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Öğe Acquired Convergence Substitution in Horizontal Gaze Palsy and Progressive Scoliosis Associated with ROBO3 Mutations(TAYLOR & FRANCIS AS, 2012) Bakbak, Berker; Kansu, TulayTwo female (aged 12 and 14 years) patients with horizontal gaze palsy and progressive scoliosis (HGPPS) from two different Turkish families were evaluated through ophthalmic, neurological, radiological, and orthopaedic examinations. Each proband had one affected sibling with HGPPS. Both patients had absence of horizontal eye movements and simultaneous adduction of both eyes on attempted horizontal gaze associated with miosis. One proband was observed to have this finding at age 9, which had not been present at 5 years old. Neuroradiological imaging revealed brainstem hypoplasia (split pons sign) and scoliosis. The two index patients harboured different homozygous mutations that were heterozygous in the parents, who are obligate carriers. The emergence of convergence and presence of miosis during lateral gaze suggests that simultaneous adduction occurs as a result of the convergence substitution phenomenon. Substituted convergence in cases with HGPPS may occur with different mechanisms than substituted convergence in cases with pontine lesions.Öğe Adie's Tonic Pupil and Anti-Ganglioside IgG Antibodies(Ege University Press, 2012) Dönmez Keklikoğlu, Hava; Bakbak, Berker; Saraç, ÖzgeObjective: The presence of anti-ganglioside IgG antibodies has been reported in the Guillain- Barre Syndrome (GBS) and the Miller-Fisher Syndrome (MFS). Adie's tonic pupil (ATP) is similar to GBS and its variants with the symmetric decrease in reflexes and the mydriasis that is an indicator of a parasympathetic disorder but the relationship between ATP and antiganglioside antibodies is unknown. Our aim in this study was to investigate the presence of anti-ganglioside IgG antibodies in patients with ATP. Patients and method: The study group consisted of a total of 20 persons with 10 patients and 10 control subjects. The control group consisted of healthy persons who did not have any problems that could influence the immune system. A neuro-ophthalmological examination was performed in all patients and the presence of anti-ganglioside antibodies in the serum was investigated. Results: Serum anti-ganglioside antibodies were negative in the 3 patients included in the study according to the review of old patient charts. Anti-GD1b, anti-GT1b and anti-GM3 antibodies were positive in 2 and anti-GM3 antibodies in 1 of the 7 patients included in the study after a new diagnosis was made. Anti-ganglioside antibodies were negative in all control group subjects. Conclusion: At least one of the anti-ganglioside antibodies was found to be positive in approximately half of the ATP patients in the acute stage (3 of the 7 acute or subacute stage ATP patients). These results indicate that anti-ganglioside antibodies may play a role in ATP development.Öğe Adie's Tonic Pupil and Anti-Ganglioside IgG Antibodies(JOURNAL NEUROLOGICAL SCIENCES, 2012) Keklikoglu, Hava Donmez; Bakbak, Berker; Sarac, OzgeObjective: The presence of anti-ganglioside IgG antibodies has been reported in the Guillain-Barre Syndrome (GBS) and the Miller-Fisher Syndrome (MFS). Adie's tonic pupil (ATP) is similar to GBS and its variants with the symmetric decrease in reflexes and the mydriasis that is an indicator of a parasympathetic disorder but the relationship between ATP and anti-ganglioside antibodies is unknown. Our aim in this study was to investigate the presence of anti-ganglioside IgG antibodies in patients with ATP. Patients and method: The study group consisted of a total of 20 persons with 10 patients and 10 control subjects. The control group consisted of healthy persons who did not have any problems that could influence the immune system. A neuro-ophthalmological examination was performed in all patients and the presence of