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    Accelerated corneal collagen cross-linking for progressive keratoconus
    (Taylor & Francis Ltd, 2014) Cinar, Yasin; Cingu, Abdullah Kursat; Turkcu, Fatih Mehmet; Yuksel, Harun; Sahin, Alparslan; Yildirim, Adnan; Caca, Ihsan
    Purpose: To evaluate the efficacy of accelerated corneal cross-linking (CXL) procedure for progressive keratoconus. Materials and methods: Twenty-three eyes of 23 patients undergone accelerated CXL procedure were evaluated preoperatively and postoperatively at 1st, 3rd and 6th month for uncorrected distant visual acuity (UDVA), best corrected distant visual acuity (CDVA), spherical error, cylindrical error, spherical equivalent (SE), keratometric values and thinnest corneal thickness (TCT) values with corneal topography by Scheimpflug camera and endothelial cell density (ECD). Results: The mean UDVA was improved from 0.97 +/- 0.41 logarithm of minimal angle of resolution (logMAR) to 0.76 +/- 0.45 logMAR at the 6th month after CXL (p = 0.332). The mean CDVA was improved from 0.49 +/- 0.30 logMAR to 0.34 +/- 0.22 logMAR at the 6th month after CXL (p = 0.026). The mean sphere was decreased from -4.47 +/- 4.1 diopter (D) to -3.79 +/- 3.86 D and the mean cylinder was decreased from -5.60 +/- 2.2D to -4.55 +/- 1.98 D and the mean SE was decreased from -7.22 +/- 4.48 D to -6.36 +/- 4.34 D at the 6th month after CXL (p = 0.128, p = 0.002 and p = 0.045, respectively). Flat keratometry, steep keratometry, mean keratometry and maximum keratometry were significantly reduced at the 6th month after CXL (p = 0.025, p < 0.001, p = 0.004 and p = 0.03, respectively). TCT and ECD were not changed significantly the 6th month after CXL (p = 0.135 and p = 0.082, respectively). Conclusion: Accelerated CXL procedure was effective to stabilize progression of keratoconus with significant reduction in topographic keratometric values and significant increase in CDVA in 6 months.
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    Amblyopia and Refractive Errors Among School-Aged Children With Low Socioeconomic Status in Southeastern Turkey
    (Slack Inc, 2013) Caca, Ihsan; Cingu, Abdullah Kursat; Sahin, Alparslan; Ari, Seyhmus; Dursun, Mehmet Emin; Dag, Umut; Balsak, Selahattin
    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. [J Pediatr Ophthalmol Strabismus 2013;50:37-43.]
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    Apert's Syndrome: Ophthalmic Importance and Clinical Findings
    (Amer Soc Contemporary Medicine Surgery & Ophthalmology, 2009) Caca, Ihsan; Caca, Fatma Nur; Sakalar, Yildirim Bayezit; Erdem, Seyfettin; Alakus, Fuat; Ciftci, Suleyman; Dogan, Eyuep
    Apert's syndrome is a rare form of craniosynostosis that exhibits with many ocular manifestations. We present two cases of Apert's syndrome. Our first case is a 10-year-old girl admitted with exotropia, V pattern and proptosis on examination. Investigations revealed coronal craniosynostosis, cleft palate, vaginal atresia and syndactyly of the hands and feet. The second case is a 5-year-old boy presented with hypertelorism, exotropia, dissociated vertical deviation and proptosis. Investigations revealed coronal craniosynostosis, bifid uvula and syndactyly of the hands and feet
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    Approach of Turkish ophthalmologists to micronutrition in age-related macular degeneration
    (Consel Brasil Oftalmologia, 2015) Sahin, Muhammed; Yuksel, Harun; Sahin, Alparslan; Cingu, Abdullah Kursat; Turkcu, Fatih Mehmet; Ozkurt, Zeynep Gursel; Caca, Ihsan
    Purpose: To evaluate the knowledge and behaviors of ophthalmologists in Turkey concerning micronutrition support in patients with age related macular degeneration (ARMD). Methods: This study involved 1,845 ophthalmologists. A scientific poll was sent to all participants by email. The survey covered the following: demographic features, subspecialty knowledge about micronutrition preference for prescribing micronutrition to age related macular degeneration patients, and the reason for this preference. If a participant indicated that he or she prescribed micronutrition, the participant was also asked to indicate the source of the treatment and supplemental treatments. Results: Of 1,845 ophthalmologists, 249 