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Yayın Comparison of Ganglion Cell and Retinal Nerve Fiber Layer Thickness in Pigment Dispersion Syndrome, Pigmentary Glaucoma, and Healthy Subjects with Spectral-domain OCT(TAYLOR & FRANCIS INC, 2017) Arifoglu, Hasan Basri; Simavli, Huseyin; Midillioglu, Inci; Ergun, Sule Berk; Simsek, SabanPurpose: To evaluate the ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL) thickness in pigment dispersion syndrome (PDS) and pigmentary glaucoma (PG) with RTVue spectral domain optical coherence tomography (SD-OCT). Methods: A total of 102 subjects were enrolled: 29 with PDS, 18 with PG, and 55 normal subjects. Full ophthalmic examination including visual field analysis was performed. SD-OCT was used to analyze GCC superior, GCC inferior, and average RNFL thickness. To compare the discrimination capabilities, the areas under the receiver operating characteristic curves were assessed. Results: Superior GCC, inferior GCC, and RNFL thickness values of patients with PG were statistically signicantly lower than those of patients with PDS (p <0.001) and healthy individuals (p <0.001 for all). No statistically significant difference was found between PDS and normal subjects in same parameters (p>0.05). Conclusions: The SD-OCT-derived GCC and RNFL thickness parameters can be useful to discriminate PG from both PDS and normal subjects.Yayın Early retinal and retinal nerve fiber layer effects of hydroxychloroquine: a follow up study by sdOCT(INFORMA HEALTHCARE, 2013) Yulek, Fatma; Ugurlu, Nagihan; Akcay, Emine; Kocamis, Sucattin Ilker; Gerceker, Sidika; Erten, Sukran; Midillioglu, Inci; Simsek, SabanContext: The antimalarial drug hydroxychloroquine (HCQ), used in the treatment of rheumatologic disease, has been associated with the development of retinopathy. The long-term incidence of HCQ retinopathy has been estimated at 0.5% when recommended dosages (<= 6.5 mg/kg per day) are used. Objective: Evaluating the patients for whom HCQ treatment will be started before and after treatment prospectively with spectral domain (sd) optical coherence tomography (OCT) to observe possible early changes in the retinal and retinal nerve fiber layer thickness. Materials and methods: Thirty-six patients from rheumatology clinic who have been started HCQ therapy had clinical examination and sdOCT imaging before and 6 months after starting treatment. The baseline ophthalmological examinations and visual field analysis (on automated Humphrey visual field (HVF) 10-2 perimetry, Humphrey HFA II-i 750 i, Carl Zeiss Meditec AG, Jena, Germany) were completely normal. The sdOCT was performed with the Optovue technology according to the manufacturer's guidelines using EMM5, retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) scans. The retinal thickness values in central foveal, inferior and superior hemispheres, temporal, superior, nasal and inferior para-and perifoveal areas and the RNFL thickness of eyes were compared before and 6 months after starting treatment by the paired t test. Results: The retinal thickness values in central parafoveal (p = 0.02), and superior hemisphere (p = 0.01) in parafoveal area, parafoveal superior (p = 0.02), temporal (p = 0.03) and nasal (p = 0.04) quadrants were significantly thicker after 6 months of treatment. The thickness of the perifoveal area and the average RNFL thickness was not significantly different in any of the quadrants before and after starting HCQ treatment. The GCC thickness also did not change significantly different in superior and inferior hemisphere after starting treatment. Discussion and conclusion: We observe increased retinal thickness in parafoveal areas in patients on HCQ therapy at short term. Its clinical significance may be apparent in longer follow up studies.Yayın Long-Term Results of Simultaneous Bilateral External Dacryocystorhinostomy in Cases with Bilateral Dacryostenosis(INFORMA HEALTHCARE, 2015) Yuksel, Dilek; Kosker, Mustafa; Akoz, Irem; Simsek, SabanObjectives: To evaluate the long-term results of simultaneous bilateral external dacryocystorhinostomy (EX-DCR) in cases with bilateral dacryostenosis. Methods: Thirty-four eyes of 17 consecutive patients with a history of bilateral epiphora were included in the study between 2007 and 2011. Demographic information, etiology of the obstruction, history of lacrimal surgery, type of anesthesia, duration of surgery, incidence of postoperative nasal bleeding and infection, surgical outcomes, and duration of follow-up were recorded. During the lacrimal irrigation, there was not any passage noticed