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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 Bilateral acute depigmentation of the iris (BADI): first reported case in Brazil(CONSEL BRASIL OFTALMOLOGIA, 2014) Gonul, Saban; Bozkurt, Banu[Abstract not Available]Öğe Bilateral acute iris transillumination (BAIT) initially misdiagnosed as acute iridocyclitis(CONSEL BRASIL OFTALMOLOGIA, 2015) Gonul, Saban; Bozkurt, BanuBilateral acute iris transillumination (BAIT) is a relatively new clinical entity characterized by bilateral acute loss of iris pigment epithelium, iris transillumination, pigment dispersion in the anterior chamber, and sphincter paralysis. We report the case of a 30-year-old male who was initially diagnosed with acute iridocyclitis in a different clinic and treated with topical and systemic corticosteroids. He was referred to our clinic to seek another opinion because his symptoms did not improve. An ocular examination revealed bilateral pigment dispersion into the anterior chamber, diffuse iris transillumination, pigment dusting on the anterior lens capsule, atonic and distorted pupils, and increased intraocular pressure, suggesting a diagnosis of BAIT rather than iridocyclitis. Clinicians should be aware of the differential diagnosis of syndromes associated with pigment dispersion from iridocyclitis to avoid aggressive anti-inflammatory therapy and detailed investigation for uveitis.Öğe Bilateral acute iris transillumination following a fumigation therapy: a village-based traditional method for the treatment of ophthalmomyiasis(TAYLOR & FRANCIS LTD, 2015) Gonul, Saban; Bozkurt, Banu; Okudan, Suleyman; Tugal-Tutkun, IlknurBilateral acute iris transillumination (BAIT) is a relatively new clinical entity characterized by bilateral acute loss of iris pigment epithelium, iris transillumination, pigment dispersion in the anterior chamber and atonic pupilla. We report herein a 50-year-old female who presented with bilateral ocular pain, severe photophobia and red eyes. One month ago, a fly hit her eye, and she instantly complained of a discomfort and sensation of a foreign body in both eyes. She used a fumigation therapy, a traditional method for the treatment of ophthalmomyiasis. During follow-up examinations, intraocular pressures increased over 40 mmHg bilaterally despite maximal medical therapy, which necessitated trabeculectomy surgery with mitomycin. This is a typical BAIT case with no antecedent fluoroquinolone use or viral disease, but a fumigation therapy. There might be a possible relationship between BAIT and traditional fumigation therapy or this association might be coincidental, both of which need further evaluation.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 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.Öğe Corneal specular microscopy findings in Behcet's disease(ASSOC RESEARCH VISION OPHTHALMOLOGY INC, 2014) Ozturk, Banu Turgut; Bozkurt, Banu; Beyoglu, Abdullah; Gonul, Saban; Okudan, Suleyman[Abstract not Available]Öğe The effect and safety of intravitreal injection of ranibizumab and bevacizumab on the corneal endothelium in the treatment of diabetic macular edema(TAYLOR & FRANCIS LTD, 2017) Guzel, Huseyin; Bakbak, Berker; Koylu, Mehmet Talay; Gonul, Saban; Ozturk, Banu; Gedik, SansalObjective: To investigate the effect and safety of intravitreal injection (IVI) of bevacizumab and ranibizumab on corneal endothelial cell count and morphology in patients with diabetic macular edema.Materials and methods: A total of 60 eyes from 60 consecutive patients who received 0.5mg/0.05ml IVIs of bevacizumab (n=30, IVB group) or 1.25mg/0.05ml ranibizumab (n=30, IVR group) for three consecutive months were investigated prospectively. Specular microscopy was performed to evaluate endothelial cell count, the percentage of hexagonal cells (pleomorphism), and the coefficient of variation of the cell size (polymegathism); optical biometry was performed to evaluate central corneal thickness. Results before injection and 1 month after the first and third injections