TR-Dizin İndeksli Açık & Kapalı Erişimli Yayınlar
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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 Atypical Intrapapillary Hemorrhage in a Patient with Glaucoma(2015) Gungor, Sirel Gur; Ozisik, Gulce Gokgoz; Akman, Ahmet; Asena, LeylaA 73-year-old man presented for routine follow-up. There were primary open-angle glaucoma, diabetes mellitus, and usage of acetylsalicylic acid in patient's history. Dilated fundus examination demonstrated cup hemorrhage in the right eye. Because of the progression of the superotemporal retinal nerve fiber layer defect in the last seven months, we think that the disk hemorrhage could be associated with glaucoma. (Turk J Ophthalmol 2015; 45: 77-8)Item Herpetic Keratouveitis and Trabeculectomy Failure during Infliximab Therapy in a Patient with Behcet's Disease(2016) Gungor, Sirel Gur; Asena, Leyla; Akman, Ahmet; Gokmen, Onur; 27800267A 51-year-old man was diagnosed with Behcet's disease in 2001. The patient was resistant to all immunosuppressive therapies. After 6 months of infliximab therapy, he presented to our clinic with pain and blurred vision in his right eye. The visual acuity was 20/200 and the intraocular pressure was 35 mmHg in the right eye. Biomicroscopic examination revealed corneal dendritic ulcers and 2+ cells in the anterior chamber in the right eye. The herpetic keratouveitis attack was controlled with antiviral therapy but the patient needed another glaucoma surgery. Trabeculectomy with mitomycin C was performed about halfway through an eight-week interval between two doses of infliximab.Item Retinal Nerve Fiber Layer Thicknesses in Three Different Optic Nerve Head Size Groups Measured by Cirrus Spectral Domain Optical Coherence Tomography(2016) Gungor, Sirel Gur; Akman, Ahmet; Kucukoduk, Ali; Colak, Meric; 27800261Objectives: To compare the retinal nerve fiber layer (RNFL) thicknesses in three different optic nerve head (ONH) size groups measured by Cirrus spectral domain optical coherence tomography (OCT). Materials and Methods: Between January and March 2013, 253 eyes of 253 healthy subjects were enrolled in this study (mean age: 42.7 perpendicular to 7.4 years [28-62 years]; 121 men and 132 women). The patients were divided into 3 groups according to ONH size: 77 patients in the "small ONH" group (ONH area < 1.63 mm(2)), 90 patients in the " medium ONH" group (ONH area 1.63-1.97 mm(2)), and 86 patients in the "large ONH" group (ONH area > 1.97 mm(2)). Results: There were significant differences in superior (p=0.008), inferior (p=0.004) and average RNFL thickness (p=0.001) between the small, medium and large ONH groups. Positive correlations between ONH size and inferior/ average RNFL thicknesses were significant but very weak (r=0.150, p=0.017 and r=0.157, p=0.013 respectively). Conclusion: RNFL thickness as measured by Cirrus OCT is positively correlated with ONH size and the differences in RNFL thickness were statistically significant between groups. This correlation and difference may be the result of a varying distance between the circular scan and the ONH margin.Item A Case of Lyme Disease Accompanied by Uveitis and White Dot Syndrome(2016) Gungor, Sirel Gur; Muftuoglu, Ilkay Kilic; Akova, Yonca Aydin; 0000-0001-6178-8362; 28058168; AAD-5967-2021In this case report we aimed to present a case of Lyme disease presenting as peripheral retinal vasculitis, intermediate uveitis and multifocal white dots in the posterior pole. The patient exhibited vitritis and snowball opacities in both eyes. A diagnosis of Lyme disease was made based on clinical, angiographic and laboratory findings. Fundus fluorescein angiography revealed optic nerve and retinal venous leakage as well as multiple hyperfluorescent foci in both eyes. The patient's symptoms and ocular findings significant improved after treatment with a combination of systemic antibiotics and steroids. Ophthalmologists should bear in mind that conditions presenting with uveitis and multifocal white dots may be related to Lyme disease.Item Prevalence of Split Nerve Fiber Layer Bundles in Healthy People Imaged with Spectral Domain Optical Coherence Tomography(2016) Gungor, Sirel Gur; Akman, Ahmet; Sezenoz, Almila Sarıgul; Tanriasik, Gulsah; 0000-0001-6178-8362; 0000-0002-7030-5454; 28050324; AAD-5967-2021; AAJ-4860-2021Objectives: The presence of retinal nerve fiber layer (RNFL) split bundles was recently described in normal eyes scanned using scanning laser polarimetry and by histologic studies. Split bundles may resemble RNFL loss in healthy eyes. The aim of our study was to determine the prevalence of nerve fiber layer split bundles in healthy people. Materials and Methods: We imaged 718 eyes of 359 healthy persons with the spectral domain optical coherence tomography in this cross-sectional study. All eyes had intraocular pressure of 21 mmHg or