Researcher: Uludağ, Günay
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Uludağ, Günay
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Publication Metadata only Quantitative analysis of structural alterations in the choroid of patients with active Behçet uveitis(Lippincott Williams and Wilkins (LWW), 2018) Oray, Merih; Herbort, Carl P.; Akman, Mehmet; Tugal-Tutkun, Ilknur; Department of Mathematics; N/A; N/A; N/A; N/A; Mengi, Emre; Önal, Sumru; Uludağ, Günay; Metin, Mustafa Mert; Akbay, Aylin Koç; Faculty Member; Other; Doctor; Undergraduate Student; Doctor; Department of Mathematics; College of Sciences; School of Medicine; N/A; School of Medicine; N/A; N/A; N/A; Koç University Hospital; N/A; Koç University Hospital; 113760; 52359; N/A; N/A; N/APurpose: To quantitatively analyze in vivo morphology of subfoveal choroid during an acute attack of Behcet uveitis. Methods: In this prospective study, 28 patients with Behcet uveitis of <= 4-year duration, and 28 control subjects underwent enhanced depth imaging optical coherence tomography. A novel custom software was used to calculate choroidal stroma-to-choroidal vessel lumen ratio. Subfoveal choroidal thickness was measured at fovea and 750 mu m nasal, temporal, superior, and inferior to fovea. Patients underwent fluorescein angiography and indocyanine green angiography. Receiver operating characteristic curve and area under the curve were computed for central foveal thickness. The eye with a higher Behcet disease ocular attack score 24 was studied. The main outcome measures were choroidal stromato-choroidal vessel lumen ratio and choroidal thickness. Results: The mean total Behcet disease ocular attack score 24, fluorescein angiography, and indocyanine green angiography scores were 7.42 +/- 4.10, 17.42 +/- 6.03, and 0.66 +/- 0.73, respectively. Choroidal stroma-to-choroidal vessel lumen ratio was significantly higher in patients (0.413 +/- 0.056 vs. 0.351 +/- 0.063, P = 0.003). There were no significant differences in subfoveal choroidal thickness between patients and control subjects. Choroidal stroma-tochoroidal vessel lumen ratio correlated with retinal vascular staining and leakage score of fluorescein angiography (r = 0.300, P = 0.036). Central foveal thickness was significantly increased in patients (352.750 +/- 107.134 mu m vs. 263.500 +/- 20.819 p.m, P < 0.001). Central foveal thickness showed significant correlations with logarithm of minimum angle of resolution vision, Behcet disease ocular attack score 24, total fluorescein angiography score, retinal vascular staining and/or leakage and capillary leakage scores of fluorescein angiography, and total indocyanine green angiography score. At 275 mu m cutoff, diagnostic sensitivity and specificity of central foveal thickness for acute Behcet uveitis were 89% and 72%, respectively (area under the curve = 0.902; 95% CI = 0.826-0.978, P < 0.001). Conclusion: There was choroidal stromal expansion which was not associated with thickening of the choroid. Central foveal thickness may be used as a noninvasive measure to assess inflammatory activity in early Behcet uveitis.Publication Metadata only Interferon alpha for the treatment of cystoid macular edema associated with presumed ocular tuberculosis(Mary Ann Liebert, Inc, 2017) Oray, Merih; Tuğal Tutkun, İlknur; N/A; Önal, Sumru; Uludağ, Günay; Akbay, Aylin Koç; Other; Doctor; Doctor; N/A; Koc University Hospital; Koc University Hospital; Koc University Hospital; 52359; N/A; N/APurpose: To report the efficacy and safety of interferon (IFN) alpha-2a in patients with cystoid macular edema (CME) associated with presumed ocular tuberculosis (TB). Methods: We reviewed the clinical records of 5 patients with presumed ocular TB who had been treated with IFN alpha-2a for recurrent