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Öğe Anatomic and functional results of macular hole surgery with silicone oil tamponade(2013) Bakbak B.; Öztürk B.T.; Gönül S.; Gedik S.Purpose: To review the anatomical and visual outcomes in patients who underwent macular hole surgery with silicone oil tamponade. Materials and Methods: A retrospective review of 21 patients who had undergone macular holes surgery with silicone oil tamponade was conducted The primary outcome variables include best-corrected visual acuity (BCVA) in Early Treatment of Diabetic Retinopathy Study (ETDRS) letters and optical coherence tomography changes in eyes with a macular hole after the surgery. Results: The median age of 21 patients was 58.32 years. Thirteen patients had Stage 3 macular holes and eight patients had Stage 4 macular holes. Anatomical closure rate was achieved in 90.4% (19/21) of all patients. The median preoperative BCVA was 31.2 ETDRS letters (range: 13-52 letters), which increased to 42.9 ETDRS letters (range: 27-74 letters), six weeks following the removal of the silicone oil. Conclusion: Our study with 21 patients indicates that the use of silicone oil tamponade in macular hole surgery showed satisfactory anatomical and functional outcomes. As an alternative to gas tamponade, silicone oil can be used for primary macular hole surgery in patients that are unable to position themselves in a face-down posture after surgery.Öğe Application and our clinical results of low vision aids [Az Görenlere Yardim Cihazi Uygulamalari ve Klinik Sonuçlarimiz](2011) Bakbak B.; Gedik S.; Güzel H.Objective: To evaluate the results of low vision aids (LVAs) in low vision patients with various reasons. Material and Methods: Forty-eight patients with low vision in whom visual acuity could not be improved with standart optical corrections were evaluated at neuroophthalmology section of our clinic between January 2010-January 2011. Best corrected visual acuity was measured with Snellen chart for distance, and with Jaeger for near. Patients were examined with high spheric lenses and Eschenbach LVAs for distance and near. Results: Low vision aids were applied to twenty-five cases for near, to six cases for distance, and to three cases for both near and distance. The success rate was 73.7% (twenty-eight out of thirty-eight patients) for near examination and 56.25% (nine out of sixteen patients) for distance. Conclusion: Low vision aids are effective optic systems in low vision patients. LVAs should be tried in all patients with low visual acuity to improve quality of life.Öğe Assessment of ocular neurotoxicity in patients treated with systemic cancer chemotherapeutics(2014) Bakbak B.; Gedik S.; Koktekir B.E.; Yavuzer K.; Tulek B.; Kanat F.; Pancar E.Purpose: Cisplatin and Paclitaxel are two chemotherapeutic agents known to produce neurotoxicity when used for cumulative dose regimens. In this study we aim to assess their toxicity in the optic nerve, and to evaluate the retinal nerve fibre layer (RNFL) thickness and visual field changes in lung cancer patients treated with Cisplatin and Paclitaxel. Methods: Fifteen patients who were treated intravenously with 75mg/m2 cisplatin and 175mg/m 2 paclitaxel every 3 weeks, up to a maximum of six courses, were enrolled in this prospective clinical trial. All patients underwent complete ophthalmological assessments before their treatments began, as well as three months after the completion of their treatments. The RNFL thickness measurements were performed using optical coherence tomography (OCT). Functional testing included the use of frequency-doubling technology (FDT) perimetry and the Humphrey visual field analyser (HFA). The main outcome measurements included the average RNFL thicknesses and visual field indices (mean deviation [MD] and pattern standard deviation [PSD]). Results: The median age of the 15 patients (nine male and six female) was 63.49 years old (range: 53-77). The average RNFL thickness measurement during the baseline examination was 103.73?m (range: 97-111). Three months after the cessation of treatment the RNFL thickness declined to 97.4?m (range: 91-102). Statistical analysis showed a significant thinning between the two measurements (p=0.032). The MD and PSD values recorded by the HFA demonstrated no statistically significant changes 3 months after the cessation of treatment (p>0.207 and p>0.186, respectively). There were statistically significant decreases in both the MD (0.48 to-1.13dB) and PSD (2.13 to 0.65dB) indices measured by the FDT perimetry (p=0.041 and p=0.025, respectively). Conclusions: In our study, the systemic administration of Cisplatin and Paclitaxel affected the peripapillary RNFL thicknesses and visual field indices as revealed by FDT perimetry. OCT and FDT perimetry may be adjunctive tools for the screening of ocular toxicity in patients treated with these agents. © 2014 Informa Healthcare USA, Inc.