Publications by authors named "Ufuk Elgin"

64 Publications

Evaluation of aqueous humor and serum clusterin levels in patients with glaucoma.

BMC Ophthalmol 2021 Jan 9;21(1):25. Epub 2021 Jan 9.

University of Health Sciences, Ulucanlar Eye Research Hospital, Ankara, Turkey.

Background: To compare the aqueous humor (AH) and the serum clusterin levels of patients with pseudoexfoliation syndrome (PEX), pseudoexfoliation glaucoma (PEXG), and primary open-angle glaucoma (POAG) with each other and with an age- and sex-matched control group.

Methods: This prospective, cross-sectionalstudy evaluated 92 eyes from 92 adult cases of uncomplicated phacoemulsification and posterior chamber intraocular lens (IOL) implantation. The cases were divided into PEX, PEXG, POAG, and control groups. Serum samples were taken from the antecubital vein just before the surgery, and the AH samples were aspirated at the beginning of the surgery. Kruskal-Wallis H, One-way ANOVA, Mann-Whitney U with Bonferroni correction and Chi-Square tests were used for statistical analysis.

Results: The serum clusterin levels were the highest in the PEXG group, but no statistically significant differences were observed between the groups (p=0.633). The mean AH clusterin levels were 286.79±29.64 μg/mL in the PEXG group, 263.92±31.70 μg/mL in the PEX group, 272.59±49.71 μg/mL in the POAG group, and 193.50±62.38 μg/mL in the control group (p< 0.001). This came out to be 1.48 times increase for the PEXG group, 1.36 for the PEX group, and 1.41 for the POAG group when compared with the control subjects.

Conclusions: A higher level of clusterin in the anterior chamber was found to be associated with PEX and PEXG. In addition, a high level of anterior chamber clusterin in POAG, which is a new finding, showed that this molecule might be important not only in pseudoexfoliation, but also other types of glaucoma like POAG.
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http://dx.doi.org/10.1186/s12886-020-01781-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796574PMC
January 2021

Peripapillary and macular choroidal vascularity index in patients with clinically unilateral pseudoexfoliation syndrome.

Eye (Lond) 2020 Sep 1. Epub 2020 Sep 1.

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

Purpose: To investigate choroidal vascular changes using an image binarization tool in patients with clinically unilateral pseudoexfoliation syndrome (XFS).

Methods: This cross-sectional study included 150 eyes of 100 patients. The eyes were divided into three groups: (1) 50 affected eyes of patients with clinically unilateral XFS; (2) 50 unaffected fellow eyes; and (3) 50 healthy control eyes. Enhanced depth imaging optical coherence tomography scans of the macula and peripapillary regions were acquired. Images were binarized using ImageJ software (National Institutes of Health, Bethesda, MD, USA). The choroidal vascularity index (CVI) was defined as proportion of the luminal area to the total circumscribed choroidal area.

Results: Horizontal and vertical scans revealed that the macular CVI values of the affected eyes (60.08 ± 2.06 and 62.21 ± 2.10, respectively) were lower compared with control eyes (67.31 ± 2.24; p = 0.001 and 68.11 ± 2.36; p < 0.001, respectively). Conversely, no significant difference in the macular CVI was found between unaffected fellow and control eyes (p = 0.094 and p = 0.120, respectively). The mean peripapillary CVI values of the temporal (58.73 ± 3.15), superior (59.84 ± 3.09), and inferior (56.94 ± 2.47) sectors were significantly lower in affected eyes compared to control eyes (63.21 ± 3.00, 62.07 ± 3.05, and 60.78 ± 2.88, respectively; p < 0.05 for all). In addition, the unaffected fellow eyes had significantly lower CVI values in the temporal (61.42 ± 3.07) and inferior (57.61 ± 2.56) peripapillary sectors compared with the control eyes (p = 0.007 and p = 0.005, respectively).

Conclusions: These findings suggest that XFS is associated with decreased macular and peripapillary choroidal vascularity. Furthermore, the unaffected eyes of patients with unilateral XFS may show vascularity changes in the peripapillary choroid.
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http://dx.doi.org/10.1038/s41433-020-01171-9DOI Listing
September 2020

Characteristics of uveitic glaucoma in Turkish patients.

Eur J Ophthalmol 2020 Aug 17:1120672120950932. Epub 2020 Aug 17.

Dünyagöz Hospital, Ankara, Turkey.

Purpose: To evaluate the prevalence of uveitic glaucoma (UG) in the Turkish population and investigate the primary underlying diseases.

Methods: This multicenter, cross-sectional, prospective study included patients who presented to the glaucoma units of 10 tertiary ophthalmology departments in Ankara, Turkey from 15th March to 16th May 2015 and fulfilled the criteria of UG. Patients were inspected for age, sex, medical history, best corrected visual acuity, biomicroscopic findings, intraocular pressure values, and visual field results.

Results: During the study period, 4604 eyes of 2541 patients with glaucoma were screened and 145 eyes of 104 patients (4.1%) were identified as having UG. One hundred and thirty-four eyes (92.4%) had open-angle glaucoma and 11 eyes (7.6%) had closed-angle glaucoma. The mean patient age was 47 ± 16 (6-90) years. Idiopathic uveitis (54 eyes), Behçet's disease (26 eyes), Fuchs heterochromic cyclitis (21 eyes), Herpes Simplex virus infectious uveitis (14 eyes), and ankylosing spondylitis (six eyes) were the leading types of uveitis associated with glaucoma. Acute anterior uveitis was the most common type of uveitis diagnosed in 72 patients (105 eyes), whereas 21 patients (27 eyes) had panuveitis, eight patients (nine eyes) had intermediate uveitis, and three patients (four eyes) had posterior uveitis. The need for surgical intervention was 37.2% among all cases and the most common surgery was trabeculectomy in 45 eyes.

Conclusion: UG is a vision-threatening complication commonly seen in patients with uveitis. This study demonstrates the epidemiological features and underlying etiologies of UG in the Turkish population. The most common primary causes of UG were Behçet's disease and Fuchs heterochromic cyclitis.
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http://dx.doi.org/10.1177/1120672120950932DOI Listing
August 2020

Analysis of Corneal Densitometry and Endothelial Cell Function in Fuchs Uveitis Syndrome.

Eye Contact Lens 2020 May 29. Epub 2020 May 29.

Department of Ophthalmology (M.S., P.C.O., M.C., U.E.), University of Health Sciences, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey; and Department of Ophthalmology (H.B.O.), Gazi University School of Medicine, Ankara, Turkey.

Objectives: To evaluate corneal densitometry and endothelial cell properties in patients with unilateral Fuchs uveitis syndrome (FUS), and to compare results with unaffected contralateral eyes and healthy control subjects.

Methods: A total of 90 participants were included in this prospective cross-sectional study. Forty-five affected eyes of patients with FUS were regarded as group 1 (FUSa), 45 fellow eyes were regarded as group 2 (FUSf), and 45 healthy-control eyes were regarded as group 3. Corneal densitometry was measured with densitometry software of Scheimpflug Corneal Topography (Pentacam HR, Oculus GmbH, Wetzlar, Germany), whereas endothelial cell measurement was evaluated with specular microscopy (Tomey, EM4000, GmbH, Germany).

