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Ankilozan spondilit ile ilişkili üveit olgularında klinik seyir ve bulgular
(2013) Oltulu, Refik; Yumak Erkoç, Hanife; Şatırtav, Günhal; Okka, Mehmet
Amaç: Ankilozan spondilit (AS) ile ilişkili üveit tanısı almış olguların klinik seyir ve bulgularının incelenmesi Yöntemler: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Göz Hastalıkları Anabilim Dalı, uvea birimi tarafından Mayıs 2009-Haziran 2012 tarihleri arasında AS ile ilişkili üveit tanısı almış olgular retrospektif olarak incelendi. Olguların sosyodemografik ve klinik özellikleri değerlendirildi. Bulgular: Toplam 13 hastanın 17 gözü çalışmaya dahil edildi. Olgular dokuz erkek (%69,2), dört kadından (%30,8) oluşmakta idi. Ortalama başvuru yaşları 38,549,61(28-63) yıl idi. Dört olguda iki taraflı tutulum (%30,8) tespit edildi. İzlem süreleri 17,4611,86 ay (3-36 ay) idi. Ortalama atak sayısı 1,150,37(1-2) idi. Üç gözde (%17,6) ön üveite eşlik eden arka segment bulguları izlendi. Bir olguda (%7,7) arka yapışıklık, bir olguda (%7,7) katarakt, iki olguda (%15,4) kistoid makula ödemi, bir olguda epiretinal membran (%7,7) tespit edildi. Hastaların sonuç görme keskinlikleri ortalama 0,9750,07 (0,2-1,0) olarak izlendi. Sonuç: AS ile ilişkili ön üveit olgularında zamanında ve doğru bir yaklaşım tarzı ile prognoz iyidir. Bu olgularda arka segment komplikasyonlarının da gelişebileceği unutulmamalı, tedavi ve takipleri romatoloji kliniği ile işbirliği içinde yapılmalıdır.
Assessment of Monocyte/HDL Ratio in Branch Retinal Vein Occlusion
(Taylor & Francis Inc, 2020) Satirtav, Gunhal; Mirza, Enver; Oltulu, Refik; Mirza, Gunsu Deniz; Kerimoglu, Hurkan
Purpose: The purpose of this article was to evaluate monocyte count and high-density lipoprotein (HDL) cholesterol levels and their ratio (monocyte/HDL ratio [MHR]) in patients with branch retinal vein occlusion (BRVO). Materials and Methods: A total of 50 participants were included in the study. Participants were divided into two groups: Twenty-five patients diagnosed with BRVO and 25 participants as the control group. Ocular examination findings and hematologic parameters were accessed from the file records and database, retrospectively. Results: The mean MHR was significantly higher in BRVO group compared to the control group (13.4 +/- 5.2 vs. 8.1 +/- 2.2, p < 0.001). In receiver operating characteristics analysis, the area under the curve for MHR was 0.862, and an MHR of >9.5 predicted BRVO with a sensitivity of 76% and specificity of 70.8%. Conclusion: The present study showed that elevated MHR is significantly associated with BRVO. Therefore, MHR may be a useful marker for the emergence of BRVO.
Assessment of Ocular Surface in Patients With Ankylosing Spondylitis
(Lippincott Williams & Wilkins, 2020) Oltulu, Refik; Turk, Huseyin Bugra; Oltulu, Pembe; Turk, Nazli; Satirtav, Gunhal; Gunduz, Mehmet Kemal
Purpose: To evaluate the clinical findings and ocular surface changes in patients with ankylosing spondylitis (AS). Methods: This prospective study involved 45 patients with AS (group 1) and 28 healthy subjects (group 2). Patients in group 1 were in the inactive period. The study subjects underwent a complete ophthalmic examination. The right eyes of the subjects in each group were tested for the study including slit-lamp examination, Schirmer I test, tear break-up time (TBUT), conjunctival impression cytology (CIC), and ocular surface disease index (OSDI). Results between the two groups were compared. Results: The mean Schirmer I test result was found as 12.2 +/- 8 mm in group 1 and 20.3 +/- 9.9 mm in group 2 (P<0.001), whereas the mean TBUT value was found as 3.8 +/- 1.9 sec in group 1 and 10.1 +/- 4.8 sec in group 2 (P<0.001). The OSDI scores were significantly higher in group 1 (36.5 +/- 19.4) than in group 2 (9.1 +/- 12.9, P<0.001). The CIC scores were significantly higher in group 1 (2.12 +/- 0.7) than in group 2 (0.57 +/- 0.6, P<0.001). Notably, none of the patients in group 1 showed grade 0 differentiation, and none of the patients in group 2 showed grade 2 or 3 differentiation. The CIC scores were significantly higher in group 1 (2.12 +/- 0.7) than in group 2 (0.57 +/- 0.6, P<0.001). Conclusion: Ocular surface changes, including squamous metaplasia in the bulbar conjunctiva, can be observed in patients with AS.
