Medical Karadži Health Information Center is honored to partner with one of the best ophthalmology centers in Turkey - the Ophthalmology Center at the American Hospital, part of the Wehby Koch Foundation.
Thanks to our experience, we can quickly arrange an appointment for a primary consultation. Helping you prepare for the mandatory specialist requirements, explaining everything down to the smallest detail so that you don't think about the organisational steps, but are relaxed and prepared.
One of the leading specialists at the ophthalmology center of American Hospital is Prof. Dr. Orkun Müftüoğlu.
Prof. Dr. Orkun Müftüoğlu
Who is Prof. Dr. Orkun Müftüoğlu?
Born in Ankara in 1975, Prof. Dr. Müftüoğlu graduated from Ataturk Anadolu Secondary School in Ankara in 1993 and from Ankara Medical University in 1999. He completed his undergraduate degree at Ankara University. She then graduated from the Medical College of Houston in 2003 and from the University of Houston in 2006. He completed his residency in vitreoretinal surgery at Duke University. In 2007, he completed advanced refractive surgery at the Instituto Ophthalmologico Alicante. He won a Cataract-Cornea Fellowship with USMLE Texas Medical License at the University of Texas Southwestern Medical Center between 2007 and 2009.
In January 2009, Prof. Dr. Müftüoğlu became an associate professor and in April 2015 he became a professor. His interests include complex cataract surgery, advanced refractive surgery, keratoconus-corneal disease and surgery, combined glaucoma and artificial cornea surgery and vitreoretinal surgery.
Since October 2016, he has been working at the Faculty of Medicine, Koç University as an ophthalmologist and ophthalmic surgeon.
Prof. Dr. Orkun Müftüoğlu has more than 50 international articles, more than 100 publications and more than 1000 international citations. He is the editor and reviewer of many foreign and international ophthalmology journals such as American Journal of Ophthalmology, British Journal of Ophthalmology, European Journal of Ophthalmology, Asia Pacific Journal of Ophthalmology, International Journal of Ophthalmology, Clinical and Experimental Ophthalmology, Journal of Refractive Cataract Surgery, Journal of Refractive Surgery, etc.
He was awarded the best performance award by the American Academy of Ophthalmology.
Prof. Dr. Orkun Müftüoğlu is a member of the Turkish Association of Ophthalmology, American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, European Society of Cataract and Refractive Surgeons (Education and Young Ophthalmologists Committees).
In his practice, Prof. Dr. Müftüoğlu has over 10,000 cases of operated eyes. Many of these relate to cataract surgery in particularly complex cases:
- trifocal and toric intraocular lens implantation
- excimer laser surgeries, including LASIK, PRK
- treatment of keratoconus with advanced corneal transplants (intracellular ring segments, crosslinking)
- complex vitreoretinal surgery
KERATOCONUS
What is keratoconus? What is this disease?
The outermost layer of the eye - the CORNEa (i.e. the part that resists touching with the finger when the eye is closed) is usually CUPOLOVID in shape. When this part of the eye, instead of having a CUPOL shape, has a PYRAMIDIC-CONUSIVIDAL shape, this condition is called CERATOCONUS (CORNEa with CONUSIVIDAL-PYRAMIDAL shape).
How does this disease arise?
Usually the cornea, i.e. that part which is the outermost layer of the eye or in other words the window of the eye, is a relatively strong and resistant tissue. The disease keratoconus is formed when the corneal tissue is softer. As a consequence, the cornea, which is pushed by the pressure in the eye, bulges outwards over time and spoils vision.
What are the reasons for its occurrence?
- Heredity plays a huge role.
- Scratching and rubbing of the eyes are thought to play a role in the onset of this disease.
- Populated area (more common in Turkey, the Middle East and the Mediterranean)
What are the symptoms
- Blurred vision, (increasing especially in the evening)
- Decreasing quality of vision
- Continuously increasing diopters (very common as increasing myopia and astigmatism)
- Blurred vision with glasses
- Apparent difference between measured diopters and glasses
- Itchy eyes, urge to rub eyes
- Eye crosslinking and light sensitivity
- Sometimes there may be no symptoms at all
- The above signs are not evidence of the presence of keratoconus. With such symptoms, examination by an eye specialist is mandatory.
How is it developing?