CME during or after completion of anti-tubercular therapy. IFN alpha-2a was administered at an initial dose of 3 million IU per day and then tapered after the initial response. Treatment efficacy was assessed by central macular thickness (CMT) measurement using spectral-domain optical coherence tomography and visual acuity. Results: Three patients were men, and 2 were women. Patients were aged between 38 and 66 years. Mean CMT was 483 +/- 178.6 mm at baseline, 302.3 +/- 56 mm at 1 week, 312.3 +/- 49.5 mm at 1 month, and 286.2 +/- 31.9 mm at 3 months. Mean LogMAR visual acuity was 0.6 +/- 0.4 at baseline, 0.4 +/- 0.3 mm at 1 week, 0.3 +/- 0.3 at 1 month, and 0.3 +/- 0.3 at 3 months. The treatment was interrupted for 10 days because of neutropenia after 2 weeks in 1 patient and discontinued in another after 10 days because of intolerance. Total treatment duration was 3-24 months in the remaining 4 patients. Conclusion: The present small case series suggests that IFN alpha-2a may be an effective and safe therapeutic option for CME that is associated with presumed ocular TB.Publication Metadata only Electroretinographic improvement after rituximab therapy in a patient with autoimmune retinopathy(Elsevier, 2016) Arf, Serra; Sayman Muslubaş, Işıl; N/A; N/A; N/A; N/A; N/A; Uludağ, Günay; Önal, Sumru; Selçukbiricik, Fatih; Akbay, Aylin Koç; Mandel, Nil Molinas; Doctor; Other; Faculty Member; Doctor; Faculty Member; N/A; School of Medicine; School of Medicine; N/A; School of Medicine; Koc University Hospital; N/A; N/A; Koc University Hospital; N/A; N/A; 52359; 202015; N/A; 194197Purpose: To describe the effect of rituximab on full-field electroretinography (ERG) in a patient with nonparaneoplastic autoimmune retinopathy (npAIR). Observations: A 58-year-old male patient with visual complaints, positive anti-retinal antibodies and negative work-up for cancer was diagnosed with npAIR. Visual acuity and ancillary tests were normal except abnormal ERG in both eyes. The patient was given one course of rituximab 375 mg/m2/week for 4 weeks and cyclophosphamide 1 gr/m2/month for 6 months. A second course of rituximab was necessary as autoantibody titers showed no change and as new antibodies were noted after treatment with rituximab and cyclophosphamide. Electroretinography was repeated after the first course of rituximab, after cyclophosphamide, and the second course of rituximab therapy. Conclusions and Importance: Rituximab therapy led to marked improvement in full-field ERG readings and regression of symptoms was reported by the patient after rituximab infusions. The effect of rituximab in npAIR was objectively demonstrated with ERG.Publication Metadata only Screening for depression and anxiety in patients with active uveitis(Taylor and Francis Inc, 2018) Oray, Merih; Akman, Mehmet; Tugal-Tutkun, Ilknur; N/A; Önal, Sumru; Yasa, Çağla; Uludağ, Günay; Akbay, Aylin Koç; Other; N/A; Doctor; Doctor; N/A; Koc University Hospital; Koc University Hospital; Koc University Hospital; Koc University Hospital; 52359; N/A; N/A; N/APurpose: To screen for psychological disorders in patients with active uveitis. Methods: Patients were screened for depression (BDI-II), state anxiety (STAI-I), VR-QOL (NEI-VFQ-25), and HR-QOL (SF-36). Association of depression and anxiety with sociodemographic and clinical parameters and with VR-QOL and HR-QOL were analyzed. Multivariate linear regression models were constructed for NEI-VFQ-25 and SF-36 subscales. Results: of 99 patients, 37.3% screened positive for depression and 52.5% for anxiety. Depressed patients had lower visual acuity in the better seeing eye (p = 0.013) and more frequently panuveitis (p = 0.018). Anxious patients were younger (p = 0.009), had earlier onset of uveitis (p = 0.015), and had more