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I Günalp

Publications and source records attributed to I Günalp.

At least 19 recordsLinked to original sources
PubMed2006

Nonpreserved human amniotic membrane transplantation for conjunctival reconstruction after excision of extensive ocular surface neoplasia.

PURPOSE: To report our experience on the use of nonpreserved human amniotic membrane transplantation (AMT) in ocular surface reconstruction after excision of extensive ocular surface neoplasia (OSN). DESIGN: Prospective noncomparative interventional case series. PARTICIPANTS: In all, 10 eyes of 10 consecutive patients with extensive OSN involving various areas of limbus, conjunctiva, and cornea (conjunctival carcinoma in situ, four eyes; squamous cell carcinoma, three eyes; malignant melanoma, two eyes; conjunctival-orbital lymphangioma, one eye) were included in this prospective noncomparative interventional case series. After excision of the neoplasia with 3-4 mm tumour-free margins, double freeze-thaw cryotherapy was applied to the margins of the remaining conjunctiva, and nonpreserved human amniotic membrane graft was sutured to the adjacent conjunctiva using 8/0 vicryl sutures and cornea using 10/0 nylon sutures, with the epithelial side facing up to cover the bare sclera and cornea. Postoperatively, topical corticosteroids were used for 3 months. RESULTS: After tumour excision and AMT, a satisfactory result with a wet, stable conjunctiva, and rapid and complete healing was observed in all eyes. Over a mean follow-up of 10.0 months (range, 6-27 months), all but one eye remained free of tumour recurrence. In one eye with conjunctival melanoma, there was a small recurrence, which was treated with excision and cryotherapy. Treatment complications were partial stem cell deficiency in two eyes and symblepharon formation in one eye. Immune graft rejection was not encountered. CONCLUSION: Nonpreserved human AMT appears to be useful for reconstruction of ocular surface following excision of extensive OSN.

Adult↗
PubMed2000

Superior oblique muscle palsy in a patient with orbital dermoid cyst.

We describe the clinical and radiologic findings and surgical outcome of an orbital dermoid cyst causing a superior oblique muscle palsy in a child. Superior oblique muscle palsy in childhood is most often congenital. Less common causes are trauma, vascular lesions, neoplasms, and infections.(1,2) The most common orbital lesions in children are dermoid and epidermoid cysts.(3-5) A dermoid cyst at the region of trochlea is suspected as the cause of superior oblique muscle palsy in our case. This unusual presentation of a dermoid cyst has not been reported previously.

Child, Preschool↗
PubMed1999

Quantitative CT of the orbit in Graves' disease.

In order to determine the value of quantitative CT of the orbit in patients with Graves' disease, we clinically examined 174 orbits of 87 patients with Graves' disease and evaluated them by CT in respect to the density and size of the extraocular muscles, the globe position and the width of the optic nerve-sheath complex. We also determined the normal ranges for density of extraocular muscles in 200 normal orbits of 100 patients for comparison. Normal ranges for the density of extraocular muscles were (mean +/- 2 SD) medial rectus, 28-63 HU; lateral rectus, 24-78 HU; inferior rectus, 20-64 HU; superior muscle group, 28-62 HU. 51 of 77 (66%) patients with Graves' disease had extraocular muscle density changes. Some extraocular muscles showed fatty infiltration on CT. 50 of 87 (57%) patients had at least one enlarged extraocular muscle, 47 (54%) patients had exophthalmos and 59 (68%) patients had either exophthalmos and/or extraocular muscle enlargement. A diagnosis of Graves' ophthalmopathy was made in 69 of 87 (79%) patients using CT and in 50 (57%) patients by clinical examination. We conclude that quantitative CT imaging of the orbit with evaluation of the size and density values of extraocular muscles and the globe position may be very helpful in detecting ophthalmopathy in patients with Graves' disease.

Adolescent↗
PubMed1998

Effect of pre-enucleation irradiation on the survival of patients with uveal melanoma.