Öğe The association of non-arteritic anterior ischemic optic neuropathy and cystoid macular edema [Non-arteritik anterior iskemik optik nöropati ve kistoid maküler ödem birlikteli?i](2013) Ekinci Köktekir B.; Yavuzer K.; Gönül Ş.; Bakbak B.; Gedik Ş.A sixty one years old patient who sufferred from visual loss in the left eye upon awakening, presented with optic atrophy in the right eye and hyperemic optic disc edema combined with flame shaped hemorrhages in the left eye. He was diagnosed as Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION) after ophthalmological examination. Optical Coherence Tomography (OCT) revealed cystoid macular edema (CME) in the left eye. NA-AION is a common disease which is associated with optic disc edema and painless visual loss. In this case report, a patient who probably experienced NA-AION in the right eye and sufferred from NA-AION and CME in the left eye is reported, and the combination and pathogenesis of NA-AION and CME have been discussed.Öğe Bilateral adie's tonic pupil [Bilateral adie'Nin tonik pupillası](Turkish Ophthalmology Society, 2013) Bakbak B.; Ekinci B.K.; Gedik S.; Yavuzer K.; Öztürk B.T.A 37-year-old male patient applied with the complaint of photophobia and having difficulties in reading. Both pupils were found to be dilated and un reactive to light but responsive to accommodation. The case was diagnosed with bilateral tonic pupil following neurological, radiological and laboratory evaluations. Tonic pupil should be kept in mind in eyes with light-near dissociation. In this case report, bilateral tonic pupils and the possible mechanism which may cause this disorder were discussed.Öğe Can intramuscular corticosteroid injection cause nonarteritic anterior ischemic optic neuropathy?(2013) Bakbak B.; Ozturk B.T.; Gedik S.; Koktekir B.E.; Gonul S.A 56-year-old man noted a sudden decrease of vision in his right eye 4 hours after intramuscular triamcinolone acetonide (TA) injection. A diagnosis of unilateral nonarteritic anterior ischemic optic neuropathy (NAION) was made, and the patient was counseled to discontinue using TA. Examination for possible risk factors revealed controlled hypertension. Final visual acuity was finger counting at 1 m, and the optic disc was pale in his right eye. This is the first reported case of unilateral NAION that has occurred in a patient after intramuscular corticosteroid injection. Although a cause-and-effect relationship is difficult to prove, the short duration between the TA injection and the NAION is noteworthy. The history of corticosteroid injection should be questioned in cases with predisposing conditions such as hypertension. © 2013 Bakbak et al, publisher and licensee Dove Medical Press Ltd.Öğe Clinical imaging of a case with optic disc melanocytoma [Optik disk melanositomlu bir olguda klinik görüntüleme](2011) Ekinci Köktekir B.; Bakbak B.; Gedik S.; Gülseren H.O.Melanocytoma is usually a stable and benign lesion that may be localized deep in the optic disc. Histological examination reveals uniformly distributed round or oval polyhedral nevus cells containing giant melanosomes(macromelanosom). Although visual acuity is not disturbed in most cases, some visual deterioration or rarely malign transformation has also been reported. These patients should be examined once a year and the follow up examination should include fundus photography, and if indicated visual field examination and retinal nerve fiber thickness measurement. In this study, we discuss a 45 years old female patient presenting with the complaint of difficulty in near vision, whose biomicroscopic examination revaled a dark pigmented lesion on the right optic disc.Öğe The effect of intravitreal bevacizumab and ranibizumab on macular edema of the contralateral eye: A comparative study of two anti-VEGFs(Medknow Publications, 2016) Bakbak B.; Ozturk B.; Gonul S.; Gedik S.Purpose: To compare the effects of bevacizumab and ranibizumab on the visual function and macular thickness in the contralateral (untreated) eye of patients with bilateral diabetic macular edema (DME). Materials and Methods: Thirty-nine patients with bilateral DME, who had been treated with both bevacizumab and ranibizumab in the same eye, were considered retrospectively for this study. Recorded outcome measurements included the best-corrected visual acuity (BCVA) assessment with the Early Treatment Diabetic Retinopathy Study (ETDRS) chart and the central