frequently panuveitis (p = 0.016). Bivariate comparisons showed significant associations between psychological disorders and VR-QOL and HR-QOL. Significant bivariate associations were mostly lost in multivariate analyses for anxiety, but were preserved for depression. Conclusions: A positive screening test for depression and anxiety is common in patients with uveitis. Low vision and panuveitis are associated with depression. Depression is associated with impairment of VR-QOL and HR-QOL.Publication Metadata only Unilateral paraneoplastic optic disc edema and retinal periphlebitis in pineal germinoma(Elsevier, 2018) N/A; N/A; N/A; Uludağ, Günay; Onay, Aslıhan; Önal, Sumru; Doctor; Doctor; Other; N/A; N/A; School of Medicine; Koc University Hospital; Koc University Hospital; N/A; N/A; N/A; 52359Purpose: To describe a unilateral ocular paraneoplastic syndrome in pineal germinoma. Observations: A 24-year-old male presented with diplopia, excessive thirst, and frequent urination. Cranial MRI showed a mass in pineal gland. Dorsal midbrain syndrome signs were present. Examination showed optic disc edema and segmental retinal periphlebitis in right and normal fundus in left eye. Rheumatologic work-up was negative. Brain biopsy confirmed pineal germinoma. Retinal findings were attributed to paraneoplastic syndrome. Resolution of optic disc edema and retinal periphlebitis occurred following chemotherapy and focal irradiation. Conclusions and Importance: To date there are two published case reports on bilateral optic disc edema and retinal periphlebitis occurring as a paraneoplastic syndrome in pineal germinoma. This is the first report on a patient with pineal germinoma who had unilateral paraneoplastic involvement characterized by optic disc edema and retinal periphlebitis and who showed complete resolution of ocular disease after treatment of underlying tumor.Publication Metadata only Outcome comparison between transcanalicular and external dacryocystorhinostomy(IJO Press, 2015) Yeniad, Barış; Ceylan, Erdinç; Yıldız-Taş, Ayşe; Kozer-Bilgin, Lale; N/A; Uludağ, Günay; Doctor; N/A; N/AAim: To compare the outcomes achieved with external dacryocystorhinostomy (EX-DCR) and transcanalicular dacryocystorhinostomy (TC-DCR) using a multidiode laser in patients with bilateral nasolacrimal duct obstruction (NLDO). Methods: This prospective study was conducted on 38 eyes of 19 patients with bilateral NLDO. Simultaneous bilateral surgery was performed on all patients. TC-DCR (Group 1) with a diode laser was used in the right eye, and EX-DCR (Group 2) was used in the left eye. All patients were placed under general anesthesia. Routine follow ups were scheduled at 1wk; 1, 3, 6 and 12mo postoperative intervals. Objective (lacrimal system irrigation) and subjective [tearing, irritation, pain, discharge and visual analogue scale (VAS) score] outcomes were evaluated. Results: The overall objective success rate at 12mo was 73.7% (14/19) in Group 1 and 89.5 % (17/19) in Group 2. This difference was statistically significant. There were no significant between group differences in the subjective results, such as tearing, pain and irritation. Only the discharge scores were found to be significantly higher in Group 1 compared to Group 2 at the 1y follow up. The average VAS score was 6.8 in Group 1 and 8.7 in Group 2, with no statistically significant differences. Conclusion: Although TC-DCR allows surgeons to perform a minimally invasive and safe procedure, EX-DCR offers better objective and subjective outcomes than TC-DCR.Publication Open Access Quantitative analysis of structural alterations in the choroid of patients with active Behçet uveitis(Lippincott Williams and Wilkins (LWW), 2018) Oray, Merih; Herbort, Carl P.; Akman, Mehmet; Tuğal Tutkun, İlknur; Department