Publications by authors named "Mehmet Cuneyt Ozmen"

24 Publications

  • Page 1 of 1

Retinopathy of prematurity incidence and treatment modalities in moderate and late preterm infants: a study from two tertiary centers.

Can J Ophthalmol 2021 Apr 20. Epub 2021 Apr 20.

Gaziantep University Faculty of Medicine, Department of Ophthalmology, Gaziantep, Turkey.

Objective: The aim of this study was to evaluate the incidence, severity, and treatment modalities of retinopathy of prematurity (ROP) in moderate and late preterm infants with a gestational age (GA) >31 + 6 weeks.

Methods: ROP screening results of preterm infants with GA >31 + 6 weeks to 36 + 6 weeks between March 2013 and January 2019 were evaluated retrospectively. Infants were divided into 2 groups according to GA as 32-33 + 6 weeks (moderate preterm) and 34-36 + 6 weeks (late preterm). In these groups, any ROP and severe ROP (requiring treatment) development rates and ROP types and treatment modalities were evaluated.

Results: A total of 4156 preterm infants, 1875 (45.1%) female and 2281 (54.9%) male, were included. Overall, 1466 (35.2%) of the infants were moderate preterm and 2690 (64.8%) were late preterm. The incidences of any ROP and severe ROP were 22% and 2.5%, respectively. The rate of severe ROP was 5.3% in moderate preterm infants and 0.9% in late preterm infants. Significant correlations were determined between duration of hospital stay, birth weight (BW), and GA with ROP development (r = +0.415, r = -0.258, r = -0.199, respectively; p < 0.001 for all). Of 102 patients (2.5%) requiring treatment, 64 (62.7%) had laser, 34 (33.3%) had intravitreal bevacizumab (IVB), 2 (1.9%) had sequential IVB and laser, and 2 (1.9%) had vitreoretinal surgery.

Conclusion: ROP seems to still be an important health problem in moderate and late preterm infants in our country according to data from screening high-risk preterm infants with a GA >31 + 6 weeks. In this cohort, ROP development correlates with GA, BW, and duration of hospitalization significantly.
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http://dx.doi.org/10.1016/j.jcjo.2021.03.014DOI Listing
April 2021

The results of intravitreal bevacizumab monotherapy for treating aggressive posterior retinopathy of prematurity and Type 1 retinopathy of prematurity.

Eye (Lond) 2021 Jan 29. Epub 2021 Jan 29.

Department of Ophthalmology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.

Objectives: This study evaluated the efficacy of intravitreal bevacizumab (IVB) monotherapy for aggressive posterior retinopathy of prematurity (APROP) and Type 1 retinopathy of prematurity (ROP), along with recurrence rates and treatment outcomes for recurrences.

Methods: This retrospective cohort study reviewed the records of infants with ROP (Type 1 and APROP), who received IVB treatment between March 2013 and February 2018.

Results: A total of 257 eyes from 130 cases (unilateral eyes in three cases) were included. Cases were followed for 121.7 ± 45.7 weeks (range: 70-260 weeks). Recurrence requiring treatment was determined in 14.8% of all eyes at a mean of 9.6 ± 2.7 weeks (range: 6-15 weeks) after initial treatment and a mean of 42.3 ± 2.2 weeks (range: 38-48 weeks) postmenstrual age. Recurrence requiring treatment was observed in 20.8% of APROP and 5.8% of Type 1 ROP eyes at a statistically significant difference (p = 0.001). Persistent avascular areas were found in 54 eyes (25.8%) at the corrected age of 1 year, and prophylactic laser treatment was applied. This was statistically significantly higher in APROP (38.6%) than in Type 1 ROP (10.5%) (p < 0.001). An unfavourable structural outcome (progression to retinal detachment) occurred in one eye (0.4%), which developed insufficient regression and progression.

Conclusions: IVB monotherapy is effective for APROP and Type 1 ROP with Zone 1 and posterior Zone 2 localisation. However, because of recurrences requiring treatment and persistent peripheral avascular areas, severe, late complications must be considered, and follow-up examinations must be made. Prophylactic laser treatment for persistent avascular areas seems effective for minimising long-term complications.
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http://dx.doi.org/10.1038/s41433-021-01413-4DOI Listing
January 2021

Combined Intrastromal Voriconazole and Amphotericin B Treatment for Persistent Fungal Keratitis.

Eye Contact Lens 2020 Sep;46(5):269-273

Department of Ophthalmology (B.A., M.E., M.C.O., T.A., F.A.), Faculty of Medicine, Gazi University, Ankara, Turkey; Ophthalmology Department (M.O.C.), Istanbul Research and Education Hospital, Istanbul, Turkey; and Ophthalmology Department (A.U.), Bolu Abant Izzet Baysal Research and Education Hospital, Bolu, Turkey.

Purpose: To evaluate the clinical outcomes of combined intrastromal voriconazole and intrastromal amphotericin B for the treatment of persistent fungal keratitis.

