Publications by authors named "Remzi Karadag"

87 Publications

Anterior Chamber Characteristics, Endothelial Parameters, and Corneal Densitometry After Descemet Stripping Automated Endothelial Keratoplasty in Patients With Fuchs Dystrophy.

J Ophthalmic Vis Res 2021 Apr-Jun;16(2):158-164. Epub 2021 Apr 29.

Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA.

Purpose: To compare anterior segment parameters in patients with Fuchs endothelial dystrophy (FED) who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) in one eye and no corneal surgery in the fellow eye.

Methods: This prospective study was conducted on 28 eyes of 14 patients with FED who underwent DSAEK in one eye at least one year prior (DSAEK group) and no corneal surgery in the fellow eye (control group). Each eye was analyzed with the anterior segment optical coherence tomography, specular microscopy, and Scheimpflug imaging systems. Data were compared between the two groups.

Results: The mean age of the patients was 76.9 7.0 years. There were no statistically significant differences in the mean central corneal thickness (CCT), central anterior chamber depth, anterior chamber angle parameters, cylinder and keratometry values between two groups (all -values 0.05). The paracentral corneal thickness, corneal volume, endothelial cell density, and hexagonal cell ratio measurements were statistically significantly higher in the DSAEK group than the control (all -values < 0.05), and anterior chamber volume in the DSAEK group was significantly less than the control ( = 0.046). While posterior and total corneal densitometry values in the DSAEK group were statistically significantly lower than the control ( < 0.001 and = 0.011, respectively), there were no statistically significant differences in the anterior or middle corneal densities ( = 0.108 and = 0.134, respectively).

Conclusion: We found that total corneal densitometry value decreased in DSAEK group. Although DSAEK surgery did not affect the anterior chamber angle parameters, it reduced the anterior chamber volume and increased the corneal volume and paracentral corneal thickness due to the addition of the DSAEK graft.
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http://dx.doi.org/10.18502/jovr.v16i2.9078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126739PMC
April 2021

Periorbital ecchymosis and subconjunctival hemorrhage due to leech therapy for headache.

Arq Bras Oftalmol 2021 Mar-Apr;84(2):183-185

Department of Dermatomology, Istanbul Medeniyet University School of Medicine, Goztepe, Kadikoy, Istanbul, Turkey.

A 62-year-old woman was admitted to our clinic with the complaints of periorbital ecchymosis and subconjunctival hemorrhage that are visible, especially on the right eye. We noted that her complaints began the day after she underwent leech therapy on the glabella area for headache. On the glabella, 2 leech bites were observed close to the right side. Examination revealed ecchymosis on the bilateral eyelids and subconjunctival hemorrhage on the inferolateral and medial limbus on the right eye. No treatment was initiated, rather control measures were recommended. The follow-up after 1 month revealed that the patient's complaints had disappeared.
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http://dx.doi.org/10.5935/0004-2749.20210057DOI Listing
April 2021

Could we accidentally measure visual acuity low in the time of the COVID-19 pandemic?

Authors:
Remzi Karadag

Arq Bras Oftalmol 2020 Nov-Dec;83(6):564-565

Veni Vidi Eye Center, Caddebostan, Kadikoy, Istanbul, Turkey.

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http://dx.doi.org/10.5935/0004-2749.20200110DOI Listing
January 2021

Trocar-assisted, flanged haptics, sutureless intrascleral fixated intraocular lens implantation combined with Descemet membrane endothelial keratoplasty.

Authors:
Remzi Karadag

Arq Bras Oftalmol 2020 Nov-Dec;83(6):547-551

Department of Ophthalmology, School of Medicine, Istanbul Medeniyet University, Goztepe, Istanbul, Turkey.

This article reports a combined technique of sutureless intrascleral fixated intraocular lens implantation and Descemet membrane endothelial keratoplasty in a patient with anterior pseudophakic bullous keratopathy. Two scleral tunnels were created, corneal incisions were made, and a foldable intraocular lens was cut and removed from the anterior chamber. After performing anterior vitrectomy, a 3-piece foldable intraocular lens was implanted into the anterior chamber. One of the intraocular lens haptics was grasped with a forceps and pulled out from the scleral tunnel. Then, the end of the haptic was cauterized. Similar maneuvers were applied for the other haptic. Next, an 8-mm-diameter donor tissue was prepared, and the recipient endothelial tissue was peeled and removed from the center of the recipient cornea. The prepared donor tissue was injected into the anterior chamber. After proper opening and placement of the donor tissue, an air bubble was injected below the tissue. There were no postoperative complications during the 1-month follow-up.
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http://dx.doi.org/10.5935/0004-2749.20200100DOI Listing
February 2021

Introduction of a novel quantitative scoring system for acanthosis nigricans and its validation in a pilot study.

Dermatol Ther 2020 11 7;33(6):e14450. Epub 2020 Nov 7.

Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.

