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1.
Int Ophthalmol ; 44(1): 23, 2024 Feb 07.
Article En | MEDLINE | ID: mdl-38324174

PURPOSE: To evaluate and compare the findings of MP and OCT in patients with inactive Behçet's uveitis (BU). METHODS: Sixty-five eyes of 38 patients were included in this retrospective study. Ophthalmologic examination findings and OCT and MP results were recorded. The relationship between best corrected visual acuity (BCVA), duration of uveitis, central macular thickness (CMT), presence of photoreceptor zone (PZ), and/or retinal pigment epithelium (RPE) damage, macular integrity index, mean threshold and fixation stability was analyzed. RESULTS: There was a positive correlation between BCVA and CMT (p < 0.001). The eyes with PZ and/or RPE damage had significantly lower visual acuity (p < 0.001). There was a negative correlation between BCVA and macular integrity index (p = 0.005). BCVA showed positive correlations with mean threshold and fixation stability [(BCVA vs. mean threshold, p < 0.001), (BCVA vs. P1, p < 0.001), and (BCVA vs. P2, p < 0.001)]. While there was no significant correlation between CMT and macular integrity index (p = 0.08), both mean threshold and fixation stability were significantly positively correlated with CMT [(CMT vs. mean threshold, p = 0.01), (CMT vs. P1, p = 0.008), and (CMT vs. P2, p = 0.005)]. Mean threshold and fixation stability (P1 and P2) were significantly lower in the eyes with PZ and/or RPE damage (p = 0.008, p = 0.02, and p = 0.01, respectively). CONCLUSION: MP showed results consistent with visual acuity and morphological findings by OCT in patients with inactive BU. Although MP is promising for patient follow-up, controlled prospective studies are needed.


Behcet Syndrome , Uveitis , Humans , Tomography, Optical Coherence , Retrospective Studies , Visual Field Tests , Retinal Pigment Epithelium
2.
Graefes Arch Clin Exp Ophthalmol ; 261(11): 3275-3281, 2023 Nov.
Article En | MEDLINE | ID: mdl-37773289

PURPOSE: To investigate the role and agreement of spectral domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) for macular edema (ME) diagnosis in Behçet uveitis (BU). METHODS: Eyes with ME detected by SD-OCT and/or FA were enrolled. Type of ME by SD-OCT and grade of macular leakage (ML) by FA were investigated. Eyes were divided into three groups according to the agreement of tests. Three groups and factors that could affect the compatibility of tests were statistically analyzed. RESULTS: Sixty-one eyes of 61 patients were included. Both imaging methods detected ME in 42.6% of eyes (group 1). In 47.5% of eyes, ME was revealed by OCT (group 2). The remaining 9.8% of the eyes had ME, detected only by FA (group 3). Grade 2 ML by FA was more common in group 1 (p = 0.01). The grade of ML by FA was similar in groups 2 and 3. In group 2, most of the eyes showed diffuse ME by OCT (p < 0.001). Epiretinal membrane was detected more frequently in group 3 (p = 0.005). Duration and activity of uveitis were similar between groups. CONCLUSION: SD-OCT was able to detect ME in 90% of the eyes with BU. Duration and activity of uveitis were not related to the compatibility of imaging methods.

3.
Eur J Ophthalmol ; 33(1): 382-390, 2023 Jan.
Article En | MEDLINE | ID: mdl-35708177

PURPOSE: To evaluate the role of laser flare photometry (LFP) for monitoring the course of intraocular inflammation in children with chronic anterior uveitis. METHODS: Seventy-six eyes of 43 children with non-infectious chronic anterior uveitis were reviewed retrospectively. RESULTS: The median follow-up was 48.6 ± 23.1 months. Patients on immunosuppressive treatment at last follow-up, showed significantly higher flare values than patients who discontinued treatment (20.47 ± 15.49 vs. 6.33 ± 4.87 p < 0.001). The higher LFP values were correlated with the duration of immunosuppressive treatment, total duration of topical corticosteroid use and the risk for development of ocular complications at all follow-ups (all p < 0.001). No significant correlation was found between the AC cell grades and the duration of immunosuppressive treatment, topical corticosteroid use and the prevalence of complications. CONCLUSION: LFP measurements have a predictive value of monitoring the course of uveitis and the occurrence of ocular complications, and it should be considered as a primary modality to monitor intraocular inflammation in children with chronic anterior uveitis.


