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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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    Automated quantification of foveal avascular zone and vascular density in Behcet's disease
    (Springer London Ltd, 2020) Turkcu, Fatih Mehmet; Sahin, Alparslan; Karaalp, Umit; Cinar, Yasin; Sahin, Muhammed; Ozkurt, Zeynep Gursel; Keklikci, Ugur
    PurposeTo measure the vascular density (VD) and foveal avascular zone (FAZ) area in patients with Behcet's disease (BD) obtained by optical coherence tomography angiography (OCTA).MethodsVD and FAZ area in the deep and superficial retinal vascular networks were measured in all eyes.ResultsThirty BD and 31 control subjects were included in the study. The mean overall VD measured in the entire scan was lower in BD compared with control group in both the superficial (49.526.54 vs 53.57 +/- 2.87%, respectively; p=0.003) and deep (53.44 +/- 7.44 vs 58.41 +/- 3.01%, respectively; p=0.002) areas. The FAZ in the BD group was significantly increased at the level of the superficial (0.52 +/- 0.67 vs 0.28 +/- 0.1 mm(2), respectively; p=0.05) and deep (0.91 +/- 1.25 vs 0.39 +/- 0.14 mm(2), respectively; p=0.024) areas compared with those of the control group. The deep and the superficial FAZ areas were positively correlated with disease duration and negatively with VA.Conclusionp id=ParIn the patients with BD, OCTA showed decreased VD in both the superficial and deep retinal vascular networks. Besides, the VA was correlated with the VD and FAZ.
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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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    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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    Early detection of macular and peripapillary changes with spectralis optical coherence tomography in patients with prediabetes
    (Taylor & Francis Ltd, 2018) Sahin, Muhammed; Sahin, Alparslan; Kilinc, Faruk; Karaalp, Umit; Yuksel, Harun; Ozkurt, Zeynep Gursel; Turkcu, Fatih Mehmet
    Purpose: To compare the retina ganglion cell complex (GCC) layer and peripapillary nerve fibre layer thickness (pRNFL) in patients with prediabetes and healthy subjects analysed by spectral domain optical coherence tomography (SD-OCT). Methods: This cross-sectional and comparative study included prediabetic patients and healthy subjects. All participants underwent SD-OCT measurement of pRNFL thickness, and GCC thickness. Results: A total of 30 eyes of the 30 patients with prediabetes and 30 eyes of 30 controls were included. The overall calculated pRNFL thicknesses were similar between the prediabetic and control subjects. The GCC thickness was significantly lower in all quadrants of the inner macula, and outer nasal quadrant in the prediabetes group when compared to the control group. Conclusion: Our study demonstrated that inner macular GCC thickness was significantly thinner in prediabetic subjects. As a result neurodegeneration may play role in the thinning of GCC.
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    The effects of delivery type and gender on intraocular pressure and central corneal thickness in newborns
    (Consel Brasil Oftalmologia, 2016) Ozkurt, Zeynep Gursel; Balsak, Selahattin; Balsak, Berrin; Guclu, Hande; Sahin, Muhammed; Yuksel, Harun; Turkcu, Fatih M.
    Purpose: To analyze intraocular pressure (IOP) and central corneal thickness (CCT) in newborns during the first 12 h of life. Methods: Forty-three newborns born by vaginal delivery (VD) and 30 newborns born by cesarean section (CS) were evaluated. IOP and CCT were measured using Tono-Pen and handheld pachymeter, respectively, at both the 5th minute after delivery and at the 12th h of life. Results: The mean IOP for the VD group was significantly higher than that of the CS group at both the 5th minute and 12th h (p=0.042 and p=0.018, respectively). In both groups, the IOP decreased by the 12th h, but the decrease was only significant for the CS group (p=0.020). The decrease in CCT over the 12 h was significant for both groups (p<0.001). In the VD and CS groups, the IOP values of the males were significantly higher than those of the females at the fifth minute only (p=0.024 and p=0.043, respectively). No other values were significantly different between the genders. Conclusions: Newborn IOP is affected by the mode of delivery and gender. A higher IOP was found in vaginally delivered newborns than in CS newborns for at least 12 h postpartum. CCT showed a significant decline within 12 h. Male newborns have significantly higher IOP values in the first minutes of life.