Inconsistent data exist regarding the diagnostic value of acanthosis nigricans (AN) or skin tags as clinical markers for obesity or diabetes. In an outpatient department-based prospective study, we designed a scoring for AN severity (SCANS) to evaluate AN and skin tags, their correlation with obesity or diabetes. Quantification of AN in six anatomic sites, in consideration of the affected skin surface areas, texture changes, number of skin tags, leads to a total severity score between 0 and 46. Among 336 adult patients (aged ≥18 years) with AN, a higher BMI was associated with AN (r = 0.299, P < .001), but not with diabetes (P = .43), as compared with 243 age- and sex-matched controls without AN. Among nondiabetics, AN scores were significantly correlated with waist circumference (r = 0.131, P = .024) and total cholesterol levels (r = 0.155, P = .04). Skin tags alone in the absence of AN were not associated with obesity (P = .333) or diabetes (P = .164). The total AN scores were positively correlated with the presence of skin tags (r = 0.132, P < .001), and the involvement of anterior neck (r = 0.668, P < .001) and axilla (r = 0.793, P < .001). Knuckles and groins were unaffected in our series. Our results indicate that combination of AN with skin tags can be used as clinical marker for obesity, but not for diabetes. Large-scale studies on patients of different ethnic background are required to further validate our proposed scoring.
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http://dx.doi.org/10.1111/dth.14450DOI Listing
November 2020

Caspase-3, p53 and Bcl-2 expression in basal cell carcinoma of the eyelid.

Postepy Dermatol Alergol 2020 Aug 2;37(4):535-539. Epub 2020 Sep 2.

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

Introduction: Eyelid tumours mostly originated from skin and its appendeges. External carcinogens like UV radiation causes cell damages in the eyelid skin and contributes to carcinogenesis. Apoptosis is a very important mechanism to prevent these damage and probable neoplatic change.

Aim: To compare caspase-3, p53 and Bcl-2 levels between patients with basal cell carcinoma (BCC) of the eyelid and healthy individuals.

Material And Methods: Pathology archives from October 2012 to April 2015 were scanned for BCC biopsies of the eyelid and tissue removed during blepharoplasty and entropion procedures. A total of 36 specimens were found. The specimens were divided into two groups: BCC group and controls (consisting of eyelid tissue removed during routine blepharoplasty). The pathology specimens were then stained using p53, Bcl-2 and caspase-3 stains and the intensity of staining was graded on a 0-3 scale.

Results: Samples from a total of 36 patients were included in the study. Eighteen (50.0%) patients were female. There were 13 patients in the BCC group and 23 patients in the control group. The mean age was 66.0 ±10.8 years in the BCC group, and 65.61 ±11.22 years in the control group. The caspase-3 staining was lower in the BCC group than in the control group. No significant differences were found between the BCC group and the control group in terms of p53 levels or Bcl-2 levels (both of them, = 1.000).

Conclusions: The caspase-3 level was lower in the BCC group. This result suggests that these enzymes can play a significant role in carcinogenesis of eyelid BCC.
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http://dx.doi.org/10.5114/ada.2020.98285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507160PMC
August 2020

Successful correction of ichthyosis-related ectropion by autografts.

Dermatol Ther 2020 11 9;33(6):e13851. Epub 2020 Jul 9.

Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University, Dresden, Germany.

Ectropion is a rather frequent complication of ichthyosis with negative functional and esthetic impact. Lid surgery can provide significant improvement. We report on a series of four ichthyosis patients with ongoing bilateral eye problems despite intense medical treatment (mean age 27.8 ± 14.1 years). All patients suffered from lagophthalmos. Two of the patients had only lower lid ectropion. In two of the patients' ectropion was forming on the upper lid in addition to the lower lid when closing the eye. In three of four patients, ectropion was repaired by skin grafts from the supraclavicular region. In a child with lower and upper lid ectropion prepuce was used for repair surgery. At the end of the follow-up period of about 23.0 ± 12.7 months, none of the patients revealed lagophthalmos or corneal exposure. No intraoperative or postoperative complications have been observed in our patients. Ichthyosis patients with ectropion resistant to medical treatment, benefit from surgical treatment with full layer autografts. In boys, prepuce can be successfully used as autograft.
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http://dx.doi.org/10.1111/dth.13851DOI Listing
November 2020

Double puncta canaliculi may exhibit different clinical presentations.

Arq Bras Oftalmol 2020 06 29;83(3):236-238. Epub 2020 May 29.

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

In this paper, we describe two adult patients who presented with double lacrimal puncta: one of them was asymptomatic and incidentally diagnosed, and the other complained of epiphora. In both patients, unilaterality, preference for the lower lid, and location medial to the normal punctum were common features of the accessory punctum. In the asymptomatic patient, irrigation revealed no obstruction in the punctum or the nasolacrimal drainage system. By contrast, the other patient's nasolacrimal drainage system exhibited obstruction. Therefore, dacryocystorhinostomy surgery and silicone tube intubation were successfully performed. Double lacrimal puncta may be associated with epiphora or dry eye. These manifestations can easily be missed in a routine examination. This report was written to emphasize that unilateral epiphora of dry eye symptoms may be related to supernumerary punctum or canalicular systems and can easily be diagnosed with lid eversion.
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http://dx.doi.org/10.5935/0004-2749.20200063DOI Listing
June 2020

Causes of congenital corneal opacities and their management in a tertiary care center.

Arq Bras Oftalmol 2020 Mar-Apr;83(2):98-102

Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA.

Purpose: To evaluate causes and management of congenital corneal opacities (CCO) diagnosed in a tertiary care eye center and to compare the data with a previous study at the same institution.

Methods: Computerized medical records in all patients with congenital corneal opacities diagnosed in the Cornea Service at Wills Eye Hospital (Philadelphia, PA) between January 1, 2007, and December 31, 2015, were retrospectively reviewed. Children aged 12 years and younger at the first visit were included in the study. Patients' demographics, ocular diagnosis, laterality, associated ocular abnormalities, other ocular surgery performed prior or subsequent to the first visit, and their treatment were extracted from the medical records.

