Eren Cerman

Clinical use of photodynamic therapy in ocular tumors

Although the introduction of intravitreal anti-vascular endothelial growth factor drugs reduced the indications for photodynamic therapy in ophthalmology, it may still be used in various ocular tumors. Although many studies have shown that photodynamic therapy is effective in ocular tumors, the literature consists of case reports and series. In this review, we systematically performed a meta-analysis for the use of photodynamic therapy in circumscribed choroidal hemangioma, diffuse choroidal hemangioma, retinal capillary hemangioma, von Hippel-Lindau angiomatosis, choroidal melanoma, retinal astrocytoma, retinoblastoma, eyelid tumors, conjunctival tumors, and choroidal metastasis.

Transepithelial versus epithelium-off crosslinking in adults with progressive keratoconus

Purpose To compare the efficacy of epithelium‐off corneal collagen crosslinking (CXL) with transepithelial CXL in patients with progressive keratoconus. Setting Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey. Design Retrospective cohort study. Methods Eyes that had transepithelial CXL were compared with eyes treated with epithelium‐off CXL. All patients with a follow‐up of 18 months were evaluated for uncorrected (UDVA) and corrected (CDVA) distance visual acuities, corneal topography, aberrometry, and pachymetry (Pentacam). Results The mean patient age was 22.8 years ± 4.7 (SD) (range 18 to 31 years) in the transepithelial group (30 eyes) and 23.7 ± 3.9 years (range 18 to 30 years) in the epithelium‐off group (30 eyes). The mean UDVA and CDVA significantly improved in both groups (P < .001). There was no significant difference in the CDVA gain between the 2 groups. In the epithelium‐off group, significant improvements occurred in spherical error (P = .002), spherical equivalent (P = .004), maximum keratometry (K), flat K (P = .036), and steep K (P < .001). The reductions in flat K, steep K, and maximum K were greater in the epithelium‐off group (P = .004 for flat K; P < .001 for steep K and maximum K). In the transepithelial group, significant improvements occurred in the cylindrical error (P = .009) and in the index of surface variance and index of surface asymmetry (both P < .001). Conclusion Although transepithelial CXL seemed to have reduced effectiveness in inducing improvement in topographic indices, its effect on visual acuity is likely to be similar to that of epithelium‐off CXL. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

The choroid and lamina cribrosa is affected in patients with Parkinson's disease: enhanced depth imaging optical coherence tomography study

To compare lamina cribrosa (LC) and choroidal thicknesses using enhanced depth imaging optical coherence tomography (EDI‐OCT) in patients with Parkinsons disease (PD) and healthy controls.

Screening for Retinopathy of Prematurity in a Tertiary Ophthalmology Department in Turkey: Incidence, Outcomes, and Risk Factors

BACKGROUND AND OBJECTIVE The aim of this study is to determine the incidence of retinopathy of prematurity (ROP), the number of preterm infants requiring treatment for ROP, and the factors influencing the development of ROP requiring treatment in a Turkish population. PATIENTS AND METHODS Data on 1,252 infants who were screened for ROP in an ophthalmology department were retrospectively reviewed. Infants with a gestational age (GA) of no more than 28 weeks (n = 157) were designated group 1, those between 29 and 32 weeks (n = 572) were assigned to group 2, and those between 33 and 37 weeks (n = 523) were assigned to group 3. RESULTS In group 1, ROP was detected in 70.0% of infants, 17.8% of whom required therapy. In group 2, ROP was detected in 41.4%, and 4.0% of those required therapy. In group 3, 18.1% were diagnosed with ROP, with 0.8% requiring treatment. CONCLUSION Retinopathy of prematurity occurs, even among more mature infants, at a frequency that merits astute screening within parameters that reflect socioeconomic differences that appear to have an effect on the incidence.

Serum Erythropoietin, Insulin-like Growth Factor 1, and Vascular Endothelial Growth Factor in Etiopathogenesis of Retinopathy of Prematurity

BACKGROUND AND OBJECTIVE The role of growth factors in the pathogenesis of retinopathy of prematurity (ROP) is known. To better understand this issue, the authors investigated vascular endothelial growth factor (VEGF), insulin-like growth factor 1 (IGF-1), and erythropoietin (EPO) levels in the cord blood of premature newborns. PATIENTS AND METHODS IGF-1, VEGF, and EPO levels were measured in cord blood samples obtained from 93 infants less than 32 weeks of gestational age at birth, and their predictive value in the development of ROP was investigated. RESULTS The mean birth age and mean birth weight were 32.2 ± 1.5 weeks and 1,678 ± 326 g, respectively, in infants without ROP and 29.6 ± 2.3 weeks and 1,384 ± 343 g, respectively, in infants with ROP. Multivariate logistic regression analysis showed that only the gestational age and the serum VEGF at birth were independently associated with the risk of developing ROP (P = .002, Exp[B] = 0.514, CI = 95%: 0.341-0.775; P = .028, Exp[B] = 0.999, CI = 95%: 0.997-1.00). CONCLUSION Serum VEGF levels at birth were lower in infants who later developed ROP. This may have a predictive value for ROP and contribute to the pathogenesis, because affected infants may be more susceptible to extrauterine hyperoxic insult.

