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    Anterior segment parameters and corneal specular microscopy findings in rheumatoid arthritis
    (2019) Tasli, Nurdan Gamze; Aktas, Nurdagül; Karakurt, Yucel; Ucak, Turgay; Agcayazi, Sumeyye Burcu; Icel, Erel; Yilmaz, Hayati
    Aim: To compare the anterior segment parameters and specular microscopy findings between patients with Rheumatoid arthritis (RA) and healthy controls. Material and Methods: In this prospective study, 55 patients diagnosed with RA and age and matched 55 control subjects without any systemic diseases were enrolled. Central corneal thickness (CCT), corneal endothelial cell density (cells/mm2) (ECD), percentage of hexagonal cells of corneal endothelial cells ( HEX), and cell size variability (CV%) of endothelial cells were measured using noncontact specular microscopy (CEM-530 Specular Mıcroscope, NIDEK ). Anterior chamber depth (ACD), Axial Length (AL), white to white limbus length and keratometry were measured using an ocular biometry system. In all patients of RA group, disease activity severity was assessed with The Disease Activity Score in 28 joints diseases activity score (DAS28 rate). Results: There were statistically significant differences between RA patients and control subjects regarding ACD (3.06±0.43 vs 3.24±0.31; p: 0.001), white to white limbus length (11.63±0.45 vs 11.76±0.38; p: 0.02), CV% (35.49±5.96 vs 32.02±5.22, p: 0.001) and hexagonality (67.31±4.66 vs 71.35±11.02; p: 0.001). In correlation analysis, there was a negative correlation between disease periods and both ACD and CCT; while there was a negative correlation with the number of cells and endothelial cell density and DAS 28 score. Conclusion: Although there was not a significant difference regarding endothelial cell density values in RA group compared with healthy controls; there was a negative correlation between the disease activity and endothelial cell density. Moreover, CV% was significantly higher and hexagonality % was significantly lower in RA group; indicating the endothelial damage and increase in the expected compensatory response. Further, larger studies are warranted to define the exact pathological mechanisms and clinical outcomes of this corneal endothelial damage in RA patients.
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    The clinical outcomes of intravitreal dexamethasone implant as the first-line treatment in retinal vein occlusion related macular edema
    (2019) Karakurt, Yucel
    Aim: To investigate the alterations in central macular thickness (CMT), best-corrected visual acuity (BCVA) and intraocular pressure (IOP) after intravitreal dexamethasone implant (IDI; Ozurdex) injections in patients with treatment-naive central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO)-related macular edema in clinical practice. Material and Methods: Totally 41 eyes of 41 patients diagnosed with BRVO or CRVO, who were treatment-naive and treated with only intravitreal dexamethasone implants, were retrospectively investigated. Anterior and posterior segment examinations were performed with a slit lamp bio-microscope. BCVA was assessed using Snellen chart and then converted to logarithm of minimum angle of resolution (log MAR) units before statistical analysis and CMT measurements were performed with spectral domain optical coherence tomography. Results: The mean age of patients was 65.95 ±6.164 years (range: 51-78). Central retinal vein was occluded in 14 patients while branches were occluded in remaining 27 patients. The patients were followed for 14.93±1.942 months (median: 15, range: 12-20 months). The mean number of injections was 2.83±0.803 (median: 3, range: 1-4). BCVA was significantly better in all time periods after treatment (p: 0.001). There was a significant decrease in CMT in all time periods after treatment compared with pre-treatment values (p: 0.001). During follow-up period, IOP was determined to be higher than 25 mm-Hg in 5 patients, and cataract was diagnosed in 6 patients. Conclusion: Intravitreal dexamethasone injection is an effective mode of treatment in patients with RVO-associated macular edema. Its side effects are not severe or common. However the patients should be kept under follow-up for recurrences.