The Association of Cataract and Lens Epithelial Cell Apoptosis in Patients with Pseudoexfoliation Syndrome
(Taylor & Francis Inc, 2018) Oltulu, Pembe; Oltulu, Refik
Purpose: The aim of this study was to measure the density of apoptotic lens epithelial cells (LECs) and to determine its association with cataract formation in eyes with pseudoexfoliation syndrome (PEX). Materials and Methods: Twenty-one eyes of 21 patients diagnosed with PEX without glaucoma (Group 1) and 22 eyes of 22 subjects without PEX (Group 2) were enrolled in this study. During cataract surgery, anterior capsule samples were obtained by the 5.5mm continuous curvilinear capsulorhexis method. Apoptosis was determined with a TUNEL kit (Boster, Wuhan, China) according to the manufacturer's protocol. Four fields in each pathology preparation were chosen randomly under a microscope, and 100 cells were counted in each field to calculate the apoptosis rates. Results: Forty-three eyes of 43 subjects were enrolled in this study. There were no significant differences in age or sex between the two studied groups (p > 0.05). Under a microscope, the LECs were stained light blue and their nuclei were oval shaped. Positive stained cells were found occasionally in Group 2, while a significant amount of black-brown positively stained LECs with condensed nuclei was found in Group 1. The apoptosis rates were 35.2 +/- 2.1% and 14.1 +/- 1% in Groups 1 and 2, respectively. The proportion of positively stained LECs was higher in Group 1 (p < 0.001). Conclusion: Our study suggests that apoptosis in LECs is the pathophysiological mechanism for the higher rate of cataracts in PEX patients, in addition to the ocular ischemia hypothesis.
Characteristics of the cornea in patients with pseudoexfoliation syndrome
(Consel Brasil Oftalmologia, 2015) Oltulu, Refik; Satirtav, Gunhal; Kayitmazbatir, Emine Tinkir; Bitirgen, Gulfidan; Ozkagnici, Ahmet; Karaibrahimoglu, Adnan
Purpose: To quantify the morphological alterations in corneal nerve fibers and cells in patients with pseudoexfoliation syndrome (PEX) and their relationship with the presence of hyperreflective endothelial deposits observed using in vivo confocal microscopy. Methods: One eye each of 37 patients with PEX and 20 age-matched healthy control subjects was evaluated by in vivo corneal confocal microscopy. Patients with PEX were further classified into two groups: those with and without hyperreflective endothelial deposits. We evaluated the densities of basal epithelial cells, anterior and posterior stromal keratocytes, and endothelial cells and structure of sub-basal nerve fibers. Results: The mean anterior and posterior stromal keratocyte and endothelial cell densities and corneal sub-basal nerve plexus variables were significantly lower in patients with PEX compared with those in healthy control subjects. The mean basal epithelial cell density did not significantly differ. Conclusion: Eyes with PEX presented decreased corneal sub-basal nerve plexus variables and cell densities in all corneas, except for the mean basal epithelial cell density. Further, a trend of lower corneal sub-basal nerve plexus measurements in patients with hyperreflective endothelial deposits compared with those without endothelial deposits was observed.
Conjunctival Impression Cytology and Dry Eye in Patients With Ulcerative Colitis: A Pilot Study
(Lippincott Williams & Wilkins, 2018) Oltulu, Pembe; Oltulu, Refik; Asil, Mehmet; Satirtav, Gunhal; Mirza, Enver
Purpose: The aim of this study was to compare signs of dry eye between ulcerative colitis (UC) patients and healthy subjects. Methods: Fifteen patients with UC (group 1) and 15 healthy subjects (group 2) were enrolled in this study. Tear volume measurement, Schirmer-I test with no anesthetic, tear break-up time, and conjunctival impression cytology (CIC) were evaluated in both groups. Results: Patients with UC showed lower tear volumes when compared with healthy subjects (P<0.05). There was a statistically significant difference in distribution of CIC grades between groups 1 and 2 (P<0.05). Tear break-up time and Schirmer-I measurements were significantly lower in group 1 compared with group 2 (P<0.05). Conclusions: The results of this study indicate that UC is associated with demonstrable disturbances in tear function and conjunctival cytology.