Results: A total of 77 eyes in 56 patients were examined. The mean age at presentation was 32.8 ± 44.2 months, with the mean follow-up period of 26.7 ± 30.1 months. The most frequent diagnosis was Peters anomaly (53.2%), followed by limbal dermoid (13.0%), aniridia with glaucoma and microphthalmos (6.5%), sclerocornea and congenital glaucoma (5.2%), idiopathic (3.9%), Axenfeld-Rieger anomaly and Hurler syndrome (2.6%), and microcornea (1.3%). Primary keratoplasty was performed in 26 eyes, with the outcome rate in the clear cornea of 76.0% during the follow-up.

Conclusion: Peters anomaly is the most common cause of congenital corneal opacities encountered at our institution. Penetrating keratoplasty is the most frequent choice of corneal surgery to treat congenital corneal opacities. Additional interventions during penetrating keratoplasty were moderately positively correlated with graft failure. This study also shows the rates of some etiologies of that changed over the recent decades in our tertiary care Cornea Service. Although Peters anomaly remains the most common presenting reason for congenital corneal opacities, its rate appears to be increasing over the recent decade. Congenital corneal opacities due to birth trauma, which is one of the preventable causes, were observed in a previous study in our clinic; however, no new cases were noted in this study.
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http://dx.doi.org/10.5935/0004-2749.20200023DOI Listing
May 2020

Trocar-assisted, flanged sutureless scleral-fixated intraocular lens implantation combined with silicone oil injection after penetrating keratoplasty surgery.

GMS Ophthalmol Cases 2020 14;10:Doc03. Epub 2020 Feb 14.

Department of Ophthalmology, Istanbul Medeniyet University School of Medicine, Goztepe, Istanbul, Turkey.

We describe a combined technique of trocar-assisted sutureless scleral-fixated intraocular lens implantation and silicone oil injection at the same session. Two 3 mm scleral tunnels were created 2 mm away from and parallel to the limbus with the 23-gauge vitrectomy trocars entering the sclera transconjunctivally at an angle of approximately 10° at the 3 o'clock and 9 o'clock meridians. After the 3-piece foldable IOL was delivered to the anterior chamber through the corneal incision, the tip of one of the IOL haptics was grasped with a 23-gauge serrated retinal forceps entered through the trocar located at the 3 o'clock meridian. Then the haptic was removed from the scleral tunnel together with the trocar out of the globe. The same procedure was applied to the other haptic. A transconjunctival secure 10-0 nylon suture was placed at the scleral tunnel entry site around the haptic. The ends of the haptics were cauterized to make a flange. The resultant flanges of the haptics were pushed back and fixed into the scleral tunnels. Perfluorooctane was taken out of the eye with vitreoretinal surgery and the silicone was injected into the eye to prevent hypotonia. No complications were seen intraoperatively or postoperatively. After 1-month follow-up period, IOL was seen stabilized.
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http://dx.doi.org/10.3205/oc000130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047885PMC
February 2020

Descemet's membrane endothelial keratoplasty in aphakic and vitrectomized eye.

GMS Ophthalmol Cases 2020 14;10:Doc02. Epub 2020 Feb 14.

Department of Ophthalmology, Faculty of Medicine, Istanbul Medeniyet University, Goztepe, Istanbul, Turkey.

To report a new technique for Descemet's membrane endothelial keratoplasty (DMEK) in aphakic and vitrectomized eyes. A 56-year-old man presented with corneal decompensation in the left eye after combined pars plana vitrectomy and lensectomy for the management of a traumatic eye injury. DMEK graft and recipient bed were prepared as regular. The posterior half of the donor stroma was dissected with a crescent knife to form a temporary stromal barrier tissue. The prepared donor stromal tissue was implanted into the anterior chamber (AC) to form a barrier over the iris and pupilla. Then, the endothelial graft was safely injected into the anterior chamber and deployed by gently tapping on the corneal surface. Air tamponade was applied into the AC for 10 minutes to allow the graft to attach. Afterwards, the stromal barrier tissue was removed through the main incision and the AC was refilled with air tamponade. There were no intraoperative or postoperative complications during 1-month follow-up. Insertion of a temporary posterior stromal tissue as a barrier over the iris and pupilla successfully provided AC stability and prevented posterior dislocation of the graft or air tamponade. This new technique was a safe and effective approach for DMEK in aphakic and vitrectomized eyes.
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http://dx.doi.org/10.3205/oc000129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047886PMC
February 2020

Effects of Different Doses of Systemic Isotretinoin on Eyes: A Histopathological and Immunohistochemical Study in Rats.

Cornea 2020 May;39(5):621-627

Departments of Dermatology, Yuzuncu Yil University, Van, Turkey.

Purpose: To evaluate ocular side effects associated with systemic isotretinoin histopathologically.

Methods: In this multicenter study, a total of 15 male and 15 female rats were randomly divided into 3 equal groups according to the oral dose of isotretinoin they were administered: 0 mg/kg/d (group A), 7.5 mg/kg/d (group B), and 15 mg/kg/d (group C). Biopsy specimens were taken from the globe conjunctiva, cornea, and eyelid conjunctiva. Expression levels of human beta-defensin-1, human beta-defensin-2, toll-like receptor (TLR)-2, and TLR-4 were evaluated by immunohistochemical methods.

Results: The number of goblet cells in eyelid conjunctiva was significantly lower in group B than that in group A and group C (P = 0.002). The sizes of meibomian gland acini were significantly smaller in group B and group C than those in group A (P < 0.001). Fibrosis of eyelid conjunctiva was significantly higher in group C and group B than that in group A (P = 0.002). The levels of staining of TLR-4 in the cornea with group B were significantly lower compared with group C (P = 0.035).

