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Öğe Autonomic nervous system involvement in Behcet's disease -: A pupillometric study(Lippincott Williams & Wilkins, 1998) Bayramlar, H; Hepsen, IF; Uguralp, M; Bölük, A; Özcan, CThe aim of this study was to elucidate whether autonomic nervous system dysfunction exists in patients with Behcet's disease by pupillometric tests. Thirty-one patients with Behcet's disease with a mean age of 41.3 years (range 21-64) and 41 control subjects with a mean age of 39.5 years (range 18-66) were selected for the study. To test the autonomic nervous system, four pupillometric techniques were used: pupil cycle time (PCT), dark-adapted pupil size (DAPS), 0.05% pilocarpine drop test, and 1% phenylephrine drop test. In all four tests, there were significant differences between the patients and controls. Mean PCTs were 1,156 ms (range 856-1,560 ms) and 919 ms (range 650-1,261 ms) in the patients and controls, respectively (p < 0.0001). The mean DAPS was 0.45 (range 0.31-0.66) in the patients, whereas it was 0.56 (range 0.42-0.67) in controls (p < 0.001). Iris sensitivity to both 0.05% pilocarpine and 1% phenylephrine showed significant differences between patients and controls, respectively (p < 0.05, p < 0.05). Among all four tests, only 0.05% pilocarpine sensitivity was correlated with the duration of Behcet's disease (p < 0.05). The results suggest that the autonomic nervous system innervating the iris is affected in Behcet's disease. This involvement may be due to the vasculitic nature of Behcet's disease.Öğe Bilateral cataract surgery in adult and pediatric patients in a single session(Elsevier Science Inc, 2000) Totan, Y; Bayramlar, H; Çekiç, O; Aydin, E; Erten, A; Daglioglu, MCPurpose: To evaluate the results of bilateral simultaneous cataract surgery in adult and pediatric patients under local or general anesthesia. Setting: Department of Ophthalmology, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey. Methods: Eighty-two eyes of 41 patients were included in the study. Twelve of 17 pediatric patients with congenital cataract had bilateral simultaneous lensectomy, posterior capsulotomy, and anterior vitrectomy; 5 patients, aged 10 to 19 years, had bilateral extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PC IOL) implantation. Forty-eight eyes of 24 adult patients had bilateral simultaneous ECCE with primary (43 eyes) or secondary (5 eyes) PC IOL implantation. Local anesthesia was administered to 20 adult patients by retrobulbar injection; the other cases were performed using general anesthesia. The procedures were treated as 2 separate surgeries in the same session; care was taken to ensure surgical asepsis. Results: No serious intraoperative complications occurred such as posterior capsule rupture, vitreous loss, endophthalmitis, and anesthesia-related problems. Of patients tested, 84.4% achieved a final best corrected visual acuity of 6/12 or better and 31.0%, of 6/6 or better. Conclusions: Simultaneous bilateral cataract surgery was not associated with an increased rate of complications, and visual results were good. If strict rules of surgical asepsis are followed, this may be a useful option in a variety of bilateral cases using general or local anesthesia. J Cataracr Refract Surg 2000; 26:1008-1011 (C) 2000 ASCRS and ESCRS.Öğe Caffeic acid phenethyl ester to inhibit posterior capsule opacification in rabbits(Elsevier Science Inc, 1997) Hepsen, IF; Bayramlar, H; Gultek, A; Ozen, S; Tilgen, F; Evereklioglu, CPurpose: To assess whether caffeic acid phenethyl ester (CAPE) prevents posterior capsule opacification (PCO) by suppressing the transformation of the lens epithelial cells. Setting: Departments of Ophthalmology, Chemistry, and Pathology, Turgut Ozal Medical Center, University of Inonu, Malatya, Turkey. Methods: Twenty pigmented island rabbits having phacoemulsification in their right eyes were randomized into two groups. In Group 1, 10 mu g/ml of CAPE was added to the anterior chamber irrigating solution and a 1% solution of CAPE was injected subconjunctivally for 3 weeks postoperatively. The irrigating solution in Group 2 (control) did not include CAPE. The development of PCO was assessed weekly and its density was graded by slitlamp biomicroscopy. Histologic analysis was performed 3 months after surgery. Results: Group I had clear capsules or minor PCO. Group 2 developed more severe PCO or complete opacification. The difference between the two groups was statistically significant (P = .04). Conclusion: These preliminary results indicate that CAPE is effective in suppressing PCO in pigmented rabbits and may be beneficial in clinical use in humans because it has no documented harmful effects on normal cells.