A Report on Children with CEP290 Mutation, Vision Loss, and Developmental Delay.

Mutations in CEP290, which encodes a centrosomal protein, cause Joubert syndrome, retinal dystrophy, and several other manifestations. Retinal dystrophy related to CEP290 mutation (Leber's congenital amaurosis type 10) presents with a severe visual impairment from birth, wandering eye movements, and oculodigital reflex. Fundus examination may initially be normal, but varying degrees of retinal pigmentation can be detected over time. This report presents 4 children who were referred to the ophthalmology clinic with a lack of eye contact and the suspicion of low vision. The ophthalmological examination revealed very poor visual function, the vision slightly improved over time, and enophthalmos became evident. There was neuromotor retardation in their history and mutations in the CEP290 gene were revealed in the whole-exome analysis. Both pediatricians and ophthalmologists should be aware of the coincidence between severe vision loss and neuromotor retardation and should refer patients for genetic testing if they suspect it. Genetic diagnosis will enable patients to be followed both neurologically and ophthalmologically and to benefit from rehabilitation opportunities that will contribute to visual and neurological development. It will also allow the family to receive genetic counseling on disease progression and heredity, and to follow ongoing gene therapy studies for mutations in the relevant gene.

Rehabilitation Methods for Patients with Geographic Atrophy due to Age-Related Macular Degeneration and Effects of Rehabilitation on Quality of Life.

Purpose: The purpose of the study is to evaluate the low vision rehabilitation methods and to investigate the effect of visual rehabilitation on quality of life in patients with low vision due to geographic atrophy from age-related macular degeneration (ARMD). Methods: The better-seeing eye of 78 patients with geographic atrophy due to ARMD were included in the study. Sociodemographic characteristics, ophthalmological examination findings, and preferred low vision aids for near and distant were recorded. Fifty-seven patients who preferred to use a low vision aid device in daily life were considered as a rehabilitation group, whereas 21 patients who did not use any device were considered as a control group. The National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) was applied to all patients at the initial examination and at least 6 months after the initial examination. Results: In the rehabilitation group, statistically significant increases were found in the overall composite score, and general vision, near and distance activities, social functioning, mental health, role difficulties, and dependency subscale scores of the NEI-VFQ-25 quality of life scale after low vision rehabilitation (p=0.009 for general vision, p < 0.001; for others). In the control group, there was no statistically significant change in any of the subscale scores or the overall score of the scale (p > 0.05). All patients (n = 78) were recommended to use at least one low vision aid for near vision. Hyperocular glasses were recommended for 77 patients (98.72%), magnifiers for 15 patients (19.23%), electro-optical devices for 2 patients (2.56%), and telemicroscope for one patient (1.28%). Furthermore, 17 patients (21.8%) were prescribed more than one low vision aids. However, for distance vision, only 29 patients (37.18%) received a recommendation for a low vision aid. Conclusions: Low vision patients with ARMD-related geographic atrophy should meet with low vision aids as soon as possible and should be included in low vision rehabilitation programs.

Evaluation of fixation characteristics in amblyopia using microperimetry.

PURPOSE: To evaluate fixation characteristics in amblyopia using macular analyzer integrity assessment (MAIA) microperimetry and to investigate the factors affecting fixation stability. METHODS: This prospective, cross-sectional study enrolled a total of 58 amblyopic patients who were between 8 and 55 years old. Average threshold macular sensitivity (AT) and fixation characteristics were assessed using MAIA microperimetry. Two Bivariate contour ellipse area (BCEA) fixation indices (63% and 95% proportional values) and the percentage of fixation points within 1° and 2° from the fovea (P1 and P2) were used to assess fixation stability. Non-amblyopic fellow eyes were used as the control group for comparison. RESULTS: AT and fixation stability indices (P1, P2, BCEA 63%, BCEA 95%) were worse in the amblyopic eyes than in the fellow eyes (p < 0.05, for all indices). There was a moderate positive correlation between best corrected visual acuity (BCVA), and AT, and P2, and a moderate negative correlation between BCVA, and BCEA indices. 48% of the eyes were eccentrically fixating (the percentage was 25% in the anisometropic group, 52% in the strabismic group, and 69% in the combined group) and 32% in the non-amblyopic eye (p = 0.052). The preferred fixation eccentricity in amblyopic eyes was significantly greater than the non-amblyopic eyes (p = 0.004), and there was a negative correlation between preferred fixation eccentricity and BCVA (p = 0.012, r = - 0.327). CONCLUSIONS: Our data showed a decrease in fixation stability, a positive correlation between fixation stability and BCVA, and a negative correlation between preferred fixation eccentricity and BCVA in amblyopic eyes.

