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Öğe Are Multiple Retinal Arterial Macroaneurysms Considered a Sign of Cerebral Aneurysms(Slack Inc, 2017) Nalcaci, Serhad; Oztas, Zafer; Eraslan, Cenk; Akkin, CezmiThe aim of this study is to report the coexistence of retinal arterial macroaneurysms (RAMs) and cerebral aneurysms (CAs) in a 58-year-old woman with hypertension. She was noted as having a 1-week history of vision loss in her left eye, along with a 2-month history of a nonspecific headache. Visual acuity was 20/32 in her left eye and 20/20 in her right eye. A fundus examination revealed multiple areas of retinal hemorrhages that were surrounded by circinate exudation in her left eye, as well as the generalized attenuation of the retinal arteries in both of her eyes. Angiographically, hyperfluorescent round leakage points confirmed the presence of five saccular RAMs. Surprisingly, computed tomography angiography completed based on the recommendation of neurology department identified three saccular CAs. Aging, hypertension, and female preponderance are the common risk factors for both RAMs and CAs. Accordingly, RAMs and CAs may exist simultaneously in hypertensive patients.Öğe Association between the ARMS2 rs10490924 risk genotype and dry-age related macular degeneration patients with and without reticular pseudodrusen in a Turkish population: findings from a study conducted at a tertiary clinic(Springer, 2024) Furundaoturan, Onur; Degirmenci, Cumali; Afrashi, Filiz; Atik, Tahir; Akkin, Cezmi; Mentes, Jale; Nalcaci, SerhadPurposeTo evaluate the relationship between the presence of reticular pseudodrusen (RPD) and the risk allele of ARMS2 rs10490924 variation in dry-AMD patients by using multimodal imaging. Also, to compare patients with and without RPD and healthy volunteers according to the distribution of the risk allele.MethodsIn this cross-sectional study, dry-AMD patients with (Group A, n = 50) and without (Group B, n = 50) RPD and healthy volunteers (Group C, n = 50) were enrolled. After detailed ophthalmologic examination, confocal scanning laser ophthalmoscope (Heidelberg, Germany) was used to acquire near infra-red (NIR) imaging for RPD and the diagnosis was confirmed by Spectral Domain-Optical coherence tomography (Heidelberg, Germany). In silent choroidal neovascularization suspicion, optical coherence tomography angiography (Optovue, Fremont, CA) was performed and those were excluded. For genetic assessment, peripheric blood sampling was performed. Using next-generation sequencing technique (NGS), ARMS2 rs10490924 single nucleotide polymorphism was investigated. Groups were compared according to the distribution of the risky allele.Results150 eyes of 150 participants were included. In Group A, 42% (21) of patients were heterozygous for the T risk allele, 30% (15) were homozygous, and the risk allele was not detected in 28% (14). In Group B, 44% (22) of patients were heterozygous, 17% (8) were homozygous, and the risk allele was not detected in 39% (20). In Group C, 30% (15) of participants were heterozygous, 4% (2) were homozygous, and variation was not observed in 64% (32). Homozygous participants in Group A were significantly higher than other two groups (Group A-B: OR = 2.67, 95% CI: 0.895, 8.020; Group A-C: OR = 17.14, 95% CI: 3.449, 85.208) while in Group B, homozygous individuals were higher than Group C (respectively, p values 0.0039, 0.0002, 0.013). T risky allele frequencies were 51%, 38%, and 20% in Groups A, B, and C, respectively, which was significantly higher in Group A (p = 0.02).ConclusionGenetic influence in AMD is inevitable while certain differences according to different ethnicities may apply. Association of genetic variations and imaging findings like RPD is lacking among literature for different populations. By the aspect of this study, the relationship between RPD and ARMS2 rs10490924 polymorphism in dry-AMD patients were highlighted among Turkish population by using multimodal imaging for the first time.Key messagesWhat is Known?Pathophysiology of age-related macular degeneration is influenced from multiple factors including single