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Öğe Gözenekli orbital implant takılan hastalarda erken dönemdeki ağrı ve inflamasyonun önlenmesinde vakum tekniğinin etkinliği(2007) Karslıoğlu, Şafak; Serin, Didem; Ziylan, Şule; Yiğit, AygenAmaç: Gözenekli orbital implant (GOİ) takılan hastalarda, eviserasyondan sonra erken dönemde ortaya çıkan şiddetli ağrı ve inflamatuar reaksiyonun önlenmesi için uyguladığımız implantasyon tekniğinin etkinliğini araştırmayı amaçladık. Gereç ve Yöntem: Eviserasyon yapılarak GOİ takılan 40 hasta (çalışma grubu) ve akrilik implant takılan 30 hasta (kontrol grubu) çalışmaya alındı. GOİ takılacak hastalarda implant 50 cc’lik bir enjektöre yerleştirilerek 10 ml bupivakain, 2 ml lidokain, 2 ml gentamisin, ve 2 ml deksametazon çekildi. Enjektörün ucu kapatılıp piston geriye çekilerek negatif basınç oluşturuldu ve gözeneklerin içindeki havanın yerini enjektördeki karışımın alması amaçlandı. Ameliyat sonrası 1., 3. ve 7. günlerde hastalardan hissettikleri ağrıyı 0-10 arasında tanımlamaları istendi. Diğer inflamatuar bulgular (kapaklarda ödem, hiperemi, kemozis) muayene ile 0-3 arası derecelendirildi. Çalışma ve kontrol gruplarında ağrı ve reaksiyon dereceleri Mann-Whitney U testi kullanılarak karşılaştırıldı. Bulgular: GOİ takılan grubun ameliyat sonrası ağrı ve inflamasyon skorları akrilik implant grubuna göre anlamlı derecede düşüktü (p<0.001). GOİ grubunda hiçbir hasta 7. günde ağrı tarif etmeyip, hiçbir hastada kapak ödemi ve kemozise rastlanmadı. Sonuç: Hastalar bu yöntemle ameliyat sonrası erken dönemi rahat geçirmekte, çok daha kısa sürelerde günlük aktivitelerine dönebilmektedir. Hasta konforu, erken rehabilitasyon ve protez kullanmaya erken başlama bakımından, önerdiğimiz tekniğin eviserasyon sonrasında görülen şiddetli ağrı ve inflamasyonun kontrolünde basit ve yararlı bir uygulama olduğu görüşündeyiz.Öğe Implant infection in porous orbital implants(Lippincott Williams & Wilkins, 2006) Karslıoğlu, Şafak; Serin, Didem; Şimşek, İlke; Ziylan, ŞulePurpose. To analyze implant infection in patients with porous orbital implants. Methods: A retrospective analysis of 212 patients with one of five types of porous orbital implants (bone-derived hydroxyapatite [HA], coralline HA, synthetic HA, porous polyethylene, and aluminium oxide) was conducted. Reasons for surgery, type of surgery, type of implant, peg system used, time of pegging, problems before and after pegging, treatment, and follow-up duration were recorded for all patients, along with additional data including time of onset of infection, microorganism cultured, antibiotics used, patient response to antibiotic therapy, additional interventions, and final status for patients with infection. Results: Of the 212 patients with porous orbital implants, 116 (54.72%) were pegged. Implant infection was observed in 11 of 116 patients (9.48%) with pegs, whereas 0% of unpegged implants was infected (p = 0.001). The interval between pegging and the onset of infection was 3 to 83 months (average, 36.27 +/- 29.12 months). Implant exposure was noted in 5 of the 11 patients with infection. Symptoms resolved completely with antibiotic treatment in 7 patients. One patient required implant removal as the result of frequent exacerbations. The remaining 3 patients presented with hemorrhagic, purulent discharge and/or pyogenic granuloma on their last visits after being free of symptoms for 5 to 6 months. Conclusions. Implant infection is a serious problem that requires additional patient visits, intensive antibiotic therapy, surgery, or some combination of these. Existence of a peg system appears to play a role in implant infection. Infection may develop as late as 6 to 7 years after pegging, and the patient should be cautioned about potential late-onset problems. It is possible to control the infection with appropriate antibiotic therapy; removal should be reserved for refractory cases.Öğe Isoametropic amblyopia in highly hyperopic children(Blackwell Publishing, 2007) Ziylan, Şule; Yabaş, Özge; Zorlutuna, Nilüfer; Serin, DidemPurpose: The purpose of this study was to evaluate the visual outcome and associated findings in isoametropic amblyopia due to high hyperopia. Methods: Children with >= 5 D spherical equivalent hyperopia and <= 1.5 D anisometropia and <= 1.5 D cylinder in both eyes were selected. Data were collected on the magnitude of spherical equivalent hyperopia, corrected visual acuity (VA) with the Snellen or Tumbling E charts, age at correction, duration of correction, ocular motility and strabismus. Children who had VA of <= 0.4 in both eyes were defined as having isoametropic amblyopia. Associations between isoametropic amblyopia and factors affecting VA were analysed. Results: A total of 160 children met the criteria. The mean follow-up was 55.8 months. In all, 31 of the children had isoametropic amblyopia. The mean age at presentation was significantly higher (5.5 years versus 4.1 years; p < 0.05) and strabismus was significantly less prevalent (p = 0.001) in the isoametropic amblyopes than in the high hyperopia group as a whole. A total of 83.9% of the isoametropic amblyopes had best corrected VA > 0.5 at the last visit. The duration of optical correction was positively correlated with the last recorded VA measurement. Conclusions: Isoametropic amblyopia is not rare among highly hyperopic children. Visual acuity improves satisfactorily with spectacle correction. The duration of optical correction seems to be an important factor in visual prognosis.Öğe Simple alternative to the Wright needle in frontalis sling surgery(Lippincott Williams & Wilkins, 2007) Karslıoğlu, Şafak; Serin, Didem; Ziylan, ŞuleThe Wright needle is a widely used instrument for insertion of fascia lata or a synthetic material during frontalis suspension surgery; however, difficulties in handling this instrument are frequently encountered by many surgeons. We describe an 18-gauge needle with a 4/0 monofilament polypropylene suture as an alternative to the Wright needle for placement of the sling material in frontalis suspension surgery. Less slippage and easier control of the needle's direction and depth of tissue penetration result in more accurate placement of the material and a reduction in damage to the surrounding tissues.