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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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    Autonomic dysfunction detection by an automatic pupillometer as a non?invasive test in patients recovered from COVID?19
    (Springer, 2021) Karahan, Mine; Demirtaş, Atılım Armağan; Hazar, Leyla; Erdem, Seyfettin; Ava, Sedat; Dursun, Mehmet Emin; Keklikçi, Uğur
    Purpose To recognize dysfunctions in the autonomic nervous system (ANS) with changes in dynamic and static pupillary responses in patients who recovered from coronavirus disease-2019 (COVID-19) Methods One month after recovery from COVID-19, patients were subjected to eye examinations. Pupillary responses were measured using a pupillometry system. Dynamic pupil parameters (i.e., pupil contraction amplitude, pupil dilatation latency, pupil contraction latency, pupil dilatation duration, pupil dilatation velocity, pupil contraction duration, pupil contraction velocity, resting pupil diameter [PD]) and static pupil parameters (i.e., mesopic PD, scotopic PD, high photopic PD, and low photopic PD) were registered. Results Although high photopic and scotopic PDs were significantly higher in patients recovering from COVID-19 than in healthy controls (P = 0.04 and P = 0.002), no statistically significant difference was found in mesopic and low photopic PD (P = 0.19 and P = 0.41). Regarding dynamic pupillometry parameters, resting PD and pupil contraction velocity (P = 0.04 and P = 0.02, respectively) were significantly higher in patients recovering from COVID-19 than in healthy controls (P < 0.001 and P < 0.001, respectively), whereas pupil dilatation latency and pupil contraction duration were lower in these patients than in healthy controls (P = 0.01 and P = 0.008, respectively). No significant differences in pupil contraction amplitude, pupil dilatation duration, pupil contraction latency, and pupil dilatation velocity were found between the study groups (P = 0.93, P = 0.91, P = 0.42, and P = 0.48, respectively). Conclusion Pupil responses, which are controlled by the ANS, were impaired in patients recovering from COVID-19. Pupillometry shows promise as a non-invasive, easy-to-apply diagnostic technology for detecting autonomic dysfunction in patients recovering from COVID-19.
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    Bilateral central retinal artery occlusion secondary to SARS-CoV-2 infection in the early and late periods: A case report
    (Georg Thieme Verlag KG, 2021) Karahan, Mine; Erdem, Seyfettin; Hazar, Leyla; Dursun, Mehmet Emin; Ava, Sedat; Emek, Hüseyin; Keklikçi, Uğur
    The causative agent of coronavirus disease (COVID-19) is a new virus termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from the coronavirus family. It was first detected in China in December 2019 and spread rapidly around the world. COVID-19 is highly contagious and mainly transmitted through contact with infected patients or droplets. The most common symptoms are fever, cough, weakness, muscle pain, and shortness of breath [1]. SARS-CoV-2 infects host cells through the renin angiotensin-converting enzyme 2 (ACE2) receptors. The ACE2 receptor is widely expressed in many organs, including the retina, and plays a role in the pathogenesis of systemic vascular diseases, which can lead to ocular symptoms such as diabetic and hypertensive retinopathy [2], [3]. SARS-COV-2 has been reported to be associated with neurological symptoms, including stroke, thromboembolism (e.g., pulmonary embolism), and myocardial infarction. Hypercoagulation associated with COVID-19 has been described as “sepsis-induced coagulopathy” and may predispose patients to the spectrum of thromboembolic events [4], [5], [6]. We present here the first case of bilateral central retinal artery occlusion (CRAO) that developed in the early and late stages secondary to the SARS-CoV-2 infection.
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    Brimonidine-timolol versus brinzolamide-timolol for treatment of elevated intraocular pressure after phacoemulsification surgery
    (Springer, 2018) Balsak, Selahattin; Kaydu, Ayhan; Erdem, Seyfettin; Alakus, M. Fuat; Ozkurt, Zeynep Gursel
    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. 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. 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). 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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    Can dynamic and static pupillary responses be used as an indicator of autonomic dysfunction in patients with obstructive sleep apnea syndrome?