- Most often the disease progresses. It progresses more rapidly mostly in people between the ages of 15 and 35. When the disease progresses continuously and more slowly, the patient may not realize it. At a high rate of progression, the disease can cause serious vision loss.
- Very often in this disease, differences between the two eyes are recorded. This causes patients to see better in one eye and with great progress in the other eye, this condition does not impress them.
- Disease progression can be accelerating and decelerating. It is impossible to accurately assess the rate of progress in individual patients. Most often, the progression of the disease decreases in the period between the 35th and 45th year of the patient. However, there are patients in whom the disease progresses even after their 45th year.
- Although rare, with very extensive disease progression, some patients develop a crack in the protective inner zipper of the eye, water accumulates in the cornea (outer surface of the pupil) and it turns white (hydrops).
How is it treated?
This disease manifests itself very differently, and this is the reason why treatment is determined according to the patient.
To increase vision:
- Glasses
- Contact lenses
- Rigid, gas permeable contact lenses
- Hybrid contact lenses
- Placement of a piece-ring in the cornea using a femtosecond laser
To delay, terminate the development of the disease:
- Crosslinking of collagen (crosslinking):
- Therapy conducted simultaneously with Riboflavin (vitamin B2) and UV irradiation, which leads to hardening of the cornea and stops the progression of the disease. Provides protection for a long period.
- Administered with drip anesthesia. No need for hospital stay. Without closing the eye.
- There are different species, Healing period: 1 to 5 days depending on the species. 2 to 6 months.
- Placement of a piece-ring in the cornea using a femtosecond laser
- With the help of the femtosecond laser (a technology that allows a body the thickness of a hair to be divided by 100), a piece is inserted into the cornea, thanks to which the outward bulging that accompanies the development of keratoconus is corrected. Fixed inside the eye, the ring is transparent and can remain in it forever without causing problems. The ring is not visible and the patient does not feel it.
- Administered with drip anesthesia. No need for hospital stay. Without closing the eye.
- Healing period: very often an obvious healing is achieved within 1 day. The healing process continues after that.
To treat progressive disease that cannot be corrected by other methods:
- Transplantation of new generation lamellae (parts)
- In this method, the part of the cornea that is diseased is replaced. The healthy inner part (the endothelium) that provides the transparency is not replaced.
- Thus, corneal transplant rejection rates are seriously reduced.
Do my relatives also suffer from this disease? Is it passed on to my children?
- Very often, relatives of keratoconus patients also suffer from keratoconus to varying degrees.
- Children do not directly inherit the disease, but they may also be predisposed to keratoconus.
CORNEAL TRANSPLANTATION
What is corneal transplantation?
- While the surface of the cornea can self-heal, the inner parts of the cornea, which are 95% of it, do not have this feature. Therefore, diseases in this area can cause damage leading to permanent visual impairment.
- In this type of disease, if no other treatment can be applied, a corneal transplant may be necessary.
- A corneal transplant is the replacement of the transparent part of the eye with tissue taken from another person.
What is the success rate of corneal transplantation?
Different diseases have different success rates. The success rates vary between 60% and 95%.
How is a cornea transplant different from a kidney, liver or other organ transplant?
An important advantage of corneal transplantation over other organ transplants is the fact that it is a transplant of tissue without blood vessels. For this reason, the rejection rate is lower compared to other organs.
Can a corneal transplant also be rejected by the recipient? What is a cornea transplant? In which people is it applied?
It is the replacement of the cornea (the transparent part) of the eye with new tissue taken from another person. The inner parts of the cornea, which represent 95% of it, cannot renew itself. Therefore, diseases in this area can cause permanent vision impairment. In such diseases, corneal transplantation may be necessary. Among these diseases can list diseases such as keratoconus, corneal infections, corneal injuries, hereditary corneal diseases, corneal injury due to eye surgeries.
What is the success rate of corneal transplantation of the eye? Corneal transplantation of the eye is an important advance over other organ transplants. Therefore, the success rate is up to 90%, although it varies depending on the diseases.
What is the success rate of corneal transplants? What advantages are there?
