Choroidal tuberculoma in a patient with ocular Behçet disease.

Behçet disease is a chronic relapsing inflammatory disease affecting many different organs. Ocular involvement is quite common in the course of Behçet disease and is frequently manifested by bilateral panuveitis and retinal vasculitis. Medications such as corticosteroids and immunosuppressive agents are used to reduce inflammation in patients with posterior or panuveitis. Chronic immunosuppression is a risk factor for systemic infections. We report a case of choroidal tuberculoma associated with tuberculosis in a patient with ocular Behçet disease. A 25-year-old female with known ocular Behçet disease contracted tuberculosis 3 months earlier. She had been receiving methotrexate and oral steroids. Funduscopy of the left eye revealed a choroidal tuberculoma located superonasally to the optic disc. Fluorescein angiography showed a central area of hypofluorescence surrounded by a hyperfluorescent zone. Since she was already receiving antituberculosis treatment combined with oral steroids, the same treatment was continued. Diagnosis of the other diseases that may cause uveitis in patients with Behçet disease should not be missed. This is especially important since immunosuppressive drugs, that cause an increased incidence of systemic infections, are the common treatment of choice for patients with Behçet disease.

One-year outcomes of less frequent bevacizumab in age-related macular degeneration.

PURPOSE: To evaluate whether a less frequent bevacizumab dosing schedule after repeated doses in short intervals would be effective in patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration. METHODS: Twenty-seven treatment-naive eyes of patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration participated in this prospective, noncomparative, and interventional study at the Ulucanlar Eye Training and Research Hospital retina clinic. All lesion types were included. Intravitreal injections (1.25 mg/0.05 mL) of bevacizumab were given with a 6-week interval (Day 0, 6 weeks, and 12 weeks) for 3 months and then given at every 12-week interval up to 48 weeks. Main outcome measures of treatment were mean change in visual acuity and foveal center point retinal thickness from baseline documented by optical coherence tomography at 6, 12, 24, 36, and 48 weeks. The effects of patient age, baseline visual acuity, lesion composition, and lesion size on final visual acuity and loss of <15 letters of logarithm of the minimum angle of resolution (logMAR) at 48 weeks were also assessed. RESULTS: Of the 27 eyes, 24 eyes of 24 patients (14 men and 10 women) completed the 48-week follow-up and study protocol. Compared with baseline (0.95 ± 0.27 on Early Treatment Diabetic Retinopathy Study charts), mean best-corrected visual acuity improved to 0.77 ± 0.21 logMAR (P < 0.001) at Week 6, to 0.74 ± 0.2 logMAR (P < 0.001) at Week 12, to 0.79 ± 0.257 logMAR (P = 0.03) at Week 24, to 0.85 ± 0.26 logMAR (P = 0.54) at Week 36, and to 0.87 ± 0.27 logMAR (P = 1) at Week 48. The baseline mean center point retinal thickness that was 343 ± 64 µm decreased to 236 ± 40 µm (P < 0.001) at Week 6, to 222 ± 39 µm (P < 0.001) at Week 12, to 237 ± 37 (P < 0.001) at Week 24, to 253 ± 44 µm (P < 0.001) at Week 36, and to 268 ± 58 µm (P = 0.002) at Week 48. The maximal visual benefit obtained during the frequent dosing schedule significantly decreased by doses every 12 weeks at 48 weeks (P < 0.001). This decline in the best-corrected visual acuity gain was associated with an increase in the mean center point retinal thickness on optical coherence tomography. Patients aged <70 years and those having a baseline vision of 20/200 or worse were more likely to gain vision at 48 weeks (P = 0.001 and P = 0.02, respectively). In addition, a lesion ≤ 4 disk areas at baseline was less likely to lose <15 letters from baseline at 48 weeks (P = 0.03). No serious ocular and nonocular adverse events were noted. CONCLUSION: Although intravitreal bevacizumab administration on a schedule of a 6-week injection interval for 3 months followed by every 12-week interval for neovascular age-related macular degeneration provided an improvement or stabilization in best-corrected visual acuity with anatomical improvement. This dosing strategy is unable to maintain the visual acuity and optical coherence tomography benefits seen with more frequent dosing.

