Tolga Kocatürk

Prevention of suture exposure in transscleral intraocular lens fixation: an original technique.

BACKGROUND In this retrospective study, we evaluated our surgical outcomes of transscleral intraocular lens (IOL) fixation and introduced a simple, quick, and effective method to fixate and bury the sutures in the sclera to avoid suture exposure. METHODS Eyes were divided into 3 groups according to surgical technique. Half-thickness scleral flaps were prepared, and polypropylene suture ends were cut short in group 1 (12 eyes). Suture ends were left long without flaps in group 2 (47 eyes) and were buried into the scleral tunnel in group 3 (21 eyes). RESULTS The suture exposure rate was significantly lower in group 3 (0%) compared with group 2 (p = 0.006) and group 1 (p = 0.040). There was no significant difference in group 1 (25%) compared with group 2 (27.6%) (p = 1.000). INTERPRETATION Burying the suture ends into the scleral tunnel is a simple, safe, and effective technique for avoiding suture exposure in scleral-fixated IOL implantation.

Effects of sunitinib and bevacizumab on VEGF and miRNA levels on corneal neovascularization

Abstract Aim: To evaluate the effects of sunitinib (0.5 mg/ml) and bevacizumab (5 mg/ml) on VEGF-A, VEGFR-2 and microRNA (miRNA) levels on corneal neovascularization (CNV). Methods: In this study, CNV was induced by silver nitrate application to the cornea, and 40 Albino male rats were equally divided into four subgroups: Group 1 (sunitinib): After silver nitrate application to the cornea, 0.5 mg/ml sunitinib eyedrop was administered twice daily for two weeks (n = 10). Group 2 (bevacizumab): After silver nitrate application to the cornea, 5 mg/ml bevacizumab eyedrop was administered twice daily for two weeks (n = 10). Group 3 (control): After silver nitrate application to the cornea, normal saline eyedrop was administered twice daily for two weeks (n = 10). Group 4 (vehicle): After silver nitrate application to the cornea, 1% DMSO eyedrop was administered twice daily for two weeks (n = 10). After two weeks from the silver nitrate application, corneas were evaluated by hand-held biomicroscope for their vascularization status. Then, corneas were excised and the expression levels of VEGFR-2, VEGF-A and the common miRNA markers for neovascularization (miR-15 b, miR-16, miR-23a, miR-126, miR-188, miR-210, miR-221, miR-222, miR-410 and miR-423) were evaluated by real-time PCR. Results: It was seen that the CNV was decreased in sunitinib- and bevacizumab-administered groups compared to the control and DMSO groups. Also, in comparison with the control group; VEGF-A expression was downregulated by nearly 0.75 times in sunitinib group and nearly 0.52 times in bevacizumab group. VEGFR-2 expression was downregulated by 0.89 times in sunitinib group and 0.68 times in bevacizumab group, compared to the control group. miR-15 b, miR-16 and miR-126 levels were statistically lower in sunitinib and bevacizumab groups, but miR-188 and miR-410 levels were two-fold higher compared to the control group. The miR-210 level was found higher only in sunitinib group compared to the control group. There were no statistically significant changes in miR-23a, miR-221, miR-222 and miR-423 levels among the groups. Conclusion: Topical application of bevacizumab (5 mg/ml) and sunitinib (0.5 mg/ml) decreases the levels of VEGFR-2 and VEGF-A in CNV. Further studies are needed for detailed analysis of genes which are targeted by up- or downregulated miRNAs in this study.

Ophthalmic artery blood flow parameters in pseudoexfoliation glaucoma

Purpose To investigate orbital flow parameters of ophthalmic artery (OA) in patients with pseudoexfoliation glaucoma (XFG) by ultrasonography. Methods This case-control study included 38 patients with XFG and 32 healthy control subjects. Color Doppler imaging was performed to evaluate orbital flow parameters of OA. Receiver operating characteristic analyses were performed to define the best cutoff value. Results In the XFG group, decreased peak systolic velocity (p = 0.114), end diastolic velocity (p = 0.002), and increased resistivity index (RI) (p<0.001) at OA compared to healthy controls were observed. A cutoff value 0.72 for OA RI was found to have a sensitivity of 66% and specificity of 94%. Conclusions The results support the findings of increased vascular resistance in OA XFG. High sensitivity and specificity obtained for OA RI may be useful in evaluation of future therapeutic vascular agents.