Transplants in which only the diseased area is transplanted are called lamellar (partial) transplants. The anterior portions of the cornea that occupy about 95% of it (stroma and epithelium) perform the function of the wall, however, the posterior portions that occupy 5% (solid layer and endothelial layer) make the cornea transparent. Basically, transplant rejections are caused against this 5% providing the transparency and liveliness part. While in some diseases only the anterior part becomes diseased, in others only the posterior part becomes diseased. Therefore, only the diseased part is transplanted and thus very little change takes place
New generation corneal transplants - what are the types of lamellar transplantation?
There are 3 main ways. These are:
- ANTERIOR TRANSPLANTATION (DALK)
- POSTERIOR TRANSPLANTATION (DSEK, DMEK)
- TRANSPLANTATIONS USING FEMTOSECOND LASER
Why are lamellar partial corneal transplants preferred?
When only one part of the cornea is changed, rejection is less frequent, the graft can live longer, spoils less, the eye's resistance to external trauma is increased, sutures are not used in some types, vision can be excellent in some types, are ultimately more successful.
Can any transplant be performed using the lamellar technique?
No, not every eye is suitable for this type of transplant. If there is damage to all layers of the cornea, this type of transplant cannot be performed. In these cases, a classic corneal transplant is applied. However, in all cases in which it is possible, the application of these techniques brings multiple benefits.
What is a dalk (anterior deep) corneal transplant? In which patients is it used?
Transplantation of the outer layer of the cornea, which is 95% of it, is called DALK. (The exact opposite of DMEK transplantation. Thus, the transplantation of the inner part that gives the transparency is not necessary. Thus rejection of the graft is very difficult, almost impossible. Furthermore, because the patient's own inner layer remains healthy, the need to replace it in the future will be reduced or not necessary, and against trauma (bumping) the eye will be at least 5 times more durable compared to a classic transplant. To separate the 5% part from the 95% part is not easy and air or special substances and techniques are used to separate them. In this way of transplantation, stitches are not used as in classical transplantation. Therefore, the degree of vision is equal to that of classic transplants.
In which patients is a dalk (anterior deep) transplant applied?
It is recommended in patients in whom the outer 95% layer is diseased. Keratoconus ranks first after these diseases, and besides it corneal dystrophies, corneal injuries, scar removal after corneal infections (after shingles or other infections) are among the most common causes.
What are dsek and dmek posterior corneal transplants?
Transplants of the 5% inner layer of the cornea are called DSEK and DMEK. While in DSEK there is still a portion of the anterior layer, in DMEK there is no anterior layer at all. Because it is a very delicate layer, the transplantation is performed with no or very little instrument touch during surgery if possible. Again for this reason, the part to be transplanted is adhered without the use of sutures, by air or gas. After the operation, it is even potentially possible to achieve 100% vision. After surgery, recovery can proceed very quickly. Practice has shown that the rejection rate is lower, and re-changing the graft will be able to be easier. In addition, in case of any impact (trauma), the endurance will be 5-7 times higher compared to an eye with a classic transplant. But as a surgical procedure, the surgery requires experience.
In which patients do dsek and dmek (posterior) corneal transplants apply?
When the layer that occupies the inner part of the cornea becomes damaged, the cornea becomes blurred and in very advanced cases causes stinging and pain. This case can be caused either due to hereditary diseases (Fuchs dystrophy), or due to undergone intraocular operations, or in connection with intraocular lenses. DSEK and DMEK transplants are appropriate for this patient.
Can cataracts, eye pressure, retinal diseases also be cured along with keratoprosthesis?
Along with corneal transplant surgery, if necessary, diseases of the colored part (iris) of the eye, cataracts - diseases of the lens of the eye and diseases of the retina can be cured in the same session through surgical techniques.
Which are the high-risk corneal transplants?
This, the success rate being low due to various reasons, is called a high-risk corneal transplant. In such cases, treating the accompanying diseases and conditions is quite important to increase success.
Which diseases can be cited as examples of high-risk corneal transplants?
The main reason for corneal transplantation to be more successful compared to transplants of other organs in the body is the fact that there are no blood vessels in the cornea. However, in some cases there may be blood vessels in the cornea and this can cause rejection of the transplant. In this case, treatment of the coverage by blood vessels is necessary If there is damage or clumping in some structures in the eye, especially in the iris tissue that gives the eye its colour, then it is necessary to carry out a pupilloplasty operation together with the transplant, which means plastic surgery on the iris tissue. If there are problems with the lenses in the eye, the intraocular lenses must be replaced and if necessary sewn to the white part of the eye, the structure called the sclera, or to the iris tissue. If there are problems in the gel that fills the eyeball and is called the vitreous, it is imperative that this is assessed and the vitrectomy operation performed together. If the eye has previously had a herpetic lesion, timely medical treatments should be administered before and after corneal transplantation.
