After I finished the education of adult and pediatric cardiovascular surgery in Hacettepe University, I have completed the post-doc. education in the same university. I am working as a head of the dept. of cardiovascular surgery in Kafkas University Schjool of Medicine.
Pulmonary alveolar microlithiasis (PAM) is a rare disease characterized by the presence of small ... more Pulmonary alveolar microlithiasis (PAM) is a rare disease characterized by the presence of small calculi in the alveolar space. The SLC34A2 is thought to be responsible for the disease. We encountered three siblings of an inbred family who have PAM. We examined the family of the proband who was admitted with dyspnea on exertion and cough, and eventually was diagnosed with PAM. Genetic analysis revealed that both parents (a consanguineous marriage) of the proband were carriers with heterozygous mutation of SLC34A2 gene, and three of their children were diagnosed with PAM with homozygous mutation in the SLC34A2 gene. These findings suggest that impaired activity of the SLC34A2 gene may be responsible for familial PAM.
Various comparative studies and techniques have been described for median sternotomy closure in t... more Various comparative studies and techniques have been described for median sternotomy closure in the literature, previously. However, some patients are still under risk of sternal dehiscence, malunion or nonunion due to intrinsic or extrinsic factors after median sternotomy closure. Sternal nonunion described as sternal pain, with clicking, instability, or both for more than 3 months in the absence of infection, is an uncommon complication of midline sternotomy incision. To date, only a few studies have addressed the entity of sternal nonunion and its treatment. The suture anchor system has been described for the fixation of tendons or ligaments to the bone in the orthopedic, and then in cardiac surgery for closure of sternum. In the present study, we used different methods for correction and reduction of sternal nonunion with the use of suture anchors and it accompanied steel wires as an alternative technique in a male patient after coronary artery bypass grafting. There was no complication due to suture anchors. Sternal stability, reduction, and fixation were achieved successfully. Sternal nonunion and dehiscence may be the cause of prolonged hospitalization and increased mortality and morbidity if the patient is not treated surgically. This device may protect the wire from cutting into the sternal bone because the thoracal lateral enforcement may be decreased by the devices when the patient is breathing, and with upper extremity movement. This technique can be used easily, safely, and effectively in the repair of sternal nonunion.
Xanthomas are benign soft-tissue lesions commonly occurring on the skin, subcutis, or tendon shea... more Xanthomas are benign soft-tissue lesions commonly occurring on the skin, subcutis, or tendon sheaths of patients. The lung and thoracic cavity is a rare location for xanthomas. We present a 39-year-old woman who was admitted to our hospital with complaints of dyspnea, cough, and chest pain. She had a prior diagnosis of type II familial hypercholesterolemia. Chest x-ray film and computed tomography scans revealed a large tumor-like mass in the right hemithorax. Thoracal mass and narrowed tracheal segments were removed using cardiopulmonary bypass. Histopathologic findings were consistent with xanthoma.
Catheter- or noncatheter-related peripheral arterial complications such as arterial pseudoaneurys... more Catheter- or noncatheter-related peripheral arterial complications such as arterial pseudoaneurysm, embolus, or arteriovenous fistula may be seen in the pediatric age group. The most common etiologies defined for arterial complications are peripheral arterial puncture performed for a routine arterial blood gas analysis, arterial catheters placed for invasive monitorization of children, or catheterization performed for diagnostic purposes through the peripheral arterial system, most commonly the femoral artery. Nine children with peripheral arterial complications, whose ages varied between 2 months and 2.5 years, were enrolled in this study. All patients were treated surgically. Following physical examination, Doppler ultrasonography, computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography were used as diagnostic tools. We studied thrombophilic panels preoperatively. Six patients had brachial artery pseudoaneurysms that developed accidentally during venipuncture, I had a brachial arteriovenous fistula that developed after an accidental brachial artery puncture during routine peripheral blood analysis. In the remaining 2 patients, peripheral arterial embolic events were detected. One had a left brachial arterial embolus and the other had a sudden onset right femoral artery embolus that was detected via diagnostic interventions. No morbidity such as amputation, extremity loss, or mortality occurred due to the arterial events or surgery. All patients were discharged from the hospital in good clinical condition. In all patients, follow-up at 3 or 6 months revealed palpable peripheral artery pulsations of the ulnar and radial arteries at wrist level. Because the incidence of peripheral arterial complications is relatively low in children compared to adults, the diagnostic and therapeutic approaches are extrapolated from the adult guidelines. We proposed that early diagnosis and surgical approach prevented the complications from further developing in the affected extremity in these particular cases.