The effect of pre-enucleation irradiation on the survival of patients with uveal melanoma was investigated in 140 patients. Of the patients, 42 received pre-enucleation cobalt external radiotherapy 2,000 cGy, in five fractions between 1981-1991. The control group consisted of 98 patients with uveal melanoma treated by enucleation alone between 1964 and 1994. The great majority of tumors in each group were confined to the choroid. The mean follow-up period was 58.3 months in the irradiated group and 61.6 months in the enucleation group. A comparison of the Kaplan-Meier survival curves of the patients managed by pre-enucleation irradiation and enucleation indicated no significant difference in survival between the groups. After 5 years of follow-up, the survival rates for the preoperatively irradiated group and the control group were, 86.5 and 86.8%, respectively. In both groups, women had a significantly better survival than men. It is more likely that pre-enucleation irradiation does not appear to improve survival in patients with uveal melanoma. The reason for this may be the micrometastases that occur before treatment.

Adolescent↗
PubMed1997

Papillary adenocarcinoma of the ciliary body simulating retinoblastoma.

PURPOSE: To report a 2 1/2-year-old boy who had papillary adenocarcinoma of the ciliary body that simulated retinoblastoma. METHOD: Initially treated for congenital glaucoma, the patient was referred with a white mass involving the iris, chamber angle, and ciliary body. RESULTS: Enucleation of the right eye, which was initially diagnosed as retinoblastoma, showed a papillary adenocarcinoma of the ciliary body epithelium involving the posterior chamber, iris, anterior chamber, and trabeculum. CONCLUSION: Adenocarcinoma of the ciliary body must be included in the differential diagnosis of tumors originating from the ciliary body in young children.

Adenocarcinoma, Papillary↗
PubMed1997

Secondary orbital tumors.

The authors reviewed their experience with 524 secondary orbital tumor cases diagnosed histopathologically during 1963-1993. Secondary tumors constituted 48.0% of all orbital biopsies during the same period. There were 186 (35.5%) cases with eyelid tumors, 146 (27.9%) cases with intraocular tumors, 137 (26.1%) cases with conjunctival tumors, 26 (5.0%) cases with nasopharyngeal tumors, 22 (4.2%) cases with sinus carcinomas, 3 (0.6%) cases with intracranial meningiomas, 3 (0.6%) cases with esthesioneuroblastomas, and 1 (0.2%) case with chordoma. The three most frequent tumors making secondary orbital invasion were basal cell eyelid carcinoma (129 cases; 24.6%), squamous cell conjunctival carcinoma (125 cases; 23.8%), and retinoblastoma (123 cases; 23.5%). Squamous cell carcinoma, from various sites of origin, was the most frequent histopathologic tumor variant, accounting for 215 (41.0%) cases. Exenteration was performed on 334 (63.7%) of 524 cases with secondary orbital invasion. The ignorance of many lid and conjunctival lesions until the advanced stages, which could otherwise be easily treatable, caused blindness and life-threatening complications under our conditions. Orbital invasion from ocular retinoblastoma and uveal malignant melanoma led to a markedly poor prognosis, again related to the late presentation of many patients. Lack of health consciousness, inadequate primary surgery, and/or insufficient follow-up were the main reasons for secondary orbital invasion in many tumor cases.

Adolescent↗
PubMed1997

Congenital symblepharon (abortive cryptophthalmos) associated with meningoencephalocele.

An 18-year-old male patient was first seen with right congenital symblepharon (abortive cryptophthalmos) and right frontal meningoencephalocele. There were no other affected members in the pedigree. Computed tomograms revealed that the right orbital roof was absent. Apart from a right harelip on the affected side, there were no other systemic abnormalities. The eye had light perception only. The upper eyelid connected with the globe and the cornea was totally opaque. Echographic studies showed that the eye was improperly developed. Electroencephalography detected slow-wave activity over the right frontoparietal region.

Adolescent↗
PubMed1997

Focal dermal hypoplasia (Goltz's syndrome).

