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Biomedical subjects

Yonca A Akova

Publications and source records attributed to Yonca A Akova.

At least 19 recordsLinked to original sources
PubMed2006

Vascularization is more delayed in amniotic membrane graft than conjunctival autograft after pterygium excision.

PURPOSE: To monitor the development of graft vascularization by indocyanine green angiography (ICGA) after pterygium excision with limbal-conjunctival autograft transplantation (LCAT) and amniotic membrane transplantation (AMT). DESIGN: Randomized prospective interventional case series. METHODS: Anterior segment ICGA findings at one, seven, and 30 days after surgery were evaluated in eyes with primary pterygium treated by excision and LCAT (14 eyes of 14 patients) or AMT (13 eyes of 13 patients), and the results for graft vascularization were compared. RESULTS: All conjunctival autografts showed early vascularization from underlying episcleral vascular bed as multiple hyperfluorescent foci at the graft margin on postoperative day 7; graft vascularization was complete on postoperative day 30. In contrast, all grafts in AMT group showed no graft vascularization at any stage after pterygium surgery. This delay of vascularization with AMT persisted until one month after surgery. CONCLUSIONS: Anterior segment ICGA is useful to monitor graft vascularization after pterygium surgery. Graft health after LCAT may be demonstrated by early graft vascularization and perfusion; however, there is a delay in graft vascularization after AMT that may be related to the antiangiogenic effects of the membrane. Further study is needed to demonstrate the relationship between this delay of graft perfusion and early postoperative pterygium recurrence.

Adult↗
PubMed2006

The spectrum of Vogt-Koyanagi-Harada disease in Turkey: VKH in Turkey.

AIM: The aim of this report was to provide a detailed description of the clinical features of Vogt-Koyanagi-Harada (VKH) disease in Turkish patients. METHODS: We retrospectively analyzed 45 patients diagnosed with VKH disease at seven referral centers in Turkey. A standard data acquisition form was used for the analysis of demographic and clinical features. RESULTS: The study cohort consisted of 45 patients (32 female, 13 male) who had a mean age at presentation of 31 years. Seven patients (15%) were aged 16 years or younger. Nineteen (42%) patients presented in the acute or subacute stage and 26 (58%) in the chronic stage. According to the revised diagnostic criteria, nine (20%) patients had the complete form of the disease, 23 (51%) had the incomplete form, and 13 (29%) had probable VKH disease. All patients had bilateral ocular involvement. Sunset-glow fundus was observed in 89% of the patients, pigment clumping in 73%, nummular depigmented scars in 71%, cataract in 53%, optic atrophy in 31%, glaucoma in 29%, subretinal fibrosis in 22%, choroidal neovascular membranes in 7%, and phthisis in 4%. All patients who presented at the acute uveitic stage received systemic corticosteroid therapy. Immunosuppressive treatment was employed in 30 (66%) patients, which was initiated at the acute uveitic stage in ten (22%) patients. Final visual acuity was better than 0.5 in 59% of the patients' eyes, between 0.1 and 0.5 in 21%, and less than 0.1 in 20%. CONCLUSIONS: VKH disease is rare in Turkey. We conclude that the majority of patients with VKH in Turkey do not have the complete form of the disease. Based on our results, most patients with VKH seem to be late referrals. Ocular complications were common among these patients.

Acute Disease↗
PubMed2006

Spontaneous posterior dislocation of both lenses in a patient with Marfan's syndrome: 17 years without complications.

In a twenty five-year-old female patient, we observed bilateral lens dislocation into the vitreous body that occurred spontaneously as a result of Marfan's syndrome and megalocornea, when she was 8 years old. Corneal diameters were 14 mm in the right eye and 13.5 mm in the left eye. Slit-lamp examination revealed miosis and iridodonesis. Fundus examination revealed bilateral inferior lens dislocation into the vitreous body. There was no lens induced posterior uveitis in either eye. This patient demonstrated that lens dislocation into the vitreous body can be present for a long time without causing any intraocular inflammation.

Adult↗
PubMed2006

Smoking associated with damage to the lipid layer of the ocular surface.

