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Öğe Branch Retinal Artery Occlusion with Paracentral Acute Middle Maculopathy in The Pediatric Age Group: A Case Report and Literature Review(2022) Utku, Emın; Öktem, Çağlar; Bulut, MuhammetRetinal artery occlusion is usually seen acutely in elderly individuals with systemical disease and results in severe vision loss. It is rare in the pediatric age group. In this case report, we aimed to present a 15-year-old female child diagnosed with left inferior hemiretinal artery occlusion with paracentral acute middle maculopathy (PAMM) secondary to cardiac embolism due to mitral valve disease. A 15-year-old female child presented with sudden and painless vision loss in the left eye. Visual acuity was 1,0 in the right eye and 0.8 in the left eye from the inferior half of the visual field. Anterior segment examination was normal. The fundus examination of the left eye revealed retinal whitening in the superior temporal and superior nasal of the the optic disc, the superior part of macula, the inferior half of macula and the inferior half of the retina, and segmentation in the blood column in the inferior branches of the retinal artery was observed, while the right eye was normal. On optical coherence tomography (OCT), diffuse thickening and hyperreflectivity in the superficial layers and shadowing in the outer layers of the retina were observed in the inferior macula and retina in the left eye. In the superior part of the macula, OCT revealed a characteristic hyperreflective band-like lesion on the inner nuclear layer consistent with PAMM. The patient was diagnosed with left inferior hemiretinal artery occlusion and her treatment was planned. The systemical examination of the patient revealed mitral valve stenosis and insufficiency. When retinal artery occlusion is seen in the pediatric age group, a comprehensive etiological investigation is required. PAMM may be associated with BRAO due to mitral valve disease in a pediatric case.Öğe Can subfoveal choroidal thickness replace subjective tests in patients using tadalafil to treat erectile dysfunction?(Blackwell Publishing Ltd, 2020) Aslan, Fatih; Topçuoğlu, Murat; Öktem, Çağlar; Akkoç, Ali; Uçar, MuratWe aimed to determine the effect on choroidal thickness of daily 5 mg tadalafil use in patients with erectile dysfunction (ED) and to evaluate agreement between short form of International Index of Erectile Function (IIEF 1–5, 15) scores and choroidal thickness during follow-up. Enhanced depth imaging spectral domain–optical coherence tomography (EDI-OCT) was used to measure full choroidal thickness in the subfoveal area, choroidal thickness (CT) and small-choroidal-vessel-layer (SCVL) thickness. Thirty of the 45 patients included complete their follow-ups and exhibited medication continuity. Patients were divided into two groups, five (16.7%) with ED at any level at third-month follow-up, and 25 (83.3%) with no ED, and subgroup analysis was then performed. Median changes in SCVL thickness at first- and sixth-month follow-ups were 20.5 µm versus 9.0 ?m (p =.001) and 23.5 µm versus 12.5 µm (p =.005) in patients without and with ED respectively. The SCVL thickness increased by 20 ?m compared with the baseline level, indicating an improvement in the patient's complaints of erectile dysfunction. The level of increase in SCVL thickness can be a useful and objective guide to clinicians if they cannot be present when the IIEF questionnaire is administered. © 2020 Blackwell Verlag GmbHÖğe Choroidal thickness in asymptomatic patients with carotid artery stenosis(Czech Medical Association J.E. Purkyne, 2020) Öktem, Çağlar; Öktem, Emel Özalp; Kurt, Alper; Kılıç, Rüya; Şahin, Burç Esra; Yetiş, Abdurrahman; Dadalı, YelizAim: To measure the choroidal thickness (CT) with enhanced-depth imaging optic coherence tomography (EDI-OCT) in patients with internal carotid artery (ICA) stenosis and to investigate the relationship between the CT and ICA stenosis. Material and methods: We included 36 eyes of 25 asymptomatic patients with 50% or