Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Clear Lens Phacoemulsification in Alport Syndrome: Refractive Results and Electron Microscopic Analysis of The Anterior Lens Capsule(2014) Bayar, Sezin Akca; Pinarci, Eylem Yaman; Karabay, Gulten; Akman, Ahmet; Oto, Sibel; Yilmaz, Gursel; https://orcid.org/0000-0001-5109-755X; https://orcid.org/0000-0003-0171-4200; https://orcid.org/0000-0002-2589-7294; 24170525; AAJ-2406-2021; AAJ-4668-2021; AAK-6987-2021Purpose: To report the ocular findings of patients with Alport syndrome and the results of clear lens extraction in this patient group. Methods: Twenty-three eyes of 15 patients with a diagnosis of Alport syndrome were included in this study. Clear corneal phacoemulsification and intraocular foldable lens implantation was performed in eyes with indeterminate refractive errors and/or poor visual acuity and anterior capsule samples were analyzed with electron microscopy. Results: All patients had a history of hereditary nephritis and/or deafness as systemic involvement. Ophthalmologic examination revealed anterior lenticonus with high myopia and/or irregular astigmatism in all patients. The mean best-corrected visual acuity (BCVA) was 0.67 +/- 0.17 logMAR (range 1.0-0.4) preoperatively and 0.17 +/- 0.08 logMAR (range 0.3-0.0) postoperatively. Postoperative refractive lenticular astigmatism dramatically decreased and no ocular complications arose during the follow-up period. Transmission electron microscopic analysis of the lens capsules supported the diagnosis of Alport syndrome. Conclusions: Clear lens phacoemulsification and foldable intraocular lens implantation is a safe and effective therapeutic choice for the management of uncorrectable refractive errors and low visual acuity due to anterior lenticonus in patients with Alport syndrome.Item Comparison of Intraocular Pressure Measurements Between Goldmann Applanation Tonometry and Reichert 7 Noncontact Tonometry(2015) Gungor, Sirel G.; Akman, Ahmet; Yazici, Ayse C.; 0000-0002-3132-242X; 0000-0001-6178-8362; 24145288; AAS-6810-2021; AAD-5967-2021Purpose:The aim of this study was to compare the Reichert 7 (R7) noncontact tonometry with Goldmann applanation tonometry (GAT) and to determine the influence of central corneal thickness (CCT) in these measurements in the healthy population.Design:A prospective cross-sectional study.Methods:Intraocular pressure (IOP) of the right eyes of 120 patients was measured with GAT and R7. All patients were free of glaucoma. All the measurements were carried out between 7 am and 9 am The measurements with the R7 were taken in the automatic mode. After 15 minutes, IOP with GAT was measured followed by pachymetry. The R7 provided a Goldmann-correlated IOP (IOPg) and a corneal-compensated IOP (IOPcc).Results:The mean age of the patients was 53.919.3 (range, 26 to 85 y). The male/female ratio was 0.9/1. When R7 measurements were compared with GAT measurements, R7 measurements (both IOPcc and IOPg) were significantly higher than GAT measurements (P0.001). Besides that, IOPcc was significantly higher than IOPg (P0.001). There was a significant positive linear relationship between IOPcc and GAT (r=0.761, P0.001), and similar relationship between IOPg and GAT (r(2)=0.739, P0.001). The mean CCT was 545.9 +/- 33.2 m (range, 476 to 634 m). A weak correlation was observed between CCT and GAT (r=0.196, P=0.032). There was a significant correlation between CCT and IOPg (r=0.283, P=0.02). The correlation between CCT and IOPcc was not statistically significant (r=0.123, P=0.179).Conclusions:IOP values of R7 are higher than GAT values. However, IOPg was observed more coherent to the GAT values than IOPcc. IOPcc should be an evaluation factor along with GAT or IOPg in glaucoma examination.