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    A LOWER DOSE OF INTRAVITREAL BEVACIZUMAB EFFECTIVELY TREATS RETINOPATHY OF PREMATURITY
    (Mosby-Elsevier, 2018) Sahin, Alparslan; Turkcu, Fatih Mehmet; Ozkurt, Zeynep Gursel
    [Abstract Not Available]
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    Managment of orbital complications of sinusitis
    (Consel Brasil Oftalmologia, 2014) Ozkurt, Fazil Emre; Ozkurt, Zeynep Gursel; Gul, Aylin; Akdag, Mehmet; Sengul, Engin; Yilmaz, Beyhan; Yuksel, Harun
    Purpose: We reported on the clinical approaches of ophthalmology and otorhinolaryngology departments in the treatment of the orbital complications of sinusitis. We also included an in-depth literature review. Methods: We retrospectively reviewed the medical files of 51 patients from January 2008 to January 2014. The records were evaluated for age, gender, type of orbital complications, symptoms, predisposing factors, imaging studies, medical and surgical management, culture results, and follow-up information. SPSS version 15.0 software (Statistical Analysis, The Statistical Package for Social Sciences Inc, Chicago, IL) was used for the statistical analysis. Results: Fifty-one patients met the criteria, with available medical records, for the study (29 male, 22 female). Thirty-two (62.7%) were diagnosed with preseptal cellulitis and 19 (37.3%) with postseptal cellulitis. After a detailed evaluation, 15 were diagnosed with a subperiosteal abscess (SPA), and 4 were diagnosed with orbital cellulitis. The age and gender was similar for the two groups. Five patients with medial SPA were treated with endoscopic sinus surgery, one patient with inferior SPA was treated with external surgery, and six patients with other localizations were treated with a combination of endoscopic sinus surgery and external surgery. All patients presented with periorbital erythema and edema. The length of hospitalization and duration of symptoms were similar in both groups. Visual acuity was between 1/10 to 10/10 (mean 7/10) and statistically significant for preseptal and postseptal cellulitis groups (p<0.001). All patients received intravenous antibiotics upon the first day of admission. Conclusion: Orbital complications of acute sinusitis required intensive follow-up and a multidisciplinary approach. A contrast-enhanced paranasal sinus computerized tomography (CT) scan can detect the extent of the infection. An initial trial of intravenosus (IV) antibiotics may be appropriate when close monitoring is possible. Surgery may be indicated when there has been no improvement within 48 hours of intravenous treatment, loss of visual acuity (under 8/10), and a non-medial abscess.
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    Metallic corneal foreign bodies: an occupational health hazard
    (Consel Brasil Oftalmologia, 2014) Ozkurt, Zeynep Gursel; Yuksel, Harun; Saka, Gunay; Guclu, Hande; Evsen, Sina; Balsak, Selahattin
    Purpose: To analyze the risk factors, outcomes, demographic characteristics, and attitudes of workers with metallic corneal foreign body (FB) injury. Methods: One hundred consecutive patients who presented with a metallic corneal FB to the eye clinic at Diyarbakir Training and Research Hospital were evaluated. The patients completed a questionnaire and were examined to determine features of the injury. Results: All patients were male. The mean age was 32.46 +/- 1.03 years. Fifty-five percent of the patients were unregistered workers, 59% were working in the metal industry sector, and 65% injuries resulted from metal cutting. Protective goggles were available in the workplace of 64% patients. However, 57% patients were not wearing goggles when the accident occurred, and 43% were injured despite goggle use. Most patients (52%) attempted to remove FBs by themselves. FBs were located in the central zone of the cornea in 16% patients. Rust marks remained after FB removal in 26% patients. Corneal scars from previous FB injuries were present in 58% patients. Only 8% workplaces provided compensation for physician visits for occupation-related illnesses. Conclusions: Workplaces with a high risk for eye injuries should increase their protective measures, and educational programs should be implemented for both workers and occupational physicians. The government should enforce laws regarding unregistered workers in a better manner.
