Browsing by Author "Altinisik, M"
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Item Quantitative analysis of early retinal vascular changes in type 2 diabetic patients without clinical retinopathy by optical coherence tomography angiographyAltinisik, M; Kahraman, NS; Kurt, E; Mayali, H; Kayikcioglu, OPurpose To investigate the quantitative differences in optical coherence tomography angiography (OCTA) data between type 2 diabetes patients without clinically detectable diabetic retinopathy (DR) and healthy subjects. Methods Thirty-nine patients with type 2 diabetes without DR and 41 age- and sex-matched healthy controls were recruited. The vessel density and foveal avascular zone (FAZ) area in the superficial capillary plexus and deep capillary plexus were measured using Nidek RS-3000 Advance (R) and compared between patient cohorts. Foveal vessel density (%) and FAZ (%) were also calculated. Results A significant decrease in vessel density has been observed in the deep capillary plexus of the patients compared to healthy individuals (5.58 +/- 0.98 mm(2) versus 6.15 +/- 0.89 mm(2), p < 0.001). However, there were no significant differences in other parameters between cohorts (p > 0.05 in all parameters). Despite the decrease of deep capillary plexus density in the macular region, there was no significant change observed in foveal vessel density (p:0.44). It has also been observed that the duration of diabetes mellitus correlates with vessel density decrease in deep capillary plexus (R:-0.52; p < 0.001). In both groups, all parameters in deep capillary plexus were significantly higher than superficial capillary plexus (p < 0.001 for all parameters). Conclusions OCTA can identify quantitative changes in DCP before the manifestation of clinically apparent retinopathy. DCP-VD reduction may be an earlier finding than FAZ enlargement. Despite the reduction of VD, FVD could be preserved for a certain period of time in DM patients.Item A multimodal ophthalmic analysis in patients with systemic sclerosis using ocular response analyzer, corneal topography and specular microscopyMayali, H; Altinisik, M; Sencan, S; Pirildar, T; Kurt, EPurposeTo conduct a multimodal ophthalmic evaluation of systemic sclerosis (SSc) in patients using ocular response analyzer (ORA), Pentacam, and specular microscopy (SM).MethodsThirty-one SSc patients and a group of age- and sex-matched controls were enrolled in this cross-sectional study. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc), and Goldmann-correlated IOP (IOPg) were measured with ORA. Anterior chamber depth (ACD), central corneal thickness (CCT), and corneal volume (CV) measurements were obtained using Pentacam. Corneal endothelial cell density (ECD) and CCT were evaluated by SM.ResultsSSc patients had significantly lower CH, ACD, and ECD values compared to the control group (p=0.018;<0.001;<0.001, respectively). There was no significant difference regarding CRF, IOP, CV, or CCT measurements acquired by Pentacam and SM. Regarding CCT, SM and Pentacam showed relatively better agreement in SSc patients.ConclusionsMultimodal imaging can provide more comprehensive and useful information regarding the ocular involvement of systemic diseases. The multimodal evaluation in our study demonstrated that the pathologic effects of SSc may manifest as reductions in ACD, corneal elasticity, and ECD before there are any detectable changes in corneal thickness or IOP.Item Analysis of the Natural Course of Quiescent Macular Neovascularization with Optical Coherence Tomography AngiographyAkgun, YD; Kurt, E; Altinisik, MPurpose This study investigates the natural progression of quiescent macular neovascularization (qMNV) using optical coherence tomography angiography (OCTA). Methods The study monitored 30 eyes of 28 qMNV patients over a period of at least six months. Best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and OCTA were used to perform qualitative and quantitative analyses, noting any cases of activation during follow-up. Results Among the 30 eyes (14 female, mean age 69.70 +/- 7.63 years), 21 had age-related macular degeneration (AMD) and 9 had pachychoroid neovasculopathy (PNV). The mean follow-up duration was 18.9 months. There were no significant changes in qualitative morphological