nucleotide polymorphisms. The variations of are suspected well in the current literature.Reticular pseudodrusen is related to advanced stages of age related macular degeneration disease.What is New?The rs10490924 risk genotype is associated with the presence of reticular pseudodrusen in dry age related macular degeneration patients.Homozygous genotype of T risk allele is evaluated significantly higher in dry age related macular degeneration patients with reticular pseudodrusen.Key messagesWhat is Known?Pathophysiology of age-related macular degeneration is influenced from multiple factors including single nucleotide polymorphisms. The variations of are suspected well in the current literature.Reticular pseudodrusen is related to advanced stages of age related macular degeneration disease.What is New?The rs10490924 risk genotype is associated with the presence of reticular pseudodrusen in dry age related macular degeneration patients. Homozygous genotype of T risk allele is evaluated significantly higher in dry age related macular degeneration patients with reticular pseudodrusen.Öğe A calipers-free intravitreal anti-VEGF injection technique(Consel Brasil Oftalmologia, 2015) Oztas, Zafer; Akkin, Cezmi; Afrashi, Filiz; Selim, SedatÖğe A calipers-free intravitreal anti-VEGF injection technique(Consel Brasil Oftalmologia, 2015) Oztas, Zafer; Akkin, Cezmi; Afrashi, Filiz; Selim, SedatÖğe A calipers-free intravitreal anti-VEGF injection technique(Consel Brasil Oftalmologia, 2015) Oztas, Zafer; Akkin, Cezmi; Afrashi, Filiz; Selim, SedatÖğe Correlation of Handheld Infrared Skin Thermometer and Infrared Videothermography Device for Measurement of Corneal Temperature(Lippincott Williams & Wilkins, 2016) Oztas, Zafer; Selver, Ozlem Barut; Akkin, Cezmi; Canturk, Ecem; Afrashi, FilizPurpose: In our study, we aimed to investigate the correlation of handheld infrared skin thermometer and videothermography device for the measurement of corneal temperature. Methods: Forty healthy individuals (80 eyes) were enrolled to the study. Participants underwent a detailed ophthalmologic examination and medical history review for excluding any ocular and systemic diseases. The measurements of the central corneal temperature were performed in a room having constant temperature, humidity, and brightness levels. To avoid any variability, all the temperature measurements were performed in the same examination room by a single examiner. The temperature was measured with a handheld infrared skin thermometer (MEDISANA, FTN) from the corneal surface. The same instrument was also used to measure the subjects' body temperature. Moreover, the subjects underwent the corneal temperature measurement by a noncontact videothermography device (Optris PI 450; Optris GmbH). Results: The male to female ratio was 19:21 among the subjects. The mean age was 25.14.7 years. The mean body temperature was 36.93 +/- 0.33 degrees C. The mean corneal temperatures measured by the handheld infrared skin thermometer and the ocular videothermography device were 36.94 +/- 0.28 degrees C and 35.61 +/- 0.61 degrees C, respectively (P<0.01). The mean temperature difference was 1.34 +/- 0.57 degrees C, with a 95% confidence interval. There was a moderate correlation between the corneal temperatures measured by the 2 devices in the right, the left eyes, and both eyes, respectively (P=0.450, 0.539, 0.490). Conclusions: Handheld infrared skin thermometers can be used for the evaluation of the corneal temperature. These devices may provide a simple, practical, and cheaper way to detect the corneal temperature, and the widely performed corneal temperature measurements may afford us to understand the temperature variability in numerous ocular conditions in a better way.