Method: Patients who received combined corneal intrastromal voriconazole (0.05 mg/0.1 mL) and intrastromal liposomal amphotericin B (0.01 mg/0.1 mL) injections in addition to topical therapy for treatment of persistent fungal keratitis were included in the study. Persistence was described as no improvement or progression in the clinical findings despite treatment with combined topical voriconazole (1 mg/0.1 mL) and topical amphotericin B drops (0.15 mg/0.1 mL) hourly for at least 10 days. The healing of keratitis was considered as the complete closure of epithelial defect with complete resolution of a corneal infiltrate.

Results: Thirty-two eyes of 32 patients who met the inclusion criteria were included in this study. Predominant organisms in fungal isolates were Aspergillus species. Combination therapy of intrastromal amphotericin B and intrastromal voriconazole in addition to topical therapy resulted in complete resolution of persistent fungal keratitis in 28 (87.5%) patients. The mean number of intrastromal injections was 9.3±6.4 and ranged from 1 to 18. The mean best-corrected visual acuity values improved from 2.17±0.43 to 1.76±0.77 logarithm of the minimum angle of resolution units (P=0.003). The mean duration of complete epithelial closure was 45.3±16.3 days. Four patients required therapeutic penetrating keratoplasty because of persistence of fungal keratitis (3 patients) and progression of keratitis (1 patient). There was no need for evisceration.

Conclusion: Combination therapy with intrastromal voriconazole and intrastromal amphotericin B may be an effective adjunct treatment for persistent fungal keratitis.
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http://dx.doi.org/10.1097/ICL.0000000000000723DOI Listing
September 2020

Rose Bengal-Mediated Photodynamic Antimicrobial Treatment of Keratitis.

Curr Eye Res 2020 10 27;45(10):1205-1210. Epub 2020 Feb 27.

Departments of Ophthalmology, Gazi University , Ankara, Turkey.

: To evaluate the in vivo efficacy of rose bengal (RB)-mediated photodynamic antimicrobial therapy (PDAT) for treatment of keratitis (AK). : An animal (rabbit) AK model was successfully achieved via intrastromal inoculation of a suspension of cells and trophozoites. Prior to RB-PDAT (pre-treatment, day-5), the severity of the induced corneal infection was graded numerically for epithelial defects, stromal edema, neovascularity, and stromal opacity/infiltration. The right eyes of rabbits (n = 18) were divided equally into three groups (n = 6/group): control (no treatment); 0.1% RB+518 nm irradiation (5.4 J/cm); and 0.2% RB+518 nm irradiation (5.4 J/cm). On post-treatment day-5, animals were euthanized, after which corneal buttons were excised and submitted for real-time polymerase chain reaction (RT-PCR) analysis. : Post-treatment clinical scores of the 0.1 and 0.2% RB groups indicated significant improvement compared to control group scores (pre-treatment clinical scores; 5.17 ± 0.98, 7.50 ± 0.62, and 6.17 ± 0.70 and post-treatment clinical scores; 4.50 ± 0.56, ( = .043), 3.50 ± 0.99 ( = .039), 6.83 ± 1.66 ( = .34), respectively). RT-PCR analysis revealed that the mean cycle threshold (Ct) values were significantly higher in treated-group corneas compared to control-group corneas, with no significant differences between treated-groups (Mean Ct values; 34.33, 34.5, and 29.67 for 0.1 and 0.2% RB, and control groups). There was a statistically significant negative correlation between post-treatment clinical scores and Ct values ( = -0.474, -value 0.047). : Our results demonstrate that RB-PDAT is effective in decreasing the parasitic load and clinical severity of AK.
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http://dx.doi.org/10.1080/02713683.2020.1731830DOI Listing
October 2020

The Effect of Sildenafil on Selenite-Induced Cataract in Rats.

Curr Eye Res 2020 09 11;45(9):1082-1088. Epub 2020 Feb 11.

Department of Medical Biochemistry, Gazi University Medical School , Ankara, Turkey.

Purpose: To investigate the effect of sildenafil on an experimental sodium selenite-induced cataract model in rats.

Materials And Methods: Twenty-six young Wistar rats were separated into four groups. On postpartum day 10, six rats received only selenite (group 1, selenite-induced cataract), seven rats received selenite and high dose oral sildenafil (group 2, high-dose sildenafil-treated), seven rats received selenite and low dose oral sildenafil (group 3, low-dose sildenafil-treated), and six rats received only saline (group 4, controls). On postpartum day 30, cataract formation was graded and recorded using an operating microscope. The rats were sacrificed, lens tissues were isolated, and serum samples were collected. Nitrite oxide metabolites (NOx), advanced oxidative protein products (AOPP), and total sulfhydryl (TSH) levels were assessed in both serum and lenticular samples.

Results: The rats treated with low-dose sildenafil showed lower levels of AOPP and NOx, and the higher levels of TSH than the rats in other experimental groups. Otherwise, the rats treated with high-dose sildenafil, similar to the selenite-induced cataract group, showed higher levels of AOPP and serum NOx than rats in the low-dose sildenafil-treated group. The rats treated with low-dose sildenafil also showed less cataract development than rats in the other experimental groups.

