaluated.

Results: Forty-seven eyes of 31 patients were included in the study. Pre- and postoperative fifth year mean SE was - 12.50 ± 3.51D and - 0.72 ± 0.40D, respectively. Pre- and postoperative fifth-year UDVA was 1.56 ± 0.22 and 0.33 ± 0.18 logMAR (p < 0.001), respectively. The safety index (pre- and postoperative CDVA) was 1.39 ± 0.63 at the 5-year follow-up (p > 0,05). The efficacy index (ratio of mean postoperative UDVA to mean preoperative CDVA) of the patients was 1.14 ± 0.60. The mean postoperative endothelial cell loss at 5 years was -7.42%. None of the patients had lost 25% of their preoperative endothelial cells at 5-year follow-up. The mean postoperative endothelial cell loss was -3.05% at 1 year, -1.23% between years one and three, -1.02% between the third and fifth years.

Conclusion: Verisyse IOL implantation is an effective and safe for high myopia surgical treatment. However, the 5-year follow-up period is not sufficient to evaluate the safety profiles in terms of endothelial cells.
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http://dx.doi.org/10.1007/s10792-021-01841-xDOI Listing
April 2021

Comparison of the efficacy and safety of anti-VEGF monotherapy versus anti-VEGF therapy combined with subthreshold micropulse laser therapy for diabetic macular edema.

Lasers Med Sci 2021 Apr 4. Epub 2021 Apr 4.

Atakoy Dunyagoz Hospital, 34158 Bakirkoy, Istanbul, Turkey.

The purpose of this study is to compare the efficacy and safety of 577-nm subthreshold micropulse laser (SML) and intravitreal bevacizumab injection (IVB) combined therapy with IVB monotherapy in the treatment of diabetic macular edema (DME). This retrospective study included 80 eyes of 80 patients; 40 eyes were treated with IVB monotherapy, and 40 eyes were treated with SML-IVB combined therapy. The mean number of required IVB injections and changes of best corrected visual acuity (BCVA) and central macular thickness (CMT) values were compared between the groups. The mean age of the patients was 60.19±7.43 years. The baseline characteristics of the patients were similar between the groups. In the SML-IVB combined group, the mean number of required SML sessions was 2.1±0.81. The mean number of required IVB injections was 4.38±0.81 in the SML-IVB combined group and 5.65±1.51 in the IVB monotherapy group (p<0.05). The increase of the BCVA was significant in the SML-IVB combined group at the 3rd, 6th, 9th, and 12th months; however, in the IVB monotherapy group, it was only significant at the 3rd month (p<0.05). The mean CMT values of the 3rd, 9th, and 12th months were similar between the groups (p>0.05); only at the 6th month was it significantly lower in the SML-IVB combined group (p<0.05). When compared with baseline, the decrease of the CMT was statistically significant in both groups at the 3rd, 6th, 9th, and 12th months (p<0.05). In this study, a significant benefit of adding SML to IVB therapy was found with less IVB need, although a very significant increase in BCVA could not be achieved. The use of SML-IVB combined treatment may be an effective and safe alternative for DME.
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http://dx.doi.org/10.1007/s10103-021-03306-0DOI Listing
April 2021

Evaluation of the effect of n95 face mask used by healthcare professionals on choroidal thickness.

Photodiagnosis Photodyn Ther 2021 Apr 1;34:102279. Epub 2021 Apr 1.

University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey. Electronic address:

Purpose: We aimed to show the changes in choroidal thickness (CT) with spectral domain optical coherence tomography (SD-OCT) after prolonged use of N95 mask.

Method: The healthcare workers who use the N95 face-mask, between 30-50 years of age who have best corrected visual acuity (BCVA) ≥10/10, spherical or cylindrical refraction errors less than 2 diopters, with normal intra ocular pressure (IOP), axial length (AL) between 22-24 mm included in the study. The choroid was imaged with enhanced depth imaging (EDI) techniques using SD-OCT. CT was measured, subfoveal, at 1000 μm nasal and temporal of the center of the fovea. Measurements were first made after wearing the N95 mask for at least 2 h without removing it and repeated 15 min after removing.

Results: After 2 h of the N95 mask using without removal, the mean subfoveal CT was 293.56 ± 76.12(min:185, max:479), the mean temporal CT was 253.81 ± 63.48(min:172, max:384), the mean nasal CT was 239.18 ± 53.92(min:139, max:356). Fifteen minutes after removal of the N95 mask, the mean subfoveal CT was 250.56 ± 52.48(min:172, max:397), the mean temporal was 218.40 ± 53.58(min:129, max:354), the mean nasal CT was 210.67 ± 53.31(min:132, max:366). The differences in subfoveal, temporal and nasal CT between 2 h of N95 mask use and 15 min after removal of the mask were statistically significant (p < 0.05 for each).

Conclusion: Hypercapnia due to prolonged use of the N95 mask may cause choroidal hemodynamic changes and transient increased choroidal thickness.
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http://dx.doi.org/10.1016/j.pdpdt.2021.102279DOI Listing
April 2021

Stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of liver metastases in oligometastatic patients: initial clinical experience.

Radiat Oncol J 2021 Mar 26;39(1):33-40. Epub 2021 Mar 26.

Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey.

Purpose: We aimed to present our initial clinical experience on the implementation of a stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of liver metastases in oligometastatic disease.

