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Öğe Association of Changes in Thickness of Limbal Epithelial and Stroma with Corneal Scars Detected by High-Resolution Anterior Segment Optic Coherence Tomography(Georg Thieme Verlag Kg, 2023) Guclu, Hande; Sattarpanah, Samira; Gurlu, VuslatAim To investigate the corneal central and limbal thickness in cornea scar patients using high-resolution anterior segment optical coherence tomography (AS-OCT) and to determine the changes in the limbal region due to the corneal scar. Also, to evaluate tear film parameters in scar patients. Methods Thirty patients with central corneal scar and 30 control subjects. The control subjects were healthy individuals who came to our clinic for routine ophthalmological examination. They were enrolled in this matched case-control study. Central epithelial thickness (ET), stromal thickness (ST), limbal epithelial thickness (LET), and limbal stromal thickness (LST) were analyzed using high-resolution AS-OCT. For evaluation of the ocular surface, the following techniques were used: tear break-up time (BUT) employing standard sterile strips of fluorescein sodium, Schirmer test- I (SCH), and the Ocular Surface Disease Index (OSDI) Questionnaire. Results The mean central ET of the patient group was 51.5 +/- 12.4 mu m, while the mean central ET of the control group was 59.2 +/- 9.0 mu m. There was a statistically significant difference between patients and controls (p = 0.008). The mean LST of the patients was 747.9 +/- 115.7 mu m, and the mean LST of the controls was 726.3 +/- 79.7 mu m. There was a statistically significant difference between patients and controls according to BUT (p = 0.009) and SCH (p = 0.04). However, there was no significant difference between OSDI results of patients and controls (p = 0.08). Conclusion Corneal monitoring with high-resolution AS-OCT is a simple, noninvasive, useful technique for corneal scar patients. Cornea scars cause decreased ET. This result could be associated with lower tear film parameters in scar patients. The scar length is associated with higher intraocular pressure (IOP) values. Decreased LET and increased LST were detected in scar patients.Öğe Choroidal neovascularization due to the use of clomiphene citrate(Taylor & Francis Ltd, 2023) Cinar, Abdulkadir Can; Cinar, Ayca Kupeli; Guclu, Hande; Gurlu, Vuslat[Abstract Not Available]Öğe Coexistence of optic pit and coloboma of iris, lens, and choroid: a case report(Consel Brasil Oftalmologia, 2016) Ozelce, Ramazan; Gurlu, Vuslat; Guclu, Hande; Ozal, Sadik AltanA 42-year-old woman was admitted to our clinic with a complaint of glare in both eyes. Biomicroscopic examination of both the eyes revealed iris and lens colobomas in the inferior quadrant. Fundus examination of the right eye revealed an oval and gray inferotemporal optic pit and two choroid colobomas in the inferior quadrant. In the left eye, two choroid colobomas were detected that were inferior to the optic nerve head. Furthermore, a 21-year-old man presented to our clinic for a routine ophthalmologic examination. Bilateral biomicroscopic examination was normal. Fundus examination of the left eye revealed an oval and gray inferotemporal optic pit and a choroid coloboma that was inferior to the optic nerve head. Here we describe optic pits co-occurring with iris, lens, and choroidal colobomas. On the basis of these cases, a defect in the closure of the embryonic fissure is the most plausible etiology of the optic pit.Öğe Comparison of corneal endothelial cell analysis in patients with uveitis and healthy subjects(Springer, 2019) Guclu, Hande; Gurlu, VuslatPurposeThe aim of this study is to investigate the effect of uveitis in corneal endothelial cell number and morphology by non-contact specular microscopy.MethodsOur cross-sectional study was performed on 56 eyes of uveitis patients and 53 eyes of healthy subjects. Non-contact specular microscopy was performed to all subjects. The cell density (CD), coefficient of variation, cell minimum area (Min) and cell maximum area (Max), the average of cell size (AVG), percent of hexagonality (HEX%), central corneal thickness (CCT), intraocular pressure (IOP) during uveitis and during remission were measured and compared between two groups.ResultsThe mean endothelial cell analysis of the patients was 2540619 cells/mm(2), and the mean