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    Comparison of Anterior Segment Measurements With a Dual Scheimpflug Placido Corneal Topographer and a New Partial Coherence Interferometer in Keratoconic Eyes
    (Lippincott Williams & Wilkins, 2015) Yagci, Ramazan; Kulak, Ali Ender; Guler, Emre; Tenlik, Aylin; Guragac, Fatma Betul; Hepsen, Ibrahim Feyzi
    Purpose:To evaluate the repeatability and agreement of the anterior segment measurements obtained using the Galilei dual Scheimpflug analyzer (Galilei DSA; Ziemer) and Nidek AL Scan (Nidek CO, Aichi, Japan) biometry in keratoconic and normal eyes.Methods:Three consecutive measurements were performed by the same examiner using both devices in 62 healthy and 88 keratoconic eyes. Central corneal thickness (CCT), anterior chamber depth, keratometry readings (K) [in flattest meridian (Kf), in steepest meridian (Ks), and mean (Km)], and white-to-white distance were evaluated. Repeatability was assessed by calculating the within-subject SD and coefficient of variation. The agreement between both devices was assessed using the Bland-Altman method.Results:Both devices achieved excellent repeatability for all parameters in each group. The 95% limits of agreement (LoA) between both devices were also very narrow and acceptable for all parameters in normal corneas. However, the 95% LoA for agreement was large for CCT and measurements related to K (Kf, Ks, and Km) using both 2.4 and 3.3 mm in keratoconic eyes. In addition, compared with the Galilei DSA, K values of the Nidek AL Scan using a diameter of 3.3 mm showed slightly closer 95% LoA than those obtained using a diameter of 2.4 mm.Conclusions:In normal eyes, the Galilei DSA and Nidek AL Scan can be used interchangeably for anterior segment measurements. In keratoconic eyes, both devices yielded interchangeable anterior chamber depth and white-to-white distance measurements, whereas CCT and keratometry measurements showed clinically significant differences.
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    Dexamethasone Intravitreal Implant for Chronic Diabetic Macular Edema Resistant to Intravitreal Bevacizumab Treatment
    (Taylor & Francis Inc, 2016) Totan, Yuksel; Guler, Emre; Guragac, Fatma Betul
    Purpose: To evaluate the safety and efficacy of intravitreal dexamethasone implant (Ozurdex) in patients with chronic diabetic macular edema (DME) resistant to prior intravitreal bevacizumab (IVB) treatment. Materials and Methods: Thirty eyes of 30 patients were administered intravitreal Ozurdex and examined at baseline and 1, 3, and 6 months postinjection in this prospective study. Main outcomes were the best corrected visual acuity (BCVA, logMAR), central foveal thickness (CFT), mean cube volume (MCV), and intraocular pressure (IOP). Patients had a CFT over 275 mu m (measured by OCT) and were unresponsive to 3 consecutive IVB injections. All data are presented as meanstandard deviation. Results: The mean BCVA significantly increased from 0.56 +/- 0.38 to 0.41 +/- 0.27 (p<0.001), and 0.44 +/- 0.28 (p=0.008) at 1 and 3 months, respectively. At months 1, 3, and 6, the mean CFT significantly decreased from 517 +/- 136 mu m at baseline, to 290 +/- 60 mu m (p<0.001), 314 +/- 88 mu m (p<0.001) and 411 +/- 126 mu m (p=0.01), respectively. However, the mean CFT (p<0.001) and MCV (p=0.01) significantly increased and BCVA significantly decreased (p=0.04) at 6 month compared to 3 month. Compared to baseline, IOP increased significantly at 1 week (p=0.01), 1 month (p=0.01) and 3 months (p=0.04). However eyes with IOP higher than 21mmHg were treated and well controlled with topical anti-glaucoma monotherapy. Macular edema recurrence occurred in 25 eyes (CFT ranged from 321 mu m to 800 mu m) at 6 months. Conclusion: Dexamethasone intravitreal implant may be an effective and safe alternative in treatment of chronic DME nonresponsive to regular IVB. However, its therapeutic efficacy decreases between the third and sixth months following the injection.
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    Evaluation of Choroidal Thickness in Amblyopia Using Enhanced Depth Imaging Optical Coherence Tomography
    (Taylor & Francis Inc, 2015) Tenlik, Aylin; Guler, Emre; Kulak, Ali Ender; Totan, Yuksel; Dervisogullari, Mehmet Serdar; Guragac, Fatma Betul
    Purpose: To evaluate the choroidal thickness (CT) in hyperopic anisometropic amblyopic eyes, fellow non-amblyopic eyes, and age-matched normal eyes, using spectral-domain optical coherence tomography (SD-OCT). Materials and methods: In total 53 subjects (17.8 +/- 11.0 years, mean +/- SD) with hyperopic anisometropic amblyopia (AE) and 53 age-matched controls (17.7 +/- 11.0 years) were included in this prospective study. Each subject underwent a dilated eye examination, cycloplegic refraction and axial length (AL) measurement using Nidek AL-Scan optical biometer (Nidek CO, Aichi, Japan). The CT of subfoveal area and at a radius of 1 and 3mm around the fovea was determined using the enhanced depth imaging program of a SD-OCT (Cirrus HD OCT, Carl-Zeiss Meditec, Dublin, CA). CT, AL and spherical equivalent refraction (SER) of the amblyopic eyes were compared to that of the fellow and control eyes. Results: The mean subfoveal CTwas 305.6 +/- 26.0 mm in the amblyopic eyes, 282.6 +/- 30.7 mm in the fellow eyes and 280.1 +/- 8.8 in the control eyes. The subfoveal choroid in amblyopic eyes was significantly thicker than that of the fellow eyes and control eyes (p<0.001). There was a significant negative correlation between the subfoveal CT and the AL in amblyopic (r=-0.298, p=0.03) eyes but not in the control and fellow eyes. Conclusions: The subfoveal choroid of eyes with hyperopic AE is significantly thicker than that of the fellow eye and the age-matched controls. Hence, CT seems to be effected in AE.