PURPOSE: To evaluate the effects of smoking on ocular surface. DESIGN: Prospective, comparative, interventional case series. METHODS: setting: Institutional. study population: Sixty smokers (33 men, 27 women) and 34 healthy subjects (18 men, 16 women) were enrolled into this study. Patients with associated ophthalmic or systemic diseases, and history of contact lens use and ocular surgery were excluded. The duration of average smoking was 13.1 years (range 5 to 35 years). INTERVENTION: Ocular surface was evaluated by measuring corneal and conjunctival sensitivity, surface staining with fluorescein, tear film breakup time, Schirmer 1 test, and conjunctival impression cytology. Dry eye symptoms were scored by questionnaire. Kinetic analysis of sequential tear interference images obtained by a DR-1 tear lipid layer interferometry was used to investigate the precorneal lipid layer spread. Results were compared with a control group. MAIN OUTCOME MEASURES: Comparison of subjective complaints with objective parameters in cigarette smokers and normal subjects. RESULTS: In the smoker group, the mean Schirmer 1 test value was 10.8 mm (range 8 to 14 mm). The mean breakup time was 5.3 seconds (range 1 to 10 seconds), the average conjunctival sensitivity was 26.2 mm (range 0 to 45 mm), and the average central corneal sensitivity was 37.6 mm (range 5 to 60 mm). There was no statistically significant difference in goblet cell densities or in Schirmer 1 test values between smokers and controls (P > .05). Higher grades of lipid layer changes were observed in smokers by DR-1 interferometry kinetic analysis. CONCLUSIONS: Smoking has deteriorating effects on the lipid layer of precorneal tear film.

Adult↗
PubMed2006

Risk factors in the development of mild and severe retinopathy of prematurity.

PURPOSE: To evaluate the risk factors in the development of mild and severe retinopathy of prematurity (ROP). METHODS: All infants (n = 88) screened for ROP at a neonatal intensive care unit over a 2-year period with gestational age <or=34 weeks and follow-up of 43 weeks postconception were included. The findings were classified in accordance with the International Classification of Retinopathy of Prematurity. The study group was classified into three subgroups: group A included patients without retinopathy; group B included patients with stage 1 or 2 (mild-ROP); and group C included patients who progressed to moderate or severe stage 3 (severe-ROP) and were treated. A retrospective review of records was performed and statistical analysis of eight possible risk factors for ROP was evaluated by using logistic regression. RESULTS: Logistic regression analysis showed birth weight (BW) (p=0.019) and respiratory distress syndrome (p = 0.029) as independent significant risk factors for the development of stage 1 and 2 ROP, with BW (p < 0.0001) as an independent significant risk factor for the progression to stage 3 ROP. Total volume of blood transfusion and duration of artificial ventilation were also found to be risk factors with high rates of stage 3 ROP. In group C, BW <or=1000 g (p = 0.0002) and gestational age <or=28 weeks (p < 0.0001) were significant risk factors associated with higher rates of ROP. CONCLUSIONS: This study showed BW and respiratory distress syndrome as independent risk factors in the development of mild ROP and BW in the development of severe ROP.

Birth Weight↗
PubMed2006

Inflammation of the posterior uvea: findings on fundus fluorescein and indocyanine green angiography.

PURPOSE: To investigate the additional benefit of indocyanine green angiography (ICGA) over fundus fluorescein angiography (FA) in patients with posterior uveal inflammation. METHODS: The features of 19 patients with different forms of posterior uveitis (Vogt-Koyanagi-Harada disease [n = 5], serpiginous choroiditis [n = 5], multifocal choroiditis [n = 5], and sarcoidosis [n = 4]) were analyzed. RESULTS: On ICGA, inflammatory lesions were hypofluorescent in all phases, and early choroidal vessel dilation and leakage was noted near the lesions. CONCLUSIONS: The combined use of FA and ICGA helps gauge the severity of inflammation in the choroid and the retina during active inflammation. In quiescent stages, however, ICGA does not give any additional information.

Adult↗
PubMed2006

Secondary bacterial keratitis associated with shield ulcer caused by vernal conjunctivitis.