Conclusion: Low doses (0.7 mg/kg) of oral sildenafil might show a protective effect on cataract development by lowering oxidative stress.
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http://dx.doi.org/10.1080/02713683.2020.1726405DOI Listing
September 2020

Is gabapentin effective in dry eye disease and neuropathic ocular pain?

Acta Neurol Belg 2020 10 27;120(5):1215-1216. Epub 2019 Nov 27.

Department of Ophthalmology, Cornea, Cataract and Refractive Surgery Unit, Gazi University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1007/s13760-019-01251-yDOI Listing
October 2020

Results of surgery for late sequelae of cicatricial retinopathy of prematurity.

Indian J Ophthalmol 2019 06;67(6):908-911

Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey.

Purpose: To report anatomical and functional results of vitreoretinal surgery in our case series of late cicatricial retinopathy of prematurity (ROP) patients with subtotal retinal detachment.

Methods: This is a retrospective, consecutive case series. Eleven eyes of 10 patients presented with partial tractional retinal detachment secondary to late cicatricial ROP (cicatricial stage 4B) who underwent vitreoretinal surgery were retrospectively reviewed. Anatomical and functional outcomes were evaluated.

Results: The mean gestational age at birth was 28.6 (26-32) weeks. The mean age at surgery was 79 (4-213) months. Patients were followed up for 21.7 (6-40) months. Six eyes (55%) had lens-sparing vitrectomy and five eyes (45%) had lensectomy + vitrectomy. Anatomical success was achieved in 10 eyes (91%). Improvement in visual acuity was noted in nine eyes (82%).

Conclusion: Eye grows but fibrotic tissue does not grow with age, and during this period retinal traction may get worse. Relieving these tractions may lead to good anatomical and visual outcomes in selected late cicatricial ROP cases.
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http://dx.doi.org/10.4103/ijo.IJO_1083_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552626PMC
June 2019

Comparison of clinical outcomes of deep anterior lamellar keratoplasty and excimer laser assisted anterior lamellar keratoplasty in keratoconus.

Int J Ophthalmol 2019 18;12(4):582-586. Epub 2019 Apr 18.

Department of Ophthalmology, Gazi University Medical School, Yenimahalle, Ankara 06500, Turkey.

Aim: To compare and evaluate the clinical outcomes of deep anterior lamellar keratoplasty (DALK) and excimer laser assisted anterior lamellar keratoplasty (ELLK) in eyes with keratoconus.

Methods: In this study, 57 eyes of 56 patients operated between 2013 to 2017 were included. Thirty-one eyes underwent big-bubble DALK and twenty-six eyes underwent ELLK. Preoperative and at control visits complete ophthalmic examination was performed.

Results: The mean patient age at the time of DALK surgery was 27y and mean follow-up period was 21±5.4mo. The mean patient age at the time of ELLK surgery was 27y and mean follow-up period was 40±18mo. Mean best spectacle corrected visual acuity (BSCVA) at postoperative period was significantly higher for DALK group (0.66±0.11) versus ELLK group (0.4±0.2) (<0.05). Descemet's membrane microperforation was occurred in 7 patients in DALK group versus in 1 patient in ELLK group. In 4 eyes, interface irregularity was developed in ELLK group. None of the patients in follow-up had graft rejection in both groups.

Conclusion: In ELLK group, complication rate is lower, the surgical technique is simpler, faster and safer and also ELLK requires less experience with respect to DALK. Further, DALK can be performed unless satisfactory visual acuity is achieved after ELLK.
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http://dx.doi.org/10.18240/ijo.2019.04.09DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469552PMC
April 2019

Blunt Scissors Stromal Dissection Technique Compared With Big-Bubble Deep Anterior Lamellar Keratoplasty.

Eye Contact Lens 2019 May;45(3):195-200

Department of Cornea (A.Y.U., N.Y., A.Y., B.A., M.C.O., F.A.), Gazi University Hospital, Ankara, Turkey; Department of Ophthalmology (N.Y.), Yildirim Beyazit University Hospital, Ankara, Turkey; and Department of Ophthalmology (A.Y.), Urfa Training and Research Hospital, Urfa, Turkey.

Objectives: To evaluate the clinical findings and results of new modified manual deep anterior lamellar keratoplasty (M-DALK) technique compared with a big-bubble DALK (BB-DALK) technique in eyes with corneal scars or lesions.

Methods: A prospective, nonrandomized, comparative study included 65 eyes of 65 patients treated by M-DALK using the blunt scissors lamellar dissection technique or standard BB-DALK. Visual acuity, endothelial cell density, corneal cylinder (Cyl), central corneal thickness (CCT), residual stromal thickness and aberrometric values were recorded pre-treatment and 1, 3, 6, 12 and 18 months after treatment.

Results: Thirty-five eyes of 35 patients underwent deep anterior lamellar keratoplasty (DALK) with successful big-bubble technique, whereas 30 eyes of 30 patients underwent DALK with manual technique (in 10 eyes as a primary technique, in 20 eyes as a secondary technique). Successful big-bubble formation was achieved in 35 of 55 (64%) eyes. Microperforations occurred in three eyes in BB-DALK group, in six eyes in M-DALK group, and DALK could be completed successfully in these eyes. Visual acuity and endothelial cell loss results were not significantly different between groups during follow-up period. Mean CCT was significantly different between groups (P=0.035). Mean corneal Cyl, residual stromal thickness, and aberrometric values were similar between groups (P>0.05) at the final visit.