endothelial cell analysis of the control group was 2834 +/- 413 cells/mm(2). The difference was statistically significant between the groups (p=0.01). There was a statistically significant difference between two groups in terms of Max, Min, AVG, and HEX values. However, there was no difference in terms of CCT between two groups. There was a significant negative correlation between CD and IOP during uveitis attack. There was a significant negative correlation between the anterior chamber cell value and CD.Conclusion Our results suggested that uveitis affected endothelial cell density, cell size and shape but not the corneal thickness without being influenced by the duration and number of attacks. Increased IOP during uveitis and anterior chamber cell value had an important role on CD in patients with uveitis.Öğe Corneal epithelium and limbal region alterations due to glaucoma medications evaluated by anterior segment optic coherence tomography: a case-control study(Taylor & Francis Ltd, 2021) Guclu, Hande; Cinar, Ayca Kupeli; Cinar, Abdulkadir Can; Akaray, Irfan; Aykutlu, Merve Sambel; Sakallioglu, Ahmet Kursad; Gurlu, VuslatAim To investigate the corneal epithelial and limbal epithelial alterations in patients under topical glaucoma treatment using anterior segment-OCT (AS-OCT) and to determine the changes of the limbal region due to the preservatives and glaucoma drugs, that can progress to limbal stem cell deficiency (LSCD). Limbal thickness was measured by AS-OCT to evaluate limbal cell deficiency. Methods Forty-seven patients using topical medication for glaucoma, and 48 control subjects were enrolled in this matched case-control study. The patients were divided into four groups according to the treatment regimens. Group 1: One-drug regimen, Group 2: Two-drug regimen, Group 3: Three-drug regimen, Group 4: Four-drug regimen For the ocular surface evaluation; tear break-up time with standard fluorescein sodium sterile strip application, Schirmer test-I, Ocular Surface Disease Index Questionnaire, and AS-OCT were performed. Results A total of 95 subjects were included: 47 eyes of 47 patients with glaucoma medication and 48 eyes of 48 healthy subjects. There was a statistically significant difference between patients and controls according to BUT, SCH, and OSDI (p < 0.001). The mean central corneal epithelium thickness was 48.5 +/- 5.3 in patients and 54.5 +/- 5.9 in controls (p < 0.001). The mean central total corneal thickness was 529.2 +/- 41.2 in patients and 536 +/- 35.3 in controls (p = 0.335). The mean limbal epithelium thickness was 64.1 +/- 9.1 in patients and 76 +/- 11.5 in controls (p < 0.001). Conclusion Using at least one glaucoma drug caused limbal area injury, changed ocular surface measurements, and significantly reduced the limbal epithelial thickness where the stem cells reside. The limbal epithelial thickness measurement by AS-OCT seems to be an innovative, non-invasive, and promising technique for detecting and staging corneal damage in topical glaucoma therapy.Öğe Diplopia in Cases With Type 1 Duane Retraction Syndrome(Springernature, 2021) Birgul, Ramazan; Gurlu, VuslatObjective In this study, we aimed to investigate the prevalence of diplopia in cases with type 1 Duane retraction syndrome (DRS). Materials and methods This study was a retrospective review of cases involving patients presenting diagnosed with DRS over a period of 24 years. Among these cases, 28 had type I DRS and fulfilled the inclusion criteria. The cases were evaluated in terms of age, gender, affected eye, concomitant ocular motility disorders, presence of amblyopia, manifest shift, abnormal head position (AHP), fusion, and stereopsis. Results Sixteen of the patients (57.1%) in the study were female, and 12 (42.8%) were male; the mean age of the patients was 18.9 years (range: 7-67 years). The right eye was affected in six of the cases (21.4%), and the left eye in 22 (78.6%) of the cases. On examination, diplopia was not observed in 21(75%) cases, but it was detected in seven (25%). AHP was present in five of the seven cases with diplopia and not present in two, and all seven of the diplopic cases had fusion, while three had stereopsis. The level of stereopsis in all diplopic cases was 400 sn/ark. When the clinical findings of patients with diplopia and those without diplopia were compared, a statistically significant difference was observed only in terms of AHP. Conclusions Although diplopia is not one of the clinical features of DRS, it must be noted that in cases with type 1 DRS, diplopia may occur in directions in which the movement of the eyeball is limited. In the presence of this finding, which might mimic sixth nerve palsy, patient history must be diligently taken, other clinical findings of DRS must be thoroughly examined, and an MR1 should be performed when necessary for an easier diagnosis.