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    Prognostic factors for stereopsis in refractive accommodative esotropia
    (Professional Medical Publications, 2015) Guclu, Hande; Gurlu, Vuslat Pelitli; Ozal, Sadik Altan; Ozkurt, Zeynep Gursel
    Objective: To determine the prognostic factors affecting stereoacuity in patients with refractive accommodative esotropia (RAE) according to the results of long follow- up period. Methods: We reviewed the charts of 70 patients with RAE between the years 1985-2014. Patients were classified into three groups. G-1: Stereoacuity score 40 second/arc. G-2: Stereoacuity score >40 second/arc (50-3000). G-3: No binocular vision. Initiation age of RAE, duration of deviation, refractive error, amblyopia, amblyopia treatment, anisometropia, visual acuity, family history, angle of deviation for distance and near at each group and the prognostic factors affecting stereoacuity were analyzed. Results: The mean initiation age of RAE was 2.7 +/- 1.5 years, the mean age at first visit was 6.4 +/- 4.2 years. The mean follow up time was 7.3 +/- 4.4 years. Seven patients had 40 second/arc, 48 patients had 50 to 3000 second/arc stereoacuity, 15 patients had no binocular vision. Mean deviation for near was statistically higher in group 2 and 3. Visual acuity levels were higher in group 1 and 2 and was statistically significant. Low visual acuity (p=0.001, 0.008), higher angle of deviation at near (p=0.01), increased duration of deviation (p=0.01), presence of amblyopia (p=0.001) and irregularity of amblyopia treatment (p=0.01) were significantly related with poor stereoacuity. Conclusion: According to the prognostic factors low stereoacuity was mostly related with amblyopia as a result the late presentation of the patients in seeking care. Appropriate treatment as full refractive correction and amblyopia treatment during the RAE is important for development of good stereopsis. Also angle of deviation at near and duration of deviation can be a useful predictor for poor stereoacuity levels.
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    Retina ganglion cell/inner plexiform layer and peripapillary nerve fiber layer thickness in patients with acromegaly
    (Springer, 2017) Sahin, Muhammed; Sahin, Alparslan; Kilinc, Faruk; Yuksel, Harun; Ozkurt, Zeynep Gursel; Turkcu, Fatih Mehmet; Pekkolay, Zafer
    Increased secretion of growth hormone and insulin-like growth factor-1 in acromegaly has various effects on multiple organs. However, the ocular effects of acromegaly have yet to be investigated in detail. The aim of the present study was to compare retina ganglion cell/inner plexiform layer (GCIPL) and peripapillary nerve fiber layer thickness (pRNFL) between patients with acromegaly and healthy control subjects using spectral domain optical coherence tomography (SD-OCT). This cross-sectional, comparative study included 18 patients with acromegaly and 20 control subjects. All participants underwent SD-OCT to measure pRNFL (in the seven peripapillary areas), GCIPL (in the nine ETDRS areas), and central macular thickness (CMT). Visual field (VF) examinations were performed using a Humphrey field analyzer in acromegalic patients. Measurements were compared between patients with acromegaly and control subjects. A total of 33 eyes of 18 patients with acromegaly and 40 eyes of 20 control subjects met the inclusion criteria of the present study. The overall calculated average pRNFL thickness was significantly lower in patients with acromegaly than in control subjects (P = 0.01), with pRNFL thickness significantly lower in the temporal superior and temporal inferior quadrants. Contrary to our expectations, pRNFL thickness in the nasal quadrant was similar between acromegalic and control subjects. The mean overall pRNFL thickness and superonasal, nasal, inferonasal, and inferotemporal quadrant pRNFL thicknesses were found to correlate with the mean deviation (MD) according to Spearman's correlation. However, other quadrants were not correlated with VF sensitivity. No significant difference in CMT values was observed (P = 0.6). GCIPL thickness was significantly lower in all quadrants of the inner and outer macula, except for central and inferior outer quadrants, in the acromegaly group than that in the control group (P < 0.05). GCIPL thicknesses of the inferior inner and outer macula quadrants were found to correlate with MD, whereas no correlation was observed between other quadrants and VF sensitivity. We demonstrated that GCIPL thickness decreased in patients with acromegaly compared with that in control subjects. However, the nasal quadrant pRNFL thickness was similar in acromegaly, in contrast to our expectations. SD-OCT may have utility in the assessment of the effects of acromegaly on retinal structures.