Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Clinical Outcomes of Scleral Misa Lenses for Visual Rehabilitation in Patients with Pellucid Marginal Degeneration(2016) Asena, Leyla; Altinors, Dilek Dursun; 0000-0002-6848-203X; 0000-0001-5223-0279; 27432029; E-5914-2016; AAK-8077-2021Purpose: To report the clinical outcomes of scleral Misa((R)) lenses (Microlens Contactlens Technolgy, Arnhem, Netherlands) for visual rehabilitation in patients with pellucid marginal degeneration (PMD). Mehods: In this prospective interventional case series, 24 eyes of 12 PMD patients were fitted with scleral Misa((R)) lenses. Patients were followed regularly for continuous daily wearing time (CDWT), contact lens handling issues, Visual acuity, and any subjective or objective contact lens related complications. Results: The mean patient age was 35.0 +/- 13.8 years (range, 23-47 years). The average length of follow-up was 14.1 +/- 3.7 months (range, 8.5-18 months). All eyes were fit with mini Misa((R)) scleral lenses with a diameter of 16.5 or 17 mm. The mean Snellen best-corrected visual acuity (BCVA) before scleral lenses with spectacle correction was 0.42 +/- 0.15 (range, 0.2-0.6). With scleral lenses, mean BCVA was 0.75 +/- 0.15 (range, 0.5-0.9), (p = 0.003) with a mean gain of 3.3 lines of BCVA. More than half (16 eyes, 67%) reported wearing theirscleral lenses for 8 h or more on a daily basis. Three patients (6 eyes, 25%) abandoned scleral lens wear. Patients who abandoned the scleral lens wear tended to have a better spectacle corrected visual acuity and less gain of lines. Conclusions: Scleral lenses can be used succesfully in patients with PMD who are intolerant to other types of contact lenses. Patients who have a low spectacle BCVA and a higher gain of visual acuity with scleral lenses are good candidates for scleral lens use. (C) 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.Item Comparison of clinical outcome with different treatment regimens in acute adenoviral keratoconjunctivitis(2017) Asena, L.; Ozdemir, E.Singar; Burcu, A.; Ercan, E.; Colak, M.; Altınors, D.D.; 0000-0002-6848-203X; 0000-0001-5223-0279; 28157224; E-5914-2016; AAK-8077-2021Purpose To compare the clinical outcome with different treatment regimens in Acute Adenoviral Keratoconjunctivitis (AAK). Methods The records of 110 patients diagnosed as AAK in two tertiary eye care centers were evaluated retrospectively. The treatment regimen, follow-up duration, time until improvement of the symptoms, visual acuity, clinical findings, Schirmer's test and the Ocular Surface Disease Index (OSDI) score at the first day, first week and third week were recorded. The Kruskal-Wallis Test and Chi-square test were used for comparison of quantitative and categorical variables, respectively. Results Forty six patients were receiving topical corticosteroids (Group 1), 32 topical 2% Cyclosporin A (CsA) (Group 2) and 32 only artificial tears (Group 3). Mean time until resolution of the symptoms was lowest in Group 1 (9.5 +/- 4.9 days) and highest in Group 3 (13.3 +/- 4.2 days)(p: 0.001). OSDI scores at the first and third weeks were highest in Group 3 (52.4 +/- 16.4 and 32.3 +/- 13.0) and lowest in Group 1 (41.0 +/- 21.3 and 23.9 +/- 13.2)(p: 0.01 and p: 0.009). At day 21, percentage of the patients with subepthelial infiltrates was the highest in Group 3 (63.4%) and lowest in Group 1 (42.5%). Conclusions The symptoms were less severe and had a shorter duration with topical corticosteroids and CsA when compared with palliative therapy. Topical 2% CsA may inhibit development of corneal subepithelial infiltrates when used in the acute phase of infection, similar to corticosteroids.Item Comparison of Keratometry Obtained by a Swept Source OCT-Based Biometer with a Standard Optical Biometer and Scheimpflug Imaging(2018) Asena, Leyla; Akman, Ahmet; Gungor, Sirel Gur; Altinors, Dilek Dursun; 0000-0001-5223-0279; 0000-0002-6848-203X; 0000-0001-6178-8362; 29630418; AAK-8077-2021; E-5914-2016; AAD-5967-2021Purpose: To assess agreement of a swept source-optical coherence tomography (SS-OCT) based Biometer with a standard IOLMaster device and Scheimpflug Imaging (SI) to acquire keratometric measurements in cataract patients. Methods: In this prospective comparative study, 101 eyes of 101 cataract surgery candidates, aged 24-81years, were sequentially examined using three devices. Keratometry values at the flat (K1) and steep (K2) axis, mean corneal power (Km) and magnitude of corneal astigmatism as well as J0 and J45 vectoral components of astigmatism obtained with the SS-OCT based biometer (IOLMaster 700) were compared with those obtained with the IOLMaster 500 and SI. The agreement between measurements was evaluated by the Bland-Altman method, intraclass correlation coefficients (ICCs) and