Eye injury (ocular trauma) in southern Turkey: epidemiology, ocular survival, and visual outcome.

PURPOSE: To evaluate the epidemiology and outcome of ocular trauma in southern Turkey. METHODS: Patients referred to the University of Cukurova, School of Medicine, Department of Ophthalmology, with ocular trauma during the last two years were reviewed retrospectively. Age and gender of patients, type of injury, cause of injury, place where injury occurred, initial and final visual acuities, and final outcome were analyzed. RESULTS: Medical records of 250 patients (four bilateral injuries), aged between three months and ninety years were reviewed. Ocular trauma mostly occurred between 0 and 15 years and a male preponderance (76.8%) was evident. There were 72% open-globe injuries, corneal and/or scleral penetration being the most common injury type. Metallic objects were the main cause of injury (32.4%). Fifty percent of injuries happened in streets. Closed-globe and self-sealing corneal injuries were found to have the best prognosis in terms of final outcome (57.6% and 57.9%, respectively; P < 0.001 for both). Initial visual acuity was found to be a significant predictor of final visual acuity (P < 0.001). Endophthalmitis was significantly associated with metallic objects (P < 0.005). CONCLUSION: Eye injury is still a common and avoidable cause of blindness. Our findings suggest that any person in the population can be subject to ocular trauma at any time. Prognosis might be challenging. Education, attention, and safety precautions would help in reducing ocular morbidity.

Possible Association of Papillophlebitis with Guillain-Barré Syndrome: Case Report.

In this case report, we presented a patient with visual deterioration as a result of papillophlebitis in the right eye who was later diagnosed with Guillain-Barré syndrome (GBS). Upon systemic and laboratory work-up to determine the etiology of papillophlebitis, the diagnosis of GBS was made and treatment was initiated immediately. The ocular and systemic symptoms resolved quickly after starting intravenous immunoglobulin therapy. We present this case to emphasize the importance of etiological diagnosis in papillophlebitis and the unusual presentation of GBS.

Comparison of optical coherence tomographic findings between Behcet disease patients with and without ocular involvement and healthy subjects.

PURPOSE:: We aimed to compare the retinal nerve fiber layer, ganglion cell layer, inner plexiform layer, and the choroid thickness between patients with Behcet disease and healthy subjects by using spectral domain optical coherence tomography (SD-OCT). METHODS:: Ninety eyes of 45 healthy subjects and 104 eyes of 52 patients with Behcet disease were included in this study. Rheumatoid factor and C-reactive protein levels were measured by blood testing in the patients. RESULTS:: The mean thickness of the retinal nerve fiber layer, ganglion cells layer, and inner plexiform layer were significantly lower in patients with Behcet's disease than in the healthy subjects. The mean choroidal thickness was significantly higher in the patients than in the healthy subjects. CONCLUSIONS:: SD-OCT was a useful and non-invasive tool for the detection of retinal nerve degeneration and choroidal changes in patients with Behcet disease even in the absence of ocular involvement.

Bilateral choroidal infiltration from indolent non-Hodgkin's lymphoma: a rapid course with poor prognosis.

A 42-year-old-woman, with a 2 year history of non-Hodgkin's lymphoma suffered sudden bilateral visual loss. This unusual patient presented with an unifocal choroidal tumor in the superionasal quadrant in both eyes. Fluorescein angiography revealed early and late intense subretinal fluorescence. Cytological examination of the anterior chamber and vitreous tap material revealed abnormal lymphocytes compatible with NHL. Diffuse choroidal infiltration was diagnosed and treated with radiotherapy. Radiotherapy did not provide local control and preservation of the vision. Non-Hodgkin's lymphoma can infiltrate to the choroid and radiotherapy may not be efffective in every case.

Genome-wide association study in an admixed case series reveals IL12A as a new candidate in Behçet disease.