features, BCVA, or choroidal thickness (p > 0.05). However, there was a statistically significant increase in the areas of MNV and flow (p = 0.043 and p = 0.018, respectively). BCVA and MNV area showed no significant correlation (p = 0.103). Four cases (13.33%) showed activation after an average follow-up period of 27.75 months (6 to 48). Additionally, extrafoveal location was identified as a significant risk factor for exudation (p = 0.033). Conclusion OCTA is a valuable tool for monitoring qMNV and identifying potential predictors of disease activation. The qMNV area may increase over time, even in the absence of activation. Extrafoveal location appears to be a potential risk factor for qMNV activation.Item Miliary microemboli of the retinal arterioles and choriocapillaris after subcutaneous injection of triamcinolone acetonideKayikcioglu, OR; Altinisik, M; Ivan, S; Kurt, EPurpose: To report a case of triamcinolone crystals associated miliary microemboli of the retinal arterioles and choriocapillaris. Methods: A 30-year-old woman with alopecia areata on her left auriculotemporal scalp, scheduled for 10 mg/ml triamcinolone acetonide steroid injections (maximum volume of 3 ml per session) for 1 month intervals, presented with a sudden decrease in vision in her left eye after 1 ml injection in a dermatology clinic. Results: On ocular examination her best corrected visual acuity (BCVA) was hand movement in the left eye. Retinal examination showed multiple white-yellow steroid emboli in the superior and inferior temporal branch retinal arterioles which involves macula. Also there were diffuse yellow infiltrates in the choroid consistent with choroidal microemboli. Fluorescein angiography and optical coherence tomography images were suggestive for the retinal and choroidal ischemia. Conclusion: Subcutaneous triamcinolon injection may cause embolic occlusion of retinal and choroidal capillaries. Copyright (C) 2018, Iranian Society of Ophthalmology. Production and hosting by Elsevier B.V.Item Pulsatile Proptosis and Sphenoid Wing Dysplasia with no Evidence of Neurofibromatosis Type 1: A Case Report and Review of the LiteratureAkgün, YD; Erdogan, M; Altinisik, M; Mayali, H; Ilker, SSIn this study, we aimed to present a rare case of pulsatile proptosis due to sphenoid wing dysplasia without the features of neurofibromatosis type 1 (NF1). A 17-year-old male patient presented with swelling in the superotemporal region of the right eye. Physical examination revealed facial asymmetry with a pulsatile, ill-defined, soft lesion with in the superotemporal region of the right orbit associated with pulsatile proptosis, downward dystopia, and hypotropia. Computer tomography imaging to establish a differential diagnosis showed temporal lobe herniation secondary to sphenoid wing dysplasia. The patient was assessed for NF1, which is most commonly associated with sphenoid wing dysplasia, but no evidence supporting the diagnosis was found. Patients presenting with proptosis should be carefully examined for pulsation and murmurs, and a trauma history should be investigated. Radiological imaging should be used to facilitate the differential diagnosis, and the current clinical condition should be managed with a multidisciplinary approach.Item Changes in optic nerve head and macula optical coherence tomography angiography parameters before and after trabeculectomyGüngör, D; Kayikçioglu, OR; Altinisik, M; Dogruya, SPurpose To evaluate the effects of lowering intraocular pressure (IOP) on foveal avascular zone (FAZ), peripapillary and macular vessel density (VD) by optical coherence tomography angiography (OCTA) in patients with open angle glaucoma after trabeculectomy. Study design Prospective study Methods Twenty eyes of 20 patients with primary open angle glaucoma (POAG) or exfoliation glaucoma (EG) who were followed up to six months and underwent trabeculectomy were included in our study. OCTA, AngioVue (Optovue Inc.) software was used to analyse the FAZ, peripapillary VD, macular superficial capillary plexus (SCP) and deep capillary plexus (DCP) VD. The parameters of the preoperative and postoperative controls were compared statistically. Results Twelve of the patients (60%) had POAG and eight (40%) had EG. Mean IOP measured was 22.4 +/- 2.4 mmHg preoperatively