We report a case of child-onset Kawasaki disease that presented as a prolonged fever and manifest... more We report a case of child-onset Kawasaki disease that presented as a prolonged fever and manifested with coronary aneurysms and peripheral gangrene of the lower limbs. Therapy with intravenous immunoglobulins, corticosteroids, aspirin, anticoagulants, and ilomedine, a prostacyclin analogue, resulted in rapid improvement in the patient's condition without extremity loss. Those treating patients with Kawasaki disease must be aware of possible vascular ischemia in the disease process that is reversible by early intervention treatments, including the use of a prostacycline analogue, that improve quality of life.
Detection of coronary artery is important when considering surgical treatment of a congenital hea... more Detection of coronary artery is important when considering surgical treatment of a congenital heart disease (CHD) such as tetralogy of Fallot (TF). Cardiac catheterization plays an important supplementary role in the evaluation of patients with CHD. In a few reports, it has been proposed that multidetector computed tomography (MDCT) can be helpful for the visualization of coronary arteries. We sought to demonstrate the feasibility and usefulness of MDCT angiography for anatomical evaluation of coronary arteries in CHD patients with suspected coronary artery anomalies. A total of 10 patients, 9 pediatric and 1 adult, underwent MDCT angiography for the investigation of coronary artery anomalies and mediastinal vascular structures. Seven patients had TF; 5 of these patients were suspected of having coronary artery anomalies and 2 were suspected of having pulmonary artery atresia or a nonconfluent pulmonary artery. The other 3 patients had truncus arteriosus and severe left pulmonary artery stenosis (n = 1), double outlet right ventricle (n = 1), and Kawasaki disease (n = 1) with suspected coronary artery aneurysms. The entire heart, major vascular structures, and coronary artery anomalies were preoperatively scanned in patients with cyanotic heart disease. Examinations were performed by 16-MDCT with 1-mm slice thickness. A breath-holding test was performed in 5 patients. Nonionic iodinated contrast material (2 cc/kg) was administered by a power injector. Major vascular structures and the proximal part of the right and left coronary arteries were visualized successfully in all patients. Mid and/or distal segments of the coronary arteries were visualized in 5 patients with TF. Pulmonary vascular bed findings were also confirmed during surgery in patients with TF and in one patient with truncus arteriosus type I and severe left pulmonary artery stenosis. Kawasaki disease was diagnosed by the presence of aneurysms in one patient. Pulmonary artery atresia was confirmed in one patient and diameter of the pulmonary arteries (4 mm and 4.5 mm) was determined in the other 2 patients by MDCT. The advantage of MDCT for cardiac imaging is the shortened scanning time for imaging the entire heart without long breath-holding times. Selective conventional coronary angiography is invasive and technically difficult in pediatric patients. We suggest that MDCT angiography can be performed as a noninvasive method in patients with CHD for the evaluation of coronary artery anatomy and anomalies and mediastinal vascular structures.
