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    A Minor Modification of Direct Browplasty Technique in a Patient with Brow Ptosis Secondary to Facial Paralysis: Copy-Paste-Excise and Stitch
    (Hindawi Ltd, 2013) Comez, Arzu Taskiran; Gencer, Baran; Kara, Selcuk; Tufan, Hasan Ali
    Purpose. This report aimed to describe a minor modification of the traditional direct browplasty technique that aids in surgical planning for patients with brow ptosis secondary to facial paralysis without changing the shape of the brow. Case Report. A 74year-old male patient with left facial paralysis secondary to chronic otitis media was referred with a complaint of low vision due to brow ptosis. We performed direct browplasty with a minor modification in order to aid a treatment customized to the patient. In this technique, a transparent film paper is used to copy the brow shape. A brow-shaped excision is facilitated just superior to the ptotic brow. Conclusion. The authors found that the copy-paste-excise and stitch technique was effective and successful for deciding the shape and the amount of excision that should be performed in patients with brow ptosis without resulting in asymmetrical, arched, and feminized brows.
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    A Rare Case of Cystinosis Presenting with Alkalosis
    (Taylor & Francis Ltd, 2013) Topaloglu, Naci; Tekin, Mustafa; Yildirim, Sule; Gencer, Baran
    A 14-month-old girl was admitted to our clinic due to failure to thrive. Her weight and height were below the third percentile for age. Laboratory examination showed signs of alkalosis, hypokalemia, and hypochloremia. However, her urinalysis was consistent with renal tubular acidosis. Radiologic examination showed signs of active rickets. Based on clinical and laboratory findings, we focused on the probable diagnosis of cystinosis. Slit-lamp examination of the cornea confirmed our diagnosis. We should note that the presence of alkalosis does not exclude the possibility of diagnosis of cystinosis and we should be aware that if any slight doubt of cystinosis exists, patients should be carefully and completely evaluated for diagnosis.
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    Accuracy and precision of cap thickness in small incision lenticule extraction
    (Dove Medical Press Ltd, 2013) Ozgurhan, Engin Bilge; Agca, Alper; Bozkurt, Ercument; Gencer, Baran; Celik, Ugur; Cankaya, Kadir IlKer; Demirok, Ahmet
    Aims: To report and compare the cap thickness predictability of small incision lenticule - extraction (SMILE) and flap thickness of femtosecond laser-assisted in situ keratomileusis (femto-LASIK). Settings and design: Beyoglu Eye Training and Research Hospital, Refractive Surgery Department, Istanbul, Turkey. Retrospective pilot study. Materials and methods: Medical records of patients who had SMILE in one eye and femtoLASIK in the other eye were reviewed. Visante corneal Optical Coherence Tomography (OCT) images at 1 week and 1month post-surgery were analyzed. Both cap and flap thickness at the temporal edge and the nasal edge were measured and compared to each other. Statistical analyses used: PAWS Statistics 18 and unpaired student t-test were used to compare the groups. Results: The study included 66 eyes of 33 patients (24.7 +/- 3.8 years, 20 females and 13 males). Mean flap thickness was 114.88 mu m +/- 4.96 mu m, and mean cap thickness was 114.63 mu m +/- 5.18 mu m. In group 1 (SMILE), cap thickness values were 115.84 mu m +/- 6.84 mu m, 114.75 mu m +/- 7.36 mu m, 113.66 mu m +/- 6.88 mu m, and 114.27 mu m +/- 6.90 mu m in measurement zones 1, 2, 3, and 4, respectively. In group 2 (FemtoLASIK), flap corneal thickness values were 115.96mmHg +/- 7.01mmHg, 114.72mmHg +/- 7.17mmHg, 113.54mmHg +/- 6.45mmHg, and 115.30mmHg +/- 6.64mmHg in measurement zones 1, 2, 3, and 4, respectively. In both groups, no statistically significant change within the measurement zones was observed. Conclusion: The predictability of cap thickness in SMILE surgery does not differ from the femto-LASIK flaps created using the same femtosecond laser platform.