Behçet disease in children.

PURPOSE: To investigate the incidence and clinical characteristics of Behçet disease in children. METHODS: The authors retrospectively reviewed the charts of 3382 patients with Behçet disease from October 1986 to December 2005 at Ankara University Medical School Behçet Unit and/or Atmaca private clinic. RESULTS: 110 children were diagnosed with Behçet disease. The 110 children represented 3.3% of the total number of Behçet patients that were reviewed. 62.7% were girls and 37.3% were boys. The mean age at initial manifestation was 11.63 ± 3.46 years and at diagnosis was 14.15 ± 2.13 years. Ocular involvement was found in 30.9% of the children. Of these, 61.8% were bilateral and 38.2% were unilateral. Anterior uveitis was found in 18 eyes (32.8%), posterior uveitis in 24 eyes (43.6%), and panuveitis in 13 eyes (23.6%). CONCLUSION: Behçet disease should be considered in the differential diagnosis of childhood uveitis, particularly in endemic areas. The collaboration of pediatricians, rheumatologists, dermatologists, ophthalmologists, and other specialists when necessary is required in the diagnosis and management of children with Behçet disease.

Laser treatment in 341 patients with exudative age-related macular degeneration.

AIM: To document the prognosis of laser treatment in patients with exudative age-related macular degeneration (AMD). METHODS: Efficacy of the intervention was evaluated using a before-after method. RESULTS: A total of 392 eyes of 341 patients with exudative AMD were examined. 77.6% had choroideal neovascularisation (CNV). Before the use of indocyanine green (ICG) angiography, occult CNV was detected in only 1.8% of the eyes, but after the use of ICG angiography, this increased to 19.5% (P<0.001). Of the 349 eyes which were followed up, visual acuity had remained stable in 68.2%. There was a statistically significant relationship between the localization of lesion and visual acuity changes on pre- and post-laser treatment (P<0.001). Also there was a statistically significant relationship between the localization of lesion and recurrence (P<0.05). The recurrence was less in subfoveal lesions than that in juxtafoveal and extrafoveal lesions. CONCLUSION: ICG angiography is highly important in the treatment of occult CNV.

Laser treatment in 341 patients with exudative age-related macular degeneration / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To document the prognosis of laser treatment in patients with exudative age-related macular degeneration (AMD).METHODS:Efficacy of the intervention was evaluated using a before-after method.RESULTS:A total of 392 eyes of 341 patients with exudative AMD were examined.77.6% had choroideal neovascularisation (CNV).Before the use of indocyanine green (ICG) angiography,occult CNV was detected in only 1.8% of the eyes,but after the use of ICG angiography,this increased to 19.5% (P<0.001).Of the 349 eyes which were followed up,visual acuity had remained stable in 68.2% of the eyes.There was a statistically significant relationship between localization of lesion and visual acuity changes on pre-and post-laser treatment (P<0.001).Also there was a statistically significant relationship between localization of lesion and recurrence (P<0.05).The recurrence was less in subfoveal lesions than that in juxtafoveal and extrafoveal lesions.CONCLUSION:ICG angiography is highly important in the treatment of occult CNV.

Ocular involvement in sarcoidosis.

PURPOSE: To evaluate ocular involvement in patients with sarcoidosis. METHODS: The prevalence of ocular manifestations was studied in 139 Turkish patients with sarcoidosis as a cross section. Color photography and fluorescein angiography were performed on patients suspected of having ocular involvement. RESULTS: Ocular involvement was seen in 12.9% patients. Of 18 patients with ocular sarcoidosis, 39% had anterior and posterior involvement, 28% only anterior, 11% only posterior, 16.7% conjuctival, and 5.6% eyelid involvement. There was no statistically significant relationship between radiological grading and ocular involvement. CONCLUSIONS: The most common ocular involvement in this study was both anterior and posterior segment involvement.

Evaluation of the optic nerve head with the heidelberg retina tomograph in diabetes mellitus.