    (Springer, 2021) Erdem, Seyfettin; Yılmaz, Süreyya; Karahan, Mine; Dursun, Mehmet Emin; Ava, Sedat; Alakuş, Mehmet Fuat; Keklikçi, Uğur
    Purpose We aimed to reveal whether static and dynamic pupillary responses can be used for the detection of autonomic nervous system (ANS) dysfunction in patients with obstructive sleep apnea syndrome (OSAS). Methods We included in this study patients with OSAS, who were divided into three groups according to the apnea-hypopnea index (AHI) (group 1, mild [n = 20]; group 2, moderate [n = 20]; and group 3, severe [n = 20]), and healthy controls (group 4, n = 20). Pupillary responses were measured using a pupillometry system. Results Static (mesopic PD, P = 0.0019; low photopic PD, P = 0.001) and dynamic pupil responses (resting diameter, P = 0.004; amplitude of pupil contraction, P < 0.001; duration of pupil contraction, P = 0.022; velocity of pupil contraction, P = 0.001; and velocity of pupil dilation, P = 0.012) were affected in patients with different OSAS severities. Also, AHI was negatively correlated with mesopic PD (P = 0.008), low photopic PD (P = 0.003), resting diameter (P = 0.001), amplitude of pupil contraction (P < 0.001), duration of pupil contraction (P = 0.011), velocity of pupil contraction (P < 0.001), and velocity of pupil dilation (P = 0.001). Conclusion We detected pupil responses innervated by the ANS were affected in the OSAS patients. This effect was more significant in the severe OSAS patients. Therefore, the pupillometry system can be an easily applicable, noninvasive method to detect ANS dysfunction in the OSA patients.
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    Crystalline gene mutations in Turkish children with congenital cataracts
    (Springer, 2021) Karahan, Mine; Demirtaş, Atılım Armağan; Erdem, Seyfettin; Ava, Sedat; Tekeş, Selahattin; Keklikçi, Uğur
    Purpose To detect crystallin gene mutations in Turkish children with congenital cataracts. Methods The present study included 56 children (38 males and 18 females) who were diagnosed with congenital cataract in our ophthalmology clinic. The patients' blood samples were collected and sent to the medical genetics laboratory. The samples were assessed using the sequence analysis method, which covered all exons of CRYAA, CRYAB, CRYBB1, CRYBB2, CRYBB3, CRYGC and CRYGD. Results In total, 56 patients with congenital cataracts were included in the present study. Of these, 68% were male and 32% were female. The age range of the patients was 2 months to 5 years. The mean age of onset was 21.08 +/- 15.15 months. All the patients had bilateral congenital cataracts. The female-to-male ratio was 1:2.1. Mutation analysis was performed to detect possible mutations in CRYAA, CRYAB, CRYBB1, CRYBB2, CRYBB3, CRYGC and CRYGD. Of the four mutations detected, one was novel (c.383A > T in CRYGD) and three were known (c.592C > T in CRYBB2, c.164A > G in CRYGC and c.592C > T in CRYBB2). Two of these three mutations were detected in the same gene (CRYBB2). Crystallin gene mutations were detected in 7% of patients with congenital cataracts (four out of 56 patients) in the present study. Conclusions We think that mutations in crystallin genes are responsible for 7% of congenital cataract cases in our country. The detection of these mutations may help in the molecular diagnosis of congenital cataracts.
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    Diabetic retinopathy knowledge and management approaches of primary care physicians
    (İnönü Üniversitesi Tıp Fakültesi, 2020) Erdem, Seyfettin
    Aim: We evaluated the level of knowledge on diabetic retinopathy (DR) and management approaches of primary care physicians with important roles in preventive health services. Material and Methods: Using a Google form, a 14-item questionnaire was prepared to the family physicians’ knowledge about DR and the examination tools they use and their management approach. This questionnaire was sent to 92 family physicians in Turkey via the What’s App Messenger. Results: According to the questionnaire responses, 90 (97.8%) of the family physician centers had a Snellen chart and 91 (98.9%) a direct ophthalmoscope. Among the physicians, 79 (85.9%) did not perform visual acuity examinations for diabetic patients, and 39 (42.4%) did not use an ophthalmoscope. While 34 (37.0%) of the surveyed physicians did not refer diabetic patients to an ophthalmologist for DR examinations at all, only 22 (23.9%) referred patients to an ophthalmologist at the time of initial diagnosis and 19 (20.7%) referred patients at 1 year after the initial diagnosis. 10 (10.8%) of the surveyed physicians referred patients to an ophthalmologist at 2-year intervals, 4 (4.3%) at 6-month intervals, and three (3.3%) at over 2-year intervals. Among the physicians, 64 (69.6%), 57 (62.0%), and 63 (68.5%) were not familiar with the stages of DR, fundus fluorescein angiography, and laser treatment for DR, and 60 (65.2%) did not know how to perform intraocular injection treatment methods. A total of 87 (94.6%) physicians stated a need for training programs in DR. Conclusion: DR, an eye complication of diabetes mellitus, is not well understood by family physicians, and more than half of physicians referred their patients to an ophthalmologist either late after diagnosis or not at all. It is therefore important for family physicians to undergo training programs on DR to increase their effectiveness in primary health care services.