Comparison of Reading Test Parameters from the Print and Tablet Application Forms of the Minnesota Low Vision Reading Test.

Objectives: To compare reading parameters measured with the Turkish version of the Minnesota Low Vision Reading Test (MNREAD-TR) printed acuity chart and the tablet application version of the same test for both normally sighted and low-vision individuals. Materials and Methods: A total of 116 individuals (92 normally sighted and 24 low-vision) were included in the study. All participants were tested with both the print version of the MNREAD-TR chart (method 1) and the tablet application version (method 2). Reading acuity (RA), critical print size (CPS), maximum reading speed (MRS), and reading accessibility index (ACC) were compared statistically. Results: No statistically significant difference was found in RA and CPS between the two methods for the normally sighted individuals (p=0.083 and p=0.075, respectively). There was no statistically significant difference in RA and ACC between the two methods for the patients with low vision (p=0.159 and p=0.103, respectively). The mean MRS was 233.1±34.7 words per minute (wpm) with method 1 and 169.3±23.4 wpm with method 2 in the normally sighted group (p<0.001) and 93.2±50.2 wpm with method 1 and 68.2±34.7 wpm with method 2 in the low-vision group (p<0.001). Conclusion: In our study, it was found that the parameters RA and CPS in the normally sighted individuals and RA and ACC in the low vision individuals provided similar results in both forms of the MNREAD. The tablet application method can be preferred to eliminate evaluators' bias of scoring the printed chart. In addition, applications have other advantages such as being faster and more practical and providing automatic analysis of parameters, especially in low-vision rehabilitation.

Comparison of Two Different Contrast Sensitivity Testing Methods in Patients with Low Vision.

Purpose: To assess the agreement between two different contrast testing modalities using the index of contrast sensitivity (ICS) in patients with low vision. Methods: Thirty-eight patients with low vision were included in the study. Contrast sensitivity (CS) was measured binocularly with both the Vector vision-standardized CS test (CSV-1000E, Vector Vision Co, Greenville, Ohio, USA) and the MonPack 3 (Metrovision, France) after refractive correction for each participant. Based on the data from the two tests, the ICS was calculated. The Bland-Altman technique was used to evaluate the agreement between ICSs obtained from different test methods. Results: Range of best corrected visual acuity was 0.50-1.00 logMAR. According to the median logCS values, CS values were highest at 3 cycles per degree (cpd) for the CSV-1000E test and at 1.5 cpd for the Metrovision MonPack 3 test. The median ICS for CSV-1000E was -0.22 (95th percentile 4.75), and the median ICS for Metrovision MonPack 3 was 0.08 (95th percentile 1.65). The mean difference was 0.655 (between -3.82 and 5.13) within limits of agreement (LoA). The difference and mean values between the two CS test measurements were found to be within LoA range. Conclusions: An agreement was found between the Metrovision MonPack 3 test and the standard CSV-1000E test results in patients with visual impairment. However, the agreement range was within very wide limits. Therefore, it was thought that they may not be used interchangeability in clinical practice.

Ocular and cerebral causes of visual impairment in young children and a new scoring system to evaluate visual function.

