Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Intraocular Pressure and Central Corneal Thickness in Premature Newborns: A Systematic Review with Meta-Analysis
Prematüre Yenidoğanlarda Göz İçi Basıncı ve Merkezi Kornea Kalınlığı: Sistematik Bir İnceleme ve Metaanaliz
Kalina TRIFONOVAa , Kiril SLAVEYKOVb , Hristo MUMDZHIEVc
aDepartment of Ophthalmology and Otorhinolaryngology, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
bFirst Department of Internal Diseases and General Medicine, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
cDepartment of Neonatology, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
Turkiye Klinikleri J Med Sci. 2024;44(2):76-84
doi: 10.5336/medsci.2024-101251
Article Language: EN
Full Text
ABSTRACT
Objective: Our study aimed to summarize and analyze the available information in the up-to-date literature, concerning intraocular pressure and central corneal thickness values in premature newborns. Material and Methods: We conducted a comprehensive literature review, gathering information from PubMed, Scopus, Embase, Google Scholar, and free-text searches on the topic. We chose only 14 of them to perform a meta-analysis. We used Review Manager 5.4 to compare the mean values of intraocular pressure and central corneal thickness between full-term and premature newborns. Results: The results of the mean value of intraocular pressure of premature infants varied significantly according to different authors-from 10 mmHg to 29 mmHg. Most of the research showed higher intraocular pressure and thicker corneas in premature infants compared to full-term ones. Many researchers looked for a positive correlation between the increased central corneal thickness in premature newborns and the increased intraocular pressure but showed conflicting results. Our meta-analysis showed that the intraocular pressure and central corneal thickness in premature newborns were significantly higher compared to full-term infants with mean difference of 1.95 mmHg [Confidence interval (CI) 0.62-3.28] and 57.82 μm (CI 34.46-81.18), respectively. Conclusion: Additional studies tracking changes in both intraocular pressure and central corneal thickness values, with larger sample sizes and in a longitudinal design with better-differentiated sample groups, are warranted.

Keywords: Preterm; infants; central corneal thickness; intraocular pressure
ÖZET
Amaç: Çalışmamız, prematüre yenidoğanlarda göz içi basıncı ve merkezi kornea kalınlığı değerleri hakkında güncel literatürde mevcut bilgileri özetlemeyi ve analiz etmeyi amaçlamaktadır. Gereç ve Yöntemler: PubMed, Scopus, Embase, Google Akademik ve konuyla ilgili ücretsiz metin aramalarından bilgiler toplayarak kapsamlı bir literatür incelemesi yürüttük. Yalnızca 14 tanesini metaanaliz yapmak için seçtik. Tam süreli ve prematüre yenidoğanlar arasında göz içi basıncı ve merkezi kornea kalınlığı ortalama değerlerini karşılaştırmak için Review Manager 5.4 programını kullandık. Bulgular: Prematüre bebeklerin göz içi basıncının ortalama değerinin sonuçları, farklı yazarlara göre 10 mmHg ile 29 mmHg arasında önemli ölçüde değişmiştir. Araştırmaların çoğu, prematüre bebeklerde tam zamanında doğanlara kıyasla daha yüksek göz içi basıncı ve daha kalın korneaların olduğunu göstermiştir. Birçok araştırmacı, prematüre yenidoğanlarda artmış merkezi kornea kalınlığı ile artmış göz içi basıncı arasında pozitif bir korelasyon aramış, ancak çelişkili sonuçlar elde etmiştir. Metaanalizimiz, prematüre yenidoğanlarda göz içi basıncının ve merkezi kornea kalınlığının, sırasıyla ortalama 1,95 mmHg [Güven aralığı (GA) 0,62-3,28] ve 57,82 μm (GA 34,46-81,18) fark ile tam zamanında doğan bebeklere göre anlamlı olarak daha yüksek olduğunu göstermiştir. Sonuç: Hem göz içi basıncı hem de merkezi kornea kalınlığı değerlerindeki değişimleri izleyen, daha büyük örneklem boyutlarına ve daha iyi ayrıştırılmış örneklem gruplarıyla uzun süreli bir tasarımda ek çalışmalar yapılması gerekmektedir.