subfield macular thickness (CSMT) measurement of the contralateral, uninjected eye before and at 4 weeks after the injections. Results: The median BCVA of the uninjected eye was 50 ETDRS letters and the median CSMT was 459 ?m preceding the bevacizumab injection whereas at the control appointment, 4 weeks after the injection, the median BCVA had increased to 52 letters (P = 0.098), and the median CSMT had decreased to 390 ?m (P = 0.036). The mean interval between the bevacizumab and ranibizumab treatments was 4.79 1.52 months. The measurements of the untreated eye after the ranibizumab treatment showed that the median BCVA decreased from 55 to 52 letters, and the median CSMT increased from 361 ?m to 418 ?m (P = 0.148 and P = 0.109, respectively). Conclusions: In contrast to ranibizumab, the intravitreal administration of bevacizumab resulted in a statistically significant decrease in macular thickness in the untreated eye in patients with bilateral DME. © 2016 Oman Ophthalmic Society | Published by Wolters Kluwer Medknow.Öğe The effects of smoking on anterior segment parameters, retinal nerve fiber layer, and pupillary functions [Sigarani{dotless}n ön segment parametreleri, retinal sinir lifi tabakasi{dotless} ve pupil fonksiyonlari{dotless} üzerine etkileri](Turkish Ophthalmology Society, 2014) Köktekir B.E.; Gönül S.; Bakbak B.; Gedik S.; Marako?lu K.Objectives: To evaluate the alterations in the anterior segment parameters, retinal nerve fber layer, and pupillary functions in smokers. Materials and Methods: In this case-control study, 45 eyes of 45 smokers and 45 eyes of 45 non-smoker control subjects were evaluated. All patients underwent measurement of anterior segment parameters with optical low coherence refectometry (OLCR), mesopic and photopic pupillary diameter with an aberrometer device, retinal nerve fber layer thickness with optical coherence tomography, and dry-eye assessment with Schirmer's test. The results were compared with independent t-test by SPSS 16.0 Inc., and a p-value lower than 0.05 was determined as signifcant. Results: There was a signifcant difference between both groups in terms of mesopic pupil diameters that were measured with both OLCR and aberrometer device (p=0.03 and 0.02, respectively). Schirmer scores were also signifcantly decreased in smokers (p=0.001). The other measured parameters demonstrated no difference between smokers and non-smokers (p>0.05 for all). Conclusion: Smoking may affect pupillary functions, especially the mesopic pupillary diameter, and may cause a defciency in pupil response under dark circumstances.Öğe Is it possible to replace automated keratometry with current devices: Comparison with lenstar and OPD II [Yeni cihazlar otomatize keratometre yerine kullanılabilir mi? Lenstar ve OPD ile karşılaştırılması](Turkish Ophthalmology Society, 2013) Köktekir B.E.; Gedik S.; Bakbak B.; Gönül S.; Do?an O.K.Purpose: To compare the keratometry results obtained with optical low-oherence reflectometer, corneal topography, and automated keratometry readings and to assess the interexaminer reproducibility of each device. Ma te ri al and Met hod: This comparative study examined 65 eyes of 65 healthy subjects. Detailed ophthalmic examination was performed in all cases following keratometry measurements with a KR 8100A (Topcon, Japan), an OPD Scan II (Nidek, Japan), and a LenStar LS900 (Haag-Streit, Switzerland). Patients with spheric values over ±3.0D or cylindric values over ±1.0D and with history of chronic ocular/systemic disease or contact lens usage were excluded from the study. The keratometry readings were compared by using ANOVA test (SPSS 16.0). A p-value lower than 0.05 was taken as statistically significant. Bland-Altmann analysis was used to demonstrate agreement between methods, and Spearman rank correlation coefficient (r) was calculated for the correlation. To assess the interexaminer reproducibility, intraclass correlation coefficient was calculated in 30 eyes for each device. Re sults: The mean age of the 65 patients enrolled in the study was 21.9±3.25 years. The mean keratometric values obtained with the autorefractokeratometer, OPD Scan II, and LenStar LS 900 were 43.30±1.47, 43.42±1.44, and 43.29±1.42 respectively. No statistically significant difference was observed among the three groups (p=0.840). Interexaminer intraclass correlation was found as 78.9%, 99.9%, and 99.7% for ARK, OPD, and LenStar, respectively. Dis cus si on: LenStar has provided comparable and well-correlated keratometry measurements in comparison with automated keratometer and corneal topography.