Iris metastasis of gastric adenocarcinoma.

BACKGROUND: Iris metastasis in patients with gastric cancer is extremely rare. Herein, it is aimed to report on a patient with gastric adenocarcinoma and iris metastasis. CASE PRESENTATION: A 65-year-old patient with the history of gastric cancer was admitted for eye pain and eye redness on his left eye. There was ciliary injection, severe +4 cells with hypopyon in the anterior chamber and a solitary, friable, yellow-white, fleshy-creamy vascularized 2 mm × 4 mm mass on the upper nasal part of the iris within the left eye. The presented patient's mass lesion in the iris fulfilled the criteria of the metastatic iris lesion's appearance. The ocular metastasis occurred during chemotherapy. CONCLUSIONS: Iris metastasis can masquerade as iridocyclitis with pseudohypopyon or glaucoma. In patients with a history of gastric cancer that present with an iris mass, uveitis, and high intraocular pressure, ocular metastasis of gastric cancer should be a consideration.

A benchmark for Monte Carlo simulations in gamma-ray spectrometry Part II: True coincidence summing correction factors.

The goal of this study is to provide a benchmark for the use of Monte Carlo simulation when applied to coincidence summing corrections. The examples are based on simple geometries: two types of germanium detectors and four kinds of sources, to mimic eight typical measurement conditions. The coincidence corrective factors are computed for four radionuclides. The exercise input files and calculation results with practical recommendations are made available for new users on a dedicated webpage.

Comparison of keratometric data obtained by automated keratometer, Dicon CT 200, Allegro Topolyzer, and Pentacam.

PURPOSE: To compare the keratometric values measured by the automated keratometer, two Placido-based computerized topography systems (Dicon CT 200 [Vismed Inc] and Allegro Topolyzer [WaveLight Inc]), and Scheimpflug analysis (Pentacam [Oculus Optikgeräte GmbH]). METHODS: The keratometric data of 200 eyes from 200 patients evaluated for refractive surgery were reviewed retrospectively. Mean simulated keratometry (Sim K) and mean corneal astigmatism measured by the four devices were compared using repeated measures analysis of variance with Bonferroni correction. The analysis of agreement between two measurements was assessed using the method of Bland and Altman. RESULTS: Mean Sim K as measured by the automated keratometer, Dicon CT 200, Allegro Topolyzer, and Pentacam was 43.39±1.50 diopters (D), 43.55±1.50 D, 43.45±1.50 D, and 43.43±1.45 D, respectively. The Dicon CT 200 measured the mean Sim K to be steeper and the automated keratometer measured the mean Sim K to be flatter than the other devices. Significant differences in corneal astigmatism were noted among the four devices except Dicon CT 200 versus Allegro Topolyzer and Allegro Topolyzer versus Pentacam comparisons (P<.013). For mean Sim K, the 95% limits of agreement between the Pentacam and other three devices were significantly wider than the other comparisons. In Bland-Altman plots comparing the Pentacam to the other devices, extreme outliers were present in 11 (5.5%) eyes. CONCLUSIONS: Because of the wide distribution range and presence of extreme outliers, Pentacam data should be used cautiously in IOL power calculation and astigmatic keratotomy procedures.

Clinical signs in cornea and ocular surface.

A careful examination of cornea and ocular surface eliciting the basic signs will help a clinician toward an accurate diagnosis. Flipping the upper lid or pulling the lower lid to look at the inferior fornix may help to pick up any subtle clinical sign. Meticulous documentation by diffuse and slit view will help in following up the disease. Eyelids and ocular surface are evaluated externally and by slit lamp. Slit-lamp examination with the use of the stains such as fluorescein, rose bengal, or lissamine green provides extensive knowledge about the ocular surface. Tests of tear production are also detailed herein. This review is intended to help the eye practitioners in eliciting common clinical signs seen in cornea and ocular surface diseases.

Topography-guided LASIK with the wavelight laser after penetrating keratoplasty.

