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    Effective management of exposure keratopathy developed in intensive care units: The impact of an evidence based eye care education programme
    (Elsevier Sci Ltd, 2014) Demirel, Soner; Cumurcu, Tongabay; Firat, Penpegul; Aydogan, Mustafa Said; Doganay, Selim
    Objectives: To assess the impact of eye care education on the incidence of corneal exposure in intensive care units (ICU). Research methodology/design: Approximately 300 ICU personnel were educated about eye care to reduce the incidence of corneal exposure. The patients were divided into two groups: pretraining (Group 1: Between February 1, 2011 and March 31, 2011 [2 months]) and post-training periods (Group 2: Between April 1, 2011 and April 1 2012 [1 year]). We compared the groups for keratopathy incidence to evaluate the efficacy of this education. Results: The number of patients were 762 in Group 1 and 6196 in Group 2 (p=0.335). Medians of patients followed in pre training ICU and post training ICU for each month were found to be 476 (interquartile range, 433-539) and 515 (interquartile range, 490-528). Exposure keratopathy was identified in 8 eyes of 6 patients (3 males and 3 females) in pre training ICU with the mean age of 27.6 +/- 31.8 years and 5 eyes of 3 patients (1 male and 2 females) in post training ICU with the mean age of 41.3 +/- 32.1 years. No significant difference was noticed between two groups in terms of the medians of patients followed in ICUs for each month (p =0.335). The time of hospitalisation in ICU when the patients were consulted for the first ocular assessment in pre training ICU and post training ICU were found to be 13 +/- 8.7 days and 8 +/- 1.7 days, respectively. After the training, the decrease in incidence of exposure keratopathy was found to be highly significant (p<0.001). Conclusion: We observed a highly significant reduction in the incidence of corneal exposure, following the eye-care education programme. (C) 2013 Published by Elsevier Ltd.
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    Effects of Ketamine-Propofol Mixture on Intraocular Pressure and Haemodynamics in Elderly Patients: A Randomised Double-Blind Trial
    (Aves, 2014) Aydogan, Mustafa Said; Demirel, Soner; Erdogan, Mehmet Ali; Firat, Penpegul; Colak, Cemil; Durmus, Mahmut
    Objective: The aim of this study was to compare the effects of a ketamine-propofol mixture (ketofol) and propofol on intraocular pressure (IOP) and haemodynamics in elderly patients during anaesthetic management at each repeated measurement times. Methods: Forty elderly ASA I and II patients were divided into two random groups and received either propofol (1.5 mg kg(-1); group P, n=20) or ketofol (1:1 single syringe mixture of 5 mg mL(-1) ketamine and 5 mg mL(-1) propofol; group KP, n=20). A proseal laryngeal mask airway (PLMA) was inserted 60 seconds after induction of anaesthesia. IOP, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) values were recorded at preinduction (t0), immediately following induction (t1), and at 1 (t2), 3 (t3), and 5 (t4) minutes after induction. Hemodynamic complications and the need for ephedrine were also recorded. Results: Patient characteristics at the beginning of the procedure were similar between the groups. SBP and HR were significantly increased in group KP compared to group P at t1 and t4 (p=0.044). Induction of both anaesthetic agents significantly decreased the IOP values from the t0 (p=0.026). A significant decrease in IOP was found at t1 and t4 in group P compared to group KP (p=0.018). The total dose of ephedrine was statistically different in group P (p=0.034). Conclusion: Ketofol can be an alternative agent to provide haemodynamic stability with a moderate decrease in IOP during anaesthesia induction in elderly patients.
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    Evaluation of corneal biomechanical properties after uneventful standard coaxial phacoemulsification surgery
    (2018) Cankaya, Cem; Ulas, Fatih; Doganay, Derya; Firat, Penpegul; Doganay, Selim
    Aim: This study was designed to investigate the alteration of intraocular pressure measurements and biomechanical properties of the cornea in patients who underwent uneventful standard coaxial phacoemulsification cataract surgery through 2.75 mm corneal main incision with intraocular lens implantation. Material and Methods: 15 eyes of 15 patients admitted to our clinic because of the cataract problems in the study. Corneal hysteresis (CH), corneal resistance factor (CRF) measurements, Goldmann correlated (IOPg), and corneal compensated intraocular pressure (IOPcc) values were recorded by ocular response analyzer (ORA) before and 1 day, 1 week and 1 month after surgery. Results: The mean age of the patients was 64.3 ± 8.06 years. Preoperative mean CH, CRF, IOPg and IOPcc values were 8.23±2.10, 9.33±2.27, 18.54±3.42 and 19.66±3.22, respectively. The mean CH, CRF, IOPg and IOPcc values were 5.50±2.07, 8.69±2.04, 22.29±3.37 and 23.83±3.32, respectively on the first day after the surgery. The mean CH, CRF, IOPg and IOPcc values were 5.25±1.83, 8.29±2.10, 18.86±2.72 and 20.20±3.37, respectively of the first week after the surgery. The mean CH, CRF, IOPg and IOPcc values were 7.88±1.99, 8.37±1.83, 15.81±2.60 and 16.41±2.80, respectively in the first month after the surgery. Conclusion: These results revealed that the biomechanical properties of the cornea may change during the first one month period after uneventful standard coaxial phacoemulsification surgery
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    Pupillary Block Glaucoma in a Patient Who Underwent Inverted Implantation of Intraocular Lens: Case Report
    (Ortadogu Ad Pres & Publ Co, 2012) Doganay, Selim; Firat, Penpegul; Cankaya, Cem; Koc, Bekir
    Current report presents an interesting case who had pupillary block glaucoma in postoperative period related to the inverted implantation of intraocular three piece-lens with optic haptic angulation of 5 degrees. A 23-year-old female admitted for severe pain and loss of vision in her left eye for 7-8 hours. Visual acuity was 0.9 in right eye and finger counting from two meters in left eye. Biomicroscopic examination showed that posterior chamber intraocular lens located in ciliary sulcus and open posterior capsule in central area in right eye. Ciliary congestion and severe corneal edema were observed in left eye. Anterior chamber structures were not clearly observed, anterior chamber was shallow and iris was dome shaped. The optic of intraocular lens which was placed in posterior chamber, entirely shifted to anterior chamber through pupilla and formed a pupillary block. Intraocular pressure was 12 mmHg in right eye, 63 mmHg in left eye. The patient whose intraocular pressure got under control by medical therapy was performed peripheral iridotomy using Nd:YAG laser. One week after iridotomy, the visual acuity was 0.5 and the intraocular pressure was measured as 15 mmHg. After corneal opacity completely improved, it was noticed that intraocular lens was placed inversely within the posterior chamber. The lens optic within the anterior chamber was placed into the posterior chamber with a surgical intervention. In the fourth month following surgery, inferior half of the intraocular lens optic was decentralized again into the anterior chamber (without pupil blockage because of the iridotomy open at 1 o'clock) and intraocular pressure was measured as 12 mmHg. With a second surgical intervention, the intraocular lens was set into correct position by inverting it and it was centralized at ciliary sulcus.