Öğe Dexamethasone Implant in Patients with Diabetic Macular Edema Resistant to Anti-VEGF Therapy(Turkish Ophthalmological Soc, 2019) Nalcaci, Serhad; Akkin, Cezmi; Afrashi, FilizObjectives: To investigate the efficacy of single dose intravitreal dexamethasone implant in patients with diabetic macular edema (DME) resistant to anti-VEGF therapy. Materials and Methods: Twenty eyes of 14 patients (8 male, 6 female; mean age, 65 +/- 5.7 years) with DME resistant to intravitreal ranibizumab injections were studied. A single intravitreal dexamethasone implant was injected into each eye and patients were followed up for 6 months. Response to therapy was assessed monthly by measuring intraocular pressure (IOP), best-corrected visual acuity (BCVA), and central foveal thickness (CFT). Results: Baseline (before injection) IOP was 14.9 +/- 2.7 mmHg and did not change significantly in the six months following injection. Baseline BCVA was 1.04 +/- 0.35 LogMAR and improved to 0.86 +/- 0.31 at month 1 without statistical significance (p=0.056). CFT was significantly lower in all monthly measurements compared to its baseline value of 682.21,229.2 mu m. During the follow-up period, endophthalmitis, significant cataract, or rhegmatogenous retinal detachment were not detected. Conclusion: Intravitreal dexamethasone implant injection is associated with significant CFT reduction for up to six months without causing any complications. Although BCVA did not improve in parallel with the CFT reduction, intravitreal dexamethasone implant should be considered as an effective and safe treatment option in the management of DME patients resistant to anti-VEGF injections.Öğe Direct Treatment Costs of Neovascular Age-related Macular Degeneration and Comparison of Gained and/or Preserved Vision with Expenditure(Turkish Ophthalmological Soc, 2018) Yildirim, Seyda; Akkin, Cezmi; Oztas, Zafer; Nalcaci, Serhad; Afrashi, Filiz; Mentes, JaleObjectives: The aim was to quantify the direct medical cost of neovascular age-related macular degeneration (AMD) versus gained or preserved vision. Materials and Methods: Data of patients treated for neovascular AMD between January 2009 to January 2014 were reviewed. Patients with complete follow-up for two years, treated with only intravitreal ranibizumab injections and with no intraocular surgery were included. Demographics, diagnostic investigations, the number of visits and injections, changes in visual acuity (VA) at one year and two years from baseline were noted. Total cost was calculated for the first and second years, and the cost of improving or preserving initial vision level was determined with subgroup analysis. Results: Two-hundred eyes of 175 patients (86 male and 89 female) with a mean age of 72.3 +/- 7.8 years were included. Mean VA was 0.67 logMAR at baseline, 0.60 logMAR at the end of the first year, and 0.67 logMAR at the end of the second year. At the end of the 2 years, VA increased in 82 eyes (41%), remained the same in 42 eyes (21%), and decreased in 76 eyes (38%). The mean number of visits in the first and second years were 6.56 (3-12) and 5.74 (3-10), respectively. An average of 4.42 (1-8) injections were performed in the first year and 2.25 (0-7) in the second. The total direct medical cost for AMD was 9,628 TL (Turkish Lira) per patient for 2 years, which consisted of 529 TL in visit costs, 115 TL in fluorescein and indocyanine angiography costs, 611 TL in injection procedure costs, and 8,371 TL in drug costs. The cost of one line of VA gain was 11,911 TL in the first year. Conclusion: This study showed that treatment increased or stabilized vision in a reasonable proportion of patients, that cost of management decreases in the second year, and that drug expenses are the leading item in reimbursement.Öğe Dry Eye and Meibomian Gland Dysfunction in Neovascular Age-Related Macular Degeneration Patients Treated with Intravitreal Injections(Turkish Ophthalmological Soc, 2022) Kiyat, Pelin; Palamar, Melis; Nalcaci, Serhad; Akkin, CezmiObjectives: To determine if patients treated with multiple intravitreal injections for neovascular age-related macular degeneration are more likely to suffer from dry eye and meibomian gland dysfunction. Materials and Methods: Sixty eyes of 30 patients were enrolled. One eye of each patient was treated with multiple monthly intravitreal injections for neovascular AMD (Group 1) and the fellow healthy eye received no treatment (Group 2). The presence of dry eye was evaluated using tear film break-up rime, Schirmer 1 