Conclusions: Our study suggests that isotretinoin in the early period affects eyelid conjunctiva and meibomian glands without affecting the globe conjunctiva and cornea. Occurrence of the initial symptoms of isotretinoin on the eyelids, especially on the meibomian glands, suggests that the symptoms of patients occur because of evaporative dry eye.
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http://dx.doi.org/10.1097/ICO.0000000000002229DOI Listing
May 2020

Ex-PRESS implantation for different types of glaucoma.

Int J Ophthalmol 2019 18;12(8):1290-1297. Epub 2019 Aug 18.

Dunyagoz Hospitals Group, Sultanbeyli 34337, Istanbul, Turkey.

Aim: To evaluate the clinical results, efficacy and safety of Ex-PRESS P200 glaucoma shunt implant in different types of medically uncontrolled glaucoma.

Methods: The study included 31 eyes of 31 patients that were unresponsive to medical antiglaucomatous therapy in whom Ex-PRESS P200 glaucoma shunt implantation was performed. The demographic characteristics of the patients, type of glaucoma, complete ocular examination results, number of antiglaucomatous drugs before and after surgery, early and late complications of surgery, additional surgical and nonsurgical medical interventions, and success rates were investigated from the patients' files, retrospectively.

Results: The mean postoperative follow-up time was 16.4±7.5mo. The preoperative mean corrected intraocular pressure (IOP) was 28.7±10.3 mm Hg and postoperative mean corrected IOP was 15.3±5.2 mm Hg (<0.05) at the last visit. The mean IOP reduction was 39.9% when the preoperative and postoperative values of the last visits were compared. The average number of antiglaucomatous drug use decreased from 3.9±0.3 to 1.7±1.7 postoperatively (<0.05). The use of antiglaucomatous medications at the last visit was more than in other studies in the literature. The most common complication was conjunctival leakage, which was seen in 7 patients. Other early complications were iris touch, intravitreal hemorrhage, hyphema, choroidal effusion, early transient hypotonia and corneal edema. One of the late complications was endophthalmitis which was seen in one case 6mo after the operation, and the other late complication was opacification of the cornea in one patient. Twelve additional surgical operations associated to Ex-PRESS surgery and 3 bleb needling have done. At the last visit, the complete success rate was 32.3% and the qualified success rate was 77.5% in all patients.

Conclusion: Ex-PRESS P200 glaucoma shunt implantation may be an effective procedure for medically uncontrolled glaucoma with significantly lower use of antiglaucomatous medications.
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http://dx.doi.org/10.18240/ijo.2019.08.09DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694050PMC
August 2019

Is it always blepharitis? Urbach-Wiethe syndrome (lipoid proteinosis).

Arq Bras Oftalmol 2019 May-Jun;82(3):242-244. Epub 2019 Mar 25.

Department of Dermatology, Istanbul Medeniyet University School of Medicine, Goztepe, Istanbul, Turkey.

A 12-year-old girl presented with recurrent crusty debris and dandruff at the base of both eyelashes despite having completed different medical treatments. She had had a hoarse voice since her early childhood. Upon anterior segment examination of the eyes, we found yellow-white, bead-like papules on the margins of the eyelids. An otolaryngologist detected multiple nodules on the vocal cords and buccal mucosa. Ultrasonography revealed salivary stones in the main parotid ducts. And a dermatological examination revealed thickened skin lesions on the elbows and knees with a biopsy showing histopathological findings of lipoid proteinosis. We diagnosed the patients as having Urbach-Wiethe syndrome or lipoid proteinosis, a rare autosomal recessive multisystem disorder with variable manifestations vary that difficult the diagnosis. The ocular manifestations are not well known among ophthalmologists, but the typical lid lesions are pathognomonic and ophthalmologists should be aware of this presentation to identify patients with Urbach-Wiethe syndrome.
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http://dx.doi.org/10.5935/0004-2749.20190051DOI Listing
January 2020

Trocar-assisted intrascleral sutureless fixation of a dislocated three-piece sulcus intraocular lens.

Arq Bras Oftalmol 2017 Nov-Dec;80(6):393-395

Istanbul Medeniyet University School of Medicine, Department of Ophthalmology, Goztepe, Istanbul, Turkey.

Trocar-assisted intraocular lens (IOL) reposition surgery using a scleral fixation method was performed for a patient with a dislocated sulcus IOL. Two 3-mm-long scleral tunnels 2 mm from and parallel to the limbus were formed using a 23-gauge vitrectomy trocar transconjunctivally entering the sclera at an angle of approximately 10°. Haptics were collected using a 23-gauge serrated retinal forceps entering from the trocar cannula and externalized from the scleral tunnels together with the trocar. The same procedure was applied for the other haptic. Both haptics were pushed into the scleral tunnel and a transconjunctival secure 10-0 nylon suture was placed at the scleral tunnel entry site around the haptic. Sutures were removed 1 week later. No complications occurred intraoperatively or postoperatively. At a 10-month follow-up, IOL was stabilized. IOL reposition surgery using the trocar-assisted IOL scleral fixation method is a viable alternative to intrascleral fixation surgery.
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http://dx.doi.org/10.5935/0004-2749.20170096DOI Listing
October 2018

A comparison of two conjunctival rotation autograft techniques in primary pterygium surgery.

Arq Bras Oftalmol 2017 Nov-Dec;80(6):373-377

Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.

