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Management of ocular complications of Vogt-Koyanagi-Harada syndrome

Perente, I. | Utine, C.A. | Cakir, H. | Kaya, V. | Tutkun, I.T. | Yilmaz, O.F.

Article | 2009 | International Ophthalmology29 ( 1 ) , pp.33 - 37

Background: Vogt-Koyanagi-Harada syndrome (VKH) is a multisystem disorder, characterized by the T-cell-mediated autoimmune process directed against melanocytic antigens in the ocular, nervous, auditory and integumentary systems. The ocular hallmarks of the disease involve severe bilateral panuveitis associated with exudative retinal detachment. Case report: We report a pediatric case of probable VKH Syndrome with isolated ocular findings, in which bilateral vitritis, papillitis and serous retinal detachments involving the macula with intra-retinal edema and choroideal thickening were detected. Intervention: Subtenon triamcinolone ac . . .etonide injection was performed in addition to systemic corticosteroid and cyclosporine treatments. Evolution: Prompt improvement was seen in the ocular manifestations of VKH syndrome, which persisted for at least 4 months. Subtenon corticosteroid injection, together with systemic corticosteroid and cytotoxic treatment, prevented the ocular complications of invasive intraocular treatment modalities, and at the same time reduced the systemic corticosteroid dosage. Conclusion: We recommend use of ocular invasive treatment modalities in Vogt-Koyanagi-Harada Syndrome only if the disease progression cannot be controlled. If systemic medications fail to stop the progression of the disease activity, subtenon injections may be considered before intraocular treatment modalities. © Springer Science+Business Media B.V. 2007 Daha fazlası Daha az

Efficacy of corneal collagen cross-linking using a custom epithelial debridement technique in thin corneas: A confocal microscopy study

Kaya, V. | Utine, C.A. | Yilmaz, O.F.

Article | 2011 | Journal of Refractive Surgery27 ( 6 ) , pp.444 - 450

PURPOSE: To examine the corneal collagen cross-linking (CXL) effect with a customized epithelial debridement technique in thin corneas using anterior segment optical coherence tomography (OCT) and confocal microscopy. METHODS: Two patients with keratoconus who underwent a customized epithelial debridement technique (preserving the epithelium in thinner corneal regions where the deepithelialized corneal thickness was

Evaluation of ocular surface disease in patients with glaucoma

Mathews, P.M. | Ramulu, P.Y. | Friedman, D.S. | Utine, C.A. | Akpek, E.K.

Article | 2013 | Ophthalmology120 ( 11 ) , pp.2241 - 2248

Purpose: To evaluate the subjective and objective measures of ocular surface disease in patients with glaucoma. Design: Cross-sectional study. Participants: Sixty-four glaucoma subjects with bilateral visual field (VF) loss and 59 glaucoma suspects with normal VFs. Methods: Consecutive patients were recruited prospectively from the Wilmer Eye Institute Glaucoma Clinic. Main Outcome Measures: Tear film breakup time (TBUT), corneal staining score (0-15), and Schirmer's test results were included as objective metrics, whereas the Ocular Surface Disease Index (OSDI) questionnaire was administered to assess symptoms. Total OSDI score, vi . . .sion-related subscore (derived from questions about vision and task performance), and discomfort-related subscore (derived from questions about ocular surface discomfort) were calculated for each subject. Results: Seventy-five percent (48/64) of glaucoma subjects and 41% (24/59) of glaucoma suspects were receiving topical medications. The corneal staining grade was greater in glaucoma subjects than in glaucoma suspects (6.4 vs. 4.1; P0.20 for both). Glaucoma subjects had significantly higher total OSDI scores than glaucoma suspects (16.7 vs. 7.9; Daha fazlası Daha az

The ocular effects of pepper spray

Utine, C.A. | Durak, I.