Materials And Methods: Twenty-one patients (24 lesions) with liver metastasis treated with SMART were included in this retrospective study. Step-and-shoot intensity-modulated radiotherapy technique was used with daily plan adaptation. During delivery, real-time imaging was used by acquiring planar magnetic resonance images in sagittal plane for monitoring and gating. Acute and late toxicities were recorded both during treatment and follow-up visits.

Results: The median follow-up time was 11.6 months (range, 2.2 to 24.6 months). The median delivered total dose was 50 Gy (range, 40 to 60 Gy); with a median fraction number of 5 (range, 3 to 8 fractions) and the median fraction dose was 10 Gy (range, 7.5 to 18 Gy). Ninety-three fractions (83.7%) among 111 fractions were re-optimized. No patients were lost to follow-up and all patients were alive except one at the time of analysis. All of the patients had either complete (80.9%) or partial (19.1%) response at irradiated sites. Estimated 1-year overall survival was 93.3%. Intrahepatic and extrahepatic progression-free survival was 89.7% and 73.5% at 1 year, respectively. There was no grade 3 or higher acute or late toxicities experienced during the treatment and follow-up course.

Conclusion: SMART represents a new, noninvasive and effective alternative to current ablative radiotherapy methods for treatment of liver metastases in oligometastatic disease with the advantages of better visualization of soft tissue, real-time tumor tracking and potentially reduced toxicity to organs at risk.
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http://dx.doi.org/10.3857/roj.2020.00976DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024184PMC
March 2021

Association between disorganization of the retinal inner layers and capillary nonperfusion area in patients with retinal vein occlusion.

Arq Bras Oftalmol 2020 Nov-Dec;83(6):497-504

Kayseri City Hospital, Kayseri, Turkey.

Purpose: To determine the correlation between the extent of disorganization of the retinal inner layers (a parameter of spectral domain optical coherence tomography) and optical coherence tomography angiography parameters in eyes with center-involved macular edema associated with retinal vein occlusion.

Methods: This retrospective observational study included 34 eyes of 34 patients with newly diagnosed macular edema associated with retinal vein occlusion and evidence of center-involved macular edema. Optical coherence tomography angiography and spectral domain optical coherence tomography were evaluated after resolution of the macular edema. Disorganization of the retinal inner layers was determined via spectral domain optical coherence tomography and optical coherence tomography angiography parameters, including foveal avascular zone area in the superficial capillary plexus and capillary nonperfusion areas, foveal avascular zone area in full retinal vasculature, foveal avascular zone perimeter, acircularity index of the foveal avascular zone, and foveal density.

Results: The mean disorganization of the retinal inner layers extent was 512.72 ± 238.47 microns, and the mean capillary nonperfusion area was 4.98 ± 2.85 mm2. There was a positive correlation between the extent of disorganization of the retinal inner layers and capillary nonperfusion area (p<0.001, r=0.901). Greater extent of disorganization of the retinal inner layers and the capillary nonperfusion area was correlated with wider foveal avascular zone area (p=0.014 and p=0.036, respectively) in the superficial capillary plexus and decreased foveal density (vessel density in 300 microns around the foveal avascular zone) (p=0.031 and p=0.022, respectively). These parameters were also correlated with decreased vessel density in both the superficial capillary plexus and deep capillary plexus in the parafoveal and peri-foveal regions (p<0.05 for all).

Conclusions: Disorganization of the retinal inner layers appears to be a correlated biomarker of capillary ischemia in retinal vein occlusion. The extent of disorganization of the retinal inner layers was strongly correlated with the capillary nonperfusion area. This may support the notion that the extent of disorganization of the retinal inner layers can be used as an easily obtainable and crucial surrogate marker of capillary ischemia.
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http://dx.doi.org/10.5935/0004-2749.20200093DOI Listing
February 2021

Optical coherence tomography parameters as predictors of treatment response to a 577-nm subthreshold micropulse laser in chronic central serous chorioretinopathy.

Lasers Med Sci 2021 Jan 7. Epub 2021 Jan 7.

Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Saglik Bilimleri University, 34752, Istanbul, Turkey.

To determine the relation between retinal microstructural changes and the response to 577-nm subthreshold micropulse laser (SML) treatment in chronic central serous chorioretinopathy (cCSC). This retrospective study included 39 eyes of 39 patients with cCSC, treated with the 577-nm SML. The eyes were evaluated in three groups: complete remission, partial remission, and failure groups. The presence of some baseline retinal microstructural changes, thickness of the outer nuclear layer (ONL), status of the ellipsoid zone (EZ), and retinal pigment epithelium (RPE) were evaluated. The changes in central macular thickness (CMT), subretinal fluid (SRF) height, and best-corrected visual acuity (BCVA) were calculated. There were 14, 13, and 12 eyes in the complete remission, partial remission, and failure group, respectively. The baseline EZ and RPE were found intact in 71.4% and 64.3% of the eyes in the complete remission group, respectively; however, these rates were respectively 25% and 16.7% in the failure group (p < 0.05). Extrafoveal foci were present in 35.7% of the eyes in the complete remission group, but none was found in the failure group (p < 0.05). Although there was no statistically significant difference, the baseline ONL thickness was higher, and the hyperreflective dots, retinal bumps, subretinal fibrinous exudates, and PEDs were seen less in the complete remission group. The changes of the BCVA were not significant in any of the groups at the last visit (p > 0.05). The presence of baseline intact EZ and RPE, and extrafoveal foci can potentially be used as predictors of the SML treatment success in cCSC.
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http://dx.doi.org/10.1007/s10103-020-03225-6DOI Listing
January 2021

Refractive and visual outcomes of small incision lenticule extraction (SMILE) in eyes with thin corneas.