of Mathematics; Önal, Sumru; Uludağ, Günay; Mengi, Emre; Metin, Mustafa Mert; Akbay, Aylin Koç; Other; Faculty Member; Department of Mathematics; School of Medicine; College of Sciences; Koç University Hospital; 52359; 175586; 113760; N/A; N/APurpose: To quantitatively analyze in vivo morphology of subfoveal choroid during an acute attack of Behçet uveitis. Methods: In this prospective study, 28 patients with Behçet uveitis of <= 4-year duration, and 28 control subjects underwent enhanced depth imaging optical coherence tomography. A novel custom software was used to calculate choroidal stroma-to-choroidal vessel lumen ratio. Subfoveal choroidal thickness was measured at fovea and 750 mu m nasal, temporal, superior, and inferior to fovea. Patients underwent fluorescein angiography and indocyanine green angiography. Receiver operating characteristic curve and area under the curve were computed for central foveal thickness. The eye with a higher Behçet disease ocular attack score 24 was studied. The main outcome measures were choroidal stromato-choroidal vessel lumen ratio and choroidal thickness. Results: The mean total Behçet disease ocular attack score 24, fluorescein angiography, and indocyanine green angiography scores were 7.42 +/- 4.10, 17.42 +/- 6.03, and 0.66 +/- 0.73, respectively. Choroidal stroma-to-choroidal vessel lumen ratio was significantly higher in patients (0.413 +/- 0.056 vs. 0.351 +/- 0.063, P = 0.003). There were no significant differences in subfoveal choroidal thickness between patients and control subjects. Choroidal stroma-tochoroidal vessel lumen ratio correlated with retinal vascular staining and leakage score of fluorescein angiography (r = 0.300, P = 0.036). Central foveal thickness was significantly increased in patients (352.750 +/- 107.134 mu m vs. 263.500 +/- 20.819 p.m, P < 0.001). Central foveal thickness showed significant correlations with logarithm of minimum angle of resolution vision, Behçet disease ocular attack score 24, total fluorescein angiography score, retinal vascular staining and/or leakage and capillary leakage scores of fluorescein angiography, and total indocyanine green angiography score. At 275 mu m cutoff, diagnostic sensitivity and specificity of central foveal thickness for acute Behçet uveitis were 89% and 72%, respectively (area under the curve = 0.902; 95% CI = 0.826-0.978, P < 0.001). Conclusion: There was choroidal stromal expansion which was not associated with thickening of the choroid. Central foveal thickness may be used as a noninvasive measure to assess inflammatory activity in early Behçet uveitis.Publication Open Access Persistence of retinopathy of prematurity in an infant with tetralogy of fallot(Hindawi, 2016) Günay, Murat; Yavuz, Taner; Çelik, Gökhan; Uludağ, Günay; Koç University Hospital; 175586We report an infant with tetralogy of fallot (TOF) who was born at 35 weeks of gestation and of 1700 g birth weight and presented with persistent retinopathy of prematurity (ROP) at 6 months of age. Follow-up ophthalmic examinations were done at 2, 3, and 4 weeks of age. A demarcation line in Zone II was noticed on the first ocular examination done at 4 weeks of postnatal age. At 6 months of postnatal age, the infant still had an avascular peripheral retina with the demarcation line in Zone II. Even though this index subject did not have any typical risk factors for ROP, TOF seems to be the probable reason for developing as well as persistence of avascular retina.Publication Open Access Incidence, risk factors and severity of retinopathy of prematurity in Turkey (TR-ROP study): a prospective, multicentre study in 69 neonatal intensive care units(BMJ Publishing Group, 2018) Baş, Ahmet Yağmur; Demirel, Nihal; Koç, Esin; Işık, Dilek Ulubaş; Hirfanoğlu, İbrahim