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    Diurnal changes in accommodation amplitude and anterior segment parameters during ramadan fasting
    (Harran Üniversitesi Tıp Fakültesi, 2021) Demirtaş, Atılım Armağan; Karahan, Mine; Erdem, Seyfettin
    Background: The purpose of this research was to investigate the diurnal effect of Ramadan fasting on the amplitude of accommodation and anterior segment parameters in visually healthy participants. Materials and Methods: The study included 68 healthy individuals, aged 26–42 years. The subjective accommodation amplitude was measured using the "minus lens" technique. Corneal refraction (K1, K2, and Kmax), central corneal thickness, corneal volume, anterior chamber volume, and anterior chamber depth parameters were evaluated using the Scheimpflug camera system. Participants were evaluated twice, at 08:00 and 16:00, while fasting during Ramadan. Data were analyzed by paired sample t-test. Results: The mean age of the participants, of which 28 were women and 40 were men, was 34.38±4.93 (range: 26–42). Comparison of measurements taken at 08:00 and 16:00 during fasting showed that at 16:00, the K1 values (08:00: 42.81±1.51 diopter and 16:00: 42.85±1.50 diopter, P = 0.016) and Kmax values (08:00: 44.29 ± 1.73 diopter and 16:00: 44.38±1.78 diopter, P = 0.020) were significantly steeper. When data collected at 08.00 and 16.00 were compared, there were no significant differences in diurnal changes: amplitude of accommodation (08:00: 7.39±1.40 diopter and 16:00: 7.37±1.40 diopter, P = 0.783), central corneal thickness (08:00: 535.60 ± 30.43 µm and 16:00: 535.25±30.66 µm, P = 0.694), corneal volume (08:00: 59.72±3.85 mm3 and 16:00: 59.60±3.98 mm3, P= 0.344), anterior chamber volume (08.00: 170.91±30.77 mm3 and 16.00: 171.22±32.61 mm3, P = 0.808) and anterior chamber depth (08:00: 2.91 ± 0.28 mm and 16:00: 2.92 ± 0.29 mm, P = 0.053). Conclusions: The results showed that dehydration due to fasting affects some anterior segment parameters, such as corneal refraction; however, it does not affect the diurnal changes of amplitude of accommodation, corneal pachymetry, or anterior chamber anatomy.