and 14.9 +/- 2.4 mmHg in the postoperative sixth month (p <0.001). There were no significant changes in OCTA optic disc and macular SCP VD values at the end of the sixth month. In macular DCP parameters; whole image VD (WI-VD), foveal VD (F-VD), parafoveal VD (PAF-VD) and perifoveal VD (PEF-VD) values increased statistically (p=0.003; p=0.026; p=0.006; p=0.004). There was a statistically significant decrease in FAZ area (FAZ-A) and FAZ perimeter (FAZ-P); and a significant increase was found in foveal density values (FD) (p=0.026; p=0.049; p=0.005). Conclusions We found that reducing IOP by trabeculectomy did not affect the microcirculation of the peripapillary region and macular SCP, while there was a significant increase in the DCP parameters of the macular region.Item Relation between nocturnal decline in blood pressure and choroidal thickness: a comparative analysis in dipper vs. non-dipper hypertensive patientsTas, S; Altinisik, M; Tas, ÜPurpose To compare choroidal thickness (ChT) and echocardiographical changes in patients with dipper and non-dipper systemic arterial hypertension (HT). Methods Patients with HT were evaluated in two groups according to the 24-hour ambulatory BP monitoring. Compared to day-time values, those whose night-time SBP decreased >= 10% were defined as dippers, and those whose SBP decreased <10% were defined as non-dippers. Transthoracic echocardiography was conducted in all patients. ChT and central macular thickness were measured with spectral-domain optical coherence tomography. ChT was obtained at the subfoveal, 1500 mu m nasal and temporal to the fovea. Results Thirty non-dipper (18 females and 12 males) and 23 dipper (16 females and seven males) hypertensive patients were recruited. Sex distribution and the mean age were similar between the groups (P = 0.472; P = 0.12). Disease duration was longer in the non-dipper group (8 +/- 3.39 vs. 4.96 +/- 1.19 years, P = 0.001). The non-dipper group had lower ChT in subfoveal and temporal locations (P = 0.02 and 0.03, respectively) and higher left atrial volume index (LAVI) and pulmonary valve maximum flow (PV-max; P < 0.001). The night-time SBP was negatively correlated with ChT (P = 0.048) and positive correlated with LAVI and PV-max (P < 0.05). However those correlations were not significant when were controlled by the possible confounding factors as disease duration, age and gender. Conclusion Non-dipper HT patients may have thinner choroid than dippers due to longer duration of HT and higher ambulatory BP levels.Item Aspergillus Endogenous Endophthalmitis as a Clue to Identifying a Delayed Lumbosacral OsteomyelitisAltinisik, M; Akgun, YD; Erdogan, M; Mutawakkil, AF; Gazi, HPurposeTo present a case of aspergillus-induced endogenous endophthalmitis evolving into delayed lumbosacral osteomyelitis, initially misdiagnosed as ankylosing spondylitis (AS) in an immunocompetent patient.MethodCase Report.ResultsA 38-year-old woman, initially treated for pneumonia, experienced sudden loss of vision in her left eye, prompting a thorough examination that revealed a distinct chorioretinal infiltrate. Microbiological analysis of the patient's vitreous samples detected Aspergillus fumigatus, leading to the diagnosis of endogenous endophthalmitis. Treatment involved vitrectomy, intravitreal injections, and intravenous amphotericin B. Two months later, she was referred for lower back pain, misdiagnosed as AS. Lumbosacral biopsy confirmed Aspergillus involvement once more, necessitating antifungal therapy.ConclusionThis case highlights the atypical progression of Aspergillus-induced endogenous endophthalmitis to delayed lumbosacral osteomyelitis in an immunocompetent individual. It highlights the crucial role of a meticulous medical history examination and interdisciplinary collaboration in diagnosing and managing diseases, especially in cases with atypical presentations.Item Efficacy of subthreshold micropulse laser combined with ranibizumab in the treatment of diabetic macular edemaBiçak, F; Kayikcioglu, ÖR; Altinisik, M; Dogruya, S; Kurt, EPurpose In this study, we aimed to evaluate and compare the visual acuity, macular volume, central macular thickness, change in number of intravitreal ranibizumab injections with micropulse laser applications after loading dose of