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    Alterations in Anterior Segment Parameters After Intravitreal Anti-VEGF Injection Assessed by Scheimpflug Camera
    (2015) Kara, Selçuk; Tufan, Hasan Ali; Gencer, Baran; Arıkan, Sedat; Hondur, Ahmet Murat; Erşan, İsmail
    Amaç: Anti-vasküler endotelyal growth factor (Anti-VEGF) enjeksiyonu sonrası kısa dönem göz içi basıncı (GİB) ve ön segment değişimlerini belirlemek.Gereç ve Yöntem: Vitreus reflüsü olmadan 0.05 ml intravitreal bevacizumab veya ranibizumab enjeksiyonu yapılan prospektif sıralı hasta serisi incelendi. GİB ölçümleri Tono-Pen ile yapıldı. Ön kamara derinliği (ÖKD), ön kamara hacmi (ÖKH) ve ön kamara açısını (ÖKA) içeren ön segment parametreleri Sirius Scheimpflug camera ile ölçüldü. Ölçümler enjeksiyondan hemen önce, enjeksiyondan 5 dakika sonra ve enjeksiyondan 24 saat sonra alındı. Bulgular: Bu çalışmaya uygun toplam 42 hasta dahil edildi. Başlangıç ortalama GİB 15.9±3 mmHg idi ve enjeksiyondan 5 dakika sonra 25.9±10.5 mmHg'ye yükseldi (p<0.001). Enjeksiyondan 24 saat sonra GİB 15±3.4 mmHg olarak normale döndü (p>0.05). Başlangıç ile karşılaştırıldığında herbir zaman diliminde ÖKD ve ÖKH istatistiksel olarak anlamlı değildi (p>0.05). Ortalama ÖKA, başlangıçta 38±6.7?'den enjeksiyondan 5 dakika sonra 36.7±7.1?'e düştü (p=0.004). 24 saat sonra ortalama ÖKA değeri 37.6±7.1? olarak normale döndü (p>0.05).Tartışma: İntravitreal enjeksiyon sonrası ön segment parametrelerinin, ÖKA hariç değişmediği görülmektedir. ÖKA'daki değişimler enjeksiyondan 24 saat sonra GİB değerlerinin düşmesiyle normale döndü.
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    Alterations in Iris Structure and Pupil Size Related to Alpha-1 Adrenergic Receptor Antagonists Use: Implications for Floppy Iris Syndrome
    (Mary Ann Liebert, Inc, 2013) Tufan, Hasan Ali; Gencer, Baran; Kara, Selcuk; Comez, Arzu Taskiran; Kurt, Hasan Anil; Alan, Cabir
    Purpose: To evaluate structural alterations of iris and pupil diameters (PDs) in patients using systemic alpha-1-adrenergic receptor antagonists (alpha-1ARAs), which are associated with intraoperative floppy iris syndrome (IFIS). Methods: Eighty-eight eyes of 49 male were evaluated prospectively. Patients were assigned to 2 different groups. Study group included 23 patients taking any systemic alpha-1ARAs treatment, and control group included 26 patients not taking any systemic alpha-1ARAs treatment. All patients underwent anterior segment optical coherence tomography to evaluate iris thickness at the dilator muscle region (DMR) and at the sphincter muscle region (SMR). The PD was measured using a computerized infrared pupillometer under scotopic and photopic illumination. Results: The study group included 46 eyes of 23 patients and the control group included 42 eyes of 26 patients. Most treated patients were on tamsulosin (16/23). Mean age was similar in the study and control groups (61.9 +/- 7.1 vs. 60.3 +/- 8, 2 years, nonsignificant). DMR (506.5 +/- 89.4 vs. 503.6 +/- 83.5 mu m), SMR (507.8 +/- 78.1 vs. 522.1 +/- 96.4 mu m) and the DMR/SMR ratio (1.0 +/- 0.15 vs. 0.99 +/- 0.23 mm) was similar in the study and control groups and these differences were nonsignificant. Scotopic PDs were also similar in both groups (3.99 +/- 1.11 vs. 3.74 +/- 1.35, nonsignificant). A significantly reduced photopic PD (2.89 +/- 0.55 vs. 3.62 +/- 0.64, P < 0.001) and an increased scotopic/photopic PD (1.42 +/- 0.44 vs. 1.02 +/- 0.30, P < 0.001) were found in the study group. Conclusions: Evaluating PD alterations might be more useful than evaluating iris structural alterations in predicting IFIS. There is still a need for a reliable method that will determine the possibility of IFIS.