The effects of topical everolimus and sunitinib on corneal neovascularization

Abstract Purpose: To evaluate the effects of topical everolimus and sunitinib on corneal neovascularization (CNV). Methods: CNV was induced by application of silver nitrate to the cornea for all groups. Rats were divided into four groups of 10 rats each, and two corneas were obtained from each rat. Group I received 1 mg/ml everolimus, Group II received 0.5 mg/ml sunitinib, Group IV received no treatment (control group) and Group IV received 1% Dimethylsulfoxide (DMSO). All treatments were administrated twice daily for 2 weeks. The right corneas were used for extracellular signal-regulated kinase 1/2 (ERK 1/2) protein analysis by western blot analysis and the left corneas were used for ERK 1/2 and vascular endothelial growth factor-receptor (VEGFR-2) gene expression analysis by quantitative real-time PCR. Results: VEGFR-2 mRNA expression levels (ΔCt, median, min-max) were reduced in the everolimus 1.0 (0.25–1.81) and sunitinib 1.06 (0.24–2.68) treated groups compared with the control 4.74 (1.02–14.74) and DMSO groups 7.41 (0.72–13.10). The expression of ERK 1/2 protein and mRNA levels were reduced in everolimus group compared with the control group (p < 0.05). These differences were not seen between the sunitinib and control groups. Conclusıon: Topical administration of both everolimus and sunitinib reduced VEGFR-2 levels and inhibited CNV. In additon, everolimus reduced ERK 1/2 levels and seems to be more effective than sunitinib on CNV.

The temperament and character personality profile of the glaucoma patient

BackgroundTo determine the temperament and character profile of glaucoma patients.MethodsA total of 234 patients (104 with primary open angle glaucoma, and 130 control subjects without any ocular disease) were selected for this prospective, cross-sectional study. All the participants underwent a comprehensive ophthalmological examination, including the best corrected visual acuity, intraocular pressure measurement, gonioscopy, and visual field analysis. All the participants were given the Turkish version of the Temperament and Character Inventory (TCI). The TCI is a self-reported evaluate, with 240 true/false items measuring four domains of temperament; harm avoidance (HA), persistence (PS), novelty seeking (NS), reward dependence (RD), and three domains of character; self-transcendence (ST), cooperativeness (C), self-directedness (SD).ResultsThe glaucoma patients achieved the higher scores than the controls for the HA and SD dimensions (p < 0.001 and p = 0.033). The glaucoma patients scored lower than the controls for the NS, P and ST dimensions (p < 0.001, p < 0.001 and p = 0.002). There were no differences in the RD and C scores between the patients and the controls (p = 0.944 and p = 0.343). There was no correlation between the duration of illness and the TCI dimensions. Disease severity was positively associated with HA (r = 0,220, p = 0,025) and the anticipatory worry (r = 0.227, p = 0.021) dimension.ConclusionsGlaucoma patients had a different personality profile to healthy individuals. This may affect treatment compliance and is also important when coping with maladaptive patient attitudes.