in the patients' eyes. The post-operative follow-up was 13 to 44 months (mean 33.6 months). Results: Of 17 patients undergoing simultaneous bilateral EX-DCR with a mean age of 42.8 years, one of the patients had a history of bilateral unsuccessful DCR performed in a different center. One patient had previously failed bilateral probing before undergoing bilateral EX-DCR. This latter patient was a four-month-old baby with bilateral dacryoceles. Bicanalicular silicone intubation was performed in 15 eyes of 10 patients that had a canalicular problem or fibrotic lacrimal sac. It has been discerned that complaints about epiphora disappeared in 33 of the eyes (97%) and that the passage was open during the lacrimal irrigation. One eye with a history of unsuccessful dacryocystorhinostomy failed to respond positively to our operation. Conclusions: In our study, high success rates of simultaneous bilateral EX-DCR were found in both children and adult patients with bilateral dacryostenosis during a long-term follow-up. We believe that simultaneous bilateral dacryocystorhinostomy has medical, social, and economic advantages.Yayın Macula and Retinal Nerve Fiber Layer in Migraine Patients: Analysis By Spectral Domain Optic Coherence Tomography(INFORMA HEALTHCARE, 2015) Yulek, Fatma; Dirik, Ebru Bilge; Eren, Yasemin; Simavli, Huseyin; Ugurlu, Nagihan; CagIl, Nurullah; Simsek, SabanAim: Investigating the retinal nerve fiber layer (RNFL), macular and ganglion cell complex thickness in eyes of migraine patients using optical coherence tomography. Methods: The study was designed as an observational cross-sectional study. 50 patients with migraine (30 patients with aura and 20 patients without aura) and 50 healthy volunteers were included. Optical coherence tomography was performed with Optovue technology. The fast RNFL thickness (3.4) scan, MM5, and GCC acquisition protocols were used. Results: There was no statistically significant difference in retinal thickness in any of the quadrants between the control group and the migraine patients (p>0.05). The average RNFL thickness (110.50 vs 102.84 microns, p = 0.03) was significantly thinner in migrainers as compared to the control. The ANOVA did not reveal any significant difference between migrainers with aura, migrainers without aura, and the control group. The VAS (visual analogue scale) score of migraine patients was not statistically significantly correlated with any of the parameters, while the length of migraine history was negatively correlated with the average RNFL thickness (r = -0.32, p = 0.03). Conclusion: The average RNFL thickness in the migraine patients was found to be thinner than that in the control group. In addition, we found a negative weak correlation between length of migraine history and the average RNFL thickness, supporting the possible association between these pathologies.Yayın Phacoemulsification with intraocular lens implantation in patients with anterior uveitis(ELSEVIER SCIENCE INC, 2013) Kosker, Mustafa; Sungur, Gulten; Celik, Tuba; Unlu, Nurten; Simsek, SabanPURPOSE: To assess the results of phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation in patients with cataract secondary to anterior uveitis. SETTING: Department of Ophthalmology, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey. DESIGN: Case series. METHOD: Consecutive patients with anterior uveitis and cataract were prospectively studied for outcomes after phacoemulsification and PC IOL implantation. RESULTS: Fifty-five eyes (48 patients; mean age 44.9 years +/- 15.6 [SD]) were included. Patients were followed for 6 months. The etiology of uveitis was presumed idiopathic anterior uveitis (n = 22), herpes simplex virus associated anterior uveitis (n = 10), Fuchs heterochromic iridocyclitis (n = 10), and anterior uveitis associated with collagen vascular disease (n = 13). Preoperative complications secondary to uveitis included posterior synechiae (12 eyes), glaucoma (26 eyes), and sequelae of cystoid macular edema (CME) (21 eyes). At the final visit, the corrected distance visual acuity (CDVA) was 20/40 or better in 52 eyes (94.5%) and 20/20 in 33 eyes (60.0%). The CDVA was worse than 20/40 in 3 eyes because of preoperative anterior and posterior segment abnormalities. Postoperative complications were CME, recurrent uveitis, and posterior capsule opacity in 7 eyes (12.7%) each; fibrinous anterior chamber reaction in 6 eyes (10.9%); raised intraocular pressure in 4 eyes; peripheral anterior synechiae in 1 eye (1.8%); and hypotony in 1 eye (1.8%). CONCLUSION: Patients with a history of anterior