Comparison of Optical Coherence Tomography Findings in Patients With Primary Open-angle Glaucoma and Parkinson Disease.

Purpose:To evaluate the peripapillary retinal nerve fiber layer (RNFL), ganglion cell complex, and macular thickness as well as their correlation with the severity of diseases. Materials and Methods:This is a cross-sectional study and comparing both eyes of 26 patients with primary open-angle glaucoma, 25 patients with Parkinson disease (PD), and 23 healthy subjects. RNFL, ganglion cell complex, and macular thickness were measured and analyzed with optical coherence tomography (OCT) in all cases and correlation with severity of the disease was assessed in PD group. Results:The mean RNFL of PD was significantly thinner compared with controls (P=0.002). In glaucoma group, the mean RNFL was significantly thinner (96.28±12.49 &mgr;m) than PD (105.43±13.45 &mgr;m) and the controls (113.75±8.53 &mgr;m) (P<0.001; P<0.001, respectively). The global loss volume (GLV) rates in the glaucoma and PD group were significantly higher than controls, respectively (P=0.006; P<0.001/P=0.002, P=0.013). However, the GLV rate was significantly lower in PD group compared with glaucoma group (P=0.001). There was no significant correlation between OCT measurements and disease duration or severity in the PD patients. Conclusions:Although RNFL thickness and GLV changes may show the ganglion cell loss in both disease but none of the OCT parameters are correlated with the severity of PD. OCT may help to reveal the ganglion cell damage but may not help in determination of severity during the clinical follow-up of PD patients.

The relationship of age when motor alignment is achieved and the subsequent development of stereopsis in infantile esotropia

PURPOSE To determine the oldest age beyond which the chance of developing stereopsis is not possible even with excellent motor alignment in patients with infantile esotropia. METHODS The medical records of children with infantile esotropia who underwent a single operation and had alignment within 10(Δ) of orthotropia at all follow-up examinations were retrospectively reviewed. Patients were assessed for stereopsis after the age of 48 months. RESULTS A total of 38 children were included. There was a statistically significant inverse correlation between age at surgery and final stereopsis (r = 0.494, P = 0.002). There was a significant difference at mean age at surgery between patients having stereopsis better than 1000 arcsec and those having no stereopsis (P = 0.002). Post hoc power analysis revealed a value of 85%. Receiver operating characteristic curve analysis revealed that the optimum cut-off value of the age at surgery for predicting stereopsis was 16 months (Youden index = 0.474; area under ROC curve, 0.784; 95% CI: 0.62-0.90; P = 0.0002). CONCLUSIONS Surgery for infantile esotropia is most likely to result in measureable stereopsis if patient age at alignment is not more than 16 months.

Two Cases With Chloroquine And Hydroxychloroquine Maculopathy

We described two cases of retinopathy due to antimalarial drugs and evaluated drug screening methods in antimalarial treatment. We reviewed our clinical records, fundus photographs, visual fields and the fluorescein angiographies of two patients from our retina referral department. The first case arose due to the misinterpretation of test results, despite the presence of adequate screening tests. The second case arose because of the inadequate information about the importance of screening tests.

Efficacy of Epithelium-Off and Epithelium-On Corneal Collagen Cross-Linking in Pediatric Keratoconus.

Objectives: To evaluate the efficacy of riboflavin/ultraviolet A epithelium-off (epi-off) and epithelium-on (epi-on) corneal collagen cross-linking (CXL) in progressive pediatric keratoconus. Methods: Thirty-six eyes of 27 patients aged 18 years or younger (12–18 years) diagnosed with progressive keratoconus and treated with epi-off (n=18 eyes) or epi-on (n=18 eyes) CXL were included in this study. All patients were followed up for 24 months postoperatively. Results: At 24-month follow-up, the mean corrected distance visual acuity (CDVA) improved from 0.24±0.17 to 0.17±0.11 logMAR in the epi-off group (P=0.032). In the epi-on group, CDVA improved from 0.33±0.23 to 0.26±0.20 logMAR (P=0.012), but the improvement was not significantly different between groups (P>0.05). In the epi-off group, all mean K values improved: K1 (&Dgr;=−0.63 D, P=0.024), K2 (&Dgr;=−0.73 D, P=0.008), and Kmax (&Dgr;=−1.4 D, P=0.035), whereas in the epi-on group, Kmax and K2 did not change significantly and K1 (&Dgr;=0.68 D, P=0.029) significantly worsened. Postoperative mild corneal haze occurred in 5 eyes (28%) in the epi-off group. No postoperative complications were observed in the epi-on group. In 94.4% of the epi-off group, keratoconus regressed (44.4%) or stabilized (50.0%), whereas in the epi-on group, only 66.6% regressed (33.3%) or stabilized (33.3%), and the difference was significant (P=0.038). Conclusions: The efficacy of the epi-on procedure in terms of its ability to halt keratoconus progression appears to be 0.70 of the efficacy of epi-off CXL.

Sterile corneal infiltrates after corneal collagen cross‐linking: evaluation of risk factors

To evaluate possible risk factors leading to sterile corneal infiltrates following corneal collagen cross‐linking (CXL).