Eye (Lond) 2020 Nov 2. Epub 2020 Nov 2.

Department of Ophthalmology, Istanbul Medeniyet University, Istanbul, Turkey.

Objectives: To report the refractive and visual outcomes of small incision lenticule extraction (SMILE) with the thinnest corneal thickness (CCT) of less than 500 µm and evaluate it in terms of safety and efficacy.

Setting: Refractive Surgery Clinic of University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.

Design: Retrospective case series.

Methods: The pre-and-postoperative examinations of all patients with thin corneas (preoperative CCT <500 µm) who underwent the SMILE procedure and had a minimum of 24 months of follow-up records were reviewed from medical files. The main outcome measures of the refractive and visual outcomes and the effect on corneal high order aberrations (HOAs) were evaluated.

Results: The study included 55 eyes of 39 patients. The mean preoperative uncorrected visual acuity (UDVA) was 1.3 ± 1.5 logMAR, and the mean postoperative UDVA was significantly improved to 0.05 ± 0.80 logMAR at the last visit (p < 0.001). At the last follow-up, 84% of the eyes were within ± 0.50D, and 96% of the eyes were within ±1.00D of attempted SE refraction. The HOAs of coma (p < 0.001), secondary astigmatism (p = 0.015), spherical aberration (p < 0.001), and RMS (p < 0.001) aberrations increased significantly from the baseline to the postoperative last visit. The increase in trefoil was not significant (p = 0.32). No sight threatening complications or ectasia were observed during the follow-up time.

Conclusion: SMILE is a safe and effective technique with long-term stability for treatment of myopia in eyes with a thin cornea, and satisfactory results can be obtained if candidates for surgery are selected carefully with particular emphasis on normal preoperative corneal topography.
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http://dx.doi.org/10.1038/s41433-020-01256-5DOI Listing
November 2020

Direct and crossover effects of Phenylephrine and Cyclopentolate on foveal avascular zone and vessel density of macular capillary plexuses: an optical coherence tomography angiography study.

Rom J Ophthalmol 2020 Apr-Jun;64(2):195-204

Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.

To determine the influence of phenylephrine and cyclopentolate on foveal avascular zone (FAZ) and vessel density of macular capillary plexus measurements via optical coherence tomography angiography (OCTA). The participants were separated into 2 groups according to the administration of drops. One drop of phenylephrine 2.5% was administered on one eye of each subject in the phenylephrine group (n=30) and one drop of cyclopentolate 1% in the cyclopentolate group (n=30). FAZ parameters and vessel density values of both superficial (SCP) and deep capillary plexuses (DCP) were calculated via OCTA priorly and at 45 min following the drop administration in both eyes. Vessel density, acircularity index of FAZ, FAZ area, perimeter of FAZ and foveal density-300 were evaluated via OCTA. The vessel density values of fovea in SCP and DCP was 18.51±7.14% and 36.05±8.76% and significantly decreased to 16.16±6.26% and 33.29±9.47% respectively after drop instillation in dilated eyes in phenylephrine group (p=0.041 and p=0.032). Likewise, the vessel density values in SCP and DCP were 21.56±7.74% and 39.27±8.76% and significantly decreased to 18.89±7.32% and 35.36±5.75% respectively, after drop instillation in dilated eyes in cyclopentolate group (p=0.035 and p=0.028). However, there was no significant difference between before and after instillation of drops in terms of foveal density-300 value via FAZ assessment tool in both dilated and nondilated contralateral eyes in both groups (p>0.05 for all). Mydriasis with phenylephrine and/ or cyclopentolate did not affect the foveal density-300 values while analyzing the perfusion of macula. Vessel density in foveal region should be evaluated via FAZ evaluation software of the OCTA.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7339688PMC
June 2021

Correction: Choroidal vascularity index as an indicator of vascular status of choroid, in eyes with nanophthalmos.

Eye (Lond) 2020 Dec;34(12):2357

University of Health Science, Istanbul Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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http://dx.doi.org/10.1038/s41433-020-1078-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784986PMC
December 2020

Choroidal vascularity index as an indicator of vascular status of choroid, in eyes with nanophthalmos.

Eye (Lond) 2020 12 15;34(12):2336-2340. Epub 2020 May 15.

University of Health Science, Istanbul Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.

Purpose: To investigate choroidal vascular index (CVI) in eyes with nanophthalmos (NO) with the use of optical coherence tomography (OCT).

Methods: Macular enhanced depth imaging OCT scans of 25 eyes of 25 patients with NO and age-gender-matched 25 eyes of 25 control subjects were analysed. Images were binarized using the ImageJ software, and total choroid area (TCA), luminal area (LA) and stromal area (SA) were acquired. The main outcome measure was CVI, defined as the ratio of LA to TCA.

Results: Twenty-five eyes of 25 patients with NO and age-gender-matched control subjects were enrolled. The mean TCA, SA and LA were found to be significantly higher in patients with NO (2.51 ± 0.44 vs. 1.91 ± 0.35 mm, P < 0.001; 0.86 ± 0.17 vs. 0.63 ± 0.13 mm, P < 0.001; and 1.65 ± 0.29 vs. 1.27 ± 0.23 mm, P < 0.000, respectively). On the contrary, CVI did not significantly differ between the two groups (65.72, 67.68, P = 0.099).