PURPOSE: To report a case of topography-guided LASIK in a patient after previous penetrating keratoplasty. METHODS: A 20-year-old man who had previous penetrating keratoplasty in his right eye for keratoconus and was intolerant to spectacles and contact lenses underwent topography-guided LASIK. RESULTS: Three months postoperatively, the patient's uncorrected visual acuity in the right eye was 20/25(+2). Best spectacle-corrected visual acuity was 20/20, with a manifest refraction of +0.25 -0.75 x 40 degree. CONCLUSION: Topography-guided LASIK is a useful therapeutic modality to address corneal irregularity after penetrating keratoplasty.

Hyperbaric oxygen for the treatment of the rare combination of central retinal vein occlusion and cilioretinal artery occlusion.

A 43-year-old male presented with sudden onset of painless, blurred vision in his left eye. Dilated fundoscopic examination showed signs consistent with the diagnosis of a combination of central retinal vein occlusion (CRVO) and cilioretinal artery occlusion (CLRAO). He received daily 2-h sessions of hyperbaric oxygen treatment (HBOT), 253 kPa for 14 days. At the end of the HBOT course, the patient's left visual acuity had improved from 20/200 to 20/20. Dilated fundoscopic examination showed that the intra-retinal haemorrhages in the entire retina and the retinal whitening along the course of the CLRA seen at presentation had completely resolved. The combination of CLRAO and CRVO comprises a discrete clinical entity. Even though there are many hypotheses concerning this condition, it is most likely the result of elevated intraluminal pressure in the retinal capillaries due to CRVO that exceeds the pressure in the CLRA. HBOT may be an effective treatment for CRVO-associated CLRAO.

The role of anterior segment optical coherence tomography in the management of an intra-corneal foreign body.

INTRODUCTION: Corneal foreign bodies are reported to be the second most common type of ocular injury. Anterior segment optical coherence tomography (AS-OCT) is a valuable tool for the early diagnosis and monitoring the progress of treatment in cases of ocular trauma. Herein we aimed to report on a patient with an intra-corneal foreign body and the role of AS-OCT in management. CASE PRESENTATION: A 34-year-old male presented with foreign body sensation in his left eye. Slit-lamp biomicroscopic examination revealed a peripherally located intrastromally embedded foreign body with a free anterior edge extending outwards from the cornea. It was not possible to visualize the foreign body's entire route through the cornea because of localized corneal edema. AS-OCT showed shadowing of the corneal layers corresponding to the location of the corneal foreign body. A hyper-reflective lesion was observed close to the inside edge of the foreign body in the cornea, indicating that the foreign body had not completely penetrated the cornea. The foreign body was removed via the external route, as it had not completely penetrated the cornea. During the postoperative period the patient was asymptomatic, although the left eye's cornea healed with scar tissue. DISCUSSION AND EVALUATION: AS-OCT facilitates non-invasive rapid imaging of ocular tissue at va rious depths, thereby providing accurate assessment of foreign body characteristics.The location of an intracorneal foreign body and the status of the surrounding ocular structure dictate the optimal surgical technique to be employed. CONCLUSIONS: AS-OCT in the present case facilitated localization and determination of the size of a corneal foreign body. In addition, AS-OCT findings assisted in selection of the appropriate surgical intervention.

LASIK with an inferior hinge.