Uveitis, Anterior , Uveitis , Humans , Child , Retrospective Studies , Uveitis, Anterior/diagnosis , Uveitis, Anterior/drug therapy , Inflammation , Anterior Chamber , Photometry , Lasers , Glucocorticoids/therapeutic use , Chronic Disease
4.
Ocul Immunol Inflamm ; 31(10): 1971-1977, 2023 Dec.
Article En | MEDLINE | ID: mdl-36083691

PURPOSE: To report demographic and clinical profiles of children with uveitis in theTurkishpopulation. METHODS: The data of the pediatric uveitis cases in the nation wide uveitis database were analyzed. RESULTS: The study included 697 eyes of 442 patients with a meanage of 10.8 ± 3.8 years. There were 333 patients (75.3%) with non-infectious uveitis and 69 patients (15.6%) with infectious uveitis. Pars planitis (20.1%) was leading clinical form followed by idiopathic cases with uveitis other than pars planitis (18.8%), juvenile idiopathic arthritis(JIA) related uveitis (12.4%), Behçet uveitis (9.3%) and toxoplasma retinochoroiditis (7.9%). Ocular involvement was unilateral in 187 patients (42.3%) and bilateral in 255 patients (57.7%). The most common anatomiclocation of uveitis was anterior uveitis (39.1%), followed by intermediate uveitis (29.4%), panuveitis (16.1%) and posterior uveitis (15.4%). CONCLUSION: The most common systemic association was JIA in the younger children and Behçet disease in the older children.


Arthritis, Juvenile , Behcet Syndrome , Pars Planitis , Uveitis , Child , Humans , Adolescent , Turkey/epidemiology , Retrospective Studies , Uveitis/diagnosis , Uveitis/epidemiology , Behcet Syndrome/diagnosis , Behcet Syndrome/epidemiology , Registries
5.
Eye (Lond) ; 36(11): 2157-2162, 2022 11.
Article En | MEDLINE | ID: mdl-34725467

OBJECTIVES: To analyse the entity of retinal vasculitis, including frosted branch angiitis (FBA), or retina vascular occlusion in patients with familial Mediterranean fever (FMF). METHODS: Retrospective collaborative case series using invitation by email to uveitis specialists around the Mediterranean basin. This series was combined with a literature review. Exclusion criteria included infectious diseases, Behçet's disease or other autoimmune diseases. RESULTS: A total of 16 patients (21 eyes) had FMF and retinal vasculitis (FBA 11 patients, mild retinal vasculitis 5 patients). The mean age at onset of vasculitis was 29.5 ± 13.4 (range 9-62) with a female to male ratio of 9 to 7. In 19 eyes treated with various forms of corticosteroid and/or immunosuppression, the mean initial spectacle-corrected visual acuity improved from 6/194 to 6/10.5 at the last mean follow-up of 29.0 ± 34.9 months (p < 0.001). The most common FEVR mutations were M680I and M694V. In addition, retinal vascular occlusions included one case of central retinal artery occlusion and one case of branch retinal artery occlusion. CONCLUSION: FBA and milder forms of retinal vasculitis are associated with FMF. Therapy involves an increase in colchicine dosage in early cases, a long period of oral corticosteroid, intravitreal dexamethasone implant or periocular corticosteroid in select cases, and combination therapy with systemic immunosuppression in severe cases. FMF needs to be included in the differential diagnosis of retinal vasculitis.


Familial Mediterranean Fever , Retinal Vasculitis , Female , Humans , Male , Colchicine , Dexamethasone , Familial Mediterranean Fever/complications , Familial Mediterranean Fever/diagnosis , Familial Mediterranean Fever/drug therapy , Fluorescein Angiography , Retinal Vasculitis/diagnosis , Retinal Vasculitis/drug therapy , Retinal Vasculitis/etiology , Retrospective Studies , Adolescent , Young Adult , Adult
6.
Turk J Ophthalmol ; 51(4): 206-211, 2021 08 27.
Article En | MEDLINE | ID: mdl-34461696

