Fakülteler / Faculties
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Item Clinical Practice Guidelines for The Diagnosis and Treatment of Cutaneous Leishmaniasis in Turkey(2018) Uzun, Soner; Gurel, Mehmet S.; Durdu, Murat; Akyol, Melih; Karaman, Bilge Fettahlioglu; Aksoy, Mustafa; Aytekin, Sema; Borlu, Murat; Dogan, Esra Inan; Dogramaci, Cigdem Asena; Kapicioglu, Yelda; Akman-Karakas, Ayse; Kaya, Tamer I.; Mulayim, Mehmet K.; Ozbel, Yusuf; Toz, Seray Ozensoy; Ozgoztasi, Orhan; Yesilova, Yavuz; Harman, Mehmet; https://orcid.org/0000-0003-1247-3932; 29663351; H-9068-2019Background Cutaneous leishmaniasis ( CL) is a vector- born parasitic disease characterized by various skin lesions that cause disfiguration if healed spontaneously. Although CL has been endemic for many years in the southern regions of Turkey, an increasing incidence in nonendemic regions is being observed due to returning travelers and, more recently, due to Syrian refugees. Thus far, a limited number of national guidelines have been proposed, but no common Turkish consensus has emerged. Objectives The aim of this study was to develop diagnostic and therapeutic guidelines for the management of CL in Turkey. Methods This guideline is a consensus text prepared by 18 experienced CL specialists who have been working for many years in areas where the disease is endemic. The Delphi method was used to determine expert group consensus. Initially, a comprehensive list of items about CL was identified, and consensus was built from feedback provided by expert participants from the preceding rounds. Results Evidence- based and expert- based recommendations through diagnostic and therapeutic algorithms according to local availability and conditions are outlined. Conclusion Because CL can mimic many other skin diseases, early diagnosis and early treatment are very important to prevent complications and spread of the disease. The fastest and easiest diagnostic method is the leishmanial smear. The most common treatment is the use of local or systemic pentavalent antimony compounds.Item Quantitative Evaluation of Macular Vessel Density Measurement by Optical Coherence Tomography Angiography in Patients with Inactive Ocular Sarcoidosis(2023) Gungor, Sirel Gur; Sezenoz, Almila Sarigul; Adwan, Noor; Gokgoz, Gulsah; Aksoy, Mustafa; Karadas, Mustafa; Colak, Meric; 0000-0001-6178-8362; 35404733; AAD-5967-2021Purpose To evaluate the macular vessel density (VD) in inactive ocular sarcoidosis (OS) and investigate the relationship between VD and both disease duration and visual acuity (VA). Methods This cross-sectional study was performed at a tertiary hospital. The macular VDs of patients with OS were obtained using optical coherence tomography angiography and compared with healthy subjects. Results Deep whole image macular VD (WI-MVD), parafoveal, and perifoveal VDs were lower in OS group (p = .01, p = .01, p = .02, respectively). Negative correlation between disease duration and both superficial and deep WI-MVD, parafoveal, and perifoveal VDs was obtained (for all p < .05). There was a positive correlation between VA and superficial VD (p < .001, r = 0.848 for WI-MVD). Conclusion OS affects deep VD significantly. Changes in superficial VD affect VA more. Disease duration is an important factor affecting macular VD.Item 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 The Diagnostic Ability of Ganglion Cell Complex Thickness-to-Total Retinal Thickness Ratio in Glaucoma in a Caucasian Population(2020) Sezenoz, Almila Sarigul; Gungor, Sirel Gur; Akman, Ahmet; Ozturk, Caner; Cezairlioglu, Sefik; Aksoy, Mustafa; Colak, Meric; 0000-0002-0294-6874; 0000-0002-7030-5454; 0000-0001-6178-8362; 0000-0003-1513-7686; 0000-0002-1507-8148; 32167260; AAA-4360-2021; AAJ-4860-2021; AAD-5967-2021Objectives: To evaluate the diagnostic accuracy of the macular ganglion cell complex-to-total retinal thickness (G/T) ratio in a Caucasian population. Materials and Methods: A total of 86 patients were