Purpose: To compare the effects of 90° and 180° conjunctival rotational autograft (CRA) techniques used in primary pterygium surgery.

Methods: Forty-five patients were included in this retrospective study. Visual acuity (VA), corneal topography, and auto-refractometer measurements, as well as detailed biomicroscopic examinations, were performed preoperatively and postoperatively. During surgery, the pterygium tissue was excised then rotated 90° in Group 1 and180° in Group 2, after which it was sutured to the bare sclera. Pterygium recurrence was defined as corneal invasion ≥1 mm.

Results: Group 1 consisted of 21 patients with a mean age of 45.1 ± 11.8 years, while Group 2 comprised 24 patients with a mean age of 47.9 ± 13.8 years. The pterygia in Group 1 were graded as more advanced than those in Group 2. A similar number of recurrences were observed in Group 1 (14.3%) and in Group 2 (16.7%). There was no statistically significant difference in terms of the preoperative and postoperative VA and astigmatism values between the two groups. There was a statistically significant improvement in the postoperative VA and astigmatism values in Group 1 and in the postoperative astigmatism values in Group 2. Although postoperative redness was more common in Group 1, no statistically significant difference was found between the groups.

Conclusion: BothCRA techniques can be successful in patients for whom it is desirable to avoid a conjunctival autograft and for patients without high cosmetic expectations.
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http://dx.doi.org/10.5935/0004-2749.20170091DOI Listing
October 2018

An investigation of human beta-defensins and cathelicidin expression in patients with pterygium.

Arq Bras Oftalmol 2017 Sep-Oct;80(5):277-280

Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.

Purpose: To investigate human beta-defensins (HBDs) and cathelicidin LL-37 (LL-37) expressions in patients with pterygium.

Methods: In this retrospective consecutive case series, 26 pterygium specimens and 15 normal conjunctival specimens of 15 control subjects were in vestigated. Expressions of HBD-1, HBD-2, HBD-3, and LL-37 were assessed using immuno histochemical staining. A brown color in the cytoplasm and/or nuclei of epithelial cells indicated positive staining for HBDs and LL-37. For each antibody, the intensity of the reaction (negative [-], weak [1+], moderate [2+], or strong [3+]) was determined to describe the immunoreactions.

Results: The median age was 52 years in both groups. There were no significant differences in age and sex between the groups (p=0.583, p=0.355, respectively). Of the 26 pterygium specimens, 15 (57.7%) (14 weak, 1 moderate staining) showed HBD-2 expression, which was not observed in any of the control specimens. One (3.8%) pterygium and one (6.7%) control specimen demonstrated weak staining for HBD-3. HBD-2 expression was significantly higher in the pterygium specimens than in the controls (p=0.002). None of the tissue specimens had positive staining for HBD-1 or LL-37 in either group (both; p=1.00).

Conclusions: HBD-2 expression was higher in pterygium specimens than in the controls. HBD-2 expression that might be stimulated by inflammatory cytokines may be related to inflammation and fibrovascular proliferation and may play a role in pterygium pathogenesis.
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http://dx.doi.org/10.5935/0004-2749.20170068DOI Listing
December 2017

Scleral suture fixation technique for dislocated plate haptic toric IOL.

Int Ophthalmol 2018 Oct 11;38(5):2183-2186. Epub 2017 Aug 11.

Department of Ophthalmology, School of Medicine, Istanbul Medeniyet University, Goztepe, Istanbul, Turkey.

Purpose We describe a scleral suture fixation technique for dislocated plate haptic toric intraocular lens (IOL) implantation. Materials and methods A double-armed 10-0 straight polypropylene suture was passed into the eye from the sclera (2 mm away from the limbus). A suture needle was passed through the hole on the corner of the IOL and pulled out from the paracentesis with a 27-gauge needle. Afterward, the suture needle was reinserted from the same paracentesis and then removed from the eye with the help of a 27-gauge needle entering the eye from a nearby point to the first scleral entrance. The needle was passed through the end of the loop and pulled slightly to initiate the formation of a cow-hitch knot. The same procedure was applied to the other hole on the plate haptic. Both sutures were adjusted and fixed to the sclera with a Z suture. Results No complications were observed and at the follow-up visits, uncorrected visual acuity was 0.8 with decimal. Conclusion Axial, sagittal, and rotational stability rules are taken into consideration, scleral fixation surgery for a dislocated plate haptic foldable toric IOL is an alternative method to eliminate astigmatic refractive error.
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http://dx.doi.org/10.1007/s10792-017-0680-6DOI Listing
October 2018

Intra-scleral fixation of the iris hooks for trans-scleral capsular bag fixation in patient with zonular dialysis.

Int Ophthalmol 2018 Aug 4;38(4):1765-1768. Epub 2017 Jul 4.

Department of Ophthalmology, Istanbul Medeniyet University Goztepe Research and Training Hospital, Goztepe, Istanbul, Turkey.

Purpose: To report a technique of intra-scleral fixation of the iris hooks for trans-scleral capsular bag fixation in patient with zonular dialysis.

Methods: Two scleral flaps, two scleral tunnels and two sclerotomies were formed. The anterior capsule was captured and pulled by the iris hooks resulting in the IOL adopting an appropriate position at which point the iris hooks extracted from the sclerotomies. The tips of the iris hooks were implanted into the scleral tunnels. Each of them was fixed with a 10.0 nylon suture to the scleral bed. The scleral flaps and conjunctiva were sutured. One of the iris hooks was seen loosened at the first-week postoperative examination but the IOL remained centralized. The loosened hook was removed.