Conclusion: New modified M-DALK technique has similar clinical findings and results with BB-DALK when using as a primary or secondary approach.
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http://dx.doi.org/10.1097/ICL.0000000000000557DOI Listing
May 2019

Parameters affecting postoperative success of surgery for stage 4A/4B ROP.

Br J Ophthalmol 2019 11 18;103(11):1624-1632. Epub 2019 Jan 18.

Gazi University School of Medicine, Ankara, Turkey.

Purpose: To describe the long-term anatomical and functional results of surgery for retinal detachment (RD) associated with stage 4 retinopathy of prematurity (ROP) and patient and surgery-related factors affecting postoperative success.

Design: Retrospective case series at a single tertiary referral paediatric vitreoretinal practice.

Methods: One hundred and twenty-one eyes of 82 infants (40 female/42 male) who underwent lens-sparing vitrectomy (LSV) or lensectomy with vitrectomy surgery for stage 4A and 4B ROP at Gazi University Department of Ophthalmology between 2011 and 2016 were enrolled in this study. Patient characteristics including gestational age, birth weight, gender, stage of ROP at presentation, preoperative treatment (laser, anti-vascular endothelial growth factor (VEGF) or combined), anatomical and functional outcome and complications were recorded. The effect of birth weight, gestational age, presence of plus disease, preoperative treatment status, surgically induced posterior hyaloid detachment, postoperative vitreous haemorrhage and iatrogenic retinal tear formation on anatomical and functional results was evaluated.

Results: 61.2% of the eyes were stage 4A and 38.8% were stage 4B ROP. The mean follow-up was 24.5 months. 18.2% of the eyes had no preoperative treatment. Anatomical success was 86.5% for stage 4A and 68.1% for stage 4B at the first year, 91.7% for stage 4A and 69.4% for stage 4B at the second year, and 95.8% for stage 4A and 57.9% for stage 4B at the third year. Functional success was 85.1% for stage 4A and 65.9% for stage 4B at the first year, 89.6% for stage 4A and 61.1% for stage 4B at the second year, and 87.5% for stage 4A and 57.8% for stage 4B at the third year. The mean visual acuity was 1.12±0.34 logarithm of the minimum angle of resolution (logMAR) for stage 4A and 1.34±0.32 logMAR at the 3-year follow-up duration (p>0.05). There was preoperative plus disease in 59.5% of the eyes. Subsequent retinal surgeries were required in 17.4% of the eyes. Presence of plus disease and absence of preoperative treatment, iatrogenic retinal tear formation and postoperative vitreous haemorrhage were found to have significant negative effects, while surgical induction of posterior hyaloid detachment and sparing the lens intraoperatively affected the anatomical and functional results positively.

Conclusions: Surgery for stage 4 ROP-associated RD resulted in encouraging anatomical and functional outcomes and the results are even better in eyes with preoperative (laser/anti-VEGF) treatment, LSV and surgically induced posterior hyaloid detachment.
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http://dx.doi.org/10.1136/bjophthalmol-2018-312922DOI Listing
November 2019

confocal microscopy and anterior segment optical coherence tomography follow-up of cysteamine treatment in corneal cystinosis.

Indian J Ophthalmol 2019 Jan;67(1):153-155

Department of Ophthalmology, School of Medicine, Gazi University, Ankara, Turkey.

A 36-year-old female presented initially with photophobia and visual deterioration. After examination and laboratory tests, patient was diagnosed with cystinosis. Cysteamine drops 4 × 1 drops/day was given as treatment for 1 year. During follow-up, in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) was performed. Photophobia was relieved and IVCM obtained the decrease in size and density of corneal crystals 1 year after. Depth of corneal crystals did not change but crystal density score reduced with cysteamine treatment.
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http://dx.doi.org/10.4103/ijo.IJO_736_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324130PMC
January 2019

Effect of Riboflavin/Rose Bengal-Mediated PACK-CXL on Acanthamoeba Trophozoites and Cysts in Vitro.

Curr Eye Res 2018 11 7;43(11):1322-1325. Epub 2018 Aug 7.

a Department of Ophthalmology, School of Medicine , Gazi University , Ankara , Turkey.

Purpose: To evaluate the antiamoebic properties of photo-activated chromophore for keratitis (PACK)-corneal cross-linking (CXL) (PACK-CXL), in combination with riboflavin (0.1 and 0.25%) or rose bengal (0.1 and 0.2%), for treatment of Acanthamoeba trophozoites and cysts.

