Yaprak Ünver - Academia.edu (original) (raw)

Papers by Yaprak Ünver

Purpose: To determine the prognostic factors of functional outcomes in eyes with severe prolifera... more Purpose: To determine the prognostic factors of functional outcomes in eyes with severe proliferative diabetic retinopathy (PDR) managed with pars plana vitrectomy (PPV). Materials and Methods: A series of 136 consecutive eyes with severe PDR and non-clearing vitreous hemorrhage (VH) or retinal detachment (RD) that underwent PPV were retrospectively reviewed for prognostic risk factors of surgical outcomes and post-operative vision. Chi-square and logistic regression analysis were used for statistical analysis. Results: Average follow-up was 35 months (range 6-56). A functional outcome (VA>5/200) was achieved in 109 eyes (80.1%) and in 51 of 66 eyes (77.3%) with traction retinal detachment. The VA was improved two lines or more in 79 eyes (58.1%), unchanged in 37 (27.2%), and was worse by 2 lines or more in 20 eyes (14.7%). Complete retinal attachment was observed at the final visit in 122 eyes (89.7%). Predictors of a poor visual outcome were found to be preoperative neovascular...

Current Concepts and Management of Eye Injuries, 2016

Turkiye Klinikleri Journal of Ophthalmology, 2010

We present a power-variable rate-adaptive LDPC-coded polarization multiplexed coherent OFDM schem... more We present a power-variable rate-adaptive LDPC-coded polarization multiplexed coherent OFDM scheme, suitable for use in optically-routed networks in which different lightwave paths experience different penalties due to deployment of ROADMs and WXCs. We demonstrate that channel capacity can be closely approached with proposed scheme .

Turkiye Klinikleri Journal of Ophthalmology Special Topics, 2011

Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2009

To determine the prognostic indicators of functional outcome in eyes with severe posterior segmen... more To determine the prognostic indicators of functional outcome in eyes with severe posterior segment trauma managed with pars plana vitrectomy. One hundred and six eyes of 101 patients were retrospectively reviewed to determine the accuracy of a number of factors in predicting functional outcome after surgery. These potential prognostic indicators included initial visual acuity (VA), retinal detachment (RD), type of trauma, presence of intraocular foreign body (IOFB), type of IOFB, posttraumatic endophthalmitis, hyphema, choroidal detachment, initial hypotonia, accompanying lens subluxation/dislocation, and severe vitreous hemorrhage. In our study, functional success was defined as VA > or =5/200. Fisher's exact and chi-square tests were used for statistical analysis. The mean follow-up time was 12.8+/-0.52 (8-18) months. Thirty-three eyes (31.13%) had functional success. Forty-four (68.7%) of 64 eyes with preoperative RD had anatomical success (total retinal reattachment). Pre...

Retinal Cases & Brief Reports, 2009

To report a case with type I osteogenesis imperfecta (OI) with intravitreal opacities who underwe... more To report a case with type I osteogenesis imperfecta (OI) with intravitreal opacities who underwent 25-gauge sutureless vitrectomy. A 2.5-year-old girl with OI type I who presented with intravitreal opacities underwent 25-gauge sutureless vitrectomy. The 25-gauge sutureless vitrectomy system, which is less traumatic, was performed in a patient with OI type I. Nine months postoperatively, funduscopic examination under general anesthesia showed a healthy optic nerve and retina without detachment. Intraocular pressure by Tonopen was 10 mmHg. The use of 25-gauge sutureless vitrectomy to avoid scleral suturing and minimize surgical trauma is an option in pediatric patients with associated thin sclera.

Retina, 2008

The purpose of this article was to evaluate the outcomes and complications of transconjunctival s... more The purpose of this article was to evaluate the outcomes and complications of transconjunctival sutureless 25-gauge vitrectomy using silicone oil tamponade in diabetic tractional retinal detachment. Patients were retrospectively evaluated. Main outcome measure was the feasibility of pars plana vitrectomy and silicone oil injection with 25-gauge system in eyes with diabetic tractional retinal detachment. Fourteen eyes of 14 patients were included in the study. Tractional retinal detachment was accompanied by vitreous hemorrhage in 9 eyes and combined traction/rhegmatogenous retinal detachment was present in 1 eye. All patients underwent transconjunctival sutureless 25-gauge vitrectomy and 1,000 centistokes silicone oil injection. Angled insertion of the trocars was made in all eyes. Bimanual surgery was performed in 6 (42.8%) eyes. The median preoperative best-corrected visual acuities were 3.00 logarithm of the minimum angle of resolution; it increased to 1.60 logarithm of the minimum angle of resolution at last visit. Retinal tear formation occurred in 4 (28.5%) eyes. Retinal detachment developed in 2 (14.2%) eyes. Intraocular pressure of 5 mmHg or less was detected in 3 (21.4%) eyes. One patient lost light perception due to anterior hyaloidal fibrovascular proliferation. Pars plana vitrectomy and 1,000 centistokes silicone oil injection with 25-gauge system is feasible in diabetic tractional retinal detachment even in complex cases. Indications of 25-gauge surgery may be expanded toward this area.

