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Öğe An Algorithm Recommendation to Detect Specific Pathology of the Lacrimal Sac(Lippincott Williams & Wilkins, 2022) Demirel, Soner; Firat, Murat; Firat, Ilknur Tuncer; Dikci, SeyhanWe aimed to recommend an efficient algorithm to detect the presence of specific pathologies of the lacrimal sac (LS). The charts of 296 patients who had undergone LS biopsy were reviewed retrospectively. The age, gender, history, examination and radiological findings, sac appearance, and pathology results of the patients were recorded. The power of our data to predict the presence of potential specific pathology was identified by regression analysis. After the causality evaluation of the statistical results, an algorithm was created to differentiate specific LS pathologies from chronic dacryocystitis. Our algorithm was mainly formed by deciding on radiological examination and biopsy according to the risk scoring created by the examination findings. A specific LS pathology was observed in 11(3.7%) patients. When we applied the recommended algorithm to cases with a suspicion of specific pathology and/or found to have a specific pathology, 36.4% of the patients would not require radiological examination and 29.6% of them would not require a biopsy. On the other hand, 80% of the frozen biopsies had been conducted on cases without a specific pathology. Managing the cases according to our algorithm would mean that frozen biopsy would be recommended in only 1 (12.5%) case without a specific pathology. Besides, the detection of cases with a specific pathology would not be prevented and the necessary diagnostic procedures would continue to be performed. Specific LS pathologies can be detected adequately, whereas decreasing unnecessary examinations and procedures in cases without a specific pathology by using our algorithm.Öğe Brown syndrome: clinical features and results of superior oblique tenotomy(Consel Brasil Oftalmologia, 2021) Ozsoy, Ercan; Gunduz, Abuzer; Firat, Ilknur Tuncer; Firat, MuratPurpose: This study was conducted to further de-fine the specific clinical characteristics of patients with Brown syndrome and evaluate the outcomes of superior oblique tenotomy in its surgical management. Methods: A retrospective analysis of the medical charts of 45 patients with Brown syndrome was performed, which revealed that 11 patients underwent superior oblique tenotomy due to abnormal head posture and/or hypotropia and 1 patient underwent bilateral superior oblique tendon elongation with a silicone band due to abnormal head posture. In the last patient, silicone bands were removed at the postoperative 3rd month due to the lack of improvement in the abnormal head posture and the limitation of elevation in adduction. Simultaneous horizontal rectus muscle surgery was performed in four patients. Results: There was a predominance of female gender, right eye, congenital form, unilaterality, A-pattern, and an abnormal head posture type with a combination of chin up and head tilting. Bilateral form was observed only in female patients. Amblyopia was detected in two patients. Among patients aged >5 years, 40% had reduced stereopsis. Abnormal head posture was found in 60% of patients. More than half of them were diagnosed with a vertical and/or horizontal deviation. Tenotomy procedure eliminated the abnormal head posture in all patients and significantly improved the mean limitation of elevation in adduction and hypotropia (p=0.001, p=0.012). Two patients developed inferior oblique overaction in the operated eye. There was complete spontaneous resolution in two patients. Conclusions: The clinical features of patients with Brown syndrome in our study are considerably consistent with those of previous reports. The present study demonstrated the effectiveness of superior oblique tenotomy with less overcorrection in the surgical treatment of Brown syndrome.Öğe Correlation between intraocular pressure obtained with water drinking test versus modified diurnal tension curve measurement in pseudoexfoliation glaucoma(Springer, 2021) Firat, Penpe Gul; Dikci, Seyhan; Firat, Ilknur Tuncer; Demirel, Soner; Firat, Murat; Ozturk, Emrah; Gok, Zarife EkiciPurpose The aim of this paper was to study the correlation and agreement between the intraocular pressure (IOP) peak value and fluctuations detected with the modified diurnal tension curve (mDTC) and the water drinking test (WDT) in pseudoexfoliation glaucoma (XFG) patients. Methods This prospective observational study enrolled 42 eyes of 42 XFG patients. The IOPs were measured at 2-h intervals from 8 am to 4 pm with a Goldmann applanation tonometer by a single observer to establish the mDTC. The WDT was then performed between 4 and 5 pm on the same day and the IOP was measured 4 times at 15-min intervals after water ingestion. The IOPpeak, IOPmean, IO (min), and IOPfluctuation were measured with both the mDTC and WDT. The paired sample t test, Spearman's correlation coefficient and Bland-Altman plots were used for statistical analysis. Results The mean age of the 42 patients consisting of 24 females and 18 males was 66.9 +/- 6.8 years, and the mean central corneal thickness was 517.7 +/- 29.1 mu m. The mean values with the mDTC and WDT measurements were 15.05 +/- 2.75 mmHg and 17.17 +/- 3.25 mmHg (p <= 0.0001, r = 0.884) for IOPmean, 16.76 +/- 3.45 mmHg and 18.92 +/- 3.94 mmHg (p <= 0.0001, r=0.787) for IOPpeak, and 13.61 +/- 2.56 mmHg and 15.11 +/- 2.84 mmHg (p <= 0.0001, r=0.824) for IOPmin, respectively, and a positive correlation was present between these values. Conclusion There was a positive correlation between the peak, minimum, and mean IOP values determined using the mDTC and WDT in treated XFG patients. WDT can be used as an alternative in the assessment of the IOP in these patients as a more practical method.