Results: The mean corneal densitometry values were higher in the midstromal (zones; 2-6, 6-10 mm), posterior (all zones), and total thickness (zones; 2-6, 6-10 mm) layers in the FUSa compared with FUSf and control eyes (P<0.05 for all comparisons). The mean values of average cell area and cell size characteristics (minimum, maximum, SD, and coefficient of variation) were higher; endothelial cell density and percentage of hexagonal cells were lower in the FUSa than in the other two groups (P<0.05 for all comparisons). There was a significantly strong correlation between specular microscopy parameters and posterior corneal densitometry values in the FUSa group.

Conclusions: Impairment of endothelial cell function in affected eyes of patients with FUS resulted in increased values of corneal densitometry, especially posterior layer.
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http://dx.doi.org/10.1097/ICL.0000000000000717DOI Listing
May 2020

Evaluation of the optic nerve head vessel density in the patients with asymmetric pseudoexfoliative glaucoma: an OCT angiography study.

Graefes Arch Clin Exp Ophthalmol 2020 Jul 16;258(7):1493-1501. Epub 2020 Apr 16.

Department of Ophthalmology, Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Kale Mahallesi, Ulucanlar Caddesi, No:59, 06250, Altındağ/Ankara, Turkey.

Purpose: To evaluate vascular microcirculation changes of the optic nerve head (ONH) in the patients with asymmetric pseudoexfoliative glaucoma (XFG) using optical coherence tomography angiography (OCTA) and to compare vessel density (VD) results with healthy individuals.

Methods: This prospective study enrolled 120 eyes in total. The eyes were divided into 3 groups: 40 glaucomatous and 40 non-glaucomatous fellow eyes without clinically pseudoexfoliation material (XFM) of patients with asymmetric XFG, and 40 healthy eyes as controls. The optic disc region was evaluated with OCTA (Optovue, Inc., Fremont, CA). VD was assessed as the ratio of the area formed by the vessels in 3 different regions: (1) inside disc; (2) in the peripapillary area defined as a 1-mm wide elliptical annulus around the disc; and (3) in the whole image defined as a 4-mm wide papillary region.

Results: There were significant decreases in VD values of all regions in XFG eyes compared to fellow and control eyes (p < 0.05 for all comparisons). The mean VD values of peripapillary area and whole image were lower in the non-glaucomatous fellow eyes compared with control eyes (p = 0.011 and p = 0.015, respectively). The receiver operating characteristic analysis for differentiating fellow eyes from healthy eyes had highest area under the curve and sensitivity at 90% specificity for superior-hemi (0.811, 65.2%), followed by ppVD (0.775, 61.8%) and whole image (0.743, 55.9%).

Conclusions: OCTA as a novel imaging may be a valuable structural test in diagnosis and follow-up of glaucoma.
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http://dx.doi.org/10.1007/s00417-020-04668-xDOI Listing
July 2020

Evaluation of biometric parameters in phacomorphic glaucoma and mature cataracts.

Eur J Ophthalmol 2020 Apr 8:1120672120914536. Epub 2020 Apr 8.

University of Health Sciences, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey.

Purpose: The aims of this study were to compare the biometric parameters and axial lengths of eyes with phacomorphic glaucoma and mature cataract and to identify differences that might predispose to development of phacomorphic glaucoma.

Methods: Three hundred forty-two patients were enrolled in this retrospective study. The eyes were divided into four groups-Group (G)1: phacomorphic glaucoma ( = 29), G2: mature cataract ( = 313), G3: contralateral phacomorphic glaucoma ( = 29), and G4: contralateral mature cataract ( = 313). Central corneal thickness and anterior chamber depth were assessed by optical low-coherence reflectometry (Lenstar LS 900®; Haag-Streit AG, Switzerland), while axial length was determined by A-scan ultrasound biometry.

Results: The mean central corneal thickness of G1 was significantly higher than in other groups ( < 0.001) and the mean anterior chamber depth of G1 was the lowest among the groups ( < 0.001). Also, G2 had lower mean anterior chamber depth than G4 ( < 0.001) and G3 had lower mean anterior chamber depth than G4 ( = 0.007). Anterior chamber depth less than 3.27 mm had the higher odds ratio for distinguishing G3 versus G4 (odds ratio = 10.79,  < 0.001). Furthermore, patients aged ⩾68.9 years had the higher odds ratio for distinguishing G1 versus G2 (odds ratio = 2.82,  = 0.019). There was no significant difference in the presence of pseudoexfoliation material between G1 and G2 ( = 0.057). There were no significant differences in axial length values among the four groups ( = 0.097).

Conclusion: Advanced age and shallow anterior chamber depth were found to be risk factors for developing phacomorphic glaucoma, but the presence of pseudoexfoliation material was not found to play a role as a risk factor in phacomorphic glaucoma development.
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http://dx.doi.org/10.1177/1120672120914536DOI Listing
April 2020

The outcome of initial mitomycin C-augmented trabeculectomy with subconjunctival bevacizumab in the management of secondary glaucoma associated with Fuchs heterochromic iridocyclitis.

Int Ophthalmol 2020 Apr 3;40(4):795-802. Epub 2019 Dec 3.

Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Ulucanlar caddesi No:59, 06240, Altindag, Ankara, Turkey.

Purpose: To investigate the outcome of mitomycin C (MMC)-augmented trabeculectomy with subconjunctival bevacizumab in the management of Fuchs heterochromic iridocyclitis (FHI)-related glaucoma in 1-year follow-up period.

Methods: This retrospective study included 50 eyes with FHI-related glaucoma those had underwent initial trabeculectomy with MMC (0.2 mg/ml-3 min). Thirty-one of them had single-dose bevacizumab injection (1.25 mg/0.05 ml) into the bleb area just at the end of the surgery, while 19 eyes did not have. The intraocular pressure (IOP) and the mean number of anti-glaucomatous medications were evaluated. The IOP value ≤ 21 mmHg was defined as complete or qualified surgical success in terms of using medical anti-glaucomatous treatment. Bleb height and vascularity were evaluated with Indiana bleb grading system. Paired sample t test, t test, Chi-square and Kolmogorov-Smirnov tests were used for statistical analysis.

Results: The preoperative IOP values of bevacizumab and without bevacizumab groups were 32.8 ± 4.5 mmHg and 32.8 ± 4.5 mmHg, respectively, and they decreased to 17.5 ± 4.6 mmHg and 17 ± 5.2 mmHg at the final visit (p < 0.001 for all values). There were no significant differences in postoperative IOP and the number of medications between the groups at the final visit. In bevacizumab group, complete success was achieved in 100% within the third month but decreased to 22.5% (complete) and 74.1% (qualified) at the first year. In the other group (without bevacizumab group), complete success was achieved in 94.7% within the third month but decreased to 15.8% (complete) and 84.2% (qualified) at the first year.

Conclusion: Initial trabeculectomy with MMC and subconjunctival bevacizumab injection was found to have lower rates of complete success with relatively acceptable qualified success rates in the management of FHI-related glaucoma. Subconjunctival bevacizumab was not found to have additional effect to improve the surgical success.
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http://dx.doi.org/10.1007/s10792-019-01240-3DOI Listing
April 2020

Early visual field changes in patients with type 1 diabetes mellitus.