Retina, 2009

To evaluate the success of initial treatment and the factors influencing the outcome in acute-ons... more To evaluate the success of initial treatment and the factors influencing the outcome in acute-onset endophthalmitis after cataract surgery. We retrospectively reviewed the medical records of all patients with acute postoperative endophthalmitis between 2000 and 2007. We performed pars plana vitrectomy (PPV) to all eyes with initial visual acuity of light perception. Eyes with visual acuity of hand motions or better underwent either intraocular antibiotic injection (IOAI) or PPV. Eyes that did not give a good clinical response to initial therapy within 60 hours underwent a second procedure. The main outcome measure was the rate of early reintervention after PPV and IOAI. We evaluated 88 eyes of 88 patients. Thirty-seven patients underwent PPV and 51 patients underwent IOAI alone. Six of 37 (16.2%) patients required 1 or more procedures within 60 hours of the initial procedure in the PPV group. Twenty-eight of 51 eyes (54.9%) in the IOAI group underwent PPV within 60 hours. The rate of response to primary PPV was significantly higher than to primary IOAI (P < 0.001). Gram-negative organisms composed 35.1% of the isolates. Pars plana vitrectomy may be preferable to IOAI in postoperative endophthalmitis since the rate of early reintervention is lower with initial PPV.

Retina, 2008

To evaluate the anatomic and functional outcomes of 25-gauge sutureless vitrectomy in primary tre... more To evaluate the anatomic and functional outcomes of 25-gauge sutureless vitrectomy in primary treatment of noncomplex pseudophakic rhegmatogenous retinal detachments (RRD). Prospective interventional institutional case series. Twenty-two eyes with pseudophakic RRD with proliferative vitreoretinopathy grade A or B underwent primary 25-gauge vitrectomy with oblique sclerotomies and gas endotamponade. Eyes with minimum follow-up of 6 months were evaluated. Main outcome measures were reattachment rate with single surgery, reoperation, complication rates, and changes in visual acuity (VA). Mean duration of visual loss was 14.68 +/- 12.87 days. Seventeen (77.27%) eyes had macular detachment. In all eyes 25-gauge sutureless vitrectomy was completed without complications. The mean follow-up period was 10.40 +/- 5.77 months. Retinal attachment was achieved in 21 (95.45%) eyes with single surgery and in all (100%) eyes with second vitrectomy. Mean preoperative VA of 1.61 +/- 1.18 improved to 0.50 +/- 0.53 at the last visit (P < 0.001). Transient hypotony was detected in 2 (9.09%) eyes with spontaneous resolution. No other postoperative complication was observed. Twenty-five-gauge sutureless vitrectomy with oblique sclerotomies in primary treatment of noncomplex pseudophakic RRDs resulted in reattachment in 95.45% with single surgery, and in 100% with reoperation in one eye, accompanied by an increase in visual acuity in 86% of eyes.

Retina, 2010

The purpose of this study was to evaluate the safety and efficacy of iris claw intraocular lens i... more The purpose of this study was to evaluate the safety and efficacy of iris claw intraocular lens implantation for correction of aphakia in vitrectomized eyes without capsular support. This was a prospective interventional case series. Twelve aphakic vitrectomized eyes without capsular support underwent iris claw intraocular lens implantation. The main outcome measures were changes in uncorrected visual acuity, best-corrected visual acuity, spheric equivalent, corneal endothelial cell density, corneal thickness, central macular thickness, and complications. Mean follow-up was 15.58 +/- 3.80 months with no intraoperative complications. Postoperatively, uncorrected visual acuity increased significantly at all follow-up visits (P < 0.05). Mean best-corrected visual acuity increased 10 letters/2 lines at the final follow-up visit (P = 0.023). Mean postoperative spheric equivalent at the last visit was -1.68 +/- 063 D, and the spheric equivalent was within +/-2.00 D of emmetropia in 9 (75%) eyes. Mean central macular thickness increased only at postoperative Month 3 (P = 0.043). Mean endothelial cell density loss was 23.87% at the last visit. Mean corneal thickness did not change during follow-up (P > 0.05). No corneal edema was observed. Complications were transient intraocular pressure increase (n = 1), cystoid macular edema (n = 1), and haptic dislocation replaced by surgery (n = 1). Retinas remained attached in all eyes. Secondary iris claw intraocular lens implantation is clinically safe and effective to correct aphakia in vitrectomized eyes without capsular support. Larger studies with longer follow-up are warranted.