PURPOSE: To investigate the refractive results and corneal pachymetric changes after laser in situ keratomileusis (LASIK) with an inferior hinge. METHODS: Forty-six eyes of 23 patients who underwent LASIK with an inferior hinge were involved in this prospective study. All patients had a complete ophthalmic examination including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, computerized corneal topography (Orbscan II Corneal Topography System; Orbscan Inc, Salt Lake City, Utah), air-puff tonometry, slit-lamp examination of the anterior segment, and fundus examination. RESULTS: Preoperatively, mean sphere was -4.09+/-0.27 diopters (D) (range: -8.00 to -0.25 D), mean cylinder was -0.60+/-0.11 D (range: -3.25 to 0.00 D), and mean spherical equivalent refraction was -4.39+/-0.27 D (range: -8.63 to -1.50 D). At 1 month postoperatively, mean sphere was -0.04+/-0.01 D (range: -0.25 to 0.00 D), mean cylinder was -0.01+/-0.01 D (range: -0.50 to 0.00 D), and mean spherical equivalent refraction was -0.04+/-0.02 D (range: -0.00 to -0.50 D). At 1 month postoperatively, no eyes lost any lines of BSCVA. CONCLUSIONS: Laser in situ keratomileusis with an inferior hinge is an alternative technique, which was safe and effective in our series. Further studies with long-term follow-up comparing the incidence of corneal ectasia in eyes with a superior hinge to that in eyes with an inferior hinge are recommended.

Microbiologic, Pharmacokinetic, and Clinical Effects of Corneal Collagen Cross-Linking on Experimentally Induced Pseudomonas Keratitis in Rabbits.

PURPOSE: To determine the effects of corneal collagen cross-linking (CXL) on the penetration of topical 0.5% moxifloxacin, on the number of colony-forming units (CFUs) in the cornea, and on the clinical course in a rabbit eye model of experimentally induced Pseudomonas aeruginosa keratitis. METHODS: In this prospective animal study, experimental Pseudomonas corneal ulcers were induced in 56 corneas of 28 albino New Zealand rabbits. The corneas were randomly divided into the following 4 groups: the control group (14 eyes), the MOX group (moxifloxacin) (14 eyes), the MOX + CXL group (14 eyes), and the CXL group (14 eyes). On day 4 of the experiment, the eyes in the control group were enucleated and CFU counting was performed. On day 10 of the experiment, all eyes were enucleated and CFU counting was performed. In the MOX and MOX + CXL groups, the moxifloxacin level in the cornea, aqueous humor, iris, plasma, and serum was measured by reverse-phase high-performance liquid chromatography. RESULTS: The difference in the corneal CFU count between the MOX group and the MOX + CXL group was not significant (P = 0.317). Clinical improvement was greatest in the MOX + CXL group (P < 0.001). The mean corneal moxifloxacin level was 0.391 ± 0.09 µg·mg in the MOX group versus 0.291 ± 0.09 µg·mg in the MOX + CXL group; as such, CXL did not have a significant effect on antibiotic penetrance (P = 0.386). CONCLUSIONS: Clinical improvement was greatest in the MOX + CXL group. The synergistic effect of CXL on corneal ulcer treatment is not through antibiotic penetrance.

Clear corneal wound infection after phacoemulsification.

OBJECTIVE: To evaluate clear corneal wound infections after phacoemulsification. MATERIALS AND METHODS: The medical records of 7 patients with clear corneal wound infections after phacoemulsification were reviewed retrospectively. Data that were reviewed included patient age, sex, onset of symptoms and signs after surgery, possible risk factors for infection, concomitant ocular disease, use of perioperative prophylactic antibiotics and steroids, culture and antibiotic sensitivity results, treatment regimen, and outcome. RESULTS: The median onset of signs and symptoms after surgery was 10 days (range, 4-60 days). Corneal cultures yielded methicillin-resistant Staphylococcus aureus in 2 cases, Streptococcus pneumoniae in 1 case, and Staphylococcus epidermidis in 1 case. Cultures yielded no microorganisms for 1 patient. Corneal cultures were not obtained in 2 patients. In 3 of the 4 culture-positive cases, the isolated microorganisms were resistant to the perioperative prophylactic antibiotics (fluoroquinolones and tobramycin) that were used. No possible risk factors were noted except use of topical steroids 4 times a day without antibiotic coverage for iritis before referral in one of our patients. Six of these 7 wound infections healed with topical antibiotic therapy. One of the patients required lamellar keratectomy and conjunctival flap for complete healing. In 4 of the 7 cases, best-corrected visual acuity at the last follow-up visit was better than 20/40. CONCLUSIONS: Clear corneal wound infection after phacoemulsification is a serious complication of cataract surgery. Infections are caused by gram-positive organisms sensitive to bacitracin and the combination of trimethoprim-sulfamethoxazole but often resistant to aminoglycosides and/or fluoroquinolones.