Conclusion: As a novel OCT-based marker, CVI could be used to assess vascular status of the choroid in eyes with NO and can provide better understanding of the pathogenesis of this disease.
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http://dx.doi.org/10.1038/s41433-020-0969-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784958PMC
December 2020

Efficacy of Palbociclib and Endocrine Treatment in Heavily Pretreated Hormone Receptor-positive/HER2-negative Advanced Breast Cancer: Retrospective Multicenter Trial

Balkan Med J 2020 02 23;37(2):104-107. Epub 2020 Jan 23.

Department of Medical Oncology, Acıbadem University, İstanbul, Turkey

Background: The synthesis of CDK4/6 inhibitors with endocrine treatment in two series of treatment has been widely accepted as the standard for patients with estrogen receptor-positive metastatic breast cancer. In spite of this, the activity of CDK4/6 inhibitors in patients with metastatic breast cancer who have progressed despite receiving multiple lines of treatment is not well understood.

Aims: To report the activity and safety of a CDK4/6 inhibitor (palbociclib) in patients in whom at least three lines of treatment for ER+ metastatic breast cancer had failed.

Study Design: Multicenter retrospective observational cohort study.

Methods: In this retrospective observational cohort study, we included 43 patients who received palbociclib after at least three lines of systemic treatment for ER+/HER2− metastatic breast cancer.

Results: The median progression-free survival in our population was 7 months (25-75 percentile, 4-10), and the median overall survival was 11 months (25-75 percentile, 6-19). Although there were some adverse events, palbociclib was generally well tolerated, so dose reduction was needed for only six patients (14%).

Conclusion: The efficacy of palbociclib among heavily treated hormone receptor-positive/HER2− patients with advanced breast cancer was acceptable in terms of clinical benefit, and it was generally well tolerated among this population.
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http://dx.doi.org/10.4274/balkanmedj.galenos.2020.2019.11.143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7094190PMC
February 2020

Comparison of two different treatment regimens' efficacy in neovascular age-related macular degeneration in Turkish population-based on real life data-Bosphorus RWE Study Group.

Int J Ophthalmol 2020 18;13(1):104-111. Epub 2020 Jan 18.

Ophthalmology Clinic, Bağcılar Training and Research Hospital, Istanbul 34200, Turkey.

Aim: To compare two different anti-vascular endothelial growth factor (anti-VEGF) treatment regimens'-a priori (PRN) and PRN regimen following the loading phase-anatomical and functional results in neovascular age-related macular degeneration (nAMD) patients.

Methods: Totally 544 nAMD patients followed and treated with aflibercept (=135) and ranibizumab (=409) at 9 different centers between 2013 and 2015 were enrolled into this retrospective multicenter study. Patients with initial best corrected visual acuity (BCVA) interval of 1.3-0.3 (logMAR) and a minimum follow-up of 12mo were included. Patients under two different regimens-a priori (1+PRN) or 3 consecutive intravitreal injections followed by a PRN regimen (3+PRN)-were compared in BCVA at 3, 6 and 12 months, and in central macular thickness (CMT) at 6 and 12 months. The total study group, intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA) groups were evaluated separately.

Results: The mean CMT decreased in the 1+PRN (=101) regimen from 407 to 358 and 340 µm and in the 3+PRN (=443) group from 398 to 318 and finally to 310 µm at months 6 and 12, respectively. Anatomically, the CMT reduction at 6 month (48.5 76.4; <0.05) was statistically significant in favor of 3+PRN group. BCVA changed in 1+PRN group from 0.77 to 0.78, 0.75 and 0.75; in 3+PRN group from 0.81 to 0.69, 0.72, and 0.76 at months 3, 6, and 12, respectively. Visual gain was statistically better in 3+PRN group at 3 month (-0.01 0.12; <0.001). In IVR group, CMT reduction was in greater in 3+PRN at 6 (44 72) and 12 month (61 84), but statistically insignificant. The 3+PRN group revealed statistically better visual results at 3 month (-0.02 0.11, <0.05). In IVA group, although statistically insignificant, CMT reduction (61 89, 6 month; 85 97, 12 month) and visual gain (0.02 0.16; 0.02 0.14; 0.05 0.11) was found in favor of 3+PRN group at all visits.

Conclusion: The loading dose of anti-VEGF treatments in nAMD leads to significantly better anatomical and functional results, regardless of the agent, specially in early follow-up interval.
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http://dx.doi.org/10.18240/ijo.2020.01.15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6942941PMC
January 2020

The impact of total neo-adjuvant treatment on nonoperative management in patients with locally advanced rectal cancer: The evaluation of 66 cases.

Eur J Surg Oncol 2020 03 8;46(3):402-409. Epub 2019 Jul 8.

Acibadem University Maslak Hospital, Radiology, Istanbul, Turkey. Electronic address:

Background: The study aimed to assess if adherence to a total-neoadjuvant-treatment (TNT) protocol followed by observation(watch-and-wait) led to the successful nonoperative-management of low-rectal-cancer.

Methods: In this study, patients with primary, resectable-T3-T4, N0-N1 distal-rectal-adenocarcinoma underwent-chemoradiotherapy + consolidation-chemotherapy (TNT). During the-TNT-period, endoscopy, MRI, and FDG-PET/CT were performed. We allocated patients with complete-clinical-tumor-regression, who underwent endoscopy every two months, MRI every-four-months, and PET/CT every-six-months-after-treatment, to the observation-group(OG). All other patients were referred for surgery. The OG was followed-up. The primary endpoint was local tumor-ecurrence after allocation to the OG.