anti-ganglioside antibodies in the serum was investigated. Results: Serum anti-ganglioside antibodies were negative in the 3 patients included in the study according to the review of old patient charts. Anti-GD1b, anti-GT1b and anti-GM3 antibodies were positive in 2 and anti-GM3 antibodies in 1 of the 7 patients included in the study after a new diagnosis was made. Anti-ganglioside antibodies were negative in all control group subjects. Conclusion: At least one of the anti-ganglioside antibodies was found to be positive in approximately half of the ATP patients in the acute stage (3 of the 7 acute or subacute stage ATP patients). These results indicate that anti-ganglioside antibodies may play a role in ATP development.Öğe Adie's Tonic Pupil and Anti-Ganglioside IgG Antibodies(2012) Dönmez, Hava Keklikoğlu; Bakbak, Berker; Saraç, ÖzgeAmaç: Anti-gangliozid IgG antikorlarının varlığı Guillain-Barre Sendromu (GBS) ve Miller- Fisher Sendromunda (MFS) bildirilmiştir. Adie'nin tonik pupillası (ATP) reflekslerde simetrik azalma ve parasempatik etkilenmenin göstergesi olan midriazis tablosu ile GBS ve varyantlarına benzerlik göstermekte, fakat ATP ile anti-gangliozid antikorların ilişkisi bilinmemektedir. Bu çalışmadaki amacımız ATP olan hastalarda anti-gangliozid IgG antikorlarının varlığını araştırmaktır. Hastalar ve yöntem: Bu çalışmada 10 hasta ve 10 kontrol olmak üzere toplam 20 kişi incelenmiştir. Kontrol grubu sağlıklı kişilerden ve immun sistemi etkileyebilecek bir hastalığı bulunmayan kişilerden seçilmiştir. Tüm hastaların ve kontrol grubunun nöro-oftalmolojik muayeneleri yapılmış ve serumlarında immunoblot yöntemi ile anti-gangliozid antikorların (Anti-GM1, Anti-GQ1b, Anti-GD1b, Anti-GT1b, Anti-GD1a, Anti-GM2 ve Anti-GM3 ) varlığı araştırılmıştır. Bulgular: Eski hasta dosyalarının taranması ile çalışmaya alınan 3 hastanın serumunda antigangliozid kompleks antikorlar negatif bulunmuştur. Yeni tanı konularak çalışmaya alınmış olan 7 hastadan 2'sinde anti-GD1b, anti-GT1b ve anti-GM3 antikorlarının ve bir hastada anti-GM3 antikorunun pozitif olduğu saptanmıştır. Kontrol grubunun tamamında anti gangliozid antikorları negatif bulunmuştur. Sonuç: Akut dönemdeki ATP hastalarının yaklaşık yarısında ( 7 akut veya subakut dönem ATP) hastasının 3'ünde) antigangliozid antikorlarından en az biri pozitif bulunmuştur. Bu sonuçlar, antigangliozid kompleks antikorların ATP gelişmesinde rol oynayabileceğini düşündürmektedir.Öğe Analysis of unilateral complex orbital fractures with a new treatment algorithm(TAYLOR & FRANCIS LTD, 2015) Karameşe, Mehtap; Akdağ, Osman; Selimoğlu, Muhammed Nebil; Koplay, Tuğba Gün; Bakbak, Berker; Koplay, Mustafa; Tosun, ZekeriyaThe aim of this study is to investigate preoperative and postoperative properties, the management of unilateral complex orbital fractures, and to offer an algorithm for orbital fractures. For this research study, 248 patients with orbital trauma were evaluated according to an offered algorithm. Diplopia, enophthalmos, dystopia, infraorbital nerve dysfunction, and ocular movement limitations were documented for clinical assessment. Orbital rim displacement and an orbital volume check with computed tomography (CT) were used for indication of surgery. The injured orbital volume was compared with the healthy orbital volume in the preoperative and postoperative periods. In total, 58 patients required operations among the 248 patients, according to the algorithm. The preoperative mean injured orbital volume measurements of the operated patients were statistically different than the healthy orbital volume measurements (30.13 cm(3) +/- 2.69 cm(3) and 27.15 cm(3) +/- 1.29 cm(3), respectively). In the postoperative period, there was no difference between the injured and healthy orbital volume. In conclusion, an algorithm may facilitate the approach to unilateral complex orbital fractures. Ophthalmic examination, rim displacement, and the measurement of orbital volume using computed tomography are key points of orbital fractures with regard to management.