Objectives: To analyze and compare sociodemographic features between Behçet uveitis and other non-infectious uveitis. Materials and Methods: The data of adults with non-infectious uveitis in the nationwide uveitis database were analyzed and the sociodemographic features of patients with and without Behçet disease were compared. Results: This study included data of 4,978 eyes of 3,363 patients from 33 centers. The mean age at presentation was 38.7±13.3 (17-87) years. The mean age was 34.3±10.5 years in the Behçet uveitis group and 41.1±14.0 years in the other non-infectious uveitis group (p<0.001). Male predominance was seen in the Behçet uveitis group (67.7% vs. 32.3%) while female patients were more common in the other non-infectious uveitis group (54.4% vs. 45.6%, p<0.001). Regarding education level, the proportion of patients with low education was higher in the Behçet uveitis group than the other non-infectious uveitis group (49.6% vs. 43.4% in males, p=0.004; 61.5% vs. 59.2% in females, p=0.021). Having a low-income job or being currently unemployed, indicators of poor income, were more frequent in the Behçet uveitis group than in the other non-infectious uveitis group (32.0% vs. 22.8%, p<0.001). In the comparison of places of residence, the proportion of patients who lived in cities with low gross national product was 37.0% in the Behçet uveitis group and 31.1% in the other non-infectious uveitis group (p<0.001). Conclusion: Patients with Behçet disease had lower education level and socioeconomic status than patients with other non-infectious uveitis entities.


Behcet Syndrome , Uveitis , Adult , Behcet Syndrome/complications , Behcet Syndrome/diagnosis , Behcet Syndrome/epidemiology , Educational Status , Female , Humans , Male , Uveitis/diagnosis , Uveitis/epidemiology , Uveitis/etiology , Young Adult
7.
Turk J Ophthalmol ; 51(4): 231-242, 2021 08 27.
Article En | MEDLINE | ID: mdl-34461710

Immunomodulatory agents are often used in the systemic treatment of non-infectious uveitis. These drugs consist of corticosteroids, conventional immunosuppressives, and biological agents. As it is known that they suppress the immune system, the most important concern associated with immunomodulatory therapy (IMT) is the increased risk of infection. The World Health Organization declared COVID-19 a pandemic on 11 March 2020. Although severe acute respiratory distress syndrome secondary to SARS-CoV-2 infection may develop in all people, patients who receive IMT may be at higher risk in terms of both the transmission of the infection and more severe disease course. Therefore, guidelines on the management of patients receiving IMT due to uveitis during the pandemic are needed. In this review, we examined the immunomodulatory drugs used in the treatment of uveitis in terms of infectious complications and the data of patients who received IMT during the COVID-19 pandemic and discussed recommendations for the use of these drugs. According to the latest information, patients who receive IMT may continue their treatment as long as there are no disruptions in regular complete blood count (especially white blood cell count >4,000/µL) and liver and kidney function tests. Patients diagnosed with COVID-19 should be managed with a multidisciplinary approach.


COVID-19/epidemiology , Glucocorticoids/therapeutic use , Immunomodulation , Immunosuppressive Agents/therapeutic use , SARS-CoV-2 , Uveitis/drug therapy , COVID-19/transmission , Clinical Decision-Making , Disease Transmission, Infectious/prevention & control , Humans , Kidney Function Tests , Leukocyte Count , Liver Function Tests , Ophthalmology , Risk Assessment
8.
Int Ophthalmol ; 41(5): 1753-1761, 2021 May.
Article En | MEDLINE | ID: mdl-33559832