Eur J Ophthalmol 2020 Nov 30;30(6):1467-1472. Epub 2019 Aug 30.

Department of Endocrinology, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.

Purpose: To assess the visual field sensitivity changes and investigate the association between visual field sensitivity and retinal nerve fiber layer thickness in patients with type 1 diabetes mellitus.

Materials And Methods: In this cross-sectional and observational study, 46 patients (22 males, 24 females) with type 1 diabetes mellitus and no diabetic retinopathy formed the diabetes mellitus group and 50 age-matched healthy subjects (32 males, 18 females) formed the control group. Retinal nerve fiber layer thickness, full-threshold standard automated perimetry, and short-wavelength automated perimetry were performed. Main outcomes were retinal nerve fiber layer thickness, mean deviation, pattern standard deviation, and short fluctuation.

Results: Average retinal nerve fiber layer thickness was significantly thinner in the diabetes mellitus group (p < 0.001). The mean values of mean deviation and pattern standard deviation of the full-threshold standard automated perimetry did not differ between the groups (p = 0.179, p = 0.139, respectively). Mean short fluctuation was significantly greater in the diabetes mellitus group (p < 0.001). Both mean deviation and pattern standard deviation of the short-wavelength automated perimetry were significantly greater in the diabetes mellitus group (p < 0.001, p < 0.001, respectively). Pattern standard deviation of short-wavelength automated perimetry equal or higher than 1.57 dB had 91% sensitivity and 90% specificity (area under the curve = 0.969, p < 0.001) and short fluctuations of full-threshold standard automated perimetry equal or higher than 0.80 dB had 80% sensitivity and 76% specificity over detecting early retinal nerve fiber layer loss in patients with type 1 diabetes mellitus (area under the curve = 0.855, p < 0.001).

Conclusion: This study showed that thinner retinal nerve fiber layer in patients with type 1 diabetes mellitus may be associated with abnormal retinal sensitivity to short-wavelength stimulations in short-wavelength automated perimetry; however, retinal sensitivity to white stimulus was similar to that in healthy subjects in full-threshold standard automated perimetry.
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http://dx.doi.org/10.1177/1120672119872896DOI Listing
November 2020

Evaluation of dynamic thiol-disulfide homeostasis in glaucoma patients and the correlation with retinal nerve fiber layer analysis.

Eur J Ophthalmol 2020 Jul 12;30(4):690-699. Epub 2019 Apr 12.

Biochemistry Department, Ankara Atatürk Education and Research Hospital, Ankara, Turkey.

Purpose: The aim of this study was to evaluate thiol/disulfide homeostasis and ischemia-modified albumin levels with primary open-angle glaucoma, ocular hypertension, and control group; also to interpret the correlation between these biochemical parameters and retinal nerve fiber layer analysis.

Material And Methods: In a prospective cross-sectional study, 30 primary open-angle glaucoma cases, 30 ocular hypertension cases, and 30 control subjects were included in the study. Native thiol, total thiol, and disulfide measurements and disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol ratios were evaluated as thiol-disulfide homeostasis. Albumin and ischemia-modified albumin parameters were also evaluated. All cases underwent detailed ophthalmologic examination including visual acuity, retinal nerve fiber layer via optical coherence tomography, intraocular pressure, and central corneal thickness measurements and visual field analysis by 24-2 Swedish Interactive Threshold Algorithm (SITA) Standard visual field test.

Results: Primary open-angle glaucoma group had significantly higher ischemia-modified albumin values than ocular hypertension and control group (p < 0.001). Native thiol and total thiol values of control group were statistically higher than those of primary open-angle glaucoma and ocular hypertension groups. The correlation between the temporal retinal nerve fiber layer value and ischemia-modified albumin, disulfide/native thiol, and disulfide/total thiol values of the primary open-angle glaucoma patients included in the study was moderate correlation in negative direction (r = -0.46, r = -0.39, r = -0.39, respectively), whereas there was a statistically significant moderate correlation in positive direction between the native thiol/total thiol values (r = 0.39) (p < 0.05).

Conclusion: These findings have reinforced the role of oxidative stress in the etiopathogenesis of primary open-angle glaucoma, suggesting that the thinning retinal nerve fiber layer may be associated with oxidative stress in favor of prooxidant shift.
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http://dx.doi.org/10.1177/1120672119839582DOI Listing
July 2020

Monitoring and management of the patient with pseudoexfoliation syndrome: current perspectives.

Clin Ophthalmol 2019 1;13:453-464. Epub 2019 Mar 1.

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

Pseudoexfoliation syndrome (PES) is a complex and age-related systemic disorder characterized by the progressive accumulation and granular deposition of pseudoexfoliative material in various intraocular and extraocular tissues. The diagnosis of PES is so important because it is a major risk factor for complications during cataract surgery and the most frequent cause of secondary glaucoma. In addition to ocular complications, PES is related with numerous systemic abnormalities, for which the list is growing steadily. Therefore, management and monitoring of patients with PES are crucial. The aim of this paper was to review current perspectives on monitoring patients with PES and addressing management of ocular and systemic associations of this clinically important and biologically fascinating disease.
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http://dx.doi.org/10.2147/OPTH.S181444DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402616PMC
March 2019

The effect of topical latanoprost on corneal clarity; 1-year prospective study.

Cutan Ocul Toxicol 2019 Sep 25;38(3):253-257. Epub 2019 Mar 25.

a Ulucanlar Eye Research Hospital , Ankara , Turkey.

Quantitatively investigate the effects of topical latanoprost on the corneal optical density parameters by using Scheimpflug system. New cases of primary open-angle glaucoma treated with topical latanoprost as first-line treatment were enrolled in this prospective study. Corneal densitometry measurements obtained with the Scheimpflug system (Pentacam; Oculus, HR) at baseline and 1st, 3rd, 12th months after topical latanoprost treatment. For densitometry analysis, the 12-mm diameter area of the cornea was subdivided into 4 concentric radial zones and also into anterior, central, and posterior layers based on corneal depth. Pre and post-treatment values were compared statistically by a paired sample -test. The mean age of 18 female (66.7%) and 9 male (33.3%), totally 27 cases were 59.48 ± 10.1 years. There was no statistically significant difference between pretreatment and 1st-month post-treatment corneal densitometry values in all regions ( > 0.05 for all). Corneal densitometry values began to decline at 3rd month after treatment. The decrease continued until the 12th month of the beginning of the treatment and was significant in all zones except 2-6 mm of the anterior and central zones ( = 0.23,  = 0.08, respectively). Long-term administration of topical latanoprost may cause decrease in corneal densitometry measurements. Further prospective studies with a longer follow-up period are required to clarify the relationship between prostaglandin analogues and their effects on the cornea transparency.
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http://dx.doi.org/10.1080/15569527.2019.1590390DOI Listing
September 2019

Comparison of Refractive Status and Anterior Segment Parameters of Juvenile Open-Angle Glaucoma and Normal Subjects

Turk J Ophthalmol 2018 12;48(6):295-298

University of Health Sciences, Ulucanlar Eye Research Hospital, Opthalmology Clinic, Ankara, Turkey

Objectives: Our aim was to compare the refractive status and anterior segment parameters of patients with juvenile open-angle glaucoma (JOAG) and normal subjects.