Review | 2012 | Turk Oftalmoloiji Dergisi42 ( 4 ) , pp.294 - 297

Recently, pepper spray has been used by both civilians, as a non-lethal personal defense spray, and law enforcement agencies in population movements. People exposed to pepper spray experience panic and disorientation due to acute severe pain, blepharospasm, tearing and sometimes blurred vision and even temporary blindness. Having knowledge about the properties and mechanism of action of pepper spray and the different aspects of this exposure from other ocular chemical injuries is important for timely and correct interventions and appropriate management of the condition by the ophthalmologists in emergency care.

Crescenteric amniotic membrane grafting in keratoprosthesis-associated corneal melt

Tay, E. | Utine, C.A. | Akpek, E.K.

Article | 2010 | Archives of Ophthalmology128 ( 6 ) , pp.779 - 782

We herein present a surgical technique for the management of corneal melt following Boston type I keratoprosthesis implantation. The technique was performed using new-generation dehydrated human amniotic membrane. The membrane was fashioned in the shape of 2 crescentic patches using disposable corneal trephines. A double layer of grafts was then sutured into the host bed with interrupted 10-0 nylon sutures. Rapid healing with corneal epithelization and vascularization was noted within days. The main advantage of the amniotic membrane that we used is that it is thicker than the older generation (110 vs 40 ?m) and suitable for tectoni . . .c purposes. It is also readily available with a long shelf life and does not require a lamellar dissection unlike a donor corneal patch. This surgical technique may potentially serve as another tool in a cornea surgeon's armamentarium. ©2010 American Medical Association. All rights reserved Daha fazlası Daha az

Intraoperative use of AS-OCT during intrastromal corneal ring segment implantation.

Kucumen, R.B. | Gorgun, E. | Yenerel, N.M. | Utine, C.A.

Article | 2012 | Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye43 ( 6 Suppl ) , pp.779 - 782

To evaluate femtosecond laser-created tunnels intraoperatively by anterior segment optical coherence tomography (AS-OCT) during intrastromal corneal ring segment implantation. The study prospectively examined 13 eyes of 11 patients who underwent intrastromal corneal ring segment surgery with the aid of femtosecond laser. All eyes had keratoconus as the primary diagnosis. Eyes were examined by AS-OCT to image the tunnel immediately after femtosecond laser and before ring segment implantation. Tunnel depth was calculated automatically using the software's flap tool and calipers. The presence of air bubbles demonstrated the tunnel succ . . .essfully by AS-OCT. Tunnel depth was measured at eight locations in four cross-sections of high-resolution cornea images. An overall evaluation was also made by changing the scan direction 360°. After confirmation that a uniform tunnel was satisfactorily created at the aimed depth, surgery proceeded with segment implantation. AS-OCT can be used intraoperatively to assess femtosecond laser-created tunnel in intrastromal corneal ring segment implantation. The qualitative and quantitative evaluation of the intrastromal tunnel by AS-OCT before implantation of the ring segments is a practical intraoperative approach that may offer a safer surgery. Copyright 2012, SLACK Incorporated Daha fazlası Daha az

Clinical features and prognosis of boston type I keratoprosthesis- associated corneal melt

Utine, C.A. | Tzu, J.H. | Akpek, E.K.

Article | 2011 | Ocular Immunology and Inflammation19 ( 6 ) , pp.413 - 418

Purpose: To describe the clinical features and outcomes of corneal melt associated with Boston type I keratoprosthesis (KPro) implantation. Methods: Medical records of patients who experienced corneal melt following KPro implantation were reviewed retrospectively. Results: Sixty-six adult patients had KPro implantation from January 2004 to November 2010. Six patients had an underlying inflammatory ocular surface disorder. Four experienced corneal melt (6.1%) 542 months after the initial surgery. One patient was diagnosed with Sjögren's syndrome as a result of diagnostic workup following melt. Three patients were treated with systemi . . .c immunomodulatory therapy; two experienced fungal keratitis and subsequent endophthalmitis. KPro had to be explanted and replaced with donor cornea in all cases. Conclusions: KPro-associated corneal melt is uncommon and appears to occur in patients with preexisting inflammatory disorders, which might not have been previously diagnosed. Timely explantation of KPro and replacement with donor cornea may prevent a poor outcome. © 2011 Informa Healthcare USA, Inc Daha fazlası Daha az

Tear osmolarity measurements in dry eye related to primary Sjögren's syndrome

Utine, C.A. | Biçakçigil, M. | Yavuz, S. | Çiftçi, F.