Modified Blalock-Taussig shunt (MBTS) is a palliative operation for cyanotic congenital heart dis... more Modified Blalock-Taussig shunt (MBTS) is a palliative operation for cyanotic congenital heart disease (CCHD) in patients for whom total correction is not appropriate. Many synthetic or biologic grafts have been proposed as alternative shunt materials. The use of a bovine mesenteric venous graft (BMVG) as a systemic-to-pulmonary artery shunt conduit without the administration of antiaggregant and anticoagulant has been proposed as a treatment for neonates with CCHD, but few reports address the importance of thrombophilic risk factors in MBTS and bovine venous graft as a shunt material. We used BMVG as a shunt material without any antiaggregant or antiplatelet regimen in 13 patients with CCHD, all of whom were candidates for MBTS and had thrombophilic risk factors assessed in our initial study. Early shunt failure occurred in the first 3 patients and was attributed to less surgical experience with this graft. No complications were attributable to graft material or surgery itself. In all cases functioning MBTSs were observed on follow-up. Our study results show that thrombophilic factors should be evaluated before the MBTS procedure. BMVG could be the choice of graft for use without the administration of antiaggregant and anticoagulants in patients with thrombophilic risk factors.
To compare preserved human amniotic membrane transplantation and conjunctival autografts for trea... more To compare preserved human amniotic membrane transplantation and conjunctival autografts for treatment of primary pterygium. Thirty-seven eyes of 35 patients with primary pterygium underwent surgical excision. In group A, 25 eyes were treated with conjunctival autografts. In group B, 12 eyes were treated with preserved human amniotic membrane transplantation. These two groups were compared in terms of complications, recurrence, and final appearance, prospectively. We observed two cases of recurrence in group A and five cases of recurrence in group B. The onset of recurrence was about 5.5 months in both groups. We observed two eyes with Dellen ulcer and one case with a Tenon's cyst in the superior temporal quadrant in group A and one case of Dellen ulcer and granulation tissue of one eye in group B. We suggest that free conjunctival autografting is a more effective technique in primary pterygium in terms of lowering recurrences compared with the amniotic membrane transplantation technique.
To determine the astigmatism outcomes after cataract surgery performed using superonasal and supe... more To determine the astigmatism outcomes after cataract surgery performed using superonasal and superotemporal clear corneal incisions. Department of Ophthalmology, Kartal Training and Research Hospital, Istanbul, Turkey. This prospective study includes consecutive 45 eyes of 34 patients having phacoemulsification with implantation of foldable acrylic intraocular lens through a corneal tunnel incision between January and April 2004. The right eye always had a superotemporal incision while the left eye a superonasal incision. Astigmatism was measured by keratometry readings before surgery and 3rd, 15th, and 45th days postoperatively. The surgically induced astigmatism (SIA) was calculated by the vector analysis using the Holladay-Cravy-Koch method at 3rd day, 2nd and 6th weeks postoperatively. The mean preoperative astigmatism was 0.74 +/- 0.45 diopter (D) in the temporal incision group and 0.69 +/- 0.39 D in the nasal incision group. Fifty-eight percent of eyes had against-the-rule (ATR) astigmatism, 26% had with-the-rule (WTR) astigmatism, and 16% were astigmatically neutral. At 6 weeks, 46% of eyes had ATR astigmatism and 35% had WTR astigmatism. The mean total astigmatism was lower in the temporal incision group than in the nasal incision group at all successive examinations postoperatively. Although the total astigmatism decreased at 6 weeks in both groups, temporal incisions yielded less total and surgically induced astigmatism (P < .05). Cataract surgery using superotemporal incision induced significantly less SIA in the early postoperative period.