Ophthalmology, 2013

To study the outcome of the treatment of complex rhegmatogenous retinal detachments (RRDs). Nonra... more To study the outcome of the treatment of complex rhegmatogenous retinal detachments (RRDs). Nonrandomized, multicenter, retrospective study. One hundred seventy-six surgeons from 48 countries spanning 5 continents reported primary procedures for 7678 RRDs. Reported data included clinical manifestations, the method of repair, and the outcome. Failure of retinal detachment repair (level 1 failure rate), remaining silicone oil at the study's conclusion (level 2 failure rate), and need for additional procedures to repair the detachments (level 3 failure rate). The main categories of complex retinal detachments evaluated in this investigation were: (1) grade B proliferative vitreoretinopathy (PVR; n = 917), (2) grade C-1 PVR (n = 637), (3) choroidal detachment or significant hypotony (n = 578), (4) large or giant retinal tears (n = 1167), and (5) macular holes (n = 153). In grade B PVR, the level 1 failure rate was higher when treated with a scleral buckle alone versus vitrectomy (P = 0.0017). In grade C-1 PVR, there was no statistically significant difference in the level 1 failure rate between those treated with vitrectomy, with or without scleral buckle, and those treated with scleral buckle alone (P = 0.7). Vitrectomy with a supplemental buckle had an increased failure rate compared with those who did not receive a buckle (P = 0.007). There was no statistically significant difference in level 1 failure rate between tamponade with gas versus silicone oil in patients with grade B or C-1 PVR. Cases with choroidal detachment or hypotony treated with vitrectomy had a significantly lower failure rate versus treatment with scleral buckle alone (P = 0.0015). Large or giant retinal tears treated with vitrectomy also had a significantly lower failure rate versus treatment with scleral buckle (P = 7×10(-8)). In patients with retinal detachment, when choroidal detachment, hypotony, a large tear, or a giant tear is present, vitrectomy is the procedure of choice. In retinal detachments with PVR, tamponade with either gas or silicone oil can be considered. If a vitrectomy is to be performed, these data suggest that a supplemental buckle may not be helpful. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Japanese Journal of Ophthalmology, 2010

Japanese Journal of Ophthalmology, 2008

As a general principle, silicone oil should be removed once the objectives of a tamponade have be... more As a general principle, silicone oil should be removed once the objectives of a tamponade have been achieved and the retinal status is stable, in order to minimize complications associated with long-term use of the oil. 1 The 25-gauge transconjunctival sutureless vitrectomy, fi rst developed by Fujii et al. in 2002, 2 makes sutureless three-port vitrectomy possible, and obviates the need for conjunctival peritomy while decreasing surgical trauma, postoperative infl ammation, and patient discomfort. 2,3 Since 2002, efforts to improve the effi ciency and ease of use of 25-gauge sutureless vitrectomy have been made, and with the recent advancement in 25-gauge instrumentation, silicone oil can be injected with a polyamide cannula. However, silicone oil removal by a 25-gauge vitrectomy, which was thought to be very diffi cult, has not been described previously to our knowledge. We report the results of a sutureless technique for passive removal of silicone oil from the pars plana with 25-gauge transconjunctival microcannulas. We evaluated the effi cacy and safety of this new technique along with its potential complications. Subjects and Methods At our hospital, 32 patients (32 eyes) underwent passive silicone oil removal from the pars plana with the 25-gauge sutureless technique between January 2005 and February 2006. Informed consent was obtained in accordance with the Helsinki Declaration prior to the procedures. The Institutional Review Board approved our review of patient data. Inclusion criteria were age >15 years, duration of use of intraocular silicone oil ≥3 months, and retinas stable without any redetachments or severe hypotony (≤5 mmHg). Pre