higher ICA stenosis and 36 eyes of 21 healthy controls in the study. The CT was measured with EDI-OCT from a total of 6 points in both groups. The results were compared statistically between the groups. Results: There were no significant differences between patients with asymptomatic ICA stenosis and non-stenotic healthy individuals at subfoveal CT (P = 0.085), at 500 ?m nasal to the fovea (P = 0.076), at 1,000 ?m nasal to the fovea (P = 0.052), at 500 ?m temporal to the fovea (P = 0.182), at 1,000 ?m temporal to the fovea (P = 0.115) and at 1,500 ?m temporal to the fovea (P = 0.174). Additionally, no significant difference was observed in CT values measured from 6 points between the stenotic side and the non-stenotic side in 14 patients with unilateral ICA stenosis (P > 0.05 for all points). Conclusion: The CT may not alter in asymptomatic ICA stenosis compared with healthy non-stenotic individuals. However, more studies are needed to corroborate our findings. © 2020, Czech Medical Association J.E. Purkyne. All rights reserved.Öğe Clinical and radiological features of traumatic orbital emphysema cases(Alanya Alaaddin Keykubat Üniversitesi, 2020) Aslan, Fatih; Öktem, ÇağlarAim: In this study, we aimed to evaluate the clinical course and treatment requirements of orbital emphysema cases resulting from orbital trauma.Material and Method: We included the 112 orbits of 82 patients who had presented to the emergency service of our hospital between 2016 and 2019 in this retrospective study. The common feature was severe orbital trauma due to various causes and referrals to the ophthalmology department with a preliminary diagnosis of ocular or orbital damage. The orbital computerized tomography images were evaluated for orbital emphysema and a classification was performed according to the location of the air as preseptal, extraconal, intraconal and intraocular. Results: We included a total of 82 subjects consisting of 65 males and 17 females in the study. The mean age was 37.85 (3-78) years in general, 36.09 (3-78) years in the males, and 44.58 (15-78) years in the females. Emphysema was present in the preseptal area in 80 cases, the extraconal area in 26, and the intraconal area in 5 of the 112 orbits. Intraocular emphysema was detected in only a single case. The orbital compartment syndrome was not present in any of our cases.Conclusion: Orbital emphysema is a common condition in orbital trauma. It may be associated with the orbital compartment syndrome. Orbital emphysema after orbital trauma is usually a benign, self-limiting condition.Öğe Does adjuvant intracameral triamcinolone acetonide increase the effectiveness of phacotrabeculectomy? A case-control study(Czech Medical Association J.E. Purkyne, 2020) Aslan, Fatih; Öktem, ÇağlarAims: To investigate the effect of intracameral triamcinolone acetonide (TA) on surgical success in 5-fluorouracil (5-FU) supported primary phacotrabeculectomy (PT) cases. Material and Methods: This retrospective study included 23 eyes (study group) of 23 patients who underwent TA during PT and 26 eyes (control group) of 26 patients without TA. PT patients in the study group received 1 mg TA intraoperatively at the end of surgery. Pre-and postoperative visual acuity, intraocular pressure (IOP), and number of antiglaucoma drugs used were compared. Postoperative complications and need for 5-FU injection were evaluated for both groups. Results: Mean age was 64.1 2 ± 1.91 (48–86) years in the control group and 66.52 ± 2.02 (52–86) years in the study group (p = 0.824). Comparison of pre-and postoperative IOP values showed significant decreases in postoperative IOP levels at all-time points in both the control and study groups (p < 0.001). The only significant difference between groups was on postoperative first day (study group: 9.22 ± 1.41 mmHg; control group: 6.35 ± 2.17 mmHg, p < 0.001). Need for postoperative 5-FU injection was significantly more common in the control group (p = 0.023). Conclusion: Intracameral injection of 1 mg TA at the end of PT surgery did not yield superior results in postoperative IOP compared to PT alone, and the two groups showed similar IOP reduction. When given as an adjunct to PT, 1 mg TA suppresses anterior segment inflammation and reduces the need for 5-FU injection. © 2020, Czech Medical Association J.E. Purkyne. All rights reserved.