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Öğe An approach to the surgical management of total oculomotor nerve palsy(2001) Köse S.; Üretmen Ö.; Pamukçu K.The goal of the procedure was to keep the eyes of patients with total oculomotor palsy in the straight ahead position by means of surgery on the horizontal and inferior rectus muscles in one session, without involving the superior oblique muscles. Six patients underwent surgery for total oculomotor nerve palsy. All of the surgical procedures were carried out on the muscles of the paralytic eye. We performed hemi-hangback recession of the lateral rectus and resection of the medial rectus for exotropia in all patients. Depending on the magnitude of vertical deviation, the insertions of the horizontal rectus muscles were moved upward, alone or in combination with hemi-hangback recession of the inferior rectus. The mean preoperative horizontal deviation was 66.6 PD. Two years after the operation, the horizontal deviation was measured to be 11.6 PD. Similarly, the mean preoperative vertical deviation of 16 PD decreased to 6.6 PD in two years. This procedure did not disturb normally functioning superior oblique and lateral rectus muscles. Subjectively, all of the patients were satisfied with their alignment two years after the operation. We are of the opinion that this technique is a safe, simple and effective procedure and can be regarded as a first-choice operation in total oculomotor palsy. If one fails to maintain the eye position with this procedure, one can still perform a second operation on the superior oblique muscle, which remains untouched in our procedure.Öğe Binocular visual function in congenital esotropia after bilateral medial rectus recession with loop suture(2002) Üretmen Ö.; Pamukçu K.; Köse S.; Uçak E.PURPOSE: Our aim was to evaluate the binocular visual function in congenital esotropia after bimedial rectus recession with loop suture and to address the factors that could take part in the attainment of binocular function. SUBJECTS AND METHODS: Forty children with congenital esotropia who were operated on between 12 and 48 months of age were included in the study group. Postoperative follow-up ranged from 2 to 10 years. In order to determine the factors affecting the sensory results in congenital esotropia, we classified our patients into two groups according to their fusion status. We compared the preoperative and postoperative characteristics of patients in these two groups. RESULTS: Twenty-one of 40 patients (52.5%) fused the Worth four-dot at near (Group 1), 19 patients (47.5%) did not (Group 2) at the final examination. No patient showed evidence of stereopsis. We found significant differences between these two groups in respect to the final angle of vertical deviation, the age at surgery, the presence of postoperative inferior oblique overaction, dissociated vertical deviation and abnormal head position. Correlation analysis revealed that early alignment of the eyes and the absence of postoperative vertical deviation were associated with increased incidence of achieving some degree of binocular vision. CONCLUSION: In congenital esotropia, not all infants may have the potential for normal binocular function owing to yet unknown constitutional factors. We determined that achieving some degree of binocular function may be related to early alignment of the eyes. Additionally, close follow-up and precise treatment of the accompanying vertical deviation, especially inferior oblique overaction and dissociated vertical deviation, in a timely manner may enhance the attainment of binocular sensory function.Öğe A case of optic neuropathy: Concurrent internal carotid artery aneurysm and optic nerve sheath meningioma [Bir optik nöropati olgusu: Eş zamanlı internal karotid arter anevrizması ve optik sinir kılıf menenjiomu](Turkiye Klinikleri, 2018) Demirkilinç Biler E.; Teker E.; Üretmen Ö.In the examination of fourty-five years old female patient with a sudden decrease in her visual acuity (VA) in the right eye, relative afferent pupillary defect with the VA of 0.3, optic disc edema, concentric visual field (VF) defect, decreased color vision and contrast sensitivity in the same eye were determined. Systemic steroid therapy was initiated to the patient with the diagnosis of papillitis with no additional pathology. Following treatment, total recovery was observed. However, the patient was continued to be followed up without treatment because of chronic optic disc edema. After a 2 years follow-up period, VA in the same eye was slightly decreased (right VA:0.8) and accompanied with a newly developed VF defect. Repeated cranial MRI displayed ICA aneurysm and stent+coil embolization was applied with the prescription of antiplatelet therapy. However, due to ongoing clinic progression, cranio-orbital MRI (surface coil) was performed for the third time and right optic nerve sheath meningioma was detected. The patient is closely followed up by neurosurgery and neurology departments. In case of chronic optic disc edema, additional accompanying pathologies should always be kept in mind and detailed investigation could be necessary. © 2018 by Türkiye Klinikleri.