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, Ahmet
Objectives: 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.
Dekstransız İzotonik Riboflavin Solüsyonu ile Yapılan Kornea Kollajen Çapraz Bağlama Uygulaması Sırasında Kornea Kalınlığı
(2014) Oltulu, Refik; Donbaloğlu, Meryem; Şatırtav Akdeniz, Günhal; Zengin, Nazmi; Özkağnıcı, Ahmet
Amaç: Dekstransız izotonik riboflavin solüsyonu ile yapılan kornea kollajen çapraz bağlama (KKÇB) uygulamasında kornea kalınlığının takip edilmesi. Gereç ve Yöntem: Progresif keratokonus olgularına uygulanan KKÇB uygulaması sırasında kornea kalınlığı değerlendirildi. Her olgunun sırası ile kornea epiteli kazındıktan sonra: 0., 15. ve 30. dakikalarda, Ultraviole A (UVA) uygulama sırasında 15. ve 30. dakikalarda santral kornea kalınlığı ultrasonik pakimetri cihazı ile ölçüldü. Bulgular: Progresif keratokonusu olan 24 olgunun 24 gözü çalışmaya dahil edildi. Ortalama en ince pakimetrik değer, kornea epiteli kazındıktan sonra 0., 15. ve 30. dakikalarda sırasıyla 409,3810,43 ?m (383-435 ?m), 434,5617,68 ?m (400-485 ?m) ve 457,4421,78 ?m (428-516 ?m) idi ve UVA uygulamasının 15. ve 30. dakikasında sırasıyla 471,6923,38 ?m (439-526 ?m) ve 482,6323,69 ?m (436-524 ?m) olarak tespit edildi. Uygulama süresince kornea kalınlığındaki artışın bir önceki ölçümle kıyaslandığında istatistiksel olarak anlamlı olduğu görüldü (p0,001). Sonuç: Dekstransız izotonik riboflavin solüsyonu ile yapılan KKÇB uygulaması sırasında korneada incelmenin olmadığı, aksine uygulama süresince korneanın düzenli şekilde kalınlaştığı görüldü. (Turk J Ophthalmol 2014; 44: 272-4)
Descemet Membrane Endothelial Keratoplasty in Toxic Anterior Segment Syndrome: A Case Series
(Lippincott Williams & Wilkins, 2021) Necip, Kara; Oltulu, Refik; Levent, Dogan; Osman, Gundogan Ali
Purpose: To evaluate the outcomes of Descemet membrane endothelial keratoplasty (DMEK) in patients with toxic anterior segment syndrome (TASS). Methods: Thirteen eyes of 13 patients who underwent DMEK for endothelial decompensation secondary to TASS were retrospectively reviewed. A comprehensive ocular examination including best-corrected visual acuity (BCVA), slitlamp biomicroscopy, intraocular pressure measurement, fundus evaluation, and measurement of central corneal thickness were performed in all patients at preoperatively and postoperatively. Results: There were 8 men and 5 women, with an average age of 56 +/- 19 years. The mean follow-up was 8.7 +/- 3.5 months. The time interval between the onset of TASS and DMEK was 4.9.+/- 6.6 months (range, 1.5-26 months). Twelve of 13 grafts were clear at last visit. The mean preoperative BCVA was 20/666 (range, hand motion to 20/200), and the mean BCVA was 20/36 (range, hand motion to 20/20) at the postoperative last visit (P = 0.003). The decrease in mean pachymetry from preoperative (768 +/- 69 mu m) to postoperative last visit (523 +/- 71 mu m) was statistically significant (P < 0.001). Conclusions: DMEK seems to be a safe and an effective treatment option in eyes with TASS-related endothelial decompensation.