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    Comparison of anterior segment parameters and corneal endothelial changes in patients with pseudoexfoliative glaucoma and pseudoexfoliation syndrome
    (2019) Ucak, Turgay; Atum, Mahmut; Karakurt, Yucel; Icel, Erel; Tasli, Nurdan Gamze
    Aim: The aim of this study is to evaluate the changes in anterior chamber morphology and corneal endothelium in patients with pseudoexfoliation syndrome (PEX) and pseudoexfoliative glaucoma (PEXG) and to determine the differences according to the control group. Material and Methods: 61 eyes of 61 PEX patients, 56 eyes of 56 PEXG patients and 46 eyes of 46 healthy subjects were included in the study. Measurement of intraocular pressure (IOP) was taken and axial length (AL), K1, K2, central corneal thickness (CCT), white-to-white distance (WTW), anterior chamber depth (ACD), pupil diameter (PD) by optical biometry and endothelial cell density (ECD), polimegatism (CV), pleomorphism (HEX) and average cell area (AVG) by specular microscope were taken of all the patients. Evaluation among the groups were made by ANOVA test, and p <0.05 was considered significant. Results: The mean age of PEX, PEXG and control group were 63.79 ± 6.62; 62.71 ± 10.73; 63.43 ± 10.58 years respectively (p> 0.05). There were no statistically significant differences among the groups in terms of IOP, AL, K1, K2, WTW, ACD (p> 0.05). Pupil diameter values were lower in the PEX group. CCT and endothelial cell counts were found to be higher in the control group compared to the other groups, while no significant difference was found between PEX and PEXG groups. AVG results were found to be significantly higher in the PEXG group than in the control group (p <0.05). No difference was observed among the groups when CV and HEX values were examined. Conclusion: In our study, no significant difference was observed among the groups in terms of the IOP, AL, K1, K2, WTW, ACD, while corneal thickness and endothelial cell density were observed to be lower in PEX and PEXG groups compared to the healthy individuals.
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    Comparison of the clinical efficacy and safety of deep sclerectomy with mitomycin-c and trabeculectomy surgeries
    (2019) Karakurt, Yucel; Mesci, Cem; Erbil, Hasan Hasbi; Salar Gomceli, Senem; Acar, Huseyin
    Aim: Comparison of clinical efficacy and safety of trabeculectomy and deep sclerectomy with mitomycin-C (MMC) surgeries.Material and Methods: 58 eyes of 58 patients with glaucoma who underwent trabeculectomy or deep sclerectomy with MMC were evaluated retrospectively. The success criterion was regarded as follows; patients having intraocular pressure (IOP) less than 21 mmHg was regarded as complete success; patients with IOP less than 21 mmHg with medication was regarded as partial success; and patients with IOP higher than 21 mmHg with medication was regarded as un-success.Results: There was no statistically significant difference in IOP lowering effects between the two surgeries. Considering the success of the groups; complete success was achieved in 32 patients (91.4%) and partial success in 3 patients (8.6%) in the trabeculectomy group. Complete success was achieved in 20 patients (86.9%) and partial success in 3 patients (13.1%) in the deep sclerectomy with MMC group. In the deep sclerectomy with MMC group, hypotonia was detected in 2 patients (8.7%). In the trabeculectomy group, 5 patients (14.3%) had hypotonia, 2 patients (5.7%) had shallow anterior chamber and 1 patient (2.85%) had choroidal detachment.Conclusion: When IOP lowering effects of deep sclerectomy with MMC and trabeculectomy operations were compared, it was found that there was no statistically significant difference between the two techniques. When complication rates were compared, less complication was found in deep sclerectomy operations. It can be concluded that deep sclerectomy is safer than trabeculectomy and as effective as it is. Keywords: Deep Sclerectomy; Glaucoma; Trabeculectomy.