What is a limbal stem cell transplant?
When the skin part (epithelium) covering the surface of the cornea is injured, it is mostly repaired thanks to the stem cells located in the gray-verrucous area (limbus) that remains between the white and transparent part of the eye. As a consequence of certain diseases or injuries, these stem cells can become damaged and then the surface of the eye never recovers. In such cases, a small stem can be taken from the other eye of the same person or a relative, multiplied and transplanted. In this way the disease may be cured.
Which patients can be treated with a limbal stem cell transplant?
Can apply in the treatment of all patients who have damage in the limbus area. Among them, mainly can be listed those suffering from burns of the ocular surface, Stevens-Johnson syndrome, trauma - blows, those who have undergone multiple operations.
When taken from the other eye of the same person (autologous) or from a different person (heterologous) is a limbal stem cell transplant more successful?
Each piece is special to the person who owns it. Even with brothers and sisters, complete conformity is not easy. For this reason, if it is healthy, taking stem cells from the patient's other eye is much more successful than taking from another person (even if that person is the patient's closest sibling).
If a limbal stem cell transplant is taken from my other eye, will the health of my healthy eye be compromised?
The trunk taken from the healthy eye is limited. Furthermore, because the trunk is in place, it grows in the same place as grass clippings or cut hair. For this reason, no damage is expected to occur in the healthy eye. Even if some not-so-serious cases occur, they can be cured with necessary and timely treatments.
What is an amniotic membrane transplant (the membrane between the mother and baby)?
It is a membrane that ensures the harmony between mother and baby and the proper development of the baby. It contains within itself features that regulate and promote the recovery of multiple wounds. Because of these features, it is used for the rapid recovery of wounds on the cornea.
Where is the amniotic membrane (the membrane between mother and baby) used?
A technique that is applied for the rapid and qualitative recovery of injuries in the eye and especially in the cornea. For this reason, after non-healing corneal wounds, it is also used in the early treatment of corneal burns together with limbal stem cell transplantation.
Will the amniotic membrane (the membrane between mother and child) permanently remain in my eye?
This membrane melts by itself and disappears with time. For this reason, its impact is temporary, but it is important because it is in a critical period.
FREQUENTLY ASKED QUESTIONS RELATED TO EXCIMER LASER SURGERY
- Surgery is applied to reduce eye pressure. It is not always possible to reduce the eye pressure to "0". Therefore, the goal is not to achieve "0" pressure, but to avoid the need for glasses.
- After surgery, even low pressure is likely to remain. The higher the pressure was before surgery so is the possibility of higher residual pressure after surgery.
- The operation has been proven successful. To date, about 30 million people have undergone this operation. Each year in the United States, nearly 1 million people undergo the laser procedure. There have been studies for the past 10 years. According to them, the successful surgeries are 99% and 95% has achieved a better result than expected. When compared to other surgeries related to the human body, these results are extremely high.
- Ophthalmologists and their relatives also do this operation. There are long term results published on this topic in the world's most prestigious journal, the Journal of Cataract Refractive Surgery in article number 2014:40:395-402 where 226 doctors in the United States perform excimer laser surgery on 439 eyes. Eventually doctors invented the laser(In a way eye doctor). After the study it was scientifically proven that there is a very high rate of good vision, satisfaction and increase in quality of life.
- But of course, as with any procedure, postoperative complications can occur.
- After LASIK surgery, cataract surgery can be done. Formulas used to calculate the cataract lens are available.
- There are generally 2 types of operations:
1. LASIK:
- After making an incision on the cornea (using a scalpel or laser), a flap is formed (similar to unfolding the first page of a book) and then the excimer laser is applied.
- Recovery is very fast, only on the day of the procedure burning-irritation and tearing are felt, the next morning these ailments almost disappear, and the patient can return to work after 1 day.
2. LASEK or PRK:
- The cornea is treated directly with an excimer laser
- Recovery takes a little time, on the day to the procedure serious burning, irritation and tearing from the eye are observed. By 4 days after the procedure, these symptoms subside.