test, the Oxford scale, and Ocular Surface Disease Index (OSDI). The loss rate of meibomian glands was evaluated by meibography and was graded and scored (meiboscore) from grade 0 (no lass of glands) to grade 3 (loss of >2/3 of total meibomian glands) for each eyelid. Results: Group I had lower mean Schirmer 1 and rear film break up-time measurements and higher mean OSDI score than Group 2, but the differences were not statistically significant (p=0.257, p=0.113, and p=0.212, respectively). Mean Oxford scale scores and meiboscore of the upper eyelids showed no statistically significant difference between the groups (p=0.594, p=0.663, respectively). The meiboscore of the lower eyelids was significantly higher in Group 1 (p=0.048). Conclusion: Multiple factors such as povidone-iodine and the preservatives in topical eye drops may cause inflammation leading to ocular surface damage in patients treated with multiple intravitreal injections. As the treatment requires repeated injections, exposure to these factors might worsen the ocular surface inflammation. The possibility of dry eye and meibomian gland dysfunction should be considered in these patients.Öğe Effect of intravitreal dexamethasone implant (Ozurdex®) injections on corneal biomechanical properties measured using ocular response analyzer(2023) Korkmaz, İlayda; Degirmenci, Cumali; Akkin, Cezmi; Palamar, Melis; Nalcaci, Serhad; Afrashi, FilizPurpose: The purpose of the study was to evaluate Ocular Response Analyzer (ORA) measurements and endothelial cell density (ECD) in patients who received intravitreal dexamethasone implant (Ozurdex®) injection for diabetic macular edema. Methods: Twenty-three eyes of 13 patients who receive intravitreal dexamethasone implant injection (Group 1) for diabetic macular edema and 33 eyes of 33 healthy individuals (Group 2) were included in the study. All participants underwent a complete ophthalmologic examination including intraocular pressure measurement with Goldmann applanation tonome- ter (IOP-GAT), ORA measurements, and specular microscopy. Results: The mean age of the patients was 65.43±8.20 (49–75) in Group 1 and 61.94±4.52 (56–71) in Group 2 (p=0.114). The mean IOP-GAT was significantly higher in Group 1 (18.22±3.41; range 12–28 mmHg) than in Group 2 (15.41±3.07; range 8–21 mmHg) (p=0.02). The mean ECD was 2632.4±209.6 (2232–3067) cell/mm 2 in Group 1 and 2567±206.37 (2140–2854) cell/mm2 in Group 2 (p=0.60). The mean corneal resistance factor (CRF) was 12.16±2.35 (7.4–15.3) mmHg in Group 1 and 10.18±1.83 (6.7–14.2) mmHg in Group 2 (p=0.02). Mean corneal hysteresis (CH) in Groups 1 and 2 was 8.87±2.45 (4.1–13.4) mmHg and 10.47±1.43 (6.9–13.2) mmHg, respectively (p=0.001). Mean corneal compensated IOP and Goldman correlated IOP (IOPg) were higher in Group 1 (24.72±7.12; range 12.1–36.4 mmHg and 23.21±7.01; range 14.2–36.2 mmHg) than in Group 2 (14.95±3.6; range 8.3–22.9 mmHg and 14.33±3.84; range 6.3–21.7 mmHg) (p<0.001). IOP-GAT was correlated with IOPg (p=0.01). Conclusion: Intravitreal Ozurdex® injection effects IOP, while it has no significant effect on ECD. Ozurdex® injections changed corneal biomechanical properties such as CH and CRF. Thus, ORA may be a useful to avoid underestimating the IOP and missing the alteration of elastic properties of the cornea.Öğe The efficacy of "IOL-Vip Revolution" telescopic intraocular lens in age-related macular degeneration cases with senile cataract(Sage Publications Ltd, 2019) Dag, Medine Yilmaz; Afrashi, Filiz; Nalcaci, Serhad; Mentes, Jale; Akkin, CezmiPurpose: To evaluate the efficacy of the IOL-Vip Revolution telescopic intraocular lens in age-related macular degeneration patients. Methods: A total of 13 eyes of 12 age-related macular degeneration patients with senile cataract were enrolled. Selection of the patients was done by means of a low vision diagnostic and rehabilitative program (IOL-Vip software) that evaluates residual visual function. After standard phacoemulsification surgery, the incision site was enlarged and the IOL-Vip Revolution system was implanted in the capsular bag. the outcome measures were best corrected visual acuity, contrast