Materials And Methods: Twenty-five recently diagnosed cases of JOAG and 24 normal subjects were included in this prospective controlled clinical trial. Central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), axial length (AL), K1 and K2 keratometry, and white-to-white distance (WTW) measurements were performed with optical biometry (LenStar LS 900, Haag Streit Diagnostics). Spherical equivalent (SE) values and anterior segment parameters were statistically compared by chi-square, Kolmogorov- Smirnov, and independent samples t-tests.

Results: The mean age of the 15 male and 10 female JOAG patients was 11.8±2.78 (8-18) years and the mean age of the 14 male and 10 female normal subjects was 11.58±3.04 (7-16) years (age: p=0.51; sex: p=0.18). Mean intraocular pressure in the JOAG group before treatment was 30.08±4.3 mmHg. The mean SE values of the JOAG and the control group were -1.94±1.86 (+2.35/-5.5) and -0.76±2.03 (+2.25/-4.85) diopters, respectively (p=0.048). JOAG patients had lower mean CCT values (p=0.016) and higher mean AL and ACD values (p=0.049 and p=0.016). There were no significant differences between the groups for LT, WTW, K1, or K2 (p=0.61; p=0.52; p=0.95; p=0.31 respectively).

Conclusion: JOAG patients were found to be more myopic and have lower CCT and greater AL and ACD values than normal subjects. These anterior segment changes may be associated with myopia, which is common in JOAG.
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http://dx.doi.org/10.4274/tjo.68915DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330661PMC
December 2018

Stabilization Time of Anterior Segment Parameters After Trabeculectomy Surgery.

Eye Contact Lens 2018 Nov;44 Suppl 2:S396-S399

Department of Ophthalmology (M.S.), Sorgun State Hospital, Yozgat, Turkey; Department of Ophthalmology (U.E., P.Y., E.S.), University of Health Sciences, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey; and Department of Ophthalmology (M.M.U.), Şirnak State Hospital, Şirnak, Turkey.

Objectives: To investigate the postoperative changes in the anterior segment parameters by Scheimpflug imaging method in patients undergoing trabeculectomy surgery.

Methods: This prospective study included 38 phakic eyes of 38 patients with primary open-angle glaucoma who underwent trabeculectomy. Anterior chamber angle (ACA), anterior chamber depth (ACD), anterior chamber volume (ACV), and central corneal thickness (CCT) of the eyes were measured by performing Scheimpflug imaging in preoperative (baseline) and postoperative periods (1st week and 1st, 3rd, and 6th months after the surgery).

Results: Significant differences were observed in all the anterior segment parameters during the postoperative period (P<0.001 for ACA, ACD, and CCT; P=0.001 for ACV). Compared with preoperative values, ACA, ACD, and ACV values decreased and CCT value increased in the 1st postoperative week (P<0.001 for all the parameters). Compared with the 1st postoperative-week values, ACA, ACD, and ACV values significantly increased and CCT value significantly decreased in the 1st postoperative month (P=0.002 for ACV; P<0.001 for ACA, ACD, and CCT). However, no significant differences were observed between the baseline and 1st postoperative-month values (P>0.05 for all the parameters). Moreover, the changes in the anterior segment parameters were not statistically significant after the 1st postoperative month.

Conclusions: Our results showed that the changes in the anterior segment parameters observed in the early postoperative period after trabeculectomy returned to their baseline values after approximately 1 month after the surgery and remained stable thereafter.
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http://dx.doi.org/10.1097/ICL.0000000000000525DOI Listing
November 2018

Comparison of total/active ghrelin levels in primary open angle glaucoma, pseudoexfoliation glaucoma and pseudoexfoliation syndrome.

Int J Ophthalmol 2018 18;11(5):823-827. Epub 2018 May 18.

Ulucanlar Eye Research Hospital, Ankara 06250, Turkey.

Aim: To investigate the levels of ghrelin (Gh), acylated ghrelin (AGh) and AGh/Gh ratio in the humor aqueous (HA) of cases with pseudoexfoliation syndrome (PXS), pseudoexfoliation glaucoma (PXG), primary open angle glaucoma (POAG) and to compare these with control subjects.

Methods: A prospective examination was made of the total Gh, and AGh levels in HA of 67 patients undergoing cataract surgery. Patients were divided into 4 groups. HA samples were aspirated at the beginning of the surgery, stored at -70°C. Gh and AGh quantification was performed with ELISA kits and the AGh/total-Gh ratios were calculated. ANOVA, Kruskal-Wallis, Chi-square and post-hoc tests were used for statistical analysis.

Results: Total Gh levels in HA were 189.2±45.6 pg/mL in the control group, 199.2±32.9 pg/mL in PXS, 180.6±20.9 pg/mL in PXG and 176.8±21.4 pg/mL in POAG groups (>0.05). AGh levels in HA were 23.09±5.01 pg/mL in the control group, 24.13±5.22 pg/mL in PXS, 22.29±1.55 pg/mL in PXG and 19.69±2.93 pg/mL in POAG groups (>0.05). The ratio of AGh/Gh was 10.3%±2.34% in the control group, 13.03%±2.58% in PXS, 12.3%±1.54% in PXG and 11.79%±1.41% in POAG groups (=0.044). The difference between the PXS and control groups was significant (=0.03).

Conclusion: In spite of statistically insignificant results, the HA total Gh levels were lower than those of the control subjects but not parallel with the AGh levels in glaucoma patients. The relative increase in the AGh/Gh ratio in glaucoma cases supports the view that proportional increases of AGh might play a role in the pathogenesis of glaucoma.
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http://dx.doi.org/10.18240/ijo.2018.05.18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5957036PMC
May 2018

Comparison of anterior segment parameters in patients with pseudoexfoliation glaucoma, patients with pseudoexfoliation syndrome, and normal subjects.

Arq Bras Oftalmol 2018 Apr;81(2):110-115

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

Purpose: To compare the anterior segment parameters of patients with pseudoexfoliation syndrome, patients with pseudoexfoliation glaucoma, and normal subjects.

Methods: This prospective, controlled, comparative study included 150 eyes of 150 patients. The patients were divided into the pseudoexfoliation syndrome group, the pseudoexfoliation glaucoma group, and the control group (50 patients in each group). Axial length, central corneal thickness, aqueous depth, anterior chamber depth, lens thickness, K1 and K2 keratometry values, and white to white distance measurements were obtained by optical biometry and compared between the groups.

Results: The mean ages of the pseudoexfoliation syndrome, pseudoexfoliation glaucoma, and control patients were 62.18 ± 6.21, 61.80 ± 6.62, and 59.40 ± 6.89 years, respectively. There were no statistically significant differences between the groups in mean age or sex ratio (p>0.05). Mean central corneal thickness was statistically significantly greater, mean aqueous depth and anterior chamber depth were statistically significantly greater, and mean lens thickness was statistically significantly less in the control group than in the pseudoexfoliation syndrome and pseudoexfoliation glaucoma groups (p<0.05). Pairwise comparisons of the pseudoexfoliation syndrome group and the pseudoexfoliation glaucoma group revealed that there were no significant differences between these two groups in central corneal thickness, aqueous depth, anterior chamber depth, and lens thickness (p>0.017).

