Browsing by Author "Tekin, Serek"

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Adherence To Drop Treatment in Glaucoma Patients and Its Relationship With Progression
(2021) Özer, Muhammet Derda; Seven, Erbil; Öcal, Halit; Tekin, Serek; Batur, Muhammed; Yaşar, Tekin
Purpose: To evaluate the adherence of glaucoma patients to eye drop therapy and determine the effects of treatment adherence on disease progression. Materials and Methods: A total of 147 patients followed at Van Yüzüncü Yıl University Department of Ophthalmology, between March 2019 and June 2019 were included in the study. Patients were examined and asked questions. Patients underwent peripapillary retinal nerve fi ber layer analysis via optical coherence tomography. Results: It was found that 66% of the patients adhered to eye drop treatment. The most common reasons for non-adherence were forgetting (40%) and running out of eye drop (38%). Correct instillation technique was demonstrated by 59% of the patients. There was signifi cantly less disease progression in adherent patients compared to non-adherent patients (p=0.002) and in patients with correct instillation technique compared to those without (p=0.001). Conclusion: This study showed adherence to eye drop therapy was 66% among glaucoma patients and 59% of patients showed correct drop instillation technique. More progression was observed in patients with poor adherence and patients who did not instill drops correctly.
Anterior Lens Capsule and Iris Thicknesses in Pseudoexfoliation Syndrome
(Taylor & Francis inc, 2017) Batur, Muhammed; Seven, Erbil; Tekin, Serek; Yasar, Tekin
Purpose: The aim of this study was to evaluate anatomic properties of the lens capsule and iris by anterior segment optical coherence tomography (AS-OCT) in patients with pseudoexfoliation (PEX).Methods: This prospective study included 62 eyes of 62 patients with PEX syndrome and 43 eyes of 43 age- and gender-matched controls. All subjects underwent full ophthalmologic examinations including AS-OCT. Pupillary diameter, midperipheral stromal iris thickness, central and temporal lens capsule thicknesses, and peripheral pseudoexfoliation material thickness on the anterior lens capsule surface were measured and recorded.Results: Mean age was 66.8 9.3 years in the PEX group and 65.5 +/- 8.9 years in the control group (p = 0.44). The PEX group consisted of 62 patients: 38 men (61.3%) and 24 women (38.7%); the control group included 43 subjects: 25 men (58.1%) and 18 women (41.9%). Pupillary diameter after pharmacologic mydriasis was 21% smaller in the PEX group than controls. Mean midperipheral iris thickness was 36 +/- 7.2 m (7.8%) thinner in the PEX group than that of control group (p = 0.047). The central anterior capsule was a mean of 3.40 +/- 0.51 m (18%) thicker in the PEX group compared to the control group (p = 0.0001). The temporal anterior lens capsule was a mean of 0.17 +/- 0.15 m thicker in the PEX group compared to the control group (p = 0.81).Conclusions: With high-resolution OCT imaging, it has become possible to evaluate the anterior lens capsule without histologic examination and demonstrate that it is thicker than normal in PEX patients.
Assessment of Serum Catalase, Reduced Glutathione, and Superoxide Dismutase Activities and Malondialdehyde Levels in Keratoconus Patients
(Springernature, 2022) Tekin, Serek; Seven, Erbil
Background: The aim of this study was to investigate the relationship between keratoconus disease and the antioxidant activities of catalase (CAT), reduced glutathione (GSH) and superoxide dismutase (SOD) and the level of the oxidative stress marker malondialdehyde (MDA) in serum. Methods: The study included 50 patients diagnosed with keratoconus and 53 healthy age- and sex-matched control subjects. The keratoconus patients were grouped according to the four keratoconus stages based on the modified Krumeich keratoconus classification system. The CAT, GSH and SOD activities and MDA levels in the serum samples collected from the patient and control groups were compared. Results: The mean serum CAT, GSH, SOD and MDA levels in the keratoconus group were determined to be 0.075 (0.074-0.078)U/L, 0.002 (0.001-0.006) mmol/ml, 1.56 (1.51-1.62)U/L and 1.69 (1.65-1.99) mmol/L, respectively, and those in the control group were determined to be 0.024 (0.013-0.037)U/L, 0.029 (0.018-0.049) mmol/ml, 4.13 (4.01-4.17) U/L and 0.74 (0.65-0.82) mmol/L. The serum GSH levels and SOD activity were significantly lower in the keratoconus group (p < 0.001 for both) than in the control group while the CAT activity and MDA levels were significantly higher (p < 0.001 for both). Conclusion: The low serum GSH levels and SOD activity and the high CAT activity and MDA levels observed in this study suggest the presence of oxidative stress and inadequate antioxidant defence mechanisms in keratoconus patients. The studied parameters may offer auxiliary markers for use in the diagnosis and treatment of the keratoconus disease and in its potential therapeutic targets in the future.