The Comparison of Four Different Methods of Perioperative Eye Protection under General Anesthesia in Prone Position

DOI: 10.4328/JCAM.607 Received: 08.02.2011 Accepted: 19.02.2011 Printed: 01.04.2012 J Clin Anal Med 2012;3(2): 163-5 Corresponding Author: Tolga Kocatürk, Department of Ophthalmology, Bartın State Hospital, 74100, Aydın, Turkey GSM: +905333444111 E-Mail: tolgakocaturk@yahoo.com Özet Amaç: Bu çalışmanın amacı hipoalerjen yapışkan bant, antibiyotik merhem, suni göz yaşı jeli ve oküler nemlendirici pomadın yüzüstü pozisyonda genel anestezi altında peroperatif göz korumasındaki etkinliğinin karşılaştırılması ve değerlendirilmesidir. Gereç ve Yöntem: Genel anestezi altında en az >90 dakika sürmüş olan spinal cerrahi geçiren 184 hasta (368 göz) rastgele olarak dört gruba ayrıldı. Gözlere hipoalerjen yapışkan bant, antibiyotik merhem, suni gözyaşı jeli veya oküler nemlendirici pomad uygulandı. Hastalara, ameliyattan önce ve sonra, düzeltilmiş görme keskinliği ölçümü, bazal gözyaşı üretimi, korneal ve konjunktival boyanma testlerini içeren detaylı göz muayenesi uygulandı. Bulgular: Bazal gözyaşı üretimi tüm gruplarda preoperatif değerlere göre azaldı (P<0.001 ). Derlenme odasında, korneal epitelyal defekt insidansı grup 1’de %2.72, grup 2’de %2.72, grup 3’de %5.16, grup 4’de %2.17 olmak üzere tüm gruplarda toplam %12.77 olarak bulundu. Göz kapaklarındaki yapışıklık yönünden gruplar arasında anlamlı fark yoktu (p>0.05). Preoperatif ve postoperatif görme keskinlikleri arasında anlamlı fark yoktu. Sonuç: Korneal hasarlardan korunmada tüm yöntemler uygundur. Ancak postoperatif dönemdeki geçici semptomların önlenmesinde hiçbiri tek başına yeterince iyi değildir. Genel anestezi sırasında korneal hasar insidansını azaltmak için gözlerin bant, gel, merhem veya pomad ile korunması gerekir.

Foveal Avascular Zone in Normal Tension Glaucoma Measured by Optical Coherence Tomography Angiography

Aim To measure diameter of foveal avascular zone (FAZ), FAZ area, and vessel density using Optical Coherence Tomography Angiography (OCT-A) in patients with normal tension glaucoma (NTG) and to establish the possible role of OCT-A in diagnosis and follow-up of patients with NTG. Methods Twenty-one eyes of 21 patients with NTG and 30 eyes of 30 healthy subjects underwent complete ophthalmic examination as well as OCT-A on ZEISS AngioPlex. 3 × 3 macula scans were used to measure vertical, horizontal, and maximum diameter of FAZ by two graders. Mean values and interobserver variability were analyzed. Image J was used for analysis of FAZ area and vessel density. Results Mean vertical diameter (t = 5.58, p < 0.001), horizontal diameter (t = 3.59, p < 0.001), maximum diameter (t = 5.94, p < 0.001), and FAZ area (t = 5.76, p < 0.001) were statistically significantly enlarged in the NTG group compared to those in the control group. Vessel density (t = −5.80, p < 0.001) was statistically significantly decreased in the NTG group compared to that in the control group. Conclusion OCT-A could have an important role in the future in diagnosis of patients with NTG. In patients with NTG, there is larger FAZ area, while the vessel density is reduced in comparison to the control group.

Diurnal blood pressure parameters in normal tension glaucoma, primary open angle glaucoma, and healthy subjects