Wavefront-guided laser in situ keratomileusis with the Bausch & Lomb Zyoptix system.

PURPOSE: To evaluate the clinical results of wavefront-guided laser in situ keratomileusis (LASIK) with the Zyoptix system. METHODS: Twelve patients (24 eyes) underwent wavefront-guided LASIK with the Bausch & Lomb Zyoptix system. Uncorrected and best spectacle-corrected visual acuity and manifest refraction were measured at postoperative day 1, week 1, and months 1 and 3. A subjective vision quality questionnaire evaluated light sensitivity, dryness, tearing, glare, halos, ghost images, and difficulties in night driving, preoperatively and 3 months postoperatively. RESULTS: Preoperatively, mean sphere was -3.70 +/- 2.33 D (range -0.50 to -8.00 D), mean cylinder was -0.90 +/- 0.98 D (range 0 to -3.00 D), and mean spherical equivalent refraction was -4.15 +/- 2.16 D (range -1.38 to -8.25 D). Three-month postoperative spherical equivalent refraction was within +/- 0.50 D of emmetropia in 17 eyes (70.8%) and within +/- 1.00 D in 22 eyes (91.7%). At 3 months postoperatively, no eyes lost any lines of BSCVA and eight eyes (33.3%) gained 2 lines. The ratio of postoperative BSCVA to preoperative BSCVA (safety) was 1.05 +/- 0.09 (range 1.00 to 1.20) at 1 month and 1.07 +/- 0.10 (range 1.00 to 1.29) at 3 months. The ratio of postoperative UCVA to preoperative BSCVA (efficacy) was 0.96 +/- 0.12 (range 0.80 to 1.20) at 1 month and 0.95 +/- 0.12 (range 0.8 to 1.2) at 3 months. The subjective vision quality questionnaire revealed less tearing, fewer halos, and less difficulty in night driving after wavefront-guided LASIK. Comparison of higher order optical aberrations before and after surgery was not done. CONCLUSIONS: Wavefront-guided LASIK with the Bausch & Lomb Zyoptix system was safe and effective in correcting low to moderate myopic refractive error.

Orbscan corneal topography system in evaluating the anterior structures of the human eye.

PURPOSE: To investigate the relationship among horizontal corneal diameter, corneal thickness, anterior chamber depth, pupil size, and spherical equivalent and to evaluate the variation in these parameters attributable to age, sex, iris color, and refractive state of the eye. METHODS: One thousand three hundred forty-one eyes of 688 consecutive patients who had a LASIK evaluation at World Eye Hospital were involved in the study. The information that was reviewed included age and sex of the patient, horizontal corneal diameter, corneal thickness, anterior chamber depth, iris color, pupil size (scotopic and photopic), and spherical equivalent. RESULTS: The mean corneal thickness was 537.6 +/- 37.5 microm (range, 334-702). The mean anterior chamber depth was 3.5 +/- 0.38 mm (range, 1.99-4.75). The iris color was dark in 829 (61.8%) eyes and light in 512 (38.2%). The mean scotopic pupil size was 6.1 +/- 0.9 mm (range, 3.5-9.0) and the mean photopic pupil size was 4.0 +/- 0.7 mm (range, 2.1-7.4). The mean spherical equivalent was -3.4 +/- 3.7 D (range, -16.00-+7.50 D). Age was correlated with corneal thickness (r = 0.069, p = 0.012), spherical equivalent (r = 0.080, p = 0.003), and inversely correlated with corneal diameter (r = -0.367, p< 0.001), anterior chamber depth (r = -0.335, p< 0.001), scotopic pupil size (r = -0.309, p< 0.001), and photopic pupil size (r = -0.367, p< 0.001). Males had larger corneas (p< 0.001) and deeper anterior chambers (p< 0.001) than females. The eyes with a dark iris color had thicker corneas (p< 0.001), deeper anterior chambers (p< 0.001), and more minus spherical equivalents (p = 0.017) than the eyes with a light iris color. CONCLUSIONS: There is a substantial range of dimensions of anterior structures of the human eye. These dimensions are related to each other and are influenced by age, sex, iris color, and refractive state of the eye.