Anahtar Kelimeler: Prematüre; bebekler; merkezi kornea kalınlığı; göz içi basıncı
REFERENCES:
  1. O'Connor AR, Wilson CM, Fielder AR. Ophthalmological problems associated with preterm birth. Eye (Lond). 2007;21(10):1254-60. [Crossref]  [PubMed] 
  2. Thiagarajah C, Kern M, Jones L. Case series of neonates with concomitant retinopathy of prematurity and congenital glaucoma. Investigative Ophthalmology&Visual Science. 2006;47(13):720. [Link] 
  3. Senthil S, Balijepalli P, Garudadri C, Jalali S. Clinical presentation and management outcomes of coexistent congenital glaucoma and retinopathy of prematurity. J Glaucoma. 2019;28(1):20-6. Erratum in: J Glaucoma. 2020;29(12):e143. [Crossref]  [PubMed] 
  4. Ricci B. Intraocular pressure in premature babies in the first month of life. J AAPOS. 1999;3(2):125-7. [Crossref]  [PubMed] 
  5. Gordon MO, Beiser JA, Brandt JD, Heuer DK, Higginbotham EJ, Johnson CA, et al. The ocular hypertension treatment study: baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002;120(6):714-20; discussion 829-30. [Crossref]  [PubMed] 
  6. Tucker SM, Enzenauer RW, Levin AV, Morin JD, Hellmann J. Corneal diameter, axial length, and intraocular pressure in premature infants. Ophthalmology. 1992;99(8):1296-300. [Crossref]  [PubMed] 
  7. Haus A, Jonescu-Cuypers C, Seitz B, Kaesmann-Kellner B. Comparison between intraocular pressure measurements with icare rebound tonometry and tonopen XL tonometry in premature infants. Investigative Ophthalmology&Visual Science. 2008;49(13):712. [Link] 
  8. Jeon GS, Yi K. [Intraocular pressure and central corneal thickness in premature infants]. J Korean Ophthalmol Soc. 2009;50(8):1237-41. [Crossref] 
  9. Zengin N, Zengin MÖ, Karahan E, Tuncer İ. Prematüre yenidoğanlarda göz içi basıncı ve santral kornea kalınlığı değişimi [Alterations in intraocular pressure and central corneal thickness in premature newborns]. İzmir Dr. Behçet Uz Çocuk Hast. Dergisi. 2014;4(1):20-4. [Crossref] 
  10. Khaja W, Chalam K, Grover S. Normative data for intraocular pressure and central corneal thickness in preterm infants. Investigative Ophthalmology & Visual Science. 2014;55(13):5913. [Link] 
  11. Grover S, Zhou Z, Haji S, Khaja W, Sambhav K, Stass-Isern M, et al. Intraocular pressure in premature low birth weight infants. J Pediatr Ophthalmol Strabismus. 2016;53(5):300-4. [Crossref]  [PubMed] 
  12. Uva MG, Reibaldi M, Longo A, Avitabile T, Gagliano C, Scollo D, et al. Intraocular pressure and central corneal thickness in premature and full-term newborns. J AAPOS. 2011;15(4):367-9. [Crossref]  [PubMed] 
  13. Muslubas IB, Oral AY, Cabi C, Caliskan S. Assessment of the central corneal thickness and intraocular pressure in premature and full-term newborns. Indian J Ophthalmol. 2014;62(5):561-4. [Crossref]  [PubMed]  [PMC] 
  14. Karahan E, Zengin MO, Tuncer I, Zengin N. Correlation of intraocular pressure with central corneal thickness in premature and full-term newborns. Eur J Ophthalmol. 2015;25(1):14-7. [Crossref]  [PubMed] 
  15. Acar DE, Acar U, Tunay ZO, Ozdemir O, Dolgun A, Erdurmus M. The intraocular pressure and central corneal thickness in healthy premature infants. J AAPOS. 2015;19(2):108-11. [Crossref]  [PubMed] 
  16. Ng PC, Tam BS, Lee CH, Wong SP, Lam HS, Kwok AK, et al. A longitudinal study to establish the normative value and to evaluate perinatal factors affecting intraocular pressure in preterm infants. Invest Ophthalmol Vis Sci. 2008;49(1):87-92. [Crossref]  [PubMed] 
  17. Lindenmeyer RL, Farias L, Mendonça T, Fortes Filho JB, Procianoy RS, Silveira RC. Intraocular pressure in very low birth weight preterm infants and its association with postconceptional age. Clinics (Sao Paulo). 2012;67(11):1241-5. [Crossref]  [PubMed]  [PMC] 