International Ophthalmology, 2012

International Ophthalmology, 2007

To report a case with acute endophthalmitis as a postoperative complication of 25-gauge transconj... more To report a case with acute endophthalmitis as a postoperative complication of 25-gauge transconjunctival sutureless vitrectomy. A 65-year-old gentleman, who underwent 25-gauge sutureless vitrectomy for an idiopathic epiretinal membrane at Beyoğlu Eye Research and Training Hospital, presented with painful loss of vision three days later. For the treatment of acute postoperative endophthalmitis, revitrectomy, phacoemulsification with total capsulectomy and silicone oil injection were performed with intravitreal vancomycin and ceftazidim injections. No predisposing risk factors for endophthalmitis or postoperative hypotony were present. Cultures were positive for coagulase negative staphylococcus. He was treated with systemic moxifloxacin and topical ofloxacin, prednisolone acetate postoperatively. Intraocular inflammation resided in 10 days. Silicone oil was removed three months later. At the last visit after 10 months of follow-up, visual acuity increased to 20/63. Postoperative endophthalmitis following 25-gauge sutureless vitrectomy occurred after 3 days in the absence of known predisposing factors. Endophthalmitis responded well to antibiotics and vitrectomy with a favorable visual outcome. Unsutured sclerotomies may provide a conduit for bacterial ingress. Preoperative prophylactic antibiotic usage may be considered as a preventive measure in sutureless vitrectomy.

BMC Research Notes, 2013

Background Children with nasal carriage of S. aureus play an important role in community spread o... more Background Children with nasal carriage of S. aureus play an important role in community spread of S. aureus and methicillin-resistant S. aureus (MRSA). Screening the nasal carriage isolates of S. aureus for antibiotic resistance patterns will provide guidelines for empiric therapy of community-acquired infections. The aim of the present study was to determine the prevalence of S. aureus and MRSA and it’s in vitro antibiotic susceptibility pattern among children in anganwaries (preschools) of Ujjain city India. This work is an extension to our previous publication in BMC Pediatrics (http://www.biomedcentral.com/1471-2431/10/100). Methods A prospective study was done among children aged 1 to 6 years of age attending 100 anganwaries chosen purposely for the study to evenly cover the city. From each anganwari 10 children were randomly selected for nasal swabbing. Children having pyoderma were not included. Information on risk factors for nasal colonization was collected using a pre-tes...

Retina, 2008

To evaluate the rate, duration, and associated complications of postoperative hypotony after 25-g... more To evaluate the rate, duration, and associated complications of postoperative hypotony after 25-gauge sutureless vitrectomy. In a retrospective, interventional, institutional case series, 25-gauge sutureless vitrectomy with straight incisions was performed on 111 eyes. Postoperative intraocular pressure (IOP) was measured routinely at 2 hours, 1 day, 1 week, and 1 month. Postoperative IOP, hypotony (IOP, <8 mmHg) rates, and complications associated with low IOP were assessed to determine outcome. Mean follow-up +/- SD was 5.45 +/- 3.44 months. Mean IOP decreased significantly by 2 hours and on postoperative day 1 (P < 0.001) and increased to preoperative levels at week 1 (P = 0.48). Postoperative hypotony rates were 26.12%, 17.11%, and 8.10% at 2 hours, 1 day, and 1 week, respectively. The ratio of postoperative vitreous hemorrhage in eyes with and without hypotony on day 1 was 2:6 (P = 0.412). Two eyes with macular holes (MHs) filled inadequately with gas endotamponade that remained hypotonic for the first postoperative week underwent reoperation due to unsealed MHs. Twenty-five-gauge sutureless vitrectomy with straight incisions resulted in a hypotony rate of 26.12% at 2 hours that decreased to 17.11% on day 1 and to 8.10% at week 1 but did not increase the incidence of postoperative complications.

Retina-Vitreus

... MD, Beyoğlu Eye Research and Education Hospital Kuledibi İstanbul/TURKEY AĞCA A., agcaalper@y... more ... MD, Beyoğlu Eye Research and Education Hospital Kuledibi İstanbul/TURKEY AĞCA A., agcaalper@yahoo.com Correspondence: MD Yaprak Banu ÜNVER Beyoğlu ... Disloke lens üzerindeki vitre yapışıklıkları ve vitre tabanı yüksek kesici hızındaki vitrektomi probu ile temizlendi ...

Aim: To report a rare case of anterior hyaloidal fibrovascular proliferation (AHFVP) which occurr... more Aim: To report a rare case of anterior hyaloidal fibrovascular proliferation (AHFVP) which occurred after cataract surgery on a non-vitrectomized diabetic eye. This complication resulted in vitreous haemorrhage and hyphaema following a YAG laser capsulotomy procedure. Method: A case report of a patient managed at the above eye department. Clinical records as indicated in the patient's case note were reported. Conclusion: Anterior hyaloidal fibrovascular proliferation is a complication which an eye surgeon should bear in mind when attending to diabetic eyes after cataract surgery. The potential danger of vitreous haemorrhage following YAG laser capsulotomy should also be borne in mind, as more centres in the country aspire to acquire a YAG laser machine to perform capsulotomy.