Öğe Comparison of the results of primary and secondary implantation of flexible open-loop anterior chamber intraocular lens(Royal Coll Ophthalmologists, 1998) Bayramlar, H; Hepsen, IF; Cekic, O; Gunduz, APurpose To assess and compare the results of primary and secondary implantation of flexible open-loop anterior chamber intraocular lenses (AC-IOLs). Methods A series of 57 eyes of 56 patients with flexible AC-IOLs were reviewed in two groups. In group I (n = 35) an AC-IOL was implanted primarily, because of posterior capsule problems during extracapsular cataract extraction (ECCE), and in group II (n = 22) secondarily after intracapsular cataract extraction (ICCE). Follow-up was from 12 to 38 months. Results Mean post-operative best-corrected visual acuity in group I was significantly lower (20/37.38) than that of group II (20/29.20) (p = 0.044). Best: corrected visual acuity of 20/40 or better was achieved in 19 of 29 eyes (65%) in group I, and in 16 of 21 eyes (76%) in group II. The difference was not statistically significant (p > 0.05). In group II 18 eyes (86%) maintained or improved visual acuity. In group I, 17 eyes (49%) had a total of 22 complications, while 7 eyes (32%) had 9 complications in group IP (p > 0.05). Conclusions Flexible open-loop AC-IOLs are suitable for both primary and secondary implantation to correct aphakia. Secondary implantation of flexible open-loop AC-IOLs after ICCE seems to have a more favourable visual outcome and a lower complication rate than primary implantation in complicated ECCE cases.Öğe Dislocation of a scleral-fixated posterior chamber intraocular lens into the anterior chamber associated with pseudophakic bullous keratopathy(Slack Inc, 2004) Aydin, E; Bayramlar, H; Totan, Y; Daglioglu, MC; Borazan, MA 48-year-old patient with a scleral-fixated posterior chamber intraocular lens had dislocation of the intraocular lens into the anterior chamber and associated pseudophakic buttons keratopathy. The patient underwent intraocular lens extraction and partial penetrating keratoplasty. Because an anterior chamber intraocular lens is easier to implant and has fewer complications, surgeons may want to consider this as the first choice for treatment. If the scleral-fixated posterior chamber intraocular lens is used, it must be implanted property and meticulously to avoid complications.Öğe Dissociated vertical deviation associated with Duane's syndrome(Slack Inc, 2003) Bayramlar, H; Borazan, M[Abstract Not Available]Öğe Does convergence, not accommodation, cause axial-length elongation at near?: A biometric study in teens(Karger, 1999) Bayramlar, H; Çekiç, O; Hepsen, IFTo determine whether convergence rather than accommodation has a primary effect on the changes in axial length and other biometric components during near fixation, we measured the anterior chamber depth, lens thickness, vitreous length and axial length in the right eyes of 124 young male subjects while their left eyes focused at distance (6 m) and near (20 cm). The measurements were performed before and after cycloplegia in the right eye, so we aimed to study biometric components of the eye in the states of ac-commodation and nonaccommodation, but converging at near. While the left eye focused at near, the axial length increased significantly with and without cycloplegia (p < 0.0005 and p < 0.0005). The vitreous length was the main increasing ocular biometric component at near both with and without cycloplegia (p < 0.044 and p = 0.001, respectively). At near, there was no difference between two mean axial length and two vitreous length measurements both with and without cycloplegia (p = 0.672 and p = 0.595, respectively), Under cycloplegia, anterior chamber depth also increased significantly at near fixation (p = 0.012). Axial elongation at near fixation, mainly due to an increase in vitreous length, may result from the effect of accommodative convergence rather than accommodation itself. Much use of convergence, not accommodation, may be one of the contributing factors in adult onset and adult progression of myopia.