were compared.Results: The groups were matched for age (p=0.11) and gender (p=0.32). There was no significant difference in endothelial cell count (IVB group, p=0.66; IVR group, p=0.74), pleomorphism (IVB group, p=0.44; IVR group, p=0.88) and polymegathism (IVB group, p=0.21; IVR group, p=0.24) before injection or 1 month after the first and third injections. There was also no difference in central corneal thickness (IVB group, p=0.15; IVR group, p=0.58) before injection or 1 month after the first and third injections.Conclusion: Monthly 1.25mg/0.05ml IVIs of bevacizumab or 0.5mg/0.05ml of ranibizumab for three consecutive months in the treatment of diabetic macular edema does not affect corneal morphology and has no harmful effects on the endothelium.Öğe Effect of Religious Fasting on Tear Osmolarity and Ocular Surface(LIPPINCOTT WILLIAMS & WILKINS, 2014) Koktekir, Bengu Ekinci; Bozkurt, Banu; Gonul, Saban; Gedik, Sansal; Okudan, SuleymanObjective: To evaluate the effects of religious fasting on tear secretion, tear osmolarity, corneal topography, and ocular aberrations. Methods: This prospective controlled study comprised 29 eyes of 29 healthy men. Before ophthalmologic examination, all subjects underwent corneal topography by a placido disc corneal topography and aberrometry device (OPD Scan II). Tear osmolarity was measured using OcuSense TearLab osmometer. Ocular surface disease index (OSDI) scores, tear break-up time (BUT), Schirmer I test, and lissamine green staining were evaluated. The measurements taken before and during Ramadan at the same hours between 4.00 and 5.00 PM were compared using paired sample t test, and a P value less than 0.05 was accepted as statistically significant. Results: The mean age of the study group was 27.8 +/- 5.9 years (range, 20-47 years). The mean tear osmolarity values were measured as 285.6 +/- 8.2 mOsm/L and 293.3 +/- 16.0 mOsm/L, whereas the mean Schirmer I values were 14.8 +/- 6.0 mm and 10.6 +/- 5.3 mm in nonfasting and fasting periods, respectively. Tear osmolarity, OSDI, and Oxford grading scores significantly increased (P=0.02, P=0.002, P=0.003, respectively), whereas Schirmer I values and intraocular pressure decreased (both, P<0.001) during the fasting period compared with the nonfasting period. There were no significant differences in tear BUT, keratometry values, and corneal aberration measurements between nonfasting and fasting periods (P>0.05, for all). Conclusion: Fasting significantly decreases tear production and increases tear osmolarity; however, it does not deteriorate corneal topographic parameters and ocular aberrations in healthy subjects.Öğe The Effect of Room Illumination on the Measurement of Anterior Segment Parameters(LIPPINCOTT WILLIAMS & WILKINS, 2014) Koktekir, Bengu Ekinci; Gonul, Saban; Bakbak, Berker; Gedik, Sansal; Dogan, Omer KamilObjective: To evaluate the effect of room illumination on the measurement of anterior segment parameters. Methods: In this comparative study, measurements of anterior segment parameters of 25 eyes of 25 healthy patients were performed by optical low-coherence reflectometry (OLCR). Measurements were taken under photopic conditions (150 lux) and under mesopic conditions (3 lux). Paired t test by SPSS 16.0 was used to compare the anterior segment measurements performed in both conditions. A P value lower than 0.05 was accepted as statistically significant. Results: The mean age of the patients was 27.09 +/- 1.72 years (range, 20-40 years). Of the anterior segment parameters, axial length and keratometry did not show significant difference between photopic and mesopic conditions (P=0.541 and P=0.812, respectively). The mean anterior chamber depth measurements was 3.04 +/- 0.35 mm and 3.06 +/- 0.35 mm, whereas the mean lens thickness was 3.75 +/- 0.36 mm and 3.77 +/- 0.36 mm in the mesopic and photopic conditions, respectively. The mean pupil diameter measurement was 4.86 +/- 0.70 mm under photopic conditions and 6.36 +/- 0.94 mm under mesopic conditions. The anterior chamber depth, lens thickness, and pupil diameter showed significant difference between photopic and mesopic conditions (P=0.01, P=0.006, and P=0.0001, respectively). Conclusion: Anterior chamber depth, lens thickness, and pupil diameter were affected by the changes in luminance while performing measurements with OLCR. Considering the age of the study group, further studies are needed to test the measurement of accommodation amplitude.