Öğe Optical coherence tomography findings in patients with Wolfram syndrome [Wolfram sendromlu hastalarda optik koherans tomografi bulgulari{dotless}](Turkish Ophthalmology Society, 2014) Köktekir B.E.; Bakbak B.; Gönül Ş.; Gedik Ş.Objectives: To report the optical coherence tomography (OCT) fndings in patients with Wolfram syndrome. Materials and Methods: Four patients who fulfilled the criteria for Wolfram syndrome were recruited to the study. In all patients, OCT was performed with Stratus OCT (OCT-3, Carl Zeiss Meditec, Inc. Germany). The fast retinal nerve fiber layer (RNFL) and fast macular thickness protocols were used to measure the RNFL and macular thickness, respectively. The fast optic disc protocol was used to determine the cup-to-disc ratios of the optic disc. All patients were examined with VEP (Retimax, CSO Strumenti Oftalmici, Florence, Italy). Results: In eight eyes of four patients (3 male and 1 female) with a mean age of 18.5±2.08 years (range 16-21 years), RNFL, macular thickness, and cup-to-disc ratios were determined. The mean RNFL was 42.2±5.6 ?m (range 34.1-49.5 ?m), while the mean macular thickness and cup-to-disc ratios were 145±15 ?m (range 125-160 ?m) and 0.79±0.07 (range 0.7-0.92), respectively. There was a moderate negative correlation between VEP latencies and macular and RNFL thicknesses (Spearman correlation coefficient was -0.23 and -0.34, respectively). Conclusions: RNFL loss and secondary optical atrophy are severe complications that may affect the visual acuity in patients with Wolfram syndrome. Retinal changes in these patients may be quantified and can be observed using OCT.Öğe Painful ophthalmoplegia manifesting with third nerve palsy in childhood [Çocukluk ça?ında üçüncü sinir felci i?le seyreden a?rılı oftalmopleji](Turkish Ophthalmology Society, 2012) Köktekir B.E.; Gedik S.; Bakbak B.The causes of painful ophthalmoplegia that manifests with third nerve palsy in childhood include postinfectious third nerve palsy, compressive lesions, vascular anomalies and ophthalmoplegic migraine. Ophthalmoplegic migraine is a rare pathology in the literature and is characterized by recurrent attacks of headache and ophthalmoplegia that usually begins during childhood. Ophtalmoplegia occurs due to paresis or paralysis of cranial nerves 3, 4 or 6. Attacks may last a few hours to weeks and usually are recovered with appropriate therapy, but some cases may demonstrate permanent defects. In this paper, we discuss the case of an 11-year-old patient, who was admitted to our outpatient clinic with the complaints of right ptosis, mydriasis and severe headache. Ophthalmologic examination revealed oculomotor nerve palsy, the patient was diagnosed as having ophthalmoplegic migraine and medical treatment was started. Her complaints have regressed with medication for migraine and recovered completely in 8 weeks. In this case report, painful ophthalmoplegia during childhood and its possible causes are discussed.Öğe Spontaneous closure of macular hole induced by accidental Nd: YAG laser injury(2013) Bakbak B.; Gedik Ş.; Öztürk B.T.; Kerimoglu H.The natural history of Neodymium:yttrium aluminum garnet (Nd:YAG) laser-induced macular holes remains uncertain because this type of injury is uncommon. A 47 years old male physicist with the diagnosis of macular hole induced by accidental Nd:YAG laser injury was followed-up. The size of the macular hole decreased and vitreous hemorrhage resolved spontaneously. Accidental exposure to high-energy Nd:YAG laser may lead to concussive retinal damage and create a macular hole. Laser-induced macular holes can resolve spontaneously. The presence of an epiretinal membrane and the size of the macular hole are the common ocular signs that seem to affect the natural course of laser-induced macular holes.Öğe Tonic pupil following traumatic hyphema: Case report [Travmatik hifema sonrası gelişen tonik pupilla: Olgu sunumu](Turkish Ophthalmology Society, 2013) Gönül S.; Köktekir B.E.; Bakbak B.; Gedik S.; Beyo?lu A.A 7-year-old girl was admitted to our clinic after crash injury with air gun pellet in her right eye. There was an intense anterior chamber reaction and hyphema on the biomicroscopic examination. During the control examination after treatment of hyphema including cyclopentolate 1%, prednisolone acetate 1% and lomefloxacin 0.3%, anisocoria and mydriasis in the right eye were observed and the difference between both pupils was less in darkness. The case was diagnosed as tonic pupil following trauma, and diluted pilocarpine 0.125% test was performed. On diluted pilocarpine test, right pupil responded excessively to pilocarpine compared with the other pupil. As in our case, in cases with anisocoria following blunt trauma to orbit, tonic pupil should be keep in mind.