PURPOSE: To evaluate spectral domain optical coherence tomography (SD-OCT) findings of 42 eyes with pars planitis and to identify risk factors affecting visual acuity. METHODS: Medical records and SD-OCT findings were retrospectively reviewed. RESULTS: Mean best-corrected visual acuity (BCVA) was 0.248 ± 0.3 on the logMAR scale at baseline. SD-OCT findings included epiretinal membrane (ERM) in 16 (38.1%) eyes, loss of normal foveal contour appearance in 8 (19.0%), ellipsoid zone (EZ) damage in 5 (11.9%), external limiting membrane (ELM) damage in 3 (7.1%), disruption of retinal pigment epithelium (RPE) in 2 (4.8%), and macular atrophy in 1 (2.4%). There was macular edema in 10 (23.8%) eyes [cystoid macular edema (CME) in 8 (19.0%), diffuse macular edema (DME) in 6 (14.3%), and serous retinal detachment in 2 (4.8%)]. The mean central macular thickness (CMT) was 272.1 ± 319.5 µm. Patients were followed up for a mean of 50.6 ± 36.7 months. Mean BCVA was 0.210 ± 0.3 at the final evaluation. SD-OCT findings included ERM in 28 (66.7%) eyes, EZ damage in 6 (14.3%), ELM damage in 3 (7.1%), disruption of RPE in 4 (9.5%), loss of normal foveal contour appearance in 12 (28.6%), and macular atrophy in 2 (4.8%). There was CME and/or DME in 6 (14.3%) eyes. The mean CMT was 238 ± 220.9 µm and was significantly lower than the baseline (p < 0.001). According to multivariate linear regression analysis, the presence of DME, and loss of normal foveal contour appearance at baseline were the independent factors associated with BCVA at the final examination (B = 0.726, p < 0.001; B = 0.766, p < 0.001, respectively). CONCLUSIONS: DME and loss of normal foveal contour appearance were more likely to have adverse effects on visual acuity.


Pars Planitis , Tomography, Optical Coherence , Humans , Retrospective Studies , Risk Factors , Visual Acuity
9.
Ocul Immunol Inflamm ; 29(2): 282-289, 2021 Feb 17.
Article En | MEDLINE | ID: mdl-31687865

Purpose: To report the manifestations, patterns of disease, treatment strategies and outcomes in pediatric patients with noninfectious uveitis.Methods: Demographic information of 76 cases was recorded. Symptoms, anatomic location, laterality, visual acuity (VA), intraocular pressure, associated systemic diseases, therapeutic strategies, side effects, complications were reviewed.Results: Thirty-one patients were diagnosed as uveitis on routine surveillance because of underlying systemic disease. The most common anatomic location was intermediate uveitis (34.2%). Juvenile idiopathic arthritis (JIA) was the most common underlying systemic disease (25%). Glaucoma was the most common complication (7.7%). The patients with refractory uveitis received adalimumab (26.5%), infliximab (4.6%) and tocilizumab (3.1%). The mean first-year VA was between 20/32 and 20/20 in 116/140 eyes.Conclusion: Most pediatric noninfectious uveitis cases have bilateral intermediate uveitis. JIA was the most common systemic association. The first-year VA was good in most eyes which may be due to early use of corticosteroid-sparing agents.


Fluorescein Angiography/methods , Tertiary Care Centers , Tomography, Optical Coherence/methods , Uvea/diagnostic imaging , Uveitis/diagnosis , Visual Acuity , Child , Female , Follow-Up Studies , Fundus Oculi , Humans , Incidence , Male , Retrospective Studies , Time Factors , Turkey/epidemiology , Uveitis/epidemiology
10.
Graefes Arch Clin Exp Ophthalmol ; 259(3): 715-721, 2021 Mar.
Article En | MEDLINE | ID: mdl-33037921

PURPOSE: To evaluate macular structural changes during the active and remission periods in patients with Behçet uveitis and to further assess the factors affecting final visual acuity. METHODS: Clinical records and spectral domain-optical coherence tomography (SD-OCT) findings of patients with Behçet uveitis were retrospectively reviewed. RESULTS: Sixty-nine eyes of 35 patients were included in the study. SD-OCT findings in the active uveitis period included epiretinal membrane (ERM) in 26 (37.1%) eyes, ellipsoid zone (EZ) damage in 11 (15.7%), external limiting membrane (ELM) damage in 10 (14.3%), macular atrophy in 6 (8.6%), disruption of retinal pigment epithelium (RPE) in 11 (15.7%), a macular scar in 1 (1.4%), and loss of normal foveal contour appearance in 15 (21.4%). There was macular edema in 23 eyes (32.9%) in the active uveitis period (11 (15.7%) cystoid macular edema, 10 (14.3%) diffuse macular edema, and 7 (10.0%) serous retinal detachment). In the remission period, SD-OCT findings included ERM in 37 (52.9%) eyes, EZ damage in 14 (20%), ELM damage in 14 (20%), macular atrophy in 7 (10%), disruption of RPE in 14 (20.0%), macular scar in 1 (1.4%), and loss of normal foveal contour appearance in 17 (24.3%). The mean central macular thickness in the remission period was significantly lower than in the active uveitis period (p < 0.001). The presence of EZ damage and loss of normal foveal contour appearance in active uveitis period were the independent factors associated with final visual acuity (logMAR) (ß = 0.736, p = 0.003; ß = 0.682, p = 0.002, respectively). CONCLUSION: Ellipsoid zone damage and loss of normal foveal contour appearance are important factors affecting visual acuity in Behçet uveitis.