Purpose: To determine the prognostic factors of functional outcomes in eyes with severe prolifera... more Purpose: To determine the prognostic factors of functional outcomes in eyes with severe proliferative diabetic retinopathy (PDR) managed with pars plana vitrectomy (PPV). Materials and Methods: A series of 136 consecutive eyes with severe PDR and non-clearing vitreous hemorrhage (VH) or retinal detachment (RD) that underwent PPV were retrospectively reviewed for prognostic risk factors of surgical outcomes and post-operative vision. Chi-square and logistic regression analysis were used for statistical analysis. Results: Average follow-up was 35 months (range 6-56). A functional outcome (VA>5/200) was achieved in 109 eyes (80.1%) and in 51 of 66 eyes (77.3%) with traction retinal detachment. The VA was improved two lines or more in 79 eyes (58.1%), unchanged in 37 (27.2%), and was worse by 2 lines or more in 20 eyes (14.7%). Complete retinal attachment was observed at the final visit in 122 eyes (89.7%). Predictors of a poor visual outcome were found to be preoperative neovascular...

Current Concepts and Management of Eye Injuries, 2016

Turkiye Klinikleri Journal of Ophthalmology, 2010

We present a power-variable rate-adaptive LDPC-coded polarization multiplexed coherent OFDM schem... more We present a power-variable rate-adaptive LDPC-coded polarization multiplexed coherent OFDM scheme, suitable for use in optically-routed networks in which different lightwave paths experience different penalties due to deployment of ROADMs and WXCs. We demonstrate that channel capacity can be closely approached with proposed scheme .

Turkiye Klinikleri Journal of Ophthalmology Special Topics, 2011

Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2009

To determine the prognostic indicators of functional outcome in eyes with severe posterior segmen... more To determine the prognostic indicators of functional outcome in eyes with severe posterior segment trauma managed with pars plana vitrectomy. One hundred and six eyes of 101 patients were retrospectively reviewed to determine the accuracy of a number of factors in predicting functional outcome after surgery. These potential prognostic indicators included initial visual acuity (VA), retinal detachment (RD), type of trauma, presence of intraocular foreign body (IOFB), type of IOFB, posttraumatic endophthalmitis, hyphema, choroidal detachment, initial hypotonia, accompanying lens subluxation/dislocation, and severe vitreous hemorrhage. In our study, functional success was defined as VA > or =5/200. Fisher's exact and chi-square tests were used for statistical analysis. The mean follow-up time was 12.8+/-0.52 (8-18) months. Thirty-three eyes (31.13%) had functional success. Forty-four (68.7%) of 64 eyes with preoperative RD had anatomical success (total retinal reattachment). Pre...

Retinal Cases & Brief Reports, 2009

To report a case with type I osteogenesis imperfecta (OI) with intravitreal opacities who underwe... more To report a case with type I osteogenesis imperfecta (OI) with intravitreal opacities who underwent 25-gauge sutureless vitrectomy. A 2.5-year-old girl with OI type I who presented with intravitreal opacities underwent 25-gauge sutureless vitrectomy. The 25-gauge sutureless vitrectomy system, which is less traumatic, was performed in a patient with OI type I. Nine months postoperatively, funduscopic examination under general anesthesia showed a healthy optic nerve and retina without detachment. Intraocular pressure by Tonopen was 10 mmHg. The use of 25-gauge sutureless vitrectomy to avoid scleral suturing and minimize surgical trauma is an option in pediatric patients with associated thin sclera.

Retina, 2008

The purpose of this article was to evaluate the outcomes and complications of transconjunctival s... more The purpose of this article was to evaluate the outcomes and complications of transconjunctival sutureless 25-gauge vitrectomy using silicone oil tamponade in diabetic tractional retinal detachment. Patients were retrospectively evaluated. Main outcome measure was the feasibility of pars plana vitrectomy and silicone oil injection with 25-gauge system in eyes with diabetic tractional retinal detachment. Fourteen eyes of 14 patients were included in the study. Tractional retinal detachment was accompanied by vitreous hemorrhage in 9 eyes and combined traction/rhegmatogenous retinal detachment was present in 1 eye. All patients underwent transconjunctival sutureless 25-gauge vitrectomy and 1,000 centistokes silicone oil injection. Angled insertion of the trocars was made in all eyes. Bimanual surgery was performed in 6 (42.8%) eyes. The median preoperative best-corrected visual acuities were 3.00 logarithm of the minimum angle of resolution; it increased to 1.60 logarithm of the minimum angle of resolution at last visit. Retinal tear formation occurred in 4 (28.5%) eyes. Retinal detachment developed in 2 (14.2%) eyes. Intraocular pressure of 5 mmHg or less was detected in 3 (21.4%) eyes. One patient lost light perception due to anterior hyaloidal fibrovascular proliferation. Pars plana vitrectomy and 1,000 centistokes silicone oil injection with 25-gauge system is feasible in diabetic tractional retinal detachment even in complex cases. Indications of 25-gauge surgery may be expanded toward this area.