Results: No complications were witnessed during the patient's 24-month follow-up.

Conclusion: Intra-scleral fixation using iris retractors in the capsular bag for patients having suffered dislocation of IOL despite the attachment of a capsular hook because of zonular dialysis can be safely implemented.
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http://dx.doi.org/10.1007/s10792-017-0623-2DOI Listing
August 2018

Periorbital discoid lupus: a rare localization in a patient with systemic lupus erythematosus.

An Bras Dermatol 2016 Sep-Oct;91(5 suppl 1):122-124

Istanbul Medeniyet University School of Medicine - Istanbul, Turkey.

A 40-year-old female patient with a 5-year history of systemic lupus erythematosus was referred to our policlinic with complaints of erythema, atrophy, and telangiectasia on the upper eyelids for 8 months. No associated mucocutaneous lesion was present. Biopsy taken by our ophthalmology department revealed discoid lupus erythematosus. Topical tacrolimus was augmented to the systemic therapeutic regimen of the patient, which consisted of continuous antimalarial treatment and intermittent corticosteroid drugs. We observed no remission in spite of the 6-month supervised therapy. Periorbital discoid lupus erythematosus is very unusual and should be considered in the differential diagnosis of erythematous lesions of the periorbital area..
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http://dx.doi.org/10.1590/abd1806-4841.20164708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5325016PMC
July 2017

Toxic anterior segment syndrome following deep anterior lamellar keratoplasty.

Arq Bras Oftalmol 2016 Sep-Oct;79(5):330-332

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

We present the case of a 31-year-old patient with toxic anterior segment syndrome (TASS) that developed after undergoing deep anterior lamellar keratoplasty (DALK). She had keratoconus, and despite wearing hard contact lenses for many years in the left eye, her vision had deteriorated; therefore, DALK was performed on this eye. The preoperative visual acuity (VA) was finger counting at 3 m. Routine DALK was performed using the "big-bubble" technique. The corneal entry incision was hydrated at the end of the surgery, which was terminated by air injection into the anterior chamber. On postoperative day 1, VA was at the level of hand movements, and the cornea was edematous. Topical high-dose dexamethasone and oral steroids were initiated considering the diagnosis of TASS. Subsequently, the patient's VA increased, and the corneal edema decreased. We believe that the use of re-sterilized cannulas may have been the likely cause of TASS. Although DALK can be performed without interfering with the anterior chamber, one should keep in mind that TASS may occur in response to the solution used to hydrate the incision site and the air injected into the anterior chamber.
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http://dx.doi.org/10.5935/0004-2749.20160094DOI Listing
July 2017

Reproducibility and repeatability of central corneal thickness measurement in healthy eyes using four different optical devices.

Int Ophthalmol 2017 Aug 8;37(4):1039-1045. Epub 2016 Oct 8.

Department of Ophthalmology, Istanbul Medeniyet University School of Medicine, Goztepe, Istanbul, Turkey.

Aim: The aim of the study is to compare the measurements of central corneal thickness (CCT) performed by two examiners with four different methods at different times inter- and intra-individually.

Methods: Thirty healthy people were included in the study. In these measurements, an optical low-coherence reflectometry (OLCR), an optic coherence tomography (OCT), a specular microscopy (SM), and a corneal topography (CT) were used. Two examiners performed the measurements in a consecutive manner. After 1-7 days of the first measurements, the second measurements were performed again consecutively. The mean of three measurements was taken in each session for all devices.

Results: In OCT measurements, there was a significant difference between two examiners in both sessions (p < 0.001), while no significant differences were found between two examiners in first and second sessions in SM, CT, and OLCR measurements. When each examiner's measurements were compared to two sessions, there were no significant differences (p > 0.05, for all) except the SM measurements of the first examiner (p = 0.041). When the first measurements of two examiners were compared, the smallest values were of OCT. At the first session of two examiners, there was a significant difference between OCT and CT measurements, and between OCT and OLCR (p < 0.001, p = 0.002 for the first examiner and p < 0.001 for the second examiner, respectively).

Conclusion: Our study showed that CCT measurements made by CT and OLCR methods were almost same and highly correlated for both the examiners' measurements. CCTs measured by OCT were on average 30 μm thinner than CT and OLCR.
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http://dx.doi.org/10.1007/s10792-016-0369-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5517583PMC
August 2017

Sutureless Intrascleral Fixated Intraocular Lens Implantation.

J Refract Surg 2016 Aug;32(9):586-97

Purpose: To review sutureless intrascleral intraocular lens (IOL) fixation methods.

Methods: Review of published literature.

Results: Sutureless intrascleral IOL fixation methods are newer and have been developed to eliminate the suture-related complications of sutured scleral fixation methods such as suture-induced inflammation or infection and IOL dislocation or subluxation due to suture degradation or suture breakage. Sutureless intrascleral fixation methods aim for intrascleral haptic fixation to achieve stability of the IOL. Various methods of sutureless scleral fixation have been described. Using a needle, a blade, or a trochar, sclerostomies are created in all techniques for intraocular access. Some surgeons prefer to create scleral tunnels, whereas others use scleral flaps for scleral fixation of haptics. The stability of IOLs is attained by the scar tissue formed around the haptics.

Conclusions: Short-term results of these new methods are acceptable; studies including more cases with longer follow-up are needed to determine their long-term success. [J Cataract Refract Surg. 2016;32(9):586-597.].
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http://dx.doi.org/10.3928/1081597X-20160601-03DOI Listing
August 2016

Survival of Primary Penetrating Keratoplasty in Children.