Öğe Evaluation of Choroidal Thickness in Non-arteritic Anterior Ischaemic Optic Neuropathy at the Acute and Chronic Stages(TAYLOR & FRANCIS AS, 2016) Gonul, Saban; Gedik, Sansal; Koktekir, Bengu Ekinci; Yavuzer, Kamil; Okudan, SuleymanThe objective of this study was to evaluate the measurements of choroidal thickness (CT) in patients with non-arteritic anterior ischaemic optic neuropathy (NAION) at the acute and chronic stages. This case-control study compares three groups: Group 1 included 23 eyes of 23 patients with chronic NAION, Group 2 consisted of 24 eyes of 24 patients with acute NAION, and Group 3 included 24 eyes of 24 age-matched control subjects. The average CTs for Group 1, Group 2, and Group 3 were 261.24 +/- 50.04, 280.05 +/- 74.94, and 254.74 +/- 50.11 mu m, respectively. For all measurements, no statistical significance was found between the groups (p = 0.319, 0.357, 0.680, and 0.178 for the CTs as average, foveal, superior, and inferior, respectively). Similarly, there was no difference between the CT measurements of the affected and unaffected eyes in Group 1 and Group 2 (p = 0.571, 0.741 for average, respectively). The amount of time after the onset of the disease ranged from 6.0 to 48 months (23.86 +/- 16.70 months) in Group 1 and from 1 to 30 days (7.45 +/- 8.86 days) in Group 2. There was no correlation between the CTs and follow-up times in Group 1 (p = 0.768 for average) and no association between the CTs and the thicknesses of the retinal nerve fibre layers in Group 2 (p = 0.453 for average). CT is not directly influenced by NAION at either the acute or the chronic stage of the disease. These results may also demonstrate that the changes of CT do not increase the risk of experiencing a NAION attack.Öğe Evaluation of Retinal Nerve Fiber Layer Thickness with Optical Coherence Tomography in Type 1 Diabetes Mellitus Patients(ORTADOGU AD PRES & PUBL CO, 2011) Gonul, Saban; Ozkagnici, Ahmet; Ozturk, Banu Turgut; Kerimoglu, Hurkan; Sahin, AlparslanObjective: To evaluate retinal nerve fiber layer (RNFL) thickness changes of type 1 diabetes mellitus (DM) patients with and without diabetic retinopathy (DR). Material and Methods: One hundred-eighteen patients with type 1 DM and 49 age-matched control subjects were enrolled in the study. Ninety eight of 118 diabetic patients with DR were assigned as group 1 and the remaining 20 patients without DR were labeled as group 20 (n = 98). The RNFL thickness of all subjects were measured using optical coherence tomography (OCT). Results: The study included 118 type 1 DM patients with a mean age of 18.77 +/- 8.80 years. The mean age of 49 subjects in the control group was 18.71 +/- 5.72 (range 7-40) years. The mean RNFL thickness was 103.79 +/- 6.45 mu m in the control group, 100.00 +/- 11.93 mu m in group 1 and 85.59 +/- 19.81 mu m in group 2. The decrease in group 2 was found statistically significant (p < 0.001). The mean RNFL thickness in the superior, nasal, inferior and temporal quadrants were less in group 1 compared to controls, however this data was not statistically significant (p = 0.274, p = 0.149, p = 0326, p = 0783, respectively). In group 2, the RNFL thickness revealed a statistically significant decrease in all quadrants (p < 0.001) except temporal quadrant (p = 0.396). The mean duration of DM was significantly longer in group 2 (153.80 +/- 70.35) compared to group 1(60.76 +/- 50.41 months) (p < 0.001). However, there was no correlation between the RNFL thickness and the duration of DM. Conclusion: The RNFL thickness of patients with type 1 DM was found less compared to control subjects. This was more prominent in patients with established retinopathy (group 2). These findings suggested that the RNFL thickness measurement with the aid of OCT may be used as an adjunctive diagnostic tool for early diagnosis of DR.