enrolled in this cross-sectional study. Patients were divided into 4 groups: healthy; ocular hypertension; preperimetric glaucoma; and early glaucoma. Macular ganglion cell complex (mGCC) thickness, total retinal thickness, and retinal nerve fiber layer thickness (RNFLT) in one randomly selected eye of each patient were measured with measured with Heidelberg HD spectral domain optical coherence tomography (Heidelberg Engineering, Inc., Heidelberg, Germany). G/T ratio (%) was calculated as (mGCC thickness / total retinal thickness) x100. The ability of each parameter to diagnose glaucoma was examined by area under the receiver operating characteristic curve (AUROC) analysis and sensitivity evaluation at a fixed level of specificity. Unpaired t test was used to compare the measured values between the healthy subjects and the different patient groups. Results: The study included 9 healthy individuals, 18 patients with ocular hypertension, 28 with preperimetric glaucoma, and 31 with early glaucoma. Total retinal thickness, mGCC thickness, RNFLT, and G/T ratio were highest in the healthy group and decreased progressively in patients with ocular hypertension, preperimecric glaucoma, and early glaucoma. All comparisons between the groups were significant for these parameters (p<0.001 for all). Average RNFLT, average GCC, and total retinal thickness showed consistently higher AUROC than G/T ratio in the differentiation between healthy individuals and patients with ocular hypertension, preperimetric glaucoma, and early glaucoma. Conclusion: G/T ratio does not contribute to separation of ocular hypertension, preperimetric glaucoma, and early glaucoma patients from the healthy population. Compared to the other parameters investigated, G/T had lower diagnostic valueItem Changes in ocular biometric parameters after renal transplantation(2020) Aksoy, Mustafa; Asena, Leyla; Gungor, Sirel Gur; Soy, Ebru H. Ayvazoglu; Akman, Ahmet; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-0993-9917; 0000-0001-6178-8362; 0000-0002-6848-203X; 0000-0003-1513-7686; 32415655; AAJ-8097-2021; AAC-5566-2019; E-5914-2016; AAD-5967-2021Purpose This study aimed to investigate the changes in postoperative ocular biometric parameters in end-stage renal disease patients who underwent renal transplantation. Material and methods This retrospective study included a total of 33 eyes of 33 patients. The ocular biometric measurements which were evaluated were axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), corneal keratometry (K1 and K2), degree of astigmatism, lens thickness (LT), and intraocular pressure (IOP). Refractive prediction error (RE) was calculated before and after renal transplantation using the same diopter (D) for intraocular lens (IOL) power calculation and evaluated for potential cataract surgery. Results The study included 15 male (45%) and 18 female (55%) patients. Mean patient age was 31.55 +/- 8.24 (range: 18-49 years). In the comparison of preoperative and 1-month postoperative measurements, there was a statistically significant difference in AL, LT, ACD, and CCT (p < 0.001). There was no statistically significant difference between K1, K2, and astigmatism measurements (p = 0.72; p = 0.35; p = 0.62, respectively). There was no statistically significant difference in RE (p = 0.61-Holladay 2). Conclusion While renal transplantation surgery does not lead to significant changes in astigmatism, predicted refractive error, corneal keratometry, or intraocular pressure, it causes significant decrease in axial length, lens thickness, and central corneal thickness and significant increase in anterior chamber depth. However, these changes do not result in significant changes in IOL power calculation in planned cataract surgery.Item Choroidal Thickness After Dexamethasone Implant or Aflibercept in Patients with Diabetic Macular Edema Persistent to Ranibizumab(2020) Aksoy, Mustafa; Yilmaz, Gursel; Vardarli, Irfan; Akkoyun, Imren; 0000-0002-2589-7294; 