Öğe Anizokori(2012) Bakbak, Berker; Gedik, ŞansalAnisocoria is a term used for unequal size of the pupils and should be evaluated as a pathological sign. In this review, the anatomy and physiology of the pupil, and the causes of pathologic anisocoria are discussed.Öğe Association of Apolioprotein E Polymorphism with Intravitreal Ranibizumab Treatment Outcomes in Age-Related Macular Degeneration(KARGER, 2014) Bakbak, Berker; Ozturk, Banu Turgut; Zamani, Ayse Gul; Gonul, Saban; Gedik, Sansal; Yildirim, Selman; Okudan, Suleyman[Abstract not Available]Öğe Association of Apolipoprotein E Polymorphism with Intravitreal Ranibizumab Treatment Outcomes in Age-Related Macular Degeneration(TAYLOR & FRANCIS INC, 2016) Bakbak, Berker; Ozturk, Banu Turgut; Zamani, Ayse Gul; Gonul, Saban; Iyit, Neslihan; Gedik, Sansal; Yildirim, M. SelmanPurpose: Genetic factors are known to influence the response to anti-vascular endothelial growth factor (VEGF) treatment in exudative age-related macular degeneration (AMD). The current study was conducted to investigate the association of Apolipoprotein E (ApoE) polymorphism with the treatment response to ranibizumab for exudative AMD.Methods: One hundred nine eyes (109 patients, 59.6% male, mean age 63.847.22 years) treated with intravitreal ranibizumab injections were included in the analysis. Smoking status and lesion type were recorded. Patients were categorized into three groups according to visual acuity (VA) change at 6 months after the first injection: VA loss >5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (Group 1); VA change between five ETDRS letters gain and loss (Group 2); VA improvement >5 ETDRS letters (Group 3). The association of ApoE gene polymorphisms with the three groups was evaluated.Results: Both smoking status and lesion type showed no significant association with VA change (p=0.12 and p=0.64, respectively). A lower frequency of 2 and a higher frequency of 4 were observed in Group 3 (2.9 and 25.7%, respectively). VA improvement with more than five ETDRS letters was significantly associated with the presence of the 4 genotype (p=0.01).Conclusions: This study demonstrated that carriers of the ApoE 4 polymorphism genotype show demonstrable improvement in VA after treatment with ranibizumab in exudative AMD. ApoE polymorphism identification may be used as a genetic screening to tailor individualized therapeutic approach for optimal treatment in neovascular AMD.Öğe Az görenlere yardım cihazı uygulamaları ve klinik sonuçlarımız(2011) Bakbak, Berker; Gedik, Şansal; Güzel, HüseyinAmaç: Çeşitli hastalıklara bağlı görme azlığı gelişen olgularda Az Görenlere Yardım (Low Vision Aids-LVA) cihaz uygulamalarımızın sonuçlarını değerlendirmek. Gereç ve Yöntem: Ocak 2010-Ocak 2011 tarihleri arası kliniğimizin Nörooftalmoloji Birimi’ne düşük görme şikayeti ile başvuran ve görme düzeyleri standart optik tashihler ile arttırılamayan 48 hasta çalışmaya dahil edildi. Hastaların uzak görme keskinliği (GK), kırma kusurları düzeltildikten sonra Snellen eşeli ile, yakın görme keskinliği Jaeger eşeli ile ölçüldü. Olgular uzak ve yakın için yüksek sferik cam ve Eschenbach LVA cihazı ile muayene edildi. Bulgular: Olguların 25’ine yakın görme için, 6’sına uzak görme için, 3 olguya da hem yakın hem uzak görme için LVA cihazı verildi. Yakın görme keskinliği açısından muayene edilen 38 olgunun 28’inde (%73.7), uzak görmesinden şikayetçi olan 16 olgunun 9’unda (%56.25) başarı sağlandı. Sonuç: Az görenlere yardım cihazları, düşük görme düzeylerine sahip hastalar için etkin optik sistemlerdir. Görme keskinliği düşük saptanan tüm hastalara, günlük yaşam kalitesini arttırabilme olanağı sağlayan bu cihazlar denenmelidir.