Results: Between 2015 and 2018, we enrolled 66-patients. Of 60-patients who were eligible to participate, 39 had complete-clinical-response(cCR) and were allocated to the OG, six underwent local-excision (LE), and 15 underwent total-mesorectal-excision (TME). The median follow-up duration was 22 (9-42) months. The local-recurrence-rate in the OG was 15.3%, and the LE and TME rates were 16.6% and 0%, respectively. All recurrence cases were salvaged through either LE or TME. The-distant-metastasis rate was 5.1%, 16.6%, and 12.5% in the OG, LE, and TME groups, respectively. The endoscopic negative-predictive-value(NPV) was 50%, and the positive-predictive-value(PPV) was 76.9% in the surgery group (LE + TME). MRI; NPV-50%, PPV-76.9%. PET/CT; NPV-100%, PPV-93.3%. Six patients(28.57%) from surgery group achieved complete pathological response (cPR).

Conclusion: Our results indicated a high proportion of selected-rectal-cancers with-cCR after neo-adjuvant-therapy could potentially be managed non-operatively, and major surgery may be avoided.
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http://dx.doi.org/10.1016/j.ejso.2019.07.012DOI Listing
March 2020

Evaluation of Choroidal Thickness in Patients with Proliferative and Non-Proliferative Macular Telangiectasia Using Enhanced Depth Imaging Optical Coherence Tomography.

Curr Eye Res 2020 04 3;45(4):504-508. Epub 2020 Jan 3.

University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.

: To compare subfoveal choroidal thickness (SFCT) in eyes with non-proliferative macular telangiectasia (MacTel) type 2 with or without subretinal neovascularization (SRNV) and healthy control eyes.: Consecutive patients with non-proliferative and proliferative MacTel type 2 were included in the current study. For comparisons subjects with no ocular pathology were recruited and used as controls. Best corrected visual acuity (BCVA), central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) were evaluated. Since axial length (AL) may affect choroidal thickness, AL measurements were performed to avoid confusion in SFCT between the groups.: Of the 63 eyes of 38 MacTel type 2 patients, 38 eyes had only MacTel type 2 (group 1) and 25 eyes had SRNV caused by MacTel type 2 (group 2). Fourty eyes of 20 subjects served as controls (group 3). BCVA was found to be significantly higher in control group compared with group 1 and group 2 ( < .005). Whereas, no difference was detected between group 1 and group 2 ( = .75). No difference was noted in CMT between the groups ( = .35). Axial length measurement was very similar among all three groups ( = .62). After adjusting for age and axial length SFCT was significantly thinner in group 3 than the other groups ( < .001), but no statistically significant difference was found between group 1 and group 2.: Choroidal thickness did not vary between eyes with MacTel type 2 with SRNV and without SRNV. Choroid was significantly thicker in MacTel type 2 with SRNV and without SRNV than healthy eyes.
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http://dx.doi.org/10.1080/02713683.2019.1673437DOI Listing
April 2020

Early and Late Switch from Ranibizumab to an Intravitreal Dexamethasone Implant in Patients with Diabetic Macular Edema in the Event of a Poor Anatomical Response.

Clin Drug Investig 2020 Feb;40(2):119-128

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

Background And Objective: Patients with diabetic macular edema may not have optimal outcomes even with monthly ranibizumab intravitreal injections. A corticosteroid implant might be considered in such patients. The objective of this study was to compare the outcomes of switching from ranibizumab to an intravitreal dexamethasone implant after three or six consecutive monthly injections of ranibizumab.

Methods: Patients with treatment-naïve diabetic macular edema who showed a poor anatomical response to three or six consecutive intravitreal ranibizumab injections and received an intravitreal dexamethasone implant were enrolled in this retrospective study. Patients were divided into two groups as early- and late-switch groups. The early-switch group consisted of the patients who initially received three consecutive monthly ranibizumab injections and the late-switch group consisted of the patients who initially received six consecutive monthly ranibizumab injections and switched to a dexamethasone implant because of a poor anatomical response. Best corrected visual acuity and central retinal thickness at the baseline and 3, 6, 9, and 12 months in the study population were recorded.

Results: Sixty-eight eyes of 68 patients were included. The early-switch group consisted of 34 eyes and the late-switch group consisted of 34 eyes. The mean change in best corrected visual acuity was similar between the two groups at 3, 9, and 12 months; however, it was significantly better in the early-switch group than the late-switch group at 6 months. The change in central retinal thickness was similar between the two groups at 3, 9, and 12 months; however, it was significantly better in the early-switch group than the late-switch group at 6 months.

Conclusions: Although both early switching and late switching are similar in terms of providing functional and morphological improvement, early switching appeared better for ensuring patient well-being in the early period and improving patient adherence.
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http://dx.doi.org/10.1007/s40261-019-00865-7DOI Listing
February 2020

The effect of curcumin on healing in an animal nasal septal perforation model.

Laryngoscope 2019 10 1;129(10):E349-E354. Epub 2019 Apr 1.

Pathology Department, University of Health Sciences Kartal Dr Lütfi Kirdar Hospital, Istanbul, Turkey.

Objectives/hypothesis: We investigated the effect of intranasal topical curcumin on nasal septum mucosa wound healing in a nasal septal perforation model produced in rabbits.

Study Design: Experimental study.

Methods: Fourteen male New Zealand rabbits were included in the study. For each rabbit, 5-mm-diameter circular perforations were created at 5 mm away from the columella to the nasal septum. Curcumin (study group) and saline (control group) were administered intranasally once daily for 10 days. At the end of the 10th day, the animals were sacrificed and the nasal septum specimens were sent for histological examination. Epithelial regeneration and degeneration, cartilage degeneration and regeneration, presences of fibroblast, eosinophil, acute/chronic inflammatory and giant cells, capillary density, amounts of granulation tissue and collagen, and macroscopic closure rate of perforation parameters were compared in each group.