Retina, 2009

To evaluate the success of initial treatment and the factors influencing the outcome in acute-ons... more To evaluate the success of initial treatment and the factors influencing the outcome in acute-onset endophthalmitis after cataract surgery. We retrospectively reviewed the medical records of all patients with acute postoperative endophthalmitis between 2000 and 2007. We performed pars plana vitrectomy (PPV) to all eyes with initial visual acuity of light perception. Eyes with visual acuity of hand motions or better underwent either intraocular antibiotic injection (IOAI) or PPV. Eyes that did not give a good clinical response to initial therapy within 60 hours underwent a second procedure. The main outcome measure was the rate of early reintervention after PPV and IOAI. We evaluated 88 eyes of 88 patients. Thirty-seven patients underwent PPV and 51 patients underwent IOAI alone. Six of 37 (16.2%) patients required 1 or more procedures within 60 hours of the initial procedure in the PPV group. Twenty-eight of 51 eyes (54.9%) in the IOAI group underwent PPV within 60 hours. The rate of response to primary PPV was significantly higher than to primary IOAI (P < 0.001). Gram-negative organisms composed 35.1% of the isolates. Pars plana vitrectomy may be preferable to IOAI in postoperative endophthalmitis since the rate of early reintervention is lower with initial PPV.

Retina, 2008

To evaluate the anatomic and functional outcomes of 25-gauge sutureless vitrectomy in primary tre... more To evaluate the anatomic and functional outcomes of 25-gauge sutureless vitrectomy in primary treatment of noncomplex pseudophakic rhegmatogenous retinal detachments (RRD). Prospective interventional institutional case series. Twenty-two eyes with pseudophakic RRD with proliferative vitreoretinopathy grade A or B underwent primary 25-gauge vitrectomy with oblique sclerotomies and gas endotamponade. Eyes with minimum follow-up of 6 months were evaluated. Main outcome measures were reattachment rate with single surgery, reoperation, complication rates, and changes in visual acuity (VA). Mean duration of visual loss was 14.68 +/- 12.87 days. Seventeen (77.27%) eyes had macular detachment. In all eyes 25-gauge sutureless vitrectomy was completed without complications. The mean follow-up period was 10.40 +/- 5.77 months. Retinal attachment was achieved in 21 (95.45%) eyes with single surgery and in all (100%) eyes with second vitrectomy. Mean preoperative VA of 1.61 +/- 1.18 improved to 0.50 +/- 0.53 at the last visit (P < 0.001). Transient hypotony was detected in 2 (9.09%) eyes with spontaneous resolution. No other postoperative complication was observed. Twenty-five-gauge sutureless vitrectomy with oblique sclerotomies in primary treatment of noncomplex pseudophakic RRDs resulted in reattachment in 95.45% with single surgery, and in 100% with reoperation in one eye, accompanied by an increase in visual acuity in 86% of eyes.

Retina, 2010

The purpose of this study was to evaluate the safety and efficacy of iris claw intraocular lens i... more The purpose of this study was to evaluate the safety and efficacy of iris claw intraocular lens implantation for correction of aphakia in vitrectomized eyes without capsular support. This was a prospective interventional case series. Twelve aphakic vitrectomized eyes without capsular support underwent iris claw intraocular lens implantation. The main outcome measures were changes in uncorrected visual acuity, best-corrected visual acuity, spheric equivalent, corneal endothelial cell density, corneal thickness, central macular thickness, and complications. Mean follow-up was 15.58 +/- 3.80 months with no intraoperative complications. Postoperatively, uncorrected visual acuity increased significantly at all follow-up visits (P < 0.05). Mean best-corrected visual acuity increased 10 letters/2 lines at the final follow-up visit (P = 0.023). Mean postoperative spheric equivalent at the last visit was -1.68 +/- 063 D, and the spheric equivalent was within +/-2.00 D of emmetropia in 9 (75%) eyes. Mean central macular thickness increased only at postoperative Month 3 (P = 0.043). Mean endothelial cell density loss was 23.87% at the last visit. Mean corneal thickness did not change during follow-up (P > 0.05). No corneal edema was observed. Complications were transient intraocular pressure increase (n = 1), cystoid macular edema (n = 1), and haptic dislocation replaced by surgery (n = 1). Retinas remained attached in all eyes. Secondary iris claw intraocular lens implantation is clinically safe and effective to correct aphakia in vitrectomized eyes without capsular support. Larger studies with longer follow-up are warranted.