anti-VEGF to DME patients. Study Design Retrospective study. Methods This study was carried out on 97 patients (45 ranibizumab and 52 micropulse grid laser+ranibizumab) with diabetic macular edema patients who were followed in the Retina Unit. At the control visit after three loading ranibizumab injections administered once a month, micropulse grid laser was applied to one group and ranibizumab injection was continued PRN to both groups for an average of 9.27 +/- 2.42 months and central macular thickness, macular volume and visual acuity were recorded. Results There was no significant difference between the groups in terms of gender, smoking and systemic diseases, initial central macular thickness, macular volume and visual acuity measurements (p > 0.05). Central macular thickness, macular volume and visual acuity values measured at the last follow-up of the patients were not significantly different between the groups (p > 0.05). The mean post-treatment injection requirement was 4.19 +/- 1.01 for the ranibizumab with micropulse laser combination group and 5.53 +/- 1.14 for the ranibizumab group (p < 0.001). Conclusion Micropulse laser treatment after initial loading doses reduces the need for anti-VEGF injections. There is no deleterious effect on visual acuity and retinal imagings. Therefore, while combination therapy provides an effective treatment, it can also reduce the risk of complications of intravitreal anti-VEGF injections. Studies with the participation of more patients may help in the selection of treatment methods by comparing micropulse laser combined with different injection protocols.Item THE MEASUREMENT OF THE CHOROIDAL THICKNESS DURING ORAL GLUCOSE TOLERANCE TESTS IN PREDIABETIC SUBJECTS: A SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY STUDYÇagiltay, E; Altinisik, M; Pouwels, S; Demir, N; Akay, FObjective: The aim of this study is to investigate how acute hyperglycaemic changes affect the choroid in patients with prediabetes. Material and Method: Each subject underwent a 75 g oral glucose tolerance test (OGTT) after overnight fasting. The measurement of choroidal thickness (ChT) was done with new generation spectral domain optical coherence tomography (SD-OCT). Results: Fasting Plasma Glucose (FPG) levels of the patients with only isolated Impaired Fasting Glucose (IGT) patients are higher (all p<0.0001). Mean insulin levels were also higher in patients with prediabetes than in healthy volunteers during the entire experiment (all p<0.0001). Changes in ChT differed between the groups, a transient increase was observed in the mean ChT as well as subfoveal, nasal and temporal locations at the 500 mu m distance to fovea in prediabetes individuals. While the subfoveal ChT difference was 1.52 +/- 4.11 mu m (range, -11.00/24.00 mu m) in prediabetes, -0.22 +/- 1.74 mu m (range -2.00/8.00 mu m) in the con- trol group at the first hour of the OGTT. A transient choroidal thickening occurred in the prediabetes group, while there was no change in the healthy volunteers. Conclusion: Detecting acute hyperglycemic changes with instant measurements may help us to better understand the effect of the disease on ocular structures.Item Comparison of postoperative anterior segment changes associated with pars plana vitrectomy with and without vitreous base shavingToklu, E; Altinisik, M; Elbay, A; Koytak, AAIM: To compare changes in anterior segment topography and axial length (AL) evaluated with Pentacam and IOL Master after pars plana vitrectomy (PPV) performed with and without vitreous base shaving. METHODS: This prospective study included patients who underwent PPV or phacoemulsification+PPV (Phaco+PPV) for various indications. Patients who underwent total posterior hyaloid detachment and excessive vitreous base shaving with scleral indentation were referred to as complete PPV (c-PPV). The patients whom posterior hyaloid was separated as far as the posterior arcades and vitreous base shaving with scleral depression was not performed were classified as the partial PPV (p-PPV) group. All patients underwent detailed ophthalmologic examinations preoperatively and 1wk, 1, and 3mo postoperatively. Changes in the anterior chamber depth (ACD), anterior chamber volume (ACV), iridocorneal angle (ICA), central corneal thickness (CCT), and