Am J Ophthalmol 2016 Nov 30;171:95-100. Epub 2016 Aug 30.

Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.

Purpose: To review the indications and outcomes of children undergoing primary penetrating keratoplasty and identify prognostic factors for graft survival.

Design: Retrospective, interventional case series.

Methods: Medical records of every child 12 years of age or younger who underwent primary penetrating keratoplasty at Wills Eye Hospital Cornea Service between 2007 and 2015 were reviewed. Survival of the primary graft was analyzed using the Kaplan-Meier survival method.

Results: Forty-six eyes of 35 children underwent primary keratoplasty during the study period. The mean age at the time of primary keratoplasty was 24.6 ± 39.9 months. The mean follow-up duration was 36.4 ± 28.8 months. Congenital opacity was the most common diagnosis for primary keratoplasty (89.1%). The overall mean graft survival time was 45.2 ± 5.8 months, with a survival rate of 75.7% at 1 year. The 1-year graft survival rate was 51.9% and 90.7% in eyes with and without glaucoma, respectively. Cox proportional hazards regression analysis demonstrated that the presence of glaucoma (P = .014) and concurrent operation during primary keratoplasty (P = .049) were independent prognostic factors for poor graft survival. On the other hand, age of primary keratoplasty (P = .626) and operation before or after primary keratoplasty (P = .800 and P = .104, respectively) were not associated with poorer graft survival. Half of our patients were able to achieve ambulatory vision at the last follow-up.

Conclusion: Although pediatric penetrating keratoplasty is challenging, successful transplantation with good graft survival can be obtained. Better understanding of prognostic factors can possibly improve graft survival in the future.
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http://dx.doi.org/10.1016/j.ajo.2016.08.031DOI Listing
November 2016

Trocar-Assisted, Sutureless, Scleral-Fixated Intraocular Lens Implantation Combined With Penetrating Keratoplasty.

Cornea 2016 Sep;35(9):1261-5

*Department of Ophthalmology, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey; and †Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.

Purpose: To evaluate the results of trocar-assisted, sutureless, scleral-fixated (SSF) intraocular lens (IOL) implantation combined with penetrating keratoplasty (PKP).

Methods: This study comprised 4 eyes (4 patients) undergoing trocar-assisted SSF-IOL implantation during PKP. The combined technique was performed in 3 eyes of 3 patients with bullous keratopathy and in 1 eye with central corneal opacity. Two eyes had anterior chamber IOL implants, and 2 were aphakic. All eyes had inadequate capsular support. Evaluated parameters were biomicroscopy, corrected distance visual acuity, intraocular pressure, IOL position, and corneal graft status. Intraoperative and postoperative complications and additional surgeries were recorded.

Results: The mean follow-up period was 28.3 ± 3.5 months. Trocar-assisted SSF-IOL implantation with PKP was successfully performed in all eyes. Visual acuity improved in all patients. During the follow-up period, a well-stabilized IOL without any IOL-related complication was obtained in all eyes. In one eye with corneal scarring and aphakic glaucoma caused by trauma, drug-resistant glaucoma developed 6 months after surgery requiring Express glaucoma shunt surgery. In one eye with a history of central retinal vein occlusion, repeat keratoplasty was performed after 10 months because of graft rejection.

Conclusions: Trocar-assisted SSF-IOL implantation combined with PKP is an alternative method for visual rehabilitation in the eyes with bullous keratopathy and corneal scarring without sufficient capsular support.
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http://dx.doi.org/10.1097/ICO.0000000000000944DOI Listing
September 2016

Safety and efficacy of autologous serum eye drop for treatment of dry eyes in graft-versus-host disease.

Cutan Ocul Toxicol 2017 Jun 22;36(2):152-156. Epub 2016 Jul 22.

d School of Medicine and Public Health , University of Wisconsin-Madison , Madison, WI , USA , and.

Purpose: To evaluate the treatment of autologous serum eye drops (ASED) on dry eyes in patients with graft-versus-host disease (GVHD).

Methods: A retrospective chart review of 35 patients with a history of ocular GVHD following hematopoietic stem cell transplantation that used ASED to alleviate dry eye symptoms was performed. Patients were categorized into three different groups. If patients had available ophthalmic data before and after starting treatment was group 1 (n = 14), had available ophthalmic data after starting treatment in group 2 (n = 10) and had available ophthalmic data before treatment or did not have any data after starting treatment in group 3 (n = 11). Data were collected on patient's age, gender, primary diagnosis, visual acuity and fluorescein corneal staining were collected on individual eyes in order to evaluate the efficacy of the ASED on alleviating dry eye-related signs and symptoms.

Results: No adverse ocular effect from the ASED was found in our series (except one fungal keratitis). All patients reported either improvement (55%) or stability (45%) in their ocular symptoms upon the use of ASED. In patients with available data before and after starting treatment, the corneal staining score improved by a median of 1 (p = 0.003) and the LogMAR visual acuity had a non-significant improvement.

Conclusion: In our study, ASED used by patients with ocular GVHD were both safe and effective. ASED should be considered in patients with GVHD who suffer from dry eyes.
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http://dx.doi.org/10.1080/15569527.2016.1209770DOI Listing
June 2017

Overcorrecting minus lens therapy in patients with intermittent exotropia: Should it be the first therapeutic choice?

Int Ophthalmol 2017 Apr 3;37(2):385-390. Epub 2016 Jun 3.