repeated-measures analysis of variance. Results: Mean K1 values from the three devices were similar (p=0.09). Mean K2 and Km values of IOLMaster 700 were higher than SI and lower than IOLMaster 500 (p=0.04 for K2 and p=0.02 for Km). There was a strong correlation between K1, K2, Km and magnitude of astigmatism obtained with all devices (r >= 0.80 and p<0.01). The 95% limits of agreement (LoA) width for each keratometric value were highest for the comparison between IOLMaster 500 and SI and lowest for the comparison between IOLMaster 700 and 500. The mean differences (width of 95% LoA) for J0 and J45 vectoral components were 0.005 (2.19) and 0.12 (2.92) for the measurements obtained by IOLMaster 700 vs IOLMaster 500 and 0.06 (1.79) and 0.02 (1.58) for the measurements obtained by IOLMaster 700 vs SI, respectively. Conclusions: With ICCs close to 1, the agreement between all devices was excellent for keratometric measurements. Mean K2, Km and astigmatism measurements from IOLMaster 700 were lower than IOLMaster 500 and higher than SI. However, the differences were quite small and are not expected to affect the final IOL power.Item Customizing Illumination by the Operating Microscope Aids the Visualization of DMEK Grafts(2018) Altinors, Dilek Dursun; Asena, Leyla; Yilmaz, Gursel; Oto, Sibel; 0000-0001-5223-0279; 0000-0002-2589-7294; 0000-0003-0171-4200; AAK-8077-2021; AAK-6987-2021; AAJ-4668-2021Item Descemet Membrane Endothelial Keratoplasty: Outcomes in the First Year of Experience(2018) Altinors, Dilek D.; Asena, Leyla; 0000-0001-5223-0279; 0000-0002-6848-203X; 29528002; AAK-8077-2021; E-5914-2016Objectives: We aimed to report the clinical outcomes of Descemet membrane endothelial keratoplasty in our first year of experience. Materials and Methods: Patients who underwent Descemet membrane endothelial keratoplasty at the Baskent University Faculty of Medicine, Department of Ophthalmology, between 2015 and 2016 were included in the study. Patient demographics, cause of endothelial dysfunction, best-corrected visual acuity, central corneal thickness, graft survival, follow-up duration, and intraoperative and postoperative complications were recorded. Results: Five eyes of 5 patients (4 female, 1 male) with a mean age of 53.4 +/- 12.7 years were included. Cause of endothelial dysfunction included corneal endothelial dystrophy in 3 patients, pseudophakic bullous keratopathy in 1 patient, and endothelial graft failure after previous penetrating keratoplasty in 1 patient. Pre-stripped Descemet membranes obtained from the Ankara State Hospital Eye Bank were used. Mean duration of postoperative follow-up was 7.4 +/- 3.7 months. Mean preoperative Snellen best-corrected visual acuity and central corneal thickness were 0.24 +/- 0.15 and 625.5 +/- 97.4 mu m. Mean best-corrected visual acuity increased to 0.67 +/- 0.26 (P = .02) in the first month and to 0.84 +/- 0.11 (P < .01) at the end of follow-up. Mean central corneal thickness decreased to 546.6 +/- 28.4 pm (P = .03). Graft detachment was observed in 1 patient on the first postoperative day, and it was reattached successfully by injection of air into the anterior chamber. There were no intra-operative complications. All corneas were clear at the end of follow-up. Conclusions: Descemet membrane endothelial keratoplasty provides a new and exciting option for endothelial transplant and has the potential to become the primary procedure for surgical management of Fuchs endothelial dystrophy and corneal endothelial disease. Rapid visual rehabilitation with few and manageable complications and good visual outcomes are the major advantages of this procedure.Item Descemet's Membrane Endothelial Keratoplasty (DMEK): 6-Month Clinical Outcomes(2018) Altinors, Dilek Dursun; Asena, Leyla; Yilmaz, Gursel; Oto, Sibel; 0000-0001-5223-0279; 0000-0002-2589-7294; 0000-0003-0171-4200; AAK-8077-2021; AAK-6987-2021; AAJ-4668-2021Item Galectin-3, IL-1A, IL-6, and EGF Levels in Corneal Epithelium of Patients With Recurrent Corneal Erosion Syndrome(2020) Candar, Tuba; Asena, Leyla; Alkayid, Husamadden; Altinors, Dilek D.; 0000-0001-5223-0279; 0000-0002-6848-203X; 32732704; E-5914-2016; AAK-8077-2021Purpose: To determine the galectin-3 (Gal3), interleukin-1 (IL-1), interleukin-6 (IL-6), and epidermal growth factor (EGF) levels in corneal epithelium of patients with recurrent corneal erosion (RCE) syndrome and compare them with healthy controls. Methods: In this prospective interventional case control study, 32 eyes of 32 patients with RCE syndrome who had corneal epithelial erosions and 28 eyes of 28 healthy participants scheduled for photorefractive keratectomy (control group) were included. Exclusion criteria included corneal dystrophies, ectasia, dry eye, previous ocular surgery or topical medications, and