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 Comparison of Keratometric Measurements Obtained by the Verion Image Guided System with Optical Biometry and Auto-Keratorefractometer(2017) Asena, Leyla; Gungor, Sirel Gur; Akman, Ahmet; 0000-0002-6848-203X; 0000-0001-6178-8362; 27271763; E-5914-2016; AAD-5967-2021The aim of this study was to compare the keratometric measurements of Verion Image Guided System with an optical biometer (Zeiss IOLMaster 500, Carl Zeiss Meditec, Jena, Germany) and an automated keratorefractometer (AKR) (Topcon KR-8900, Topcon, Japan). In this prospective clinical trial, the right eyes of 52 patients with cataract were examined (mean age 62.25 +/- 12.16 years). The measurements were taken by the three systems in a random order. Keratometric data, magnitude of astigmatism, and astigmatic axis measurements from all three instruments were compared. The results were evaluated using, intraclass correlation coefficients (ICC), Bland-Altman plots, and paired samples t tests. The mean flat/steep K of Verion, IOLMaster, and AKR were 43.22 +/- 1.38D/44.23 +/- 1.46D, 43.07 +/- 1.26D/44.05 +/- 1.34D, and 43.07 +/- 1.31D/43.89 +/- 1.42D, respectively. Flat K readings of Verion were higher than IOLMaster and AKR (p < 0.05 for both). Steep K readings were different for all three (p < 0.05). The magnitude of astigmatism by Verion and IOLMaster were 0.98 +/- 0.65D and 0.98 +/- 0.59D (p = 0.88). The mean astigmatism measured by the AKR was 0.82 +/- 0.62D, less than the other two instruments (p < 0.001). Astigmatic axis measurements of Verion and AKR differed < 10A degrees in 38, between 10A degrees and 20A degrees in 5, and > 20A degrees in 9 eyes; the same difference was 30, 11, and 11 eyes, respectively, between Verion and IOLMaster. Although, keratometric and astigmatic results obtained from Verion were not completely interchangeable with IOLMaster and AKR, especially the agreement between Verion and IOLMaster was excellent with ICCs close to one. However, there were pronounced astigmatic axis measurement differences between three instruments.Item Non-Contact and Contact Tonometry in Corneal Edema(2016) Gungor, Sirel Gur; Akman, Ahmet; Kucukoduk, Ali; Asena, Leyla; Simsek, Cem; Yazici, Ayse Canan; https://orcid.org/0000-0001-6178-8362; https://orcid.org/0000-0001-8024-4758; https://orcid.org/0000-0002-6848-203X; https://orcid.org/0000-0001-8003-745X; https://orcid.org/0000-0002-3132-242X; 26583789; AAD-5967-2021; E-5914-2016; N-8970-2018; AAS-6810-2021Purpose To compare the intraocular pressure (IOP) values by Goldmann applanation tonometry (GAT) and Reichert 7 CR noncontact tonometry (R7CR-NCT) in patients with postsurgical corneal edema and to examine the impact of postoperative corneal edema on these values. Methods Forty-six patients with grade 4 and 5 cataracts were included in this study. Intraocular pressure was measured using GAT and R7CR-NCT before and 1 day after phacoemulsification. Central corneal thickness (CCT) was determined before and after surgery to quantify postsurgical corneal edema. The R7CR-NCT provided a Goldmann-correlated IOP (IOPg) and corneal-compensated IOP (IOPcc). Results The CCT increased significantly 1 day after surgery (the mean preoperative CCT, 543.5 25.4 m; the mean postoperative CCT, 681.5 +/- 19.8 m; p < 0.001), a mean increase of 26.7%. The preoperative R7CR-NCT measurements (the mean IOPcc, 18.8 +/- 5.6 mm Hg; the mean IOPg, 17.8 +/- 4.5 mm Hg) were significantly higher than GAT measurements (the mean GAT-IOP, 16.0 +/- 3.4 mm Hg) (p < 0.001). On postoperative day 1, the R7CR-NCT measurement (the mean IOPcc, 27.0 +/- 9.8 mm Hg; the mean IOPg, 25.1 +/- 8.9 mm Hg) were significantly higher than GAT measurements (the mean GAT-IOP, 18.3 +/- 7.9 mm Hg) (p < 0.001). The difference between postoperative R7CR-NCT and GAT-IOP values were significantly higher than the difference between preoperative R7CR-NCT and GAT-IOP values (p < 0.001 for both IOPcc to GAT-IOP and IOPg to GAT-IOP). The difference between postoperative IOPcc and GAT-IOP was significantly correlated to the change