Macular Edema , Uveitis , Visual Acuity , Humans , Retrospective Studies , Tomography, Optical Coherence
11.
Ophthalmic Surg Lasers Imaging Retina ; 51(1): 31-34, 2019 12 01.
Article En | MEDLINE | ID: mdl-31935300

BACKGROUND AND OBJECTIVE: To evaluate the optical coherence tomography angiography (OCTA) features of patients with Behçet disease (BD) without ocular involvement. PATIENTS AND METHODS: Twenty-three patients with BD without ocular involvement and 29 healthy age/sex-matched control subjects were involved. The authors measured foveal avascular zone (FAZ) area, vessel density in the parafoveal region, and flow area (fovea-centered 3-mm radius area) in the superficial and deep capillary plexuses evaluated by OCTA. RESULTS: FAZ area was significantly larger in eyes with BD in both the superficial and deep capillary plexuses (0.331 vs. 0.240 mm2 [P = .004] and 0.352 vs. 0.257 mm2 [P = .003], respectively). Although mean capillary vessel density in parafoveal region and mean flow area were lower in eyes with BD for both superficial and deep capillary plexuses, these findings were not statistically significant. CONCLUSION: Microvascular changes in macular region can be identified in patients with BD without ocular manifestation. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:31-34.].


Behcet Syndrome/diagnosis , Behcet Syndrome/physiopathology , Retinal Vessels/pathology , Adult , Capillaries/pathology , Female , Fluorescein Angiography , Fovea Centralis/blood supply , Humans , Male , Middle Aged , Tomography, Optical Coherence , Visual Acuity/physiology
12.
Ocul Immunol Inflamm ; 26(1): 17-26, 2018.
Article En | MEDLINE | ID: mdl-27467500

PURPOSE: To describe the demographic and clinical profiles of uveitis patients seen at secondary and tertiary care centers in Turkey. METHODS: A nationwide web-based registry of patients with uveitis was initiated in November 2008. We analyzed data from a single baseline registry-enrollment visit. RESULTS: In 33 centers, 6967 eyes of 4863 consecutive patients were registered. The mean age at presentation was 36.6 ± 15.7 (1-92) years; 51.3% were male. Behçet disease was the leading diagnosis (24.9%), followed by ankylosing spondylitis and/or HLA-B27-associated anterior uveitis (9.7%), toxoplasmosis (7.1%), Fuchs uveitis (6.3%), and presumed herpetic anterior uveitis (6.0%). Visual acuity was 0.1 or worse in 22% of eyes. The most common ocular complications were posterior synechiae (16.2%) and cataract formation (16.2%). CONCLUSIONS: Behçet disease is still the most common non-infectious etiology in Turkish uveitis patients, while ocular toxoplasmosis and herpetic anterior uveitis are the most common infectious uveitic entities.


Uveitis/diagnosis , Uveitis/epidemiology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Child , Child, Preschool , Demography , Epidemiologic Studies , Female , Humans , Infant , Male , Middle Aged , Prospective Studies , Registries , Sex Distribution , Turkey/epidemiology , Uveitis/classification
13.
Graefes Arch Clin Exp Ophthalmol ; 251(7): 1807-12, 2013 Jul.
Article En | MEDLINE | ID: mdl-23553285