Article | 2011 | Current Eye Research36 ( 8 ) , pp.683 - 690

Background: To evaluate the tear osmolarity in patients with dry eye syndrome related to primary Sjögren's Syndrome (SS). Materials and Methods: Twenty eyes of 10 patients with dry eye and primary SS (Group 1) and 20 eyes of 20 subjects who do not have dry eye syndrome (Group 2) were included in this cross-sectional study. In all eyes, ophthalmic examination was performed in the same order: International Ocular Surface Disease Index survey, visual acuity assessment, conjunctival hyperemia scoring, tear osmolarity measurement with TearLab™ Osmolarity System, tear film break-up time assessment, corneal fluorescein staining scoring, oc . . .ular surface Lissamine Green staining scoring, anesthetized Schirmer test. Dry eye severity was graded according to Dry Eye Workshop (DEWS) classification system. Results: Four eyes with grade 1, four eyes with grade 2, seven eyes with grade 3, and five eyes with grade 4 dryness, according to DEWS system, were included. The mean tear osmolarity value was 301.9 ± 11.40 mOsm/L (range: 290328) in Group 1, and 294.85 ± 8.33 mOsm/L (range: 283311) in Group 2 (p = 0.03). In Group 1, tear osmolarity values were positively correlated with OSDI scores (r(18) = 0.55, r2 = 0.31, p = 0.01), DEWS classification grades (r(18) = 0.73, r2 = 0.54, p < 0.01), temporal and total corneal staining scores (r(18) = 0.67, r2 = 0.44, p < 0.01, and r(18) = 0.51, r2 = 0.26, p = 0.02, respectively), temporal conjunctival staining scores (r(18) = 58, r 2 = 0.34, p < 0.01); and negatively correlated with anesthetized Schirmer test results (r(18) = -0.62, r2 = 0.38, p < 0.01) and TFBUT (r(18) = -0.50, r2 = 0.25, p = 0.02). Conclusions: Tear osmolarity values were found to be greater in patients with dry eye syndrome related to primary SS compared to control subjects, and positively correlated with the severity of dry eye. © 2011 Informa Healthcare USA, Inc Daha fazlası Daha az

Evaluation of macular changes after uncomplicated phacoemulsification surgery by optical coherence tomography

Perente, I. | Utine, C.A. | Ozturker, C. | Cakir, M. | Kaya, V. | Eren, H. | Yilmaz, O.F.

Article | 2007 | Current Eye Research32 ( 3 ) , pp.241 - 247

Purpose: To evaluate the effect of uncomplicated phacoemulsification surgery on macula by optical coherence tomography (OCT). Methods: A total of 110 eyes of 102 patients who underwent uncomplicated phacoemulsification and foldable intraocular lens implantation at Beyoglu Eye Research and Training Hospital between February and March 2005 and who were without any systemic disease, fundus or other ocular pathology were included. Postoperatively, topical prednisolone acetate (6 x 1) and ofloxacine (5 x 1) was started, and by decreasing the dosage progressively, treatment was continued for 6 weeks. Full ophthalmologic and OCT examinatio . . .ns were done preoperatively and at the postoperative 1st day, 1st week, 1st, 3rd, and 6th months. Mean retinal thicknesses, volumetric analyses at central fovea, superior, inferior, temporal, and nasal macular quadrants, and thinnest foveal retinal thicknesses were recorded. Preoperative and postoperative measurements were analyzed statistically by using ANOVA test, paired samples t-test with Bonferroni correction, and Pearson's correlation test. Results: The mean central foveal retinal thickness was preoperatively 202.4 ± 25.9 µm, postoperatively 200.4 ± 26.1 µm at 1st day (p = 0.29), 208.4 ± 27.6 µm at 1st week (p = 0.29), 226.2 ± 54.9 µm at 1st month, 215.2 ± 24.0 µm at 3rd month, 213.5 ± 29.4 µm at 6th month (p < 0.001). Perifoveal macular thicknesses at superior, inferior, temporal, and nasal quadrants were 264.9 ± 28.8 µm, 266.1 ± 29.5 µm, 255.0 ± 31.3 µm, 260.3 ± 34.0 µm, respectively, preoperatively; 287.9 ± 28.4 µm, 288.0 ± 26.3 µm, 286.8 ± 33.1 µm, 272.0 ± 32.4 µm, respectively, at postoperative 1st month (p < 0.001). The change in mean central foveal thickness, foveal thinnest retinal thickness, mean perifoveal retinal thickness and volumetric analyses was insignificant at postoperative 1st day (p > 0.05), and significant at 1st week, 1st, 3rd, and 6th months (p < 0.05 for all measurements). Conclusions: Statistically significant increase in macular thickness was detected at postoperative early periods, after the 1st week after uncomplicated cataract operation. The increase in macular thickness starts from parafoveal regions. Longer follow-up of patients is required for the macular consequences, and different treatment protocols should be studied in a randomized controlled fashion. Copyright © Informa Healthcare Daha fazlası Daha az