0000-0003-1513-7686; 0000-0002-2860-7424; 32460600; AAK-6987-2021; AAK-7713-2021Purpose: This study aims to compare subfoveal choroidal thicknesses (SFCTs) after intravitreal dexamethasone (IVD) or intravitreal aflibercept (IVA) treatment in patients with persistent diabetic macular edema (DME) unresponsive to intravitreal ranibizumab (IVR). Methods: The study consisted of patients with DME unresponsive to IVR treatment in which 37 were administered 1 dose IVD (group A) and 34 patients who were administered 3 doses of IVA (group B), as well as 35 healthy individuals (group C). Detailed ophthalmological examination and optical coherence tomography parameters of group A and group B, including central retinal thickness and SFCT, were retrospectively evaluated before and after treatment. Results from preinjection, and 1, 2, and 3 months after injection were analyzed. Results of group A and group B were compared within themselves and also compared with group C. Results: SFCT measurements were compared within group A and group B (1 = preinjection; 2 = 1 month postinjection; 3 = 2 months postinjection; 4 = 3 months postinjection). There was significant thinning in SFCT between 1-2, 1-3, 1-4, 2-3, 2-4, and 3-4 time intervals within both group A and group B (both P < 0.001). Comparison of SFCT measurements showed preinjection, 1-, and 2-month values of group A were significantly thicker than those of group C (P < 0.001), whereas there was no significant difference between 3-month values (P = 0.09). Preinjection, 1-, and 2-month values of group B were significantly thicker than those of group C (P < 0.001), whereas there was no significant difference between 3-month values (P = 0.06). Conclusions: Three month follow-up showed thinning in SFCT measurements in patients with persistent DME unresponsive to IVR who were applied IVD or IVA treatment.Item CHANGES IN OCULAR BIOMETRIC PARAMETERS AFTER RENAL TRANSPLANTATION(2020) Aksoy, Mustafa; Asena, Leyla; Gungor, Sirel Gur; Soy, Ebru H. Ayvazoglu; Haberal, Mehmet A.Item Changes in Anterior Chamber Depth after Phacoemulsification in Pseudoexfoliative Eyes and their Effect on Accuracy of Intraocular Lens Power Calculation(2016) Gungor, Sirel Gur; Akman, Ahmet; Asena, Leyla; Aksoy, Mustafa; Sezenoz, Almila Sarıgul; 0000-0002-6848-203X; 0000-0002-7030-5454; 0000-0001-6178-8362; 0000-0003-1513-7686; 28050320; E-5914-2016; AAJ-4860-2021; AAD-5967-2021Objectives: To compare anterior chamber depth (ACD) changes after phacoemulsification surgery in patients with pseudoexfoliation syndrome (PEX) and normal patients using an anterior segment imaging method. Another aim of this study was to evaluate the effect of these changes on the accuracy of intraocular lens (IOL) power calculation and postoperative refraction. Materials and Methods: Twenty-two eyes of 22 patients with PEX and 30 eyes of 30 normal patients who underwent uneventful phacoemulsification surgery and IOL implantation were included in the study. The ACD of all patients was evaluated preoperatively and at 3 months postoperatively with the ALLEGRO Oculyzer (WaveLight (R) Oculyzer (TM) II, Alcon, Novartis)-Scheimpflug imaging system. Results: The postoperative mean ACD values were significantly larger than the preoperative ACD values in both groups (p < 0.001 for both groups). The pre- to postoperative change in ACD was 0.46 +/- 0.3 mm in the PEX group, which was a larger change than seen in the normal patients (0.12 +/- 0.1 mm) (p = 0.04). The mean absolute errors (MAE) calculated with different IOL formulas (SRK/T, Haigis, Hoffer and Holladay 1 formulas) were comparable and no statistically significant difference was observed between the two groups (p = 0.21). Conclusion: Phacoemulsification induces more significant ACD changes in patients with PEX compared to normal patients. However, the MAE did not differ significantly between the groups.Item İntravitreal ranibizumab enjeksiyonuna dirençli diyabetik maküler ödem tedavisinde intravitreal