A 17-year-old female with Goltz's syndrome was examined because of visual acuity loss in her right eye. Ocular examination revealed microcornea, iris, choroid and optic disc coloboma in the right eye. There were several erthematous and hyperpigmented areas on the body. Magnetic resonance (MR) imaging of the orbits and brain demonstrated right optic nerve hypoplasia and diffuse cortical and cerebellar atrophy. Skeletal manifestations were short stature, scoliosis, syndactyly, clinodactyly, and osteopathia striata. Dental defects included hypodontia, developmental defects, and malocclusion. There were multiple papillomatous lesions on the lids and perioral skin and the nose was asymmetric. Her mental development was apparently normal. She had left bifid ureter and renal pelvis, scant hair on the pubic and genital region, and poor breast development. Histopathologic examination of the biopsy taken from a characteristic skin lesion revealed attenuated epidermis, hypoplastic dermis, and subcutaneous fat close to epidermis. Immunofluorescence staining was negative for IgG, IgM, IgA, C3, C4, fibrin, and albumin. Ultrastructural examination showed that no viral particles were present. Prometaphase chromosome analysis revealed a normal 46, XX female karyotype. Cortical and cerebellar atrophy can occur in a patient with Goltz's syndrome.

Abnormalities, Multiple↗
PubMed1996

Idiopathic orbital inflammatory disease.

The purpose of this study was to review our clinical experience with 132 idiopathic orbital inflammation cases seen between 1971 and 1994. Clinical charts of the patients were evaluated retrospectively. Patient age ranged from 5 to 80 (mean 46.5) years. The follow-up period was between 6 to 172 (mean 42.8) months. Proptosis (82%), motility restriction (54%), visual acuity loss (38%) were the three more common presenting signs. The diagnosis was made by open biopsy in 96 cases and clinically in 36 cases. Radiologic patterns of involvement were available for 84 cases. Diffuse inflammatory disease (40 cases) was the most frequent radiologic pattern followed by myositis (21 cases) and dacryoadenitis (14 cases). Focal encapsulated mass (5 cases), Tolosa-Hunt syndrome (2 cases) perineuritis (1 case) and periscleritis (1 case) were the other types of orbital pseudotumors. The response to treatment was known for 60 of the 84 radiologically classified cases. High-dose oral corticosteroid treatment was successful in 35 out of 60 (58.3%) cases and radiotherapy in 9 out of 14 (64.3%) cases resistant to corticosteroids. One resistant case responded to cyclophosphamide and 2 cases with focal mass lesions were treated with orbitotomy. Four additional cases had spontaneous remission. Overall, 51 out of 64 patients (79.7%) had an eventual good outcome. In conclusion, we found open biopsy to be a safe and reliable procedure in orbital pseudotumors with the exclusion of acute phase cases. The success rate of treatment for this group of orbital disorders is high with the exception of certain disease patterns.

Adolescent↗
PubMed1996

Septo-optic dysplasia associated with bilateral complex microphthalmos.

An 8-month-old girl was examined because of corneal clouding and microphthalmos. The fundi of both eyes could not be visualized because of corneal clouding. Orbital and cranial computerized tomographic scanning and magnetic resonance imaging demonstrated bilateral microphthalmos and presumed retinal dysplasia, hypoplasia of the optic nerves and chiasm, agenesis of the septum pellucidum, thinning of corpus callosum, and a normal pituitary infundibulum. Cerebral cortex and white matter were unremarkable. Other ocular malformations were anterior segment dysgenesis in the right eye and congenital cataract or lens abnormality in the left eye. Endocrine studies revealed normal serum hormone levels. There were no colobomatous lesions and systemic anomalies suggestive of a coloboma syndrome. This case represents the rare association of septo-optic dysplasia with complex microphthalmos.

Anterior Eye Segment↗
PubMed1996

Retinoblastoma in Turkey: diagnosis and clinical characteristics.