Blood levels of many medications are acutely lowered by cardiopulmonary bypass (CPB). Because nif... more Blood levels of many medications are acutely lowered by cardiopulmonary bypass (CPB). Because nifedipine is often used to provide protection from coronary ischemia, a determination of the effect of CPB on plasma nifedipine levels might help to determine the potential clinical benefit of nifedipine during and after bypass. Four samples of blood were drawn from each of eight patients undergoing cardiac surgery: one before, two during, and one after CPB. Although plasma levels of nifedipine declined during and after bypass (P less than 0.05, analysis of variance), the time-course and slope of the decline indicate that this was an effect of normal metabolism of the drug rather than an effect of physiologic changes occurring during CPB. An important additional finding was that the majority of patients had subtherapeutic levels of nifedipine before bypass, suggesting that additional nifedipine given during and after surgery might be of benefit. The effect of the CPB circuit itself was also examined in vitro by mixing nifedipine into a pump prime solution that was then recirculated with 2 U of outdated blood while levels of nifedipine were measured for 3 h. Plasma levels did not change in either a CPB circuit exposed to light or kept in a darkened room.
To compare the effects of dorzolamide-timolol combination and brimonidine on intraocular pressure... more To compare the effects of dorzolamide-timolol combination and brimonidine on intraocular pressure (IOP) after phacoemulsification surgery. This prospective, randomized study included 69 eyes of 43 patients undergoing phacoemulsification and foldable intraocular lens implantation. Twenty-one patients were women and 22 were men. The mean patient age was 69.7+/-12.4 years. Patients were randomly assigned to one of three treatment groups preoperatively. Group A (n=23) received one drop of dorzolamide-timolol fixed combination and group B (n=23) received one drop of brimonidine tartrate 0.2% immediately after surgery. In group C (n=23), patients received no treatment and served as a control group. IOP was measured by Goldmann applanation tonometry 6 hours and 24 hours after surgery. Six hours after surgery, the mean IOP was significantly lower in group A (16.3+/-2.9 mm Hg) than in groups B (20.6+/-2.9 mm Hg) and C (24.6+/-5.4 mm Hg). However, 24 hours after surgery, the mean IOP was higher in group C (19.8+/-4.7 mm Hg) than in the other two groups (14.1+/-2.8 mm Hg in group A and 17.5+/-2.7 mm Hg in group B). Prophylactic treatment with dorzolamide-timolol fixed combination was more effective than brimonidine in reducing IOP 6 hours and 24 hours after phacoemulsification surgery.
To identify the incidence of and risk factors associated with the development of glaucoma after p... more To identify the incidence of and risk factors associated with the development of glaucoma after penetrating keratoplasty. A retrospective study was carried out between September 1996 and January 2007 with 729 patients' 749 eyes, which underwent penetrating keratoplasty at the 1st Eye Clinic at Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul. Six attending surgeons performed all the surgeries at the same center. Age, sex, preoperative diagnosis, the presence of preoperative glaucoma, the status of the lenses, and additional surgery performed during keratoplasty, which may affect the postoperative intraocular pressure, were evaluated. The patients' ages ranged from 5 to 86 years (with a mean of 40.9 +/- 20.4 years). Two hundred seventy-seven (61.9%) of the patients were female and 452 (38.1%) were male. Intraocular pressure increases in the early postoperative period occurred in 41 (5.5%) eyes and chronically elevated intraocular pressure was found in 124 (16.6%) eyes. Preoperative diagnosis of inflammatory diseases such as graft thinning (relative risk [RR] = 4.96), traumatic scar formation (RR = 2.66), graft abscess (RR = 2.62), graft rejection (RR = 2.61), bullous keratopathy (RR = 2.59), and corneal abscess (RR = 1.52) were found to be risk factors for the development of glaucoma. Also, the following were significantly associated with an increased risk of glaucoma: peripheral anterior synechia (P = 0.019), preoperative glaucoma (P = 0.0001), and additional surgery combined with penetrating keratoplasty (P = 0.0001). The average period between surgery and the first intraocular pressure elevation was 5.0 +/- 6.5 months for all eyes. The mean intraocular pressure value of eyes that developed glaucoma after penetrating keratoplasty was 27.9 +/- 5.8 mmHg. Increased intraocular pressure after penetrating keratoplasty is a common clinical problem, and the risk factors are preoperative diagnosis of inflammatory diseases, peripheral anterior synechia, preoperative glaucoma, and additional surgery combined with penetrating keratoplasty.