Öğe The effect of reading and near-work on the development of myopia in emmetropic boys: a prospective, controlled, three-year follow-up study(Pergamon-Elsevier Science Ltd, 2001) Hepsen, IF; Evereklioglu, C; Bayramlar, HThis study aimed to investigate the effect of reading and near work on myopic development in emmetropic boys in school age. It involved totally 114 children in two groups. Right eyes of 67 randomly selected students (mean age = 12.93) with mean 6 h of reading and near work (Group 1) were compared with the right eyes of 47 apprentices (mean age = 12.96) working as skilled laborers (Group 2). Cycloplegic refraction, keratometric readings and biometric measurements including anterior chamber depth (ACD), lens thickness (LT), vitreous chamber depth (VCD) and axial length (AL) were performed for 3 years at 18 month intervals. Two analyses were conducted: (1) for subjects in both groups with baseline refractive error from + 0.50 to - 0.50 D: (2) for all subjects in both groups with baseline refractive error from + 1.00 to - 1.00 D. For subjects with baseline refractive error of + 0.50 D, myopic shift was present in 20 of 41 (48.8%) in group I and in seven of 37 (18.9%) in group 2 at the end of the study. The magnitude of the myopic shift was 0.56 and 0.07 D in group I and I respectively. For subjects with a baseline refractive error of +/- 1.00 D. myopic progression was present in 40 of 67 (59.7%) in group I and in 10 of 47 (21.3%) in group 2 at the last readings. In this larger refractive range, the magnitude of the myopic shift was 0.61 and 0.12 D in group I and 2. respectively. The mean ACID, VCD and AL were significantly higher in the last readings after 36 months than in the first readings (for each, P = 0.0001) in group 1. There was no statistically significant difference between two measurements of these parameters in group 2. The final keratometric dioptric readings were lower than the first values (for each, P = 0.0001) in both groups at the end of the study. This prospective and controlled study suggested that reading and near work., important environmental factors, might cause refractive myopic shifts in emmetropic students. The myopic shift was primarily related to significant increases in ACID, VCD and AL in this young age group. (C) 2001 Elsevier Science Ltd. All rights reserved.Öğe Evaluation of hemodynamic changes in the ophthalmic artery with color Doppler ultrasonography after strabismus surgery(Slack Inc, 2000) Bayramlar, H; Totan, Y; Çekiç, O; Yazicioglu, KM; Aydin, EPurpose: To investigate the blood flow changes in ophthalmic artery with color Doppler ultrasonography after strabismus surgery. Methods: Twenty eyes of 19 patients who underwent recession or resection surgery on two horizontal rectus muscles in 1 eye were examined using color Doppler ultrasonography preoperatively and 1 week and 1 month postoperatively. Measurements from both eyes of 16 age- and sex-matched normal subjects served as control data. The systolic maximum velocity, mean velocity, end-diastolic velocity, pulsatility index, and resistance index of the ophthalmic artery were determined. The Mann-Whitney U test was performed for comparison of the control and study group preoperatively for any hemodynamic parameter. Statistical comparison of the preoperative and postoperative measures in the study group was performed with Friedman's two-way analysis of variance. Results: No difference (P>.05) was observed preoperatively between the study and control groups for any hemodynamic parameter in the ophthalmic artery. Although the ophthalmic artery showed a slight increase in systolic maximum velocity 1 month postoperatively, there were no statistically significant differences (P>.05) in velocities or resistance in the ophthalmic artery at any interval. Conclusion: Two horizontal rectus muscle operations in a previously unoperated eye do not cause significant hemodynamic changes in the ophthalmic artery. However, further studies are needed to obtain more information about the effect of multiple vertical rectus muscle operations on the blood flow parameters of the ophthalmic artery.