Öğe Esculetin Protects Human Retinal Pigment Epithelial Cells from Lipopolysaccharide-induced Inflammation and Cell Death(Taylor & Francis Inc, 2018) Ozal, S. Altan; Turkekul, Kader; Gurlu, Vuslat; Guclu, Hande; Erdogan, SuatPurpose: Age-related macular degeneration (AMD) is the most common cause of visual loss. The dry AMD is characterized by retinal pigment epithelium (RPE) death and changes in AMD lead to severe loss of vision. Coumarin-derived esculetin has a number of therapeutic and pharmacological effects such as anti-inflammatory and antioxidant with various mechanisms. The purpose of this study was to investigate the effects of esculetin treatment on lipopolysaccharide (LPS)-induced inflammation, oxidative stress, and cell survival.Material and methods: Human RPE cells (ARPE-19) were incubated for 24-72h with 5g/ml LPS to induce inflammation and oxidative stress. Esculetin (5 M) was used to protect the cells from LPS-induced damage. The cell viability was evaluated by quantitative 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide test. Interleukin 6 (IL-6), IL-12, and vascular endothelial growth factor (VEGF) levels were determined by enzyme-linked immunosorbent assay (ELISA). IL-1, tumor necrosis factor receptor (TNFR), TNF-related apoptosis-inducing ligand (TRAIL), catalase, glutathione peroxidase (GPx), superoxide dismutase 1 (CuZnSOD) and SOD2 (MnSOD) mRNA expressions were analyzed by RT-quantitative polymerase chain reaction. Apoptosis was monitored by cell-based cytometer. NF-kappa B (NF-B) p65/RelA levels were determined by ELISA, and NF-B protein expression and extracellular signal-regulated kinase (ERK1/2) phosphorylation were evaluated by Western blot analysis.Results: Esculetin treatment significantly suppressed LPS-induced cell death mediated by apoptosis and necrosis in a concentration-dependent manner. While LPS caused significant inflammation with cytokine increase in cells, esculetin reduced the expression of LPS-induced cytokines, VEGF, TNFR, and TRAIL. Furthermore, exposure to LPS increased the expression of GPx and mitochondrial MnSOD, leading to oxidative stress in the cells. Esculetin treatment attenuated phosphorylation of ERK1/2 and NF-B expression mediated by LPS.Conclusions: These results suggest that esculetin may be an alternative treatment option for endotoxin-induced inflammation and oxidative stress, which therefore may inhibit the development of LPS-mediated AMD.Öğe Evaluation of Parameters Affecting Measurement Quality of Dynamic Contour Tonometry(Galenos Publ House, 2011) Gencer, Baran; Gurlu, VuslatObjective: To evaluate factors affecting measurement quality of dynamic contour tonometry (DCT). Material and Methods: Three hundred patients took part in this prospective clinical study. For each patient, measurements for one eye were included in the study. Of the participants, 116 had ocular hypertension, 114 had glaucoma, and 70 had normal eyes. We used automatic refractokeratometry, ultrasonic pachimetry, Goldmann applanation tonometry, and DCT measurements to investigate the effects of age, corneal astigmatism, refractive error, central corneal thickness (CCT), intraocular pressures (IOP), and ocular pulse amplitude (OPA) on DCT measurement quality (Q). Logistic regression analysis was used for statistical analysis. Results: For 159 patients, the DCT Q score was 1 (group 1). For the remaining 141 patients, the Q score was 2-3 (group 2). The following values were determined for the two groups, respectively: mean age 58.9 +/- 9.9 and 61.4 +/- 10.6; mean corneal astigmatisms -0.78 +/- 0.67 and -0.92 +/- 0.77 diopter; mean spherical equivalents 0.33 +/- 1.87 and -0.01 +/- 2.02 diopter; mean CCT 547.0 +/- 35.2 and 549 +/- 38.7 mu m. Measurements with DCT provided mean IOPs of 18.5 +/- 3.70 and 21.27 +/- 6.19 mm Hg and mean OPA 3.5 +/- 1.4 and 3.2 +/- 1.2 mm Hg. By logistic regression analysis, we determined that the parameters affecting measurement quality were age, DCT measurement level, and OPA (p=0.015, p=0.000, and p=0.000, respectively). Conclusion: High IOP values, advanced age, and low OPA values can lead to decreased DCT measurement quality.