Pulmonary alveolar microlithiasis (PAM) is a rare disease characterized by the presence of small ... more Pulmonary alveolar microlithiasis (PAM) is a rare disease characterized by the presence of small calculi in the alveolar space. The SLC34A2 is thought to be responsible for the disease. We encountered three siblings of an inbred family who have PAM. We examined the family of the proband who was admitted with dyspnea on exertion and cough, and eventually was diagnosed with PAM. Genetic analysis revealed that both parents (a consanguineous marriage) of the proband were carriers with heterozygous mutation of SLC34A2 gene, and three of their children were diagnosed with PAM with homozygous mutation in the SLC34A2 gene. These findings suggest that impaired activity of the SLC34A2 gene may be responsible for familial PAM.
Various comparative studies and techniques have been described for median sternotomy closure in t... more Various comparative studies and techniques have been described for median sternotomy closure in the literature, previously. However, some patients are still under risk of sternal dehiscence, malunion or nonunion due to intrinsic or extrinsic factors after median sternotomy closure. Sternal nonunion described as sternal pain, with clicking, instability, or both for more than 3 months in the absence of infection, is an uncommon complication of midline sternotomy incision. To date, only a few studies have addressed the entity of sternal nonunion and its treatment. The suture anchor system has been described for the fixation of tendons or ligaments to the bone in the orthopedic, and then in cardiac surgery for closure of sternum. In the present study, we used different methods for correction and reduction of sternal nonunion with the use of suture anchors and it accompanied steel wires as an alternative technique in a male patient after coronary artery bypass grafting. There was no complication due to suture anchors. Sternal stability, reduction, and fixation were achieved successfully. Sternal nonunion and dehiscence may be the cause of prolonged hospitalization and increased mortality and morbidity if the patient is not treated surgically. This device may protect the wire from cutting into the sternal bone because the thoracal lateral enforcement may be decreased by the devices when the patient is breathing, and with upper extremity movement. This technique can be used easily, safely, and effectively in the repair of sternal nonunion.
Xanthomas are benign soft-tissue lesions commonly occurring on the skin, subcutis, or tendon shea... more Xanthomas are benign soft-tissue lesions commonly occurring on the skin, subcutis, or tendon sheaths of patients. The lung and thoracic cavity is a rare location for xanthomas. We present a 39-year-old woman who was admitted to our hospital with complaints of dyspnea, cough, and chest pain. She had a prior diagnosis of type II familial hypercholesterolemia. Chest x-ray film and computed tomography scans revealed a large tumor-like mass in the right hemithorax. Thoracal mass and narrowed tracheal segments were removed using cardiopulmonary bypass. Histopathologic findings were consistent with xanthoma.
Catheter- or noncatheter-related peripheral arterial complications such as arterial pseudoaneurys... more Catheter- or noncatheter-related peripheral arterial complications such as arterial pseudoaneurysm, embolus, or arteriovenous fistula may be seen in the pediatric age group. The most common etiologies defined for arterial complications are peripheral arterial puncture performed for a routine arterial blood gas analysis, arterial catheters placed for invasive monitorization of children, or catheterization performed for diagnostic purposes through the peripheral arterial system, most commonly the femoral artery. Nine children with peripheral arterial complications, whose ages varied between 2 months and 2.5 years, were enrolled in this study. All patients were treated surgically. Following physical examination, Doppler ultrasonography, computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography were used as diagnostic tools. We studied thrombophilic panels preoperatively. Six patients had brachial artery pseudoaneurysms that developed accidentally during venipuncture, I had a brachial arteriovenous fistula that developed after an accidental brachial artery puncture during routine peripheral blood analysis. In the remaining 2 patients, peripheral arterial embolic events were detected. One had a left brachial arterial embolus and the other had a sudden onset right femoral artery embolus that was detected via diagnostic interventions. No morbidity such as amputation, extremity loss, or mortality occurred due to the arterial events or surgery. All patients were discharged from the hospital in good clinical condition. In all patients, follow-up at 3 or 6 months revealed palpable peripheral artery pulsations of the ulnar and radial arteries at wrist level. Because the incidence of peripheral arterial complications is relatively low in children compared to adults, the diagnostic and therapeutic approaches are extrapolated from the adult guidelines. We proposed that early diagnosis and surgical approach prevented the complications from further developing in the affected extremity in these particular cases.
