Publications by authors named "Selahattin Balsak"

11 Publications

  • Page 1 of 1

Effects of pupillary dilation on ocular optical biometry outcomes in pediatric patients.

Arq Bras Oftalmol 2020 08 29;83(4):289-293. Epub 2020 Jul 29.

Department of Ophthalmology, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.

Purpose: Pharmacological pupillary dilation is performed in comprehensive ophthalmological examinations and before biometric measurements. So far, there is no consensus regarding its impact on biometric measurements. This study's aim was to investigate the effects of pharmacological pupillary dilation on ocular biometric measurements in healthy children.

Methods: This was a prospective, observational, non-randomized study of children (4-18 years of age) who were admitted for routine ophthalmological examination. Biometric measurements were performed, using a non-contact optical biometry device, both before and after pharmacological pupillary dilation with cyclopentolate hydrochloride. Intraocular lens power calculations were performed using Hill-RBF, Barrett, Olsen, Sanders-Retzlaff-Kraff/Theoretical, Holladay, and Hoffer Q formulas. Descriptive statistical analyses were also performed. The Wilcoxon signed-rank test was used to compare measurements before and after pharmacological pupillary dilation. Relationships between variables were analyzed using the Spearman-Brown rank correlation coefficient.

Results: The study included 116 eyes of 58 children (mean age, 8.4 ± 0.32 years; 34 girls). Significant changes were observed after pupillary dilation, compared with before pupillary dilation, in terms of anterior chamber depth, aqueous depth, and central corneal and lens thicknesses. No significant change was observed in axial length. Intraocular lens power calculations revealed no significant changes after pupillary dilation in most formulas except for the Olsen formula. The intraocular lens power was significantly inversely correlated with axial length and anterior chamber depth.

Conclusions: Pharmacological pupillary dilation in children appeared to have no impact on axial length and intraocular lens power, but caused a significant increase in anterior chamber depth. The difference in anterior chamber depth measurements before and after pupillary dilation could be related to the optical biometry device model used. These outcomes should be considered in intraocular lens power calculations performed using anterior chamber depth parameters.
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August 2020

Is there an association between congenital nasolacrimal duct obstruction and cesarean delivery?

Eur J Ophthalmol 2020 Nov 19;30(6):1228-1231. Epub 2019 Nov 19.

Department of Endocrinology and Metabolic Diseases, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey.

Purpose: The aim of this study was to research the relationship between types of birth and congenital nasolacrimal duct obstruction.

Method: The study enrolled 665 infantile patients with prediagnosis of congenital nasolacrimal duct obstruction due to associated ophthalmic symptoms. Age, gender, family history, delivery type, and patient medical records were investigated. Patients were grouped and compared according to their birth type and whether it was the first birth.

Results: The number of the infants with and without congenital nasolacrimal duct obstruction was 227 (34.1%) and 438 (65.9%), respectively. Comparison of the congenital nasolacrimal duct obstruction and non-congenital nasolacrimal duct obstruction groups according to the first births showed that ratio of cesarean section was significantly higher in the congenital nasolacrimal duct obstruction group than the non- congenital nasolacrimal duct obstruction group (58.7% and 20.7%, respectively). Number with positive family history also was significantly higher in the congenital nasolacrimal duct obstruction group.

Conclusion: Cesarean section in first birth and positive family history of congenital nasolacrimal duct obstruction appear to be important risk factors in the etiopathogenesis of congenital nasolacrimal duct obstruction.
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November 2020

Approach of Family Physicians to Pediatric Eye Screening in Diyarbakır

Turk J Ophthalmol 2019 02;49(1):25-29

Dicle University Faculty of Medicine, Department of Ophthalmology, Diyarbakır, Turkey

Objectives: In Turkey, preventive medicine services are the responsibility of family physicians and vision screening is a key component of this responsibility. In this study, we aimed to investigate the approach of family physicians to vision screening in infants and children.

Materials And Methods: Data were collected using a 16-item questionnaire administered to 100 family physicians working in the center and provinces of Diyarbakır.