in CCT (r = 0.526, p < 0.001). Similarly, the difference between postoperative IOPg and GAT-IOP was significantly correlated to the change in CCT (r = 0.536, p < 0.001). Conclusions The R7CR-NCT IOP values were high in patients with postsurgical intensive corneal edema. Consequently, the difference between R7CR-NCT IOP and GAT-IOP increased in edematous corneas.Item Comparison of The Mechanical Properties of The Anterior Lens Capsule in Senile Cataract, Senile Cataract with Trypan Blue Application, and Pseudoexfoliation Syndrome(2017) Simsek, Cem; Oto, Sibel; Yilmaz, Gursel; Altinors, Dilek Dursun; Akman, Ahmet; Gungor, Sirel Gur; https://orcid.org/0000-0001-8003-745X; https://orcid.org/0000-0003-0171-4200; https://orcid.org/0000-0002-2589-7294; https://orcid.org/0000-0001-5223-0279; https://orcid.org/0000-0001-6178-8362; 28917406; N-8970-2018; AAJ-4668-2021; AAK-6987-2021; AAK-8077-2021; AAD-5967-2021Purpose: To evaluate the elastic modulus, hardness, and mechanical properties of the anterior lens capsule in different types of cataract and to assess the correlation with age. Setting: Baskent University Hospital, Department of Ophthalmology, Ankara, Turkey. Design: Prospective comparative study. Methods: Patients were divided into 3 groups. Group 1 comprised patients with senile cataract, Group 2 patients had pseudoexfoliation (PXF) syndrome, and Group 3 patients had dye-enhanced cataract surgery. The capsules were analyzed using a nanoindentation device. Young's modulus of elasticity was measured by the Oliver-Pharr method and capsule hardness by the Martens method. Results: The study comprised 72 patients, 24 per group. The mean Young's modulus was 7.53 GPa +/- 1.07 (SD) in Group 1, 6.01 +/- 1.25 GPa in Group 2, and 8.12 +/- 0.98 GPa in Group 3. The capsules in Group 2 were more elastic than in Group 1 and Group 3 (P < .001). The capsules in Group 3 had lower elasticity than in Group 1, although the difference was not significant (P = .94). The mean capsule stiffness was 326.41 +/- 98.40 MPa in Group 1, 210.5 +/- 52.32 MPa in Group 2, and 315.54 +/- 163.15 MPa in Group 3. The lens capsules in Group 2 were less stiff than those in Group 1 and Group 3 (P < .001). Conclusions: Capsule thickness was positively correlated with increasing age in all groups. The anterior lens capsules of patients with PXF had more elasticity and less stiffness than the other groups. Intracameral trypan blue application had no effect on capsule elasticity and stiffness. (C) 2017 ASCRS and ESCRSItem Circumferential Ciliary Body Cysts Presenting as Acute Pigment Dispersion and Ocular Hypertension(2018) Sezenoz, Almila Sarigul; Gungor, Sirel Gur; Kiratli, Hayyam; Akman, Ahmet; 0000-0002-7030-5454; 0000-0001-6178-8362; 0000-0003-2100-4740; 28914584; AAJ-4860-2021; AAD-5967-2021Purpose: To report a case of circumferential neuroepithelial cyst of the ciliary body presenting with pigment dispersion (PD) and ocular hypertension. Case report: 48-year-old female patient presented with a complaint of pain in the left eye. On examination, visual acuity of the left eye was 0.9, and the intraocular pressure was 48 mmHg. Biomicroscopic anterior segment examination of the left eye revealed 4+ pigmented cells in the anterior chamber. Active PD from the pupillary region at 11 o'clock was noticed at the time of the examination. Ultrasound biomicroscopy demonstrated 360o cystic lesions of the ciliary body in the left eye. The patient was diagnosed as neuroepithelial cyst of the ciliary body. Conclusion: Our case is unique as it is the first case of circumferential neuroepithelial ciliary body cyst presenting with acute PD and ocular hypertension.Item Letter to the Editor: Peripapillary and Macular Vessel Density Measurement With Optical Coherence Angiography in Exfoliation Syndrome(2021) Gungor, Sirel Gur; Sezenoz, Almila Sarigul; Ozturk, Caner; Gokgoz, Gulsah; Akman, Ahmet; 0000-0002-4837-7937; 