We report a case of child-onset Kawasaki disease that presented as a prolonged fever and manifest... more We report a case of child-onset Kawasaki disease that presented as a prolonged fever and manifested with coronary aneurysms and peripheral gangrene of the lower limbs. Therapy with intravenous immunoglobulins, corticosteroids, aspirin, anticoagulants, and ilomedine, a prostacyclin analogue, resulted in rapid improvement in the patient's condition without extremity loss. Those treating patients with Kawasaki disease must be aware of possible vascular ischemia in the disease process that is reversible by early intervention treatments, including the use of a prostacycline analogue, that improve quality of life.
Detection of coronary artery is important when considering surgical treatment of a congenital hea... more Detection of coronary artery is important when considering surgical treatment of a congenital heart disease (CHD) such as tetralogy of Fallot (TF). Cardiac catheterization plays an important supplementary role in the evaluation of patients with CHD. In a few reports, it has been proposed that multidetector computed tomography (MDCT) can be helpful for the visualization of coronary arteries. We sought to demonstrate the feasibility and usefulness of MDCT angiography for anatomical evaluation of coronary arteries in CHD patients with suspected coronary artery anomalies. A total of 10 patients, 9 pediatric and 1 adult, underwent MDCT angiography for the investigation of coronary artery anomalies and mediastinal vascular structures. Seven patients had TF; 5 of these patients were suspected of having coronary artery anomalies and 2 were suspected of having pulmonary artery atresia or a nonconfluent pulmonary artery. The other 3 patients had truncus arteriosus and severe left pulmonary artery stenosis (n = 1), double outlet right ventricle (n = 1), and Kawasaki disease (n = 1) with suspected coronary artery aneurysms. The entire heart, major vascular structures, and coronary artery anomalies were preoperatively scanned in patients with cyanotic heart disease. Examinations were performed by 16-MDCT with 1-mm slice thickness. A breath-holding test was performed in 5 patients. Nonionic iodinated contrast material (2 cc/kg) was administered by a power injector. Major vascular structures and the proximal part of the right and left coronary arteries were visualized successfully in all patients. Mid and/or distal segments of the coronary arteries were visualized in 5 patients with TF. Pulmonary vascular bed findings were also confirmed during surgery in patients with TF and in one patient with truncus arteriosus type I and severe left pulmonary artery stenosis. Kawasaki disease was diagnosed by the presence of aneurysms in one patient. Pulmonary artery atresia was confirmed in one patient and diameter of the pulmonary arteries (4 mm and 4.5 mm) was determined in the other 2 patients by MDCT. The advantage of MDCT for cardiac imaging is the shortened scanning time for imaging the entire heart without long breath-holding times. Selective conventional coronary angiography is invasive and technically difficult in pediatric patients. We suggest that MDCT angiography can be performed as a noninvasive method in patients with CHD for the evaluation of coronary artery anatomy and anomalies and mediastinal vascular structures.