Authors' Reply To: Using Anterior Segment Optical Coherence Tomography To Compare the Smoothness of Anterior Iris Surface Between Two Eyes in Unilateral Fuchs' Uveitis Syndrome
(Springer, 2019) Ozer, Muhammet Derda; Kebapci, Fatih; Batur, Muhammed; Seven, Erbil; Tekin, Serek
Bakteriyel Keratit Tedavisinde Koenzim Q10 Göz Damlasının Korneal Yara İyileşmesi Üzerine Etkisi: Prospektif Klinik Çalışma
(2024) Batur, Muhammed; Seven, Erbil; Tekin, Serek; Ozer, Muhammet Derda
Amaç: Bu çalışmada, bakteriyel keratitte Koenzim Q10 (KoQ10) göz damlasının korneal yara iyileşmesi üzerindeki etkinliğini ve güve- nilirliğini değerlendirmeği amaçladık. Gereç ve Yöntemler: Bakteri- yel keratit tanısıyla yatırılarak tedavisi yapılan hastalar çalışmaya alındı. Hastaların yaşı, cinsiyeti ve hangi gözün tutulduğu kaydedildi. Hasta- lara tam bir göz muayenesi yapıldı ve hipopiyon olup olmadığı kayde- dildi. Korneal ülser büyüklüğü yatay ve dikey olarak ölçüldü. Hastalar rastgele 2 gruba ayr ıldı. Her iki gruba da topikal antibiyotik ve siklo- pentolat damla verildi. Birinci gruba ek olarak KoQ10 göz damlası 4×1 tedaviye eklendi. Tedavi öncesi ve tedaviye ba şlandıktan sonra ülser iyileşene kadar günlük olarak korneal ülser görüntüleri al ındı ve kay- dedildi. Bulgular: Çalışmaya alınan toplam 32 hastanın yaş ortalaması 51,16±25,31 (7-90) yıl olup, 20’si (%62,5) erkek, 12’si (%37,5) kadın idi. KoQ10 göz damlası verilen grup (n=16) ile kontrol grubunun (n=16) yaş, cinsiyet, sağ-sol göz tutulumu, hipopiyon varlığı ve korneal ülser boyutu açısından istatistiksel olarak anlamlı farkı yoktu (p>0,05). Or- talama iyileşme süresi KoQ 10 göz damlası verilen grupta 12,25±6,02 gün ve kontrol grubunda 19±12,9 gün idi (p=0,076). Sonuç: KoQ10 göz damlası, bakteriyel keratite bağlı gelişen korneal ülser tedavisindeki etkisi istatistiksel olarak anlaml ı bulunamadı. Ancak iyile şme süresi- nin kısalması açısından adjuvan ajan olarak düşünülebilir. Bu konuda daha geniş serilere sahip randomize, prospektif klinik çalışmalara ihti- yaç vardır.
Behçet Hastalığına Bağlı Üveitin Tedavisinde Oral Steroidler ve İmmünsupresan/immünmodülatörlerin Kullanımı
(2018) Batur, Muhammed; Özer, Muhammet Derda; Tekin, Serek
Behçet hastalığı sebebi bilinmeyen kronik, multisistemik enflamatuar bir hastalıktır. Hastalığın seyri sırasındaöngörülemeyen ciddi enflamatuar ataklar gözlenmektedir ve arka segmenti etkileyen ciddi ataklar hızlı ve etkilitedavilerle sakinleştirilemezse kalıcı oküler hasar kaçınılmazdır. Sadece ön segment tutulumu olan olgularda topikaltedavi yeterli olurken, ciddi arka segment tutulumu olan dirençli üveit ataklarında, yüksek doz sistemik kortikosteroidile kombine immünsüpresif ilaçlar kullanılır. Fakat konvansiyonel immünsüpresif ilaçlara rağmen dirençli üveit ataklarıgözlenebilmektedir.
Choroid Vascularity Index as a Parameter for Chronicity of Fuchs' Uveitis Syndrome
(Springer, 2020) Ozer, Muhammet Derda; Batur, Muhammed; Tekin, Serek; Seven, Erbil; Kebapci, Fatih
Purpose This study aimed to compare the choroidal vascularity index (CVI) of eyes having Fuchs' uveitis syndrome (FUS) with healthy fellow eyes (N). Methods This prospective, cross-sectional study included unilateral FUS cases and an age- and gender-matched healthy control group. Thirty-nine participants were included in the FUS group, and 24 age- and gender-matched individuals were randomly selected for the control group. Endothelial cell density (ECD) was measured using Tomey specular microscopy. Spectral-domain optical coherence tomography was used to acquire the choroidal images, and binarization was applied to the images. Two blinded investigators analyzed the CVI in both eyes of the FUS cases and the right eyes of the healthy control group. Results CVI was found to be significantly decreased in FUS (p < 0.001). Additionally, ECD had a strong positive correlation with CVI (r = 0.383, p = 0.008). Conclusion CVI may provide information about the chronicity of the disease.
Comparasion of Optic Nerve Head With Stereophotometric and Scanning Laser Ophthalmoscopic Imaging
(derman Medical Publ, 2015) Tekin, Serek; Yasar, Tekin
Aim: To compare theevaluation results of two experienced clinicians about examination of optic discs in glaucoma patients and healthy inidividuals by stereophotometry and scanning laser ophthalmoscopy. Material and Method: We studied 116 individuals (217 eyes) who were divided as normal, glaucoma and suspected glaucoma in numbers of 54, 42 and 20 respectively. Stereo-photometric photographs of optic disc were examined with fundus camera (Zeiss, FF 450 plus). Optic disc was also evaluated with HRT-3 in the same visit. Two experienced clinicians evaluated the cup/disc ratios and whether the optic discs were glaucomatous or not. Evaluation results were analysed and compared with HRT-3 examinations. Results: There were no significant age and gende rdifferences between the groups(p>0.05). Stereophotographic C/D ratio correlations between the clinicians were 0.79 (p<0.001) in theright-eyesand 0.82 (p<0.001) in thelefteyes. Correlationbetween C/D ratios of the-firstclinicianexaminationand HRT-3 was 0.57 (p<0.001) in therighteyesand 0.50 (p<0.001) in thelefteyes. Correlationratios of thesecondclinicianwas 0.66 (p<0.001) in therighteyesand 0.68 (p<0.001) in thelefteyes. Consistency of thefirstclinician in means of correlation of stereographyand HRT-3 C/Dratioswas %51.2 (p<0.001) in therighteyesand % 47.5 (p<0.001) in thelefteyes. Consistencyforthesecondclinicianwas 0.40 (p<0.001) in therighteyesand % 62.7 (p<0.001) in thelefteyes. Discussion: Although the consistency between the clinician was well, consistency between the clinicians and HRT-3 was in lower rates. Imaging methods were insufficient in glaucoma suspected eyes despite both of methods was effective in the discrimination of normal and glaucomatous eyes.