Retinoblastoma (RB) is the most frequent malignant intraocular tumor in childhood. Six hundred and thirty-six cases with 831 RB-affected eyes were diagnosed and treated in our specialist center between 1963-1994. The diagnosis was made by histopathologic examination in 617 cases and clinically in 19 cases. Four hundred and forty-one (69.3%) cases were unilateral and 195 (30.7%) were bilateral. Two hundred and sixty-eight (42.1%) were females and 368 (57.9%) were males. The youngest patient was 20 days old and the oldest was 16 years old at the time of diagnosis (mean: 2.2 years). In thirty-four (5.3%) cases, a family history of RB was present. Ten of these cases were unilateral and 24 were bilateral. The most frequent presenting signs were leukocoria (394 cases, 61.9%), buphthalmos (92 cases, 14.5%), and strabismus (68 cases, 10.7%). The referring initial diagnoses were correct in 519 (81.6%) cases and false-negative in 117 (18.4%) cases. The most frequent initial false-negative diagnoses of the referring physicians were buphthalmos (43 cases, 6.8%), endophthalmitis (37 cases, 5.8%), and retinal detachment (12 cases, 1.9%). Apart from these 636 cases, there were 29 false-positive RB diagnoses during the same study period for which enucleation was performed. False-positive diagnoses included endophthalmitis (9 cases), retinal dysplasia (6 cases), retinal detachment (5 cases), vitreous hemorrhage (4 cases), Coats' disease (4 cases), and toxocariasis (one case). Ancillary testing for metastasis was carried out in all cases with newly diagnosed retinoblastoma. Five hundred and ninety-eight (72%) eyes had intraocular disease and 233 (28%) had extraocular spread. Of these 233 RBS, 58 had systemic disease. Fifty-two out of 58 tumors showing systemic involvement had either optic nerve or extrascleral extension at the histopathologic examination of enucleation material. The remaining six eyes had intraocular Class IV-V RB.

Adolescent↗
PubMed1996

Retinoblastoma in Turkey--treatment and prognosis.

The treatment modalities and prognosis of 636 retinoblastoma (RB) cases diagnosed and treated in our specialist center between 1963 and 1994 were evaluated. Patient age ranged from 20 days to 16 years, the mean age being 2.2 years (26.4 months). Of the 636 cases, 441 were unilateral and 195 were bilateral. Enucleation was the most frequent treatment employed in unilateral RB patients (412 cases). Follow-up treatment included exenteration (48 cases), radiotherapy (154 cases) and chemotherapy (108 cases) for cases with optic nerve invasion and/or orbital recurrence following enucleation. Seventeen cases displayed massive proptosis, ocular damage and blindness at initial presentation and underwent exenteration as the initial treatment. Two cases were subjected to external beam radiotherapy without invasive surgical procedures. Ten cases regressed spontaneously without treatment. For bilateral cases, the most frequent treatment used was enucleation for one eye and radiotherapy for the other (132 cases). Adjuvant treatment included exenteration (9 cases) and chemotherapy (50 cases) depending on orbital recurrence and/or systemic metastasis. Spontaneous bilateral regression was noted in one case. Six cases underwent bilateral external beam radiotherapy without surgery. One eye of the remaining 56 bilateral cases underwent enucleation. The treatment for the contralateral eyes included cryotherapy in 14 cases, enucleation in 11 cases, Cobalt plaque (Co plaque) therapy in 10 cases, photocoagulation in 6 cases and exenteration in one case. No treatment was undertaken in the contralateral eyes of 14 cases. Secondary treatment modalities employed in these 56 bilateral cases were radiotherapy (11 cases), chemotherapy (8 cases), Co plaque (8 cases) and exenteration (5 cases). Treatment complications were detected in 25 cases followed for at least 18 months. Eighteen cases had radiation cataracts and 6 of these 18 patients underwent intraocular lens implantation. Post-radiation orbital malignancy (osteosarcoma) was noted in two cases aged 14 and 15 years. Phthisis bulbi was observed in three cases and radiation keratitis in two cases. The overall survival rate was 82.2% after a mean follow-up of 5 years. The survival rate of unilateral cases was 82.8% and that of bilateral cases was 81.1% at 5 years.

Adolescent↗
PubMed1995

Vascular tumors of the orbit.

Eighty-five vascular lesions of the orbit examined and treated between 1963-1993 were reviewed retrospectively to reveal the types of vascular tumors, age and sex distribution, clinical characteristics, treatment options and prognosis. Capillary hemangioma was the most frequent orbital vascular tumor accounting for 37 of 85 cases making up 43.5% of the entire orbital masses. Cavernous hemangioma accounted for 35 cases (41.2%), varices for 3 cases (3.5%), anteriovenous malformations for 3 cases (3.5%), angiosarcomas for 3 cases (3.5%), lymphangiomas for 3 cases (3.5%) and hemangiopericytoma for one case (1.2%). Of the 85 vascular tumor cases 43 were encountered in children aged 18 years or less. Capillary hemangioma was the most frequent pediatric orbital vascular lesion, making up 86% of the vascular tumors in this age group. Capillary hemangiomas have been treated with observation and intralesional corticosteroid injections. Cavernous hemangiomas, vascular malformations, lymphangiomas and two cases of angiosarcomas received orbitotomy. One case each of angiosarcoma and hemangiopericytoma underwent exenteration because of the advanced stage of the lesion. There was one tumor-related death who was a 9-year-old boy diagnosed with angiosarcoma. Vascular tumors with the exception of angiosarcomas and hemangiopericytoma behaved as benign lesions.