sensitivity, anterior chamber depth, endothelial cell density, central corneal thickness, and quality-of-life questionnaire. Results: the mean age of the subjects was 72.3 +/- 8.5 years. the mean positive power of the intraocular lens was 59 +/- 2 D and the negative intraocular lens power was standard (-46 D). Pre- and postoperative best corrected visual acuity were 1.08 +/- 0.14 and 0.81 +/- 0.16 logMAR in the operated eye and 1.13 +/- 0.36 and 1.01 +/- 0.40 logMAR in the unoperated eye, respectively. the best corrected visual acuity was increased significantly in both operated and unoperated eyes (p = 0.005 and 0.021, respectively). Quality of life and anterior chamber depth increased significantly (p = 0.018 and 0.008, respectively), while endothelial cell density decreased (p = 0.002). No significant differences were detected in central corneal thickness or contrast sensitivity (p = 0.133 and 0.684, respectively). Conclusion: the results showed that IOL-Vip Revolution telescopic intraocular lens is a promising treatment option in age-related macular degeneration patients. the rehabilitation program may have an important role in the restored clinical results, which also provided visual improvement in the unoperated eyes.Öğe Etiological factors in young patients with Retinal Vein Occlusion(Professional Medical Publications, 2019) Nalcaci, Serhad; Degirmenci, Cumali; Akkin, Cezmi; Mentes, JaleObjective: To present the etiological factors of patients with Retinal Vein Occlusion (RVO) under the age of 50 years. Methods: The study was conducted at Ege University Medicine Faculty Department of Ophthalmology. The clinical records of patients with RVO under the age of 50 seen between January 2014 and March 2018 were analyzed retrospectively. Forty patients comprised the study. Detailed ophthalmologic examination was performed. Past medical history, drug use, thrombophilic features, hyperviscosity syndromes and pathologies that may cause vasculitis were noted. Results: Forty patients, 22 (55%) male and 18 (45%) female, were included. Mean age was 41.6 +/- 10.01 years. Mean intraocular pressure and best-corrected visual acuity were 16.8 +/- 5.47mmHg and 0.76 +/- 0.64 logMAR, respectively. Hyperhomocystenemia (15 patients, 37.5%), Behget's disease (three patients, 7.5%), diabetes and/or hypertension (16 patients, 40%), methylenetetrahydrofolate reductase gene mutation (11 patients, 27.5%), prothrombin gene mutation (four patients, 10%) and factor V Leiden mutation (five patients, 12.5%) were present among the patients as etiological factor. Multiple etiological factors were detected in 11 (27.5%) patients. Factor V Leiden mutation and methylenetetrahydrofolate reductase gene mutation were detected in one patient (2.5%) with Behget's disease. Four patients with diabetes and/or hypertension also had hyperhomocystenemia and one of them had additionally prothrombin gene mutation. Two patients with methylenetetrahydrofolate reductase gene mutation also had a factor V Leiden mutation and one of them had additionally a prothrombin gene mutation. Three patients with methylenetetrahydrofolate reductase gene mutation also had hyperhomocystenemia and one patient with prothrombin gene mutation also had methylenetetrahydrofolate reductase gene mutation. Conclusions: Etiological factors that might result in RVO in young individuals should be investigated in detail. Targeted therapies may help to prevent development of new RVOs and potential vascular problems in other organs.Öğe Evaluation of Choroidal Vascular Index in Amblyopic Patients(Turkish Ophthalmological Soc, 2022) Furundaoturan, Onur; Degirmenci, Cumali; Akkin, Cezmi; Biler, Elif Demirkilinc; Uretmen, Onder; Nalcaci, Serhad; Afrashi, FilizObjectives: To compare subfoveal choroidal thickness (SFCT) and choroidal vascular index (CVI) in patients with hyperopic refractive and strabismic amblyopia and healthy subjects. Materials and Methods: The study included 17 patients with strabismic amblyopia (Group 1), 29 patients with hyperopic refractive amblyopia (Group 2), and 16 eyes of 16 healthy volunteers (Group 3). Best corrected visual acuity