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    Effect of fasting on diurnal fluctuation of parafoveal and peripapillary vessel density and related oculodynamic and haemodynamic parameters
    (Elsevier, 2021) Demirtaş, Atılım Armağan; Karahan, Mine; Erdem, Seyfettin; Han, Çağla Çilem; Keklikçi, Uğur
    Purpose: To investigate the effects of Ramadan fasting on diurnal superficial-deep parafoveal vessel density (pfVD) and nerve head (NH)-radial peripapillary capillary (RPC) peripapillary vessel density (ppVD) using optical coherence tomography angiography (OCTA), as well as other related oculodynamic and haemodynamic parameters, and to compare these findings with those in the nonfasting period in healthy individuals. Methods: A total of 105 healthy individuals, 42 women and 63 men, were included in this prospective study. OCTA was used to examine the superficial-deep pfVD and NH-RPC ppVD. In the third week of Ramadan, OCTA readings were obtained twice daily at 08:00 and 16:00 hour (h) under fasting conditions and compared with nonfasting values 2 weeks after Ramadan. Both intraocular pressure (IOP) and blood pressure values were assessed accordingly. Results: The mean age (23-51) of individuals was 34.37 +/- 7.04 years. In comparison with the 08:00-h values, the 16:00-h IOPs, superficial-deep pfVDs and RPC ppVDs were substantially reduced both during the fasting and nonfasting periods (P = 0.001, P = 0.009, P = 0.006, P = 0.006, P = 0.004, P = 0.004, P = 0.41, P = 0.032 and P = 0.021). No differences were found in the diurnal change of superficial-deep pfVDs, NH-RPC ppVDs, IOPs and mean ocular perfusion pressures (MOPPs) between the fasting and nonfasting periods, whereas the same was not true for mean arterial blood pressures (MABPs) (P = 0.049). Conclusions: The parafoveal and peripapillary VDs (except for NHpp-VD) and IOPs were found to have decreased significantly throughout the day both in fasting and nonfasting periods. Our study confirms the diurnal changes in the IOPs, MOPPs, superficial-deep pfVDs and NH-RPC ppVDs under dehydration and normal terms.
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    The effectiveness of automatic pupillometry as a screening method to detect diabetic autonomic neuropathy
    (Springer, 2020) Erdem, Seyfettin; Karahan, Mine; Ava, Sedat; Pekkolay, Zafer; Demirtas, Atilim Armagan; Keklikci, Ugur
    Purpose This study aimed to compare static and dynamic pupil responses of diabetic patients with and without nonproliferative diabetic retinopathy (DR) and normal healthy individuals under different lighting conditions via quantitative automated pupillometry. Methods Forty patients with DM with nonproliferative DR (group 1), 40 patients with DM without DR (group 2), and 40 healthy controls (group 3) underwent a complete ophthalmologic examination. Static pupillometry [scotopic pupil diameter (PD), mesopic PD, low photopic PD, and high photopic PD] and dynamic pupillometry (resting PD, contraction amplitude, latency, duration, velocity of contraction, dilatation latency, and duration and velocity at rest) were measured via automatic quantitative pupillometry. Results Analysis of variance revealed that scotopic PD [F(2, 117) = 6.42;p = 0.02], mesopic PD [F(2, 117) = 3.20;p = 0.04], and low photopic PD [F(2, 117) = 4.86;p = 0.009] were significantly different among the groups. Scotopic PD and low photopic PD were significantly lower in group 1 than in group 2 (p = 0.03 andp = 0.03, respectively). Meanwhile, the resting diameter, velocity of pupil contraction, and velocity of pupil dilatation were found to be significantly lower (p = 0.02,p = 0.01, andp = 0.008, respectively), and the duration of pupil contraction was significantly higher in group 1 than in group 3 (p = 0.03). Conclusion Both DM patients with and without nonproliferative DR exhibited pupillary involvement. Automated pupillometry may be an easily applicable, noninvasive screening option for reducing mortality and morbidity rates associated with diabetic autonomic neuropathy.
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    Evaluation of anterior segment parameters with Pentacam in children with poorly-controlled type 1 Diabetes Mellitus without diabetic retinopathy
    (Elsevier, 2021) Karahan, Mine; Demirtaş, Atılım Armağan; Erdem, Seyfettin; Ava, Sedat; Dursun, Mehmet Emin; Beştaş, Aslı; Haspolat, Yusuf Kenan; Keklikçi, Uğur
    urpose: To determine the effect of abnormal glucose metabolism on the cornea, lens, anterior chamber volume (ACV), and anterior chamber depth (ACD) in children with poorly-controlled type 1 diabetes mellitus (DM) without diabetic retinopathy (DR). Methods: After the complete ophthalmologic examination of children with poorly-controlled (glycosylated hemoglobin [HbA1c] >7.0 %) type 1 DM without DR and age-matched healthy subjects (control group), the central corneal thickness (CCT), keratometry (K) values (Kmean front and back, and Kmax), radius (R) values (Rmin front and back), corneal volume (CV), ACD, ACV, pupil diameter, mean lens density (MLD), lens density standard deviation (LD SD), and maximum lens density (LD max) were measured using Pentacam High Resolution. Endothelial cell density was measured using a specular microscope. The results were assessed and compared between the two groups. Results: There were 60 patients (38 boys and 22 girls) in the DM group and 30 (14 boys, 16 girls) in the control group. There were considerable differences between the groups in terms of CCT, CV, ACD, MLD, LD SD and LD max, and Kmean back. Further, there was a positive correlation between HbA1c and MLD, LD SD, CV, and CCT in patients with DM. Conclusion: The results of our study demonstrate that poorly-controlled type 1 DM without DR affects the cornea, ACD, and LD based on anterior segment measurements taken with a Scheimpflug camera. CCT, CV, LD SD, and MLD values may be parameters that can be used to follow-up patients with type 1 DM.