Öğe Bilateral Adienin Tonik Pupillası(2013) Bakbak, Berker; Köktekir, Bengü Ekinci; Gedik, Şansal; Yavuzer, Kamil; Turgut, Banu ÖztürkIşığa hassasiyet ve okumada zorlanma şikayeti ile başvuran 37 yaşındaki erkek hastada bilateral, geniş, ışığa yanıt vermeyen ancak yakına bakışta küçülen pupilla saptandı. Nörolojik, radyolojik ve laboratuar değerlendirmelerin ardından hastaya bilateral tonik pupilla tanısı kondu. Tonik pupilla, ışık-yakın disosiyasyonu saptanan gözlerde ayırıcı tanıda düşünülmesi gereken bir durumdur. Bu olgu raporunda ender rastlanılan bilateral tonik pupilla ve bu klinik tablonun oluşum mekanizması tartışıldı. (Turk J Ophthalmol 2013; 43: 64-6)Öğe Bilateral Papillophlebitis in a Patient with Mutation of Metilenetetrahydrofolate Reductase Enzyme(TURKISH OPHTHALMOLOGICAL SOC, 2016) Guzel, Huseyin; Ozturk, Banu Turgut; Gedik, Sansal; Bakbak, Berker; Beyoglu, Abdullah; Kocak, NadirPapillophlebitis is known as central retinal vein occlusion seen in young patients. It usually presents as unilateral optic disc edema with cotton wool spots and hemorrhage in the peripapillary region. As it may be due to many autoimmune and inflammatory causes, a thorough systemic evaluation of the patient is warranted. In this case report we describe a bilateral, simultaneous papillophlebitis case thought to be related to hyperhomocysteinemia secondary to C677T polymorphism of methylenetetrahyrofolate reductase enzyme.Öğe Bilateral severe anterior uveitis after unilateral selective laser trabeculoplasty(WILEY, 2013) Koktekir, Bengu E.; Gedik, Sansal; Bakbak, Berker[Abstract not Available]Öğe Bilateral Tonic Pupils in the Absence of Pupillary Cholinergic Supersensitivity(INFORMA HEALTHCARE, 2012) Bakbak, Berker; Gedik, Sansal; Koktekir, Bengu Ekinci[Abstract not Available]Öğe Chronic Relapsing Inflammatory Optic Neuropathy(KARE PUBL, 2019) Yassa, Ertugrul Tan; Bakbak, BerkerChronic relapsing inflammatory optic neuropathy (CRION) is a form of recurrent, isolated, subacute optic neuropathy. A 33-year-old female presented at an outpatient clinic with a pain-ful reduction of vision in the left eye that had developed 10 days earlier. The patient provided a background history of 5 similar attacks over the past 5 years. CRION was diagnosed following ophthalmological and imaging examinations, which revealed optic neuritis without demye-lination. The patient was successfully treated with steroids. The early detection of CRION is important because of the associated risk of blindness if CRION is treated inappropriately.Öğe Cluster Headache with Ptosis Responsive to Intranasal Lidocaine Application: A Case Report(2012) Bakbak, Berker; Gedik, Şansal; Ekinci Köktekir, Bengü; Okka, MehmetIntroduction. The application of lidocaine to the nasal mucosal area corresponding to the sphenopalatine fossa has been shown to be effective at extinguishing pain attacks in patients with a cluster headache. In this report, the effectiveness of local administration of lidocaine on cluster headache attacks as a symptomatic treatment of this disorder is discussed. Cases presentation. A 22-year-old Turkish man presented with a five-year history of severe, repeated, unilateral periorbital pain and headache, diagnosed as a typical cluster headache. He suffered from rhinorrhea, lacrimation and ptosis during headaches. He had tried several unsuccessful daily medications. We applied a cotton tip with lidocaine hydrochloride into his left nostril for 10 minutes. The ptosis responded to the treatment and the intensity of his headache decreased. Conclusion: Intranasal lidocaine is a useful treatment for the acute management of a cluster headache. Intranasal lidocaine blocks the neural transmission of the sphenopalatine ganglion, which contributes to the trigeminal nerve as well as containing both parasympathetic and sympathetic fibers.