Dry eye disease and ocular surface characteristics in patients with keratoconus
(Wolters Kluwer Medknow Publications, 2022) Mirza, Enver; Oltulu, Refik; Oltulu, Pembe; Mirza, Gunsu D.; Okka, Mehmet
PURPOSE: The purpose of this study is to investigate the ocular surface alterations in patients with mild or severe keratoconus (KC). METHODS: A total of 80 participants were included in the study. The corneal topography was performed on each participant using Pentacam and the grouping was done accordingly. The patients with Kmax >= 52.0 D (severe KC) were considered Group 1 (n = 28), the patients with Kmax >= 47.2 and <52.0 D (mild KC) were considered Group 2 (n = 30). Healthy control participants with Kmax <47.2 D were considered Group 3 (n = 22). Tear breakup time (TBUT), Schirmer-I test, ocular surface disease index (OSDI) questionnaire, and conjunctival impression cytology (CIC) were evaluated among the groups. RESULTS: The mean values of TBUT and Schirmer-I test were significantly lower (P = 0.012, P = 0.012) and the mean scores of OSDI and CIC were significantly higher (P = 0.006, P < 0.001) in Group 1 and Group 2 than in Group 3. The mean values of TBUT and Schirmer-I test were lower and the mean scores of OSDI and CIC were higher in Group 1 than in Group 2 but the differences were insignificant (P > 0.05 for all). CONCLUSION: These results indicated that the tests associated with dry eye disease are correlated with KC. Tear film alterations and goblet cell loss are higher in severe KC.
The Effect of Dehydration and Fasting on Corneal Biomechanical Properties and Intraocular Pressure
(Lippincott Williams & Wilkins, 2016) Oltulu, Refik; Satirtav, Gunhal; Ersan, Ismail; Soylu, Erkan; Okka, Mehmet; Zengin, Nazmi
Purpose: To evaluate the changes in corneal biomechanical properties and intraocular pressure (IOP) during fasting period in healthy subjects. Methods: Seventy-two eyes of 72 fasting subjects (study group), and 62 eyes of 62 nonfasting subjects (control group) were enrolled in this prospective study undertaken at a single university hospital. All subjects underwent complete ophthalmologic examination including ocular biomechanical evaluation with ocular response analyzer. Ocular response analyzer measurement was performed on the right eyes of the subjects between 5.00 and 6.00 PM after approximately 14 hr of fasting for the study group and after a nonfasting period for the control group. The corneal hysteresis, corneal resistance factor, mean corneal compensated IOP (IOPcc), and Goldmann-correlated IOP (IOPg) values were measured with a patented dynamic bidirectional applanation process. Results: Goldmann-correlated IOP and IOPcc measurements in the study group and the control group were found as 13.8 +/- 2.8 mm Hg, 14.6 +/- 2.6 mm Hg and 16.3 +/- 2.2 mm Hg, 15.7 +/- 2.4 mm Hg, respectively. There was statistically significant difference within the two groups in IOPg and IOPcc (P < 0.001). In addition, corneal hysteresis and corneal resistance factor significantly decreased in study group compared with control group (P < 0.001, P = 0.012, respectively). Conclusion: Prolonged fasting causes a significant decrease in IOPg, IOPcc, corneal hysteresis, and corneal resistance factor in healthy subjects, altering the biomechanical properties of the cornea.
Effect of Eye Rubbing on Corneal Biomechanical Properties and Intraocular Pressure
(Turkish Ophthalmological Soc, 2014) Oltulu, Refik; Donbaloglu, Meryem; Satirtav, Gunhal; Okka, Mehmet; Ozkagnici, Ahmet
Objectives: 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.
Effect of mydriasis induced by topical 0.5% tropicamide instillation on the corneal biomechanical properties in healthy individuals measured by ocular response analyzer
(Taylor & Francis Ltd, 2015) Oltulu, Refik; Satirtav, Gunhal; Altunkaya, Orhan; Bitirgen, Gulfidan; Okka, Mehmet
Purpose: This observational study aims to investigate the effects of tropicamide (0.5%) on corneal biomechanical properties, with the ocular response analyzer (ORA), in healthy individuals. Methods: Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated intraocular pressure (IOPcc) measurements of 38 (21 female and 17 male) healthy individuals, before and after 30 min of 0.5% tropicamide instillation, were performed by using the ORA. Results: The mean CH, CRF, IOPg and IOPcc measurements of the eyes were 10.2 +/- 1.9 mmHg, 10.3 +/- 2.1 mmHg, 15.7 +/- 3.4 mmHg, 16.4 +/- 3.3 mmHg pre-tropicamide, and 10.4 +/- 1.7 mmHg, 10.3 +/- 2.1 mmHg, 15.3 +/- 3.4 mmHg, 15.8 +/- 2.7 mmHg post-tropicamide, respectively. The differences between the pre- and post-tropicamide measurements of the eyes were insignificant (p = 0.184, p = 0.659, p = 0.294, p = 0.150, respectively; paired t-test). Conclusions: A tropicamide instillation does not lead to significant changes in the corneal biomechanical properties. Therefore, it can be used safely in disease, i.e. in the diagnosis and follow-up ORA as it does not cause any change.