Ophthalmology, 2013

To study the outcome of the treatment of complex rhegmatogenous retinal detachments (RRDs). Nonra... more To study the outcome of the treatment of complex rhegmatogenous retinal detachments (RRDs). Nonrandomized, multicenter, retrospective study. One hundred seventy-six surgeons from 48 countries spanning 5 continents reported primary procedures for 7678 RRDs. Reported data included clinical manifestations, the method of repair, and the outcome. Failure of retinal detachment repair (level 1 failure rate), remaining silicone oil at the study's conclusion (level 2 failure rate), and need for additional procedures to repair the detachments (level 3 failure rate). The main categories of complex retinal detachments evaluated in this investigation were: (1) grade B proliferative vitreoretinopathy (PVR; n = 917), (2) grade C-1 PVR (n = 637), (3) choroidal detachment or significant hypotony (n = 578), (4) large or giant retinal tears (n = 1167), and (5) macular holes (n = 153). In grade B PVR, the level 1 failure rate was higher when treated with a scleral buckle alone versus vitrectomy (P = 0.0017). In grade C-1 PVR, there was no statistically significant difference in the level 1 failure rate between those treated with vitrectomy, with or without scleral buckle, and those treated with scleral buckle alone (P = 0.7). Vitrectomy with a supplemental buckle had an increased failure rate compared with those who did not receive a buckle (P = 0.007). There was no statistically significant difference in level 1 failure rate between tamponade with gas versus silicone oil in patients with grade B or C-1 PVR. Cases with choroidal detachment or hypotony treated with vitrectomy had a significantly lower failure rate versus treatment with scleral buckle alone (P = 0.0015). Large or giant retinal tears treated with vitrectomy also had a significantly lower failure rate versus treatment with scleral buckle (P = 7×10(-8)). In patients with retinal detachment, when choroidal detachment, hypotony, a large tear, or a giant tear is present, vitrectomy is the procedure of choice. In retinal detachments with PVR, tamponade with either gas or silicone oil can be considered. If a vitrectomy is to be performed, these data suggest that a supplemental buckle may not be helpful. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Japanese Journal of Ophthalmology, 2010

Japanese Journal of Ophthalmology, 2008

As a general principle, silicone oil should be removed once the objectives of a tamponade have be... more As a general principle, silicone oil should be removed once the objectives of a tamponade have been achieved and the retinal status is stable, in order to minimize complications associated with long-term use of the oil. 1 The 25-gauge transconjunctival sutureless vitrectomy, fi rst developed by Fujii et al. in 2002, 2 makes sutureless three-port vitrectomy possible, and obviates the need for conjunctival peritomy while decreasing surgical trauma, postoperative infl ammation, and patient discomfort. 2,3 Since 2002, efforts to improve the effi ciency and ease of use of 25-gauge sutureless vitrectomy have been made, and with the recent advancement in 25-gauge instrumentation, silicone oil can be injected with a polyamide cannula. However, silicone oil removal by a 25-gauge vitrectomy, which was thought to be very diffi cult, has not been described previously to our knowledge. We report the results of a sutureless technique for passive removal of silicone oil from the pars plana with 25-gauge transconjunctival microcannulas. We evaluated the effi cacy and safety of this new technique along with its potential complications. Subjects and Methods At our hospital, 32 patients (32 eyes) underwent passive silicone oil removal from the pars plana with the 25-gauge sutureless technique between January 2005 and February 2006. Informed consent was obtained in accordance with the Helsinki Declaration prior to the procedures. The Institutional Review Board approved our review of patient data. Inclusion criteria were age >15 years, duration of use of intraocular silicone oil ≥3 months, and retinas stable without any redetachments or severe hypotony (≤5 mmHg). Pre