Öğe Evaluation of cornea and anterior chamber using pentacam in pediatric cases [Pediatrik olgularda kornea ve ön kamarani{dotless}n pentacam ile degerlendirilmesi](2011) Onay M.P.; Egilmez S.; Üretmen Ö.; Yagci A.; Köse S.Purpose: To evaluate the anterior segment structures using Pentacam in pediatric cases. Material and Method: One hundred sixty-two eyes (study group) of 81 healthy children who attended our clinic were compared with 114 eyes (control group) of 57 healthy adults. The central corneal thickness, anterior chamber volume, and anterior chamber depth of all cases were evaluated with Pentacam. Independent t-test and Pearson's correlation analysis were used for statistics. Results: The mean age of the study group (40 male, 41 female) was 9.99±2.80 (range: 6-16) years. The mean central corneal thickness in the right eyes was 580.74±42.04 (range: 492-669) micrometers and in the left eyes was 586.52±43.51 (range: 495-699) micrometers. The mean anterior chamber depth, volume, and anterior chamber angle were 3.02±0.29 (range: 2.39-3.9) mm, 176.43±31.77 (range: 117-272) mm3 and 36.23±5.41 (range: 25.8-50.7) degree, respectively. When the right and the left eyes were compared, significant differences were observed between central corneal thickness (p=0.001) and anterior chamber angles (p=0.05). The mean left eye keratometry was found to be significantly flatter in children (p=0.002). The mean anterior chamber depth, anterior chamber volume, and anterior chamber angle values were higher in children than in adults (p<0.001). Discussion: Pentacam is an easy-to-use and noninvasive technique that can be used for the evaluation of central corneal thickness and anterior chamber even in pediatric cases. Significant differences were detected in measurements with this device between adults and pediatric cases, and between the right and left eyes. Being aware of these differences in normal eyes will be a guide in correct evaluation of pathologic eyes.Öğe Idiopathic orbital myositis in childhood: A case report [Çocuklarda idiopatik orbital miyozit: Bir vaka takdimi](2006) Ülger Z.; Tosun A.; Rala S.; Serdaroglu G.; Üretmen Ö.; Darcan Ş.; Tekgül H.; Gökben S.Idiopathic orbital myositis is an autoimmune disease which is rarely seen among children. Corticosteroids are the mainstay of treatment, inducing rapid and dramatic reversal of inflammatory findings. An extended taper of the corticosteroids is advised to prevent rebound inflammation. In this case report, we present an 11-years-old girl who admitted to our clinic with acute onset orbital pain, periorbital edema and diplopia and who was finally diagnosed as idiopathic orbital myositis.Öğe Intracranial hypertension in children: Etiological, clinical features, treatment and prognosis [Çocuklarda İntrakraniyal Hipertansiyon: Etiyolojik, Klinik Özellikler, Tedavi ve Prognoz](OrtadogÂ?u Reklam Tanitim Yayincilik Turizm Egitim Insaat Sanayi ve Ticaret A.S., 2018) Serin H.M.; Şimşek E.; Kanmaz S.; Demirkilinç Biler E.; Üretmen Ö.; Yilmaz S.; Aktan G.; Tekgül H.; Gökben S.Objective: Idiopathic intracranial hypertension is a syndrome characterized by symptoms and signs of increased intracranial pressure. The aim of this study is to retrospectively evaluate the etiological and clinical features of the cases with the diagnosis of intracranial hypertension. Material and Methods: 14 patients with at least one year of follow up at Ege University Medical School Pediatric Neurology Department with Idiopathic intracranial hypertension diagnosis were included. The etiologic, clinical, treatment features and prognoses were evaluated. Results: Among 14 patients 9 were girls and 5 were boys. Their ages ranged from 3-17 years and the mean age was 10.42 (± 4.65 years). The most common complaint was headache. Seven patients (57.14%) were diagnosed as idiopathic intracranial hypertension. The etiologic factors detected in patients with secondary intracranial hypertension were sinusitis, hypervitaminosis A, obesity, sagittal sinus thrombosis, transverse sinus thrombosis and neuro-Behcet. All of the cases received medical treatment. Optic nerve fenestration was applied to a patient who did not benefit from medical treatment. One patient had recurrence. Conclusion: Idiopathic intracranial hypertension is one of the preventable causes of visual loss and rapid diagnosis and treatment are important because of the rare occurrence of visual field loss and decrease in the accuracy of visual acuity despite adequate treatment. © 2018 by Türkiye Klinikleri.