Adolescent↗
PubMed1995

Pediatric orbital tumors in Turkey.

A retrospective review of 376 pediatric orbital tumor cases seen at the Ankara University Eye Clinic between 1963 and 1993 was undertaken. The diagnosis was made histologically in every case. Secondary tumors accounted for 127 cases (33.8%), cystic lesions for 82 cases (21.8%), rhabdomyosarcomas for 23 cases (6.1%), vascular lesions for 21 cases (5.6%), inflammatory lesions for 21 cases (5.6%), lymphoma and leukemias for 18 cases (4.8%), other mesenchymal tumors for 11 cases (2.9%), metastatic tumors for 5 cases (1.3%), traumatic foreign bodies for 2 cases (0.5%), and lacrimal fossa lesions for 1 case (0.3%). The most common benign orbital tumors were the cystic lesions. The most common primary malignant tumor was rhabdomyosarcoma. Overall, the most frequent orbital lesion was the secondary orbital invasion of retinoblastoma.

Adolescent↗
PubMed1995

Metastatic orbital tumors.

A review was made of the clinical data of 28 patients with metastatic orbital disease diagnosed in our clinic between 1972 and 1993. Fifteen were men and 13 were women. The average age at diagnosis was 58.7 years. The right orbit was involved in 12 and the left orbit in 14 cases. Two cases had bilateral orbital involvement. Breast carcinoma was the most frequent tumor (8 of 28, 28.6%) followed by neuroblastoma (7 of 28, 25.0%), lung carcinoma (6 of 28, 21.4%), prostate carcinoma (3 of 28, 10.7%), gastrointestinal carcinoma (2 of 28, 7.1%), renal cell carcinoma and thyroid carcinoma (1 of 28, 3.6% each). Proptosis (67.9%), motility disturbance (57.1%) and mass (50.0%) were the three most common presenting signs. Enophthalmos was noted in two cases with breast carcinoma. Nine cases presented with ophthalmic signs and metastatic tumor was recognized later. In the remaining 19 cases, the diagnosis of the primary tumor preceded the onset of orbital metastasis. The time interval between the detection of the primary malignancy and metastatic orbital tumor was shortest for lung carcinoma (mean: 2 months) and longest for breast carcinoma (mean: 34 months). Radiotherapy and chemotherapy were applied in 12 cases. Improvement in orbital signs and visual acuity was noted in 5 cases. Radiotherapy, chemotherapy and hormonal therapy were used in 8 patients and improvement in orbital signs was noted in 4 of these patients. Four of 28 patients (2 with breast carcinomas, one with prostate carcinoma and one with thyroid carcinoma) survived longer than 5 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Pneumatic retinopexy with drainage of subretinal fluid.

Thirty bullous retinal detachments were treated with pneumatic retinopexy and drainage of subretinal fluid. Patient selection criteria were similar to pneumatic retinopexy. All the eyes were reattached after the first operation. In three (10%) eyes new breaks with retinal detachment developed within two months after the initial operation and were treated with scleral buckling. One of these three eyes developed proliferative vitreoretinopathy grade D3 two months after scleral buckling. Twenty-nine (96.7%) out of thirty eyes were eventually reattached. The follow-up period was at least nine months. Visual acuity was maintained or improved in 29 (96.7%) eyes. Complications developing due to subretinal fluid like extension of detachment, persistence of subretinal fluid, subretinal gas, reopened retinal breaks were not encountered. By applying cryotherapy to a reattached retina after drainage of subretinal fluid, retinal pigment epithelial dispersion is decreased and the so-called steamroller technique is avoided. Drainage of subretinal fluid did not prevent a good success rate and did not result in additional complications.

Body Fluids↗