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Öğe Corneal Thickness During Corneal Collagen Cross-Linking with Isotonic Riboflavin Solution without Dextran(Turkish Ophthalmological Soc, 2014) Oltulu, Refik; Donbaloglu, Meryem; Satirtav, Gunhal; Zengin, Nazmi; Ozkagnici, AhmetObjectives: To monitor the corneal thickness change during the dextran-free isotonic riboflavin solution-aided corneal collagen cross-linking procedure in keratoconus patients. Materials and Methods: Corneal thickness measurements during the corneal collagen cross-linking (CXL) treatment for progressive keratoconus were evaluated. The corneal thickness measurements were obtained with ultrasonic pachymetry device at five different time points: 0, 15, and 30 minutes after epithelial removal and 15 and 30 minutes after the initiation of UVA irradiation. Results: Twenty-four eyes of 24 patients with progressive keratoconus were included in the study. The thinnest pachymetric values obtained at the 0, 15, and 30 minute measurements after corneal deepithelisation were 409.38 +/- 10.43 mu m (383-435 mu m), 434.56 +/- 17.68 mu m (400-485 mu m), and 457.44 +/- 21.78 mu m (428-516 mu m), respectively. Pachymetric values obtained at 15 and 30 minutes after UVA application to the cornea were 471.69 +/- 23.38 mu m (439-526 mu m) and 482.63 +/- 23.69 mu m (436-524 mu m), respectively. The gradual increase was found to be statistically significant when each measurement was compared with the previous values (p < 0.001). Conclusion: We found that the corneal thickness was not decreased during the CXL with dextran-free isotonic riboflavin solution; on the contrary, corneal thickness was increased regularly during the procedure.Öğe Effect of Eye Rubbing on Corneal Biomechanical Properties and Intraocular Pressure(Turkish Ophthalmological Soc, 2014) Oltulu, Refik; Donbaloglu, Meryem; Satirtav, Gunhal; Okka, Mehmet; Ozkagnici, AhmetObjectives: To determine whether corneal biomechanical properties and intraocular pressure (IOP) are affected by eye rubbing. Materials and Methods: Healthy individuals, aged between 15 and 50 years, without any ocular pathological signs were included. Corneal biomechanical parameters, Goldmann-equivalent intraocular pressure (IOPg), corneal-compensated intraocular pressure (IOPcc), corneal resistance factor (CRF), and corneal hysteresis (CH) values were measured using an ocular response analyzer (ORA). Measurements were taken at baseline and immediately after 30 seconds of eye rubbing. ORA parameters before and after eye rubbing were analyzed using student's t test. A p-value less than 0.05 was considered statistically significant. Results: We included eighty-one eyes of 53 individuals with a mean age of 32 +/- 10.11(15-50) years. Before eye rubbing, the mean measurement values were as follows: CH 10.93 +/- 1.69 mmHg, CRF 10.82 +/- 1.78 mmHg, IOPg 15.76 +/- 3.18 mmHg, and IOPcc 15.74 +/- 2.69 mmHg. The mean values after eye rubbing were: CH 11.11 +/- 1.52 mmHg, CRF 10.54 +/- 1.56 mmHg, IOPg 14.32 +/- 3.10 mmHg, and IOPcc 14.20 +/- 2.77 mmHg. The decrease in CRF, IOPg, and IOPcc was statistically significant, while the change in CH was found to be statistically insignificant. Conclusion: CRF, IOPg, and IOPcc decreased significantly after eye rubbing and this should be considered before taking any ORA measurements and interpreting the results.Öğe Granulomatous Anterior Uveitis, Internal Ophthalmoplegia, and Retinal Vasculitis During Chickenpox Disease in A Child(Turkish Ophthalmological Soc, 2013) Donbaloglu, Meryem; Bozkurt, Banu; Kerimoglu, Hurkan; Ozturk, Banu TurgutHerein, we report the case of a patient who had granulomatous anterior uveitis, internal ophthalmoplegia, and retinal vasculitis during chickenpox disease. A 9-year-old girl was admitted to our clinic with blurred vision and hyperemia in the right eye. Corrected visual acuity was 20/20 in both eyes. Direct/indirect pupillary reactions were negative in the right eye and pupil was dilated. Biomicroscopic examination revealed middle-sized granulomatous keratic precipitates and a severe anterior chamber reaction. Fundus examination was normal. As there were red papules all over the body she was diagnosed as anterior uveitis secondary to chickenpox and systemic/topical acyclovir, topical steroid, antihistaminic suspension, isolation, and follow-up were recommended. On day 6, anterior chamber inflammation decreased remarkably, whereas a salt-pepper appearance was observed in the retina. On day 10, a perivascular sheathing was observed, which regressed after 1 month, and her medications were slowly tapered and discontinued. Although anterior uveitis is a common finding after chickenpox, the occurrence of three different involvements is very rare.