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    Evaluation of blood inflammatory parameters of infants with premature retinopathy treated with intravitreal anti vascular endothelial growth factor
    (Gazi Göz Vakfı, 2022) Ava, Sedat; Hazar, Leyla; Karahan, Mine; Erdem, Seyfettin; Dursun, Mehmet Emin; Keklikçi, Uğur
    Purpose: This study compared the blood inflammatory parameters between early preterm infants with retinopathy of prematurity (ROP) who were treated with intravitreal anti-vascular endothelial growth factor (VEGF)) and those who did not need treatment. Materials and Methods: One hundred and six infants were included in the study. Early preterm infants with a gestational age (GA) ≤ 32 weeks and birth weight (BW) ≤ 1500 gm were included. These infants were divided into three groups: infants without ROP (group 1), infants with ROP who did not require treatment (group 2) and infants with ROP who were treated with intravitreal anti-VEGF (group 3). In the first week, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR) of the groups were calculated and compared. Results: Of 106 infants, 38 (35.8%) were in group 1, 30 (28.3%) were in group 2 and 38 (35.8%) were in group 3. GA was 24.89 ± 1.48 weeks, and BW was significantly lower in group 3, 775.21 ± 175.11 gm. (p < 0.001). There was no significant difference between the groups in terms of NLR, MLR and PLR (p = 0.833, p = 0.918 and p = 0.082, respectively). Logistic regression analysis was performed; BW was a statistically significant independent risk factor (OR: 0,999 %CI: 0,992-0,999 p = 0.022) associated with ROP that required treatment. Conclusion: It was shown that systemic inflammation parameters, including NLR, MLR and PLR, are not a reliable marker in the diagnosis and prognosis of ROP.
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    Evaluation of choroidal thickness in patients who have recovered from COVID-19
    (Springer, 2022) Erdem, Seyfettin; Karahan, Mine; Ava, Sedat; Dursun, Mehmet Emin; Dursun, Birgul; Hazar, Leyla; Bozarslan Senol, Berivan
    Purpose We aimed to evaluate choroidal thickness (CT) in patients who have recovered from COVID-19 by using enhanced depth imaging optical coherence tomography (EDI-OCT). Methods We included fifty-eight patients who have recovered from COVID-19 (group 1) and fifty healthy control subjects (group 2) in this prospective study. Best corrected visual acuity, anterior segment and posterior segment examinations of all subjects were performed. CT scan and measurements were taken with the EDI mode of the Spectral Domain OCT device. Results Of the 108 subjects included in this study, 57 were female and 51 were male. The mean age was similar in both groups (36.10 +/- 7.12 and 35.58 +/- 7.29, respectively, p = 0.276). Group 1 had the following characteristics: the mean time since diagnosis was 53.18 +/- 2.84; it had been 38.48 +/- 4.07 days since the PCR test was negative; and all subjects were outpatients. It was detected that the CT of the patients in group 1 decreased in all areas compared to group 2, and this decrease was significant in subfoveal, temporal and inferior areas (257.48 +/- 32.79, 273.62 +/- 45.04, p = 0.04; 232.96 +/- 41.79, 252.76 +/- 46.09, p = 0.02, and 245.22 +/- 44.58, 271.54 +/- 55.07, p = 0.01, respectively). In the retinal nerve fiber layer analysis for group 1, thickening was detected in all areas, although it was not statistically significant, except in the temporal area where it was (superotemporal, superonasal, nasal, inferonasal, inferotemporal, temporal, and global [p = 0 .08, p = 0.45, p = 0.73, p = 0.64, p = 0.74, p = 0.02, and p = 0.10, respectively]). Conclusion For individuals who had recovered from COVID-19, it was found that CT decreased in all areas in these patients. Therefore, this study in which we have demonstrated the decrease in the thickness of the choroidal tissue, a tissue with high blood flow, may contribute to the understanding of the systemic microvascular waste of this disease.