International Ophthalmology, 2012

International Ophthalmology, 2007

To report a case with acute endophthalmitis as a postoperative complication of 25-gauge transconj... more To report a case with acute endophthalmitis as a postoperative complication of 25-gauge transconjunctival sutureless vitrectomy. A 65-year-old gentleman, who underwent 25-gauge sutureless vitrectomy for an idiopathic epiretinal membrane at Beyoğlu Eye Research and Training Hospital, presented with painful loss of vision three days later. For the treatment of acute postoperative endophthalmitis, revitrectomy, phacoemulsification with total capsulectomy and silicone oil injection were performed with intravitreal vancomycin and ceftazidim injections. No predisposing risk factors for endophthalmitis or postoperative hypotony were present. Cultures were positive for coagulase negative staphylococcus. He was treated with systemic moxifloxacin and topical ofloxacin, prednisolone acetate postoperatively. Intraocular inflammation resided in 10 days. Silicone oil was removed three months later. At the last visit after 10 months of follow-up, visual acuity increased to 20/63. Postoperative endophthalmitis following 25-gauge sutureless vitrectomy occurred after 3 days in the absence of known predisposing factors. Endophthalmitis responded well to antibiotics and vitrectomy with a favorable visual outcome. Unsutured sclerotomies may provide a conduit for bacterial ingress. Preoperative prophylactic antibiotic usage may be considered as a preventive measure in sutureless vitrectomy.

BMC Research Notes, 2013

Background Children with nasal carriage of S. aureus play an important role in community spread o... more Background Children with nasal carriage of S. aureus play an important role in community spread of S. aureus and methicillin-resistant S. aureus (MRSA). Screening the nasal carriage isolates of S. aureus for antibiotic resistance patterns will provide guidelines for empiric therapy of community-acquired infections. The aim of the present study was to determine the prevalence of S. aureus and MRSA and it’s in vitro antibiotic susceptibility pattern among children in anganwaries (preschools) of Ujjain city India. This work is an extension to our previous publication in BMC Pediatrics (http://www.biomedcentral.com/1471-2431/10/100). Methods A prospective study was done among children aged 1 to 6 years of age attending 100 anganwaries chosen purposely for the study to evenly cover the city. From each anganwari 10 children were randomly selected for nasal swabbing. Children having pyoderma were not included. Information on risk factors for nasal colonization was collected using a pre-tes...

Retina, 2008

To evaluate the rate, duration, and associated complications of postoperative hypotony after 25-g... more To evaluate the rate, duration, and associated complications of postoperative hypotony after 25-gauge sutureless vitrectomy. In a retrospective, interventional, institutional case series, 25-gauge sutureless vitrectomy with straight incisions was performed on 111 eyes. Postoperative intraocular pressure (IOP) was measured routinely at 2 hours, 1 day, 1 week, and 1 month. Postoperative IOP, hypotony (IOP, <8 mmHg) rates, and complications associated with low IOP were assessed to determine outcome. Mean follow-up +/- SD was 5.45 +/- 3.44 months. Mean IOP decreased significantly by 2 hours and on postoperative day 1 (P < 0.001) and increased to preoperative levels at week 1 (P = 0.48). Postoperative hypotony rates were 26.12%, 17.11%, and 8.10% at 2 hours, 1 day, and 1 week, respectively. The ratio of postoperative vitreous hemorrhage in eyes with and without hypotony on day 1 was 2:6 (P = 0.412). Two eyes with macular holes (MHs) filled inadequately with gas endotamponade that remained hypotonic for the first postoperative week underwent reoperation due to unsealed MHs. Twenty-five-gauge sutureless vitrectomy with straight incisions resulted in a hypotony rate of 26.12% at 2 hours that decreased to 17.11% on day 1 and to 8.10% at week 1 but did not increase the incidence of postoperative complications.

Retina-Vitreus

... MD, Beyoğlu Eye Research and Education Hospital Kuledibi İstanbul/TURKEY AĞCA A., agcaalper@y... more ... MD, Beyoğlu Eye Research and Education Hospital Kuledibi İstanbul/TURKEY AĞCA A., agcaalper@yahoo.com Correspondence: MD Yaprak Banu ÜNVER Beyoğlu ... Disloke lens üzerindeki vitre yapışıklıkları ve vitre tabanı yüksek kesici hızındaki vitrektomi probu ile temizlendi ...

Aim: To report a rare case of anterior hyaloidal fibrovascular proliferation (AHFVP) which occurr... more Aim: To report a rare case of anterior hyaloidal fibrovascular proliferation (AHFVP) which occurred after cataract surgery on a non-vitrectomized diabetic eye. This complication resulted in vitreous haemorrhage and hyphaema following a YAG laser capsulotomy procedure. Method: A case report of a patient managed at the above eye department. Clinical records as indicated in the patient's case note were reported. Conclusion: Anterior hyaloidal fibrovascular proliferation is a complication which an eye surgeon should bear in mind when attending to diabetic eyes after cataract surgery. The potential danger of vitreous haemorrhage following YAG laser capsulotomy should also be borne in mind, as more centres in the country aspire to acquire a YAG laser machine to perform capsulotomy.