deksametazon implant enjeksiyonu veya intravitreal aflibercept enjeksiyonu uygulanmış olguların koroid kalınlıklarının incelenmesi(Başkent Üniversitesi Tıp Fakültesi, 2017) Aksoy, Mustafa; Akkoyun, İmrenÇalışmamızda, intravitreal ranibizumab (İVR) tedavisine dirençli diyabetik maküler ödemi (DMÖ) bulunan olgularda intravitreal deksametazon (İVD) veya intravitreal aflibercept (İVA) uygulanan hastaların subfoveal koroidal kalınlıklarının (SFKK) değerlendirilmesi ve tedavi seçeneklerine göre koroid kalınlıklarının karşılaştırılması amaçlanmıştır. Ayrıca olguların koroid kalınlıklarındaki değişimine göre görme keskinliği ve santral retinal kalınlık (SRK) ölçümlerindeki değişikliklerin korelasyonu incelenmiştir. Çalışmaya 6 doz İVR tedavisine dirençli DMÖ olan 52 hasta ve 25 sağlıklı birey dahil edildi. Yirmiyedi hastaya İVR sonrası İVA tedavisi uygulanırken, 25 hastaya İVR sonrası İVD tedavisi uygulandı. Hastaların detaylı oftalmolojik muayenesi yapıldı. Hastaların ve sağlıklı bireyden oluşan kontrol grubunun SFKK ölçümleri spektral domain enhaced depth imaging optik koherens tomografi (SD-EDI-OKT) (Heidelberg Spectralis, Heidelberg Engineering, Heidelberg, Germany) ile ölçüldü. Retrospektif değerlendirilen tıbbi kayıtlarda, İVD veya İVA enjeksiyonu öncesi ve sonrası fonksiyonel ve morfolojik bulgular, en iyi düzeltilmiş görme keskinliği (EİDGK), Goldmann applanasyon tonometri ile ölçülen göz içi basıncı (GİB), SD-OKT (Heidelberg Spectralis, Heidelberg Engineering, Heidelberg, Germany) ile saptanan SRK ölçümü, SD-EDI-OKT ile değerlendirilen SFKK ölçümü incelendi. Olguların İVD veya İVA enjeksiyonundan 1 gün önce ve enjeksiyon sonrası 1., 2. ve 3. aylardaki bulguları analiz edildi. İVD enjeksiyonu öncesi SFKK değerleri enjeksiyon sonrası değerler ile (2= 1. ay, 3=2. ay, 4=3. ay) karşılaştırıldığında 1/2, 1/3 ve 1/4 süreçleri arasından istatistiksel anlamlı fark bulunurken (p=0.0001), 2/3, 2/4 ve 3/4 süreçleri arasında anlamlı fark tespit edilmedi (p=0,0001; 0,0001; 0,006). İVA enjeksiyonu öncesi SFKK değerleri enjeksiyon sonrası değerler ile (2= 1. ay, 3=2. ay, 4=3. ay) karşılaştırıldığında 1/2, 1/3 ve 1/4 süreçleri arasında istatistiksel anlamlı fark görüldü (p=0.0001), ayrıca 2/3, 2/4 ve 3/4 süreçleri arasında da anlamlı fark bulundu (p=0,0001; 0,014; 0,0001). İVD enjeksiyon öncesi EİDGK değerleri (1) enjeksiyon sonrası değerler ile (2= 1. ay, 3=2. ay, 4=3. ay) karşılaştırıldığında 1/2, 1/3 ve 1/4 süreçleri arasında istatistiksel anlamlı fark bulundu (p=0.0001). Ayrıca enjeksiyon sonrası süreçte EİDGK karşılaştırıldığında 2/3, 2/4 ve 3/4 süreçleri arasında da anlamlı fark görüldü (p=0,0001; 0,0001; 0.032). İVA enjeksiyon öncesi EİDGK değerleri (1) enjeksiyon sonrası değerler ile (2= 1. ay, 3=2. ay, 4=3. ay) karşılaştırıldığında 1/2, 1/3 ve 1/4 süreçleri arasında istatistiksel anlamlı fark bulundu (p=0,0001; 0,0001; 0,0001). Ayrıca enjeksiyon sonrası süreçte 2/3 ve 2/4 süreçleri arasında da anlamlı fark görülürken (p=0,0001; 0,0001), 3/4 süreçleri arasında anlamlı fark görülmedi (p=0,057). İVD enjeksiyon öncesi SRK değerleri (1) enjeksiyon sonrası değerler ile (2= 1. ay, 3=2. ay, 4=3. ay) karşılaştırıldığında 1/2, 1/3 ve 1/4 süreçleri arasında istatistiksel anlamlı fark bulunurken (p=0.0001), 2/3, 2/4 ve 3/4 süreçleri arasında anlamlı fark görülmedi (p=0,9; 0,9; 1,0). İVA enjeksiyon öncesi SRK değerleri enjeksiyon sonrası değerler ile (2= 1. ay, 3=2. ay, 4=3. ay) karşılaştırıldığında 1/2, 1/3 ve 1/4 süreçleri arasında istatistiksel anlamlı fark bulunurken (p=0.0001), 2/3, 2/4 ve 3/4 süreçleri arasında anlamlı fark görülmedi (p=0,9; 0,9; 1,0). Sonuç olarak, çoklu İVR enjeksiyonlarına cevapsız DMÖ olgularının, İVD ve İVA enjeksiyonu sonrası 3 aylık takiplerinde SFKK’da istatistiksel anlamlı incelme, görme keskinliğinde istatistiksel anlamlı artış elde edilmiştir. SRK’daki azalma EİDGK’deki artış ile anlamlı korelasyon göstermektedir. SFKK enjeksiyon sonrası dönemde anlamlı incelmeye devam ederken SRK sabit kalmaktadır. Prospektif