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    Evaluation of ocular hypoperfusion in patients with acromegaly by using optical coherence tomography angiography
    (Taylor & Francis, 2021) Karahan, Mine; Demirtaş, Atılım Armağan; Erdem, Seyfettin; Ava, Sedat; Pekkolay, Zafer; Keklikçi, Uğur
    Purpose: This study aimed to evaluate the retinal blood vessel parameters and the foveal avascular zone (FAZ) area using optical coherence tomography angiography (OCTA) in patients with acromegaly in comparison with healthy controls. Methods: A total of 45 patients with acromegaly and 45 healthy controls were included in this study. In all patients, the vessel density (VD) of the deep and superficial macular vascular networks and the foveal avascular zone (FAZ) were measured using OCTA. The correlation of insulin-like growth factor 1 (IGF-1) level and disease duration with deep macular VD and FAZ values was analyzed. All parameters were registered. Results were assessed and compared between the two groups. Results: Deep macular plexus VD values were lower in patients with acromegaly compared to the control group. No significant differences in VD values in the superficial segment, except for that in the inferior parafovea (P = .01) were found between the two groups. Furthermore, patients with acromegaly showed enlargement in the superficial (P = .30) and deep FAZ areas (P < .001). IGF-1 level and disease duration showed a significant negative correlation with the deep whole image (R = -0.216, P = .041, R = -0.339, P = .001, respectively), deep parafovea (R = -0.271, P = .01; R = -0.372, P < .001, respectively), deep parafovea superior hemi (R = -0.342, P = .001; R = -0.350, P = .001, respectively), deep parafovea temporal (R = -0.224, P = .034; R = -0.234, P = .026, respectively), deep parafovea nasal (R = -0.320, P = .002; R = -0.361, P < .001, respectively), and deep parafovea superior VD values (R = -0.293, P = .005; R = -0.307, P = .003, respectively) and a significant positive correlation with the deep FAZ area values (R = 0.244, P = .02; R = 0.329, P = .002, respectively). Conclusion: VD values in the deep macular capillary plexus were lower in patients with acromegaly, and the superficial and deep FAZ area enlarged. Patients with acromegaly may have an increased risk of developing ocular vascular complications. OCTA can be used to evaluate retinal blood VD in patients with acromegaly.
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    Evaluation of parafoveal and peripapillary vascular densities using optical coherence tomography angiography in children with thalassemia major
    (SAGE Publications Ltd., 2023) Dursun, Mehmet Emin; Hazar, Leyla; Karahan, Mine; Erdem, Seyfettin; Ava, Sedat; Üzel, Veysiye Hülya; Dursun, Birgül; Keklikçi, Uğur
    Background: Thalassemia major (TM) is an inherited anaemia caused by faulty haemoglobin synthesis. Reducing serum iron levels using iron chelating agents is an important step in the treatment of TM, and the effects on the eye of both the disease and these agents can be determined by regular eye examination. Objectives: We evaluated macular and optic nerve vascular densities in children with TM and compared the results with healthy controls using optical coherence tomography angiography (OCTA). Design: This is a prospective study. Methods: A total of 30 children with TM and 30 healthy controls were included in the study. The area of the foveal avascular zone (FAZ) and the vascular densities (VD) of the optic nerve head (ONH), radial peripapillary capillary (RPC) and deep and superficial retinal vascular networks were measured using OCTA. Results: A statistically significant decrease in VD was observed in the whole image and the parafovea, superior hemi, superior and inferior parts of the superficial capillary plexus and in the whole image and the superior regions of the deep capillary plexus in the TM patient group compared with the control group (p < 0.05). A significant decrease in VD was also observed in the whole image and the inside disc, peripapillary, nasal, inferonasal and temporal regions of the ONH and in the whole image and the inside disc, peripapillary and inferonasal regions of the RPC network in patients with TM (p < 0.05). A significant positive correlation was observed between both serum ferritin levels and deferasirox dosage, on one hand, and both the superficial (p = 0.023 and p = 0.002, respectively) and deep FAZs (p = 0.015 and p = 0.045, respectively), on the other hand. A negative correlation was also found between the deferasirox dosage and the VDs of the superficial (p = 0.010) and deep (p = 0.001) foveal plexuses. Conclusion: Retinal VD and FAZ are affected in patients with TM. OCTA, which can noninvasively measure retinal VD in patients with TM, may be a useful tool for the early detection of retinal microvascular changes that may occur during the course of the disease.