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    Authors reply to Letter to the Editor-In response to: Ersan I, Kilic S, Arikan S, et al. Evaluation of macular ganglion cell-inner plexiform layer and choroid in psoriasis patients using enhanced depth imaging spectral domain optical coherence tomography
    (Taylor & Francis Inc, 2017) Ersan, Ismail; Kilic, Sevilay; Arikan, Sedat; Kara, Selcuk; Isik, Selda; Gencer, Baran; Ogretmen, Zerrin
    [Anstract Not Available]
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    Bacterial Contamination of Needles Used for Intravitreal Injections: Comparison between 27-gauge and 30-gauge Needles
    (Informa Healthcare, 2013) Tufan, Hasan Ali; Vural, Ahmet; Gencer, Baran; Kara, Selcuk; Arikan, Sedat; Yuksel, Erdem
    Purpose: To compare the contamination rate between 27-gauge and 30-guage needles used for intravitreal injection (IVT). Methods: Patients undergoing IVT injections were enrolled prospectively. Injections were performed with 27- or 30-gauge needles. All needle tips were collected and placed in brain-heart infusion broth. The contamination rates of needles were compared. Results: A total of 109 patients participated in the study and a total of 126 IVT injections were performed. Injections were performed by 27-gauge (49%) and 30-gauge (51%) needle. No patient developed endophthalmitis. The overall contamination rate of the used needles were 13% for 27-guage and 29% for 30-guage (p = 0.022). However, this difference was nonsignificant after Bonferroni's correction was applied. The most common bacteria isolated from the used needles are coagulase-negative Staphylococcus (CNS). Conclusion: The results suggest that the needle bore size seems not to be a risk factor for contamination during IVT injection.
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    Behçet üveitli bir olguda oral metilprednisolon tedavisine bağlı inatçı hıçkırık
    (2013) Tufan, Hasan Ali; Kocabıyık, Ömer; Arıkan, Sedat; Gencer, Baran; Kara, Selçuk; Güneş, Fahri
    Kortikosteroidler, üveit tedavisinde kullanılan en önemli ilaç grupları arasında yer almaktadır. Bu ajanların topikal, sistemik veya göz çevresine olan kullanım şekilleri, inflamasyonun yeri ve şiddetine göre değişmektedir. Sistemik steroidler; iştah ve davranış değişiklikleri, flushing, sıvı retansiyonu gibi kısa süreli veya osteoporoz, miyopati, hipertansiyon, Cushing sendromu, katarakt ve glokom gibi uzun süreli yan etkilere neden olabilmektedir. Bu çalışmada Behçet üveiti nedeniyle sistemik metilprednisolon başlanan bir hastada gelişen inatçı hıçkırık tablosu sunulmuştur. (Turk J Ophthalmol 2013; 43: 471-3)
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    Bir yetişkinde siklopentolat damla kullanımı sonrası gelişen akut deliryum
    (Çanakkale Onsekiz Mart Üniversitesi, 2013-06) Kara, Selçuk; Gencer, Baran; Ekim, Yeliz Özkanoğlu; Arıkan, Sedat
    [No Abstract Available]
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    Blood gas analyzer utility in evaluating oxygen kinetics of the aqueous humor
    (Consel Brasil Oftalmologia, 2015) Ersan, Ismail; Arikan, Sedat; Toman, Huseyin; Kara, Selcuk; Gencer, Baran; Erbas, Mesut; Tufan, Hasan Ali
    Purpose: To measure the partial pressure of oxygen (PO2) and carbon dioxide (PCO2) and the pH of aqueous humor (AH) and arterial blood samples from rabbits using a blood gas analyzer. Methods: Twenty New Zealand rabbits were anesthetized intramuscularly with ketamine and xylazine and were then allowed to breathe room air. Using a gas blood analyzer, arterial blood and AH samples were analyzed for PO2, PCO2, and pH. Results: The mean arterial blood pressure was 87.14 +/- 15.0 mmHg. The mean blood and AH PO2 were 95.18 +/- 11.76 mmHg and 88.83 +/- 9.92 mmHg, the mean blood and AH PCO2 were 25.86 +/- 5.46 mmHg and 29.50 +/- 5.36 mmHg, and the mean blood and AH pH were 7.38 +/- 0.06 and 7.33 +/- 0.09, respectively. Conclusions: The blood gas analyzer was easily employed to evaluate the aqueous humor in rabbits. When comparing the results of studies evaluating aqueous PO2, care should be taken to determine the methods used in these studies.