less, normal appearance of the optic nerve head, and normal visual fields (Humphrey Field Analyzer 24-2 full threshold program). In our study, a bundle was defined as 'split' when there is localized defect not resembling a wedge defect in the RNFL deviation map with a symmetrically divided RNFL appearance on the RNFL thickness map. The classification was performed by two independent observers who used an identical set of reference examples to standardize the classification. Results: Inter-observer consensus was reached in all cases. Bilateral superior split bundles were seen in 19 cases (5.29%) and unilateral superior split was observed in 15 cases (4.16%). In 325 cases (90.52%) there was no split bundle. Conclusion: Split nerve fiber layer bundles, in contrast to single nerve fiber layer bundles, are not common findings in healthy eyes. In eyes with normal optic disc appearance, especially when a superior RNFL defect is observed in RNFL deviation map, the RNLF thickness map and graphs should also be examined for split nerve fiber layer bundles.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 Corneal, Scleral, Choroidal, and Foveal Thickness in Patients with Rheumatoid Arthritis(2017) Akman, Ahmet; Gungor, Sirel Gur; Gokmen, Onur; Yesilirmak, Nilufer; Yucel, Ahmet Eftal; Yesil, Hilmi; Yildiz, Fatih; Sise, Adam; Diakonis, Vasilios; 29326847; I-6542-2012Objectives: To investigate corneal, scleral, choroidal, and foveal thicknesses in female patients with rheumatoid arthritis (RA) and compare them with healthy subjects. Materials and Methods: This prospective study included consecutive female patients diagnosed with RA and healthy subjects. Corneal, scleral, choroidal, and retinal (foveal) thicknesses were obtained by using optical coherence tomography and a comparison was performed between groups for all outcome measures. Results: Thirty-six eyes of 36 female patients diagnosed with RA (group 1) and 36 eyes of 36 healthy female volunteers (group 2) were included. Mean corneal, scleral, choroidal thicknesses and retinal thickness at the fovea of group 1 were 543.3 +/- 33.7 mu m, 343.7 +/- 42.2 mu m, 214.6 +/- 50, and 213.5 +/- 18.9 mu m, respectively; in group 2, these values were 549.9 +/- 29.6 mu m, 420.9 +/- 42.4 mu m, 206.4 +/- 41.9 mu m, and 222 +/- 15.5 mu m, respectively. The comparison between group 1 and 2 with respect to corneal, choroidal, and foveal thicknesses did not reveal statistical significant differences (p>0.05). On the contrary, there was a statistically significant difference with respect to scleral thickness between the groups, with the RA patients demonstrating a thinner scleral layer (p<0.001). Conclusion: Female patients with RA seem to demonstrate statistically significant scleral thinning when compared with healthy subjects, while there was no difference concerning corneal, choroidal, and foveal thickness.Item Are All Retinal Nerve Fiber Layer Defects on Optic Coherence Tomography Glaucomatous?(2017) Gungor, Sirel Gur; Akman, Ahmet; 0000-0001-6178-8362; 29109895; AAD-5967-2021Objectives: In this study, we investigated the patients who were referred to our clinic with a prediagnosis of glaucoma based on retinal nerve fiber layer (RNFL) defects on optic coherence tomography (OCT) but were determined to have nonglaucomatous RNLF defects upon detailed examination. Materials and Methods: The ophthalmic examination notes, OCT images, Heidelberg retinal tomography (HRT) II and fundus photographs of 357 patients were retrospectively evaluated. Final diagnoses of these patients were investigated. Results: Of the 357 patients, 216 (60.5%) were diagnosed as open angle glaucoma, 33 (9.2%) as low-tension glaucoma, 39 (10.9%) as pre-perimetric glaucoma. The ophthalmic examinations of 14 patients (3.9%) were normal and there were no RNFL defects in OCT examinations after dilatation. In 39 patients (10.9%), the ophthalmic and optic disc examinations were completely normal and no etiologic factor explaining RNFL defects was found. Twenty-two eyes of 16 patients (4.5%) were included in this study (the mean age was 53.8 +/- 11.5 years; 9 men and 7 women). After detailed questioning of the medical history and systemic and neurologic examinations, a diagnosis of ischemic optic neuropathy was made in 11 eyes (10 patients) (2.8%), optic neuritis in 3 eyes (2 patients) (0.6%), optic disc drusen in 4 eyes (2 patients) (0.6%), pseudotumor cerebri in 2 eyes (1 patient) (0.3%), and cerebral palsy in 2 eyes (1 patient) (0.3%). Conclusion: Decrease in RNFL thickness on OCT images alone may be misleading in glaucoma examination. In cases where optic disc cupping is not evident, diagnosis should not be based on OCT RNFL examinations alone, and the patient's medical history, detailed ophthalmic examination, OCT optic disc parameters, HRT, and visual field tests should all be carefully evaluated together.