was noted in all patients and volunteers. In addition to detailed anterior and posterior segment examinations, macular images were obtained by enhanced-depth imaging mode of optical coherence tomography (OCT). SFCT measurements were made from these images and CVI was calculated using the Image J program. Results: No significant difference was found between the groups in terms of age, gender, and intraocular pressure (p=0.27, 0.64, and 0.85, respectively). Mean BCVAs in Group 1 were 0.57 +/- 0.16 (0.3-0.8) in the amblyopic eyes, 0.94 +/- 0.08 (0.8-1.0) in the fellow eyes, and in Group 2 were 0.61 +/- 0.1 7 , (0.2-0.8) in amblyopic eyes, 0.92 +/- 0.1 (0.8-1.0) in fellow eyes. BCVA in Group 3 was 1.0 +/- 0 (1.0-1.0). Mean SFCT of the amblyopic eyes in Groups 1 and 2 was 341.50 +/- 60.4 (277-481) and 370.06 +/- 65.3 (247-462), respectively, and in the healthy eyes of Groups 1 and 2 and Group 3 was 321.92 +/- 68.26 (251-440), 330.35 +/- 74.00 (194-502), and 327.62 +/- 40.79 (238-385), respectively. SFCT was significantly greater in the amblyopic eyes of Group 2 compared to Group 3 (p=0.01). Mean CVI was 0.681 +/- 0.032 (0.642-0.736) in the amblyopic eyes and 0.685 +/- 0.054 (0.587-0.788) in the fellow eyes of Group 1 patients; 0.664 +/- 0.033 (0.592-0.719) in the amblyopic eye and 0.707 +/- 0.039 (0.625-0.779) in the fellow eye in Group 2 patients; and 0.689 +/- 0.031 (0.612-0.748) in Group 3 patients. CVI was significantly lower in the amblyopic eyes of Group 2 compared with fellow eyes (p=0.02) and Group 3 (p=0.025). Conclusion: Morphological changes may be seen in the choroid in amblyopic eyes. We observed that the choroidal stromal component is increased in hyperopic amblyopic patients especially.Öğe Evaluation of posterior vitreous detachment after uneventful phacoemulsification surgery by optical coherence tomography and ultrasonography(Wiley-Blackwell, 2017) Degirmenci, Cumali; Afrashi, Filiz; Mentes, Jale; Oztas, Zafer; Nalcaci, Serhad; Akkin, CezmiBackgroundThe aim was to investigate the effect of uneventful phacoemulsification on vitreoretinal interface evaluated by optical coherence tomography (OCT) and ultrasound. MethodsOne hundred and fifty eyes were evaluated for the presence or absence of posterior vitreous detachment by ultrasound and OCT prior to cataract surgery. Only those eyes with intact vitreoretinal adhesion were included in the study. All patients underwent cataract surgery. At one month, three months and six months, all patients were assessed with OCT and ultrasound. The data were analysed for statistical significance. ResultsThe study was carried out on 30 of 31 patients with no posterior vitreous detachment. The mean age of patients was 62.63 7.15 years (range 49 to 75 years) and 15 were female. Posterior vitreous detachment developed in 17 patients (56.66 per cent) at one month, 21 patients (70 per cent) at three months and 22 patients (73.33 per cent) at six months following the surgery. No complications or acute symptoms were detected associated with posterior vitreous detachment. ConclusionVitreoretinal interface changes and vitreoretinal separations and progression of separation can be easily evaluated by OCT. The current study confirms that posterior vitreous detachment occurs commonly soon after cataract surgery.Öğe Expert recommendations for the management of diabetic macular edema with intravitreal dexamethasone implant: A Turkish Delphi study(Sage Publications Ltd, 2022) Batioglu, Figen; Yanik, Ozge; Saatci, Ali Osman; Eldem, Bora; Akkin, Cezmi; Afrashi, Filiz; Ozdemir, HakanPurpose To provide consensus on the clinical use of intravitreal dexamethasone (DEX) implant for the treatment of diabetic macular edema (DME) in Turkey. Methods A panel of 22 retina experts prepared 77 statements of recommendation, and 80 retinal specialists practicing in Turkey were chosen to vote either in support or against each one. A Delphi-based method was used through which the ophthalmologists were able to view all of the results anonymously after two rounds and modify their subsequent answers. The survey was conducted via a mini website, and statements without consensus