Öğe Comparison of central corneal thickness measurements using optical low-coherence reflectometry, Fourier domain optical coherence tomography, and Scheimpflug camera(CONSEL BRASIL OFTALMOLOGIA, 2014) Gonul, Saban; Koktekir, Bengu Ekinci; Bakbak, Berker; Gedik, SansalPurpose: To compare the results of central corneal thickness (CCT) measurements obtained using optical low-coherence reflectometry (OLCR), Fourier domain optical coherence tomography (FD-OCT), and a Scheimpflug camera (SC), combined with Placido corneal topography. Methods: A total of 25 healthy subjects were enrolled in the present study, and one eye of each subject was included. A detailed ophthalmic examination was performed in all cases following CCT measurements with OLCR, FD-OCT, and SC. The results were compared using an ANOVA test. Bland-Altman analysis was used to demonstrate agreement between methods. Intra-examiner repeatability was assessed by using intraclass correlation coefficients (ICCs). Results: Statistically significant differences were observed between the results of the CCT measurements obtained using the three different devices (p=0.009). Significant correlations were found between OLCR and FD-OCT (r=0.97; p<0.0001), FD-OCT and SC (r=0.91; p<0.0001), and OLCR and SC (r=0.95; p<0.0001). The 95% limits of agreement (LOA) obtained from Bland-Altman plots were from -7.2 mu m to 28.7 mu m for OLCR versus FD-OCT, from -19.2 mu m to 30.4 mu m for OLCR versus SC, and from -42.6 to 32.3 mu m for FD-OCT versus SC. Intra-examiner repeatability was excellent for each method, with ICCs >0.98. Conclusions: Although the results of CCT measurements obtained from these three devices were highly correlated with one another and the mean differences between instruments were comparable with the reported diurnal CCT fluctuation, the measurements are not directly interchangeable in clinical practice because of the wide LOA values.Öğe Comparison of Central Corneal Thickness Measurements With Optical Low-Coherence Reflectometry and Ultrasound Pachymetry and Reproducibility of Both Devices(LIPPINCOTT WILLIAMS & WILKINS, 2012) Koktekir, Bengu E.; Gedik, Sansal; Bakbak, BerkerPurpose: To compare the accuracy of optical low-coherence reflectometry (Lenstar LS 900; Haag Streit, Koniz, Switzerland) and conventional ultrasound pachymetry (UP) (US 4000; Nidek, Japan) for measuring central corneal thickness and to assess the interexaminer reproducibilities of both devices. Methods: Department of Ophthalmology, Selcuklu Faculty of Medicine, Selcuk University was the study setting. Central corneal thickness (CCT) was measured in both eyes of 65 emmetropic patients by the same examiner using Lenstar LS 900 noncontact biometry and UP. To assess the interexaminer reproducibility, 2 different examiners consecutively obtained CCT measurements in 16 eyes with Lenstar LS 900 noncontact biometry and UP. Results: Mean CCT measurements with Lenstar LS 900 noncontact biometry and ultrasound biometry were 541.09 +/- 33.8 and 545.69 +/- 34.0, respectively. Significant correlation was present between these 2 measurements; intraclass correlation coefficient was found to be 95.8% (95% confidence interval: 93.2%-97.4%) (P < 0.001). Interexaminer reproducibility with Lenstar was high, and the intraclass correlation was found to be 99.3% (95% confidence interval: 98.0%-99.7%). We have also investigated the interexaminer reproducibility with UP in these 16 patients, and the results showed a 99.2% (95% confidence interval: 97.7%-99.7%) intraclass correlation. Conclusions: The results of Lenstar LS 900 noncontact biometry correlated with the results of UP. It may be used as an alternative method to UP for measuring CCT. Because of the mild underestimation of CCT by Lenstar, the measurements should be carefully evaluated in patients whose intraocular pressure must strictly be monitored.