Öğe Does choroidal thickness change in parkinson’s disease?(Czech Medical Association J.E. Purkyne, 2019) Öktem, Çağlar; Öktem, Emel Özalp; Kurt, A.; Kılıç, R.Aim: To evaluate the choroidal thickness (CT) in patients with Parkinson’s disease (PD) compared to healthy individuals and to investigate the relationship between the disease duration and the CT. Materials and methods: The study group included 24 right eyes of 24 PD patients and the control group included 25 right eyes of 25 healthy individuals. The CT was measured in both groups using spectral domain optical coherence tomography (SD-OCT) at 6 points: The foveal centre and at 500-?m intervals temporal (3 points) and nasal (2 points) to the foveal centre. The groups were compared in terms of CT values and group analyses were performed. The correlation between the PD duration and the CT was also evaluated. Results: The mean age of the 24 PD patients (14 males) was 67.5 ± 12.8 years and the mean age of the 25 healthy individuals in the control group (13 males) was 66.1 ± 9.7 years. There were no significant differences between the groups in terms of age or gender (P = 0.59 and P = 0.768). The PD patients had significantly increased CT values subfoveal (P = 0.04), 500 ?m nasal (P = 0.03), and 500, 1,000 and 1,500 ?m temporal to the foveal centre (P = 0.02, P = 0.02, P = 0.02, resp.). No correlation was detected between the PD duration and the CT (P > 0.05). Conclusion: The choroidal thickness may increase in PD compared with healthy individuals. However, more studies are needed to corroborate our findings and to assess the underlying pathophysiology. © 2019, Czech Medical Association J.E. Purkyne. All rights reserved.Öğe Does pseudoexfoliation syndrome affect the choroidal response after uneventful phacoemulsification(Association for Research in Vision and Ophthalmology Inc., 2020) Aslan, Fatih; Öktem, ÇağlarPURPOSE. To examine subfoveal and peripapillary choroidal thickness changes after successful phacoemulsification in cataract cases with nonglaucomatous pseudoexfoliation syndrome (PXS). MATERIALS AND METHODS. Nineteen cataract patients with PXS and 19 without PXS were included in this prospective and interventional controlled study. Subfoveal and peripapillary choroidal thicknesses were measured before surgery and on the postoperative first day (D1), first week (W1), first month (M1), second month (M2), and third month (M3). Subfoveal choroidal thickness measurement included total subfoveal choroidal thickness (tSFCT), the small choroidal vessel layer (SF-SCVL) thickness, and the large choroidal vessel layer (SF-LCVL) thickness. RESULTS. The greatest increase in mean tSFCT compared to baseline was observed between W1 and M1 with values of 23.33 ± 2.96 ?m and 31.84 ± 2.88 ?m, respectively, for the PXS and non-PXS groups (P = 0.014). The greatest increase in SF-SCVL thickness compared with baseline occurred at M1 with values of 6.66 ± 1.97 ?m and 26.52 ± 1.92 ?m, respectively, for the PXS and non-PXS groups (P < 0.001). The peripapillary choroidal thickness only showed a significant difference between the groups at the inferior measurement point with values of 117.94 ± 14.15 ?m and 137.52 ± 34.53 ?m, respectively, for the PXS and non-PXS groups (P = 0.032). CONCLUSIONS. Cataract cases with PXS exhibited a different choroidal thickness response compared to non-PXS eyes after successful phacoemulsification. The increased choroidal thickness was particularly observed in Haller’s layer in the eyes with PXS and in the choriocapillaris and Sattler’s layer in the eyes without PXS. Copyright 2020 The Authors.