uveitis and cataract having phacoemulsification with PC IOL implantation had excellent visual results with a relatively low complication rate.Yayın Surgical Treatment of Mucoepidermoid Carcinoma of the Lacrimal Sac(INFORMA HEALTHCARE, 2014) Yuksel, Dilek; Kosker, Mustafa; Saribas, Ferhat; Simsek, SabanPurpose: We report successful management of a case with high-grade mucoepidermoid carcinoma of the lacrimal sac managed by aggressive soft tissue and bony resection with adjuvant radiotherapy. Methods: Case report. Results: A 32-year-old man was referred to us with a two-year history of epiphora and slow-growing mass in the area of the lacrimal sac. On physical examination, a firm and nontender mass was visible overlying the area of the right lacrimal sac. Computed tomography and magnetic resonance imaging confirmed a 30 mm x 15 mm, well-enhanced soft tissue mass occupying the lacrimal fossa and extending to include the nasolacrimal duct, and FNA biopsy of the mass demonstrated high-grade mucoepidermoid carcinoma. On this basis, the tumor, lacrimal sac, and nasolacrimal duct were removed en bloc with the frontal process of the maxilla, lateral nasal wall, lacrimal fossa, ethmoids, and anterior part of the medial orbital wall with two intraoperative frozen section examinations. Postoperatively, the patient received adjuvant radiotherapy. The clinical evaluation and positron emission tomography at 38 months showed recovery and no recurrence of the disease. Conclusions: MEC of the lacrirnal sac is extremely rare and spreads locally in an aggressive manner. Despite the fact that orbital exenteration have generally been recommended for these tumors, radical surgical resections with external radiation therapy might be effective. In our case, despite the high-grade MEC, the patient underwent successful radical surgical excision and postoperative adjuvant external radiotherapy. As a result, we achieved an aesthetically satisfying result by preserving the eye and the vision.Yayın TIME COURSE OF SILICONE OIL EMULSIFICATION(LIPPINCOTT WILLIAMS & WILKINS, 2012) Toklu, Yasin; Cakmak, Hasan B.; Ergun, Sule B.; Yorgun, Mucella A.; Simsek, SabanPurpose: To investigate the natural course of silicone oil emulsification after silicone oil tamponade usage in retinal detachment surgery. The presence of a group of patients whose silicone oil tamponades we preferred to keep as long as possible because of high risk of redetachment enabled us to investigate the course of in vivo silicone oil emulsification. Methods: Thirty-two cases that were considered to have a high risk of redetachment after silicone oil removal were closely monitored, and it was preferred to keep the silicon oil as long as possible until first signs of silicone oil emulsification were observed. Any ocular complication directly related to the silicone oil tamponade did not arise in any of these cases, and the only indication for silicone oil removal was the signs of emulsification. Results: The silicone oil emulsification time ranges from 5 months to 24 months with a mean of 13.2 +/- 4.8 months. In most cases, it occurs within the first year. However, there are also 2 cases where emulsification is not observed until the 24th month. Conclusion: It could be possible to extend the silicone oil removal time up to 1 year to achieve a stable retinal status in cases with a high risk of redetachment. RETINA 32: 2039-2044, 2012Yayın The Treatment of Lacrimal Gland Prolapse in Blepharoplasty by Repositioning the Glands(INFORMA HEALTHCARE, 2013) Yuksel, Dilek; Yakin, Mehmet; Kosker, Mustafa; Simsek, SabanProlapse of the lacrimal gland is an unusual condition. An appearance of bilateral dermatochalasis was observed in the medical examination of a 30-year-old female patient with bilateral upper eyelid edema. The patient underwent bilateral blepharopylasty. During the surgery, it was noticed that in the temporal portions of the eyelids, there was a prolabed tissue-like lacrimal gland. We did incisional biopsy from the prolabed tissue that was thought to be orbital lobe of the lacrimal gland and carried out reposition of the orbital rim with 5-0 polyester suture and closed the orbital septum. Lacrimal gland reposition is a procedure which entails the separation of such anatomic structures as orbital septum, adipose tissue, and levator complex. However, failure to recognize a prolapsed lacrimal gland may mistreat by simple excision, and will lead to important alterations in ocular lubrication. In our case, repositioning of the glands was successfully performed during upper-lid blepharoplasty.