Results: Epithelial and cartilage regeneration, and the amounts of collagen and granulation tissue were significantly higher in the curcumin group compared to the control group (P < .05). No statistically significant difference was found in comparison of other parameters (P > .05).

Conclusions: Topical application of curcumin improves the wound-healing process of nasal septum perforation in the animal model. Therefore, curcumin can be used as a safe and effective medical agent to prevent the development of septal perforation.

Level Of Evidence: NA Laryngoscope, 129:E349-E354, 2019.
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http://dx.doi.org/10.1002/lary.27949DOI Listing
October 2019

Glutathione S-transferase enzyme activity and protein expression in patients with recurrent tonsillitis and idiopathic tonsillar hypertrophy.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019 Dec 12;163(4):349-354. Epub 2019 Feb 12.

Department of Biology, Kirikkale University, Faculty of Arts and Sciences, Kirikkale, Turkey.

Objectives: The palatine tonsil is a significant part of the secondary immune system. Tonsillitis and idiopathic tonsillar hypertrophy (ITH) are the most common pathologies of this component. Although there are studies on their pathogenesis, there is insufficient study of the role of antioxidant agents. Glutathione S-transferase (GST) isozymes contribute to the antioxidation reactions in the tissue via the glutathione pathway. The purpose in this study was to reveal the levels of the GST enzyme activity and protein expression of GSTP1 and GSTA1 isozymes in patients with tonsillitis and tonsil hypertrophy, and to investigate their role in the pathogenesis of these diseases.

Materials And Methods: Sixteen patients with recurrent tonsillitis and 5 patients with ITH and were included in the study. Cytosolic extracts were prepared from post-tonsillectomy tissues of both patient groups and GST enzyme activities were measured.

Results: The expression of GSTP1 was found to be significantly higher than GSTA1 in tissue samples of patients with ITH and recurrent tonsillitis (P<0.001). Increased GST activity and GSTP1 isozyme expression were shown in patients with recurrent tonsillitis compared to the idiopathic tonsillar hypertrophy study group. There was a positive correlation between the expressions of GSTP1 (P=0.040; r=0.47).

Conclusion: Increased GST activity and GSTP1 isozymes were demonstrated histologically in the pathogenesis of ITH and recurrent tonsillitis. We believe that the data of changes in antioxidant capacity, obtained from studies with more extensive and larger samples, would support our findings.
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http://dx.doi.org/10.5507/bp.2019.002DOI Listing
December 2019

Comparison of aflibercept and ranibizumab in diabetic macular edema associated with subretinal detachment.

Eur J Ophthalmol 2020 Mar 13;30(2):363-369. Epub 2019 Feb 13.

Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.

Purpose: To compare the efficacy of ranibizumab and aflibercept in the treatment of diabetic macular edema associated with subfoveal retinal detachment.

Methods: This is a retrospective, comparative study. The treatment-naïve diabetic macular edema patients who had diabetic macular edema associated with subfoveal retinal detachment and underwent intravitreal aflibercept or intravitreal ranibizumab treatment were included. The patients were treated on a pro re nata treatment regimen after a loading dose of 3-monthly injections and the follow-up time was 12 months. The primary outcome measure of this study was the presence of subfoveal retinal detachment after treatment at different time points. The secondary outcome measures were the change in best corrected visual acuity and central retinal thickness.

Results: A total of 46 eyes of 46 patients were included. The aflibercept group consisted of 20 and the ranibizumab group consisted of 26 eyes. During the follow-up period of 12 months, subfoveal retinal detachment was completely resolved in 75% versus 57.7% of the eyes at month 3 (p = 0.2), 90% versus 76.9% at month 6 (p = 0.2), 90% versus 65.4% at month 9 (p = 0.05), and 100% versus 80.8% at month 12 (p = 0.03) in the intravitreal aflibercept versus intravitreal ranibizumab groups. The change in best corrected visual acuity was not statistically different between the groups at months 3, 6, 9, and 12, respectively (p > 0.05 for all).

Conclusion: Both intravitreal aflibercept and intravitreal ranibizumab were effective in regards to anatomical and functional outcomes of diabetic macular edema patients associated with subfoveal retinal detachment. Interestingly, intravitreal aflibercept seemed more effective than intravitreal ranibizumab in the resolution of subfoveal retinal detachment at month 12.
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http://dx.doi.org/10.1177/1120672119827855DOI Listing
March 2020

Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group.

Turk J Gastroenterol 2019 Jul;30(7):584-598

Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey.

The geographical location and differences in tumor biology significantly change the management of gastric cancer. The prevalence of gastric cancer ranks fifth and sixth among men and women, respectively, in Turkey. The international guidelines from the Eastern and Western countries fail to manage a considerable amount of inconclusive issues in the management of gastric cancer. The uncertainties lead to significant heterogeneities in clinical practice, lack of homogeneous data collection, and subsequently, diverse outcomes. The physicians who are professionally involved in the management of gastric cancer at two institutions in Istanbul, Turkey, organized a consensus meeting to address current problems and plan feasible, logical, measurable, and collective solutions in their clinical practice for this challenging disease. The evidence-based data and current guidelines were reviewed. The gray zones in the management of gastric cancer were determined in the first session of this consensus meeting. The second session was constructed to discuss, vote, and ratify the ultimate decisions. The identification of the T stage, the esophagogastric area, imaging algorithm for proper staging and follow-up, timing and patient selection for neoadjuvant treatment, and management of advanced and metastatic disease have been accepted as the major issues in the management of gastric cancer. The recommendations are presented with the percentage of supporting votes in the results section with related data.
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http://dx.doi.org/10.5152/tjg.2018.18737DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6629281PMC
July 2019

The outcomes of epiretinal membrane peeling in patients with foveal herniation.