Öğe Heparin in the intraocular irrigating solution in pediatric cataract surgery(Elsevier Science Inc, 2004) Bayramlar, H; Totan, Y; Borazan, M\Purpose: To investigate the antiinflammatory effects of adding heparin sodium to the irrigating solution to prevent fibrinoid reaction and related long-term complications after pediatric cataract surgery. Setting: Department of Ophthalmology, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey. Methods: Thirty eyes of 18 children who had cataract or other ocular surgery were included in the study. Bilateral cataract surgery was performed in 20 eyes of 10 children and bilateral secondary intraocular lens (IOL) implantation in 4 eyes of 2 children (Group 1). Four eyes of 4 children had unilateral cataract surgery and 2 eyes of 2 children with previous perforating eye injury had synechiotomy and pupilloplasty (Group 2). Heparin sodium was added to the irrigating solution during surgery in 12 left eyes of children with bilateral surgery (Group 1a) and in all eyes in Group 2. Heparin sodium was not added during surgery in 12 right eyes of children having bilateral surgery (Group 1b, control). Early and late postoperative intraocular reactions were recorded and compared. Results: In Group la (heparin added), 6 eyes had less fibrinoid reaction and fewer related complications such as posterior synechias, pupil irregularity, and intraocular lens (IOL) decentration than the fellow right eyes. No eye in Group la having primary cataract surgery had hyphema or intraocular bleeding. Hyphema occurred on the first postoperative day in 1 eye in Group 1 a that had secondary IOL implantation. Conclusions: Adding heparin sodium to the irrigating solution decreased postoperative inflammatory and fibrinoid reactions and related complications such as synechias, pupil irregularity, and IOL decentration in pediatric cataract surgery. However, the use of heparin during surgery can be risky in eyes with a defective blood-aqueous barrier such as after previous ocular surgery.Öğe Inferior oblique paresis, mydriasis, and accommodative palsy as temporary complications of sinus surgery(Lippincott Williams & Wilkins, 2004) Bayramlar, H; Miman, MC; Demirel, SA 15-year-old boy had temporary hypertropia, supraduction deficit, ipsilateral mydriasis, and accommodative paresis after bilateral endoscopic ethmoidectomy, bilateral partial inferior turbinectomy, septoplasty, and Caldwell-Luc procedures for chronic sinusitis. Postoperative imaging did not disclose any intra-orbital abnormalities. The patient was treated with oral prednisolone 70 mg/day on a tapering schedule. Within two months, the ophthalmic abnormalities had resolved. This is the second report to describe such findings., which are attributed to damage of the inferior division of the third cranial nerve secondary to manipulation of adjacent ethmoid tissues.Öğe Limbal relaxing incisions for primary mixed astigmatism and mixed astigmatism after cataract surgery(Elsevier Science Inc, 2003) Bayramlar, H; Daglioglu, MC; Borazan, MPurpose: To evaluate the effect of limbal relaxing incisions (LRIs) in the treatment of primary mixed astigmatism and mixed astigmatism after cataract surgery. Setting: Department of Ophthalmology, Inonu University, Malatya, Turkey. Methods: Limbal relaxing incisions were performed to correct astigmatism in 37 eyes of 26 patients with mixed astigmatism. Twenty-four eyes had primary astigmatism, and 13 eyes had astigmatism after cataract surgery. The length, number, and depth of the incisions were determined using the Gills and Gayton nomogram. The manifest refractive astigmatism was measured preoperatively and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Surgically induced astigmatism using the vector method, preoperative and postoperative uncorrected visual acuity (UCVA), and best spectacle-corrected visual acuity (BSCVA) were evaluated. Follow-up was at least 6 months in all cases. Results: The mean preoperative and postoperative refractive astigmatism was 3.31 diopters (D) +/-1.50 (SD) and 1.59+/-1.28 D, respectively (P<.001). The mean absolute change in refractive astigmatism was 1.72 +/- 0.81 D. No patient lost lines of UCVA or BSCVA. The safety index was 1.21 and the efficacy index, 0.88. The mean preoperative and postoperative UCVA was 0.29 +/- 0.22 and 0.54 +/- 0.31, respectively (P=.0001) and the mean BSCVA, 0.61 +/- 0.30 and 0.74 +/- 0.30, respectively (P=.0001). The mean vectorial magnitude was 2.32 +/- 1.36 D at the last follow-up. There were no serious postoperative complications. Conclusion: Limbal relaxing incisions are a simple, safe, and effective method to correct primary mixed astigmatism and mixed astigmatism after cataract surgery.