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    Central serous chorioretinopathy associated with latanoprost use
    (2013) Tufan, Hasan Ali; Gencer, Baran
    A 55 years old man presented to our clinic with a 3 month history of blurred vision and micropsia in his left eye. He was previously diagnosed with unilateral glaucoma and treatment was initiated with topical latanoprost 0.005% and brimonidine tartrate/timolol maleate 0.2%/0.5% combination for the left eye in another clinic. The symptoms occurred one month after the initiation of glaucoma treatment. Fundus examination, optical coherence tomography and fluorescein angiography revealed a juxtafoveal neurosensory detachment which was coherent with central serous chorioretinopathy (CSC). After the cessation of latanoprost treatment, his clinical status improved and almost complete resolution of neurosensory detachment was observed spontaneously. The use of topical latanoprost may lead to CSC. Clinicians should consider this complication especially in patients presented with decreased visual acuity while using latonoprost.
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    Central serous chorioretinopathy associated with latanoprost use
    (2013) Tufan, Hasan Ali; Gencer, Baran
    Elli beş yaşında erkek hasta kliniğimize üç aydır devam eden sol gözde bulanık görme ve mikropsi şikayetleriyle başvurdu. Hastaya daha önce başka bir klinikte tek taraflı glokom tanısıyla sol göze topikal %0.005 latanoprost ve brimonidin tarta- rat/timolol maleat %0.2/%0.5 kombinasyonu başlanmış. Hastanın şikayetleri glokom tedavisinden bir ay sonra başlamış. Fundus muayenesi, optik koherens tomografi ve floresein anjiografide santral seröz korioretinopati (SSK) ile uyumlu olan jusktafoveal nörosensoryal dekolman izlendi. Latanoprost tedavisinin kesilmesini takiben spontan olarak hastanın klini- ğinin düzeldiği ve neredeyse tama yakın nörosensoryal dekolmanda çözülme izlendi. Topikal latanoprost kullanımı SSK’ye neden olabilir. Klinisyenler, latanoprost kullanırken görme azalması şikayeti ile başvuran hastalarda bu komplikasyonu göz önünde bulundurmalıdır.
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    Changes in retinal nerve fiber layer thickness after spinal surgery in the prone position: a prospective study
    (Elsevier Science Inc, 2015) Gencer, Baran; Cosar, Murat; Tufan, Hasan Ali; Kara, Selcuk; Arikan, Sedat; Akman, Tarik; Kiraz, Hasan Ali
    Background and objectives: Changes in ocular perfusion play an important role in the pathogenesis of ischemic optic neuropathy. Ocular perfusion pressure is equal to mean arterial pressure minus intraocular pressure. The aim of this study was to evaluate the changes in the intraocular pressure and the retinal nerve fiber layer thickness in patients undergoing spinal surgery in the prone position. Methods: This prospective study included 30 patients undergoing spinal surgery. Retinal nerve fiber layer thickness were measured one day before and after the surgery by using optical coherence tomography. Intraocular pressure was measured by tonopen six times at different position and time-duration: supine position (baseline); 10 min after intubation (Supine 1); 10 (Prone 1), 60 (Prone 2), 120 (Prone 3) min after prone position; and just after postoperative supine position (Supine 2). Results: Our study involved 10 male and 20 female patients with the median age of 57 years. When postoperative retinal nerve fiber layer thickness measurements were compared with preoperative values, a statistically significant thinning was observed in inferior and nasal quadrants (p=0.009 and p=0.003, respectively). We observed a statistically significant intraocular pressure decrease in Supine 1 and an increase in both Prone 2 and Prone 3 when compared to the baseline. Mean arterial pressure and ocular perfusion pressure were found to be significantly lower in Prone 1, Prone 2 and Prone 3, when compared with the baseline. Conclusions: Our study has shown increase in intraocular pressure during spinal surgery in prone position. A statistically significant retinal nerve fiber layer thickness thinning was seen in inferior and nasal quadrants one day after the spinal surgery. (C) 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.