Modified Blalock-Taussig shunt (MBTS) is a palliative operation for cyanotic congenital heart dis... more Modified Blalock-Taussig shunt (MBTS) is a palliative operation for cyanotic congenital heart disease (CCHD) in patients for whom total correction is not appropriate. Many synthetic or biologic grafts have been proposed as alternative shunt materials. The use of a bovine mesenteric venous graft (BMVG) as a systemic-to-pulmonary artery shunt conduit without the administration of antiaggregant and anticoagulant has been proposed as a treatment for neonates with CCHD, but few reports address the importance of thrombophilic risk factors in MBTS and bovine venous graft as a shunt material. We used BMVG as a shunt material without any antiaggregant or antiplatelet regimen in 13 patients with CCHD, all of whom were candidates for MBTS and had thrombophilic risk factors assessed in our initial study. Early shunt failure occurred in the first 3 patients and was attributed to less surgical experience with this graft. No complications were attributable to graft material or surgery itself. In all cases functioning MBTSs were observed on follow-up. Our study results show that thrombophilic factors should be evaluated before the MBTS procedure. BMVG could be the choice of graft for use without the administration of antiaggregant and anticoagulants in patients with thrombophilic risk factors.
To compare preserved human amniotic membrane transplantation and conjunctival autografts for trea... more To compare preserved human amniotic membrane transplantation and conjunctival autografts for treatment of primary pterygium. Thirty-seven eyes of 35 patients with primary pterygium underwent surgical excision. In group A, 25 eyes were treated with conjunctival autografts. In group B, 12 eyes were treated with preserved human amniotic membrane transplantation. These two groups were compared in terms of complications, recurrence, and final appearance, prospectively. We observed two cases of recurrence in group A and five cases of recurrence in group B. The onset of recurrence was about 5.5 months in both groups. We observed two eyes with Dellen ulcer and one case with a Tenon's cyst in the superior temporal quadrant in group A and one case of Dellen ulcer and granulation tissue of one eye in group B. We suggest that free conjunctival autografting is a more effective technique in primary pterygium in terms of lowering recurrences compared with the amniotic membrane transplantation technique.
To determine the astigmatism outcomes after cataract surgery performed using superonasal and supe... more To determine the astigmatism outcomes after cataract surgery performed using superonasal and superotemporal clear corneal incisions. Department of Ophthalmology, Kartal Training and Research Hospital, Istanbul, Turkey. This prospective study includes consecutive 45 eyes of 34 patients having phacoemulsification with implantation of foldable acrylic intraocular lens through a corneal tunnel incision between January and April 2004. The right eye always had a superotemporal incision while the left eye a superonasal incision. Astigmatism was measured by keratometry readings before surgery and 3rd, 15th, and 45th days postoperatively. The surgically induced astigmatism (SIA) was calculated by the vector analysis using the Holladay-Cravy-Koch method at 3rd day, 2nd and 6th weeks postoperatively. The mean preoperative astigmatism was 0.74 +/- 0.45 diopter (D) in the temporal incision group and 0.69 +/- 0.39 D in the nasal incision group. Fifty-eight percent of eyes had against-the-rule (ATR) astigmatism, 26% had with-the-rule (WTR) astigmatism, and 16% were astigmatically neutral. At 6 weeks, 46% of eyes had ATR astigmatism and 35% had WTR astigmatism. The mean total astigmatism was lower in the temporal incision group than in the nasal incision group at all successive examinations postoperatively. Although the total astigmatism decreased at 6 weeks in both groups, temporal incisions yielded less total and surgically induced astigmatism (P < .05). Cataract surgery using superotemporal incision induced significantly less SIA in the early postoperative period.
Blood levels of many medications are acutely lowered by cardiopulmonary bypass (CPB). Because nif... more Blood levels of many medications are acutely lowered by cardiopulmonary bypass (CPB). Because nifedipine is often used to provide protection from coronary ischemia, a determination of the effect of CPB on plasma nifedipine levels might help to determine the potential clinical benefit of nifedipine during and after bypass. Four samples of blood were drawn from each of eight patients undergoing cardiac surgery: one before, two during, and one after CPB. Although plasma levels of nifedipine declined during and after bypass (P less than 0.05, analysis of variance), the time-course and slope of the decline indicate that this was an effect of normal metabolism of the drug rather than an effect of physiologic changes occurring during CPB. An important additional finding was that the majority of patients had subtherapeutic levels of nifedipine before bypass, suggesting that additional nifedipine given during and after surgery might be of benefit. The effect of the CPB circuit itself was also examined in vitro by mixing nifedipine into a pump prime solution that was then recirculated with 2 U of outdated blood while levels of nifedipine were measured for 3 h. Plasma levels did not change in either a CPB circuit exposed to light or kept in a darkened room.