keratometric measurements (K-1 and K-2) were evaluated with Pentacam HR. Changes in the AL measurements were analyzed with IOL Master. RESULTS: A significant increase in ACD was observed in c-PPV cases (P=0.02), but this increase was not significant in the p-PPV group (P=0.053). In contrast, ICA increased significantly in the c-PPV group (P=0.02) but decreased in the p-PPV group (P=0.09). BCVA was significantly improved in the c-PPV group from week 1 (P<0.001) while the increase in the p-PPV group reached significance at 3mo (P=0.035). CCT increased in the first week and later returned to baseline in both groups. No significant differences in the other parameters were observed between the groups, and there were no significant changes in intraocular pressure, ACV, AL, K-1 or K-2 values (P>0.05 for all). CONCLUSION: Incomplete posterior hyaloid excision and not removing the vitreous base in PPV surgeries may create a more stable anterior chamber, thus preventing the downward movement of the lens-iris diaphragm, and may cause ciliary body retraction, thereby reducing ICA. Awareness of these effects can provide some amount of guidance to physicians in selecting the appropriate PPV procedure and preempting surgical complications.Item Multimodal ocular evaluation in hemodialysis patientsMayali, H; Altinisik, M; Sarigul, C; Toraman, A; Turkoglu, MS; Kurt, EPurpose To evaluate choroidal thickness, intraocular pressure (IOP), axial length, central corneal thickness (CCT), lens thickness, anterior chamber depth, and ocular pulse amplitude (OPA) in hemodialysis patients. Materials and methods The patients with end-stage renal disease and undergoing hemodialysis were included in the study. Immediately before and 1 hour after hemodialysis, all patients underwent measurement of choroidal thickness with spectral domain optical coherence tomography (SD-OC, Cirrus HD-OCT; Carl Zeiss Meditec Inc., Dublin, CA), IOP and OPA with Pascal dynamic contour tonometry (Ziemer Ophthalmic Systems AG, Port, Switzerland), and anterior chamber depth, lens thickness, and axial length with optical biometry (LenStar LS900; Haag-Streit AG, Koeniz, Switzerland). Data from the patients' right eyes were included in the statistical analysis. Results The patient group included 8 (36.4%) males and 14 (63.6%) females with a mean age of 56, 14 +/- 9, 96 (40-70) years. The mean subfoveal choroidal thickness before and after hemodialysis was 255.21 +/- 6.15 (245-263) mu m and 234.95 +/- 7.89 (220-247) mu m, respectively (p < 0.001). Mean choroidal thickness at 1500 mu m and 3000 mu m nasal and temporal of the fovea also decreased significantly after hemodialysis (p < 0.001). Mean OPA values before and after hemodialysis were 2.14 +/- 1.07 (0.6-4) mmHg and 1.6 +/- 0.86 (0.5-3.2) mmHg, respectively (p < 0.001). There was a statistically significant correlation between OPA and choroidal thickness measurements (p < 0.001, R = 0.923). IOP increased from 15.11 +/- 2.58 (11-20) to 15.99 +/- 2.21 (13-20) mmHg, but the change did not reach statistical significance (p = 0.05). There was no statistically significant change in mean axial length, anterior chamber depth, lens thickness, or CCT after hemodialysis (p > 0.05 for all). Conclusion Although choroidal thickness and OPA may be decreased immediately after hemodialysis, there may be no significant changes in IOP or avascular ocular structures such as the lens and cornea.Item CHANGES IN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY MEASURES THROUGHOUT THE DAYAltinbay, BT; Kurt, E; Altinisik, MVariations in vessel density, foveal avascular zone, and central macular thickness measurements obtained using optical coherence tomography angiography could be attributed to test-retest variation rather than diurnal rhythm. Purpose:To evaluate the repeatability and diurnal variation of the retinal vessel density and foveal avascular zone parameters using optical coherence tomography angiography.Methods:Forty-one healthy individuals were measured twice in the morning and once in the evening. Foveal avascular zone area, perimetry, foveal density; superficial and deep capillary plexus (superficial capillary plexus, deep capillary plexus) vessel density, and central macular thickness were evaluated with the intraclass correlation coefficient, coefficient