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    Comparison of conjunctival graft thickness after primary and recurrent pterygium surgery: Anterior segment optical coherence tomography study
    (Medknow Publications & Media Pvt Ltd, 2014) Ozgurhan, Engin Bilge; Kara, Necip; Bozkurt, Ercument; Gencer, Baran; Yuksel, Kemal; Demirok, Ahmet
    Objective: The objective of the following study is to compare the conjunctival graft thickness measured with anterior segment optical coherence tomography (OCT) after primary and recurrent pterygium excision. Design: Prospective, interventional and comparative study. Participants: A total of 20 eyes of 20 patients with primary pterygium (primary group) and 20 eyes of 20 patients with recurrent pterygium (recurrent group) were enrolled. Materials and Methods: All patients underwent pterygium excision with conjunctival autograft transplantation. Conjunctival graft thickness was measured at 1 week, 1 month and 3 months after surgery using the Visante-OCT (Carl-Zeiss Meditec, Dublin, CA, USA). Main outcome measure was the mean conjunctival thickness determined as the mean of three measurements at 1, 2 and 3 mm posterior to the scleral spur. Results: There were no statistically significant differences in age, sex, or laterality between the groups. Mean thickness of the graft in primary and recurrent groups, respectively, was 430 +/- 127 mu m and 461 +/- 178 mu m at 1 week after surgery (P = 0.587), 114 +/- 19 mu m and 162 +/- 48 mu m at 1 month after surgery (P = 0.001) and 109 +/- 15 mu m and 107 +/- 18 mu m at 3 months after surgery (P = 0.726). Conclusion: The findings revealed that conjunctival thickness after primary or recurrent pterygium excision was greatest at 1 week after surgery and continued to decrease for up to 3 months. Mean graft thickness differed significantly between the two groups only at 1 month after surgery.
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    Comparison of glaucoma diagnosis rates in the tertiary and district clinics
    (Anatolian Journal of Clinical Investigation, 2014) Gencer, Baran; Tufan, Hasan Ali; Yilmaz, Mehmet; Taşkiran Çömez, Arzu
    Between dates 14.11.2012 - 03.09.2013 the patients over the age of 18 were included to the study who applied to the both centers. In patients whose intraocular pressure was found to be elevated and/or optic nerve was found yo be suspect glaucomatous, the glaucoma diagnosis was confirmed by doing computerized visual field and by measuring the retinal nerve fiber layer thickness. Within a year, in both centers the proportion of patients newly diagnosed with glaucoma were compared. Total number of patients who were examined at district polyclinics was 3032 (1406's men and women 1626's) and 17,173 in the university hospital (8019 males and 9154 females) and the mean age was46.7 and 49.3, respectively. While the average age was found statitically higher in faculty hospital (p <0.05), there was not found significant difference between the groups in terms of gender (p> 0.05). The number of newly diagnosed glaucoma patients was found 2 (0.065%) in district polyclinic and 47 (0.27%) in faculty hospital. The proportion of newly diagnosed patients in the university hospital were statistically higher (p <0.05). Even if in the city center, the location and pre-opening promotion of health institutions are also important. We thought that the studies comparing between previously opened, well-known district polyclinics and university hospitals with longer term follow-up would be useful in this topic. © 2014, Anatol J Clin Investig. All rights reserved.