Öğe Effect of trabeculectomy and Ahmed glaucoma valve implantation surgery on corneal biomechanical changes(Springer, 2020) Kaderli, Ahmet; Demirok, Gülizar; Kaderli, Sema Tamer; Öktem, Çağlar; Karnaz, Ali; Özen, Doğukan; Ekşioğlu, ÜmitPurpose To evaluate alterations in corneal biomechanical properties before and 6 months after conventional trabeculectomy (TRAB) and Ahmed glaucoma valve (AGV) implantation. Methods Thirty-nine eyes of 39 patients were evaluated retrospectively. Complete ophthalmological examinations including evaluation of corneal biomechanical properties using the Ocular Response Analyzer were performed before and after 6 months postoperatively. A mean of four measurements for corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann correlated intraocular pressure (IOPg), and corneal compensated intraocular pressure (IOPcc) was recorded. The participants had undergone trabeculectomy or shunt surgery as the first surgical procedure for glaucoma treatment of uncontrolled IOP with maximum antiglaucoma eyedrops. Results There were 20 eyes of 20 patients in trabeculectomy group and 19 eyes of 19 patients in AGV implantation group. There was no significant difference between two groups in terms of sex, age, eye laterality, lens status, antiglaucoma drug usage, preoperatively measured Mean Deviation of Humphrey Visual Field Analyzer, CH, CRF, IOPcc, and IOPg (p > 0.05). CH and CRF increased significantly after shunt surgery (p < 0.001). CH increased in trabeculectomy group postoperatively (p < 0.001); however, CRF showed a small amount of decrease, but this reduction was not statistically significant (p > 0.05). CH and CRF showed higher increase after AGV surgery than trabeculectomy surgery (p < 0.05). There was no significant correlation between IOP changes and CH-CRF changes in both TRAB and AGV groups (p > 0.05). Conclusion According to our results, surgical technique differences may have an impact on postoperative corneal biomechanical outcomes. AGV surgery offers better corneal biomechanical results than standard trabeculectomy in 6-month follow-up.Öğe Evaluation of patients presenting to the ophthalmology department of a tertiary hospital for nonemergency reasons during the covid-19 pandemic(2020) Aslan, Fatih; Öktem, ÇağlarObjective: To evaluate changes in the demographic and diagnostic distribution of patients presenting to the ophthalmology department during the COVID-19 pandemic, compared to the pre-pandemic period. Methods: The study included patients who made outpatient appointments in our ophthalmology department. The COVID-19 group (CovG) comprised patients who presented between April 15 and May 15, 2020, the 30-day period with the highest daily number of new cases in Turkey. The control group (CG) was obtained by randomization through a computer program from among 2 245 patients who applied in the same period of the previous year. The patients’ presenting complaint(s), diagnostic(s) and demographic information’s were collected from a database, with all identifying information concealed. For patients who presented more than once, their initial complaint and diagnoses were analyzed. Results: The study included a total of 400 patients: 200 in the CovG and 200 in the CG. Mean ages in the CovG and CG were 41.23 ± 14.48 and 48.20 ± 17.49 years, respectively (p < 0.001). The female to male patient ratio was 0.53 in the CovG and 0.83 in the CG (p = 0.032). There were fewer university graduates compared to other education levels among the patients who presented during the pandemic (p = 0.013). During the COVID-19 pandemic, there was no increase in presentation frequency for any ocular disease compared to the previous year. The only statistical decrease in patient application complaints was observed in reading difficultness (11 % in CovG vs. 37 % in CG; p < 0.001). Presentations due to dry eye (DE) and allergic conjunctivitis (AC) were similar to the same period of the year (p = 0.303 and p = 0.550, respectively). At least 1 chronic ocular disease was present in 25 % of the CovG and 45.5 % of the CG (p < 0.001). A statistically significant decrease was observed in CovG for age-related macular degeneration and glaucoma in the diagnoses made at the end of