BACKGROUND: To evaluate the optic nerve head by means of the Heidelberg retina tomograph (HRT) in patients with diabetes mellitus (DM). METHODS: The study group consisted of 47 patients with DM [group 1; 29 patients without diabetic retinopathy (DR) and 18 patients with non-proliferative DR] and 50 normal subjects (group 2). All patients and controls underwent a complete ophthalmological examination, and the optic nerve head topography of both eyes was evaluated by using HRT-I. One eye of these cases was randomly selected for statistical analysis. Glycosylated haemoglobin (HbA(1c)) levels of all the study participants were measured. RESULTS: The HRT parameters were similar between diabetic and control groups (p > 0.05). In group 1, in the patients with duration of diabetes < or =10 years, when compared with the patients with duration of diabetes >10 years, we did not detect any statistically significant difference between the HRT parameters (p > 0.05). There was no statistically significant correlation between HBA(1c) levels and rim volume (r = -0.078, p = 0.601), and mean retinal nerve fibre layer thickness (r = 0.058, p = 0.700) in DM patients. CONCLUSION: These results suggest that non-glaucomatous diabetic patients had no decreased neuroretinal rim when compared with non-diabetic patients.

Intravitreal triamcinolone acetonide in the management of cystoid macular edema in Behçet's disease.

PURPOSE: To determine the efficacy of intravitreal triamcinolone acetonide (ivTA) injection in the management of cystoid macular edema (CME) due to uveitis in patients with Behçet's disease. METHODS: Ten eyes of seven patients with CME associated with Behçet's disease were included in the study. A quantity of 4 mg of triamcinolone acetonide was injected intravitreally in all of the eyes. The maculas of the patients were evaluated with optical coherence tomography (OCT) and fluorescein angiography (FA). The change in visual acuity, fluorescein leakage, macular thickness, and potential complications were assessed. RESULTS: The mean follow-up was 15.6 months (range 7-19 months). There was an increase of more than two Snellen lines in the visual acuity in seven of the ten eyes (70%) at the last examination. Macular edema regressed completely in eight of the ten eyes (80%) at the last visit on OCT and FA. The mean central macular thickness assessed by OCT was 406 mum before treatment and 186.9 mum at the last visit. The intraocular pressure (IOP) exceeded 21 mmHg in six eyes of five patients (60%) during the follow-up. At the last visit, the IOP was less than 21 mmHg in five eyes with medication. One eye underwent glaucoma filtration surgery. Four eyes of three patients had cataract progression. In four eyes of four patients (40%), a second ivTA injection was given due to relapsing CME. CONCLUSION: Intravitreal triamcinolone acetonide (ivTA) may be beneficial in the management of CME in patients with Behçet's disease. Repeated ivTA injections might be required if CME reoccurs.

Fluorescein and indocyanine green angiography in ocular toxoplasmosis.

PURPOSE: To document fluorescein and indocyanine green angiographic findings in patients with ocular toxoplasmosis. METHODS: Charts of patients with ocular toxoplasmosis who were evaluated with fluorescein and indocyanine green angiograpy were reviewed. RESULTS: In this study, eight (38%) females and 13 (62%) males with a mean age of 20.3 years were included. Of the 21 patients, five (24%) had bilateral involvement with active or inactive toxoplasmic lesion. There were active lesions in 12 (46%) eyes and inactive lesions in 14 (54%) eyes. Indocyanine green angiograpy showed hypofluorescence of the active and inactive retinochoroiditis lesions at all phases. Hypofluorescent multiple satellite dark dots were observed in 11 (92%) eyes with active retinochoroiditis and in two (14%) eyes with inactive lesions. In two patients with unilateral active toxoplasmic retinochoroiditis, hyperfluorescent plaques were observed in the fellow eyes on indocyanine green angiograpy. The fundus examination and fluorescein angiography of the fellow eyes were normal and had a visual acuity of 10/10. Choroidal neovascularization was observed in two (8%) eyes. In eyes with active inflammation, fluorescein angiography revealed early hypo-fluorescence and late intense hyper-fluorescence with fuzzy margins of the retinochoroiditis lesion (12 eyes), hyperfluorescence of the optic nerve head (four eyes) and leakage from the vessels and/or vascular sheathing (four eyes) and neuroretinitis (one eye). CONCLUSION: Toxoplasmic retinochoroiditis is a more widespread inflammation than visible fundus lesions. Indocyanine green angiography is a useful method for evaluating the amount of inflammatory activity and late complications in patients with ocular toxoplasmosis.