Objective: The pathophysiology of glaucoma is still undisclosed. Cardiovascular hemodynamic changes are hypothesized to contribute to glaucoma. This study aimed to determine the differences in the diurnal blood pressure (BP) of patients with normal tension glaucoma (NTG), primary open angle glaucoma (POAG), and controls without glaucoma. Methods: A total of 129 patients were included in this study. The day–night average systolic and diastolic BPs, the day–night average pulse pressures (PPs), the day–night average heart rates, and the percentage of BP decline at night were obtained from the Holter devices and compared. Study design: Prospective, randomized, case-control study. Results: This study included 43 NTG patients (Group 1), 44 POAG patients (Group 2), and 42 healthy subjects without glaucoma (Group 3). The age (p=0.138) and sex (p=0.216) distributions between the groups were similar. The average day–night PP values of Group 1 were 49.17±9.90 and 46.07±10.84 mm Hg, respectively, while their total average PP was 48.48±9.60, their total average systolic BP was 120.02±12.65, and their night average systolic BP was 111.93±15.87 mm Hg. In Group 2, the average day and night PP values were 54.83±10.35 and 51.73±9.10 mm Hg, respectively, their total average PP was 54.00±9.87, their total average systolic BP was 126.75±11.50, and their night average systolic BP was 119.21±12.38 mm Hg. These differences were statistically significant and the corresponding p values were 0.040, 0.040, 0.037, 0.033, and 0.038. Conclusion: NTG patients have low diurnal BP parameters, which may reduce their optic nerve perfusion and may be responsible for their glaucomatous visual field damage.

The effect of methimazole-induced postnatal hypothyroidism on the retinal maturation and on the Sirtuin 2 level

Abstract Purpose: To investigate the effect of methimazole-induced postnatal hypothyroidism on the retinal maturation and to study Sirtuin 2 (SIRT2) level in the hypothyroidic rat retina. Methods: Twenty newborn Wistar albino rat pups were used in this prospective, randomized study. Wistar albino rats, weight 250–300 g, were impregnated (without addition of any drug) and were fed normally. Rat pups were randomly divided into two groups and were fed with breast milk. After weaning till they were 90 days of age, rat pups received the same water as their lactating mothers drank. Group 1 (methimazole (MMI)-induced hypothyroidy group), rats were given MMI-water, whereas, in Group 2, normal tap water. When the pups were 90 days of age, 20 rat pups were decapitated and the eyes were isolated. Eyes were investigated using histological, histomorphometric and immunohistochemistrical techniques. Results: No histological difference was seen between the groups stained with hematoxylin and eosin. In both groups the retinal layer structures and cells were observed as normal. The examples in the groups had a normal distribution for retinal thickness (pixel) measure. The mean value (mean ± std. deviation) was 554.7 ± 228.4 in the control group and 494.7 ± 129.4 in the hypothyroidy group. There was no significance between the groups in terms of retinal thickness (p = 0.231). However, immunohistochemistry revealed that SIRT2 was weaker stained in the ganglion cell layer and visual cell layer in the hypothyroidy group compared to the control group. Conclusion: Postnatal hypothyroidism altered the retinal cytoarchitecture and layering which are regulated by thyroid hormones (THs) during retinal maturation in the postnatal period. THs may act by the induction of the SIRT family proteins or through their receptors. Postnatal screenings for THs levels are very important to provide normal retinal development.

Long Term Results of Visual Field Progression Analysis in Open Angle Glaucoma Patients Under Treatment

Purpose : To evaluate visual field progression with trend and event analysis in open angle glaucoma patients under treatment. Materials and Methods : Fifteen year follow-up results of 408 eyes of 217 glaucoma patients who were followed at Adnan Menderes University, Department of Ophthalmology between 1998 and 2013 were analyzed retrospectively. Visual field data were collected for Mean Deviation (MD), Visual Field Index (VFI), and event occurrence. Results : There were 146 primary open-angle glaucoma (POAG), 123 pseudoexfoliative glaucoma (XFG) and 139 normal tension glaucoma (NTG) eyes. MD showed significant change in all diagnostic groups (p<0.001). The difference of VFI between first and last examinations were significantly different in POAG (p<0.001), and XFG (p<0.003) but not in NTG. VFI progression rates were -0.3, -0.43, and -0.2 % loss/year in treated POAG, XFG, and NTG, respectively. The number of empty triangles were statistically different between POAG-NTG (p=0.001), and XFG-NTG (p=0.002) groups. The number of half-filled (p=0.002), and full-filled (p=0.010) triangles were significantly different between XFG-NTG groups. Conclusion : Functional long-term follow-up of glaucoma patients can be monitored with visual field indices. We herein report our fifteen year follow-up results in open angle glaucoma.