Öğe Manual tunnel incision extracapsular cataract extraction using the sandwich technique(Amer Soc Cataract Refractive Surgery, 1999) Bayramlar, H; Çekiç, O; Totan, YSmall incision extracapsular cataract extraction (ECCE) using the sandwich technique is described. After capsulorhexis, hydrodissection, and hydrodelineation, the endonucleus is moved into the anterior chamber and extracted by sandwiching it between the irrigating vectis and iris spatula. In a series of 37 eyes, most achieved a best corrected visual acuity of 5/10 or better postoperatively. Complications were posterior capsule rupture, vitreous loss, and transient corneal edema. Small incision ECCE using the sandwich technique is safe, easy, and does not require expensive instrumentation.Öğe Medium term outcomes of strabismus surgery in patients with monocular dense amblyopia(Saudi Med J, 2006) Bayramlar, H; Gunduz, A[Abstract Not Available]Öğe Myopia - Convergence might cause myopia(British Med Journal Publ Group, 2002) Bayramlar, H[Abstract Not Available]Öğe Myopic shift from the predicted refraction after sulcus fixation of PMMA posterior chamber intraocular lenses(Canadian Ophthal Soc, 2006) Bayramlar, H; Hepsen, IF; Yilmaz, HBackground: To evaluate the refractive results of sulcus-fixated polymethylmethacrylate (PMMA) posterior chamber intraocular lenses (PC IOLs) after cataract surgery with and without posterior capsule complications. Methods:The charts of patients who had undergone cataract surgery were reviewed, and eyes that had received sulcus-fixated PMMA PC IOLs were included in the study. Postoperative refraction, predicted postoperative refraction for in-the-bag IOL with the same diopter, intraoperative posterior capsular complications and vitrectomy, axial eye length, incision type (corneal or scleral), and surgery type were recorded and analyzed. The difference between actual postoperative refraction and predicted refraction for the in-the-bag lens was calculated for each patient. Results: Of 143 patients (84 men and 59 women), 162 eyes with a sulcus-fixated posterior chamber intraocular lens were investigated. Mean age was 63.7 +/- 12.1 years. A mean myopic shift of -1.02 +/- 0.96 D from the predicted in-the-bag refraction was found. There were no significant differences between eyes with or without vitreous loss-vitrectomy (p = 0.8), eyes with scleral or corneal incisions (p = 0. 11), and eyes having phacoemulsification or extracapsular cataract extraction (p = 0.93). In terms of axial length, there were no significant differences between long, normal, or short eyes (p = 0.85). Interpretation: Sulcus fixation of a PMMA IOL originally planned for in-the-bag fixation caused approximately -1.00 D myopic shift in this study. We recommend that when sulcus fixation is necessary PMMA OOL power should be approximately 1.25 to 1.50 D less than the power for in-the-bag fixation. Axial length, incision type, vitreous loss and use of vitrectomy, and type of the surgery do not appear to alter the postoperative refraction significantly in eyes with sulcus fixation.