Conclusions: Patients with pseudoexfoliation glaucoma and pseudoexfoliation syndrome had greater lens thickness, shallower aqueous depth and anterior chamber depth, and less central corneal thickness than normal subjects. None of the anterior segment parameters differed between patients with pseudoexfoliation syndrome and patients with pseudoexfoliation glaucoma.
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http://dx.doi.org/10.5935/0004-2749.20180025DOI Listing
April 2018

Seasonal distribution of ocular conditions treated at the emergency room: a 1-year prospective study.

Arq Bras Oftalmol 2018 Apr;81(2):116-119

Ulucanlar Eye Research Hospital, Ankara, Turkey.

Purpose: To determine the clinical characteristics and seasonal distribution of patients admitted to the ocular emergency department of a tertiary ophthalmology care center.

Methods: The study cohort includes 27,120 patients who were admitted to ocular emergency room between November 2013 and November 2014. The age, sex, reason for admission, diagnosis, and complete ocular examination reports were recorded for each patient. X-ray and ultrasonographic examinations were performed if necessary.

Results: The mean patient age was 32.83 ± 17.62 years (range, 0-95). The number of males was nearly two times the number of females, with 18,808 (69.4%) males and 8312 (30.6%) females. The diagnoses included viral conjunctivitis (7,859 patients; 29.0%), corneal foreign body (5,286 patients; 19.5%), bacterial conjunctivitis (3,892 patients; 14.4%), corneal abrasions (2,306 patients; 8.5%), and allergic conjunctivitis (1,433 patients; 5.3%) (Table 1). Other frequent diagnoses included subconjunctival hemorrhage, photo keratopathy, chemical eye injury, and penetrating and blunt eye injuries. Allergic conjunctivitis, ocular trauma, and corneal foreign body were more frequent in spring, whereas keratitis and chemical eye injury were more common in winter (chi-square test). The most common reasons for emergency room admission, in order of frequency, were viral conjunctivitis, corneal foreign body, bacterial conjunctivitis, and corneal abrasions.

Conclusion: This study is the first long-term prospective study to evaluate the seasonal distribution and diagnosis of all adult and pediatric patients admitted to the emergency room for ocular conditions. The frequency of ophthalmological conditions seen in the emergency room may vary according to the season.
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http://dx.doi.org/10.5935/0004-2749.20180026DOI Listing
April 2018

Initial trabeculectomy with 5-fluorouracil with or without subconjunctival bevacizumab in the management of pseudoexfoliation glaucoma.

Int Ophthalmol 2019 Jun 25;39(6):1211-1217. Epub 2018 Apr 25.

University of Health Sciences, Ulucanlar Eye Education and Research Hospital, Ulucanlar caddesi No:59, 06240, Altindag, Ankara, Turkey.

Purpose: To investigate the outcomes of trabeculectomy with 5-fluorouracil (5-FU) with or without subconjunctival bevacizumab in the surgical management of pseudoexfoliation glaucoma (PXG).

Methods: This retrospective study consisted of 49 cases with PXG who underwent initial trabeculectomy with 5-FU. The cases were divided into two age- and sex-matched groups. In 23 cases, subconjunctival bevacizumab was injected (1.25 mg/0.05 mL) at the end of the surgery and in 26 of them the surgery was performed without bevacizumab. The groups were evaluated for the postoperative differences of the intraocular pressure (IOP) and the number of the anti-glaucomatous medications. Independent t, Kolmogorov-Smirnov and Chi square tests were used for statistical analysis.

Results: The mean preoperative IOP was 30.91 ± 4.50 mmHg under the mean number of 2.4 ± 0.7 drops in bevacizumab group. The IOP decreased to 10.22 ± 2.63 mmHg (first week), 10.91 ± 1.88 mmHg (first month), 12.35 ± 2.5 mmHg (3rd month), 12.65 ± 2.35 mmHg (sixth month) and 12.7 ± 1.9 mmHg at the final visit. The mean preoperative IOP was 31.27 ± 5.60 mmHg under the mean number of 2.3 ± 0.7 drops in without bevacizumab group. The IOP decreased to 10.08 ± 2.59 mmHg (first week), 11.00 ± 1.87 mmHg (first month), 12.81 ± 2.04 (3rd month), 13.62 ± 2.21 mmHg (sixth month) and 12.9 ± 2.4 mmHg at the final visit. In both groups, IOP reduced significantly postoperatively. There were no significant differences between the preoperative and the postoperative IOP values.

Conclusion: The additional benefit of single dose of intraoperative bevacizumab was not observed in trabeculectomy with 5-FU in PXG.
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http://dx.doi.org/10.1007/s10792-018-0926-yDOI Listing
June 2019

The effect of trabeculectomy on serum brain-derived neurotrophic factor levels in primary open-angle glaucoma.

Graefes Arch Clin Exp Ophthalmol 2018 Jun 7;256(6):1173-1178. Epub 2018 Feb 7.

University of Health Sciences, Ulucanlar Eye Research and Training Hospital, Ankara, Turkey.

Purpose: We aimed to investigate the effect of trabeculectomy on serum brain-derived neurotrophic factor (BDNF) levels. Our secondary goal was to compare serum and aqueous humor (AH) BDNF levels in primary open-angle glaucoma (POAG) and control subjects.

Methods: This prospective, cross-sectional study consists of 20 eyes of with advanced-stage POAG who had trabeculectomy and 19 eyes of age- and sex-matched control healthy subjects who had cataract surgery. Serum and AH samples were obtained preoperatively in trabeculectomy group and control subjects. Serum samples were obtained at the third postoperative month in both groups.

Results: The aqueous humor and serum levels of BDNF at the surgery day were found to be strongly positive correlated (r = 0.868; p < 0.001). Serum and AH BDNF levels of POAG cases were significantly lower than control subjects at the surgery day (respectively p = 0.038, p = 0.011). In POAG cases, serum BDNF levels significantly increased at the third month after trabeculectomy while there was not a significant difference in control subjects with cataract surgery (p < 0.001; p = 0.717 respectively).

Conclusion: Trabeculectomy was found to have a positive effect on serum BDNF levels in POAG cases.
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http://dx.doi.org/10.1007/s00417-018-3923-yDOI Listing
June 2018

Comparison of anterior segment parameters and axial lengths of myopic, emmetropic, and hyperopic children.

Int Ophthalmol 2019 Feb 29;39(2):335-340. Epub 2017 Dec 29.

Ulucanlar Eye Research Hospital, Ankara, Turkey.

Purpose: To compare the anterior segment parameters of myopic, hyperopic, and emmetropic children by using optical biometry.

Methods: This prospective cross-sectional study included 150 eyes of 150 children between 6 and 16 years old. The eyes were divided into three groups according to their spherical equivalent (SE) refractive error values as myopic [between - 1.0 and - 6.0 diopter (D)], emmetropic (between + 0.50 and - 0.50 D), and hyperopic (between + 1. 0 and + 3.0 D). Axial length (AL), central corneal thickness, anterior chamber depth (ACD), lens thickness (LT), and mean keratometry (K mean) measurements were obtained by an optical biometry (LenStar LS 900, Haag Streit Diagnostics) were compared between the groups.