Öğe Extensive Bone Formation in a Painful Blind Eye(LIPPINCOTT WILLIAMS & WILKINS, 2014) Koktekir, Bengu Ekinci; Karabagli, Pinar; Gonul, Saban; Bozkurt, Banu; Gedik, SansalOsseous metaplasia may occur in phthisis bulbi, usually caused by long-standing retinal detachment, ocular trauma, or inflammation. However, extensive intraocular bone formation is a rare phenomenon. We report a case with long-standing phthisis bulbi demonstrating subretinal extensive bone formation. Results of histopathologic examination revealed extensive bone formation overlying the choroid with accompanying bone marrow without hematopoiesis.Öğe Measurement of choroid thickness in pregnant women using enhanced depth imaging optical coherence tomography(CONSEL BRASIL OFTALMOLOGIA, 2015) Gonul, Saban; Ozturk, Banu Turgurt; Okudan, Suleyman[Abstract not Available]Öğe Metallic corneal foreign bodies: an occupational health hazard(CONSEL BRASIL OFTALMOLOGIA, 2014) Gonul, Saban; Bozkurt, Banu; Okudan, Suleyman[Abstract not Available]Öğe Ocular effects of pegylated interferon-alpha in patients with chronic hepatitis B(INFORMA HEALTHCARE, 2013) Koktekir, Bengu Ekinci; Sumer, Sua; Bakbak, Berker; Gedik, Sansal; Gonul, Saban; Ural, OnurPurpose: To evaluate the early retinal changes and its reflection on the visual field examination in chronic hepatitis B (CHB) patients using pegylated interferon-alpha (PEGIFN-alpha) monotherapy. Patients and methods: Thirty eyes of fifteen patients with CHB were examined prospectively for changes in the fundus examination and visual field examination (both Humphrey Perimetry and Frequency Doubling Perimetry). The patients were examined before and in 3 months intervals after starting the PEGIFN-alpha treatment. The changes in the fundus examination were noted and the visual field examinations, retinal nerve fiber thickness, Schirmer scores and color vision before and at 3 months of the treatment were compared. The statistical evaluation was performed with paired-t test, using SPSS 16.0 Inc. (Chicago, IL). Results: The mean age of the 15 patients (seven male, eight female) was 52.5 +/- 12.4 years. There was no significant retinal change in none of the patients. Neither the visual field examination with Humphrey Field Analyzer nor the Frequency Doubling Perimetry results has demonstrated any significant change during 3 months follow-up. There was a statistically significant increase in the retinal nerve fiber layer (RNFL) thickness; while Schirmer test scores for dry eye assessment was significantly decreased. Conclusion: PEGIFN-alpha monotherapy, which is used for treatment of CHB, may cause some changes in the thickness of RNFL that may necessitate the close follow-up for further morphological changes of the optic disc in these patients.Öğe Postoperative fungal endophthalmitis caused by Trichosporon asahii treated with voriconazole(CONSEL BRASIL OFTALMOLOGIA, 2015) Gonul, Saban; Gedik, Sansal; Ozturk, Banu Turgut; Bakbak, Berker; Koktekir, Bengu Ekinci; Okudan, Suleyman; Dagi, Hatice TurkPostoperative fungal endophthalmitis is a rare but devastating complication of cataract surgery. Vitrectomy and intravitreal amphotericin B injection as well as administration of systemic antifungal agents have been suggested as optimal treatments for fungal endophthalmitis. However, this therapy may fail to eliminate fungal species resistant to current antifungal agents. The saprophytic fungus Trichosporon asahii is frequently observed as a cause of endogenous endophthalmitis in immunosuppressed patients. We report a case of postoperative endophthalmitis caused by T. asahii, resistant to amphotericin B. To the best of our knowledge, this is the first report of T. asahii endophthalmitis successfully treated with intravitreal and systemic voriconazole, pars plana vitrectomy, and removal of the intraocular lens and entire lens capsule.