To compare the effects of dorzolamide-timolol combination and brimonidine on intraocular pressure... more To compare the effects of dorzolamide-timolol combination and brimonidine on intraocular pressure (IOP) after phacoemulsification surgery. This prospective, randomized study included 69 eyes of 43 patients undergoing phacoemulsification and foldable intraocular lens implantation. Twenty-one patients were women and 22 were men. The mean patient age was 69.7+/-12.4 years. Patients were randomly assigned to one of three treatment groups preoperatively. Group A (n=23) received one drop of dorzolamide-timolol fixed combination and group B (n=23) received one drop of brimonidine tartrate 0.2% immediately after surgery. In group C (n=23), patients received no treatment and served as a control group. IOP was measured by Goldmann applanation tonometry 6 hours and 24 hours after surgery. Six hours after surgery, the mean IOP was significantly lower in group A (16.3+/-2.9 mm Hg) than in groups B (20.6+/-2.9 mm Hg) and C (24.6+/-5.4 mm Hg). However, 24 hours after surgery, the mean IOP was higher in group C (19.8+/-4.7 mm Hg) than in the other two groups (14.1+/-2.8 mm Hg in group A and 17.5+/-2.7 mm Hg in group B). Prophylactic treatment with dorzolamide-timolol fixed combination was more effective than brimonidine in reducing IOP 6 hours and 24 hours after phacoemulsification surgery.
To identify the incidence of and risk factors associated with the development of glaucoma after p... more To identify the incidence of and risk factors associated with the development of glaucoma after penetrating keratoplasty. A retrospective study was carried out between September 1996 and January 2007 with 729 patients' 749 eyes, which underwent penetrating keratoplasty at the 1st Eye Clinic at Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul. Six attending surgeons performed all the surgeries at the same center. Age, sex, preoperative diagnosis, the presence of preoperative glaucoma, the status of the lenses, and additional surgery performed during keratoplasty, which may affect the postoperative intraocular pressure, were evaluated. The patients' ages ranged from 5 to 86 years (with a mean of 40.9 +/- 20.4 years). Two hundred seventy-seven (61.9%) of the patients were female and 452 (38.1%) were male. Intraocular pressure increases in the early postoperative period occurred in 41 (5.5%) eyes and chronically elevated intraocular pressure was found in 124 (16.6%) eyes. Preoperative diagnosis of inflammatory diseases such as graft thinning (relative risk [RR] = 4.96), traumatic scar formation (RR = 2.66), graft abscess (RR = 2.62), graft rejection (RR = 2.61), bullous keratopathy (RR = 2.59), and corneal abscess (RR = 1.52) were found to be risk factors for the development of glaucoma. Also, the following were significantly associated with an increased risk of glaucoma: peripheral anterior synechia (P = 0.019), preoperative glaucoma (P = 0.0001), and additional surgery combined with penetrating keratoplasty (P = 0.0001). The average period between surgery and the first intraocular pressure elevation was 5.0 +/- 6.5 months for all eyes. The mean intraocular pressure value of eyes that developed glaucoma after penetrating keratoplasty was 27.9 +/- 5.8 mmHg. Increased intraocular pressure after penetrating keratoplasty is a common clinical problem, and the risk factors are preoperative diagnosis of inflammatory diseases, peripheral anterior synechia, preoperative glaucoma, and additional surgery combined with penetrating keratoplasty.
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Papers by Omer F Dogan