PURPOSE: To report a patient with vernal keratoconjunctivitis-induced shield ulcer superinfected with Staphylococcus aureus. METHODS: Observational case report. A 12-year-old boy who had been followed for vernal keratoconjunctivitis for 3 years was admitted to our clinic complaining of visual loss, photophobia, and a ropy discharge. On slit-lamp examination, a transversely oval shield ulcer, which was situated in the center of the superior third of the cornea, was seen in the left eye. The vernal corneal plaque area and margins were infiltrated, and hypopyon was also observed. With the diagnosis of shield ulcer with secondary bacterial keratitis and hypopyon, the patient underwent medical treatment consisting of topical fortified cefazolin (50 mg/mL) and tobramycin (14 mg/mL), lodoxamide 0.1%, prednisolone acetate 1%, cyclopentolate, and systemic cetirizine. RESULTS: After treatment, the bacterial keratitis, shield ulcer, and inflammation in the anterior chamber disappeared. CONCLUSION: Bacterial keratitis associated with shield ulcer may be rarely observed in patients with vernal keratoconjunctivitis. Prompt diagnosis and treatment may prevent permanent complications and vision loss.

Anti-Bacterial Agents↗
PubMed2006

Amniotic membrane transplantation for treatment of symblepharon in a patient with recessive dystrophic epidermolysis bullosa.

PURPOSE: To report the surgical treatment of a case with epidermolysis bullosa. METHODS: A 12-year-old girl with dystrophic epidermolysis bullosa presented to our clinic with a symblepharon connecting the lateral half of the left upper lid to the upper temporal quadrant of the cornea. The central cornea exhibited diffuse opacity and vascularization. RESULTS: During surgery, the symblepharon was lysed, and lamellar keratectomy was performed. The operated portion of cornea and palpebral conjunctiva was covered with amniotic membrane to promote healing. Fourteen months later, the operated eyelid margin was normal and the eye was fully mobile. The temporal portion of the corneal stroma was still thinner than normal and showed mild superficial vascularization and opacification. CONCLUSION: We believe that amniotic membrane transplantation is a valuable way to treat symblepharon in cases of epidermolysis bullosa.

Amnion↗
PubMed2005

Tear clearance measurement in patients with dry eye syndrome using quantitative lacrimal scintigraphy.

OBJECTIVE: The aim of this study was to evaluate the tear clearance in patients with dry eye syndrome using quantitative lacrimal scintigraphy. MATERIALS AND METHODS: We investigated 21 patients (42 eyes; 18 women, 3 men; mean age, 63.19 +/- 13.33 years) with dry eye syndrome. Additionally, for the sake of comparison, 12 normal subjects of the same age group (24 eyes; 10 women, 2 men; mean age, 68.25 +/- 2.63 years) were included. Lacrimal scintigraphy, Schirmer-1 test, BUT, and rose bengal ocular surface vital staining were performed in these cases. RESULTS: According to the results of lacrimal scintigraphy, the mean value of T 1/2 was 4.16 +/- 1.22 minutes and the mean value of RI was 14.15% +/- 2.30% in normal subjects. However, in patients with dry eye syndrome, these values were 20.59 +/- 1.97 minutes and 55.64% +/- 6.90%, respectively. Consistent with the results of ophthalmologic tests, the mean Schirmer-1 value was 12.46 +/- 2.10 mm, the mean value of BUT was 14.36 +/- 3.40 seconds, and the mean staining value of the rose bengal was 1.98 +/- 0.80 in normal subjects, whereas these values were 1.36 +/- 0.49 mm, 5.46 +/- 1.33 seconds, 6.62 +/- 0.86, respectively, in patients with dry eye syndrome. When we compared the results of lacrimal scintigraphy and the results of ophthalmologic tests, an inverse correlation was noted between both the T1/2 and RI values and both the Schirmer-1 and BUT values in all subjects (p < 0.001). However, there was a greater positive correlation between the rose bengal ocular surface staining value and both the T1/2 and RI values in all cases (p < 0.001). CONCLUSION: In the current study, it was concluded that although the lacrimal drainage system was normal, tear clearance was significantly delayed in dry eye patients. With this study, we have shown that quantitative lacrimal scintigraphy, which is an objective, practical, and noninvasive method, appears to be useful for the assessment of the tear clearance in patients with dry eye syndrome.

Aged↗
PubMed2004

Scleritis associated with sarcoidosis.