Öğe Long-term results in pediatric developmental cataract surgery with primary intraocular lens implantation(Turkish Ophthalmology Society, 2018) Biler E.D.; Yıldırım Ş.; Üretmen Ö.; Köse S.Objectives: The aim of this study was to evaluate the outcomes of pediatric developmental cataract surgery with primary intraocular lens (IOL) implantation. Materials and Methods: Patients between 2 and 16 years old who underwent cataract surgery with primary IOL implantation were retrospectively evaluated. Age at time of surgery, pre- and postoperative best corrected visual acuities, postoperative ocular complications, and any accompanying ocular pathologies were obtained from the patients’ charts. Mean refractive changes and degree of myopic shift were analyzed according to the age groups. Operated eyes were also compared with the fellow eyes in unilateral cases. Results: A total of 101 eyes of 65 patients were included. The average age at time of surgery was 76±40 months and the average follow-up period was 44±30 months. Among the 78 eyes that could be assessed for visual acuity improvement, 66 (84.6%) of them showed ?2 lines of improvement. The difference in the mean refractive change between the 2-5 years old and 8-16 years old age groups was found to be statistically significant. However, the mean refractive change per year was not found to be significant between the same age groups. In unilateral cases, the operated eyes showed a greater myopic change than the fellow eyes, with no statistically significant difference. The most common postoperative complication was visual axis opacity. Conclusion: Good visual outcomes can be achieved following pediatric cataract surgery with primary IOL implantation. Optic axis opacities were the most common postoperative complications. Overall, refractive changes following surgery are inevitable, and more prominent in younger age groups. © 2018 by Turkish Ophthalmological Association Turkish Journal of Ophthalmology, published by Galenos Publishing House.Öğe Optic disc and retinal nerve fiber layer thickness evaluation of the fellow eyes in non-arteritic ischemic optic neuropathy [Non-arteritik İskemik optik nöropati geçirmiş olguların sağlıklı gözlerinin optik sinir yapısı ve retina sinir lifi kalınlığının değerlendirilmesi](Turkish Ophthalmology Society, 2015) Dağ M.Y.; Biler E.D.; Alkan Z.; Üretmen Ö.; Köse S.; Afrashi F.Objectives: To examine the fellow eyes in unilateral non-arteritic ischemic optic neuropathy (NAION) and to compare their optic disc parameters and peripapillary retinal nerve fiber layer (RNFL) thickness with age-and refraction-matched normal controll subjects, using Heidelberg Retinal Tomograph 2 (HRT II). Materials and Methods: The fellow eyes of 40 patients with typical unilateral NAION (study group) and one randomly chosen eye of 42 age-, sex-, and refraction-matched normal control subjects were enrolled in the study. Optic disc morphologic features (average disc area, cup area, rim area, disc volume, rim volume, cup/disc area ratio, cup depth) and peripapillary RNFL thickness were evaluated using HRT II, a confoal scanning ophtalmoscopy. Results: In the study group, there were 26 (65%) men and 14 (35%) women, whereas there were 27 (64%) men and 15 (36%) women in the control group (Chi square test, p=0.89). Mean age of the patients in the study and control groups was 59.4±10.3 and 57.7±9.1 years, respectively (T test, p=0.72). There was not any statistically significant difference regarding mean spheric equivalent between the two groups (Mann-Whitney U-test, p=0.203). The NAION unaffected fellow eyes had significantly smaller disc areas, cup areas, cup volumes, cup-disc area ratios (vertical and lineer), and cup depths than the control eyes (Mann-Whitney U-test; p<0.05), whereas there was no significant difference in the RNFL thickness between the two. Conclusion: A comparison of the fellow eyes in patients with unilateral NAION and the control eyes showed a significant difference in optic disc parameters and the morphology of RNFL. These differences could be important in the pathogenesis of NAION and needs to have further investigated. © 2015, Turkish Ophthalmology Society. All rights reserved.Öğe Outcome of pediatric uveitis at an university clinic [Bir üniversite klinigindeki pediatrik üveit olgulari{dotless}ni{dotless}n sonuçlari{dotless}](Turkish Ophthalmology Society, 2013) Yüce B.; Yilmaz S.G.; Köse S.; Üretmen Ö.Purpose: To determine the etiology, clinical course, complications, and outcome of uveitis in pediatric patients. Material and Method: We retrospectively reviewed the medical charts of 64 eyes of 43 patients, who had been followed up at a University clinic. Demographic and etiological features, clinical course, complications, and visual outcome were analyzed. Results: Male/female ratio was 22/21. Median age at the first visit was 14 (3-18) years. Unilateral involvement was observed in 22 (51.16%) patients. Anterior uveitis was the most common form (67.19%). Idiopathic uveitis was seen in 25 (58.14%) patients. The most commonly identified etiological entities were juvenile idiopathic arthritis (JIA) (5 patients) and Behcet's disease (4 patients). Both glaucoma and cataract were the most common complications (12.50%, 6.25%; respectively). Final VA was equal or better than 20/40 in 47 eyes (73.43%). Discussion: Uveitis in pediatric patients was mostly idiopathic. The most commonly identified etiologic entities were JIA and Behcet's disease. Final visual outcome was favorable with appropriate treatment.
