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Sevim M.S.,Haydarpasa Numune Research and Education Hospital | Buttanri I.B.,Haydarpasa Numune Research and Education Hospital | Kugu S.,Kartal Lutfi Kirdar Research and Education Hospital | Serin D.,Haydarpasa Numune Research and Education Hospital | Sevim S.,Uskudar State Hospital

Purpose: To assess the efficacy of preoperative intravitreal bevacizumab injection (IVB) before Ahmed glaucoma valve (AGV) implantation in the treatment of neovascular glaucoma (NVG). Methods: This retrospective, comparative and consecutive case series study included 41 eyes from 41 patients who underwent AGV implantation for treatment of NVG. The study group was composed of 19 patients (19 eyes) to whom IVB was administered before surgery, while the control group was composed of 22 patients (22 eyes) to whom IVB was not administered before AGV implantation. Findings such as intraocular pressures measured before and after surgery, surgical success rates, and postoperative complications were compared between the groups. Results: There were no significant differences in preoperative data between groups. The surgical success rate in the study group (79%) was better than in the control group (64%), but this difference was not statistically significant (p = 0.28). Early postoperative complications such as fibrinous reaction in the anterior chamber as well as hyphema were less frequently observed in the study group. Conclusions: Intravitreal bevacizumab is a useful preparatory step to safely and effectively implant an aqueous shunting tube in eyes with severe NVG and intractable intraocular pressure. Copyright © 2012 S. Karger AG, Basel. Source

Akdemir M.O.,Bulent Ecevit University | Kandemir B.,Kartal Lutfi Kirdar Research and Education Hospital | Sayman I.B.,Kartal Lutfi Kirdar Research and Education Hospital | Selvi C.,Darica Armedica Eye Hospital | Dogan O.K.,Kudret Eye Hospital
International Journal of Ophthalmology

AIM: To evaluate postoperative visual acuity and contrast sensitivity results following deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in patients with keratoconus (KC). METHODS: All the patients' records with KC who had PK or DALK surgery between May 2010 and May 2011 were retrospectively reviewed. Sixty patients who underwent successful corneal transplantation for KC: 30 eyes underwent DALK and 30 eyes underwent PK were included in this study. Preoperative and postoperative mean logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity (UCVA), logMAR best spectacle-corrected visual acuity (BSCVA) and intraocular pressure (IOP) were evaluated. Contrast sensitivity tests (CS) were done preoperative and 2 months after all sutures had removed. All surgeries were performed under regional anesthesia (retrobulbar anesthesia) by 1 surgeon (B.K.) who was experienced in penetrating and lamellar keratoplasty techniques. RESULTS: The mean age of the DALK group was 29.67 ± 4.95 (range 18-40) years and the PK group was 28.7 ± 3.53 (range 18-39) years. Preoperatively there was no significant difference in the logMAR UCVA, logMAR BSCVA and IOP between the DALK (1.281 ± 0.56; 0.97 ± 0.85; 12.07 ± 2.12mmHg) and PK (1.34 ± 0.21; 0.98 ± 0.21; 13 ± 2.12mmHg) groups. One-year after surgery there was no significant difference in the mean logMAR UCVA and IOP between the DALK (0.46 ± 0.37; 11.73 ± 2.1mmHg) and PK (0.38 ± 0.21; 12 ± 2.12mmHg) groups. The mean contrast sensitivity was evaluated by CC-100 Topcon LCD at 1.5, 2.52, 4.23, 7.10 and 11.91 cycles per degree (cs/deg) spatial frequencies before and 2 months after the all sutures had removed. CONCLUSION: All patients with keratoconus in both DALK and PK groups performed good visual function postoperatively. The mean contrast sensitivity increased considerably at all spatial frequencies compared with preoperative levels in the DALK and PK groups. The mean post-operative evaluation of contrast sensitivity measurements was not significantly different between the two groups. Copyright International Journal of Ophthalmology Press. Source

Simsek-Yavuz S.,Istanbul University | Sensoy A.,Siyami Ersek Thoracic and Cardiovascular Surgery Hospital | Kasikcioglu H.,Siyami Ersek Thoracic and Cardiovascular Surgery Hospital | Ceken S.,Siyami Ersek Thoracic and Cardiovascular Surgery Hospital | And 6 more authors.
International Journal of Infectious Diseases

Objective: In order to define the current characteristics of infective endocarditis (IE) in Turkey, we evaluated IE cases over a 14-year period in a tertiary referral hospital. Methods: All adult patients who were hospitalized in our hospital with a diagnosis of IE between 2000 and 2013 were included in the study. Modified Duke criteria were used for diagnosis. The Chi-square test, Student's t-test, Mann-Whitney U-test, Cox and logistic regression analysis were used for the statistical analysis. Results: There were 325 IE cases during the study period. The mean age of the patients was 47 years. Causative microorganisms were identified in 253 patients (77.8%) and included staphylococci (36%), streptococci (19%), enterococci (7%), and Brucella spp (5%). A streptococcal aetiology was associated with younger age (<40 years) (p= 0.001), underlying chronic rheumatic heart disease (CRHD) (odds ratio (OR) 3.89) or a congenital heart defect (OR 4.04), community acquisition (OR 17.93), and native valve (OR 3.68). A staphylococcal aetiology was associated with healthcare acquisition (OR 2.26) or pacemaker lead-associated endocarditis (OR 6.63) and an admission creatinine level of >1.2. mg/dl (OR 2.15). Older age (>50 year) (OR 3.93), patients with perivalvular abscess (OR 9.18), being on dialysis (OR 6.22), and late prosthetic valve endocarditis (OR 3.15) were independent risk factors for enterococcal IE. Independent risk factors for mortality in IE cases were the following: being on dialysis (hazard ratio (HR) 4.13), presence of coronary artery heart disease (HR 2.09), central nervous system emboli (HR 2.33), and congestive heart failure (HR 2.15). Higher haemoglobin (HR 0.87) and platelet (HR 0.996) levels and surgical interventions for IE (HR 0. 33) were found to be protective factors against mortality. Conclusions: In Turkey, IE occurs in relatively young patients and Brucella spp should always be taken into consideration as a cause of this infection. We should first consider streptococci as the causative agents of IE in young patients, those with CRHD or congenital heart valve disease, and cases of community-acquired IE. Staphylococci should be considered first in the case of pacemaker lead IE, when there are high levels of creatinine, and in cases of healthcare-associated IE. Enterococci could be the most probable causative agent of IE particularly in patients aged >50 years, those on dialysis, those with late prosthetic valve IE, and those with a perivalvular abscess. The early diagnosis and treatment of IE before complications develop is crucial because the mortality rate is high among cases with serious complications. The prevention of bacteraemia with the measures available among chronic haemodialysis patients should be a priority because of the higher mortality rate of subsequent IE among this group of patients. © 2014 The Authors. Source

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