Comparative Analysis of Oxidative Stress Biomarkers in 50 Primary Open-Angle Glaucoma Patients
(int Scientific information, inc, 2025) Seven, Erbil; Tekin, Serek
Background: Glaucoma, a leading cause of irreversible blindness, is associated with increased oxidative stress and impaired antioxidant defense mechanisms. This study compared serum levels of malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), and reduced glutathione (GSH) in 50 patients with primary open-angle glaucoma (POAG) and 52 healthy controls. Material/Methods: Fifty patients in the POAG group and 52 age-and sex-matched individuals in the control group were included in the study. SOD activity was evaluated using the optical density of the blue formazan dye formed at 560 nm due to the interaction of nitroblue tetrazolium with xanthine and superoxide radicals generated by xanthine oxidase. CAT activity in serum was assessed using hydrogen peroxide and phosphate buffer solution. Measurement of GSH levels was performed using a phosphate buffer and DTNB (Ellman's reagent) solution. MDA levels were quantified by measuring the colored complex formed with thiobarbituric acid. All biomarkers were measured using spectrophotometric methods. Results: The results indicated significantly higher serum MDA levels (P<0.001) and CAT levels (P<0.001), along with lower SOD levels (P<0.001) and GSH levels (P<0.001) in patients with POAG compared to the controls. Conclusions: These findings suggest that POAG patients experience increased oxidative stress and have an insufficient antioxidant defense system. The imbalance in the oxidant-antioxidant equilibrium in POAG patients suggests a role of oxidative stress in pathogenesis of the disease. Evaluating serum levels of these biomarkers could be valuable for diagnosing and treating POAG.
Comparesion of the Evaluation Results of Two Experienced Clinicians About Examination of Optic Discs in Glaucoma Patients and Healthy Inidividuals by Stereophotometry and Scanning Laser Ophthalmoscopy
(2010) Tekin, Serek; Yaşar, Tekin
Amaç: Glokomlu ve sağlıklı bireylerde optik sinir başının stereofotometri ve scanning laser oftalmoskopi ile değerlendirilmesi ve deneyimli iki klinisyenin, değerlendirme sonuçlarını karşılaştırması.Metodlar: Çalışmamıza 54'ü normal, 42'si glokom, 20'si glokom şüphesi olan 116 kişi dahil edildi. OSB'nin stereofotometrik görüntüleri FF 450 plus fundus kamera (ZEISS) ile elde edildi. Aynı seansta OSB, HRT-3 ile de görüntülendi. Stereofotometrik görüntülerin, glokom olup olmadığı ve C/D oranları iki deneyimli klinisyen tarafından değerlendirildi. Değerlendirmeler kendi arasında ve HRT-3 ile karşılaştırıldı.Bulgular: Gruplar arasında yaş ve cinsiyet bakımından anlamlı fark yoktu (p?0.05). Birinci ve ikinci klinisyenler arasında stereofotoğrafik C/D oranları arasındaki korelasyon, sağ gözlerde 0.79 (p?0.001) , sol gözlerde 0.82 (p?0.001) idi. Birinci klinisyenin sağ göz stereofotoğrafisine göre belirlediği C/D oranları ile HRT-3 lineer C/D oranları arasındaki korelasyon 0.57 (p?0.001), sol gözde 0.50 (p?0.001) idi. İkinci klinisyenin sağ gözlerdeki korelasyonu 0.66 (p?0.001) iken sol gözlerde 0.68 (p?0.001) idi. Birinci klinisyenin stereofotoğrafi ve HRT-3 arasındaki C/D ölçümleri arasındaki uyum sağ gözde % 51.2 (p?0.001) sol gözde % 47.5 (p?0.001) dir. İkinci klinisyenin stereofotoğrafi ile HRT-3 arasındaki C/D ölçümleri arasındaki uyum sağda % 40 (p?0.001), solda % 62.7 (p?0.001) idi.Sonuçlar: Klinisyenler arası uyum genel olarak iyiyken klinisyenler ile HRT-3 arasındaki uyum nispeten düşük bulundu. Her iki yöntem de glokomlu ve normal gözü ayırmada etkili olsada glokom şüpheli gözlerde görüntüleme yöntemlerinin yetersiz kaldığı görüldü.Anahtar kelimeler: Glokom, stereofotometrik fundus fotoğrafisi, Heidelberg retina tomografisi.?