Results: There were no statistically significant differences regarding the ages and genders of the participants between the groups (p > 0.05). The mean SE refractive error values were - 2.20 ± 0.71 D in myopic, - 0.08 ± 0.49 D in emmetropic, and + 2.06 ± 0.53 D in hyperopic eyes. The mean AL values were 24.50 ± 0.69, 23.41 ± 0.61, and 22.33 ± 0.61 mm, respectively, in myopic, emmetropic, and hyperopic eyes (p < 0.001). The mean ACD values were 3.94 ± 0.22, 3.78 ± 0.23, and 3.45 ± 0.20 mm, respectively, in myopic, emmetropic, and hyperopic eyes (p < 0.001). The mean LT values were 3.56 ± 0.20, 3.43 ± 0.17, and 3.31 ± 0.12 mm, respectively, in myopic, emmetropic, and hyperopic eyes (p < 0.001). There were no significant differences in the other parameters between the groups.

Conclusions: Refractive errors are the main factors those affect anterior segment parameters and AL in children and the most severely affected parameters were found to be the AL, ACD, and LT values.
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http://dx.doi.org/10.1007/s10792-017-0816-8DOI Listing
February 2019

Prospective, non-interventional, multicenter study of the intraocular pressure-lowering effects of prostaglandin analog/prostamide-containing therapies in previously treated patients with open-angle glaucoma or ocular hypertension.

Clin Ophthalmol 2017 19;11:723-731. Epub 2017 Apr 19.

Allergan l˙Iaçları Tic AŞ, Istanbul, Turkey.

Objective: The objective of this study was to assess the intraocular pressure (IOP)-lowering efficacy, tolerability, safety, and usage patterns of prostaglandin analog/prostamide (PGA/P)-containing topical ocular hypotensives in ocular hypertension (OHT) and primary open-angle glaucoma in the Turkish clinical setting.

Methods: This non-interventional, multicenter study enrolled previously treated patients who failed to achieve target IOP (or experienced unacceptable adverse events [AEs]) and were prescribed a PGA/P-containing IOP-lowering agent. Treatment was initiated at baseline (V1), and patients returned at weeks 4-6 (V2) and 8-12 (V3). The primary efficacy measure was the change in IOP from baseline at V3 in each eye. The secondary measures were physician's assessment of IOP-lowering efficacy, patients (%) reaching target IOP determined at V1, hyperemia score, physician and patient assessment of study treatment tolerability at V3, and AE frequency/severity. A subgroup analysis of patients receiving the most common study treatment was conducted. All analyses were performed using the safety population (patients who received one or more doses and had any data available).

Results: Of 358 enrolled patients, 60.6% had primary open-angle glaucoma, 29.9% had secondary open-angle glaucoma (protocol amendment), and 13.1% had OHT; 13 patients had multiple diagnoses. At V3, the mean IOP change from baseline was ≥-4.2 mmHg (≥21.1%). IOP met or was lower than the target in 81.7% of patients, 95% exhibited none to mild conjunctival hyperemia (most common AE), and tolerability was rated good/very good by >91.1% of patients and physicians. The results were similar in patients who received the most common study treatment, bimatoprost 0.03%/timolol 0.5% (bim/tim; n=310).

Conclusion: PGA/P-containing medications, including bim/tim, significantly reduced IOP in previously treated patients with open-angle glaucoma or OHT; most reached their target IOP or an IOP even lower than their target and reported good/very good tolerability. PGA/P-containing medications such as bim/tim should be considered as a safe, effective therapeutic option for Turkish patients who exhibit poor response, tolerance, or adherence to their previous therapy.
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http://dx.doi.org/10.2147/OPTH.S119963DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5402998PMC
April 2017

Analysis of clinical features and visual outcomes of pars planitis.

Int Ophthalmol 2018 Apr 7;38(2):727-736. Epub 2017 Apr 7.

University of Health Sciences, Ulucanlar Eye Research and Training Hospital, Guzeltepe Mh, 747. sk, Parkvadi Apartments, 06690, Cankaya, Ankara, Turkey.

Purpose: To evaluate the demographic characteristics, clinical features, treatment and outcomes of patients with pars planitis in a tertiary referral center in Turkey.

Methods: Medical records of patients with pars planitis were retrospectively reviewed. The data including demographic and ocular features and treatment outcomes were recorded. The distribution of clinical findings and complications were evaluated according to age and gender groups. The changes in final BCVA compared to the initial BCVA were noted. Statistical analysis was performed using SPSS software (Version 18.0, SPSS Inc., Chicago, USA).

Results: Twenty-seven patients (54 eyes) were included in this study. 16 patients were male (59.3%), and 11 were female (40.7%). Mean age at diagnosis was 12.84 ± 8.26 (range 4-36) years. Mean follow-up period was 61.3 ± 52.15 (range 9-172) months. Mean BCVA was 0.58 ± 0.36 (range 0.03-1.00) (0.40 ± 0.45 logMAR) at presentation, and 0.81 ± 0.28 (range 0.10-1.00) (0.14 ± 0.27 logMAR) at final visit (P = 0.001). Vitreous inflammation (100%), vitreous haze (92.6%), snowballs (74.1%), snowbanks (66.7%), anterior chamber cells (66.7%) and peripheral retinal vascular sheathing (48.1%) were the most common presentations. Ocular complications included vitreous condensation (51.9%), cystoid macular edema (22.2%), cataract (18.5%), inferior peripheral retinal detachment (11.1%), glaucoma (5.6%) and vitreous hemorrhage (3.7%). Treatments included topical, periocular, intravitreal and systemic corticosteroids, immunosuppressives, peripheral laser photocoagulation and pars plana vitrectomy when needed.

Conclusions: Pars planitis is an idiopathic chronic intermediate uveitis mostly affecting children and adolescents. In spite of its chronic nature with high potential of causing ocular complications, adequate treatment and close follow-up lead to favorable visual outcomes.
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http://dx.doi.org/10.1007/s10792-017-0526-2DOI Listing
April 2018

Comparison of anterior segment measurements with LenStar and Pentacam in patients with newly diagnosed glaucoma.

Int Ophthalmol 2018 Feb 21;38(1):171-174. Epub 2017 Jan 21.

Ulucanlar Eye Research Hospital, Ulucanlar caddesi. No:59., 06240, Altindag, Ankara, Turkey.

Purpose: To compare anterior segment measurements obtained using the Pentacam; Oculus, HR and the LenStar LS 900 in patients with newly diagnosed glaucoma.

Methods: Patients with ocular hypertension and primary open-angle glaucoma who had been treated with PGA were included in the study. Anterior segment measurements including central corneal thickness (CCT), keratometry, anterior chamber depth (ACD) and white-to-white (WTW) corneal diameter obtained with the optic low-coherent reflectometer (LenStar LS-900, Haag-Streit AG, Switzerland) and with the Scheimpflug system (Pentacam; Oculus, HR) were compared. In order to compare LenStar and Pentacam measurements, paired sample t test and 'Bland-Altman' plot were used in the statistical analysis.

Results: Twenty-two female (59.5%) and 15 male (40.5%) totally 37 cases with newly diagnosed glaucoma were included in the study. Anterior segment parameter measurements obtained with both the LenStar and the Pentacam were significantly correlated for right and left eyes, so the right eye values were used in statistical analysis. WTW and ACD values measured with LenStar were statistically significantly higher than those measured with Pentacam (p: 0.0001, p: 0.0001, respectively). There was no statistically significant difference between the CCT values measured by the two devices (p: 0.217).