Öğe Periorbital solitary-type infantile myofibromatosis(Slack Inc, 1997) Bayramlar, H; Hepsen, IF; Sarac, K; Hasanoglu, A; Tecimer, T; Ozgen, U; Senol, M[Abstract Not Available]Öğe Retrospective comparison of surgical techniques to prevent secondary opacification in pediatric cataracts(Slack Inc, 2000) Er, H; Doganay, S; Evereklioglu, C; Erten, A; Cumurcu, T; Bayramlar, HPurpose: To evaluate the effect of different surgical methods for management of the posterior capsule and anterior vitreous on the rate of posterior capsule opacification in pediatric cataracts. Methods: Charts of 34 children (47 eyes) aged 40 days to 18 years (mean: 8.5 years) who had primary cataract surgery with or without posterior chamber intraocular lens (IOL) implantation during the past 5 years were reviewed. In 26 eyes, cataracts were managed with a posterior continuous curvilinear capsulorhexis, and in 21 eyes, the posterior capsule was left intact. Follow-up averaged 10 months (range: 6.5 months to 5 years). Results: Visually significant secondary cataract developed in nine eyes with intact posterior capsules, and seven eyes required Nd:YAG laser posterior capsulotomy. The average time for YAC capsulotomy postcataract removal in the second group was 4 months. The visual axis remained clear in all eyes that had posterior continuous curvilinear capsulorhexis with or without posterior chamber IOL. Complications such as fibrinoid membrane, stromal edema, posterior synechiae, updrawn pupil, and transient glaucoma occurred in both groups at a similar rate. Conclusion: Primary posterior continuous curvilinear capsulorhexis is an effective method for preventing secondary cataract formation in pediatric cataracts.Öğe Small incision extracapsular cataract surgery with manual phacotrisection(Amer Soc Cataract Refractive Surgery, 2000) Hepsen, IF; Çekiç, O; Bayramlar, H; Totan, YPurpose: To evaluate the safety and efficacy of small incision extracapsular cataract extraction (ECCE) using the manual phacotrisection technique. Setting: Department of Ophthalmology, Turgut Ozal Medical Center, Inonu University, Malatya, Turkey. Methods: Fifty-nine eyes of 54 patients had small incision ECCE by the manual phacotrisection technique. Mean follow-up was 10 months. After capsulorhexis and hydrodissection were performed, the endonucleus was prolapsed into the anterior chamber and trisected using an anteriorly positioned triangular trisector and posteriorly placed solid vectis. Pieces were extracted with a forceps through a small incision. Results: Postoperatively, best spectacle-corrected visual acuity of 20/40 or better was achieved in 48 eyes (83%) and of 20/25 or better in 28 eyes (47%). The most frequent intraoperative complication was posterior capsule rupture (n = 5). Of eyes that developed posterior capsule rupture, 3 had vitreous loss and 2 had implantation of an anterior chamber intraocular lens (IOL), in 44 eyes, the IOL was implanted in the bag and in 12 eyes, in the ciliary sulcus. The most significant postoperative complication was transient corneal edema, which developed in 32 eyes (54%). No permanent complications (e.g., corneal endothelial decompensation) occurred in any case. Conclusion: Manual phacotrisection has several advantages such as nucleus safety, less dependence on assistant personnel, the elimination of the phaco machine, and cost effectiveness. J Cataract Refract Surg 2000; 26:1048-1051 (C) 2000 ASCRS and ESCRS.Öğe Trabeculectomy with brief exposure of mitomycin C(Amer Soc Contemporary Ophthalmology, 1996) Hepsen, IF; Bayramlar, H; Oram, OIn this study, mitomycin-C (MMC) al a concentration of 0.2 mg/mL was applied intraoperatively for 1 minute in 11 consecutive primary trabeculectomies to increase the success of glaucoma-filtration surgery while minimizing the incidence of postoperative complications resulting from MMC use. The success criteria included a postoperative intraocular pressure (IOP) lower than 21 mmHg without treatment, a 20% or more drop from preoperative IOP levels, and a visual loss limited to one or fewer lines of Snellen acuity. The procedure was considered successful in 10 eyes (90.9%), with a mean follow-up period of 25.6 weeks. Blebs were ischemic and microcystic in all successful eyes at the time of the last follow up. Postoperative complications included subconjunctival hemorrhage, hyphema, conjunctival wound leak, and corneal epithelial defects. Complications related to low IOP, such as choroidal detachment and hypotonic maculopathy, were not seen in any of the eyes. Although the longer term of follow-up results of this regimen are not well known, this alternative intraoperative application of MMC at a concentration of 0.2 mg/mL for 1 minute seems to control postoperative IOP effectively in primary trabeculectomies with fewer hypotony-related complications.