Materials And Methods: Cultures of Acanthamoeba castellanii were grown in a fluid medium at a concentration of 2.7 × 10 cell/ml. PACK-CXL was used on A. castellani cells in combination with either riboflavin (0.1 and 0.25%) or rose bengal (0.1 and 0.2%). Riboflavin-containing wells were irradiated with ultraviolet-A (UVA) light (365-nm wavelength). Rose bengal-containing wells were irradiated with green light (523-nm wavelength). A power density of 9 mW/cm for 10 min and total irradiation dose of 5.4 J/cm was used for both riboflavin and rose bengal. After UVA and green light irradiation, cell viabilities were evaluated, and percentage of dead cells calculated.

Results: No significant amoebicidal activity was observed following PACK-CXL/riboflavin at either concentration. PACK-CXL/rose bengal, however, was observed to be highly effective in eradicating Acanthamoeba cells at either concentration, with no significant difference observed between the two concentrations. The percentage of dead cells was 63% following treatment at either rose bengal concentration.

Conclusion: PACK-CXL with rose bengal demonstrated pronounced antiamoebic activity against A.castellanii. Further in vitro and in vivo studies are needed to confirm this finding.
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http://dx.doi.org/10.1080/02713683.2018.1501074DOI Listing
November 2018

Descemet Membrane Endothelial Keratoplasty with Irregular-Edged Graft: A Salvage Method for Large Radial Graft Tears.

Turk J Ophthalmol 2018 Apr 25;48(2):85-88. Epub 2018 Apr 25.

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

Large radial tears of donor Descemet membrane (DM) during the preparation of Descemet membrane endothelial keratoplasty (DMEK) grafts can make the trephination stage impossible because of small graft diameter. This results in irregular-edged grafts. In this study, we report two pseudophakic bullous keratopathy patients who underwent DMEK surgery with irregular-edged Descemet membrane (DM) grafts. Main outcome measures were preoperative and postoperative 1-, 3-, and 6-month best corrected visual acuity (BCVA), endothelial cell density (ECD) and central corneal thickness (CCT). Intraoperative and early postoperative complications were also evaluated. Both irregular-edged grafts were successfully implanted into the anterior chamber, unfolded, and attached to the posterior corneal stroma. Patients' BCVA at 6 months was 1.0 (Snellen equivalent: 20/20) and 0.6 (Snellen equivalent: 20/32) respectively. Decrease in ECD at the last visit was 27% and 25%. CCT decreased from 723 μm and 850 μm to 530 μm and 523 μm, respectively. No intraoperative complications occurred except for the large radial Descemet membrane graft tears that developed during donor DM stripping. None of the cases needed a rebubbling procedure postoperatively. We have demonstrated that irregular-edged DM grafts can be successfully implanted for DMEK surgery with good clinical outcomes.
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http://dx.doi.org/10.4274/tjo.39019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938482PMC
April 2018

Results of ethanol-assisted epithelium-on corneal cross-linking with and without intrastromal corneal ring implantation.

Int Ophthalmol 2019 Mar 10;39(3):651-659. Epub 2018 Feb 10.

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

Purpose: To evaluate the topographic, refractive, and pachymetric changes after ethanol-assisted transepithelial corneal cross-linking (CXL) to stabilize progression of keratoconus (KC).

Patients And Methods: This study retrospectively evaluated the long-term topographic, refractive, and pachymetric changes in patients diagnosed with KC who underwent corneal cross-linking and/or intrastromal corneal ring segment (ICRS) implantation. The subjects were divided into three groups, corresponding to eyes treated with CXL alone (group 1), CXL and ICRS at the same time (group 2), and CXL after ICRS implantation (group 3). Corrected visual acuity and refraction, steep keratometry (SteepK) values, steepest keratometry reading on sagittal curvature map, and corneal thickness were recorded preoperatively and at each visit. Changes between measurements were assessed during follow-up.

Results: Corrected distant visual acuity (CDVA) values improved in all groups compared with baseline, but the differences were not statistically significant except for the first year (p > 0.05). In groups 1 and 3, SteepK values did not change statistically significantly during the entire follow-up (p > 0.05). In group 2, SteepK values statistically significantly decreased at all follow-up examinations compared with baseline, determined as the first month after ICRS implantation (p < 0.05). Complication rates were acceptable without any need for surgical intervention.

Conclusions: Single-session ethanol-assisted transepithelial CXL with or without ICRS implantation was a safe and effective procedure to halt progression of KC.
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http://dx.doi.org/10.1007/s10792-018-0858-6DOI Listing
March 2019

Prediction of Descemet Membrane Perforation During Deep Anterior Lamellar Keratoplasty in Patients With Keratoconus With Stromal Scar.

Eye Contact Lens 2018 Nov;44 Suppl 2:S176-S179

Department of Cornea, Gazi University Hospital, Ankara, Turkey.

Objectives: To report big-bubble deep anterior lamellar keratoplasty (DALK) in patients with keratoconus with corneal stromal scar, and to investigate factors that can influence intraoperative Descemet membrane (DM) perforation.

Methods: A retrospective study included patients with keratoconus with central stromal scar that underwent DALK using the big-bubble technique. Best spectacle-corrected visual acuity (BSCVA), keratometry, minimum corneal thickness (MCT), stromal scar depth, and endothelial cell density (ECD) were recorded. Receiver operating characteristic (ROC) curves were analyzed to predict an intraoperative perforation related to stromal scar.