Boston type 1 keratoprosthesis implantation in traumatic stem cell deficiency and keratoplasty rejection

Utine, C.A. | Tatlipinar, S. | Altunsoy, M. | Kaya, V. | Akpek, E.K. | Çiftçi, F.

Review | 2012 | Turk Oftalmoloiji Dergisi42 ( 1 ) , pp.66 - 71

A 31-year-old male patient was admitted with the complaint of decreased vision in both eyes. He underwent multiple pars plana vitrectomy and silicone oil injection operations due to bilateral retina detachment after rocket projectile explosion in his hands at the age of 15. The right eye was pre-phthisical after choroidal hemorrhage that occurred during combined silicone oil extraction and penetrating keratoplasty. The aphakic and vitrectomized left eye had corneal conjunctivalisation of seven dials, deep and superficial stromal neovascularization and history of immunological graft rejection. As the estimated success rate for repeat . . . penetrating keratoplasty was low, Boston type 1 keratoprosthesis surgery was performed. Postoperatively, visual acuity was 0.2 Snellen lines. Macular scar and optic nerve atrophy limited further visual gain. In this study, we aimed to review the current literature about Boston type keratoprosthesis surgery, which should be evaluated as an alternative when conventional penetrating keratoplasty success is deemed to be low Daha fazlası Daha az

Permanent keratoprosthesis combined with pars plana vitrectomy and silicone oil injection for visual rehabilitation of chronic hypotony and corneal opacity

Utine, C.A. | Gehlbach, P.L. | Zimmer-Galler, I. | Akpek, E.K.

Article | 2010 | Cornea29 ( 12 ) , pp.1401 - 1405


Update and critical appraisal of the use of topical azithromycin ophthalmic 1% (AzaSite®) solution in the treatment of ocular infections

Utine, C.A.

Review | 2011 | Clinical Ophthalmology5 ( 1 ) , pp.801 - 809

Azithromycin is an azalide that acts by binding to the 50S ribosomal subunit of susceptible microorganisms and interfering with microbial protein synthesis. Azithromycin is also noted by anti-inflammatory and immunomodulatory activity. AzaSite® (Inspire Pharmaceuticals, Inc, Durham, NC) is azithromycin ophthalmic solution, 1% formulated in polycarbophil (the aqueous mucoadhesive polymer contained in DuraSite®) that delivers high and prolonged azithromycin concentrations in a variety of ocular tissues, including the conjunctiva, cornea and particularly the eyelid. AzaSite was approved by the Food and Drug Administration (FDA) in the . . .US in 2007, for the treatment of bacterial conjunctivitis caused by susceptible isolates. This article aims to evaluate the peer-reviewed published scientific literature and to define wellestablished uses of AzaSite eye drops in the field of ocular infections. © 2011 Utine, publisher and licensee Dove Medical Press Ltd Daha fazlası Daha az

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