randomize daha uzun takipli çalışmalar bu verilere ışık tutacaktır. The purpose of the study was to evaluate the subfoveal choroidal thicknesses of patients with ranibizumab resistant diabetic macular edema (DME), treated with intravitreal dexamethasone (İVD) or intravitreal aflibercept (IVA) and to compare the subfoveal choroidal thickness (SFCT) after different treatments. Also, the correlation between choroidal thickness and change in visual acuity and central retinal thickness (CRT) was investigated. Fifty-two patients with resistant DME after 6 doses of intravitreal ranibizumab (IVR) and 25 healthy subjects were included in the study. Twenty-seven patients were administered IVA after IVR, 25 patients İVD treatment after IVR. Detailed ophthalmologic examinations of all patients were done. The SFCT of the patients and the control group with healthy subjects were measrued using spectral-domain enhanced depth imaging optical coherence tomography (SD-EDI OKT) (Heidelberg Spectralis, Heidelberg Engineering, Heidelberg, Germany). In the retrospectively evaluated medical records, the functional and morphological findings best corrected visual acuity (BCVA), intraocular pressure (IOP), CRT obtained by SD-OCT and SFCT obtained by SD-EDI OKT (Heidelberg Spectralis, Heidelberg Engineering, Heidelberg, Germany), before and after IVD or IVA were evaluated. The findings of the subjects 1 day before IVD or IVA injection and the findings at 1st, 2nd and 3rd months after injection were analyzed. When the SFCT values before IVD injection (1) and after IVD injection (2=1st month, 3=2nd month, 4=3rd month) were compared, the differences between 1/2, 1/3, 1/4 were found statistically significant (p=0.0001 for all). Also, statistically significant differences were found between 2/3, 2/4 and 3/4 periods (p=0,0001; 0,0001; 0,006 respectively). When the SFCT values before IVA injection (1) and after IVA injection (2=1st month, 3=2nd month, 4=3rd month) were compared, the differences between 1/2, 1/3, 1/4 were found statistically significant (p=0.0001 for all). Also, statistically significant differences were found between 2/3, 2/4 and 3/4 periods (p=0,0001; 0,014; 0,0001 respectively). When the BCVA values before IVD injection (1) and after IVD injection (2=1st month, 3=2nd month, 4=3rd month) were compared, the differences between 1/2, 1/3, 1/4 were found statistically significant (p=0.0001 for all). Also, statistically significant differences were found between 2/3, 2/4 and 3/4 periods (p=0,0001; 0,0001; 0.032 respectively). When the BCVA values before IVA injection (1) and after IVA injection (2=1st month, 3=2nd month, 4=3rd month) were compared, the differences between 1/2, 1/3, 1/4 were found statistically significant (p=0,0001; 0,0001; 0,0001 respectively). Also, statistically significant differences were found between 2/3, 2/4 periods (p=0,0001; 0,0001 respectively) while no significant difference was observed between 3/4 periods (p=0,057). When CRT values before IVD injection (1) and after IVD injection (2=1st month, 3=2nd month, 4=3rd month) were compared, the differences between 1/2, 1/3, 1/4 were significant (p=0.0001 for all), while no significant difference was observed between 2/3, 2/4 and 3/4 periods (p=0,9; 0,9; 1,0 respectively). When CRT values before IVA injection (1) and after IVA injection (2=1st month, 3=2nd month, 4=3rd month) were compared, the differences between 1/2, 1/3, 1/4 were significant (p=0.0001 for all), while no significant differences was obtanined between 2/3, 2/4 and 3/4 periods (p=0,9; 0,9; 1,0 respectively). In conclusion, in DME patients resistant to multiple IVR injections, both IVD and IVA injections lead to a decrease in SFCT and a significant increase in BCVA after 3 months of follow-up. Decrease in CRT shows a significant correlation with BCVA increase. While the decrease in SFCT continues, the CRT stabilizes. Our data should be supported with prospective randomized studies with longer follow up periods.