PURPOSE: Childhood blindness is important cause contributing to the burden of blindness. It is necessary to identify the most frequently observed diseases in different populations. We aimed to demonstrate clinical features of low vision children and to evaluate the factors affecting visual function by a new visual function scoring system. METHODS: Two hundred forty nine children between the age of 6 months and 3 years were included. Visual function was scored from 0 to 15 according to; response to threat, light, object, presence of fixation, duration of fixation, following of light and object in horizontal, vertical, oblique, and circular gazes, optokinetic nystagmus. Patients were classified according to neurological diagnosis and cranial magnetic resonance imaging findings. Correlation between visual function score and ocular and neurologic findings were evaluated. RESULTS: While 136 patients (54.6%) had cerebral visual impairment (CVI), 89 (35.7%) had ocular pathology, 24 patients (9.6%) had combined pathology. The most common ocular and cerebral pathologies were oculocutaneous albinism (23.9%) and hypoxic ischemic encephalopathy (HIE) (27.5%), respectively. Patients with CVI had lower visual function than ocular pathologies. Neurological structural disorders and HIE had worse visual function. Widespread involvement of brain had lower visual function score. Seizure negatively affected visual function. CONCLUSIONS: Cerebral causes were found in approximately half of infants and children with low vision who were referred to our center for visual habilitation. The visual function scoring system we developed in this study will provide an opportunity to be objective in the follow-up of babies and in evaluating the effectiveness of visual habilitation programs.

Visual habilitation in young children with visual impairment.

PURPOSE: To evaluate the effectiveness of the visual habilitation programme in improving the visual functions of visually impaired children under 3 years old. METHODS: Case records of children with visual impairment (VI) who had at least 1 follow-up visit were reviewed. Children's visual functions were scored between 0 and 15 based on mainly fixation and following skills. Differences in patients' visual function score (VFS) between the time of the presentation and the last follow-up visit were recorded. RESULTS: One hundred thirty children with VI (63 male and 67 female) were identified. The mean age at the presentation was 13.94 ± 9.23 months, and the mean follow-up was 12.79 ± 9.4 months. Forty of the patients had ocular, 70 of them had cerebral, and 20 of them had combined VI. Correlations were found between the age of the patients at the presentation and the initial VFS; and gestational age and the initial VFS (p Ë‚ 0.001, r = 0.332; p Ë‚ 0.05, r = 0.262, respectively). Vision improvement was noted in ocular, cerebral and combined VI groups. No significant difference among the groups was found (p = 0.430). There was a significant difference between the change in the VFSs of those who attended the special education and rehabilitation centre regularly for 2 h a week and had regular visual stimulation for 8-10 sessions every day at home and those who did not go to the centre and did not receive any visual stimulation by their parents at home (p Ë‚ 0.001). CONCLUSIONS: The visual functions of visually impaired children can be improved by habilitation, which includes visual stimulation programmes.

Comparison of Quality of Life Questionnaires in Patients with Low Vision

Objectives: To compare the quality of life assessed by the Low Vision Quality of Life Questionnaire (LVQOL) and National Eye Institute Visual Function Questionnaire (NEI VFQ-25) in patients with low vision. Materials and Methods: A total of 64 consecutive patients who presented to the Ankara University Low Vision Rehabilitation Department for the first time were included in the study. Patients aged 18 or older who had a best-corrected visual acuity of less than 20/60 or a visual field of equal to or less than 20° from the fixation point in the better eye were included. After examination, the patients were asked to complete the LVQOL and NEI VFQ-25 questionnaires. Results: A very strong correlation was found between the total scores of the two questionnaires. A strong correlation was found between the "distance vision" subscale score of LVQOL and "distance activities" subscale score of NEI VFQ-25. There was also a strong correlation between the "reading and fine work" subscale score of LVQOL and "near activities" subscale score of NEI VFQ-25. There was a weak correlation between the LVQOL total score and visual acuity. There were moderate negative correlations between age at disease onset and the total scores of the two questionnaires. Conclusion: Both the LVQOL and NEI VFQ-25 are able to quantify the quality of life of individuals with low vision and it is possible to compare the studies carried out with these two questionnaires which are validated in Turkish.