the examination (p = 0.001 and p < 0.001, respectively). Conclusion: During the first peak of the COVID-19 pandemic in Turkey, the most common outpatient presentations to the ophthalmology department were for the diagnoses of DE and AC. During peak pandemic period, elderly patients, women and academically trained patients significantly reduced their visits to the Eye Clinic. The reduction in presentation of patients with glaucoma and age-related macular degeneration may be due to the longterm treatment planning for these patients and the social isolation measures issued for the older population. These patients should be encouraged to use video consultation / telemedicine in eye patients at risk of vision loss.Öğe Üçüncü basamak bir hastanenin göz hastalıkları polikliniğine sevk edilen sürücü adaylarının özellikleri: Kesitsel tanımlayıcı çalışma(2020) Öktem, Çağlar; Aslan, FatihAmaç: Üçüncü basamak bir merkez olan hastanemiz göz hastalıkları polikliniğine aile sağlığı merkezlerinden sürücü sağlık raporu almak üzere sevk edilen olguların özelliklerini ve sevk gerekliliğini araştırmak. Gereç ve Yöntem: Ekim 2019-Aralık 2019 tarihleri arasında yapılan kesitsel-tanımlayıcı çalışmaya 252 olgu dahil edildi. Katılımcıların oftalmolojik ve sistemik özgeçmişleri sorgulandı. Sevk öncesi birinci basamak merkezlerde göz muayenesinin yapılıp yapılmadığı ve göz hastalıkları polikliniğine sevk nedenleri sorgulandı. Ardından tüm katılımcılara detaylı oftalmolojik muayene yapıldı. Bulgular: 252 olgunun 185’i erkek, 67’si kadındı. Ortalama yaş 42,650±14,90 (18-82) yıl bulundu. Sevk öncesi aile sağlığı merkezlerindende görme muayenesi yapılanların sayısı 114 (%42,23), yapılmayanlar ise 138 (%54,76) idi. Sevk nedenleri arasında en sık 89 (%35,31) olgu ile gözlük veya kontakt lens kullanımı vardı. 78 (%30,9) olgu herhangi bir neden belirtilmeksizin sevk edilmişti. Kırkiki (%16,66) olgu az görme-küçük harfleri görememe, 11 (%4,36) olgu ileri yaş, 16 (%6,34) olgu göz ameliyatı öyküsü ya da organik bir göz patolojisi nedeniyle sevk edilmişti. 252 olgunun 232’si (%92,06) 2. grup, 16’sı (%6,34) 1. grup sürücü olabilecek görme düzeyine sahipti. Çeşitli sebeplere bağlı olarak tek gözde körlüğü olan 2 olguya (%0,79) monoküler sürücü belgesi sağlık raporu verildi. Yalnızca 2 (%0,79) olguya, sürücü olamaz raporu verildi. Sonuç: Göz hastalıkları bölümüne sevk edilen sürücü adaylarının önemli bir kısmının birinci basamak sağlık merkezlerinde sürücü olur sağlık raporu alabileceği gözlemlendi. Çalışmamızın sevk zincirinin etkin şekilde işletilmesi ve farkındalığın arttırılması açısından literatüre katkı sağlayacağına inanıyoruz.Öğe Vitamin D Levels in Young Adult Cataract Patients: A Case-Control Study(2021) Öktem, Çağlar; Aslan, FatihObjective: We aimed to investigate whether a relationship is present between early cataract formation and vitamin D in young adults. Methods: A total of 37 cataract patients (18 males and 19 females) and 53 healthy participants (27 males and 26 females) under the age of 60 years were included in this study. The 25-OH vitamin D values were measured in all subjects and the mean vitamin D levels compared between the 2 groups. Additionally, the differences between the vitamin D levels of the genders in both groups were investigated. Results: The mean age of the study group was 48.1 ± 8.5 (range 33-59) years, and the mean age of the control group was 49.3 ± 7.8 (range 31-59) years (p = 0.48 and p = 0.83). The mean vitamin D level was 15.6 ± 8.4 ng/mL in the study group and 20.8 ± 7.1 ng/mL in the healthy subjects (p = 0.002). Among the females, the vitamin D level was 10.6 ± 4.7 ng/mL in the study group and 18.1 ± 6.4 ng/mL in the control group (p = 0.0001). No significant difference was found between the groups among the males (p = 0.24). Conclusion: We found vitamin D deficiency to be associated with early age-related cataract in a statistically significant manner. We believe it is worth investigating the reason for this concurrence with large longitudinal studies. © 2020 S. Karger AG, Basel. All rights reserved.