of repeatability, and Bland-Altman plots.Results:Repeatability was evaluated with two consecutive scans taken in the morning. The coefficient of repeatabilities (%) was 5.4; 4.3, and 8.8 for the foveal avascular zone area, perimetry, and foveal density, respectively, with excellent intraclass correlation coefficients. Intraclass correlation coefficient was poor for parafovea (0.33), whereas excellent for fovea (0.97) in superficial capillary plexus-vessel density. Coefficient of repeatability for fovea and parafovea was 19.19% and 10.43%, respectively. Intraclass correlation coefficient values were poor (0.3-0.4) with 10% to 16% measurement differences in deep capillary plexus-vessel density parameters. Coefficient of repeatabilities for central macular thickness was between 1% and 2% with excellent intraclass correlation coefficient. The analysis on diurnal variation yielded comparable results.Conclusion:Except for the parafoveal vessel density, optical coherence tomography angiography is a highly reproducible device for measuring foveal avascular zone and vessel density using 6 x 6 scans with undilated pupils. However, variation in optical coherence tomography angiography parameters observed throughout the day could be attributed to test-retest variation rather than diurnal rhythm.Item Evaluation of retinochoroidal tissues in third trimester pregnants: An optical coherence tomography angiography studyYildirim, A; Kurt, E; Altinisik, M; Uyar, YIntroduction: The structural and vascular changes in the retina and choroid in women in the third trimester of pregnancy were analyzed using optical coherence tomography angiography (OCTA). Methods: Forty women in the third trimester of uncomplicated pregnancy and 40 age-matched healthy women were included. Vascular density (VD) in the superficial and deep capillary plexuses (SCP/DCP), foveal density (FD), and foveal avascular zone (FAZ) area and perimetry measured with OCTA, as well as OCT measurements of central macular thickness (CMT) and choroidal thickness (CT) were compared between the groups. Correlations between structural OCT parameters and vascular OCTA metrics were analyzed. Results: The mean gestational age was 34 (28-41) weeks. Mean age was comparable in the groups (p = 0.732). The pregnant women had significantly higher parafoveal DCP-VD (p = 0.015), FAZ area (p = 0.044), and FD (p = 0.002). Mean subfoveal CT was 21 mu m higher in pregnant women but was not significant (p = 0.472). There was no difference in CMT (p = 0.448). FAZ metrics were positively correlated with CT in pregnants and with CMT in the control group (p < 0.05). Parafoveal VD was negatively correlated with CT in the control group (p < 0.05). After adjusting for CT and CMT, the significant difference in VD and FD persisted (p < 0.05), while the difference in FAZ area lost significance (p > 0.05). Conclusions: Considering the effects of the probable covariant factors CMT and CT, systemic changes in pregnant women in their third trimester may cause an increase in VD in the macula and parafoveal DCP.Item Clinical Results in Patients with Combined Penetrating Keratoplasty and Vitreoretinal Surgery Using Landers Wide-field Temporary KeratoprosthesisMayali, H; Kayikçioglu, Ö; Altinisik, M; Biçak, F; Kurt, EObjectives: To evaluate the clinical results of corn bined pars plana vitrectomy (PPV) with Landers wide-field temporary keraroprosthesis and penetrating keratoplasty (PK). Materials and Methods: From January 2016, traumatic eyes with coexisting corneal and vitreoretinal diseases that underwent combined keratoprosthesis/PPV/PK surgery were retrospectively evaluated. Demographic characteristics, visual acuity (VA), intraocular pressure (IOP) and clinical findings of the cornea, lens, and retina were recorded during the follow-up. Cases with clear corneal graft, attached retina, normotonic IOP, and improved or stable VA were considered successful. Results: Eight eyes were enrolled in the study. The mean follow-up time was 21.1 +/- 8.20 months. Surgery was performed a mean of 23 (10-40) days after trauma. Preoperative VA ranged from no light perception to counting fingers from 50 cm. Postoperatively, corneal graft was clear in 5 patients (62.5%) and retina was attached in 6 eyes (75%). Chronic hypotonia developed