Results: Thirty-eight eyes of 38 patients with keratoconus (mean age: 30.0±9.2 years) were included in this study. Thirty-four eyes had successful DALK; in four eyes, the procedure was converted to penetrating keratoplasty because of DM macroperforations. Successful big-bubble formation was achieved in 24 of 38 (63.2%) eyes, whereas in 10 eyes, manual dissection was used to complete the DALK. Mean preoperative and postoperative second year BSCVA were 1.3 (±0.4) and 0.5 (±0.2) logarithm of the minimum angle of resolution (P<0.001), keratometry values were 65.5±7.4 and 42.8±7.8 diopters (P<0.001), and ECD were 2,740±359 and 2,279±452 cells/mm (P<0.001), respectively. Using ROC analysis, the area under curve value to predict DM perforation was found to be 0.792 (scar/MCT ratio, P=0.04) and the best cutoff point for scar depth/MCT ratio was 53%.

Conclusion: Big-bubble DALK is effective in patients with keratoconus with stromal scars. Scar depth/MCT ratio seems to predict the DM perforation.
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http://dx.doi.org/10.1097/ICL.0000000000000434DOI Listing
November 2018

Soluble Endoglin Level Increase Occurs Prior to Development of Subclinical Structural Vascular Alterations in Diabetic Adolescents.

J Clin Res Pediatr Endocrinol 2016 Sep 21;8(3):313-20. Epub 2016 Apr 21.

Gazi University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey, Phone: +90 462 341 56 56/11572 E-mail:

Objective: Soluble endoglin (S-endoglin) has been implicated as a potential marker of endothelial dysfunction (ED) and was reported to be elevated in diabetic adults, correlating with the severity of diabetic vasculopathy. However, circulating S-endoglin and its association with other markers of ED have not been formerly analyzed in the first decade of diabetes onset in adolescents with type 1 diabetes mellitus (T1DM).

Methods: Fifty-eight adolescents with moderately/poorly controlled T1DM were included in this study and twenty-nine healthy adolescents served as controls. The diabetic group was divided into two groups based on the presence of microalbuminuria, as the microalbuminuria group (n=15) and the normoalbuminuria group (n=43). Functional vascular alterations were evaluated by measuring serum S-endoglin and plasma nitric oxide (NO) concentrations, the flow-mediated dilatation (FMD) of the brachial artery. Carotid intima media thickness (CIMT) was measured for evaluation of structural vascular alterations.

Results: The S-endoglin and NO levels of both microalbuminuria and normoalbuminuria groups were higher than those of the control group (for S-endoglin, p=0.047 and p<0.001; for NO, p=0.004 and p=0.006, respectively). The FMD percent was lower in the microalbuminuria group compared to the normoalbuminuria and control groups (p=0.036 and p=0.020, respectively). There were negative correlations between S-endoglin concentration and FMD percent (r=-0.213, p=0.051) and between serum S-endoglin concentration and albumin excretion rate (r=-0.361, p=0.005). No significant differences were found in CIMT among any of the groups (p=0.443).

Conclusion: In adolescents with T1DM, S-endoglin concentrations might increase in parallel to the deterioration in endothelial function before subclinical structural vascular alterations become evident.
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http://dx.doi.org/10.4274/jcrpe.2906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096495PMC
September 2016

In-vivo corneal biomechanical analysis of unilateral keratoconus.

Int J Ophthalmol 2015 18;8(6):1141-5. Epub 2015 Dec 18.

Kudret Eye Hospital, Ankara 06700, Turkey.

Aim: To evaluate and compare corneal biomechanical findings measured by ocular response analyzer, topographic and pachymetric findings in patients with unilateral keratoconus patients and healthy controls.

Methods: This is an observational, case-control study. Patients with keratoconus in one eye and forme fruste keratoconus in the fellow eye were compared with sex and age matched with controls healthy subjects. All subjects were evaluated with rotating scheimpflug imaging system. The receiver-operating-characteristic curves were analyzed to evaluate the sensitivity and specificity of the parameters.

Results: Twenty-seven patients with keratoconus in one eye and forme fruste keratoconus in the fellow eye were compared with 40 eyes of 40 normal subjects. Corneal hysteresis (CH) was 8.0±1.7 mm Hg in keratoconus group, 8.3±1.6 mm Hg in forme fruste keratoconus group, and 9.8±1.6 mm Hg in control groups (P=0.54 between keratoconus and forme fruste keratoconus groups, P<0.01 between control group and other groups). Corneal resistance factor (CRF) was 7.1±2.2 mm Hg in keratoconus group, 7.8±1.2 mm Hg in forme fruste keratoconus group and 9.9±1.5 mm Hg in control group (P<0.001 between control group and other groups). Using receiver-operating-characteristic analysis, the area under curve values of the parameters to distinguish forme fruste keratoconus from control subjects were: CH (0.768), CRF (0.866). Best cut-off points were 9.3 mm Hg and 8.8 mm Hg for CH and CRF respectively.