Öğe Fat Embolism: Case Report(Aves, 2006) Ozdemir, Levent; Tabakoglu, Erhan; Gurlu, Vuslat; Hatipoglu, Osman Nuri; Altiay, Gundeniz; Yilmam, Ilker; Ozlen, BurcuFat embolism syndrome is a rare disorder which usually may be seen as a complication of long bone trauma. It becomes apparent 24-72 hours after injury with respiratory, neurological, urinary, ocular and cutaneous symptoms and sings. Our case is a 46 years old male patient who evaluated 30 hours after left tibia fracture for confusion, fever, dyspnea, tachypnea and a petechial rash on the anterior chest and anterior axillary folds. Chest radiograph was normal. The patient had hypoxemia and hypocapnia in arterial blood gases measurement. Ventilation perfusion scintigraphy revealed emboli with intermediate probability. No other etiology could be found to explain the state of confusion. Cotton-wool exudates and small haemorrhages were observed in retina. Many fat globules were found in urine samples. After steroid treatment, rapid clinical improvement was observed.Öğe Metabolic Syndrome May Exacerbate Macular and Retinal Damage in Psoriasis Vulgaris(Taylor & Francis Inc, 2019) Korkmaz, Selma; Guclu, Hande; Hatipoglu, Esra Sueheda; Ficicioglu, Sezin; Gurlu, Vuslat; Ozal, Sadik AltanPurpose: To evaluate whether cases with both psoriasis and metabolic syndrome are prone to retinal and macular changes. Materials and Methods: A total of 174 eyes of 87 subjects were evaluated. Of the 87 subjects, 24 had psoriasis, 19 had psoriasis and metabolic syndrome, 18 had metabolic syndrome only and 26 were healthy subjects. Biochemical analysis, anthropometric, blood pressure and optical coherence tomography measurements and thickness analysis were obtained for each case. Results: The superior retinal nerve fibre layer thickness was significantly lower in the psoriasis and metabolic syndrome group than in the psoriasis group. For all parafoveal quadrants, the ganglion cell complex thickness was statistically significantly lower in the psoriasis group than in the healthy group. The central macula was thinnest in the healthy group among the four groups. Conclusions: Psoriasis can cause retinal changes, and metabolic syndrome may cause additional damage in the retina and macula in cases with psoriasis.Öğe NATURAL COURSE OF VITREOMACULAR TRACTION IN EYES WITH DIABETIC RETINOPATHY AND FACTORS ASSOCIATED WITH SPONTANEOUS RELEASE(Lippincott Williams & Wilkins, 2021) Garip, Ruveyde; Cinar, Ayca Kupeli; Cinar, Abdulkadir Can; Gurlu, VuslatPurpose: The aim of this study was to determine the natural course of vitreomacular traction (VMT) in patients with diabetic retinopathy and to evaluate the factors associated with VMT relief. Methods: Seventy-four eyes of 65 patients with VMT accompanying diabetic retinopathy were evaluated retrospectively. The presence of intravitreal injection and the presence of panretinal photocoagulation were obtained from the medical records of the patients. Spontaneous release of VMT, the horizontal length of vitreomacular traction, the presence of hyperreflective retinal spots, the presence of the epiretinal membrane, and the grade of VMT were evaluated from the spectral-domain optical coherence tomography images. Factors associated with the spontaneous release of VMT were evaluated by logistic regression analysis. Results: Spontaneous release was observed in 28 eyes (37.8%). The horizontal length of VMT was lower in the release of the VMT group compared with the persistent VMT group (P = 0.03). The persistent VMT group had a higher rate of hyperreflective retinal spots and epiretinal membrane compared with the release of the VMT group (respectively; P = 0.003 and P = 0.031). No statistically significant difference was observed between the release of VMT and persistent VMT groups in terms of intravitreal injection and panretinal photocoagulation treatment (respectively; P = 0.938 and P = 0.36). The absence of hyperreflective retinal spots was the most important prognostic factor for the spontaneous release of VMT (P = 0.029). Conclusion: Spontaneous release of VMT observed higher rates of patients without hyperreflective retinal spots, epiretinal membrane, and patients with lower horizontal length of VMT.