systemic diseases. Epithelial samples were obtained during epithelial debridement in the study group and mechanical epithelial keratectomy in the control group. Galectin-3 levels were studied by the chemiluminescent microparticle immunoassay method. IL-1, IL-6, and EGF levels were determined using corresponding ELISA kits. Results: The median Gal3 levels were 132.25 ng/mL in the study group and 106.50 ng/mL in the control group. The median IL-1 and IL-6 levels were 6.24 pg/mL and 10.16 pg/mL, respectively, in the study group which were higher than that in the control group. The median EGF level in the study group was lower than that the control group with 1.30 pg/mL versus 2.67 pg/mL. In the control group, there was a significant positive correlation between EGF and IL-6 (r = 0.554;P= 0.040). A similar correlation was not observed in patients with RCE (r = -0.071;P= 0.794). Conclusions: The lack of increased EGF expression and the imbalance between growth factors, adhesion molecules, and interleukins may be the reason for the impaired wound healing response in RCE syndrome.Item Human Breast Milk Drops Promote Corneal Epithelial Wound Healing(2017) Asena, Leyla; Suveren, Esra Hulya; Karabay, Gulten; Altinors, Dilek Dursun; 0000-0001-5223-0279; 0000-0002-6848-203X; 27759431; AAK-8077-2021; E-5914-2016Purpose: To investigate the effects of human breast milk on corneal epithelial wound healing. Methods: The effects of human breast milk on epithelial healing is compared with autologous serum and artificial tears on 24 female Bal-b/C mice. A central corneal epithelial defect was created using a 2 mm trephine. Four groups were formed. By a random pick-up, topical human breast milk 4 x 1 was given to Group 1, topical mouse autologous serum 4 x 1 was applied to Group 2, and preservative-free artificial tears 4 x 1 was applied to Group 3.Group 4 was evaluated as control. Biomicroscopical examination was performed on days 1, 2, and 3. Mice were sacrificed on the third day. Histopathological and electron microscopic examinations were performed as well. Results: The fastest and best healing group was Group 1, followed by Group 2. Re-epithelization was not complete even at the end of the second day in groups 3 and 4. Conclusions: The rich content of human breast milk may be an alternative to epithelial healers and artificial tears.Item Results of Combined Penetrating Keratoplasty and Implantation of Posterior Chamber Intraocular Lenses(2018) Asena, Leyla; Altinors, Dilek Dursun; Yilmaz, Gursel; Oto, Sibel; 0000-0001-5223-0279; 0000-0002-2589-7294; 0000-0003-0171-4200; AAK-8077-2021; AAK-6987-2021; AAJ-4668-2021Item Visual Rehabilitation After Penetrating Keratoplasty(2016) Asena, Leyla; Altinors, Dilek D.; 0000-0002-6848-203X; 0000-0001-5223-0279; 27805532; E-5914-2016; AAK-8077-2021Objectives: Here, our aim was to report our treatment strategies and their results performed for visual rehabilitation after penetrating keratoplasty. Materials and Methods: The medical records of 98 patients (54 male/44 female), with results from 104 eyes, who underwent penetrating keratoplasty between January 2013 and January 2015 at the Baskent University Faculty of Medicine, Department of Ophthalmology were reviewed. Patient age, indication for penetrating keratoplasty, interventions performed for visual rehabilitation, follow-up duration, topo graphic and refractive astigmatism at the end of follow-up, and final best corrected visual acuity results were recorded. Results: Mean age of patients was 54 +/- 23 years. Indications for penetrating keratoplasty included keratoconus, Fuchs endothelial dystrophy, pseu dophakic bullous keratopathy, and corneal scarring. The mean duration of follow-up was 23 +/- 11.5 months. Topography-guided suture adjustment and selective suture removal were performed 2 to 6 weeks and after 3 months in eyes with more than 3 diopters of corneal astigmatism in patients who had continuous and interrupted sutures. Spectacle correction was administered for 86 eyes (83%), and contact lenses including rigid gas-permeable and scleral lenses were fitted in 18 eyes (17%) in patients who were unsatisfied with spectacle correction. Relaxing corneal incisions were performed in 23 eyes (22%), and toric intraocular lens implantations were performed in 34 eyes (33%) with cataracts. The mean topographic and absolute refractive astigmatism at the end of followup was 3.4 +/- 2.6 and 3.6 +/- 1.9 diopters. Conclusions: Topography-guided suture adjustment and selective suture removal are effective for minimizing early postoperative astigmatism. If significant astigmatism remains after suture removal, which cannot be corrected by optical means, then further surgical procedures including relaxing incisions and toric intraocular lens implantation can be performed.