Comparison of the Efficacy of Accelerated Corneal Cross-Linking Therapy in Different Pediatric Age Groups Having Progressive Keratoconus
(Springer, 2020) Ozer, Muhammet Derda; Batur, Muhammed; Mesen, Selma; Tekin, Serek; Seven, Erbil; Yasar, Tekin
Purpose To report a comparison analysis of accelerated corneal cross-linking (A-CXL) treatment for progressive keratoconus patients in different pediatric age groups. Study design Retrospective, cross-sectional. Methods Patients with progressive keratoconus aged <= 18 were retrospectively reviewed. Forty-one eyes of 41 patients were included in the study. Patients were divided into two groups according to their age (<= 14 years and 15-18 years). All patients underwent epithelium-off A-CXL protocol. Acquired data were compared between the two groups. Results The mean age was 14.3 +/- 1.8 (10-18) years. Twenty-five (61%) of the participants were male, and 16 (39%) were female. Twenty (49%) patients were separated into group 1 (<= 14 years of age), and 21 (51%) were in group 2 (15-18 years). Age at presentation was found to be the only factor in anticipating the progression of keratoconus at the second postoperative year visit (p < 0.001). Progression in keratometric values was detected in seven (35%) of the 20 eyes in group 1, and one (4%) of the 21 patients in group 2 (Z = - 2.44, p = 0.014). Conclusion Even if proper treatment is applied, the progression of keratoconus is likely in patients younger than 14 years of age. Instead of evaluating pediatric patients as a whole, closer follow-up and early treatment may be useful in younger age groups (<= 14 years).
Comparison of Three Different Intraocular Lens Implantation Method for Eyes With Defi Cient Capsular Support
(2021) Tekin, Serek; Özer, Muhammet Derda; Yavuzer, Beyza; Yaşar, Tekin; Batur, Muhammed; Seven, Erbil
Purpose: The aim of this study was to compare three different intraocular lens (IOL) implantation methods performed primary or secondary in eyes with defi cient capsular support. Materials and Methods: The records of patients who underwent IOL implantation due to defi cient capsular support were analyzed. The patients were fi rst separated into primary and secondary IOL implantation group (PIG and SIG, respectively), then divided into three subgroups among themselves as iris-claw IOL (IC-IOL), scleral fi xated IOL (SF-IOL), and anterior chamber IOL (AC-IOL). Data were compared according to the groups. Results: The most important cause of IOL implantation was perioperative capsule rupture and insuffi cient capsular support (61.7%, n=29) in PIG, aphakia (55.8%, n=24) in SIG. The most preoperative comorbid condition was iridodonesis (30.4%, n=14) in PIG and IOL subluxation (93.8%, n=15) in SIG. The mean BCVA in the 3rd months was signifi cantly better in the IC-IOL subgroup than AC-IOL subgroups (p=0.001) in PIG. The mean BCVA at the last follow-up was signifi cantly better in the SF-IOL group than the AC-IOL group (p<0.001) in PIG. Postoperative complication rate was 38.3% in PIG and 27.9% in SIG. There was no signifi cant difference among subgroups in postoperative complications in both groups (p>0.05, Chi-square test). Conclusion: All three methods have advantages and disadvantages. The surgeon should consider the patient’s condition when determining the implantation method to be chosen. Future long-term studies comparing the different methods with a large number of patients may provide more information about the most appropriate method to use in eyes with insuffi cient capsular support.
Conjunctival Lymphangiectasis: Successful Surgical Resection of an Idiopathic Case
(Ophthoscience Publ, 2019) Seven, Erbil; Batur, Muhammed; Tekin, Serek; Bulut, Gulay; Yasar, Tekin
Conjunctival lymphagiectasis is a topical ocular condition characterized by swelling of conjunctiva as a result of dilated lymphatics of the bulbar conjunctiva. In this case report, a 51-year-old man presented with conjunctival swelling in the left eye. Conjunctival lymphangiectasis was diagnosed and a conjunctival resection was performed. No recurrence was found in follow-up examination at 9 months.
Corneal Parameters, Ocular Biometers, and Retinal and Choroidal Thickness in Acromegaly Patients
(Elsevier, 2023) Batur, Muhammed; Ozer, Muhammet Derda; Ucler, Rifki; Seven, Erbil; Tekin, Serek; Unal, Fikret
Background: To compare ocular findings of acromegaly patients with healthy individuals and investigate the relation of serum levels of insulin-like growth factor (IGF-1) along with growth hormone (GH) and pituitary tumor (adenoma) dimensions (TD) with specific ocular parameters. Methods: The ocular parameters of acromegaly patients (n = 38) were compared with those of healthy subjects (n = 36). These parameters were intraocular pressure, keratometric (K1-K2) values, central corneal thickness (CCT), total axial length along with anterior chamber-lens-vitreous length, retinal nerve fiber layer (RNFL) thickness, central foveal thickness (CFT), choroidal thickness (CT), ganglion cell layer thickness (GCLT), and inner plexiform layer thickness (IPLT). Also investigated was whether there was a correlation between disease duration, TD, GH, IGF-I, CCT, RNFL, CFT, GCLT, IPLT, and CT. Results: The lens length of the acromegaly group was increased (p = 0.014). GH and IGF-1 levels were positively correlated with CT and CCT, respectively (p = 0.041, r = 0.343) (p = 0.03, r = 0.347). Analysis of TD also found a highly negative correlation with the mean RNFL thickness of the acromegaly patients (p < 0.01, r = -0.603). The mean value of the inner parts of GCLT and IPLT was negatively correlated with TD (p = 0.041, r = -0.343 and p = 0.025, r = -0.379, respectively). Conclusion: Serum IGF-1 and GH levels might be determinant factors in CCT and CT, respectively. The pituitary adenoma size increasing may be prone to lead RNFL, ganglion cell layer, inner plexiform layer thinning. Increased lens thickness was found in the acromegaly group.