INTRODUCTION: The etiology of Behçet's disease (BD) is unknown, but widely considered an excessive T-cell mediated inflammatory response in a genetically susceptible host. Recent genome-wide association studies (GWAS) have shown limited number of novel loci-associations. The rarity and unequal distribution of the disease prevalence amongst different ethnic backgrounds have hampered the use of GWAS in cohorts of mixed ethnicity and sufficient sample size. However, novel statistical approaches have now enabled GWAS in admixed cohorts. METHODS: We ran a GWAS on 336 BD cases and 5,843 controls. The cases consisted of Western Europeans, Middle Eastern and Turkish individuals. Participants from the Generation R study, a multiethnic birth cohort in Rotterdam, The Netherlands were used as controls. All samples were genotyped and data was combined. Linear regression models were corrected for population stratification using Genomic Principal Components and Linear Mixed Modelling. Meta-analysis was performed on selected results previously published. RESULTS: We identified SNPs associated at genome-wide significant level mapping to the 6p21.33 (HLA) region. In addition to this known signal two potential novel associations on chromosomes 6 and 18 were identified, yet with low minor allele frequencies. Extended meta-analysis reveal a GWS association with the IL12A variant rs17810546 on chromosome 3. DISCUSSION: We demonstrate that new statistical techniques enable GWAS analyses in a limited sized cohort of mixed ethnicity. After implementation, we confirmed the central role of the HLA region in the disease and identified new regions of interest. Moreover, we validated the association of a variant in the IL2A gene by meta-analysis with previous work. These findings enhance our knowledge of genetic associations and BD, and provide further justification for pursuing collective initiatives in genetic studies given the low prevalence of this and other rare diseases.

Serous retinal detachment in a case with chronic lymphocytic leukemia: no response to systemic and local treatment.

Leukemias are systemic hematopoietic neoplasias and not infrequently cause ocular findings. Serous retinal detachment (SRD) is one of these manifestations and even may be the first sign of the underlying leukemia. Here we reported a case with chronic lymphocytic leukemia (CLL) presenting with SRD and discussed the clinical importance and therapeutic options.

Validity and agreement of uveitis experts in interpretation of ocular photographs for diagnosis of Behçet uveitis.

UNLABELLED: Abstract Purpose: To evaluate agreement and estimate sensitivity and specificity of uveitis specialists' interpretation of ocular photographs in diagnosing Behçet uveitis. METHODS: Fourteen Turkish uveitis specialists, masked to demographic and clinical features of patients, independently labeled ocular photographs (29 Behçet/30 other diagnoses) as "Behçet uveitis" or "non-Behçet." Level of agreement was evaluated using kappa statistics. Photographs were categorized based on ocular signs captured and performance of observers. RESULTS: Exact agreement with the correct diagnosis was 56-81%. Seven reviewers correctly labeled more than 70% of photographs. Interobserver agreement among those 7 reviewers revealed moderate (κ = 0.41-0.60) or substantial (κ = 0.61-0.80) agreement in 76% of pairs. Smooth layered hypopyon, superficial retinal infiltrate with retinal hemorrhages, and branch retinal vein occlusion with vitreous haze were correctly recognized as Behçet uveitis by majority of reviewers. CONCLUSIONS: There are ocular signs of Behçet disease that can be considered diagnostic even in the absence of any other clinical information.

Is retinopathy of prematurity decreasing?--comparison of two different periods in the same NICU.

Retinopathy of prematurity is a retinal vascular disorder seen frequently in very premature infants, and is associated with poor clinical outcomes. The aim of the present study was to assess the association between the incidence of retinopathy of prematurity and mechanical ventilation, oxygen therapy, gestational age, and antenatal steroids in extremely low birth weight infants as well as to retrospectively analyze changes in the incidence and risk factors of retinopathy of prematurity over two study periods.

Bilateral acute idiopathic frosted branch angiitis in a pregnant woman.

PURPOSE: To present a case of frosted branch angiitis in a pregnant woman. METHODS: A 27-week pregnant 18-year-old woman was presented with bilateral decreased visual acuity. Fundoscopy showed typical appearance of frosted branch angiitis. RESULTS: A good spontaneous clinical improvement was observed during systemic evaluation. No treatment was started. CONCLUSION: Frosted branch angiitis may be seen during pregnancy, without any associated underlying disease, and can be resolved without any intervention. The treatment may not be necessary for some cases.