  18. Sekeroglu MA, Hekimoglu E, Petricli İS, Karakaya J, Ozcan B, Yucel H, et al. Central corneal thickness and intraocular pressure in premature infants. Int Ophthalmol. 2015;35(6):847-51. [Crossref]  [PubMed] 
  19. Erginturk Acar D, Acar U, Ozdemir O, Tunay ZO. Determination of normal values of intraocular pressure and central corneal thickness in healthy premature infants-a prospective longitudinal study. J AAPOS. 2016;20(3):239-42. [Crossref]  [PubMed] 
  20. Balci O, Tanriverdi C, Gulkilik G, Aras C, Tastekin A. Longitudinal assessment of intraocular pressure in premature infants. Eur J Ophthalmol. 2018;28(1):108-11. [Crossref]  [PubMed] 
  21. Monteiro C, Vivas M, Almeida J, Ramalho M, Mota M, Teixeira S, et al. Intraocular pressure values using icareⓇ rebound tonometer and correlation with postconceptional age in premature infants. J Ophthalmic Vis Res. 2023;18(3):267-71. [Crossref]  [PubMed]  [PMC] 
  22. Choo MM, Yeong CM, Grigg JR, Khaliddin N, Kadir AJ, Barnes EH, et al. Central corneal thickness changes and horizontal corneal diameter in premature infants: a prospective analysis. Medicine (Baltimore). 2018;97(48):e13357. [Crossref]  [PubMed]  [PMC] 
  23. Ehlers N, Sorensen T, Bramsen T, Poulsen EH. Central corneal thickness in newborns and children. Acta Ophthalmol (Copenh). 1976;54(3):285-90. [Crossref]  [PubMed] 
  24. Gunay M, Celik G, Gunay BO, Dogru M, Gursoy T, Ovali HF. Central corneal thickness measurements in premature infants. Int J Ophthalmol. 2014;7(3):496-500. [PubMed]  [PMC] 
  25. Kirwan C, O'Keefe M, Fitzsimon S. Central corneal thickness and corneal diameter in premature infants. Acta Ophthalmol Scand. 2005;83(6):751-3. [Crossref]  [PubMed] 
  26. Jethani J, Shah K, Jethani M. Evaluating the change in central corneal thickness in neonates (term and preterm) in Indian population and the factors affecting it. Indian J Ophthalmol. 2015;63(6):501-3. [Crossref]  [PubMed]  [PMC] 
  27. Sehrawat P, Beri S, Garg R, Datta V, Shandil A. Central corneal thickness and corneal diameter in preterm and term newborns and preterm neonates at term. Indian J Ophthalmol. 2019;67(10):1575-8. [Crossref]  [PubMed]  [PMC] 
  28. Liu C, Wu H, Lao J, Wu S, Xu X, Lv Z, et al. Measurement and analysis of central corneal thickness at different postnatal stages in chinese premature infants. J Ophthalmol. 2020;2020:7313909. [Crossref]  [PubMed]  [PMC] 
  29. Celik G, Gunay M, Kızılay O, Tuten A. Association between central corneal thickness and growth parameters following preterm birth. Akdeniz Tıp Dergisi. 2022;8(1):28-32. [Crossref] 
  30. Yildirim N, Sahin A, Basmak H, Bal C. Effect of central corneal thickness and radius of the corneal curvature on intraocular pressure measured with the Tono-Pen and noncontact tonometer in healthy schoolchildren. J Pediatr Ophthalmol Strabismus. 2007;44(4):216-22. [Crossref]  [PubMed] 
  31. Gandhi PD, Gürses-Ozden R, Liebmann JM, Ritch R. Attempted eyelid closure affects intraocular pressure measurement. Am J Ophthalmol. 2001;131(4):417-20. [Crossref]  [PubMed] 
  32. Iester M, Mermoud A, Achache F, Roy S. New tonopen XL: comparison with the Goldmann tonometer. Eye (Lond). 2001;15(Pt 1):52-8. [Crossref]  [PubMed] 
  33. McKee EC, Ely AL, Duncan JE, Dosunmu EO, Freedman SF. A comparison of Icare PRO and Tono-Pen XL tonometers in anesthetized children. J AAPOS. 2015;19(4):332-7. [Crossref]  [PubMed] 
  34. Mikhail M, Sabri K, Levin AV. Effect of anesthesia on intraocular pressure measurement in children. Surv Ophthalmol. 2017;62(5):648-58. [Crossref]  [PubMed] 
  35. Epley KD, Tychsen L, Lueder GT. The effect of an eyelid speculum on intraocular pressure measurement in children. Am J Ophthalmol. 2002;134(6):926-7. [Crossref]  [PubMed] 

.: Up To Date

Login



Contact


Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com