Int J Retina Vitreous 2018 7;4:40. Epub 2018 Nov 7.

Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok., 34421 Beyoglu, Istanbul, Turkey.

Background: To evaluate the surgical outcomes of vitrectomy in patients with foveal herniation associated with epiretinal membrane (ERM).

Methods: This was a retrospective case series. The patients who had a foveal herniation associated with ERM, underwent vitrectomy, and had a minimum follow-up period of 12 months were included. The visual and anatomical outcomes were assessed during the first 12 months of follow-up and at the last follow-up visit. The main outcome measure was the reorganization pattern of foveal pit at month 12.

Results: Eleven eyes of 11 patients were included. The mean postoperative follow-up period was 14.8 ± 2.6 months. The foveal contour was completely restored in 5 eyes (45.5%), partially restored in 5 eyes (45.5%), and was not restored in 1 eye (9.1%) at postoperative month 12 follow-up visit. The mean preoperative best corrected visual acuity was 0.61 ± 0.16 LogMAR and increased to 0.49 ± 0.16 LogMAR at month 12 ( < 0.0001). The mean preoperative central retinal thickness was 476 ± 128 micrometers and decreased to 302 ± 70 micrometers at month 12 ( < 0.0001).

Conclusion: The foveal contour was restored in 45.5% of the eyes and visual acuity was significantly increased by a mean of 1.2 LogMAR lines at month 12 in patients with foveal herniation associated with ERM.
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http://dx.doi.org/10.1186/s40942-018-0145-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220454PMC
November 2018

Real-World Outcomes of Anti-VEGF Treatment for Neovascular Age-Related Macular Degeneration in Turkey: A Multicenter Retrospective Study, Bosphorus Retina Study Group Report No: 1.

Turk J Ophthalmol 2018 Oct 31;48(5):232-237. Epub 2018 Oct 31.

Bosphorus Retina Study Group.

Objectives: To evaluate the real-world outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in neovascular age-related macular degeneration (nAMD) patients.

Materials And Methods: Multicenter, retrospective, interventional, non-comparative study. The records of nAMD patients treated with an anti-VEGF agent on a pro re nata treatment regimen basis between January 2013 and December 2015 were reviewed. The patients who completed a follow-up period of 12 months were included. Primary outcome measures of this study were the visit and injection numbers during the first year.

Results: Eight hundred eighty eyes of 783 patients met the inclusion criteria for the study. Mean number of visits at month 12 was 6.9±2.5 (range: 1-15). Mean number of injections at month 12 was 4.1±1.9 (range: 1-11). Mean visual acuity at baseline and months 3, 6, and 12 was 0.90±0.63 LogMAR (range: 0.0-3.0), 0.79±0.57 LogMAR (range: 0.0-3.0), 0.76±0.57 LogMAR (range: 0.0-3.0), and 0.79±0.59 LogMAR (range: 0.0-3.0), respectively. Mean central retinal thickness at baseline and months 6 and 12 was 395±153 μm (range: 91-1582), 330±115 μm (range: 99-975), and 332±114 μm (range: 106-1191), respectively.

Conclusion: The numbers of visits and injections were much lower than ideal and were insufficient with the pro re nata treatment regimen.
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http://dx.doi.org/10.4274/tjo.31697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6216527PMC
October 2018

Quantitative Analysis of Optical Coherence Tomography Angiography Features in Patients with Nonocular Behcet's Disease.

Curr Eye Res 2019 02 9;44(2):212-218. Epub 2018 Oct 9.

d Beyoglu Eye Training and Research Hospital , Istanbul , Turkey.

Purpose: To quantitatively measure the flow, nonflow, density, and foveal avascular zone (FAZ) assessment tool parameters of optical coherence tomography angiography (OCTA) in patients with nonocular Behcet's Disease (BD), and to compare the results with those obtained in healthy controls.

Methods: FAZ parameters, flow area of choriocapillaris, and vessel density values of both superficial (SCP) and deep capillary plexuses (DCP) were measured using OCTA.

Results: The FAZ area in SCP, FAZ area in full retinal vasculature, and FAZ perimeter were significantly higher and foveal density-300 was significantly lower in the BD group than in the control group (p = 0.008, p = 0.015, p = 0.011, and p = 0.045, respectively). Vessel density of the foveal region in SCP and DCP were significantly lower in the BD group than in the control group (p = 0.039 and p = 0.010).

Conclusion: Lower capillary vessel densities, particularly in the foveal region, could be considered a subclinical form of ocular involvement in nonocular BD.
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http://dx.doi.org/10.1080/02713683.2018.1530361DOI Listing
February 2019

Prognostic value of ocular trauma score for open globe injuries associated with metallic intraocular foreign bodies.

BMC Ophthalmol 2018 Aug 9;18(1):194. Epub 2018 Aug 9.

Beyoğlu Eye Research and Training Hospital, Bereketzade Mah, Bereketzade Sok. No:2, Beyoğlu, İstanbul, Turkey.

Background: The prognostic value of the ocular trauma score (OTS) in patients who underwent 23-gauge pars plana vitrectomy (23-G PPV) for surgical removal of posterior segment metallic intaocular foreign bodies (IOFB) was evaluated.