in 3 patients (37.5%). VA was unchanged in 3 patients and improved in 5 patients. A total of 5 cases (50%) were considered successful. Shorter interval between trauma and surgery was associated with higher likelihood of success (p=0.043). No significant difference was observed between the groups in terms of type or location of trauma (p= 1; p= 0.143). Conclusion: Although the functional results are not very satisfactory, the combined procedure provides a final opportunity for preserving remaining vision and anatomic reconstruction in eyes that will otherwise result in phthisis due to severe anterior and posterior segment pathologies.Item A comparative study of type 1 neovascularization: Neovascular age-related macular degeneration versus pachychoroid neovasculopathyAltinisik, M; Kurt, E; Sonmezer, P; Kayikcioglu, O; Ilker, SSPurpose: This study aimed to compare type 1 choroidal neovascularization (CNV) characteristics in eyes with pachychoroid neovasculopathy (PNV) and neovascular age-related macular degeneration (nAMD) using optical coherence tomography angiography (OCTA). Methods: Treatment naive 23 eyes of 23 patients with PNV and 24 eyes of 24 patients with nAMD were evaluated. The height of pigment epithelial detachment (PED) and the central macular thickness were determined. OCTA sensitivity, CNV area, morphological patterns, and retinal superficial capillary plexus vessel density (SCP-VD) values were compared. The frequency of quiescent CNV, subretinal hyperreflective exudation (SHE), subretinal/intraretinal fluid, serous PED, double-layer sign (DLS), and pachyvessels were noted. Results: CNV was detected on OCTA in 83.3% of nAMD eyes and 91.3% of PNV eyes (p = 0.66). Indistinct pattern was more common (74% vs 50%) and the CNV area (mm(2)) was smaller in PNV (0.77 +/- 0.54 vs 1.57 +/- 1.43) but did not reach significant levels (p = 0.27 and 0.33 respectively). SCP-VD was similar between the groups (p = 0.38). Statistically significant differences were found between groups in age and subfoveal choroidal thickness (p < 0.05). DLS and pachyvessels were found to be more frequently in PNV (p < 0.05). However, both groups had similar rates of quiescent CNV, SHE, subretinal/intraretinal fluid, and serous PED (p > 0.05). Conclusion: Morphological features, area, and activation findings of type 1 CNV may play a limited role in differentiating nAMD and PNV cases.Item Histopathological Results of Conjunctival Masses with Suspected Malignancy Based on Slit-lamp BiomicroscopyErdogan, M; Mayali, H; Malgaz, S; Altinisik, M; Ilker, SSObjective: To evaluate the histopathological results of conjunctival masses suspected to be malignant based on biomicroscopic exami-nation.Study Design: Observational study.Place and Duration of the Study: Department of Ophthalmology, Celal Bayar University, Hafsa Sultan Hospital, Manisa, Turkiye, from November 2013 to February 2021.Methodology: Patients who underwent excision for the diagnosis and treatment of conjunctival surface masses with clinical suspicion of malignancy were evaluated retrospectively. The masses were categorised as benign, premalignant, and malignant lesions according to the histopathological results. The distribution of conjunctival masses was analysed according to patients' gender and age groups.Results: The study included 98 conjunctival masses in 98 patients (57.1% men, mean age 48.6 & PLUSMN;21.85 years). On pathological examina-tion, 63 of the masses were found to be benign (64.3%), 22 were premalignant (22.4%), and 13 were malignant (13.3%). The most common benign lesion was nevus (n=21, 21.4%). All detected premalignant lesions were conjunctival intraepithelial neoplasms (CIN), detected in 22 patients (22.4%). Of these, 13 patients (13.3%) had carcinoma in situ (CIN III). Thirteen (13.3%) of the masses were malignant, the most common being squamous cell carcinoma (n=10, 10.2%). The frequency of premalignant and malignant lesions increased with age (p<0.001). There was no statistical relationship between malignancy and gender (p=0.619). Conclusion: Most conjunctival masses in this series were benign, with nevi being the most common. The most common premalignant and malignant lesions were intraepithelial neoplasia and squamous cell carcinoma, respectively. Malignant conjunctival