Demographic, ocular and associated neurological findings in corpus callosum malformations.

BACKGROUND: The corpus callosum is a primary commissural part of the brain which connects the two hemispheres. Processing sensory, motor, visuo-motor and cognitive functions are related to a healthy connection. In this study, we aimed to evaluate the ocular, neurologic and other systemic findings of corpus callosum malformations and to focus on the association between the ocular and neurological findings and the type of callosal malformation according to cranial magnetic resonance imaging (MRI). METHODS: A retrospective chart review of 57 patients with corpus callosum malformation was performed. Demographic features, neurologic, ocular and other systemic findings were noted. Patients were divided into 3 groups according to the severity of corpus callosum malformation on MRI (total agenesis, partial agenesis and hypoplasia) and also evaluated as a part of a genetic disorder/syndrome or not. The differences between demographic features, ocular and neurological findings between these 3 groups and also between syndromic and non-syndromic groups were evaluated statistically. RESULTS: Only 35.1% of patients had fixation and following pattern of visual acuity. Anterior segment pathologies were observed in 6.9% of patients. However, 57.9% of patients had posterior segment malformations. Only 19.3% of patients had a normal ocular alignment. There was no statistically significant difference of demographic features, ocular and neurologic findings between the 3 groups or between the syndromic/non-syndromic groups. CONCLUSIONS: Ocular findings can be reliable depending on the severity of the corpus callosum malformations. However, delay in fixation reflex development or loss of fixation should remind us of central nervous system pathologies especially corpus callosum malformations.

Evaluation of the effect of subtenon autologous platelet-rich plasma injections on visual functions in patients with retinitis pigmentosa.

Aim: The photoreceptors in retinitis pigmentosa (RP) remain in dormant status for a while with a decrease in the growth factors in their microenvironment before apoptosis. Growth factors reduce retinal degeneration and apoptosis in animal models. Materials & methods: The data of 188 eyes of 94 patients who were injected with autologous platelet-rich plasma (PRP) into the subtenon space three-times every 2 weeks were evaluated retrospectively. Results: Statistically significant improvements in visual acuity, visual field and fixation stability were detected after treatment. When the treatment response of the patients' better-seeing eye compared with the response of the other eye, there was no statistically significant difference. Conclusion: The PRP treatment has a favorable effect on visual functions in patients with RP. This approach is promising as it is safe and easy.

Ophthalmologic approach to babies with cerebral visual impairment.

BACKGROUND: Cerebral visual impairment (CVI) is an increasingly common type of visual disturbance in infants and children. The increased incidence is associated with improved neonatal intensive care services and survival of premature infants, especially in developed countries and our country. For accurate ophthalmological evaluation, it is important to know the behavioral responses to visual stimuli that are unique to CVI such as color preference, need for movement, visual latency, visual field preference, and difficulty in visual complexity. METHODS: This review is prepared to draw attention to the subject within the scope of Ankara University Vision, Artificial Vision and Low Vision Rehabilitation training programs. RESULTS: The most common causes are hypoxia and perinatal ischemia. Ocular structures are generally normal or are not sufficient to explain the visual impairment. Diagnosis and habilitation methods differ from visual impairment of ocular origin. As a result, early diagnosis of CVI in infants and toddlers and an effective visual habilitation with a multidisciplinary approach where ophthalmologists and pediatricians lead the team is very valuable. CONCLUSIONS: Early diagnosis and early visual habilitation will increase the quality of life of babies and will provide important gains for families and therefore the whole society. Pediatricians should be familiar with this group of disturbances and the available resources, as they are best placed to refer the child for evaluation and rehabilitation and encourage the family for follow-up.

Macular pigment optical density in central serous chorioretinopathy.