The Depigmentation Degree of Iris Pigment Epithelium in Pseudoexfoliation Syndrome
(Elsevier, 2021) Ozer, Muhammet Derda; Batur, Muhammed; Tekin, Serek; Seven, Erbil; Kebapci, Fatih; Bilmez, Rumeysa
Background: To compare the optical density of iris pigment epithelium (ODIPE) and iris stromal thickness (IST) measurements in patients having pseudoexfoliation syndrome (PXS) and age-gender matched participants. Methods: This is a cross-sectional study. Patients with PXS were enrolled in the study group. Age and gendermatched healthy subjects with no evidence of PXS were recruited as controls. After a comprehensive ophthalmological evaluation, the anterior segment images were acquired using anterior segment spectral-domain optical coherence tomography (AS SD-OCT). The acquired pictures were further analyzed using the ImageJ program. Two investigators measured the ODIPE and the IST of the subjects, and the repeatability and reproducibility were checked. SPSS program was used for statistical analysis. Results: The PXS group was comprised of twenty-two eyes (n = 22 patients), and the control group contained twenty-six eyes of 26 age and gender-matched healthy subjects. The mean temporal ODIPE of the study group was found to be decreased significantly in comparison to the mean temporal ODIPE of the control eye (p = 0.018). Both the mean nasal (N) and temporal (T) ISTs of the PEX eyes were thinner than the control eyes (p = 0.006 and p = 0.002, respectively). The mean baseline IOP was found to significantly negatively correlate with the ODIPE in the PEX group at both N and T sides (r = -0.531, p = 0.011 and r = -0.685, p < 0.001, respectively). Conclusion: The pupillary margin IPE was found more depigmented, and the mean N and T IST were significantly thinner in the PEX group by comparison with the age-gender matched healthy controls. The mean baseline IOP was negatively correlated with the pupillary margin's IPE pigmentation degree in patients with PXS.
Effect of Insulin Therapy on Ocular Biometric Parameters in Diabetic Patients
(Mary Ann Liebert, inc, 2020) Seven, Erbil; Yildiz, Saliha; Tekin, Serek; Altas, Ahmet Serkan; Ozer, Muhammet Derda; Batur, Muhammed; Yasar, Tekin
Purpose: To evaluate effects of insulin on ocular parameters in patients with type 2 diabetes mellitus who start insulin therapy. Methods: In this prospective study, ocular biometric parameters were obtained using optical biometer (Lenstar LS900; Haag-Streit AG) and refraction test (ARK-510A Auto refracto-keratometer; Nidek Co. Ltd, Aichi, Japan) before and at 3 months after initiating insulin therapy. In addition, patients' fasting blood glucose (FBG), glycosylated hemoglobin (HbA1C), and blood lipid levels were measured at the same time points. Pretreatment and post-treatment results were compared. In addition, associations between ocular parameters with initial dose and type of insulin treatment regimen, HbA1C, and FBG levels were evaluated. Results: The patients' mean age was 51.2 +/- 12.9 (18-73) years. Post-treatment HbA1C and FBG levels (8.5% +/- 2.5% and 188.1 +/- 111.2 mg/dL, respectively) were significantly lower than pretreatment values (12% +/- 1.4% and 325.3 +/- 95.7 mg/dL, respectively; P < 0.001 for both). There was a significant positive correlation between the change in HbA1C and the change in lens thickness (P = 0.03), and a significant negative correlation between the change in FBG and the change in the spherical equivalent refraction (P = 0.045). Insulin dose and treatment regimen type were not significantly correlated with ocular parameters (P > 0.05). Conclusion: HbA1C-lowering glycemic effect of insulin was correlated with a small decrease in lens thickness. Long-term, randomized controlled trials including larger patient numbers are needed to shed light on the long-term effects of insulin use and glycemic control on ocular parameters.
Effectiveness of Pulmonary Surfactant in the Treatment of Corneal Edema
(Mary Ann Liebert, inc, 2021) Artuc, Tuncay; Batur, Muhammed; Seven, Erbil; Tekin, Serek; Ozer, Muhammet Derda
Purpose: To compare the effectiveness of topical surfactant and 3% sodium chloride (NaCl) in the treatment of corneal edema occurring after cataract surgery. Methods: Ninety eyes of 90 patients with no corneal disease who underwent cataract surgery were included in the study. Thirty eyes without corneal edema comprised group 1. Patients with corneal edema were divided into two groups: those treated with 3% NaCl (group 2, 30 eyes) and those treated with surfactant drop (group 3, 30 eyes). Results: The mean age was 70.8 +/- 6.6 years, with no significant age difference between the groups. Preoperatively, there was no significant difference in mean central corneal thickness (CCT) or mean endothelial cell count (ECC) among the groups (P = 0.999). On postoperative day 1, CCT was significantly lower in group 1 (P < 0.001) but did not differ between groups 2 and 3 (P = 0.999). There was no significant difference between groups in terms of ECC (P > 0.05). At postoperative day 7 and 14, CCT differed significantly between groups 1 and 2 (P < 0.001) and between groups 2 and 3 (P = 0.001), with no significant difference between groups 1 and 3 (P = 0.474). ECC was significantly higher in group 1 (P < 0.05), whereas there was no significant difference between groups 2 and 3 (P > 0.05). Conclusion: Topical pulmonary surfactant may be a more effective treatment option than 3% hypertonic NaCl for the treatment of corneal edema that develops after cataract surgery.