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    Evaluation of parafoveal vascular density using optical coherence tomography angiography in patients with central serous chorioretinopathy
    (Springer London Ltd, 2022) Dursun, Mehmet Emin; Erdem, Seyfettin; Karahan, Mine; Ava, Sedat; Hazar, Leyla; Dursun, Birgul; Keklikci, Ugur
    Using optical coherence tomography angiography (OCTA), we sought to evaluate parafoveal vascular density (VD) in patients with central serous chorioretinopathy (CSCR). Our study included 43 patients with a diagnosis of CSCR and 40 healthy controls. Ophthalmologic examination findings and OCTA measurements of the participants were retrospectively analysed. Of the 43 patients with CSCR, 31 were males (72%) and 12 were females (28%); the control group was 30 males (75%) and 10 females (25%) (p = 0.657). There were significant differences between affected eyes, unaffected eyes and healthy control eyes for all parameters in the superficial capillary plexus (SCP) VD and deep capillary plexus (DCP) VD (p < 0.05 for all values). It was also determined that the affected eyes had lower SCP-VD and DCP-VD than the unaffected eyes and that the unaffected eyes had lower SCP-VD and DCP-VD than the healthy control eyes (p < 0.05 for all values). While there were no significant differences in the deep foveal avascular zone (FAZ) area, the superficial FAZ area was larger in affected eyes than in both unaffected eyes and healthy control eyes (p < 0.05). In most areas, the SCP-VD and DCP-VD values were lower and the FAZ larger in the chronic group than in the acute group (p < 0.05). Retinal vascular changes were found in patients with both acute and chronic CSCR, and the fellow eyes of these patients were also affected. OCTA can therefore be considered an easily applicable, non-invasive screening option for evaluating the microvascular structure in these patients.
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    Evaluation of plasma inflammatory markers in patients with nonarteritic retinal artery occlusion
    (2023) Karahan, Mine; Ava, Sedat; Erdem, Seyfettin; Keklikçi, Uğur; Dursun, Mehmet Emin; Hazar, Leyla; Vural, Esra
    Purpose: To examine the clinical characteristics, comorbid status and laboratory parameters of patients followed up with a diagnosis of retinal artery occlusion (RAO) and to compare blood inflammation parameters with control subjects. Methods: The medical records of 49 patients who were followed up for RAO at Dicle University Medical Faculty between 2017 and 2020 were retrospectively analysed. The occlusion type was divided into two groups, central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO). The demographic characteristics and clinical and laboratory tests of the groups were compared. The blood WBC, neutrophil, lymphocyte, monocyte and platelet counts of the patients were also recorded, and the neutrophil/lymphocyte, monocyte/lymphocyte and platelet/lymphocyte counts were calculated by simple division and compared with 41 age- and gender-matched controls. Results: There was no difference in age and gender between the CRAO and BRAO groups (p = 0.220 and p = 0.303 respectively). Heart disease was significantly more common in CRAO patients (p = 0.004), and hypertension was observed more often, although not significantly (p = 0.084). WBC, neutrophil and monocyte values were found to be significantly higher in those with RAO than in the controls (p = 0.005, p < 0.001, p = 0.035 respectively). The neutrophil-lymphocyte ratio (NLR) was found to be significantly higher in those with RAO (p = 0.007). Conclusion: RAO is associated with significant elevation in WBC and NLR. The association of CRAO with cardiovascular disease is prominent.