Conclusion: There was a statistically significant difference between the mean values of ACD and WTW measured with the LenStar and Pentacam. These biometric devices should not be used interchangeably. It should be appropriate to use the same device on follow-up of glaucoma patients.
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http://dx.doi.org/10.1007/s10792-016-0440-zDOI Listing
February 2018

Early Postoperative Effects of Cataract Surgery on Anterior Segment Parameters in Primary Open-Angle Glaucoma and Pseudoexfoliation Glaucoma.

Turk J Ophthalmol 2016 Jun 6;46(3):95-98. Epub 2016 Jun 6.

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

Objectives: To compare the effect of cataract surgery on anterior segment parameters measured by optical biometry in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG).

Materials And Methods: Twenty-five eyes of 25 patients with POAG and 29 eyes of 29 patients with PXG who had uncomplicated phacoemulsification and posterior chamber intraocular lens implantation surgery were included to our prospective study. Central corneal thickness (CCT), anterior chamber depth (ACD) and axial length (AL) were measured with an optical biometer preoperatively and at 1 month postoperatively. The pre- and postoperative values of intraocular pressure (IOP) and the anterior segment parameters and the differences between POAG and PXG were compared statistically by paired t, independent t and chi-square tests.

Results: The mean values of preoperative CCT (p=0.042) and ACD (p=0.012) were significantly lower in the PXG than in the POAG group. In the PXG group, IOP decreased (p=0.001) but CCT (p=0.03) and ACD (p=0.001) increased significantly postoperatively; AL did not change significantly. In the POAG group, IOP decreased (p=0.01) and ACD (p=0.004) increased significantly postoperatively, while AL and CCT did not change significantly. There were no significant differences in the pre- to postoperative changes in IOP (p=0.76), AL (p=0.44) and CCT (p=0.52) values between the two groups. However, the postoperative increase in ACD was larger in the PXG group (p=0.03).

Conclusion: Cataract surgery may cause some changes in IOP and anterior segment parameters like ACD and CCT postoperatively in eyes with POAG and PXG, and these changes may differ between eyes with PXG and POAG.
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http://dx.doi.org/10.4274/tjo.92604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5076299PMC
June 2016

Canaliculitis Awareness.

Turk J Ophthalmol 2016 Jan 5;46(1):25-29. Epub 2016 Jan 5.

Ulucanlar Eye Education and Research Hospital, Ankara, Turkey.

Objectives: To evaluate the demographic characteristics, treatment, and results of patients with canaliculitis.

Materials And Methods: Medical records including the demographic characteristics, clinical findings, and treatment outcomes of patients diagnosed and treated for canaliculitis between September 2009 and March 2014 were analyzed retrospectively.

Results: The median age of the 7 canaliculitis patients consisting of 4 women and 3 men was 49 (range 8-58) years. All patients had unilateral canaliculitis (on the right side in 2 and left side in 5 patients) and the inferior canaliculus was involved more frequently (71.4%). Epiphora, chronic conjunctivitis, a palpable and thickened canaliculus, and yellow discharge from the punctum were present in all cases. Actinomyces spp. was the most frequently cultured microorganism (75%). Dacryolith was observed in 6 patients. Canaliculotomy and dacryolith removal with canalicular curettage were performed, followed by medical treatment (topical penicillin 100,000 U/ml and oral ampicillin/sulbactam) for 10 days. Patients were followed up for a mean duration of 17.0±15.2 (range 3-46) months. Signs and symptoms resolved completely within a month. Epiphora recurred in the 36th month in a single patient and was treated with daily canalicular irrigation with antibiotics and there were no further symptoms during 10 months of follow-up after the recurrence.

Conclusion: Canaliculitis is often overlooked and can be misdiagnosed. Every patient with chronic conjunctivitis and lacrimal infection should be examined carefully for canaliculitis.
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http://dx.doi.org/10.4274/tjo.68916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5076306PMC
January 2016

Comparison of anterior segment parameters in juvenile diabetes mellitus and healthy eyes.

Eur J Ophthalmol 2016 Nov 5;26(6):618-622. Epub 2016 Mar 5.

 Dr. Sami Ulus Obstetrics and Pediatrics Research and Educational Hospital, Ankara - Turkey.

Purpose: To compare the anterior segment parameters of patients with juvenile diabetes mellitus (DM) and healthy children by optical biometry.

Methods: This prospective controlled clinical trial included 47 patients with juvenile type 1 DM and 50 age- and sex-matched healthy children. Central corneal thickness (CCT), aqueous depth (AD), lens thickness (LT), axial length, pupillary diameter (PD), K1 and K2 keratometry, and white to white distance (WTW) measurements were performed with optical biometry. The glycosylated hemoglobin (HbA1c) levels of the DM cases were obtained. Kolmogorov-Smirnov test, t test, χ2 test, and Pearson correlation test were used for statistical analysis.

Results: The mean age of the 20 boys and 27 girls with DM was 10.91 ± 3.24 years and the mean age of the 29 healthy boys and 21 girls was 11.61 ± 3.6 years (age p = 0.42; sex p = 0.09). The mean LT was thicker (p = 0.001), the mean AD was lower (p = 0.001), and the mean PD was smaller (p = 0.001) in the DM cases and all were statistically significant. There was no significant difference between the groups for AU, CCT, WTW, or K1 and K2 (p = 0.12; p = 0.83; p = 0.54; p = 0.97; p = 0.21, respectively). We also found a significant negative correlation between HbA1c levels and PD (r = -0.37 p = 0.01).

Conclusions: Juvenile DM may affect anterior segment parameters and cause thicker LT, smaller PD, and lower AD. These effects may change the refractive status and should be considered during the examination of these children.
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http://dx.doi.org/10.5301/ejo.5000764DOI Listing
November 2016

Interocular Comparison of Anterior and Posterior Segment Findings and Laterality in Hyperopic Anisometropia.

Eye Contact Lens 2018 Jan;44(1):29-34

Ophthalmology Department, Ankara Ulucanlar Eye Research Hospital, Ankara, Turkey.

Objectives: To investigate the laterality and the differences in anterior and posterior segment findings in hyperopic patients with anisometropia between their eyes using spectral domain optical coherence tomography and LenStar LS-900 device.

Methods: This prospective institutional study included hyperopic anisometropic patients with and without amblyopia, aged between 6 and 40 years. The refractive error and the values of keratometry, axial length (AL), central corneal thickness (CCT), peripapillary retinal nerve fiber layer (RNFL) thickness, and central macular thickness (CMT) obtained using the RK-F1 autorefractor, LenStar LS-900, and Spectralis optical coherence tomography were compared between the higher hyperopic and fellow eyes.

Results: Eighty of the patients had hyperopic anisometropia with amblyopia and 30 of them had hyperopic anisometropia without amblyopia. The left eyes of the patients in this series were significantly more commonly affected. Axial length and CCT were significantly different between the higher hyperopic and the fellow eyes of all patients. In addition, the mean CMT and RNFL thickness of the higher hyperopic eyes were significantly higher than that of the fellow eyes.