The Effects of Corneal Cross-Linking Treatment on Lens Capsule, Iris, and Other Anterior Segment Parameters in Keratoconus Patients
(2024) Subaşı, Merve; Tekin, Serek
Amaç: Keratokonus hastalarını cross-linking (CXL) öncesi ve sonrasındaki 1. ay ve 6. ayda görme keskinliği, keratometri değerleri, ön segment optik koherens tomografi (ÖS-OKT) ile değerlendirilen ön segment parametreleri, optik biyometri, korneal topografi, ve speküler mikroskopi ile değerlendirerek, cross-linking tedavisinin bu hastalarda meydana getirdiği değişimi görmeyi amaçladık. Gereç ve Yöntem: Çalışma, Yüzüncü Yıl Üniversitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalı, Göz Hastalıkları Polikliniği'nde keratokonus tanısı alan, takibi yapılan ve hızlandırılmış CXL için cerrahi endikasyonu olan 12-40 yaş arası, 32 göz üzerinde yapılmak üzere planlanmıştır. Hastaların cerrahi öncesi ve cerrahi sonrası (1. ay, 6. ay) kontrollerinde snellen eşeli ile alınıp logMAR'a çevrilmiş en iyi düzeltilmiş görme keskinliği (EİDGK), refraksiyon değerleri kaydedilmiş, aynı zamanda yarıklı ışık biyomikroskopi ve fundus muayenesi yapılmıştır. ÖS-OKT kullanılarak elde edilen görüntüler Image J programına aktarılıp ön kamara açısı (ÖKA 500, ÖKA 750), açı açıklık mesafesi (AAM 500, AAM 750), trabeküler iris boşluk alanı (TİBA 500, TİBA 750) ve iris stromal kalınlık (İSK) değerleri bu program üzerinden; santral kornea kalınlığı (SKK) ve ön lens kapsül kompleksi (ÖLKK) ise ölçüm yapılan cihazda, ölçüm aleti yardımıyla manuel olarak ölçülmüştür. Optik biyometri ile aksiyel uzunluk (AU), ön kamara derinliği (ÖKD), K1 ve K2, lens kalınlığı (LK); korneal topografi ile en yüksek keratometri (Kmax), astigmatik power, santral kornea kalınlığı (SKK), en ince kornea kalınlığı (Thinnest korneal thickness [ TCT] ) ve speküler mikroskopi ile endotel hücre yoğunluğu (EHY) ölçülerek CXL öncesi ve sonrası değerler karşılaştırılmıştır. Bulgular: Çalışmamızda ortalama yaşı 20,78 ± 4,54 yıl olan 17'si kadın (%53,1), 15'i erkek (%46,9) 32 göz incelendi. EİDGK'de istatistiksel olarak anlamlı iyileşme saptanırken (p<0,001), SKK-orbscan ve TCT'de 6. ay sonunda istatistiksel olarak anlamlı azalma izlendi (p<0,001), Kmax'ın her ne kadar 1. ay değeri, 6. aydan istatistiksel olarak daha yüksek bulunsa da (p=0,03), preoperatif değerle kıyaslandığında 6. ayda anlamlı bir fark yoktu. Optik biyometri ile alınan K2 ( K2- optik) ve korneal topografi ile ölçülen astigmatik güç değerleri preoperatif değere göre 1. ay sonunda anlamlı şekilde yüksek (sırasıyla p=0,003 ve p=0,01); EHY ise daha düşük bulunsa da (p=0,004); 6. ay sonuçları ile preoperatif değerleri arasında anlamlı fark yoktu. ÖS-OKT ile ölçülen SKK'de ise 1. ay sonunda ölçülen değerin istatistiksel olarak anlamlı şekilde daha düşük, otorefraktometre ile alınan K2 ( K2-ORM) değerinin ise daha yüksek ölçüldüğü görüldü (p<0,001); preoperatif ve 6. ay sonuçlarının birbirine yakın olup istatistiksel olarak anlamlı farkın olmadığı izlendi. ORM sferik/silindirik değer, K1-ORM, AU, ÖKD parametrelerinde preoperatif ve 6. ay sonunda anlamlı bir fark yoktu. Aynı şekilde AAM 500 ve 750, TİBA 500 ve 750, ÖKA 500 ve 750, İSK, ÖLKK, hem nazal hem de temporal taraf ölçümlerinde preoperatif ve 6. ay sonunda anlamlı değişim izlemedik. Sonuç: Çalışmamızda keratokonus hastalarına hızlandırılmış CXL uygulanmış, EİDGK'de artış elde edilirken, CXL sonrası progresyon izlenmemiştir. Bu bize hızlandırılmış CXL'nin daha önceki çalışmalara benzer şekilde keratokonusun stabilizasyonunda etkili olduğunu gösterir. CXL öncesi ve sonrası, daha önce bakılmayan İSK, ÖLKK, AAM ve TİBA gibi parametrelerin çalışmamızda ilk defa bakılması çalışmamız için önemlidir. Ancak bu parametrelerin değerlendirilmesi ve Ultraviyole A'nın etkilerini görebilmek için daha uzun takipli çalışmalara ihtiyaç vardır. Anahtar Kelimeler: Keratokonus, cross-linking, ön kamara açısı, ön segment optik koherens tomografi, , iris stromal kalınlığı, ön lens kapsül kompleksi
Efficacy of Bakuchiol in Corneal Alkali Injury Model in Rats
(2024) Tan, Rumeysa Bilmez; Tekin, Serek