PURPOSE: The aim of our study was to evaluate the macular pigment optical density in patients with acute and chronic central serous chorioretinopathy and to describe the association between central retinal thickness and choroidal thickness with the macular pigment optical density. MATERIALS AND METHODS: Eyes with acute central serous chorioretinopathy and chronic central serous chorioretinopathy (patients, who were diagnosed as having disease activity for 6 months) were included in this study. Macular pigment was measured using the heterochromatic flicker technique of the MPS II device for both eyes in patients with acute and chronic central serous chorioretinopathy and in control subjects. RESULTS: Twenty-seven eyes with acute central serous chorioretinopathy, 23 eyes with chronic central serous chorioretinopathy, and 25 control eyes were enrolled. The mean macular pigment optical density in chronic central serous chorioretinopathy (0.480 ± 0.16 density unit (95% confidence interval: 0.390-0.570) was found to be significantly lower than in the control eyes (0.571 ± 0.128 density unit) (95% confidence interval: 0.480-0.670) (p = 0.007). In correlation analysis, no significant association was detected between the central retinal thickness, choroidal thickness, and macular pigment optical density values in central serous chorioretinopathy group (p = 0.31, p = 0.71). CONCLUSION: Macular pigment optical density levels were significantly lower in chronic central serous chorioretinopathy patients than in controls, possibly due to degeneration of the neurosensorial retina, as a result of the long-term persistence of subretinal fluid. There was not a significant correlation between choroidal thickness and macular pigment optical density levels in central serous chorioretinopathy group.

How Much Do Clinical and Microperimetric Findings Affect Reading Speed in Low Vision Patients with Age-related Macular Degeneration?

Purpose: To investigate the factors affecting the reading speed of patients with central scotoma due to age-related macular degeneration (AMD).Materials and Methods: We included 63 eyes of 63 patients with AMD who applied to our low vision clinic between August 2018 and September 2019 in this prospective study. We evaluated socio-demographic characteristics, eye examination findings and Minnesota Low Vision Reading Test (MNREAD) results. We used the MAIA microperimeter device to evaluate the properties of the preferred retinal locus for fixation (PRL) of the patients. Evaluations included the assessment of the effects of all parameters on reading speed.Results: The PRL was most commonly in the nasal (31%) and superior (26%) quadrants. Twenty-nine percent of the cases preferred the left visual field. PRL localization had no effect on reading speed, whereas, fixation stability, educational status, presence of foveal absolute scotoma, reading acuity and duration of reading interruption were found to have the most significant effects. Multiple regression analysis showed that reading speed decreased by 67 units in the presence of unstable fixation, by 17 units in the presence of foveal absolute scotoma, by 3 units with every 0.1 increase in logMAR value, and by 1.7 units with every 1-year increase in reading interruption. Additionally, being a university graduate was associated with an increased reading speed (by 18 units)Conclusion: Increased reading performance is one of the factors that can improve quality of life. The factors found to affect the reading speed in the current study may guide the rehabilitation process in low vision patients.

Effectiveness of Low Vision Rehabilitation Using Microperimetric Acoustic Biofeedback Training in Patients with Central Scotoma.

PURPOSE: To evaluate the efficacy of visual rehabilitation with microperimeter biofeedback in patients with central scotoma. MATERIALS AND METHODS: 35 consecutive patients with central scotoma (17 age-related macular degeneration (AMD), 14 Stargardt disease, and 4 cone dystrophy) were included in the study. Visual acuity, reading performance by Minnesota Low Vision Reading Test (MNREAD), quality of life by 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), and fixation analysis by MAIA microperimeter were evaluated before and 1 month after training. The rehabilitation program consisted of 10 training sessions of 10 minutes. RESULTS: The median best-corrected visual acuity (BCVA) was 0.80 logMAR (range 0.3 to 1.3 logMAR). Fifty-nine percent of patients with AMD developed a preferred retinal locus (PRL) nasal to the fovea, and 64% of the patients with Stargardt disease preferred a PRL superior to the fovea. The PRL location in 3 of 4 cone dystrophy patients was nasal to the fovea. The mean PRL distance from the fovea was 7.57 ± 3.61 degrees. Fixation stability improved with P1 values of 22.34 ± 11.81 versus 32.05 ± 18.79 (p = .003) and 95% bivariate contour ellipse area (BCEA) values of 41.6 versus 23.6 (p = .018) before and after training, respectively. There was a significant difference in reading acuity between before and after training (p = 0.008). The overall score and near activities score of NEI VFQ-25 were found to be increased at the end of the rehabilitation (p < 0.001). CONCLUSION: Rehabilitation with acoustic biofeedback in patients with central scotoma looks like a useful technique for improving fixation stability, reading performance and quality of life.