Öğe Neferine inhibits epidermal growth factor-induced proliferation and migration of retinal pigment epithelial cells through downregulating p38 MAPK and PI3K/AKT signalling(Taylor & Francis Ltd, 2020) Ozal, Sadik Altan; Gurlu, Vuslat; Turkekul, Kader; Guclu, Hande; Erdogan, SuatPurpose: Proliferative vitreoretinopathy (PVR) occurs in approximately 5-10% of patients after retinal detachment surgery. Neferine is a bis-benzylisoquinoline alkaloid found in the green seed embryos (Nelumbo nucifera) of the lotus flower and has various properties, such as being antithrombotic, antioxidant, neuroprotective, anticancerous, and anti-inflammatory. Although the effects of neferine on the proliferation and migration of cancer cells have been partially shown, their possible role and the mechanism of action on PVR remain unclear. Materials and methods: To mimic a PVR model in vitro, retinal pigment epithelial (RPE) cells were exposed to epidermal growth factor (EGF) and treated with various concentrations of neferine. Cell viability was determined by MTT test. Cell-cycle phase distribution and cell migration were examined by image-based cytometry and wound healing test, respectively. Messenger RNA (mRNA) and protein expression were determined by RT-qPCR and Western blotting, respectively. Results: Stimulation of the cells with EGF significantly increased the rate of proliferation, whilst treatment with low concentrations of neferine-reduced proliferation to a level equal to that seen in untreated cells. Neferine significantly downregulated EGF-increased cell viability, and survivin mRNA expression was depressed to the basal level. In addition, neferine treatment contributed to cell proliferation loss by upregulating p21 and p27 expression leading to cycle arrest at the G1 phase. The treatment significantly inhibited cell migration by upregulating the expression of epithelial markers, such as E-cadherin and occludin, and decreased MMP2, MMP9, alpha-SMA, and vimentin. Neferine treatment markedly reduced phosphotidyl inositol 3-kinase (PI3K), AKT, p-p38 mitogen-activated protein kinase (MAPK), and NF-kappa B (nuclear factor kappa-light-chain-enhancer of activated B cells) protein expression. Conclusion: It can be considered that neferine may be a potential candidate molecule in the treatment of PVR by inhibiting cell proliferation and the migration of EGF-induced RPE cells through the modulation of various transcriptional activities.Öğe Optical biometry-based axial length alterations after intravitreal dexamethasone implant(Consel Brasil Oftalmologia, 2019) Ozal, Sadik Altan; Kupeli, Ayca; Ozal, Ece; Gurlu, VuslatPurpose: To investigate changes in axial length after intravitreal dexamethasone implantation in patients with macular edema. Methods: We performed a prospective comparative study of 46 patients with unilateral macular edema, due to diabetic retinopathy, retinal vein occlusion, and non-infectious uveitis, who underwent dexamethasone implantation. The fellow eyes of the patients were considered the control group. The central macular thickness was measured by spectral-domain optical coherence tomography, and axial length was measured by IOLMaster 700 optical coherence biometry. We compared axial length and central macular thickness values within the groups. Results: In the study group, the baseline central macular thickness was 460.19 +/- 128.64 mu m, significantly decreasing to 324.00 +/- 79.84 mu m after dexamethasone implantation (p=0.000). No significant change in central macular thickness measurements was seen in the control group (p=0.244). In the study group, the baseline axial length was 23.16 +/- 0.68 mm, significantly increasing to 23.22 +/- 0.65 mm after dexamethasone implantation (p=0.039). However, the control group exhibited no significant change in axial length (p=0.123). Conclusions: In addition to significantly reducing central macular thickness measurements, intravitreal dexamethasone implantation also significantly changes optical biometry-based axial length measurements.