lesions were more common in older patients.Item Quantitative Analysis of the Activity in Choroidal Neovascularizations after a Single Anti-VEGF injection: OCT Versus OCT AngiographyAltinisik, M; Kurt, E; Kayikcioglu, O; Yildirim, APurpose: To analyze early quantitative changes in the choroidal neovascularization (CNV) area observed with optical coherence tomography angiography (OCTA) after single anti-vascular endothelial growth factor (anti-VEGF) injection. Materials and Methods: Treatment-naive patients with CNV secondary to neovascular age-related macular degeneration were analyzed immediately before and -4 weeks after anti-VEGF injection. The primary endpoints of the study included changes in CNV total and vascular area. Secondary endpoints were best-corrected visual acuity (BCVA), central macular thickness (cMT), central total macular thickness (cTMT), and subfoveal choroidal thickness (SFCT). Results: A total of 27 patients (69.19 +/- 5.91 years, 21 men/6 women, 14 type 1 NV, 11 type 2 NV, and 2 type 3 NV) were included in the study. There was a significant increase in BCVA and decreases in cMT, cTMT, and SFCT after treatment (p<0.05 for all). CNV total and vascular area changed by -11.55 +/- 44.26% (95% confidence interval [CI]: -29.06 and 5.95; p=0.269) and -21.06 +/- 41.2% (95% CI: -36.45/-5.67; p=0.786), respectively. The cases with decreased cTMT were accompanied by a decrease in CNV area only in 37% of the cases. No significant correlation was detected between cTMT and CNV total and vascular area percentage changes (r = -0.06, p=0.74; r = 0.02, p=0.9, respectively). Conclusions: Changes in CNV total and vascular area seem to have limited sensitivity as a biomarker in terms of activation, as wide variability was observed in CNV area after anti-VEGF injection.Item Acute Posterior Multifocal Placoid Pigment Epitheliopathy: A Rare Presentation of Anklylosing Spondylitis or a Paradoxical Reaction to Secukinumab?Altinisik, M; Delibay, Y; Erdogan, MPurpose: To describe an atypical presentation of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) in a patient with ankylosing spondylitis (AS) receiving secukinumab. Methods: Retrospective chart review. Results: A 48-year-old female patient with AS receiving secukinumab complained of impaired vision in her left eye. Left eye examination revealed multiple yellow-white lesions at the posterior pole and central subfoveal fluid.The lesions regressed without scarring. The case was diagnosed with clinically APMPPE. Conclusion: In AS patients, posterior uveitis can manifest as APMPPE. It should be recorded as an entity to be considered in the differential diagnosis.Item Evaluation of Cerebral Vasomotor Reactivity by Transcranial Doppler Ultrasound in Patients with Diabetic RetinopathyKula, AY; Deniz, C; Gültekin, TÖ; Altinisik, M; Asil, TThe aim of this study was to assess the correlation between cerebral vasomotor reactivity (CVR) and the grade of diabetic retinopathy. A total of 43 diabetic patients with matched severity of diabetic retinopathy between their right and left eyes were included in this study. Diabetic retinopathy was graded in three groups. Right and left middle cerebral artery CVR was assessed by the breath-holding index (BHI) using transcranial Doppler ultrasound (TCD). The mean age of the patients was 56.51 +/- 9.34 years with a mean duration of having diabetes mellitus of 14.49 +/- 8.06 years. Diabetic retinopathy was graded as mild, moderately severe, and severe in 27.9%, 34.9%, and 37.2% of the patients, respectively. The grade of diabetic retinopathy was associated with the HbA1c level (p < .049), microalbuminuria (p < .024), and BHI (p = .001). In patients with severe diabetic retinopathy, the right-sided BHI was significantly lower as compared to those with mild or moderately severe retinopathy (p = .001 and p = .008, respectively). The left-sided BHI value in patients with severe diabetic retinopathy was significantly lower as compared to those with mild or moderately severe retinopathy (p = .001 and p = .012, respectively). In subjects with moderately severe diabetic retinopathy, both-sided BHI was significantly reduced compared to those with mild retinopathy (p = .001). Our results indicate that the grade of diabetic retinopathy was associated with impaired CVR.