Results: The results indicated that 88 (88%) physicians declared knowing what the red reflex test was, while 12 physicians declared that they had never heard of it. Only 16 (16%) physicians performed the test routinely and 36 (36%) physicians performed it only in suspicious cases. Ten (10%) physicians indicated that they did not refer the patients to an ophthalmologist even though they did not perform the red reflex test. Moreover, 5 (5%) physicians did not have an ophthalmoscope and 12 (12%) physicians reported not knowing how to use an ophthalmoscope. Forty (40%) of the physicians measured preschool visual acuity at least once. Sixty-six (66%) physicians referred younger children who could not express their vision problems to an ophthalmologist. Four (4%) physicians declared that they would delay surgery in children with strabismus until they were old enough for surgery. Ninety-three (93%) physicians suggested that educational seminars about vision screening would be beneficial.

Conclusion: Educational seminars about vision screening may have favorable outcomes. The medical devices in family medicine centers should be improved. Vision screening can be added to the negative performance-based compensation system in order to increase physicians’ attention to vision screening. To implement detailed eye screening programs like those in developed countries, an infrastructure should be established for this screening program.
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February 2019

Associations between red reflex abnormality, consanguinity and intensive care hospitalization of newborns in Turkey.

East Mediterr Health J 2018 Sep 6;24(7):631-636. Epub 2018 Sep 6.

Department of Ophthalmology, Dicle University of Medicine, Diyarbakir, Turkey.

Background: Red reflex screening is the primary but unheeded test for the detection of vision- and life-threatening eye conditions.

Aims: To evaluate the red reflex of newborns, percentage of ocular diseases resulting in red reflex abnormality, and their relation with consanguinity in Southeast Turkey.

Methods: Newborns (n = 1358) were examined with pencil light and direct ophthalmoscopy.

Results: Eight hundred of these newborns were hospitalized in a rooming-in unit. (RIU) and 558 were in the neonatal intensive care service (NICS). In the RIU there were 7 (0.88%) newborns with abnormal red reflex and in the NICS there were 14 (2.51%). Sensitivity of pencil light examination was 71.4%. Studies from the Middle East have shown potential recessive genetic causes of common paediatric ocular conditions. In our study, consanguineous marriage was found to have a significant association with red reflex abnormality (P = 0.017).

Conclusions: Red reflex screening test is important in the early diagnosis of vision- and life-threatening eye disorders in Southeast Turkey where consanguinity is common.
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September 2018

Brimonidine-timolol versus brinzolamide-timolol for treatment of elevated intraocular pressure after phacoemulsification surgery.

Int Ophthalmol 2018 Aug 3;38(4):1583-1589. Epub 2017 Jul 3.

Dicle University Medical Faculty, Diyarbakir, Turkey.

Purpose: To compare the efficacy of the fixed combination of brimonidine-timolol (FCBT) and the fixed combination of brinzolamide-timolol (FCBZT) treatments for elevated intraocular pressure (IOP) after phacoemulsification cataract surgery.

Methods: A randomised, prospective, double-blinded study was conducted on 277 eyes of 257 patients who underwent phacoemulsification cataract surgery. Patients were divided into three groups based on the medication administered after cataract surgery as follows: FCBT, FCBZT and a control group where no antiglaucoma medications were used. IOP was recorded at preoperative and postoperative hours 6 and 24 and days 3 and 5.

Results: No statistical differences were observed among the groups regarding age, sex and baseline IOP levels (p > 0.05). Mean IOP levels were significantly lower in the treatment groups than in the control group at postoperative hours 6 and 24 and days 3 and 5 (p < 0.001). Administration of one drop of FCBT or FCBZT demonstrated similar effects on preventing IOP spikes within 24 h of phacoemulsification cataract surgery. FCBZT more effectively lowered IOP than FCBT at days 3 and 5 (p < 0.05).

Conclusions: We demonstrate that the postoperative administration of FCBT or FCBZT is effective in lowering IOP after phacoemulsification cataract surgery; FCBZT more effectively lowered IOP than FCBT at postoperative days 3 and 5.
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August 2018

An Analysis of Morphometric Qualities of Bulbus Oculi in Cataract Patients: A Comparative Biometric Study.

Anat Rec (Hoboken) 2016 09 8;299(9):1308-12. Epub 2016 Jul 8.

Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.