Öğe Prognostic factors associated with the course of vitreomacular traction in eyes with age-related macular degeneration(Elsevier, 2022) Garip, Ruveyde; Cinar, Ayca K.; Cinar, Abdulkadir C.; Sakallioglu, Ahmet Kursad; Guclu, Hande; Gurlu, VuslatClinical relevance: Vitreomacular traction(VMT) is a clinical syndrome that can cause decreased vision and may affect the treatment response in cases of age-related macular degeneration(AMD). Factors affecting the course of VMT in AMD cases will guide the clinician in terms of patient management.Background: The aim of this study was to determine the prevalence of VMT in patients with AMD, to evaluate the natural course of VMT, and to investigate factors associated with the prognosis of VMT in eyes with AMD.Methods: This retrospective case series was conducted with 55 eyes of 46 patients who were diagnosed as having AMD accompanying with VMT. Demographic data, complete ophthalmologic examination findings, type of AMD, receiving an intravitreal injection(IVI), number of IVIs, and the presence of complete spontaneous release were obtained from the medical records of the patients. The horizontal length of VMT(HLVMT), central macular thickness(CMT), the horizontal length of choroidal neovascularization(HLCNV) were evaluated from spectral -domain optical coherence tomography(SD-OCT) images.Results: Spontaneous release was observed in 7(28%) eyes of the exudative AMD group and 10(33.3%) eyes of the nonexudative AMD group. On the last visit, the HLVMT was increased in 22(40%) of the eyes and a decrease in HLVMT was observed in 8(14.5%) of the eyes. In the remaining 12(21.8%) eyes had unchanged HLVMT. In all eyes with CNV, the area of VMT corresponded in 100% with localization of the CNV complex. No significant difference was found between the eyes with spontaneous release and persistent traction in terms of the type of AMD, IVI, HLVMT, age, gender, and crystalline lens status. Conclusion: In this study, VMT was observed at higher rates in eyes with exudative AMD compared to the eyes with nonexudative AMD. However, spontaneous release rates were found close to those with idiopathic VMT independently of the type of AMD, HLVMT, and IVI.Öğe Thickness changes in foveal, macular, and ganglion cell complex regions associated with Behcet uveitis during remission(Wichtig Publishing, 2016) Gurlu, Vuslat; Guclu, Hande; Ozal, AltanPurpose: To investigate foveal, macular, and ganglion cell complex (GCC) thickness in patients with Behcet uveitis during remission. Methods: We included patients with panuveitis attacks caused by Behcet disease. Patients were taking immunosuppressive therapy and had no active ocular inflammation. After complete ophthalmologic examination, optical coherence tomography (OCT) was performed with a macula multi-cross protocol. The OCT images were evaluated for structural changes. Patients with no structural changes were imaged with the macula map protocol to obtain parafoveal and perifoveal macular and GCC thicknesses. Patients were compared to an age-matched control group with the Mann-Whitney U test. In correlation analyses, we examined relationships among visual acuity (logMAR), disease duration, and the number of attacks. Results: The study included 27 eyes of 21 patients (mean age 38.14 +/- 9.18 years; mean disease duration 65.4 +/- 74.6 months; mean number of attacks 2.5 +/- 1.9). The OCT showed foveal thicknesses of 260.29 +/- 34.17 mu m in patients and 280.58 +/- 19.54 mu m in controls (p = 0.010). Foveal thickness was not related to visual acuity (p = 0.485), but was negatively correlated to disease duration (p = 0.016) and number of attacks (p = 0.001). Patients and controls showed similar macular thickness in parafoveal quadrants (p = 0.294, p = 0.096, p = 0.88, p = 0.111) and perifoveal quadrants (p = 0.241, p = 0.517, p = 0.53288, p = 0.241). Patient parafoveal GCCs were significantly thinner than in controls in the inferior temporal quadrant (p = 0.041), but not in other quadrants (p = 0.867, p = 0.832, p = 0.390). Patient perifoveal GCCs were significantly thicker than in controls in the superior and inferior temporal quadrants (p = 0.008, p = 0.008) and somewhat thicker (but not significantly) in the superior and inferior nasal quadrants (p = 0.052, p = 0.138). Conclusions: Patients with Behcet uveitis in remission showed insignificant decreases in foveal and macular thickness and significant increases in perifoveal GCC thickness compared to controls. The increased perifoveal GCC thickness may result from macular ischemia persisting in remission.