responded to the survey. Of the respondents, 9% (22) never, 43% (107) sometimes, 37% (92) frequently, and 11% (27) always used micronutrition. The most frequent prescribing subgroup was general ophthalmology (22%), followed by the retina-uvea subspecialty (13.9%). The micronutrition prescribing ratio was 54.8% in retina-uvea specialists when the frequent and always responses were combined. There was no statistically significant difference between subgroups with respect to prescribing micronutrition. Among the ophthalmologists prescribing micronutrition, 57.1% of them did not use the Age-Related Eye Disease Study-1 (AREDS) criteria, and only 31.3% prescribe micronutrition according to AREDS criteria. The results for the general ophthalmologist and retina-uvea specialist subgroups were similar, 56.3% vs 20.2%, and 54.1% vs 36.1%, respectively. Micronutrition was not recommended for the following reasons: expensive (55.4%), low patient expectancy (40%), no effect (30%), and low patient drug compliance (25.4%). Moreover, 55.2% of the clinicians recommended physical activities, dietary changes, and smoking cessation; 7.3% did not recommend these behavioral changes. Conclusion: This survey demonstrated that micronutrition preference in age related macular degeneration was low in ophthalmologists in Turkey. Additionally, retina specialists have a lower rate of prescribing micronutrition. Micronutrition support and behavior such as smoking cessation, dietary changes, etc. should be recommended more often to patients with age related macular degeneration.
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    Associations between red reflex abnormality, consanguinity and intensive care hospitalization of newborns in Turkey
    (Who Eastern Mediterranean Regional Office, 2018) Ozkurt, Zeynep; Balsak, Selahattin; Tildirim, Yusuf; Yuksel, Harun; Caca, Ihsan
    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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    Bee sting of the cornea -: A case study and review of the literature
    (Amer Soc Contemporary Medicine Surgery & Ophthalmology, 2006) Caca, Ihsan; Ari, Seyhmus; Uenlue, Kaan; Ayata, Ali
    Bee stings of the cornea are rarely reported, but have the potential for causing serious ophthalmological injuries. We present a case of corneal bee sting with retained stinger apparatus. A 35-year-old patient presented with an acute, corneal bee sting of the right eye 12 hours after he was stung. The patient suffered from pain, blurred vision, and epiphora. The right eye showed edema of the upper and lower eyelid, conjunctival hyperemia, chemosis, and striate keratitis of the paracentral cornea by biomicroscopic examination. The stinger was identified in the depth of the corneal infiltration. Visual acuity was 5/10. It was removed surgically. After 2 months, the eye only showed a minimal residual corneal opacification. Visual acuity was 10/10. We present a case of bee sting to the cornea with retained stinger apparatus and treatment of this unusual presentation.
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    Bilateral Cataract Extraction With Posterior Chamber Intraocular Lens Implantation Simultaneous in Pediatric Cataracts
    (Amer Soc Contemporary Medicine Surgery & Ophthalmology, 2008) Caca, Ihsan; Sakalar, Yildirim Bayezit; Ari, Seyhmus; Alakus, Fuat; Dogan, Eyuep
    We evaluated the results of simultaneous bilateral cataract extraction with intraocular lens (IOL) inplantation 32 pediatric cataract patients. Simultaneous cataract extraction and posterior capsulotomy with anterior vitrectomy and IOL implantation is an effective and safe procedure in bilateral pediatric cataracts treatment.
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    Bilateral complete optic atrophy and hemorrhagic infarction of the putamen caused by methanol intoxication
    (Humana Press Inc, 2007) Ari, Seyhmus; Caca, Ihsan; Kayabasi, Hasan
    Methanol is a potent toxic substance for the optic nerves. Even small amounts of ingested methanol can acute permanent neurological dysfunction and irreversible blindness. Methanol intoxication can cause severe visual dysfunction and death. We present a case of a 25 years old admitted to our clinic with bilateral optical atrophy after drinking eau de cologne.