Conclusion: Ocular response analyzer parameters (CH and CRF) are found to be significantly lower in forme fruste keratoconus patients compared to normal control subjects.
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http://dx.doi.org/10.3980/j.issn.2222-3959.2015.06.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4651878PMC
December 2015

Safety of Polyacrylamide 1.5% Left in Anterior Chamber in Combined Phacoemulsification and Pars Plana Vitrectomy Surgery.

Curr Eye Res 2016 04 30;41(4):501-6. Epub 2015 Jun 30.

a Department of Ophthalmology , Gazi University Medical Faculty , Ankara , Turkey .

Purpose: To evaluate safety, efficacy and postoperative characteristics of polyacrylamide 1.5% ophthalmic viscosurgical device (OVD) left in anterior chamber during and at the end of combined phacoemulsification and pars plana vitrectomy surgery.

Materials And Methods: This prospective study comprised 20 eyes that received combined phacoemulsification and pars plana vitrectomy performed by the same surgeon. Polyacrylamide 1.5% was left in anterior chamber at the end of the surgery. Preoperative and postoperative examinations (4, 12 and 24 hours; 14 days; 1 and 3 months) included measurement of intraocular pressure (IOP), central corneal thickness (CCT), endothelial cell density and assessment of any ocular adverse reactions.

Results: Four of the 20 patients (20%) showed increased IOP at hours postoperatively and needed medical treatment for IOP control. There was no significant difference in IOP between the preoperative visit and postoperative 3 months (p > 0.05). CCT measurements were similar between preoperative and postoperative visits (p > 0.05). A mean endothelial cell density loss of 6.7% was observed at postoperative day 14, however there was no change after this visit.

Conclusion: Polyacrylamide 1.5% is safe, well-tolerated and protective in eyes undergoing combined phacoemulsification and pars plana vitrectomy.
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http://dx.doi.org/10.3109/02713683.2015.1039652DOI Listing
April 2016

Retinal vessel diameters and their correlation with retinal nerve fiber layer thickness in patients with pseudoexfoliation syndrome.

Int J Ophthalmol 2015 18;8(2):332-6. Epub 2015 Apr 18.

Department of Ophthalmology, Gazi University Medical School, Ankara 06500, Turkey.

Aim: To compare retinal artery-vein diameters (RAVDs) of patients with pseudoexfoliation (PSX) syndrome with healthy controls and investigate the correlations between retinal nerve fiber layer (RNFL) thickness parameters and RAVDs.

Methods: Seventeen eyes with PSX and 17 eyes of age-matched controls were included in the study. All participants underwent routine ophthalmological examination, Humphrey visual field and RNFL examination by using Stratus OCT. Retinal images were obtained by using a retinal camera (Topcon 501X). RAVDs were measured from inferior nasal, inferior temporal, superior nasal and superior temporal arcuates by using IMAGEnet software. Superior, inferior, nasal, temporal and average RNFL thicknesses were recorded. RAVDs and RNFL parameters in groups and correlations were analyzed by Mann-Whitney U and Spearmann correlation tests.

Results: Only inferior quadrant and average RNFL thickness were detected thinner in the PSX group compared with control group (P=0.009, P=0.038, respectively). No statistically significant difference regarding RAVDs was found between two groups.

Conclusion: RAVDs seems to be comparable in the PSX and control group. RNFL is thinner in the inferior quadrant in the PSX group. RNFL thickness and RAVDs show significant correlations in both groups. This correlation doesn't seem to be specific to PSX.
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http://dx.doi.org/10.3980/j.issn.2222-3959.2015.02.21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4413581PMC
May 2015

Microbiologic Examination of Bandage Contact Lenses Used after Corneal Collagen Cross-linking Treatment.

Ocul Immunol Inflamm 2016 11;24(2):217-22. Epub 2015 Mar 11.

a Department of Ophthalmology , Gazi University, School of Medicine , Ankara , Turkey and.

Purpose: To investigate the agents of bacterial contamination of contact lenses after corneal collagen cross-linking (CCL), and to present the possible changes of ocular flora after riboflavin/ultraviolet A.

Methods: Seventy-two contact lenses of patients who underwent CCL and 41 contact lenses of patients who underwent photorefractive keratectomy (PRK) as control group were enrolled to the study. After 48 h of incubation, broth culture media was transferred to plates. Samples were accepted as positive if one or more colony-forming units were shown.

Results: There were positive cultures in 12 (16.7%) contact lenses in the CCL group and 5 (12.2%) had positive cultures in PRK group. Coagulase-negative staphlycocci (CNS) were the most frequent microorganism. Alpha hemolytic streptococci and Diphteroid spp. were the other isolated microorganisms.

Conclusions: Bacterial colonization can occur during and early after the CCL procedure in epithelial healing. To prevent corneal infections after the treatment, prophylactic antibiotics should be prescribed.
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http://dx.doi.org/10.3109/09273948.2014.1001518DOI Listing
December 2016

A histological study of rabbit corneas after transepithelial corneal crosslinking using partial epithelial photoablation or ethanol treatment.