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    Comparison of Transcanalicular Diode Laser Dacryocystorhinostomy and External Dacryocystorhinostomy in Patients with Primary Acquired Nasolacrimal Duct Obstruction
    (Wiley-Blackwell, 2014) Comez, Arzu Taskiran; Karadag, Onur; Arikan, Sedat; Gencer, Baran; Kara, Selcuk
    Background and Objective: To compare the success, complication, and patient discomfort rates of transcanalicular diode laser dacryocystorhinostomy (TCDL-DCR) and external dacryocystorhinostomy (EX-DCR) surgeries performed in patients with primary acquired nasolacrimal duct obstruction. Materials and Methods: Eighty consecutive patients were included in the study, and groups were assigned according to DCR technique. Thirty-four (42.5%) patients received TCDL-DCR (Group A) and 46 (57.5%) patients (Group B) received EX-DCR with temporary silicone stent intubation. The success of surgery was determined by the relief of epiphora, patient satisfaction, endoscopic evaluation of ostium patency, and lacrimal system syringing. Pearson Chi-Square test, Fisher's Exact test, and Student's t-test were used for statistical analyses. Results: Group A included 22 females and 12 males with a mean age of 49.1 +/- 15.1 years, Group B included 35 females and 11 males with a mean age of 50.8 +/- 11.7 years. There was no difference between groups in terms of age and gender (P=0.905 and P=0.167, respectively). The duration of the operation was 22.2 +/- 4.8 minutes for Group A, while it was 56.3 +/- 15.7 minutes for group B (P=0.0001). In two patients in Group A, injury in the medial turbinate was recorded, and in Group B, 14 patients experienced mild to severe perioperative bleeding. The perioperative complication rate was significantly different between the groups (P=0.004). Success in relieving symptoms was 79.4% for Group A and 89.1% for Group B. The difference in the success rates was not statistically significant (P=0.229). Conclusions: Although EX-DCR success rate was higher than that achieved with TCDL-DCR, the latter, with its shorter duration of surgery, lower perioperative complication rate, and a similar success rate, may be a good and acceptable surgical alternative in treatment of primary acquired nasolacrimal duct obstruction. Lasers Surg. Med. 46:275-280, 2014. (C) 2014 Wiley Periodicals, Inc.
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    Corneal thickness of eyes with unilateral age-related macular degeneration
    (Sage Publications Ltd, 2015) Arikan, Sedat; Ersan, Ismail; Kara, Selcuk; Gencer, Baran; Korkmaz, Safak; Vural, Azer Sara
    Purpose: To compare the central corneal thicknesses (CCT), peripheral corneal thicknesses, and corneal volumes (CV) of the 2 eyes of patients with unilateral age-related macular degeneration (AMD). Methods: Twenty patients who were diagnosed with unilateral AMD were included in this prospective study for the purpose of making comparison between the diseased and healthy eyes. Optical coherence tomography and fundus fluorescein angiography imaging were applied to all patients in order to confirm and reveal the presence of unilateral AMD. Then, the measurements of CCT, peripheral corneal thickness measured 4 mm distant from the center of the cornea (4 mm CT), and CV of each eye of these patients were obtained through the rotating Scheimpflug corneal topographer. Results: Wilcoxon signed-rank test did not demonstrate a statistically significant difference between the 2 eyes of patients with unilateral AMD when we compared the CCT and CV of diseased and healthy eyes (p>0.05). However, 4 mm CT of the diseased eyes of these patients were statistically significantly thicker than the healthy eyes (p<0.05). Conclusions: The significant difference in terms of 4 mm CT between the diseased and healthy eyes of patients with unilateral AMD may demonstrate the possible effect of peripheral corneal thickness on the development of AMD.
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    Derin Yerleşimli kornea yabancı cisminin ön segment optik koherans tomografi ile değerlendirilmesi
    (2014) Gencer, Baran; Arıkan, Sedat; Kara, Selçuk; Çömez, Arzu Taşkıran; Tufan, Hasan Ali
    Derin yerleşimli kornea yabancı cisimlere yaklaşımda ön kamaraya girişini değerlendir- mek önemlidir. Ancak biyomikroskobik muayenede bunu değerlendirmek bazen güç olabilmek- tedir. Bu olgunun biyomikroskopik muayenesinde ön kamaraya girişini net olarak değerlendi- rilemeyen derin yerleşimli bir kornea yabancı cisim olduğunu saptadık. Ön segment optik ko- herans tomografi görüntülemesinde yabacı cismin korneayı tam kat olarak geçmediği net ola- rak görüldü. Bu olgu ile derin yerleşimli kornea yabancı cisimlerin değerlendirilmesinde ön segment optik koherans görüntülerinin faydalı olabileceğini göstermeyi amaçladık.
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    Diyabetik Hastalarda Görülen Retinal Nörodejenerasyon İnsülin Direnci Evresinde mi Başlamaktadır?