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    Bilateral Optic Disc Drusen Mimicking Papilledema
    (Korean Neurological Assoc, 2012) Sahin, Alparslan; Cingu, Abdullah Kursat; Ari, Seyhmus; Cinar, Yasin; Caca, Ihsan
    Background Optic disc drusen, which are calcified deposits that form anterior to the lamina cribrosa in the optic nerve, may mimic papilledema. Case Report We report herein three cases referred to us with suspicion of disc swelling and papilledema. Following ophthalmologic evaluation with B-scan ultrasound, red-free fundus photography, and computed tomography, the diagnosis of papilledema was excluded in all cases and optic disc drusen was diagnosed. Conclusions Clinical suspicion of optic disc drusen in cases presenting with swelling of the optic nerve head is important in order to avoid unnecessary interventions and anxiety. The reported cases highlight the commonly encountered clinical presentations and the practical aspects of diagnosis and management of optic disc drusen. J Clin Neurol 2012;8:151-154
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    Central Retinal Vein Occlusion Associated with Hyperhomocysteinemia in a Patient with Heterozygous for the Methylenetetrahydrofolate Reductase C677T Mutation: Case Report
    (Ortadogu Ad Pres & Publ Co, 2012) Sakalar, Y. Bayezit; Keklikci, Ugur; Unlu, Kaan; Caca, Ihsan; Alakus, Mehmet Fuat
    A 19-year-old male patient presented with blurring of vision in his left eye. Central retinal vein occlusion was detected on ophthalmic examination. Clinical examination and laboratory analysis were performed for risk factors predisposing him to retinal vein occlusion. His plasma homocysteine concentration was 14.30 U/mL. No other abnormalities were found in other hematologic tests. C677T heterozygous mutation in the methylenetetrahydrofolate reductase (MTHFR) gene was detected by real-time polymerase chain reaction. A heterozygous mutation was detected in the same gene in the patient's mother, father and one of his sisters, also a homozygous mutation was detected in the other sister. Retinal vein occlusion in young patients may be related to mild hyperhomocysteinemia and a C677T mutation in the MTHFR gene.
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    Central serous chorioretinopathy due to tadalafil use
    (Springer, 2013) Turkcu, Fatih Mehmet; Yuksel, Harun; Sahin, Alparslan; Murat, Mehmet; Bozkurt, Yasar; Caca, Ihsan
    Phosphodiesterase-5 (PDE5) inhibitors are commonly used in the treatment of erectile dysfunction. There are a small number of case reports that associate this agent with central serous chorioretinopathy (CSCR). Our report presents the treatment approach to a 42-year-old patient who described blurred vision and metamorphopsia and was diagnosed with CSCR following the use of tadalafil, a PDE5 inhibitor.
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    Comparison of accelerated and conventional corneal collagen cross-linking for progressive keratoconus
    (Taylor & Francis Ltd, 2014) Cinar, Yasin; Cingu, Abdullah Kursat; Turkcu, Fatih Mehmet; Cinar, Tuba; Yuksel, Harun; Ozkurt, Zeynep Gursel; Caca, Ihsan
    Purpose: To compare outcomes of accelerated and conventional corneal cross-linking (CXL) for progressive keratoconus (KC). Materials and methods: Patients were divided into two groups as the accelerated CXL group and the conventional CXL group. The uncorrected distant visual acuity (UDVA), corrected distant visual acuity (CDVA), refraction and keratometric values were measured preoperatively and postoperatively. The data of the two groups were compared statistically. Results: The mean UDVA and CDVA were better at the six month postoperative when compared with preoperative values in two groups. While change in UDVA and CDVA was statistically significant in the accelerated CXL group (p = 0.035 and p = 0.047, respectively), it did not reach statistical significance in the conventional CXL group (p = 0.184 and p = 0.113, respectively). The decrease in the mean corneal power (K-m) and maximum keratometric value (K-max) were statistically significant in both groups (p = 0.012 and 0.046, respectively in the accelerated CXL group, p = 0.012 and 0.041, respectively, in the conventional CXL group). There was no statistically significant difference in visual and refractive results between the two groups (p > 0.05). Conclusions: Refractive and visual results of the accelerated CXL method and the conventional CXL method for the treatment of KC in short time period were similar. The accelerated CXL method faster and provide high throughput of the patients.
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    A comparison of latanoprost monotherapy with a combination therapy of timolol/dorzolamide in patients with primary open-angle glaucoma
    (Amer Soc Contemporary Medicine Surgery & Ophthalmology, 2006) Caca, Ihsan; Simsek, Hueseyin; Uenlue, Kaan; Ari, Seyhmus; Keklikci, Ugur
    We compared latanoprost monotherapy therapy with timolol/dorzolamide in patients with primary open-angle glaucoma to evaluate the effects on intraocular pressure (IOP) and occurrence of adverse events. IOP and topical side, effects were evaluated at the begining, first, and third months. Mean IOP was decreased at the third month. The most common side effect was hyperemia (43.6%). We Concluded that latanoprost reduces IOP better than fixed combination and its topical side effects are tolerable.