Conclusions: During the process of emmetropization and development of the retina, higher hyperopic eyes in hyperopic patients with anisometropia and amblyopic eyes may have blurred and abnormal vision, leading to under-development of vision, significantly higher CCT, CMT, and RNFL thickness, more hyperopic refraction, and shorter AL in the affected eye.
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http://dx.doi.org/10.1097/ICL.0000000000000296DOI Listing
January 2018

Oxidant/antioxidant balance in the aqueous humor of patients with glaucoma.

Int J Ophthalmol 2016 18;9(2):249-52. Epub 2016 Feb 18.

Department of Biochemistry, Turgut Ozal University, Ankara 06010, Turkey.

Aim: To evaluate total antioxidant status (TAS), total oxidant status (TOS), and the oxidative stress index (OSI) of the aqueous humor (AH) in patients with glaucoma.

Methods: The prospective study was composed of a study group (n=31) and a control group (n=31). Fifteen patients in the study group were diagnosed with primary open angle glaucoma (POAG), and 16 patients were diagnosed with pseudoexfoliation glaucoma (PEG). The control group was composed of non-glaucomatous patients with cataracts. AH samples were collected and analyzed for TAS, TOS, and OSI levels.

Results: Mean AH TAS level was significantly higher in patients with glaucoma than that in the control group (P<0.01). Mean TOS and OSI levels tended to increase in patients with glaucoma. No significant differences in TAS, TOS, or OSI levels were observed between patients with POAG and PEG.

Conclusion: High levels of TAS were observed in patients with glaucoma, which was likely a response to the increased oxidative stress observed in these patients.
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http://dx.doi.org/10.18240/ijo.2016.02.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761736PMC
March 2016

The early effects of intravitreal anti vascular endothelial growth factor agents on intraocular pressure and central corneal thickness.

Int Ophthalmol 2016 Oct 16;36(5):665-70. Epub 2016 Jan 16.

Ulucanlar Eye Research Hospital, Ulucanlar Caddesi No: 59, Altindag, 06240, Ankara, Turkey.

To investigate the early effects of two intravitreal (IV) anti vascular endothelial growth factor agents (anti-VEGF), bevacizumab and ranibizumab, on intraocular pressure (IOP) and central corneal thickness (CCT) within the first post-injection month. This prospective study comprised 109 eyes of 109 adult cases who had IV bevacizumab or ranibizumab injections because of age-related macular degeneration (ARMD), retinal venous occlusion (RVO), diabetic retinopathy, and macular edema or central serous chorioretinopathy (CSCR). None of the cases had medical histories of any kinds of glaucoma or increased IOP and IV injection before and all of them underwent a detailed ocular examination including measurements of IOP by non-contact tonometer and CCT by ultrasonic pachymeter pre-injection. IOP measurements were repeated at 30 min and 1st, 7th, and 30th day after the injection. CCT measurements were repeated at the 7th and 30th post-injection day. Paired sample t tests were used for the statistical analysis in order to evaluate the significance of changes in IOP and CCT. The mean age of 56 male and 53 female cases was 63.58 ± 11.04 years. Fifty-six cases (51.4 %) had diabetic retinopathy, 33 cases (30.3 %) had ARMD, 11 cases (10.1 %) had RVO, and 9 cases (8.3 %) had CSCR. Bevacizumab was used in 97 (89 %) cases and ranibizumab was used in 12 (11 %) cases. The IOP increased significantly 30 min after the injection (p < 0.001) but significant decreases were observed at the 1st, 7th, and 30th day post-injection (p < 0.001). No significant differences were observed in CCT between pre-injection and 7th and 30th post-injection day values (p = 0.924 and p = 0.589, respectively). Intravitreal bevacizumab and ranibizumab injections can cause hyper acute increase in IOP because of vitreal expansion but this effect is generally reversible in non-glaucomatous cases.
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http://dx.doi.org/10.1007/s10792-016-0171-1DOI Listing
October 2016

Are There Any Changes in Corneal Biomechanics and Central Corneal Thickness in Fuchs' Uveitis?

Ocul Immunol Inflamm 2016 Oct 23;24(5):561-7. Epub 2015 Sep 23.

a Ulucanlar Eye Education and Research Hospital , Ankara , Turkey .

Purpose: To compare corneal biomechanics, intraocular pressure (IOP) and central corneal thickness (CCT) of 38 patients with unilateral Fuchs' uveitis (FU) with 42 healthy controls.

Methods: Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated and corneal-compensated IOP (IOPg and IOPcc, respectively) and CCT were measured.

Results: The mean CH, CRF, and IOPg of the involved FU eyes were significantly lower (9.5 ± 1.6, 9.0 ± 1.9 and 13.1 ± 4.3 mmHg) than contralateral eyes (10.1 ± 1.7, 9.9 ± 1.7 and 14.6 ± 3.4 mmHg), and controls (10.5 ± 1.5, 10.3 ± 1.5 and 14.8 ± 2.5 mmHg), respectively. There was no significant difference for mean IOPcc between involved FU or contralateral eyes and controls (14.8 ± 4.1, 15.5 ± 3.4 and 15.0 ± 2.7 mmHg). The CCT values correlated with CH and CRF in the involved and contralateral eyes.

Conclusions: Involved FU eyes had lower CH, CRF, and IOPg than contralateral eyes and controls, with no difference regarding IOPcc.
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http://dx.doi.org/10.3109/09273948.2015.1037459DOI Listing
October 2016

Comparing acromegalic patients to healthy controls with respect to intraocular pressure, central corneal thickness, and optic disc topography findings.

Indian J Ophthalmol 2014 Aug;62(8):841-5

Department of Glaucoma, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey.

Aims: The aim was to compare the intraocular pressure (IOP), central corneal thickness (CCT), and optic disc topography findings of biochemically controlled acromegalic patients and the control group and to evaluate the effect of the duration of acromegaly and serum growth hormone and insulin-like growth factor-1 (IGF-1) levels on these ocular parameters.

Materials And Methods: IOP measurement with Goldmann applanation tonometry, CCT measurement with ultrasonic pachymetry, and topographic analysis with Heidelberg retinal tomograph III were performed on 35 biochemically controlled acromegalic patients and 36 age- and gender-matched controls.

Results: Mean IOP and CCT were 14.7 ± 2.9 mmHg and 559.5 ± 44.9 μm in the acromegaly patients and 13.0 ± 1.6 mmHg and 547.1 ± 26.7 μm in controls (P = 0.006 and P = 0.15, respectively). A significant moderate correlation was found between the duration of acromegaly and CCT (r = 0.391) and IOP (r = 0.367). Mean retinal nerve fiber layer (RNFL) thickness was significantly lower in the acromegalic patients (0.25 ± 0.05 mm) as compared to controls (0.31 ± 0.09 mm) (P = 0.01). A significant moderate correlation was detected between IGF-1 level and disc area (r = 0.362), cup area (r = 0.389) and cup volume (r = 0.491).

Conclusion: Biochemically controlled acromegalic patients showed significantly higher CCT and IOP levels and lower RNFL thickness compared to healthy controls and the duration of disease was correlated with CCT and IOP levels.
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http://dx.doi.org/10.4103/0301-4738.141035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4185160PMC
August 2014