Amaç: Bu çalışma, ratlarda korneal alkali yanık modelinde, hidrojele yüklenmiş bakuchiolün tedavi yöntemi olarak epitel defekti boyutlarına; korneal neovaskülerizasyon, korneal opaklık şiddetine; histopatolojik kesitlere, immünohistokimyasal belirteçlere (TNF-α, VEGF) olan etkilerini araştırmayı amaçlamıştır. Gereç ve Yöntem: 35 tane erkek Wistar cinsi erkek ratın sağ kornea santraline topikal ve genel anestezi altında 1 N NaOH emdirilmiş 3mm çapındaki filte kağıdının 30 saniye süre ile yerleştirilmesi ile korneal alkali yanık oluşturuldu. Randomize edilen ratlar 5 gruba ayrıldı (kontrol, visco, steroid, 250 IU/g bakuchiol yüklü visco ve 500 IU/g bakuchiol yüklü visco). Tüm gruplara enfeksiyon riskine karşı 12 saat arayla günde 2 defa siprofloksasin içeren göz damlası uygulaması yapıldı. Kontrol grubu antibiyotik dışı tedavi almadı. Visco grubuna günde 4 defa oftalmik hidrojel uygulaması yapıldı. Steroid grubuna günde 4 defa deksametazon içeren göz damlası uygulaması yapıldı. 250 IU/g bakuchiol yüklü visco ve 500 IU/g bakuchiol yüklü visco grupları belirtilen dozlarda Bakuchiol yüklemesi yapılmış oftalmik hidrojel uygulamaları günde 4 defa yapıldı. Ratlar 0, 3, 7 ve 14. günler intraperitoneal ketamin genel anestezisi altında stero mikroskop ile muayene edilip fotoğraflandı. 14.gün yüksek doz inteperitoneal genel anestezi altında ratlar dekapitasyon ile sakrifiye edildi. Enükleasyon işlemi gerçekleştirilek gözler %10'luk formol ile sabitlendi. Histopatolojik değerlendirmeler Hematoksilen-Eozin boyama ile yapıldı. İmmünohistokimyasal değerlendirmeler TNF Alfa ve VEGF antikorları ile boyama ile yapıldı. Bulgular: 500 IU/g bakuchiol yüklü visco grubu ile kontrol, Visco grubu ve Steroid grubu arasında Muayeneye Dayanıklı Korneal Vaskulerizasyon Oran ortalamalarında anlamlı fark vardı (p<0,05), Kontrol grubu ile 250 IU/g bakuchiol yüklü visco grubu arasında da Muayeneye Dayanıklı Korneal Vaskulerizasyon Oran ortalamalarında anlamlı fark vardı (p<0,05). Diğer gruplar arası Muayeneye Dayanıklı Korneal Vaskülerizasyon ran ortalamalarında anlamlı fark gözlenmedi (p>0,05) fakat oransal olarak en düşük korneal neovaskülerizasyon oranına sahip gubunun 500 IU/g bakuchiol yüklü visco grubu olduğu görüldü, onu sırasıyla 250 IU/g bakuchiol yüklü visco grubu, steroid grubu, visco grubu ve konrol grubu takip etti. Kontrol grubu ile 500 IU/g bakuchiol yüklü visco grubu arasında Kornea Opaklık Skor ortalaması bakımından anlamlı fark var iken (p<0,05), diğer gruplar arası Kornea Opaklık Skor ortalamalarında anlamlı fark gözlenmedi (p>0,05) fakat oransal olarak en düşük korneal opaklık ortalamasına sahip gubunun 500 IU/g bakuchiol yüklü visco grubu olduğu görüldü, onu sırasıyla 250 IU/g bakuchiol yüklü visco grubu, steroid grubu=visco grubu ve konrol grubu takip etti. Gruplara göre ratlarda '3. Gün Kornea Epitel Defekti Yüzdesi' ortalamaları arasında anlamlı fark gözlendi (p†=0.004). Steroid grubu ile visco grubu ve 500 IU/g bakuchiol yüklü visco grubu arasında Kornea Epitel Defekti Yüzdesi ortalaması bakımından anlamlı fark vardı (p<0,05). Diğer gruplar arası Kornea Epitel Defekti Yüzdesi ortalamalarında anlamlı fark gözlenmedi (p>0,05). 3.gün kornea epitel defekti ortalamasının steriod grubunda en yüksek olduğu bunu sırasıyla 250 IU/g bakuchiol yüklü visco grubu ve kontrol grubunun takip ettiği gözlemlendi. 500 IU/g bakuchiol yüklü visco grubu ve visco grubunda 3. günde epitel defektinin tamamen kapanmış olduğu görüldü. 7. Gün ve 14. Gün Kornea Epitel Defekti Yüzdesi tüm guruplardaki ratlarda sıfır idi. Gruplara göre ratlarda, 'Epitel Nekroz Skor, Inflamatuar Hücre Yoğunluk Skor' ortalamaları arasında anlamlı fark gözlenmedi (p†=0.09, p†=0.1). Gruplara göre ratlarda Kornea Hemoraji Skoru ortalamaları arasında anlamlı fark gözlendi (p†=0.04). Kontrol grubu ile 500 IU/g bakuchiol yüklü visco grubu arasında Kornea Hemoraji Skor ortalamaları arasında anlamlı fark var (p<0,05) iken diğer gruplar arası Kornea Hemoraji Skor ortalamalarında anlamlı fark gözlenmedi (p>0,05). En az korneal hemoraji izlenen grup 500 IU/g bakuchiol yüklü visco grubuydu. Onu sırasıyla 250 IU/g bakuchiol yüklü visco grubu, steroid grubu, visco grubu ve kontrol grubu izledi. Gruplara göre ratlarda Stromal Ödem Skoru ortalamaları arasında anlamlı fark gözlendi (p†=0.008). Visco grubu ile 250 IU/g bakuchiol yüklü visco