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    Cognitive Function Deficits Associated With Type 2 Diabetes and Retinopathy: Volumetric Brain MR Imaging Study
    (Wiley, 2025) Oktem, Ece Ozdemir; Sayman, Dila; Ayyildiz, Sevilay; Oktem, Caglar; Ipek, Lutfiye; Ayyildiz, Behcet; Aslan, Fatih
    Introduction: Type 2 diabetes mellitus is a ubiquitous chronic inflammatory disease with deleterious effects on various tissues, including the kidney, retina, and peripheral nerves. Studies using histopathology and magnetic resonance imaging have revealed that diabetes-related chronic hyperglycemia may impact the brain's essential functioning by causing microvascular damage. The aim of this study was to examine the cognitive functioning of type 2 diabetic individuals with and without retinopathy by evaluating their morphological, structural, and biochemical differences. Methods: Demographic characteristics, education level, type of diabetes mellitus (DM), disease duration, treatment received, other diabetic complications, such as nephropathy and neuropathy, and detailed medical histories were recorded. All participants underwent an extensive neuropsychological examination with Montreal Cognitive Assessment (MoCA) testing. Brain magnetic resonance imaging was performed to evaluate gray matter volume differences between the groups. Results: Gray matter volume differences between the groups were observed. Differences were observed after multiple corrections (age, education, and total intracranial volume [TIV]). First, the diabetic retinopathy group exhibited a significantly smaller gray matter volume in the right inferior temporal gyrus than the diabetic group (p = 0.032). In addition, the diabetic retinopathy group exhibited a significantly smaller gray matter volume than the control group in the right insula (lateral and central part) (p = 0.011). In addition, MoCA scores exhibited significant correlation with the two regions emerging as statistically significant in our analyses (the right inferior temporal gyrus and right insula) (p = 0.003, p = 0.002, respectively). Conclusion: Our results suggest the presence of a neurodegenerative process associated with cognitive dysfunction that is particularly prominent in the retinopathy stage of DM.
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    Evaluation of the effect of unilateral late blindness on the retina, optic nerve and choroid parameters in the sighted eye
    (Springer, 2021) Oktem, Caglar; Aslan, Fatih; Oktem, Ece Ozdemir
    Background To investigate whether unilateral late blindness alters the peripapillary retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), central macular thickness (CMT) and choroidal thickness (CT). Methods The 17 healthy eyes of 17 monocular patients with late blindness due to isolated eye trauma in one eye and the 19 eyes of 19 healthy individuals were evaluated in this retrospective study. Patients with at least 10 years of monocular blindness, a refractive error between + 1.5 and -1.5 D in the sighted eye, a best-corrected visual acuity of at least 20/20 and an axial length (AL) < 25 mm were included in the study. Following ophthalmologic examination, the RNFL, GCC, CMT and CT values were measured with spectral domain optic tomography (SD-OCT). Those with ocular, systemic or neurological disease that could influence the measured parameters were excluded from the study. Results A total of 17 (14 males, 3 females) monocular patients [mean age 41.00 +/- 11.95 (24-64)] and 19 (16 males, 3 females) healthy individuals [mean age 39.79 +/- 6.74 (30-56)], similar in age and gender (p = 0.949 and p = 0.881), were included in the study. The mean duration of being monocular was 22.76 +/- 11.76 (10-49) years. No difference was present between the RNFL, GCC, CMT and CT measurements of the monocular patients and the healthy individuals (p = 0.692, p = 0.294, p = 0.113, p = 0.623, respectively). No significant correlation was found between the duration of monocularity and the retinal and optic nerve parameters. Conclusion The results of our study indicate no difference in the optic nerve, retina and choroid OCT findings in the sighted eyes of subjects with long-term monocular blindness compared to subjects with bilateral normal eyes. Although functional and volumetric neuroimaging studies suggest the possibility of compensation in these patients, our findings indicate that this is not at the ocular level.
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    Our Combined Phacotrabeculectomy and Post-phacotrabeculectomy Laser Suture Lysis Results
    (2020) Oktem, Caglar; Ekşioğlu, Ümit; Kaderlı, Ahmet; Yakin, Mehmet; Demırok, Gulizar; Ornek, Firdevs
    Purpose: To share our combined phacotrabeculectomy (PT) results and to evaluate the effectiveness and reliability of this procedure together with that of laser suture lysis (LSL) for postoperative early intraocular pressure (IOP) control after combined PT.Materials and Methods: This retrospective study evaluated the 33 eyes of 30 patients who had undergone combined PT. The age, gender, glaucoma type, preoperative and postoperative best corrected visual acuity (BCVA), number of antiglaucomatous drugs, IOP, surgical compli-cations, early postoperative LSL requirement, IOP changes after LSL, and complications after LSL were investigated.Results: There were 18 male and 12 female patients with a mean age of 68.64±9.27 (40-86) years. The preoperative glaucoma type was most commonly pseudoexfoliative glaucoma as seen in 14 eyes and primary open angle glaucoma as seen in 12 eyes. The IOP was signifi cantly lower (p<0.0001) and the BCVA signifi cantly better (p<0.0001) postoperatively compared to the preoperative values. Similarly, the need for antiglaucoma drugs decreased postoperatively (p<0.0001). Postoperative LSL was required once in 12 eyes and twice in 4 eyes. Preoperative mean IOP was 26.75±5.4 mmHg and postoperative mean IOP was 11.31±2.96 mmHg in the eyes that underwent LSL (p<0.0001). No compli-cations that threatened vision or affected surgical success were seen after LSL.Conclusion: Combined phacotrabeculectomy is an effective and reliable surgical method in cases with glaucoma and cataract together. Suturelysis with the argon laser is an effective and reliable method in the early period to achieve target intraocular pressure after phacotrabeculectomy, and can be performed multiple times.