Int J Ophthalmol 2014 18;7(6):959-63. Epub 2014 Dec 18.

Department of Ophthalmology, Gazi University, Ankara 06500, Turkey.

Aim: To evaluate the histological changes after transepithelial corneal crosslinking (CXL) using partial thickness excimer laser ablation or epithelial ethanol application in an experimental rabbit study.

Methods: Right eyes of twenty-four rabbits were studied. Four eyes received total epithelial debridement (group I). Four eyes received partial thickness epithelial ablation with excimer laser (group II). Twelve eyes were treated with different durations (30s and 60s) and concentrations (18% to 48%) of ethanol (group III). Riboflavin was applied for 30min intervals along with topical proparacaine drops with benzalkonium chloride, and 370 nm irradiation was performed for 30min, while riboflavin was instilled every 3min. Four eyes (group IV) received 48% ethanol for 30s without riboflavin and irradiation. Eyes were collected after 24h and examined histologically.

Results: All eyes in group I showed keratocyte loss in the superficial 300 µ of corneal storma. In group II, 1-4 layers of epithelium were preserved and no keratocyte loss occurred. In group III, CXL after treatment with ethanol up to 24% concentration and up to 60s revealed no keratocyte loss. CXL after treatment with 48% and higher ethanol concentrations yielded keratocyte loss in the superficial 200 µ to 300 µ of cornea.

Conclusion: Incomplete excimer laser ablation of the epithelium or treatment with ethanol up to 24% concentration and up to 60s duration yielded no stromal keratocyte loss. To get the same histological appearance seen in epithelial debridement group, partial thickness excimer laser epithelial ablation or ethanol application is not adequate for transepithelial CXL.
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http://dx.doi.org/10.3980/j.issn.2222-3959.2014.06.08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270988PMC
December 2014

Reply: To PMID 25255134.

Cornea 2015 Feb;34(2):e5

Department of Ophthalmology, Sorgun State Hospital, Yozgat, Turkey Department of Ophthalmology, Gazi University Medical Faculty, Ankara, Turkey Department of Ophthalmology, Medical Faculty, Recep Tayyip Erdoğan University, Rize, Turkey Department of Ophthalmology, Medical Faculty, Gazi University, Ankara, Turkey Department of Statistics, Faculty of Science, Gazi University, Ankara, Turkey.

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http://dx.doi.org/10.1097/ICO.0000000000000322DOI Listing
February 2015

Neutrophil-to-lymphocyte ratio may predict progression in patients with keratoconus.

Cornea 2014 Nov;33(11):1168-73

*Department of Ophthalmology, Sorgun State Hospital, Yozgat, Turkey; †Medical Faculty, Department of Ophthalmology, Gazi University, Ankara, Turkey; ‡Medical Faculty, Department of Ophthalmology, Recep Tayyip Erdoğan University, Rize, Turkey; and §Faculty of Science, Department of Statistics, Gazi University, Ankara, Turkey.

Purpose: Neutrophil-to-lymphocyte ratio (NLR) is a new potential predictor of systemic inflammation in several diseases. In this study, we aimed to evaluate NLR in patients with keratoconus.

Methods: This cross-sectional observational study included 54 patients with keratoconus and 25 age- and sex-matched control subjects. All participants underwent a detailed ophthalmological examination and corneal topography. The patients were divided into progressive and nonprogressive keratoconus groups on the basis of topographic parameters. Serum samples were obtained from all subjects, and the NLR was calculated.

Results: The NLR was 3.27 ± 1.37 in the progressive keratoconus group versus 1.87 ± 0.39 and 1.87 ± 0.52 in the nonprogressive and control groups, respectively (P < 0.01). There was a positive correlation between NLR and progression (P < 0.05). In the receiver-operating characteristic analysis, an NLR ≥ 2.24 predicted the presence of progression with 79% sensitivity and 81% specificity.

Conclusions: The NLR is a simple and inexpensive marker of systemic inflammation. The NLR was found to be higher in patients with progressive keratoconus than in the nonprogressive group and controls.
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http://dx.doi.org/10.1097/ICO.0000000000000260DOI Listing
November 2014

Photodynamic therapy for best disease complicated by choroidal neovascularization in children.

J Pediatr Ophthalmol Strabismus 2012 Jul-Aug;49(4):216-21. Epub 2011 Oct 11.

Gazi University, School of Medicine, Ophthalmology Department, Ankara, Turkey.

Purpose: To describe the results of photodynamic therapy (PDT) with verteporfin for the treatment of choroidal neovascularization (CNV) associated with Best vitelliform macular dystrophy (BVMD) in children.

Methods: Five eyes of four children diagnosed as having BVMD complicated by CNV received a single session of PDT. Response to treatment was monitored with fluorescein angiography and optical coherence tomography.

Results: All eyes responded well to one session of PDT with significant increases in visual acuity in four of the five eyes. Increase or stabilization of visual acuity was preserved during a mean follow-up period of 25 months.

Conclusion: PDT may be an effective treatment for CNV associated with BVMD in children.
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http://dx.doi.org/10.3928/01913913-20111004-01DOI Listing
September 2013