Efficacy of pulsed-light accelerated crosslinking in the treatment of progressive keratoconus: Two-year results
(Sage Publications Ltd, 2020) Belviranli, Selman; Oltulu, Refik
Purpose: The aim of this study was to evaluate the 2-year results of epithelium-off pulsed-light accelerated corneal collagen crosslinking treatment in progressive keratoconus using 30 mW/cm(2) ultraviolet A light for 6 min with a total dose of 5.4 J/cm(2). Methods: A total of 30 eyes of 22 patients with documented progressive keratoconus and treated with epithelium-off pulsed-light accelerated corneal collagen crosslinking using the KXL (R) crosslinking device (Avedro Inc, Waltham, MA, USA) were included in this retrospective study. Corneal tomographic measurements and best spectacle-corrected visual acuity were compared using analysis of variance with repeated measurements between the baseline visit (before the corneal collagen crosslinking treatment), and the sixth month, first, and second year visits. Results: Flat keratometry (K1), steep keratometry (K2), and mean keratometry (Km) decreased significantly at sixth month, first, and second years (p < 0.001, p = 0.001, and p < 0.001, respectively). Maximum keratometry (Kmax) decreased from 55.40 +/- 4.90 D at baseline to 54.82 +/- 4.68 D, 54.80 +/- 5.12 D, and 54.65 +/- 5.36 D at sixth month, first year, and second year, respectively (p = 0.007). The best spectacle-corrected visual acuity improved from 0.34 +/- 0.24 logMAR at baseline to 0.25 +/- 0.16 logMAR, 0.22 +/- 0.15 logMAR, and 0.17 +/- 0.13 logMAR at sixth month, first year, and second year, respectively (p < 0.001). At the second year visit, best spectacle-corrected visual acuity remained stable (no lines lost) with respect to the baseline in 8 eyes and increased 1 or more lines in 22 eyes. Conclusion: Pulsed-light accelerated corneal collagen crosslinking using 30 mW/cm(2) ultraviolet A light for 6 min with a total dose of 5.4 J/cm(2) is an effective treatment modality in cases with progressive keratoconus-it stops progression at 2 years also regresses some of the cases.
Elektrik Yaralanmasına Bağlı Bilateral Katarakt
(2016) Oltulu, Refik; Erşan, İsmail; Kamış, Ümit; Alparslan, Şahin
Altı ay önce yüksek voltajlı elektrik akımına maruz kalan sekiz yaşındaki erkek hasta, her iki gözde görme keskinliğinde azalma şikayetiyle kliniğimize başvurdu. Görme keskinliği her iki gözde 2/10 düzeyindeydi. Ön segment muayenesinde yoğun arka ve ön kapsül altı kesafet tespit edildi. Hastanın her iki gözüne katarakt cerrahisi ve göz içi lens implantasyonu uygulandı. Özellikle baş ve boyun bölgesinde meydana gelen elektrik yaralanmasına maruz kalan olgularda ilerleyen dönemlerde katarakt gelişebileceği akılda tutulmalıdır. Bu makalede elektrik yaralanmasına bağlı katarakt gelişen olgunun cerrahi müdahale ile sağlanan tam görsel rehabilitasyonu sunulmuştur.