Öğe Comparison of pupil diameter measurement with Lenstar LS 900 and OPD Scan II. Not interchangeable devices(SAUDI MED J, 2012) Gedik, Sansal; Koktekir, Bengu E.; Bakbak, Berker; Gonul, Saban[Abstract not Available]Öğe Comparison of the Effect of Unilateral Intravitreal Bevacizumab and Ranibizumab Injection on Diabetic Macular Edema of the Fellow Eye(MARY ANN LIEBERT, INC, 2013) Bakbak, Berker; Ozturk, Banu Turgut; Gonul, Saban; Yilmaz, Mevlut; Gedik, SansalPurpose: To find out whether intravitreally administered bevacizumab and ranibizumab affect the contralateral, untreated, eyes of patients with bilateral diabetic macular edema (DME). Methods: A retrospective review of patients with bilateral DME, who were treated with intravitreal bevacizumab or ranibizumab, was performed. All enrolled patients received intravitreal 1.25mg bevacizumab or 0.5mg ranibizumab in the eye with more severe macular edema. As outcome measures, best-corrected visual acuity (BCVA) was assessed with the Early Treatment Diabetic Retinopathy Study chart and central foveal thickness (CFT) measurement was obtained using optical coherence tomography-3 before and at 2 and 4 weeks after injections. Results: The study included 55 eyes of 55 patients who received bevacizumab (group 1) and 32 eyes of 32 patients who received ranibizumab (group 2). The mean age of the 55 patients [35 female (63.6%), 20 male (36.4%)] in group 1 was 54.3112.67 years, and the mean age of the 32 patients [20 female (62.5%), 12 male (37.5%)] in group 2 was 56.01 +/- 13.29 years. The median BCVA in the uninjected eye showed no statistically significant change at any visit after either bevacizumab or ranibizumab injection (P=0.302, P=0.582, respectively). In group 1, the median CFT in the uninjected eye was 417m at baseline; this was reduced to 401m at 2 weeks and 372m at 4 weeks. The change in CFT was found to be statistically significant (P=0.009). No statistically significant change was found in the median CFT of uninjected eyes of patients treated with ranibizumab (399, 403, and 407m before and at 2 and 4 weeks after treatment, respectively). Conclusions: Compared with ranibizumab, intravitreal administration of bevacizumab resulted in a greater decrease in macular thickness in the untreated eye, in patients with bilateral DME.Öğe Comparison of the ganglion cell complex and retinal nerve fibre layer measurements using Fourier domain optical coherence tomography to detect ganglion cell loss in non-arteritic anterior ischaemic optic neuropathy(BMJ PUBLISHING GROUP, 2013) Gonul, Saban; Koktekir, Bengu Ekinci; Bakbak, Berker; Gedik, SansalObjective To evaluate the diagnostic ability of macular ganglion cell complex (GCC) and peripapillary nerve fibre layer (NFL) measurements to detect ganglion cell loss (GCL) in patients with non-arteritic anterior ischaemic optic neuropathy (NAION), at the chronic stage. Methods This study included 10 eyes from 10 patients with NAION and 15 eyes from 15 age-matched healthy subjects. The measurements included the GCC thicknesses as average, superior and inferior, the GCC parameters as focal loss volume (FLV) and global loss volume (GLV), the NFL thicknesses as average, superior hemisphere and inferior hemisphere, and the disc parameters as rim area and rim volume. The curves for the area under the receiver operator characteristic (AUROC) were generated to assess the ability of each parameter to detect GCL. Results The patient group had significantly lower GCC thicknesses than the control group (p<0.001, <0.001 and 0.004, for the GCC average, superior and inferior, respectively), and also significantly higher FLV and GLV measurements (p<0.001). The NFL thicknesses were found to be significantly lower in the patient group than the control subjects (p<0.001). Among all the parameters, the FLV and the GLV had the highest levels of AUROC values (1.000, 0.990, respectively). Conclusions The FLV and the GLV showed the strongest abilities to detect GCL in patients with NAION. In addition, peripapillary NFL thickness was comparable to macular GCC thickness in detecting GCL. Therefore, macular GCC scans may provide a good alternative or a complementary practice to NFL scans in the detection of GCL in patients with NAION.
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