Clinical features and prognosis in ocular toxoplasmosis.

PURPOSE: To evaluate retrospectively the clinical characteristics, complications, and prognosis in patients with ocular toxoplasmosis. PATIENTS AND METHODS: We reviewed the records of 189 patients (243 eyes) with ocular toxoplasmosis who were examined between 1972 and 1999. Color fundus photography and, in some patients, fluorescein angiography and indocyanine green angiography were performed. There were 98 male (52%) and 91 female (48%) patients with a mean age of 22.8 +/- 8.9 years. RESULTS: Of the patients, 140 (74%) had congenital and 49 (26%) had acquired toxoplasmosis. At the initial examination, there were active lesions in 65 eyes and inactive lesions in 178 eyes. Active lesions included retinochoroiditis in 59 (91%), papillitis in 2 (3%), and neuroretinitis in 4 (6%) eyes. There was also an inactive scar in 17 eyes with active retinochoroiditis. Localisation of the active retinochoroiditis was the macula in 44 (74%), the macula and peripheral retina in 3 (5%), the peripheral retina in 9 (15%) and the peripapillary retina in 3 (5%) eyes. Optic atrophy, pigment epithelial detachment, choroidal neovascularization, lamellar macular hole, and retinal neovascularization were seen during the follow-up period. CONCLUSIONS: Ocular toxoplasmosis commonly affects the macula and seriously impairs visual acuity. The prevention of acquired and congenital infections is very important in controlling ocular toxoplasmosis. Patients should be followed to avoid late complications.

Factor V Leiden and prothrombin gene G20210A mutations in ocular Behçet disease.

PURPOSE: To investigate genetic prothrombotic factors (factor V Leiden and prothrombin gene G20210A mutations) and their relation with retinal vascular occlusions in ocular Behçet disease. METHODS: Thirty Behçet patients were prospectively recruited into the study. Their mean age was 34.2 +/- 8.3 years. All patients underwent complete ophthalmic examination and fluorescein angiography. Of the 30 patients, 15 (16 eyes) had retinal vascular occlusion. Patients were tested for the presence of factor V Leiden and prothrombin gene G20210A mutations by polymerase chain reaction. The results were compared with the frequencies of factor V Leiden in 285 and prothrombin gene G20210A mutation in 182 healthy members of the Turkish population. RESULTS: The prevalence of factor V Leiden mutation was significantly higher in ocular Behçet patients (12/30, 40%), compared with healthy control subjects (28/285, 9.8%) (p < 0.001). Of the 12 Behçet patients with factor V Leiden mutation, eight had retinal vascular occlusion. The prevalence of factor V Leiden was 53.3% (8/15) of the 15 patients with retinal vascular occlusion and 26.7% (4/15) of the remaining 15 patients without vascular occlusion. Prothrombin gene mutation was detected in none of Behçet patients compared with 2.7% (5/182) of the control group. CONCLUSION: These data suggest that factor V Leiden may be an additional risk factor in ocular Behçet disease, whereas factor II mutations do not seem to be relevant.

A long-term follow-up of Eales' disease.

PURPOSE: To provide long-term follow-up information on Eales' patients. METHODS: Eales' patients, who had been examined at varying periods between the years 1970 and 1991 with a minimum five-year follow-up, were included in the study. RESULTS: A total of 130 patients were followed up for a minimum of five and a maximum of 26.5 years. The retinal lesions found during the first examination included vascular sheathing, disc and/or retinal neovascularization, vitreous hemorrhage, branch retinal vein occlusion, retinitis proliferans, and retinal detachment. Visual acuity improved in 37 (20%) of the 185 treated eyes, was maintained in 79 (43%), and worsened in 69 (37%). The complications were tractional detachment, cataract, rubeosis iridis, neovascular glaucoma, and phthisis bulbi. CONCLUSION: The most important elements in dealing with Eales' disease are periodic follow-up, a good and adequate laser treatment, pars plana vitrectomy combined with procedures for nonclearing vitreous hemorrhage, and retinal vasoproliferative changes to stabilize the retinal lesions and maintain functional levels of vision.