Comparison of optical coherence tomographic findings between Behcet disease patients with and without ocular involvement and healthy subjects / Comparação de achados de tomografia de coerência óptica em pacientes com doença de Behcet com e sem envolvimento ocular e indivíduos saudáveis

ABSTRACT Purpose: We aimed to compare the retinal nerve fiber layer, ganglion cell layer, inner plexiform layer, and the choroid thickness between patients with Behcet disease and healthy subjects by using spectral domain optical coherence tomography (SD-OCT). Methods: Ninety eyes of 45 healthy subjects and 104 eyes of 52 patients with Behcet disease were included in this study. Rheumatoid factor and C-reactive protein levels were measured by blood testing in the patients. Results: The mean thickness of the retinal nerve fiber layer, ganglion cells layer, and inner plexiform layer were significantly lower in patients with Behcet's disease than in the healthy subjects. The mean choroidal thickness was significantly higher in the patients than in the healthy subjects. Conclusions: SD-OCT was a useful and non-invasive tool for the detection of retinal nerve degeneration and choroidal changes in patients with Behcet disease even in the absence of ocular involvement.

RESUMO Objetivo: Comparar a camada de fibras nervosas da retina, a camada de células ganglionares, a camada plexiforme interna e a espessura coróide entre os pacientes com doença de Behçet e indivíduos saudáveis usando tomografia de coerência óptica (OCT) de domínio espectral (SD). Métodos: Noventa olhos de 45 indivíduos saudáveis e 104 olhos de 52 pacientes com doença de Behcet foram incluídos no estudo. O fator reumatoide e os níveis de proteína C-reativa foram medidos por exames de sangue em pacientes com doença de Behcet. Resultados: As médias de espessura da camada de fibras nervosas da retina, da camada de células ganglionares e da camada plexiforme interna dos pacientes com Doença de Behcet foram significativamente menores do que o grupo controle. As medidas de espessura coróide média dos pacientes com doença de Behcet foram significativamente mais elevadas do que o grupo controle. Conclusões: Tomografia de coerência óptica é uma ferramenta útil e não invasiva para acompanhar a degeneração nervosa retiniana e as alterações coroidais em pacientes com doença de Behcet, mesmo sem envolvimento ocular.

Demographic and clinical features of uveitis in tertiary centers in Turkey.

PURPOSE: To analyze the referral patterns and clinical features of uveitis in tertiary eye care centers in Turkey. METHODS: Uveitis services of eight university clinics collected data on uveitis patients who presented during 2004. Data were collected on a form including a questionnaire on socio-demographic and clinical features which were documented at presentation. RESULTS: A total of 761 patients (1187 eyes) with a mean age of 35.5 years were included in the study. Male to female ratio was 1.04:1. The majority of patients (89.6%) were from an urban population, 53% were referrals and 43% had had uveitis for more than one year. The most common type of uveitis was anterior uveitis (52.5%) followed by panuveitis (28.1%), posterior uveitis (12.7%) and intermediate uveitis (6.7%). In 56.8% of patients an etiological classification was established. The most common etiology was Behcet's disease (32.1%), followed by Fuchs' heterochromic iridocyclitis (5.1%) and ocular toxoplasmosis (4.7%). Among 48 pediatric patients uveitis associated with juvenile idiopathic arthritis and ocular toxoplasmosis both having equal frequencies (12.5%) were the most common diagnosis. These were followed by Behcet's disease with juvenile-onset (10.4%). At the time of presentation, 6.25% of the patients were legally blind (having visual acuity less than 0.1 in the better seeing eye). CONCLUSION: Compared to the uveitis series reported from other countries, Behcet uveitis was the leading cause of uveitis in this series. Uveitis associated with juvenile idiopathic arthritis and ocular toxoplasmosis were the most common cause of uveitis in childhood. On the other hand, entities like acquired immunodeficiency syndrome-related uveitis, presumed ocular histoplasmosis and Birdshot retinochoroidopathy were rare.