OBJECTIVES: The aim of this study was to investigate the possible role of angiogenin, vascular endothelial growth factor, (VEGF) and basic fibroblast growth factor (bFGF) in the pathogenesis of BD. DESIGN AND METHODS: Sixty-five patients with BD and 21 healthy control subjects were included in the study, and serum angiogenin, bFGF, and VEGF concentrations were measured by using in-vitro enzyme immunoassay (ELISA) kits according to the manufacturer's instructions. RESULTS: The median serum angiogenin level was significantly higher in patients with BD (391.8; range:151.6-594.8 pg/ml) than controls (298.8; range:241.9-449.6 pg/ml) (p = 0.001). The levels were similar in both ocular and non-ocular BD patients (p = 0.537). The mean serum bFGF level was higher in patients with BD (38.8 ± 12.3 pg/ml) than controls (33.2 ± 11.3 pg/ml); the median serum VEGF level was also higher in BD patients (239.7; range:53-991.3 pg/ml) than controls (189.4; range:53.6-357.9 pg/ml). But these differences were not statistically significant. Serum bFGF and VEGF levels were also not different statistically in ocular and non-ocular Behçet's patients. There was no statistically significant relationship between serum angiogenin, bFGF, and VEGF levels and the presence of active eye disease or anatomic location of uveitis. While there was a correlation of borderline significance in angiogenin levels between the patients with anterior uveitis and panuveitis (p = 0.053), we did not obtain any correlation between serum angiogenin, bFGF, and VEGF levels and the duration of BD. CONCLUSIONS: This study suggests that angiogenin may be associated with pathophysiology of BD, and highlights the need of further investigation of the role of angiogenin, bFGF, and VEGF serum levels in BD susceptibility and its clinical manifestations.


Behcet Syndrome/blood , Eye Diseases/blood , Fibroblast Growth Factor 2/blood , Ribonuclease, Pancreatic/blood , Vascular Endothelial Growth Factor A/blood , Adult , Aged , Behcet Syndrome/physiopathology , Enzyme-Linked Immunosorbent Assay , Eye Diseases/physiopathology , Female , Humans , Male , Middle Aged , Young Adult
14.
Neuroophthalmology ; 37(6): 257-259, 2013.
Article En | MEDLINE | ID: mdl-28167997

We present a case in which Gilbert syndrome was diagnosed following a neuro-ophthalmic complaint. Adverse effects of drugs as well as various systemic, neurological, and local ocular pathologies can cause accommodative insufficiency and loss of accommodation. A 29-year-old man was admitted to an ophthalmology department with blurred vision and diagnosed as suffering from acute accommodation paralysis. He had a history of being given a pheniramine maleate injection for pruritus 20 days previously. Symptoms began immediately following the injection. After systemic evaluation and laboratory tests, he was diagnosed as having Gilbert syndrome. His complaints and symptoms recovered in approximately a further 10 days. Metabolism of pheniramine maleate can be impaired in Gilbert syndrome and anticholinergic effects can cause accommodation paralysis.

15.
Curr Eye Res ; 37(7): 630-2, 2012 Jul.
Article En | MEDLINE | ID: mdl-22559296

PURPOSE: Vasculitis is one of the major findings of Behçet's disease (BD). Protein Z (PZ) is a glycoprotein that acts as a cofactor of PZ-dependent protease inhibitor and suppresses trombus formation by inhibiting activated factor Xa. Polymorphism of the PZ gene was mentioned as a genetic risk factor for various thrombotic events. The aim of this study is to investigate the intron F G79A polymorphism of the PZ gene in Behçet patients with and without ocular involvement. METHODS: Seventy-six patients and 70 controls were included in the study. Intron F G79A polymorphism of PZ gene was determined by polymerase chain reaction based DNA analysis. The frequency of A allele and the distribution of genotypes were assessed by χ(2) test and the genotype distribution and Hardy-Weinberg equilibrium were tested with the χ(2) test for quality of fit. RESULTS: The frequency of the A allele was significantly higher in overall Behçet patients than in controls (odds ratio [OR] = 6.8; 95% CI, 2.6 to 17.9; p = 0.0001). It was also significantly higher in patients with (OR = 5.3; 95% CI, 1.83 to 15.6; p = 0.0024) or without (OR = 8.2; 95% CI, 2.95 to 22.5; p = 0.0001) ocular involvement compared to controls. However, A allele frequency was not significantly different between patients with eye involvement versus patients without eye involvement (OR = 0.65; 95% CI, 0.3 to 1.4; p = 0.28). CONCLUSIONS: Although thrombosis in BD is multifactorial, intron F G79A polymorphism of PZ gene in BD may be one of the factors that contribute to this pathological process.