Öğe Intraocular lens explantation or exchange: indications, postoperative interventions, and outcomes(Consel Brasil Oftalmologia, 2015) Oltulu, Refik; Ersan, Ismail; Satirtav, Gunhal; Donbaloglu, Meryem; Kerimoglu, Hurkan; Ozkagnici, AhmetPurpose: To analyze the indications for explantation or exchange of intraocular lenses (IOLs), which were originally implanted for the correction of aphakia during cataract extraction. Methods: All cases that involved intraocular lens explantation or exchange in one institution between January 2008 and December 2014 were analyzed retrospectively. Results: In total, 93 eyes of 93 patients were analyzed. The median time interval between implantation and explantation of the anterior chamber intraocular lenses (AC IOL) and posterior chamber intraocular lenses (PC IOL) was 83.40 +/- 83.14 months (range: 1-276 months) and 55.14 +/- 39.25 months (range: 1-168 months), respectively. Pseudophakic bullous keratopathy (17 eyes, 38.6%) and persistent iritis (12 eyes, 27.8%) in the AC IOL group and dislocation or decentration (30 eyes, 61.2%) and incorrect IOL power (nine eyes, 18.4%) in the PC IOL group were the most common indications for explantation of IOLs. The mean logMAR best corrected visual acuity (BCVA) improved significantly from 1.30 preoperatively to 0.62 postoperatively in the PC IOL group (p<0.001) but did not improve significantly in the AC IOL group (p=0.186). Conclusions: The primary indication for IOL explantation or exchange was pseudophakic bullous keratopathy in the AC IOL group and was dislocation or decentration in the PC IOL group. PC IOL explantation or exchange is safe and improves visual acuity.Öğe Intraoperative Corneal Thickness Monitoring During Corneal Collagen Cross-Linking With Isotonic Riboflavin Solution With and Without Dextran(Lippincott Williams & Wilkins, 2014) Oltulu, Refik; Satirtav, Gunhal; Donbaloglu, Meryem; Kerimoglu, Hurkan; Ozkagnici, Ahmet; Karaibrahimoglu, AdnanPurpose: The aim of this study was to analyze and compare corneal thickness changes during corneal collagen cross-linking procedures performed with isoosmolar riboflavin solution with 20% dextran and without dextran in corneal ectatic diseases. Methods: The patients in this study were analyzed in 2 groups: group 1 receiving riboflavin solution containing 20% dextran and group 2 receiving dextran-free riboflavin solution. Corneal thickness measurements were obtained with ultrasonic pachymetry at 6 different time points: preoperatively and at 0, 15, 30, 45, and 60 minutes after epithelial removal and initiation of ultraviolet A irradiation. Results: Twenty-seven eyes of 27 patients with progressive keratoconus were included in the study. In group 1 (n = 13), the mean preoperative thinnest pachymetric readings were 469.3 +/- 8.5 mu m, which decreased to 423.8 +/- 8.9 mu m after deepithelization and further decreased to 385.9 +/- 10.9 mm at 15 minutes. The corneal thickness assumed a steady course at the 30-, 45-, and 60-minute measurements (378.9 +/- 9.8 mu m, 384.5 +/- 10.5 mu m, and 396.7 +/- 9.4 mu m, respectively). The initial change was statistically significant (P < 0.01). In group 2 (n = 14), the corneal thickness decreased from 459.4 +/- 3.8 mu m to 414.7 +/- 2.6 mu m with deepithelization, after which it increased steadily with the initiation of the dextran-free riboflavin solution. The final measurement in group 2 was 474.1 +/- 9.4 mu mm; the increase at each time point was statistically significant when compared with the previous measurement (P < 0.01). Conclusions: Using isoosmolar riboflavin solution without dextran causes a steady increase in the corneal thickness during the cross-linking procedure, as opposed to riboflavin with dextran. This result might be beneficial in broadening the spectrum of cross-linking indications in patients with thin corneas.