were resent to the specialists with the latest vote results a week later. Results A total of 72 ophthalmologists answered the first and second round questions. After the first stage, consensus was achieved on 55 of the statements, leaving 22 without agreement. After the second stage, consensus was reached on 11 of the remaining statements. Strong consensus was achieved on statements regarding the etiopathogenesis of DME and the first-line indications and safety of the DEX implant procedure. The panel recommended the use of DEX implant for patients with an arterial thromboembolic event in the last three months and also agreed that pro re nata DEX implant treatment not only provides better outcomes for DME patients but also reduces the treatment burden for those who could not receive an adequate number of anti-vascular endothelial growth factor (VEGF) injections. Conclusion This study provides clinical consensus and recommendations about the use of DEX implant in the clinical practice of DME management in Turkey.Öğe Functional and morphological assessment of ocular structures and follow-up of patients with early-stage Parkinson's disease(Springer, 2019) Hasanov, Samir; Biler, Elif Demirkilinc; Acarer, Ahmet; Akkin, Cezmi; Colakoglu, Zafer; Uretmen, OnderPurposeTo evaluate and follow-up of functional and morphological changes of the optic nerve and ocular structures prospectively in patients with early-stage Parkinson's disease.Materials and methodsNineteen patients with a diagnosis of early-stage Parkinson's disease and 19 age-matched healthy controls were included in the study. All participants were examined minimum three times at the intervals of at least 6month following initial examination. Pattern visually evoked potentials (VEP), contrast sensitivity assessments at photopic conditions, color vision tests with Ishihara cards and full-field visual field tests were performed in addition to measurement of retinal nerve fiber layer (RNFL) thickness of four quadrants (top, bottom, nasal, temporal), central and mean macular thickness and macular volumes.ResultsBest corrected visual acuity was observed significantly lower in study group within all three examinations. Contrast sensitivity values of the patient group were significantly lower in all spatial frequencies. P100 wave latency of VEP was significantly longer, and amplitude was lower in patient group; however, significant deterioration was not observed during the follow-up. Although average peripapillary RNFL thickness was not significant between groups, RNFL thickness in the upper quadrant was thinner in the patient group. While there was no difference in terms of mean macular thickness and total macular volume values between the groups initially, a significant decrease occurred in the patient group during the follow-up. During the initial and follow-up process, a significant deterioration in visual field was observed in the patient group.ConclusionStructural and functional disorders shown as electro-physiologically and morphologically exist in different parts of visual pathways in early-stage Parkinson's disease.Öğe Fundus Fluorescein Angiographic Findings in Patients Who Underwent Ventricular Assist Device Implantation(Wiley-Blackwell, 2013) Ozturk, Taylan; Nalcaci, Serhad; Ozturk, Pelin; Engin, Cagatay; Yagdi, Tahir; Akkin, Cezmi; Ozbaran, MustafaDisruption of microcirculation in various tissues as a result of deformed blood rheology due to ventricular assist device (VAD) implantation causes novel arteriovenous malformations. Capillary disturbances and related vascular leakage in the retina and choroidea may also be seen in patients supported by VADs. We aimed to evaluate retinal vasculature deteriorations after VAD implantation. The charts of 17 patients who underwent VAD implantation surgery for the treatment of end-stage heart failure were retrospectively reviewed. Eight cases (47.1%) underwent pulsatile pump implantation (Berlin Heart EXCOR, Berlin Heart Mediprodukt GmbH, Berlin, Germany); however, nine cases (52.9%) had continuous-flow pump using centrifugal design (HeartWare, HeartWare Inc., Miramar, FL, USA). Study