Cataract is considered to be the primary reason for curable blindness that is caused by progressive loss of lens transparency and affects millions of people around the world. This study aims to analyze the changes in morphometric qualities of bulbus oculi (BO) as well as its morphometric measurements such as anterior chamber depth (ACD), lens thickness (LT), vitreous length (VL), axial length (AL), etc. depending on age and gender in cataract patients through comparison with healthy eyes. 200 eyes with cataract were separately analyzed in five different categories of ages for males and females at the ages of 40-89. Biometric measurements of a total of 128 eyes (64 males and 64 females) were used as the control group. The study revealed a strong negative relation between age and ACD and a strong positive relation between age and LT in males and females for healthy eyes and eyes with cataract (P < 0.05). No significant relation was found for VL and AL in either gender (P > 0.05). A significant decrease was observed in ACD with aging while a positive correlation with age was detected in LT. We believe that the data obtained from this study will serve as a guide for BO interventions, diagnose and treatment stages and training of physician assistants. Anat Rec, 299:1308-1312, 2016. © 2016 Wiley Periodicals, Inc.
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September 2016

The effects of delivery type and gender on intraocular pressure and central corneal thickness in newborns.

Arq Bras Oftalmol 2016 Apr;79(2):92-5

Ophthalmology Department, Dicle University of Medicine, Diyarbakir, Turkey.

Purpose: To analyze intraocular pressure (IOP) and central corneal thickness (CCT) in newborns during the first 12 h of life.

Methods: Forty-three newborns born by vaginal delivery (VD) and 30 newborns born by cesarean section (CS) were evaluated. IOP and CCT were measured using Tono-Pen and handheld pachymeter, respectively, at both the 5th minute after delivery and at the 12th h of life.

Results: The mean IOP for the VD group was significantly higher than that of the CS group at both the 5th minute and 12th h (p =0.042 and p =0.018, respectively). In both groups, the IOP decreased by the 12th h, but the decrease was only significant for the CS group (p =0.020). The decrease in CCT over the 12 h was significant for both groups (p <0.001). In the VD and CS groups, the IOP values of the males were significantly higher than those of the females at the fifth minute only (p =0.024 and p =0.043, respectively). No other values were significantly different between the genders.

Conclusions: Newborn IOP is affected by the mode of delivery and gender. A higher IOP was found in vaginally delivered newborns than in CS newborns for at least 12 h postpartum. CCT showed a significant decline within 12 h. Male newborns have significantly higher IOP values in the first minutes of life.
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April 2016

Novel FGF10 mutation in autosomal dominant aplasia of lacrimal and salivary glands.

Clin Oral Investig 2017 Jan 9;21(1):167-172. Epub 2016 Mar 9.

Department of Pediatric Dentistry & Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea.

Objective: Aplasia of lacrimal and salivary glands (ALSG) is a rare autosomal dominant inherited disease, characterized by aplasia, atresia, or hypoplasia of the lacrimal and salivary systems with variable expressivity. The purpose of this study was to identify genetic etiology of an ALSG family.

Materials And Methods: We recruited a Turkish family with ALSG and performed a mutational analysis, based on the candidate gene approach, to clarify the molecular genetic etiology.

Results: The candidate gene sequencing of the FGF10 gene identified a novel heterozygous nonsense mutation (c.237G > A, p.Trp79*) in the exon 1.

Conclusion: The identified novel mutation would result in a haploinsufficiency of the FGF10, because of nonsense-mediated mRNA decay caused by a premature stop codon. This report further confirms that ALSG is caused by the haploinsufficiency of functional FGF10.

Clinical Relevance: Identification of the genetic etiology of the ALSG will help both the family members and dentist understand the nature of the disorder. Therefore, it will positively motivate oral health care to avoid further destruction of the tooth due to the lack of salivary production.
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January 2017

Metallic corneal foreign bodies: an occupational health hazard.

Arq Bras Oftalmol 2014 Apr;77(2):81-3

Diyarbakir Education and Research Hospital, Diyarbak?r, Turkey.

Purpose: To analyze the risk factors, outcomes, demographic characteristics, and attitudes of workers with metallic corneal foreign body (FB) injury.