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    Evaluation of the effect of chronic smoking habit on corneal endothelial cells, central corneal thickness and dry eye tests
    (2019) Karakurt, Yucel; Sunar, Mukadder; Tasli, Nurdan Gamze; Ucak, Turgay; Agcayazi, Sumeyye Burcu; Ugurlu, Adem; Icel, Erel
    Aim: The aim of our study was to evaluate the effects of chronic smoking habit on corneal endothelial cells, central corneal thickness, and dry eye tests. Material and Methods: A total of 160 eyes of 160 chronic smokers and 160 eyes of 160 control cases were included in the study. The smokers were grouped into 4 groups according to pack-year smoking as follows: 0-10, 10-20, 20-30, >30. Endothelial cell density (CD), average cell size (AVG), percentage of hexagonal cell (HEX), and coefficient of variation (CV), central corneal thickness (CCT) were measured using a specular microscope. The Tear Break-Up Time (TUBT) and Schirmer tests were performed. Results: In Group 1 and Group 2, there was no significant difference between the smoker and the control groups in terms of CD, AVG, HEX and CV. In Group 3 and Group 4, there was a significant decrease in CD and HEX values, while there was a significant increase in AVG and CV values. CCT values were not significantly different in the Groups 1,2 and 3, whereas there was a significant decrease in the Group 4. TBUT and Schirmer tests were significantly decreased in all groups. Conclusion: It was found that as the number of pack-year increased, CD and HEX values decreased and AVG and CV values increased. Dry eye tests were affected in a shorter period of time, while CCT was affected in a longer period of time than the time required for CD, HEX, AVG and CV parameters to be affected.
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    The findings of corneal specular microscopy in patients with keratoconus
    (2019) Tasli, Nurdan Gamze; Ucak, Turgay; Karakurt, Yucel; Icel, Erel; Ugurlu, Adem; Agcayazi, Sumeyye Burcu
    Aim: The aim of this study was to determine the correlation of corneal endothelial cell density, coefficient of variation and hexagonal cell ratio with the stages of keratoconus and corneal thickness. Material and Methods: The study included 102 eyes from 51 patients. The corneal topography was performed using the Sirius corneal topographic device and the examination of the endothelium was performed using Nidek CEM-530. The patients were divided into groups in accordance with keratometry values (group 1: K2<45 D, group 2: K2 45-52 D, group 3: K2> 52 D) and thinnest cornea thickness (group 1:> 450 µm, group 2: 400-450 µm, group 3: <400 µm). Specular microscopic findings were compared according to the severity of keratoconus and corneal thickness. Results: Of the patients, 29 (50%) were male and 22 (50%) were female. The mean age was 29.8 ± 7.7 (15-45) years. Endothelial cell count and hexagonal cell ratio were significantly lower in severe keratoconus compared to mild and moderate keratoconus and the coefficient of variation was higher in severe keratoconus compared to the other groups (p <0.001). When the patients were compared according to the pachymetry value at the thinnest point of the cornea, the endothelial cell number and the hexagonal cell ratio were found to be lower in the group with pachymetry less than 400 µm (p <0.001). The coefficient of variation was higher in the same group compared to the others (p <0.001). Conclusion: It was revealed that endothelial cell density, hexagonal cell ratio decreased and the coefficient of variation increased with the progression of keratoconus. Specular microscopic examinations in patients with keratoconus provide important data in addition to topography
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    The role of protein oxidation in the development of diabetic microvascular complications
    (Kare Publ, 2021) Mertoglu, Cuma; Siranli, Gulsah; Coban, T. Abdulkadir; Karakurt, Yucel; Ersoy, Alevtina; Ozcicek, Adalet; Arslan, Yusuf
    OBJECTIVE: The role of protein oxidation in the development of diabetic microvascular complications was investigated. METHODS: In total, 266 participants were split into five groups: Group 1; diabetes mellitus for at least 10 years without any complications, Group 2; diabetic nephropathy, Group 3; diabetic neuropathy, Group 4; diabetic retinopathy, and Group 5; control group. Thiol, disulfide, ferroxidase, and ischemia-modified albumin (IMA) levels were analyzed in the serum. RESULTS: Native thiol, total thiol, and native thiol/total thiol were lower in Group 4 than Groups 1, 3, and 5 (p<0.001). However, disulfide/native thiol and disulfide/total thiol were higher in Group 4 than all other groups (p<0.001). IMA was higher in Groups 3 and 4 than all other groups (p<0.001). Ferroxidase was lower in Groups 3 and 4 than Group 2 (p<0.001). CONCLUSION: Thiol-disulfide homeostasis impairment in favor of disulfide may have a function in the progress of diabetic retinopathy. Furthermore, the disruptions of IMA and ferroxidase levels involve in the development of diabetic retinopathy and neuropathy.