The spectrum of Vogt-Koyanagi-Harada disease in Turkey: VKH in Turkey.

AIM: The aim of this report was to provide a detailed description of the clinical features of Vogt-Koyanagi-Harada (VKH) disease in Turkish patients. METHODS: We retrospectively analyzed 45 patients diagnosed with VKH disease at seven referral centers in Turkey. A standard data acquisition form was used for the analysis of demographic and clinical features. RESULTS: The study cohort consisted of 45 patients (32 female, 13 male) who had a mean age at presentation of 31 years. Seven patients (15%) were aged 16 years or younger. Nineteen (42%) patients presented in the acute or subacute stage and 26 (58%) in the chronic stage. According to the revised diagnostic criteria, nine (20%) patients had the complete form of the disease, 23 (51%) had the incomplete form, and 13 (29%) had probable VKH disease. All patients had bilateral ocular involvement. Sunset-glow fundus was observed in 89% of the patients, pigment clumping in 73%, nummular depigmented scars in 71%, cataract in 53%, optic atrophy in 31%, glaucoma in 29%, subretinal fibrosis in 22%, choroidal neovascular membranes in 7%, and phthisis in 4%. All patients who presented at the acute uveitic stage received systemic corticosteroid therapy. Immunosuppressive treatment was employed in 30 (66%) patients, which was initiated at the acute uveitic stage in ten (22%) patients. Final visual acuity was better than 0.5 in 59% of the patients' eyes, between 0.1 and 0.5 in 21%, and less than 0.1 in 20%. CONCLUSIONS: VKH disease is rare in Turkey. We conclude that the majority of patients with VKH in Turkey do not have the complete form of the disease. Based on our results, most patients with VKH seem to be late referrals. Ocular complications were common among these patients.

Pars plana vitrectomy in ocular injury with intraocular foreign body.

BACKGROUND: We evaluated 70 cases of ocular injuries with intraocular foreign bodies to determine the results of surgical management. METHODS: The site of penetration was cornea in 58 (82.9%), sclera in 8 (11.4%), and limbus in 4 (5.7%) eyes. The foreign body was in the vitreous in 40 (57.1%) and embedded in the retina in 30 (42.9%) cases. Before pars plana vitrectomy, the most common findings were found to be lens perforation (77.1%), vitreous hemorrhage (45.7%), endophthalmitis (20%), hyphema (4.3%), and retinal detachment (2.9%). RESULTS: After pars plana vitrectomy, visual acuity improved in 39 (55.7%), did not change in 19 (27.2%), and decreased in 8 (11.4%) cases. We observed secondary glaucoma in 11 (15.7%), retinal detachment in 10 (14.3%), and phthisis bulbi in 3 (4.3%) cases postoperatively. CONCLUSION: Pars plana vitrectomy is found to be an effective therapeutic approach in removing intraocular foreign bodies, but the preoperative and postoperative complications determine the visual outcome.

Non-Hodgkin lymphoma presenting with uveitis occurring after blunt trauma.

We report here an unusual patient suffering from visual loss with refractory uveitis which was occured after a blunt trauma to her left eye. While in the hospital cervical lymph node and anterior chamber aspiration cytology with immunohistochemical staining were performed. The histopathologic diagnosis was highly malignant B-cell non-Hodgkin lymphoma. After the inflammation of the eye was regressed with chemotherapy, pars plana vitrectomy-lensectomy was performed. She was free of inflammation and the best corrected visual acuity was increased. However, she had a refractory inflammatory episode with clumps of cells in the anterior chamber 10 months after the operation. Local radiotherapy to the left eye was applied. Radiotherapy provided local control and preservation of the vision. The present case is presented in order to emphasize the importance of systemic evaluation in uveitis and possible role of trauma leading migration of atypical cells into the eye.