Öğe Relationship of inferior oblique overaction to macular and subfoveal choroidal thickness(Mosby-Elsevier, 2015) Ersan, Ismail; Oltulu, Refik; Altunkaya, Orhan; Satirtav, Gunhal; Arikan, Sedat; Donbaloglu, Meryem; Ozkagnici, AhmetPURPOSE To evaluate the macular and subfoveal choroidal thickness of eyes with inferior oblique muscle overaction (IOOA) using enhanced depth imaging spectral domain optical coherence tomography (EDT SD-OCT). METHODS The measurements of macular and subfoveal choroidal thickness obtained by EDI SD-OCT of patients with IOOA (24 patients) were compared with those of age- and sex-matched controls (25 subjects). RESULTS There were no morphological abnormalities of the macula in patients with IOOA or in control subjects. There were no statistically significant differences in macular and subfoveal choroidal thickness between the eyes with IOOA and the eyes of the control subjects (P > 0.05). When the patients with IOOA were assigned to two distinct groups according to the degree of IOOA, the macular thickness did not differ between groups (P = 0.66), whereas subfoveal choroidal thickness measures were significantly lower in eyes with severe IOOA compared to eyes of the controls (P = 0.01). CONCLUSIONS IOOA has no effect on the morphology and the thickness of the macula. Severe IOOA seems to be related to thinning of subfoveal choroid due to possible external mechanical effect.Öğe RELATIONSHIP OF INFERIOR OBLIQUE OVERACTION TO MACULAR AND SUBFOVEAL CHOROIDAL THICKNESS REPLY(Mosby-Elsevier, 2016) Ersan, Ismail; Oltulu, Refik; Altunkaya, Orhan; Satirtav, Gunhal; Arikan, Sedat; Donbaloglu, Meryem; Ozkagnici, Ahmet[Abstract Not Availabe]Öğe Six-month outcomes of corneal crosslinking with dextran-free isotonic riboflavin solution(Consel Brasil Oftalmologia, 2016) Oltulu, Refik; Satirtav, Gunhal; Donbaloglu, Meryem; Gunduz, Mehmet Kemal; Lu, Hurkan Kerimog; Okka, Mehmet; Ozkagnici, AhmetPurpose: To analyze the short-term clinical and topographic outcomes in patients with keratoconus after corneal collagen cross-linking treatment (CXL) with dextran-free isotonic riboflavin solution. Methods: In this retrospective case series, 26 eyes from 26 patients with keratoconus were studied. The best corrected visual acuity (BCVA) and refractive and topographic findings were analyzed at a 6-month follow-up. Results: The mean BCVA (Snellen lines) values before and 1, 3, and 6 months after CXL were 0.51 +/- 0.2, 0.48 +/- 0.2, 0.57 +/- 0.2, and 0.64 +/- 0.2, respectively, and the difference between the preoperative and 6-month values was statistically significant (p=0.006). The mean spherical equivalent refraction decreased from -5.6 +/- 2.4 diopters (D) preoperatively to -5.0 +/- 2.1 D, and mean simulated keratometry decreased from 48.5 +/- 2.5 D to 47.8 +/- 2.6 D at 6 months. (p=0.145 and p=0.001, respectively). In addition, the maximum keratometry decreased progressively and significantly from the preoperative value during follow-up (p=0.003). The central and minimal corneal thicknesses, including those of the epithelium, also decreased from 442.8 +/- 25.6 mu m and 430.5 +/- 23.9 mu m preoperatively to 420.7 +/- 31.8 mu m and 409.3 +/- 28.7 mu m at the most recent follow-up (p<0.001), respectively. No intraoperative or postoperative complications were observed. Conclusions: CXL with dextran-free isotonic riboflavin solution appears to be a safe treatment alternative for keratoconus and yields sustained short-term improvements in visual acuity, keratometric readings, and corneal thickness. However, long-term results are needed to confirm these outcomes.Öğe Unilateral Recurrent Anterior Uveitis as the Presenting Sign of Bladder Carcinoma(Turkish Ophthalmological Soc, 2016) Satirtav, Gunhal; Donbaloglu, Meryem; Oltulu, Refik; Oltulu, Pembe; Kerimoglu, Hurkan; Ozkagnici, AhmetA 79-year-old male patient was followed for unilateral uveitis with 3 attacks in 10 months, despite initial improvement with steroid therapy. The patient had visual acuity (VA) of counting fingers in right eye, hypopyon and vitritis with no chorioretinal lesions. The left eye was normal. The patient was evaluated for intraocular foreign body, intraocular lymphoma and associated systemic disease and malignancy. Computed tomography of the abdomen showed a mass in the bladder. Biopsy confirmed bladder carcinoma. After resection of the mass, intraocular inflammation improved completely and no attack was noted in the follow-up. In his last examination, two years after the operation, VA was light perception; seclusio pupilla and mature cataracts were seen on biomicroscopy. There was no sign of vitritis on ocular ultrasonography. Evidence is discussed that suggests a link and potential etiology between refractory uveitis with hypopyon and bladder carcinoma. This is the first case of unilateral recurrent uveitis with hypopyon as the initial presenting sign of bladder carcinoma.