Öğe İlerleyici Keratokonus Tedavisinde Hızlandırılmış ve Standart Korneal Kollajen Çapraz Bağlama Tedavisinin Başarısının Değerlendirilmesi(2022) Fırat, Murat; Polat, Nihat; Firat, Ilknur TuncerAmaç: İlerleyici keratokonusta hızlandırılmış ve standart korneal kollajen çapraz bağlama tedavi sonuçlarını karşılaştırmak. Gereç ve Yöntem: Bu geriye dönük çalışmaya, hızlandırılmış korneal kollajen çapraz bağlama (10 mW/cm 2, 9 dakika) yapılan 37 has- tanın 48 gözü ve standart korneal kollajen çapraz bağlama tedavisi (3 mW/cm 2, 30 dakika) yapılan 55 hastanın 73 gözü dahil edildi. Ameliyat sonrası dönemde 1 D altında maksimum keratometri (Kmax) artışı ve/veya 1 D manifest refraktif sferik eşdeğer artışı ve /veya görme keskinliğinin 0,1 (ondalık) ve altında azalması başarı olarak kabul edildi. Bulgular: Hızlandırılmış korneal kollajen çapraz bağlama ve standart korneal kollajen çapraz bağlama gruplarında tedavi başarı ora- nı sırasıyla %68,8 ve %82,2 idi (p= 0,086). Kmax değişimine göre başarı oranı hızlandırılmış korneal kollajen çapraz bağlama ve stan- dart korneal kollajen çapraz bağlama grubunda sırasıyla %77,1 ve %90,4 idi (p=0,044). İki grubun manifest refraktif sferik eşdeğer ve uzak düzeltmeli görme keskinliğinde başarısı birbirine benzerdi. Hızlandırılmış korneal kollajen çapraz bağlama ve standart korneal kol- lajen çapraz bağlama gruplarında ortalama uzak düzeltmeli görme keskinliğinde anlamlı artış göstermişti (sırasıyla p=0,028 ve p<0,001). Ortalama Kmax hızlandırılmış korneal kollajen çapraz bağlama grubunda 0,13±1,46 D azalma gösterirken (p=0,537) stan- dart korneal kollajen çapraz bağlama grubunda 0,69±1,44 D azalma göstermişti (p<0,001) ve ortalama Kmax değişimi açısından iki grup arasında anlamlı fark yoktu (p=0,108). Ortalama manifest refraktif sferik eşdeğer, hızlandırılmış korneal kollajen çapraz bağlama grubunda 0,16±1,79 D azalırken (p=0,975) standart korneal kollajen çapraz bağlama grubunda 0,27±1,33 D azalmıştı (p=0,118). Sonuç: Standart korneal kollajen çapraz bağlama prosedürünün korneal düzleştirme etkisi daha fazla iken görme keskinliği ve refraktif kusurların değişimi açısından iki prosedür benzer sonuçlara sahiptir.Öğe Impact of serous macular detachment on visual recovery in retinal vein occlusion treatment(Consel Brasil Oftalmologia, 2022) Firat, Ilknur Tuncer; Polat, Nihat; Firat, Murat| Purpose: The aim of this study was to evaluate the effect of serous macular detachment observed during retinal vein occlusion on treatment results. Methods: A total of 117 eyes from 115 patients who had been treated with intravitreal injections for macular edema secondary to retinal vein occlusion were retrospectively reviewed. Visual acuity, optical coherence tomography, and fundus fluorescein angiography findings were evaluated according to the status of serous macular detachment. Results: In the branch retinal vein occlusion group, a statistically significant increase was detected in the mean visual acuity compared to the baseline value at each visit in the absence of serous macular detachment, whereas the increase in the mean visual acuity was significant only at the 3-and 6-month visits in the presence of serous macular detachment. In the central retinal vein occlusion group, there was an increase in the mean visual acuity compared to the baseline value at every visit in the absence of serous macular detachment, whereas the mean visual acuity decreased compared to the baseline value at every visit except at the 3-month visit in the presence of serous macular detachment. The ellipsoid zone defect was more prominent in the presence of serous macular detachment in eyes with branch retinal vein occlusion, whereas there was no significant diffe-rence in the ellipsoid zone in the absence or presence of serous macular detachment in eyes with central retinal vein occlusion. Conclusions: In the group with macular edema due to retinal vein occlusion, the initial mean visual acuity increase observed in the first year was maintained in cases without serous macular detachment but not in those with serous macular detachment. Serous macular detachment could be a negative factor in eyes with retinal vein occlusion.Öğe Prediction of Pentacam image after corneal cross-linking by linear interpolation technique and U-NET based 2D regression model(Pergamon-Elsevier Science Ltd, 2022) Firat, Murat; Cinar, Ahmet; Cankaya, Cem; Firat, Ilknur Tuncer; Tuncer, TanerKeratoconus is a common corneal disease that causes vision loss. In order to prevent the progression of the disease, the corneal cross-linking (CXL) treatment is applied. The follow-up of keratoconus after treatment is essential to predict the course of the disease and possible changes in the treatment. In this paper, a deep learningbased 2D regression method is proposed to predict the postoperative Pentacam map images of CXL-treated patients. New images are obtained by the linear interpolation augmentation method from the Pentacam images obtained before and after the CXL treatment. Augmented images and preoperative Pentacam images are given as input to U-Net-based 2D regression architecture. The output of the regression layer, the last layer of the U-Net architecture, provides a predicted Pentacam image of the later stage of the disease. The similarity of the predicted image in the final layer output to the Pentacam image in the postoperative period is evaluated by image similarity algorithms. As a result of the evaluation, the mean SSIM (The structural similarity index measure), PSNR (peak signal-to-noise ratio), and RMSE (root mean square error) similarity values are calculated as 0.8266, 65.85, and 0.134, respectively. These results show that our method successfully predicts the postoperative images of patients treated with CXL.
