Fakülteler / Faculties
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Item Evaluation Of Gap Formation For Different Adhesive Agents In Primary Teeth With Optical Coherence Tomography(EUROPEAN ORAL RESEARCH, 2024-05-23) Uyar, Didem Sakaryali; Asena, Leyla; Tirali, Resmiye EbruPurpose This study aimed to evaluate gap formation between the tooth surface and restorative material in terms of microleakage by using optical coherence tomography (OCT) for self-etch and selective-etch applications of two different universal and one self-etch adhesives. Materials and Methods Sixty non-caries, primary molar teeth were divided into six groups; self-etch and selective-etch application ways of two different universal and one self-etch adhesive systems (n:10). After Class-V cavities were prepared, every tooth was distributed randomly in groups to apply adhesion procedure and then, all cavities were restored with polyacid-modified composite resin. Microleakage was evaluated by measuring the gap between the tooth surface and restoration by a blind researcher with Image J Software from OCT images. During statistical analysis, the significance level was accepted as p<0.05. Results According to the statistical analysis of the measurements obtained by Image J Software, selective-etch groups showed less gap formation than self-etch groups for each tested adhesive (p<0.05), and self-etch adhesive without etching showed significantly highest gap formation among all groups (p<0.05). Conclusion Universal adhesives with a selective-etching step might be preferred over self-etch adhesives for long-lasting polyacid-modified composite resin restorations in primary teeth. However, obtained results should be considered with another prospective clinical study for long-term prognosis.Item Comparison of Visual Performance and Quality of Life with A New Nondiffractive EDOF Intraocular Lens and A Trifocal Intraocular Lens(2023) Asena, Leyla; Dogan, Irem Kirci; Oto, Sibel; Altinors, Dilek Dursun; 0000-0003-0171-4200; 0000-0002-6848-203X; 0000-0002-5574-7318; 36700928; AAJ-4668-2021; E-5914-2016Purpose: To compare visual performance and quality of life (QoL) following bilateral implantation of a new nondiffractive extended depth-of-focus (EDOF) intraocular lens (IOL) and a trifocal IOL. Setting: Department of Ophthalmology, Baskent University Faculty of Medicine, Ankara, Turkey. Design: Prospective comparative interventional case series. Methods: 104 eyes of 52 patients with cataract, bilaterally implanted with a nondiffractive EDOF IOL or a trifocal IOL, were included. Outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), distance corrected intermediate visual acuity and distance corrected near visual acuity, defocus curves, QoL (Visual Function Index 14), quality of vision (Quality of Vision [QoV] index), contrast sensitivity (Pelli-Robson chart), and binocular reading speed. Results: Twenty-six patients were included in each group. The UDVA and CDVA were better in the EDOF group (0.05 +/- 0.04 and 0.01 +/- 0.04) than the trifocal group (0.13 +/- 0.06 and 0.11 +/- 0.07) (P=.02 and .01). Defocus curves showed that visual acuity was better with the EDOF IOL for vergences at 0.00, -0.50, and -1.00 and better with the trifocal IOL for vergences at -2.50, -3.00, -3.50, and -4.00. Contrast sensitivity scores were similar with both IOLs (P=.12). The overall mean QoL scores were lower in the EDOF group, indicating a better QoL (P=.04). The QoV was better in the EDOF group with significantly less glare, halos, and blurry vision (P<.01). Conclusions: The EDOF IOL performed better at distance, and the trifocal IOL performed better at near. Overall QoL and quality of vision were better with the EDOF IOL. Copyright (c) 2023 Published by Wolters Kluwer on behalf of ASCRS and ESCRSItem Ophthalmologic Examination and Echocardiography Should be the Essential Components of Candidemia Bundle(2023) Erol, Cigdem; Sari, Nuran; Yanik Yalcin, Tugba; Yesilkaya, Aysegul; Asena, Leyla; Gur Gungor, Sirel; Kurt Azap, Ozlem; 0000-0002-6848-203X; 0000-0001-5996-8639; 0000-0002-2535-2534; 0000-0001-6178-8362; 0000-0002-3171-8926; 0000-0002-3165-4520; 38633906; E-5914-2016; AAA-4708-2022; AAJ-1219-2021; AAD-5967-2021; AAK-4089-2021Objective: Candidemia is the most common form of invasive candidiasis, and it is associat-ed with end-organ involvement, prolonged hospitalization, increased mortality, and higher healthcare costs. Candidemia can lead to metastatic heart and ocular infections. This study aimed to define the incidence, characteristics, and mortality of candidemia episodes and compare the data with our center's previous results.Materials and Methods: In this single-center retrospective observational study, we enrolled 250 patients over 18 years diagnosed with candidemia between January 2015 and December 2020. We obtained patients' demographic, clinical, laboratory, and therapeutic data from medical records. An ophthalmologic examination and screening with echocardiography were carried out within the first week after candidemia diagnosis.Results: There were 275 candidemia episodes from 250 patients. The incidence of candidem-ia was 2.8/1000 admissions and 5.68/ 10,000 inpatient days, higher than our previous results (1.23/1000 and 3.29/10,000). The median age was 65 (interquartile range [IQR]=52-75) years. Malignancies were the most frequent comorbidity (50%). The most common type was Candida albicans (n=115, 41.8%). Candida glabrata (n=61, 22.2%) was common, particularly in surgical patients, patients with malignancy, and critically ill patients. There was Infectious disease consultation in 93.3% (257) episodes. The ophthalmoscopic examination was made in 145 episodes (52.7%), and ophthalmitis was detected in 16 (11.0%). Echocardiography was per-formed in 139 (50.5%) episodes; one case had an endocarditis diagnosis. The 30-day mortal-ity was 44.7% (n=123). Mortality rates in C. glabrata and Candida krusei infections were high-er (54.1% and 66.7). The factors related to mortality were intensive care unit requirement (p=0.0001), chronic liver disease (p=0.005), corticosteroid usage (p=0.0001), previous antibiotic usage (p=0.013), multiple antibiotic usage (p=0.020), and CVC related candidemia (p=0.010).Conclusion: Because of the life-threatening complications such as endocarditis, increased mortality rates, and higher healthcare costs, systematic and comprehensive candidemia bundle applications would be effective strategies for providing an effective antifungal stew-ardship program.Item Visual Rehabilitation After Penetrating Keratoplasty(2018) Asena, Leyla; Altinors, Dilek Dursun; Yilmaz, Gursel; Oto, Sibel; https://orcid.org/0000-0002-6848-203X; https://orcid.org/0000-0001-5223-0279; https://orcid.org/0000-0002-2589-7294; https://orcid.org/0000-0003-0171-4200; E-5914-2016; AAK-8077-2021; AAK-6987-2021; AAJ-4668-2021Item 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 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 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 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 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.