Evaluation of the Effect of Proptosis on Choroidal Thickness in Graves' Ophthalmopathy

Objectives: To evaluate the effect of proptosis on choroidal thickness in patients with Graves' ophthalmopathy. Materials and Methods: Twenty-five eyes of 25 Graves' patients with proptosis, 25 eyes of 25 Graves' patients without proptosis, and 25 eyes of 25 healthy individuals were included in this prospective study. The subfoveal choroidal thickness and choroidal thicknesses at 6 points from the fovea at 500 µm intervals were measured by Cirrus HD-OCT. All measurements were compared among the proptosis, non-proptosis, and control groups and the active, inactive, and control groups. Results: The mean subfoveal choroidal thickness in the proptosis group was 289.7±68.5 µm, 322.5±55.8 µm in the non-proptosis group, and 316.1±63.0 µm in the control group. The mean nasal choroidal thickness was 260.5±63.5 µm in the proptosis group, 293.9±57.9 µm in the non-proptosis group, and 279.5±63.1 µm in the control group. The mean temporal choroidal thickness was 261.8±60.9 µm in the proptosis group, 289.0±51.8 µm in the non-proptosis group, and 287.8±56.2 µm in the control group. Mean choroidal thickness was 264.7±58.5 µm in the proptosis group, 296.2±47.5 µm in the non-proptosis group, and 288.3±55.1 µm in the control group. There were no statistically significant differences among the groups with respect to choroidal thickness measurements (p>0.05). Conclusion: No significant difference in choroidal thickness was detected between Graves' patients with and without proptosis and the controls. There was no effect of clinical activation on choroidal thickness.

Regression of macular edema with topical brinzolamide and nepafenac alone and identification of a novel gyrate atrophy mutation.

Gyrate atrophy is a rare metabolic autosomal recessive disorder caused by ornithine aminotransferase enzyme deficiency that leads to characteristic progressive, degenerative chorioretinal findings. Patients complain mostly of low vision, night blindness, and peripheral vision loss. Posterior subcapsular cataract, myopia, choroid neovascularization, and intraretinal cysts may be accompanying factors related to vision loss. We encountered a patient with vision loss secondary to posterior subcapsular cataract and intraretinal cysts. After treatment with topical brinzolamide and nepafenac (and without any diet mo dification and/or supplementation), we observed 143- and 117-mm macular thickness resolutions with 2 and 1 Snellen lines of visual gain in his right and left eyes, respectively. Also, we detected a novel homozygous mutation in the ornithine aminotransferase gene: c.1253T>C (p.Leu418Pro). Carbonic anhydrase inhibitors and/or non-steroid anti-inflammatory drugs can control macular edema in patients with gyrate atrophy-associated intraretinal cysts. The genetic variants may also be a determinant in the responsiveness to the therapy type.

A Common Approach to Low Vision: Examination and Rehabilitation of the Patient with Low Vision

Due to the increasing age of the global population, rates of visual disability are increasing. Visual rehabilitation is an effective method for increasing quality of life among individuals with low vision or blindness due to unpreventable or untreatable causes. The goal of low vision rehabilitation is to produce people who are independent, have an economically viable profession or skill, and are able to enjoy their lives. The stages of modern low vision rehabilitation include the intake interview, assessment of residual visual functions, assessment of residual functional vision, interventions and recommendations, and vision rehabilitation therapies.