grubu ve 500 IU/g bakuchiol yüklü visco grubu arasında Stromal Ödem Skor ortalamaları arasında anlamlı fark var (p<0,05) iken diğer gruplar arası Stromal Ödem Skor ortalamalarında anlamlı fark gözlenmedi (p>0,05). En az stromal ödem izlenen grup 500 IU/g bakuchiol yüklü visco grubuydu. Onu sırasıyla 250 IU/g bakuchiol yüklü visco grubu, steroid grubu, kontrol grubu ve visco grubu izledi. Bu bulgular bakuchiolün stromal ödemi azaltma konusunda doza bağlı artan bir etkisi olduğunu düşündürmektedir. Gruplara göre ratlarda TNF Alfa Boyanma Skor ortalamaları arasında anlamlı fark gözlenmedi (p†=0.08) fakat en düşük TNF Alfa skoru alan grup 500 IU/g bakuchiol yüklü visco grubuydu. Onu sırasıyla steroid grubu, kontrol grubu, 250 IU/g bakuchiol yüklü visco grubu ve visco grubu takip etti. Gruplara göre ratlarda VEGF Boyama Skoru ortalamaları arasında anlamlı fark gözlendi (p†=0,002). Kontrol grubu ile 500 IU/g bakuchiol yüklü visco grubu arasında VEGF Boyama Skor ortalamaları arasında anlamlı fark var (p<0,05), Visco grubu ile Steroid grubu, 250 IU/g bakuchiol yüklü visco grubu ve 500 IU/g bakuchiol yüklü visco grubu arasında da VEGF Boyama Skor ortalamaları arasında anlamlı fark var (p<0,05) iken diğer gruplar arası VEGF Boyama Skor ortalamalarında anlamlı fark gözlenmedi (p>0,05). En düşük VEGF skoru alan grup 500 IU/g bakuchiol yüklü visco grubuydu. Onu sırasıyla 250 IU/g bakuchiol yüklü visco grubu, steroid grubu, kontrol grubu ve visco grubu takip etti. Sonuç: Bakuchiol korneal alkali yaralanmalarda, kornea vaskülerizasyonunu, korneal skar oluşumunu engelleme; korneal hemorajiyi ve stromal ödemi azaltma konusunda doza bağlı artan bir etki göstermiştir ve klasik tedavinin bir parçası olan steroidden daha etkili olmuştur. Verilerimiz hidrojele yüklü bakuchiolün anti TNF alfa ve anti VEGF etkilerinin topikal steroidden daha etkili olduğunu göstermektedir. Gerek bakuchiolün tanımlanmış organ koruyucu etkileri gerek antienflamatuvar etkileri bakuchiolün bu olumlu sonuçları almamıza sebep olan mekanizmaları aktive etmiş olabilir. Mekanizmanın tam olarak anlaşılabilmesi için moleküler düzeyde daha detaylı çalışmalar yapmak gerekmektedir. Bakuchiolün korneal kimyasal yaralanmaların tedavisinde etkili bir tedavi yöntemi olabileceğini düşünmekteyiz. Doz ayarlaması, uygulama zamanı ve uygulama tekniği açısından ileri preklinik ve klinik çalışmalara ihtiyaç duyulmaktadır. Anahtar kelimeler: Bakuchiol, korneal alkali yaralanma, VEGF, TNF Alfa, hidrojel
Epidemiology of Open Globe Injury in Children
(Lippincott Williams & Wilkins, 2017) Batur, Muhammed; Seven, Erbil; Akaltun, Mahmut Nedim; Tekin, Serek; Yasar, Tekin
Purpose: The purpose of this study was to evaluate the epidemiology and outcomes of pediatric open globe injury (OGI). Method: The medical records of all patients diagnosed with OGI in the authors' clinic between 1996 and 2015 were screened retrospectively. A total of 893 eyes of 892 patients aged 16 years or younger were included in the study. Open globe injury was classified according to the ocular trauma classification (OTS). Age, sex, history, cause and month of trauma, treatment received, visual acuity at presentation, final visual acuity, and cause of vision loss were recorded. Results: Children aged 16 years or younger comprised 67.7% of all OGI patients within the studied time period. The annual incidence of OGI in children was 5.16 per 100,000 overall, with 6.12 per 100,000 boys and 4.14 per 100,000 girls. Open globe injuries occurred most frequently in the 3 to 7 year age group and in the summer months. The most common scene of injury was playgrounds (50.2%). A strong, linear, negative correlation was found between OTS values and final visual acuity in logMAR (r(p)=-0.550, P=0.0001). Conclusion: The authors' study revealed that a high proportion of all OGIs in the authors' region occurred in children under 17 years old. As with adults, OGI in children often results in significant vision loss. However, considering the varying degrees of visual recovery demonstrated by some of the authors' patients, particularly those with no light perception at admission, the authors believe an eye-sparing approach is warranted in pediatric OGI.