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    Influences of Topical Cyclopentolate on Anterior Chamber Parameters With a Dual-Scheimpflug Analyzer in Healthy Children
    (Slack Inc, 2015) Guler, Emre; Guragac, Fatma Betul; Tenlik, Aylin; Yagci, Ramazan; Arslanyilmaz, Zeynel; Balci, Mehmet
    Purpose: To evaluate the changes of anterior segment parameters following the topical instillation of cyclopentolate hydrochloride 1% with the Galilei dual-Scheimpflug analyzer (GSA) (Ziemer Ophthalmology Co., Port, Switzerland) in healthy children. Methods: Fifty children (29 boys, 21 girls) were evaluated before and 60 minutes after instillation of three drops of 1% cyclopentolate hydrochloride using the GSA. The measurements before and after cycloplegia, including anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), central corneal thickness (CCT), and pupil size, were evaluated using the paired t test. Results: The mean age of the patients was 10.27 +/- 3.32 years (range: 5 to 15 years). Measurements between the two sessions were significantly different for all parameters (P < .05), except for CCT (P > .05). Conclusions: The GSA demonstrated a statistically significant increase in ACD, ACV, ACA, and pupil size following the topical application of cyclopentolate hydrochloride 1%. These results should be considered during biometric measurement and refractive surgery planning.
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    Intravitreal bevacizumab and dexamethasone implant for treatment of chronic diabetic macular edema
    (Taylor & Francis Ltd, 2017) Guler, Emre; Totan, Yuksel; Guragac, Fatma Betul
    Objective: To evaluate anatomical and functional outcomes of intraviteal bevacizumab (IVB) in patients with chronic diabetic macular edema (DME), and the effectivity and safety of dexamethasone implant in those unresponsive to regular IVB treatment. Methods: Thirty-five eyes of 35 patients (16 male and 19 female) with chronic DME (central foveal thickness (CFT) >275m, duration >6 months) received three injections of 2.5mg IVB with six-week intervals. At 18 weeks, dexamethasone implant was applied to patients unresponsive to IVB. Main outcomes were the change in best corrected visual acuity (BCVA), CFT and ocular and systemic adverse effects for both drugs. The patients responsive to IVB were followed up for 36 weeks and those patients receiving dexamethasone implant were followed up for 24 weeks postoperatively. Results: At 18 weeks, the mean BCVA (0.68 +/- 0.40 logMAR, p=0.45) and CFT (453 +/- 169m, p=0.58) did not show any significant change compared to baseline (0.74 +/- 0.42 logMAR and 521 +/- 151m, respectively). In 20 patients (%57.1) responsive to IVB, the CFT was significantly improved from 12 to 36 weeks with the mean value of 295 +/- 42 (p=0.01). However, no significant difference was observed for BCVA during this period (p=0.17). Dexamethasone was implanted in 15 eyes (42.8%) unresponsive to IVB at 18 weeks. Statistically significant improvements were observed in BCVA (at postoperative 4 and 12 weeks) and CFT (at postoperative 4, 12 and 24 weeks). In addition, both parameters significantly worsened at 24 weeks compared to 12 weeks (p<0.001 and p=0.01, respectively). Conclusions: Patients with chronic DME should be followed in accordance with a fixed treatment protocol combining anti-VEGF and steroid treatments.
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    Normative Spectral Domain Optical Coherence Tomography Data in Healthy Turkish Children
    (Taylor & Francis Inc, 2017) Guragac, Fatma Betul; Totan, Yuksel; Guler, Emre; Tenlik, Aylin; Ertugrul, Ihsan Gokhan
    Purpose: To determine the normative database of macular and retinal nerve fiber layer (RNFL) thickness parameters in healthy Turkish children by OCT. Methods: 318 eyes of 318 children (138 boys, 183 girls) aged between 3 and 17 years were evaluated. The children were scanned by Cirrus HD-OCT (Carl Zeiss Meditec) to measure the macula, RNFL, and optic nerve head parameters. Results: Axial length (AL) (p <0.001, R-2 = 0.08), spherical equivalent (SE) (p < 0.001, R-2 = 0.12), and rim area (p <0.001, R-2 = 0.15) were the strongest predictors of RNFL thickness. All of the macular measurements were significantly related to age (p <0.001, R-2 > 5%). Average macular thickness (p < 0.01) and outer macula (p = 0.002) showed significant relationship with the AL and SE. Conclusion: This study ensures an age-adjusted pediatric normative database using OCT to diagnose and monitor macular diseases, optic nerve diseases, and glaucoma in children.