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    Evaluation of retinal and optic nerve vasculature by optic coherence tomography angiography in Migraine with Aura
    (Elsevier Masson s.r.l., 2021) Karahan, Mine; Erdem, Seyfettin; Ava, Sedat; Kaya, A. A.; Demirtaş, Atılım Armaǧan; Keklikçi, Uǧur; 0000-0002-6504-8385; 0000-0002-3591-721X
    Purpose: This study aimed to evaluate the retina by optic coherence tomography angiography (OCTA) in patients with migraine with aura (MA) in comparison with healthy controls. Materials and methods: A total of 60 patients with MA and 56 control subjects who applied to the Ophthalmology Clinic of Dicle University between January 2020 and February 2020 were included in this study. In all patients, the vascular density (VD) of the radial peripapillary capillaries (RPCs) and optic nerve head (ONH), the VD of deep and superficial macular vascular networks, and foveal avascular zone (FAZ) were measured. Results: Patients with MA showed reduced VD measurements of the nasal and inferotemporal ONH, inferonasal RPCs, and deep macular plexus. No statistically significant difference was observed in the superficial macular VD values between the study groups. The majority of patients with MA showed hypertrophy in the deep FAZ. Conclusion: There was a decrease in VD measurements in the deep macular capillary plexus, ONH, and peripapillary capillaries and hypertrophy in the deep FAZ in patients with MA. According to these results, patients with MA may have an increased risk of developing ocular and systemic vascular complications. Therefore, OCTA can be used to evaluate systemic and ocular hypoperfusion in patients with MA.
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    Evaluation of Retinal Microvascular Perfusion Changes in Patients with Celiac Disease
    (Taylor & Francis Inc, 2022) Erdem, Seyfettin; Ucmak, Feyzullah; Karahan, Mine; Ava, Sedat; Dursun, Mehmet Emin; Dursun, Birgul; Hazar, Leyla
    Purpose We aimed to determine whether there are retinal microvascular changes in patients with celiac disease (CD). Methods A total of 30 patients with CD (group 1) and 30 healthy controls (group 2) were included in this study. AngioVue optical coherence tomography angiography (OCTA) device was used to evaluate the retinal microvascular structure. Results Some of the values of both optic nerve head (ONH) vessel density (VD) and radial peripapillary capillary VDs were found to be significantly lower in group 1 than in group 2. These 2 groups were similar except for one of the parameters of superficial capillary plexus VD (SCP-VD), whereas it was found that deep capillary plexus VD (DCP-VD) was lower in group 1 than in group 2 except for the foveal area. Conclusion It was determined that some VDs obtained from the ONH and DCP-VD obtained from most areas of the macular region were significantly lower.
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    Evaluation of the effect of obstructive sleep apnea syndrome on retinal microvascularity by optical coherence tomography angiography
    (Elsevier, 2022) Ava, Sedat; Erdem, Seyfettin; Karahan, Mine; Dursun, Mehmet Emin; Hazar, Leyla; Şen, Hadice Selimoğlu; Keklikçi, Uğur
    Purpose: Using optical coherence tomography angiography (OCTA), we sought to determine whether there are retinal microvascular changes in patients with obstructive sleep apnea syndrome (OSAS). Method: The study included 56 patients diagnosed with OSAS by polysomnography [21 patients with mild OSAS (group 1), 14 with moderate OSAS (group 2) and 21 with severe OSAS (group 3)], and 26 healthy individuals as a control group (group 4). The vascular densities of the superficial capillary plexus and deep capillary plexus of the retinal segmentations, together with the foveal avascular zone (FAZ) width, were measured for all participants, using OCTA.Result: Compared with the control group, vascular densitiy in whole image of superficial capillary plexus were found to be significantly lower in group 2. In addition, vascular densitiy in fovea region of superficial capillary plexus was significantly lower in group 1 than the control group. In deep capillary plexus, vascular densitiy of whole image, superior hemi and nasal regions were found to be significantly lower in group 2 and group 3 compared with the control group. Parafoveal region in group 3 had significantly lower vascular densities than the controls. A significantly larger FAZ was also found in group 1 and group 3 in the deep capillary plexus, compared with the controls. Conclusion: We detected smaller vascular densities in both the superficial capillary plexus and deep capillary plexus and a larger deep capillary plexus FAZ in OSAS patients. Therefore, OCTA may be useful as a non-invasive method to understand the systemic effects of OSAS.