Behcet Syndrome/genetics , Blood Proteins/genetics , Polymorphism, Single Nucleotide , Retinal Vasculitis/genetics , Adult , Female , Genotype , Humans , Introns/genetics , Male , Middle Aged , Polymerase Chain Reaction , Turkey , Young Adult
16.
J Ocul Pharmacol Ther ; 28(4): 439-43, 2012 Aug.
Article En | MEDLINE | ID: mdl-22455657

PURPOSE: Corticosteroids, the main treatment option in acute attacks of ocular Behcet's disease (BD), are ineffective in preventing recurrent inflammation. Even combined therapy with systemic corticosteroids and azathioprine, cyclosporine, chlorambucil, or cyclophosphamide may be ineffective in controlling the disease in severe cases. We report our clinical experience with the efficacy and tolerability of interferon alpha-2a (IFN-α-2a) monotherapy in patients with Behcet uveitis refractory to conventional immunosuppressive agents. METHODS: We retrospectively analyzed the medical records of 12 Turkish Behcet patients who had been treated with IFN-α-2a between February 2009 and October 2011 because of severe uveitis refractory to traditional immunosuppressants. IFN-α-2a was initially administered at 4.5×10(6) IU/day subcutaneously; then, the dosage was tapered gradually depending on the clinical response. Previous immunosuppressive drugs such as systemic corticosteroids, azathioprine, and cyclosporine were stopped 1 day before the initiation of IFN-α-2a treatment. RESULTS: The mean duration of IFN-α-2a use was 13.3 months (range: 3-28 months). Eighty-three percent of patients with ocular BD achieved partial or complete response. Best-corrected visual acuity improved or remained stable in all of patients. All patients experienced flu like symptoms responding to oral acetaminophen, hair loss was also developed in 7 of them (58%), and psoriatic skin rash was seen in 3 patients (25%) during treatment with IFN-α-2a. No other side effects were observed. CONCLUSIONS: IFN-α-2a treatment is effective in Behcet uveitis refractory to traditional treatment regimens and provides significant improvement in visual prognosis.


Behcet Syndrome/drug therapy , Immunosuppressive Agents/therapeutic use , Interferon-alpha/therapeutic use , Uveitis, Anterior/drug therapy , Adult , Drug Resistance , Eye/blood supply , Female , Fluorescein Angiography , Humans , Immunosuppressive Agents/adverse effects , Interferon alpha-2 , Interferon-alpha/adverse effects , Light , Male , Middle Aged , Optic Disk/blood supply , Recombinant Proteins/adverse effects , Recombinant Proteins/therapeutic use , Retrospective Studies , Treatment Outcome , Vision, Ocular/physiology , Visual Acuity , Visual Perception/physiology , Young Adult
17.
Int Ophthalmol ; 32(1): 93-6, 2012 Feb.
Article En | MEDLINE | ID: mdl-22310876

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.


Behcet Syndrome/complications , Choroid Diseases/complications , Tuberculoma/complications , Tuberculosis, Ocular/complications , Adult , Antitubercular Agents/therapeutic use , Behcet Syndrome/diagnosis , Choroid Diseases/diagnosis , Choroid Diseases/drug therapy , Diagnosis, Differential , Female , Fluorescein Angiography , Follow-Up Studies , Fundus Oculi , Humans , Tuberculoma/diagnosis , Tuberculoma/drug therapy , Tuberculosis, Ocular/diagnosis , Tuberculosis, Ocular/drug therapy
19.
Thromb Res ; 128(3): 274-6, 2011 Sep.
Article En | MEDLINE | ID: mdl-21470667

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.


Behcet Syndrome/blood , Receptors, Urokinase Plasminogen Activator/blood , Adult , Aged , Behcet Syndrome/pathology , Case-Control Studies , Female , Humans , Immunoassay , Male , Middle Aged , Young Adult
20.
Ocul Immunol Inflamm ; 19(2): 103-7, 2011 Apr.
Article En | MEDLINE | ID: mdl-21428747

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.


Behcet Syndrome/complications , Behcet Syndrome/epidemiology , Panuveitis/etiology , Uveitis, Anterior/etiology , Uveitis, Posterior/etiology , Adolescent , Adult , Behcet Syndrome/diagnosis , Child , Diagnosis, Differential , Female , Fluorescein Angiography , Humans , Incidence , Male , Panuveitis/diagnosis , Retrospective Studies , Sex Distribution , Turkey/epidemiology , Uveitis, Anterior/diagnosis , Uveitis, Posterior/diagnosis , Young Adult
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