Thyroid-associated Ophthalmopathy.

Thyroid-associated ophthalmopathy is the most frequent extrathyroidal involvement of Graves' disease but it sometimes occurs in euthyroid or hypothyroid patients. Thyroid-associated ophthalmopathy is an autoimmune disorder, but its pathogenesis is not completely understood. Autoimmunity against putative antigens shared by the thyroid and the orbit plays a role in the pathogenesis of disease. There is an increased volume of extraocular muscles, orbital connective and adipose tissues. Clinical findings of thyroid-associated ophthalmopathy are soft tissue involvement, eyelid retraction, proptosis, compressive optic neuropathy, and restrictive myopathy. To assess the activity of the ophthalmopathy and response to treatment, clinical activity score, which includes manifestations reflecting inflammatory changes, can be used. Supportive approaches can control symptoms and signs in mild cases. In severe active disease, systemic steroid and/or orbital radiotherapy are the main treatments. In inactive disease with proptosis, orbital decompression can be preferred. Miscellaneous treatments such as immunosuppressive drugs, somatostatin analogs, plasmapheresis, intravenous immunoglobulins and anticytokine therapies have been used in patients who are resistant to conventional treatments. Rehabilitative surgeries are often needed after treatment.

Urokinase plasminogen activator receptor levels in Behcet's disease.

PURPOSE: To determine urokinase plasminogen activator receptor (uPAR) concentrations in Behcet patients with and without ocular involvement; and to investigate the associations between uPAR levels and clinical manifestations of Behcet's disease. METHODS: Sixty-four patients with Behcet's disease (31 patients with and 33 patients without ocular involvement) and 23 healthy control subjects were included in this study. A complete ophthalmologic examination was performed. Venous blood was collected from all patients and control subjects. Serum uPAR levels were determined by using human uPAR immunoassay (Quantikine) kits. RESULTS: There was no statistically significant difference in serum uPAR levels between the patients and the control subjects (p>0.05). There were no statistically significant correlations between uPAR levels and age, gender, duration of the disease, clinical manifestations (genital ulcer, arthritis, skin lesions, ocular and vascular involvements) and activity of the disease. CONCLUSION: This finding is important since this is the first study regarding uPAR levels in Behcet's disease.

The effect of topical cyclosporine A on clinical findings and cytological grade of the disease in patients with dry eye.

PURPOSE: To compare the clinical findings and the cytological grade of the disease before and after 6 months of topical cyclosporine A treatment in patients with dry eye. SETTING: : This single-center prospective study was performed at the Department of Ophthalmology, Ankara University School of Medicine, between January 2007 and June 2008. METHOD: Forty-five patients with dry eye (with 5 mm/5 minutes or less Schirmer test) were included in the study. Patients were treated with cyclosporine A 0.005% ophthalmic emulsion (RESTASIS) twice daily in addition to lubricant eyedrops 5 times a day. Schirmer test values, tear breakup time (BUT), and impression cytology (goblet cell density, nucleus to cytoplasmic ratio, and epithelial cell morphology) were evaluated at baseline and after 6 months. RESULTS: Before and after 6 months of the treatment with topical cyclosporine A, the median Schirmer test scores were found as 3.00 and 4.00 mm, respectively. The median BUT score at baseline was 4.00 seconds, and after treatment, the median score was 5.00 seconds. There were statistically significant differences in the median Schirmer and BUT values between, before, and after 6 months of treatment (P < 0.05). The mean cytological grade according to Nelson grading system was 1.84 at baseline and 1.51 after treatment with topical cyclosporine A for 6 months. Statistically significant improvement in cytological grades after treatment was observed (P < 0.05). CONCLUSION: Treatment of patients with dry eye for 6 months with topical cyclosporine A resulted in an increase in Schirmer test results, an increase in BUT scores, and an improvement in cytological grade of the disease.