Evaluation of Contact Lens-Induced Changes in Keratoconic Corneas Using In Vivo Confocal Microscopy
(Assoc Research Vision Ophthalmology Inc, 2013) Bitirgen, Gulfidan; Ozkagnici, Ahmet; Malik, Rayaz A.; Oltulu, Refik
PURPOSE. To quantitatively analyze laser scanning in vivo confocal microscopy (IVCM) images of all corneal layers in contact lens-wearing and noncontact lens-wearing keratoconus patients. METHODS. The study population included rigid gas permeable (RGP) contact lens-wearing keratoconus patients (group 1; N = 29), keratoconus patients who did not wear contact lenses (group 2; N = 30), and subjects who neither had keratoconus nor wore contact lenses (group 3; N = 30), with groups 2 and 3 matched to group 1 by age and sex. The central cornea was examined with IVCM in all subjects. The mean duration of contact lens wear was 5.50 +/- 3.68 years (range, 2-15 years). RESULTS. Eyes with keratoconus showed significantly lower basal epithelial cell and anterior and posterior stromal keratocyte densities, as well as subbasal nerve fiber density, nerve branch density, and nerve fiber length compared with healthy control subjects. Furthermore, compared with group 2, group 1 had significantly lower basal epithelial cell density (4920 +/- 476 cells/mm(2) vs. 4503 +/- 461 cells/mm(2), P = 0.001) and anterior stromal keratocyte density (561 6 91 cells/mm2 vs. 464 6 55 cells/mm2, P < 0.001), but there was no significant difference for posterior stromal keratocyte density (P = 0.808), endothelial cell density (P = 0.699), or subbasal nerve fiber density (P = 0.142), nerve branch density (P = 0.614), and nerve fiber length (P = 0.850). CONCLUSIONS. Significant corneal microstructural abnormalities were observed in eyes with keratoconus. RGP contact lens wear was associated with a further reduction in the basal epithelial cell and anterior stromal keratocyte densities, but with no effect on posterior stromal keratocyte density, endothelial cell density, or corneal nerve morphology.
Evaluation of inflammatory biomarkers in patients with keratoconus
(Sage Publications Ltd, 2022) Oltulu, Refik; Katipoglu, Zeynep; Gundogan, Ali Osman; Mirza, Enver; Belviranli, Selman
Objective: To investigate the monocyte-to-HDL-cholesterol ratio (MHR), neutrophil to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), eosinophil-to-lymphocytes ratio (ELR), platelet distribution width (PDW), red blood cell distribution width (RDW), mean platelet volume (MPV), MPV to platelet count ratio (MPV/PC), and RDW to platelet ratio (RPR) that are accepted as inflammatory markers in patients with keratoconus. Methods: In this study, 43 patients with keratoconus and 43 healthy individuals as the control group were retrospectively evaluated. High density lipoprotein cholesterol (HDL-c), lymphocyte, neutrophil, eosinophil, monocyte, platelet, MPV, PDW, and RDW values were obtained with complete blood count performed on the peripheral blood samples. Results: Absolute monocyte (593 +/- 182 vs 492 +/- 177; p < 0.05) and neutrophil (4860 +/- 1553 vs 3954 +/- 1297; p < 0.01) counts were statistically significantly higher in the keratoconus groups compared to the control group. MHR (13.18 +/- 5.02 vs 9.88 +/- 4.45; p < 0.01) and NLR (2.30 +/- 0.87 vs 1.77 +/- 0.61; p < 0.01) were statistically significantly higher and LMR (4.07 +/- 1.67 vs 5.18 +/- 2.06; p < 0.01) was significantly lower in the keratoconus group. As a result of univariate logistic regression analysis, it was observed that MHR and NLR were statistically significant relationship with keratoconus (p = 0.02 and p = 0.021) (Odds ratio = 5.41 (95% CI: 1.169-6.669) and Odds ratio:5.28 (95% CI: 1.024-6.321); respectively). No statistically significant difference was found between the groups in terms of PLR, ELR, RDW, MPV, PDW, MPV/PC, and RPR. Adjusting for age and gender, multivariate regression analysis revealed that MHR was the most significant parameter to demonstrate relationship with keratoconus (p = 0.025) (Odds ratio = 4.99 (95% CI: 1.019-6.332)). Conclusion: MHR and NLR values considered as inflammatory markers were statistically significantly higher and LMR value was significantly lower in the keratoconus group. Among these values, MHR was the most reliable parameter.