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

To evaluate medium-term outcomes of overminus lens treatment in patients with intermittent exotropia [X(T)]. A retrospective analysis was performed of the outcomes of 19 children with X(T) who were prescribed overminus lens (-2.00 to -4.00 D) for a median period of 18 months (6-33). The success was evaluated using two assessment methods: 1. Newcastle Control System (NCS), and 2. Jampolsky's assessment. The mean age of the patients was 6.8 ± 3.3 years (range 3-14 years). After the therapy, the median NCS score significantly improved from 5 to 1 (p < 0.001). Sixteen children (84 %) showed a NCS score of 2 or less after overminus lens treatment. According to Jampolsky's assessment, 84 % of the patients showed marked improvement from the baseline (47 % had qualitative improvement, 37 % quantitative decrease in the angle of deviation in addition to a qualitative improvement). The median pre-treatment distant angle decreased from 25 prism diopters (PD) to 18 PD after the treatment (p = 0.002). Overcorrecting minus lens treatment has a reasonable rate of success in the medium term and may be advised as primary therapeutic alternative for X(T). Both NCS and Jampolsky's scoring system appear to be useful and comparable for follow-up of patients with X(T).
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http://dx.doi.org/10.1007/s10792-016-0273-9DOI Listing
April 2017

Measurements of central corneal thickness and endothelial parameters with three different non-contact specular microscopy devices.

Int Ophthalmol 2017 Feb 24;37(1):229-233. Epub 2016 May 24.

Department of Ophthalmology, Istanbul Medeniyet University Goztepe Research and Training Hospital, Goztepe, Istanbul, Turkey.

We aimed to compare the measurements of central corneal thickness (CCT) and endothelial parameters with three different non-contact specular microscopy (SM) devices. Fifteen eyes of 15 healthy individuals (6 males; 9 females) were enrolled in the study. Mean age was 37.93 ± 15.13 years. Endothelial parameters and CCT were measured with Nidek CEM-530, Topcon SP-3000P, and Tomey EM-3000 SM devices by the same physician. Endothelial parameters included endothelial cell count (ECC), maximum, minimum, and average endothelial cell size. and hexagonality ratio. There were no statistically significant differences in ECC, CTT, and average endothelial size (AES) between the devices (p > 0.05). The measurement of maximum endothelial size (MES) was different between Nidek SM and Topcon SM devices (p = 0.001), but there was no difference in MES between Nidek SM and Tomey SM (p = 0.058), and between Topcon SM and Tomey SM (p = 0.081). There was no difference in minimum endothelial size (MinES) between Nidek SM and Topcon SM (p = 0.794); however, there was a significant difference in MinES between Tomey SM and Nidek SM (p < 0.001), and between Tomey SM and Topcon SM (p < 0.001). Comparison of hexagonality ratio showed statistically significant difference between the devices (p < 0.001). No significant differences in the measurements of ECC, CCT, and AES were detected between different SM devices, whereas a statistically significant difference in hexagonality ratio was detected between the devices. These devices should not be used alternatively in the endothelial morphology assessment in patient's follow-up.
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http://dx.doi.org/10.1007/s10792-016-0264-xDOI Listing
February 2017

An easy and practical method for toric intraocular lens implantation: marking corneal astigmatic axis at slit-lamp.

Int Ophthalmol 2017 Feb 12;37(1):179-184. Epub 2016 May 12.

Department of Ophthalmology, Istanbul Medeniyet University Medical Faculty, Kadikoy, Istanbul, Turkey.

The objective of this study was to present a practical method of marking the corneal astigmatic axis for the patient sitting at the slit-lamp before toric intraocular lens (IOL) implantation. Eighteen eyes of 18 patients, who underwent uncomplicated phacoemulsification, with an implantation of Acrysof toric IOL were included. We marked the astigmatic axis while the patient sitting at the slit-lamp before surgery. The patient was asked to look at a distant target at head height with the fellow eye. Using the rotator switch, the slit light of the slit-lamp was just turned on to the steep astigmatic meridian in the orthograde position. Then, two tips of the astigmatic meridian were marked with a marking pen, where the slit light crossed at the limbus 180° away. Preoperative corneal and postoperative refractive astigmatism values were compared. Uncorrected and corrected postoperative visual acuities (UDVA and BCVA) and IOL rotations at early and late periods were noted. The mean age and mean follow-up were 63.6 ± 14.6 years and 9.4 ± 5.3 months (range 3-16 months), respectively. Mean postoperative UDVA and BCVA at Snellen chart were 0.62 ± 0.21 and 0.82 ± 0.13, respectively. Mean preoperative keratometric and mean postoperative refractive astigmatism values were 2.48 ± 0.87 D and 0.66 ± 0.48 D, respectively. Reduction of astigmatism was significant (p < 0.01). The mean rotation at 1 week and that at last follow-up were 2.1° ± 3.1° and 2.3° ± 3.0°, respectively. Marking corneal astigmatic axis at slit-lamp is a simple and effective method in toric intraocular lens implantation. Surgeon does not need additional instrument except a slit-lamp and a marking pen, and can complete the marking task in just one setting.
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http://dx.doi.org/10.1007/s10792-016-0250-3DOI Listing
February 2017

Two-spatulae maneuver to intraocularly flip a reverse-opened, foldable intraocular lens.

Int Ophthalmol 2017 Apr 5;37(2):459-461. Epub 2016 May 5.

Istanbul Medeniyet University, Istanbul, Turkey.

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http://dx.doi.org/10.1007/s10792-016-0238-zDOI Listing
April 2017
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