PURPOSE: To review scleritis cases associated with sarcoidosis and to evaluate clinical features, medical treatment, and clinical course. METHODS: Two cases of diffuse anterior scleritis and a nodular scleritis case associated with systemic sarcoidosis were evaluated. Scleritis was the first manifestation of sarcoidosis in two of the patients and the diagnosis of sarcoidosis was confirmed with a conjunctival biopsy. The third patient had the diagnosis of systemic sarcoidosis when she developed scleritis. RESULTS: Based on the clinical and histological appearance, two patients presented with bilateral diffuse anterior scleritis and the third patient with an anterior nodular scleritis. One patient already had the diagnosis of systemic sarcoidosis at presentation, while ocular findings led to the diagnosis in the other two cases. Conjunctiva or skin biopsies revealed features compatible with the diagnosis of sarcoidosis. Scleritis attacks recurred in two patients. All patients responded well to systemic corticosteroid (prednisone) therapy. CONCLUSIONS: Scleritis associated with sarcoidosis has rarely been described and it may be the presenting sign of systemic sarcoidosis.

Aged↗
PubMed2004

Branch retinal arterial occlusion associated with toxoplasmic chorioretinitis.

BACKGROUND: Ocular toxoplasmosis can cause a variety of retinal vascular changes including branch retinal arterial occlusion, which is a rare complication of the disease. PATIENT AND METHODS: We report a case of toxoplasmic chorioretinitis in a pregnant woman, who developed branch retinal arterial obstruction adjacent to the active chorioretinitis lesion. RESULTS: The patient received an appropriate steroid and antibiotic treatment and the retinitis lesion resolved over a six-week period. At two months after diagnosis, visual acuity in her right eye was 20/30 and there was a hyperpigmented scar at the site where active retinitis had been observed. CONCLUSION: Especially in young patients with branch retinal vascular occlusion associated with posterior uveitis, the diagnosis of ocular toxoplasmosis should be kept in mind and serologic test results should be obtained.

Adult↗
PubMed2003

Ocular surface changes in keratoconjunctivitis sicca with silicone punctum plug occlusion.

PURPOSE: To evaluate histopathologic and clinical response to silicone plug insertion in dry eye patients. METHODS: Punctal plugs were placed in 32 eyes of 18 dry eye patients with aqueous deficiency who were on maximum medical therapy and who had Schirmer testing with topical anesthetic measuring less than 5 mm. Pre-treatment and post-treatment (6 weeks and 1 year) evaluations included temporal and inferior quadrant impression cytology examinations, Schirmer-1, BUT, corneal fluorescein and rose-bengal staining patterns and questionnaire scores. The cytology samples were graded according to the method described by Nelson. RESULTS: There was an improvement in subjective symptoms of patients 6 weeks after punctal occlusion. Corneal fluorescein and rose-bengal staining scores decreased from a mean of 5.33 +/- 1.74 to 1.37 +/- 1.48 and from 5.90 +/- 1.2 to 2.45 +/- 1.89 (p < 0.05) respectively. BUT values increased from 2.98 +/- 1.1 to 11.3 +/- 3.1 seconds (p < 0.05) at 6 weeks post-treatment. Increase in goblet cell density was observed after punctal occlusion at 6 weeks (p < 0.05) and at 1 year (p < 0.05) compared to the pre-treatment values. After occlusion, 3% of temporal specimens had Grade 0 squamous metaplasia, 63% had Grade 1, 34% had Grade 2; while 25% of inferior specimens had Grade 0, 56% had Grade 1, 19% had Grade 2 squamous metaplasia. CONCLUSIONS: Punctum plug occlusion in keratoconjunctivitis sicca provides improvement of tear film stability, ocular surface staining scores, conjunctival squamous metaplasia grades and goblet cell density. Increased ocular surface exposure to essential tear components with punctal occlusion may be important for the genesis of these changes.

Adult↗
PubMed2002

Ocular toxoplasmosis presenting as neuroretinitis: report of two cases.

BACKGROUND: Neuroretinitis is a clinical entity usually seen in young healthy adults, that is characterized by rapid profound unilateral loss of vision and includes optic nerve head edema, splinter hemorrhages, macular exudate in a stellate pattern, and variable vitreous inflammation. There are numerous entities that can cause a picture of neuroretinitis ranging from vascular to infectious to autoimmune. PATIENT AND METHODS: We report two patients with neuroretinitis, who presented with unilateral blurred vision and had serologic evidence of Toxoplasma gondii infection. RESULTS: Both patients responded well to treatment with systemic antibiotics and corticosteroids. Visual acuity returned to 20/60 in one patient and 20/20 in the other. CONCLUSION: Although the etiology is usually idiopathic, infectious causes of neuroretinitis, including toxoplasmosis, should be kept in mind in order to maintain visual acuity by early diagnosis and appropriate therapy.

Animals↗