33273286; AAY-7932-2021Item Comparison of refractive outcomes using Scheimpflug Holladay equivalent keratometry or IOLMaster 700 keratometry for IOL power calculation(2021) Aksoy, Mustafa; Asena, Leyla; Gungor, Sirel Gur; Kucukoduk, Ali; Akman, Ahmet; 0000-0001-8024-4758; 33733281Purpose This study aims to compare postoperative refractive error results using Pentacam (Oculus Optikgerate GmbH) Holladay equivalent keratometry readings (EKR) or IOLMaster 700 (Carl Zeiss Meditec AG) keratometry (K) values in IOL power calculation. Material and methods This retrospective study included 54 eyes of 31 patients who underwent cataract surgery. Preoperative biometric measurements of all patients were obtained using IOLMaster 700 followed by Pentacam measurements. IOLMaster 700 K measurements on horizontal (K1) and vertical (K2) axes and EKR measurements on 2 mm (EKR2mm), 3 mm (EKR3mm) and 4.5 mm (EKR4.5 mm) corneal zones were recorded. EKR4.5 mm value and IOLMaster 700 K values were used in Holladay-II, SRK/T, Haigis, and Hoffer-Q formulas to calculate predictive refractive error (PRE). Absolute refractive error (ARE) was calculated as the absolute difference between actual postoperative refractive error (APRE) and PRE values. Results Mean age was 72.2 +/- 8.3 (51-87) years and mean IOL power was 21.5 +/- 2.9 D (18-23 D). There was no significant difference between PRE values when IOLMaster 700 K measurements and EKR4.5 mm K measurements were used in Holladay-II, SRK/T, Haigis, and Hoffer-Q formulas (p = 0.571, p = 0.833, p = 0.165, p = 0.347, respectively). There was no significant difference between APRE and ARE values (p = 0.124). According to mean ARE results, the closest estimate was achieved when the IOLMaster 700 K values were used in the Holladay-II formula (p = 0.271). Conclusion IOLMaster 700 K measurement and Pentacam EKR4.5 mm measurements can be used interchangeably. IOLMaster 700 K values yielded the most predictive measurement of the refractive result using the Holladay-II formula.Item Relationship between primary open angle glaucoma and blood pressure(2020) Yilmaz, Kerem Can; Gungor, Sirel Sur; Ciftci, Orcun; Akman, Ahmet; Muderrisoglu, Haldun; 0000-0002-9635-6313; 0000-0001-8926-9142; 30650042; AAG-8233-2020; W-5233-2018; AAJ-1331-2021Background: Glaucoma is commonly defined as high intra ocular pressure (>= 21 mmHg) with optic neuropathy characterised by progressive loss of retinal ganglion cells which is associated with characteristic structural damage to the optic nerve and visual field loss. There are several studies investigating relation between primary open angle glaucoma (POAG) and both systemic hypertension and especially night hypotension. Our aim was to compare 24-h ambulatory blood pressure variability of patients with glaucoma followed-up in the eye outpatient clinic with that of patients free of glaucoma. Methods: A total of 75 patients were included in the study, 35 in the patient group and 40 in the control group. Both groups were compared for daytime, night-time, and whole day mean systolic and diastolic blood pressure (BP) readings in the ambulatory blood pressure testing. Results: Mean daytime systolic BP of the glaucoma patients was 119.5 +/- 11.6 mmHg, and 128.3 +/- 15.5 mmHg for control group (p = 0.008). The night-time systolic blood pressure, whole day systolic BP, and mean diastolic BP were significantly lower in patients with glaucoma (p = 0.001, p = 0.001, p = 0.028, respectively). In multiple regression analysis, we identified daytime systolic BP, night-time systolic BP, and whole day systolic BP were independent risk factors for developing glaucoma. Conclusion: If the progression of the disease is noticeable in patients with glaucoma at follow-up, night-time hypotension should be ruled out with ambulatory blood pressure and if this is observed medical treatments used by the patients should be reviewed and necessary measures should be taken.