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    Comparison of Mitomycin C and Limbal-Conjunctival Autograft in the Prevention of Pterygial Recurrence in Turkish Patients: A One-Year, Randomized, Assessor-Masked, Controlled Trial
    (Elsevier, 2009) Ari, Seyhmus; Caca, Ihsan; Yildiz, Zennure Oezdemir; Sakalar, Yildirim Bayezit; Dogan, Eyuep
    BACKGROUND: A pterygium is a fibrovascular overgrowth of degenerative bulbar conjunctival tissue that grows over the limbus onto the cornea. Although various approaches have been proposed for the treatment of pterygium, the common problem after these treatments is recurrence. OBJECTIVES: The goals of this study were to compare the efficacy of mitomycin C (MMC) and limbal-conjunctival autograft (LCAU) in preventing recurrence of primary pterygia and to monitor long-term adverse effects (AEs). METHODS: Patients undergoing pterygium surgery between February 2006 and May 2007 were assessed prospectively and randomly divided into 2 groups using a random number table. The MMC group underwent pterygium excision and received 0.02%, MMC intraoperatively for 2 minutes. The LCAU group under-went pterygium excision and LCAU. Recurrence and AE rates of the 2 treatments were compared during the 1-year follow-up period. Assessors for pterygial recurrence were masked to treatment group. RESULTS: One hundred thirteen eyes (57 patients in the MMC group and 56 patients in the LCAU group) were included in the study. Thirteen of the patients (7 in the MMC group and 6 in the LCAU group) were withdrawn due to irregular attendance at follow-up visits or lack of sufficient dose and duration for postoperative topical antibiotic and steroid administration; their data were excluded from analysis. Fifty patients (MMC group: 26 men, 24 women; mean [SD] age, 48.0 [12.3] years; age range, 30-73 years; LCAU group: 27 men, 23 women; mean age, 49.0 [12.6] years; age range, 28-71 years) in each group completed the study. The mean (SD) length of the pterygium across the limbus was similar in the MMC group and the LCAU group (4.18 [1.27] vs 4.07 [1.24] mm). The mean follow-up period was also similar in the 2 groups (16.0 [1.9] vs 15.0 [1.7] months). The rate of recurrence was significantly greater in the MMC group than in the LCAU group (10 [20.0%] vs 2 [4.0%] patients; P = 0.035). Seven patients (14.0%) In the MMC group experienced AEs: conjunctival cyst (3 patients), symblepharon (2), conjunctival granuloma (1), and dellen (1). In the LCAU group, 1 patient (2.0%; P = 0.032 vs MMC group) experienced permanent graft edema. All patients in the LCAU group experienced transient graft edema, with recovery occurring in 3 to 4 weeks. There were no intraoperative complications and there was no graft rejection. CONCLUSIONS: Recurrence and postoperative AEs were less frequently observed in primary excision with LCAU than with MMC in these Turkish patients who completed the study. This study found that pterygium excision with LCAU was well tolerated and effective in these patients. (Curr Ther Res Clin Exp. 2009;70:274-281) (C) 2009 Excerpta Medica Inc.
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    Comparison of Vertical C/D Ratio Obtained by Assistant of Ophthalmology with Results of Optical Cohorence Tomography
    (Turkish Ophthalmological Soc, 2008) Sakalar, Yildirim Bayezit; Unlu, Kaan; Keklikci, Selahattin Ugur; Caca, Ihsan; Ari, Seyhmus; Balsak, Selahattin; Akkus, Zeki
    Purpose: To compare vertical C/D ratio that measured with ophthalmoscopic examination of second, third and fourth year assistant of ophthalmology with vertical C/D ratio obtained by optical cohorence tomography. Materials and Methods: One hundred and ten eyes of 72 glaucoma patients which are followed in glaucoma unit were included to study. Each assistant examined vertical C/D ratio by Goldman tree mirror lens and results were recorded independently from results of the other assistants. The measurements of vertical C/D ratio were obtained by optic nerve head analyses of Stratus Optical Cohorence Tomography after pupillary dilatation and vertical C/D ratio were enlisted. All measurements of vertical C/D ratio were compared each other. Results: Thirty patients were male and 42 patients were female, mean age was 51.43 +/- 19.2. Mean vertical C/D ratio measured by second year asisstant was 0.556 +/- 0.246, mean vertical C/D ratio measured by third year assistant was 0.534 +/- 0.251, mean vertical C/D ratio measured by fourth year assistant was 0.529 +/- 0.250. Mean vertical C/D ratio obtained by optical cohorence tomography was 0.651 +/- 0.223. There was no statistically signicant differences among vertical C/D ratio measured by assistants (p>0.05). The mean vertical C/D ratio that measured by each assistant was statistically lower than obtained by optical cohorence tomography (p<0.05). Conclusions: The vertical C/D ratio that measured with ophthalmoscopic examination by assistant of ophthalmology will be different from vertical C/D ratio obtained by optic nerve head analyses of optical cohorence tomography.