participants were selected among the patients who had survived with a VAD for at least 6 months, and results of detailed ophthalmologic examinations including optic coherence tomography (OCT) and fundus fluorescein angiography (FA) were documented. All of the 17 patients were male, with a mean age of 48.5 +/- 14.8 years (15-67 years). Detailed ophthalmologic examinations including the evaluation of retinal vascular deteriorations via FA were performed at a mean of 11.8 +/- 3.7 months of follow-up (6-18 months). Mean best-corrected visual acuity and intraocular pressure were found as logMAR 0.02 +/- 0.08 and 14.6 +/- 1.9mmHg, respectively in the study population. Dilated fundoscopy revealed severe focal arteriolar narrowing in two patients (11.8%), and arteriovenous crossing changes in four patients (23.5%); however, no pathological alteration was present in macular OCT scans. In patients with continuous-flow blood pumps, mean arm-retina circulation time (ARCT) and arteriovenous transit time (AVTT) were found to be 16.8 +/- 3.0 and 12.4 +/- 6.2s, respectively; whereas those with pulsatile-flow blood pumps were found to be 17.4 +/- 3.6 and 14.0 +/- 2.1s in patients (P=0.526 and P=0.356, respectively). FA also revealed a tendency for increased frequency of dye leakage from the optic disc in our study population. Except for remarkable delays in both ARCT and AVTT as well as a tendency for increased frequency of dye leakage from the optic disc, ophthalmologic evaluations revealed no other significant pathology or vascular deterioration in the retina that could be attributed to artificial heart systems.Öğe THE IMPORTANCE OF THE PERIPHERAL RETINA IN PATIENTS WITH CENTRAL SEROUS CHORIORETINOPATHY(Lippincott Williams & Wilkins, 2018) Oztas, Zafer; Akkin, Cezmi; Ismayilova, Nergiz; Nalcaci, Serhad; Afrashi, FilizPurpose: This research investigated the peripheral retinas of patients with central serous chorioretinopathy (CSCR). Methods: Sixty patients with CSCR and 60 age-and gender-matched controls were included in this prospective cross-sectional study. All 120 participants underwent ocular examinations and peripheral retinal evaluations using a Goldmann three-mirror lens. Results: The examinations demonstrated peripheral retinal degeneration, atrophic or hyperplastic retinal pigment epithelial changes, and retinal breaks. The peripheral retinal degeneration rate was 39% in the CSCR group and 15% in the control group, and the CSCR group reported significantly more lattice degeneration than the control group (22 vs. 3%) (P = 0.004, odds ratio = 1.97, confidence interval = 0.68-5.65 and P = 0.002, odds ratio = 4.55, confidence interval = 0.77-26.83, respectively). Symptomatic U-shaped retinal breaks were found in three eyes (5%) in the CSCR group, and the rate of peripheral retinal degeneration was higher in the patients with chronic CSCR (vs. acute CSCR). However, this difference was not significant (P = 0.244). Conclusion: This study showed that peripheral retinal abnormalities, particularly lattice degeneration, are more common in patients with CSCR. Therefore, the authors recommend regular retinal examinations, with the inclusion of peripheral retinal assessments, for patients with CSCR.Öğe Intravitreal aflibercept for ruptured retinal arterial macroaneurysm(Ijo Press, 2017) Oztas, Zafer; Nalcaci, Serhad; Akkin, CezmiÖğe Paracentral Acute Middle Maculopathy(Turkish Ophthalmological Soc, 2020) Kiyat, Pelin; Degirmenci, Cumali; Nalcaci, Serhad; Afrashi, Filiz; Akkin, CezmiParacentral acute middle maculopathy (PAMM) is a variant of acute macular neuroretinopathy which is characterized by a hyperreflective band-like lesion in the inner nuclear layer and outer plexiform layer on spectral domain optical coherence tomography (SD-OCT). The etiology is believed to involve vasopressor exposure or systemic microvascular diseases that cause retinal ischemia. SD-OCT is the main imaging method in the diagnosis or evaluation of progression of PAMM, whereas multimodal imaging is useful to support the diagnosis. Herein, we present a case of PAMM in a healthy young woman using multimodal imaging methods.