Methods: Patients who underwent 23-G PPV for surgical removal of retained metallic IOFBs were retrospectively analyzed. OTS score for each patient was calculated and raw scores were converted to their corresponding OTS categories. The final VAs in study patients were compared with their respective OTS categories.

Results: Twenty-five eyes from 25 patients were examined. Twenty-four (96%) of the patients were male, and the mean age was 34 ± 12 years. The time from injury to 23-G PPV was 9 ± 4 days. Fourteen (56%) patients had zone 1 trauma, eight (32%) patients had zone 2 trauma, and three (12%) patients had zone 3 trauma. Postoperative visual acuity was ≥ 20/200 in 14 (56%) of the patients and ≥ 20/40 in seven (28%) eyes. At the final visit, anatomical success was achieved in 86% of patients with retinal detachment at presentation. No statistically significant differences were found between our final VAs and OTS scores.

Conclusion: OTS, which provides prognostic information after general ocular trauma, may also provide valuable prognostic information for patients who undergo 23-G PPV for the surgical removal of metallic posterior segment IOFBs.
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http://dx.doi.org/10.1186/s12886-018-0874-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6085662PMC
August 2018

Pediatric Traumatic Retinal Detachment: Clinical Features, Prognostic Factors, and Surgical Outcomes.

J Ophthalmol 2018 25;2018:9186237. Epub 2018 Jun 25.

Department of Ophthalmology, Beyoğlu Eye Research and Training Hospital, No. 2, Beyoglu, 34421 Istanbul, Turkey.

Purpose: We report the clinical characteristics, prognostic factors, and surgical outcomes for 23-gauge pars plana vitrectomy (23-G PPV) in pediatric cases of traumatic retinal detachment (RD).

Methods: Medical records of pediatric patients who underwent 23-G PPV to treat traumatic retinal detachment were retrospectively reviewed. These patients underwent a follow-up examination at least 1 year following surgery. Associations between various preoperative factors and anatomical and visual outcomes were analyzed. An Ocular Trauma Score (OTS) and a Pediatric Ocular Trauma Score (POTS) were calculated for each patient. Raw scores were converted to their corresponding OTS and POTS categories. Final visual acuities by categories were compared with those in the OTS and POTS studies.

Results: The mean age of the patients was 9 ± 4 years, and the male-to-female ratio was 4.7 : 1. The mean follow-up time was 23 ± 14 months. Anatomical success was achieved in 72% of the eyes, and functional success (>5/200) was achieved in 37% of the eyes. Functional success was less common among patients with visual acuities less than hand motion, macula-off retinal detachment, proliferative vitreoretinopathy at presentation, and recurrent retinal detachment during follow-up. When we compared the categorical distribution of final visual acuities in all categories, our results were significantly different than those suggested by OTS and POTS.

Conclusions: Visual outcomes are poorer compared to anatomical outcomes. OTS and POTS do not provide reliable prognostic information if the patient has RD. Presenting visual acuity, the presence of macula-off RD, and PVR are all important predictors of final visual acuity.
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http://dx.doi.org/10.1155/2018/9186237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6036795PMC
June 2018

Treatment of intravitreal bevacizumab combined with focal laser photocoagulation in the case of macular telangiectasia type 2 with retinal arterial macroaneurysm.

Lasers Med Sci 2019 Mar 19;34(2):427-430. Epub 2018 Jul 19.

Beyoglu Eye Training and Research Hospital, The University of Health Sciences, İstanbul, Turkey.

Macular telangiectasia type 2 (Mac Tel 2) is a bilateral disease of unknown cause with characteristic changes of the retinal vasculature. To the best of our knowledge, we could not find any reported cases of Mac Tel 2 with retinal arterial macroaneurysm (RAM). Our aim is to report a case of Mac Tel 2 with RAM.
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http://dx.doi.org/10.1007/s10103-018-2587-5DOI Listing
March 2019

Comparison of Intravitreal Aflibercept and Ranibizumab following Initial Treatment with Ranibizumab in Persistent Diabetic Macular Edema.

J Ophthalmol 2018 19;2018:4171628. Epub 2018 Apr 19.

Beyoglu Eye Research and Training Hospital, Istanbul, Turkey.

Purpose: To compare the visual and anatomic outcomes in patients with persistent diabetic macular edema (DME) who switched from ranibizumab to aflibercept with those who continued with previous ranibizumab therapy.

Methods: In this retrospective comparative study, medical records of consecutive patients with center-involved DME ≥ 350 m who had at least three recent consecutive monthly ranibizumab injections followed by as-needed therapy with either aflibercept or ranibizumab were reviewed. Data were collected at presentation (preinjection), at the intermediary visit, and at the last visit (at the end of the follow-up period).

Results: Forty-three eyes of 43 patients were divided into two groups: the switch group ( = 20) and the ranibizumab group ( = 23). Though no significant improvement was found in the mean BCVA from the intermediary visit to the last visit, there was a difference in the mean CMT in the switch group and the ranibizumab group ( < 0.001 and = 0.03, resp.). The mean CMT decreased after the intermediary visit by 188.6 ± 120.5 m in the switch group and by 60.3 ± 117.1 m in the ranibizumab group ( = 0.003).

Conclusions: Both aflibercept and ranibizumab decreased CMT in patients with persistent DME who showed a poor response to ranibizumab injections. However, switching to aflibercept provided only morphologic improvement.
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http://dx.doi.org/10.1155/2018/4171628DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932981PMC
April 2018