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    Congenital Bilateral Upper Eyelid Eversion: Report of a Case
    (Informa Healthcare, 2014) Cingu, Abdullah Kursat; Sahin, Alparslan; Yuksel, Harun; Ozkok, Ahmet; Ari, Seyhmus; Caca, Ihsan
    Congenital bilateral upper eyelid eversion is a rare condition and the definite cause is not known. It is often seen in Black babies or babies with Down's syndrome. With early diagnosis and appropriate treatment, the condition can be managed without surgery. We report a case of congenital upper eyelid eversion in an otherwise healthy Caucasian neonate, born by normal vaginal delivery. The case responded well to conservative treatment, including eyelid repositioning, lubricants, antibiotic ointment, and eyelid patching.
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    Congenital isolate and total optic disc coloboma -: Case report and review of the literature
    (Humana Press Inc, 2007) Ari, Seyhmus; Keklikci, Ugur; Caca, Ihsan; Unlu, Kaan; Alakus, Fuat
    Isolated and total optic disc coloboma is a markedly rare congenital anomaly of the eye. Congenital eye colobomas frequently present with eye anomalies and systemic signal findings. We present a case of isolated total optic disc coloboma without systemic involvement, which has been rarely reported in the literature.
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    Corneal perforation during Nd:YAG laser capsulotomy: a case report
    (Springer, 2013) Turkcu, Fatih Mehmet; Yuksel, Harun; Cingu, Kursat; Cinar, Yasin; Murat, Mehmet; Caca, Ihsan
    We report a case where corneal perforation developed during Nd:YAG laser capsulotomy. We present a 20-year-old male with the complaint of impaired vision in the right eye. Leukoma consistent with the incision line in the cornea and opacity in the posterior capsule were observed.
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    Cutaneous Anthrax of the Eyelid
    (Iranian Soc Ophthalmology, 2010) Sahin, Alparslan; Caca, Ihsan; Ece, Aydin; Ari, Seyhmus; Sen, Velat
    Purpose: Cutaneous anthrax of the eyelid is a rare condition in clinical practice, but should be considered in the differential diagnosis of preseptal and orbital cellulitis. Here we report a case of palpebral anthrax. Case report: A 5-year-old girl with anthrax infection of the right upper eyelid is presented. Her eyelid showed an edematous, necrotic, and partially bullous lesion. Following complete healing of the eyelid lesion, mild cicatricial ectropion resulted. Conclusion: Anthrax is a rare disease that is not well known by ophthalmologists. Clinicians should be aware of the complications and the management of palpebral anthrax.
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    Cutaneous Palpebral Anthrax: Case Report
    (Ortadogu Ad Pres & Publ Co, 2012) Ari, Seyhmus; Sakin, Feyyat; Sahin, Alparslan; Caca, Ihsan
    Anthrax is an infectious disease caused by Bacillus anthracis. Cutaneous, respiratory and gastrointestinal involvements can be seen. The face and eyelids are the most commonly involved areas in cutaneous anthrax. If eyelid anthrax is not promptly treated, it may cause severe deformities of eyelids including cicatrization and ectropion. In this study, a 38-year-old male presenting with right eye palpebral cutaneous anthrax was reported. There was periorbital edema and a black eschar on right eyelid leading to closed eye. Gram-positive rods were seen in the microscopic examination of scrapings taken from the lesion. The patient received high dose intravenous penicillin G (16 million units/day) for 10 days. The lesion healed within 10 days, leaving no clinical evidence of any eyelid deformity. No eyelid deformity was observed during one-year follow-up period. Observing this case suggested that early diagnosis and treatment can prevent development of potential antrhax eyelid complications.