Methods: One hundred consecutive patients who presented with a metallic corneal FB to the eye clinic at Diyarbakir Training and Research Hospital were evaluated. The patients completed a questionnaire and were examined to determine features of the injury.

Results: All patients were male. The mean age was 32.46 ± 1.03 years. Fifty-five percent of the patients were unregistered workers, 59% were working in the metal industry sector, and 65% injuries resulted from metal cutting. Protective goggles were available in the workplace of 64% patients. However, 57% patients were not wearing goggles when the accident occurred, and 43% were injured despite goggle use. Most patients (52%) attempted to remove FBs by themselves. FBs were located in the central zone of the cornea in 16% patients. Rust marks remained after FB removal in 26% patients. Corneal scars from previous FB injuries were present in 58% patients. Only 8% workplaces provided compensation for physician visits for occupation related illnesses.

Conclusions: Workplaces with a high risk for eye injuries should increase their protective measures, and educational programs should be implemented for both workers and occupational physicians. The government should enforce laws regarding unregistered workers in a better manner.
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April 2014

Amblyopia and refractive errors among school-aged children with low socioeconomic status in southeastern Turkey.

J Pediatr Ophthalmol Strabismus 2013 Jan-Feb;50(1):37-43. Epub 2012 Sep 11.

Department of Ophthalmology, Dicle University Faculty of Medicine, Diyarbakir, Turkey.

Purpose: To investigate the prevalence of refractive errors and other eye diseases, incidence and types of amblyopia in school-aged children, and their relation to gender, age, parental education, and socioeconomic factors.

Methods: A total of 21,062 children 6 to 14 years old were screened. The examination included visual acuity measurements and ocular motility evaluation. Autorefraction under cycloplegia and examination of the external eye, anterior segment, media, and fundus were performed.

Results: There were 11,118 females and 9,944 males. The average age was 10.56 ± 3.59 years. When all of the children were evaluated, 3.2% had myopia and 5.9% had hyperopia. Astigmatism 0.50 D or greater was present in 14.3% of children. Myopia was associated with older age, female gender, and higher parental education. Hyperopia was inversely proportional with older age. Spectacles were needed in 4,476 (22.7%) children with refractive errors, and 10.6% of children were unaware of their spectacle needs. Amblyopia was detected in 2.6% of all children. The most common causes of amblyopia were anisometropia (1.2%) and strabismus (0.9%).

Conclusion: Visual impairment is a common disorder in school-aged children. Eye health screening programs are beneficial in early detection and proper treatment of refractive errors.
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July 2013

The effect of I-gel ™ airway on intraocular pressure in pediatric patients who received sevoflurane or desflurane during strabismus surgery.

Paediatr Anaesth 2012 Aug 12;22(8):772-5. Epub 2012 Apr 12.

Department of Ophthalmology, Dicle University School of Medicine, Diyarbakır, Turkey.

Objectives: The aim of this study was to investigate the effect of I-gel(TM) laryngeal mask airway on intraocular pressure (IOP) in children with strabismus undergoing balanced anesthesia with sevoflurane or desflurane.

Methods: Forty-seven children, ASA physical status I, were scheduled for elective strabismus surgery. Patients were randomly assigned to one of the two inhalation anesthetic groups. Sevoflurane group comprised of 27 children, and desflurane group comprised of 20 children. Anesthesia was induced and maintained with sevoflurane or desflurane. No muscle relaxant was used. IOPs were measured before anesthesia, at 2 and 5 min after insertion of I-gel(TM) and after removal of I-gel(TM) . IOP measurements were obtained by Tonopen(®).

Results: Intraocular pressure significantly decreased 2 min after insertion of I-gel(TM) in both sevoflurane and desflurane groups (P < 0.001). Measurements 5 min after I-gel(TM) insertion were also significantly lower than those of before insertion in both groups (P < 0.01). However, no significant differences were found between the preoperative measurement and the measurement after removal of I-gel(TM) within two groups (P = 0.072 and P = 0.547, respectively). No significant differences were found in all IOP measurements between sevoflurane and desflurane groups.

Conclusion: Insertion of I-gel(TM) laryngeal mask airway with giving sevoflurane or desflurane inhalation anesthetics seemed not to cause any increase in IOPs in pediatric ophthalmic surgery.
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August 2012