    (2016) Arıkan, Sedat; Erşan, İsmail; Eroğlu, Mustafa; Yılmaz, Mehmet; Tufan, Hasan Ali; Gencer, Baran; Kara, Selçuk
    Amaç: Diyabetik hastalarda, diyabetik retinal vaskülopati bulgularının varlığından önce başladığı gösterilmiş olan retinal nörodejenerasyon ve kontrast duyarlılıktaki (KD) bozukluğun insülin direnci döneminde de oluşup oluşmadığını araştırmaktır.Gereç ve Yöntem: Retinal nörodejenerasyonunun varlığını değerlendirmek için, optik koherens tomografi kullanılarak ölçülmüş olan gangliyon hücre-iç pleksiform tabakanın (GHİPT) averaj, minimum ve sektöryel (inferior, superior, inferonazal, superonazal, inferotemporal ve superotemporal) kalınlıkları insülin direnci olan grup ile kontrol grubu arasında kıyaslandı. Bunun yanı sıra, her iki grubun KD fonksiyonel keskinlik kontrast testi (FKKT) kullanılarak fotopik ışıkta, 1,5, 3, 6, 12 ve 18 döngü/derecelik uzaysal frekanslarda ölçülmüş logaritmik değerlerine göre kıyaslandı. Bulgular: İnsülin direnci olan 25 hastanın 25 gözü (insülin dirençli grup) ve sağlıklı olan 25 bireyin 25 gözü (kontrol grup) bu çalışmaya dahil edildi. Her iki grup arasında FKKT'nin tüm uzaysal frekansları açısından istatistiksel olarak anlamlı fark yoktu. Kontrol grubu ile karşılaştırıldığında, insülin dirençli grupta GHİPT'nin ortalama averaj kalınlığı ve GHİPT'nin inferotemporal kısmının ortalama kalınlığı anlamlı olarak daha azdı [(GHİPT'nin ortalama averaj kalınlığı insülin dirençli grup ve kontrol grubunda sırasıyla 83,6±4,7 ve 86,7±3,7 µm idi, p=0,01], (GHİPT'nin inferotemporal bölgesinin ortalama kalınlığı insülin dirençli grup ve kontrol grubunda sırasıyla 83±6,0 ve 86,7±4,6 µm idi, p=0,02)].Sonuç: KD kaybı gibi görme gücünde fonksiyonel bozukluğa yol açmamış olsa bile, diyabetik hastalarda görülen retinal nörodejenerasyon insülin direnci evresinde de başlayabilmektedir.
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    Does Retinal Neurodegeneration Seen in Diabetic Patients Begin in the Insulin Resistance Stage?
    (Turkish Ophthalmological Soc, 2016) Arikan, Sedat; Ersan, Ismail; Eroglu, Mustafa; Yilmaz, Mehmet; Tufan, Hasan Ali; Gencer, Baran; Kara, Selcuk
    Objectives: To investigate whether retinal neurodegeneration and impairment in contrast sensitivity (CS), which have been demonstrated to begin in diabetic patients before the presence of signs of diabetic retinal vasculopathy, also occur in the stage of insulin resistance. Materials and Methods: The average, minimum and sectoral (inferior, superior, inferonasal, superonasal, inferotemporal and superotemporal) thicknesses of the ganglion cell-inner plexiform layer (GCIPL) measured using optical coherence tomography were compared between an insulin-resistant group and control group in order to evaluate the presence of retinal neurodegeneration. The CS of the two groups was also compared according to the logarithmic values measured at spatial frequencies of 1.5, 3, 6, 12 and 18 cycles per degree in photopic light using functional acuity contrast test (FACT). Results: Twenty-five eyes of 25 patients with insulin resistance (insulin resistant group) and 25 eyes of 25 healthy subjects (control group) were included in this study. There were no statistically significant differences between the two groups in any of the spatial frequencies in the FACT. The mean average GCIPL thickness and mean GCIPL thickness in the inferotemporal sector were significantly less in the insulin-resistant group when compared with the control group (mean average GCIPL thicknesses in the insulin-resistant and control groups were 83.6 +/- 4.7 mu m and 86.7 +/- 3.7 mu m respectively, p = 0.01; mean inferotemporal GCIPL thicknesses in the insulinresistant and control groups were 83 +/- 6.0 mu m and 86.7 +/- 4.6 mu m respectively, p = 0.02). Conclusion: Although it may not lead to functional visual impairment such as CS loss, the retinal neurodegeneration seen in diabetic patients may begin in the insulin resistance stage.