Evaluation of Lacrimal Canalicular Trauma Patients Admitted to Our Clinic
(Turkish Ophthalmological Soc, 2014) Oltulu, Refik; Belviranli, Selman; Zengin, Nazmi
Objectives: To retrospectively evaluate the patients who presented to our clinic with lacrimal canalicular injury. Materials and Methods: In this study, we included 20 patients who presented to the Necmettin Erbakan University Meram Medical Faculty, Department of Ophthalmology, with lacrimal canalicular injury between September 2010 and October 2012. Epidemiological data, mode of the injury, period between the injury and surgical repair, surgical technique, and outcomes were analyzed retrospectively from the patient records. Results: Mean age of the patients was 19.35 +/- 9.5 years. 85% of patients were male and 15% were female. The most common cause of injury was metallic foreign bodies (30% of patients). Injuries with plants, trees, and wooden objects, glass, animal hits, and injuries associated with falling down are the other causes, respectively. Of the 20 patients, 14 had isolated lower canalicular injury (70%), 4 had upper canalicular injury (20%), and the remaining 2 had both lower and upper canalicular injury. Monocanalicular intubation was performed in 16 cases, and bicanalicular in tubation was performed in 1 case. Postoperatively, none of the patients had epiphora. Conclusion: Canalicular injuries are ophthalmologic emergencies affecting all age groups, especially children and teenagers. Canalicular intubation is necessary in the surgical repair, and monocanalicular or bicanalicular techniques can be performed according to the patient characteristics and the experience of the surgeon. In our clinic, monocanalicular intubation is mostly performed in isolated lower or upper canalicular injuries, and successful results were achieved with this technique.
Evaluation of the Systemic Inflammation in Patients with Pterygium: Monocyte-to- High-Density Lipoprotein Cholesterol Ratio and Hematologic Indexes of Inflammation
(Wolters Kluwer Medknow Publications, 2021) Belviranli, Selman; Oltulu, Refik; Gundogan, Ali O.; Mirza, Enver; Okka, Mehmet
PURPOSE: The purpose of this study is to evaluate systemic inflammation in patients with pterygium using the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) and hematologic indexes of inflammation. METHODS: Thirty-one patients with primary pterygium and 31 age-and sex-matched healthy participants were enrolled in this retrospective study. The MHR, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, eosinophil-to-lymphocyte ratio, monocyte-to-eosinophil ratio, mean platelet volume-to-platelet count ratio, platelet distribution width, and red cell distribution width were compared between the two groups. RESULTS: There was not a statistically significant difference in terms of the MHR between the pterygium group and the control group (P = 0.693). The NLR was higher in the pterygium group than in the control group (P = 0.028). In the other hematologic indexes, there were no statistically significant differences between the two groups (P > 0.05 for all). CONCLUSION: The MHR is not associated with the presence of pterygium. An increased NLR in patients with pterygium may be an indicator of systemic inflammation.
Expression of placental growth factor, neuropilin-1, and neuropilin-2 in primary pterygium tissue
(Springer, 2023) Gundogan, Ali Osman; Oltulu, Refik; Belviranli, Selman; Oltulu, Pembe
Purpose The aim of this study was to evaluate the expression of placental growth factor (PLGF), neuropilin-1 (NP-1), and neuropilin-2 (NP-2) molecules in primary pterygium tissue compared with normal conjunctival tissue.Methods The records of 42 patients who underwent excision surgery with autografts for primary pterygium (pterygium group) and 20 patients who underwent conjunctival nevus excision surgery (control group) in the same period were reviewed retrospectively. The samples obtained from the pterygium tissues in the pterygium group and the clean conjunctival tissues adjacent to the nevus in the control group were collected from the archive. Immunohistochemical stains of the primary antibodies-1/100 diluted PLGF, NP-1, and NP-2 (Abcam Cambridge Science Park, UK)-were applied to all groups. Staining intensities and the percentage of positive cells in epithelial, endothelial, stromal, and inflammatory cells were analyzed by an experienced pathologist.Results The positivity rates of PLGF and NP-2 expression in epithelial, endothelial, stromal, and inflammatory cells were found to be higher in the pterygium group than in the control group (PLGF: p < 0.001, p < 0.001, p = 0.001, and p < 0.001, respectively; NP-2: p < 0.001 for all). Staining intensities for PLGF and NP-2 were higher in the pterygium group than in the control group (PLGF: p < 0.001, p < 0.001, p = 0.005, and p < 0.001, respectively; NP-2: p < 0.001, p < 0.001, p = 0.001, and p < 0.001, respectively). However, no significant differences were found in any cell type in terms of NP-1 expression positivity rates (p = 0.730, p = 0.121, p = 0.524, and p = 0.624, respectively) or staining intensity (p = 0.716, p = 0.147, p = 0.147, and p = 0.780, respectively).Conclusion PLGF and NP-2 levels were found to be higher in pterygium tissue, while there was no difference in NP-1. These results indicate the possible roles of NP-2 and PLGF in primary pterygium.

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