Murat; Tunç, Turan; Sarı, Fatma Nur; Karatekin, Güner; Köklü, Esad; Altunhan, Hüseyin; Turgut, Hatice; Narter, Fatma; Tarakçı, Nuriye; Tekgündüz, Kadir Şerafettin; Özkiraz, Servet; Aydemir, Cumhur; Özdemir, Ahmet; Çetinkaya, Bilin; Kazancı, Ebru; Taştekin, Ayhan; Calkavur, Şebnem; Özyurt, Banu Mutlu; Demirelli, Yaşar; Asker, Hüseyin Selim; Mutlu, Birgul; Uygur, Özgün; Özkan, Hilal; Armangil, Didem; Özlü, Ferda; Mert, Mustafa Kurthan; Ergin, Hacer; Özcan, Beyza; Baş, Evrim Kıray; Okulu, Emel; Acunas, Betül; Çelik, Ülker; Uslu, Sait İlker; Mutlu, Mehmet; Demir, Nihat; Eroğlu, Funda; Gökmen, Zeynel; Beken, Serdar; Bayraktar, Bilge Tanyeri; Hakan, Nilay; Küçüktaşçı, Kazım; Orman, Ayşen; Cömert, Serdar; Ertuğrul, Sabahattin; Üstün, Nuran; Şahin, Özlem; Terek, Demet; Kale, Yusuf; Konak, Murat; Yurttutan, Sadık; Aydemir, Özge; Zenciroğlu, Aysegül; Sarıcı, Dilek; Güzoğlu, Nilüfer; Hamilçıkan, Şahin; Tüzün, Funda; Örs, Rahmi; Arslan, Selda; Akdağ, Arzu; Memişoğlu, Aslı; Yasa, Beril; Hekimoğlu, Berna; Turan, Özden; Aylanc, Hakan; Takçı, Şahin; Çelik, Tolga; Şahin, Suzan; Kılıç, İlknur; Kara, Caner; Tunay, Zuhal Özen; Çelik, Gökhan; Gözen, İbrahim; Satırtav, Günhal; Polat, Nihat; Oral, Ayşe Yeşim; Tokgöz, Mine; Keleş, Sadullah; Bilgin, Burak; Uğurbaş, Silay Cantürk; Karaca, Çağatay; Keşkek, Nedime Şahinoğlu; Ekinci, Dilbade Yıldız; Balcı, Özlem; Altan, Emir Volkan; Bakbak, Sevda; Ceylan, Nihan Aksu; Kimyon, Sabit; Alyamaç, Günay; Türe, Gamze; Yıldız, Meral; Çalış, Feyza; Sızmaz, Selçuk; Sukgen, Emine; Çetin, Ebru Nevin; Özçimen, Muammer; Demir, Semra Tiryaki; Atila, Huban; Özal, Altan; Tufaner, Gökhan; Yücel, Özlem Eski; Kola, Mehmet; Seven, Erbil; Özdek, Şengül; Durukan, Ali Hakan; Kal, Ali; Çelebi, Ali Riza Cenk; Koytak, İbrahim Arif; Alaçamlı, Göksu; Esme, Arif; Çatak, Onur; Perente, İrfan; Şahin, Alparslan; Akçakaya, Aylin Ardagil; Kıray, Gülünay; Nalçacı, Serhat; Aksoy, Ümit; Bakbak, Berker; Çömez, Ayşegül; Gürsoy, Hüseyin; Kabataş, Emrah Utku; Petricli, İkbal Seza; Yumuşak, Mehmet Erhan; Kırgız, Ahmet; Yaman, Aylin; Dadacı, Zeynep; Karataş, Ali; Çeliker, Hande; Cebeci, Zafer; Esenülkü, Mahmut Cenap; Akkoyun, İmren; Ersan, İsmail; Demir, Selim; Kadayıfçılar, Sibel; Ünsal, Ayşe İpek Akyüz; Hocaoğlu, Mümin; N/A; Uludağ, Günay; Gürsoy, Tuğba; Faculty Member; School of Medicine; 175586; 214691Background to evaluate the prevalence, risk factors and treatment of retinopathy of prematurity (ROP) in Turkey and to establish screening criteria for this condition. Methods: a prospective cohort study (TR-ROP) was performed between 1 April 2016 and 30 April 2017 in 69 neonatal intensive care units (NICUs). Infants with a birth weight (BW)=1500 g or gestational age (GA)<= 32 weeks and those with a BW> 1500 g or GA> 32 weeks with an unstable clinical course were included in the study. Predictors for the development of ROP were determined by logistic regression analyses. Results: the TR-ROP study included 6115 infants: 4964 (81%) with a GA <= 32 weeks and 1151 (19%) with a GA>32 weeks. Overall, 27% had any stage of ROP and 6.7% had severe ROP. A lower BW, smaller GA, total days on oxygen, late-onset sepsis, frequency of red blood cell transfusions and relative weight gain were identified as independent risk factors for severe ROP in infants with a BW=1500 g. Of all infants, 414 needed treatment and 395 (95.4%) of the treated infants had a BW <= 1500 g. Sixty-six (16%) of the treated infants did not fulfil the Early Treatment for Retinopathy of Prematurity requirements for treatment. Conclusions: screening of infants with a GA <= 34 weeks or a BW<1700 g appears to be appropriate in Turkey. Monitoring standards of neonatal care and conducting quality improvement projects across the country are recommended to improve neonatal outcomes in Turkish NICUs.