Corneal laceration and intraocular foreign body in a post-LASIK eye.

PURPOSE: To describe a case of full-thickness corneal laceration and intraocular foreign body in an eye that underwent laser-assisted in situ keratomileusis (LASIK). METHODS: A 43-year-old man underwent uneventful bilateral LASIK. Seventeen months after LASIK, the patient suffered penetrating trauma to the right eye while hammering metal without safety glasses. Examination on the night of the injury showed an uncorrected visual acuity of 20/30 in the right eye. Slit-lamp biomicroscopy showed a 2.4-mm full-thickness peripheral corneal laceration at the 11-o'clock position extending over the edge of the previous LASIK flap and a foreign body partially embedded in the superior iris. He was started on prophylactic topical and intravenous antibiotics. Under general anesthesia, the corneal laceration was repaired, and the intraocular foreign body was removed without any complications. RESULTS: At the follow-up visit 9 months after the surgery, the uncorrected visual acuity was 20/25 in the right eye. On slit-lamp examination, the corneal sutures and the well-positioned LASIK flap were in place. CONCLUSION: Penetrating trauma of the cornea did not lead to flap-related complications in this post-LASIK eye. Repair of the corneal laceration and removal of the intraocular foreign body after LASIK were managed without complications. Care must be taken to try not to manipulate or lift the LASIK flap during corneal laceration repair.

Chalazion as a cause of decreased vision after LASIK.

PURPOSE: To describe a post-LASIK patient with decreased vision and a chalazion of the upper eyelid. METHODS: A 46-year-old man was referred with decreased vision of 1 month's duration. He underwent bilateral uncomplicated LASIK for myopic astigmatism 1.5 years and bilateral enhancements 1 year previously. He had 20/20 uncorrected vision in both eyes after those procedures. He developed a chalazion of his right central upper eyelid 1 month prior with simultaneous blurring of vision. On our examination, his uncorrected visual acuity was 20/60 in the right eye. Complete eye examination including refraction, computerized corneal topography, and pachymetry were done. RESULTS: With a manifest refraction of +1.25 +0.50x80, the visual acuity in the right eye improved to 20/20. Computerized corneal topography revealed circular central corneal flattening in both eyes, much greater in the right eye than the left eye. The location of the chalazion with the right eye closed corresponded to the area of central corneal flattening. The central power from the corneal topography was 39.4 D OD and 40.8 D OS. He was diagnosed as having acquired hyperopia associated with chalazion-induced central corneal flattening of the right eye. Chalazion-induced hyperopic change on topography disappeared, and his uncorrected vision improved to 20/20 in the left eye as the chalazion resolved completely. CONCLUSION: In post-LASIK patients with decreased vision and topography changes late after surgery, periocular masses should be considered in the differential diagnosis. Decreased corneal thickness and rigidity after LASIK might be a predisposing factor to external compression-induced curvature changes.

The clinical efficacy of silicone punctal plug therapy.

PURPOSE: To evaluate the clinical efficacy and safety of silicone punctal plugs in various ocular surface disorders. PATIENTS AND METHODS: Medical records of patients who underwent silicone punctal plug insertion from January 1996 to November 2000 were retrospectively reviewed. The clinical data collected included sex and age of the patients, indications for plug insertion, symptoms, corneal fluorescein staining and frequency of lubricant use at baseline and at 4 +/- 2 weeks after the insertion, location (upper versus lower punctum), initial versus replacement plug, spontaneous extrusion or removal of the plug, and percentage of complications and punctum cauterization. RESULTS: There were 203 eyes of 153 patients (126 women and 27 men) in the study group. The total number of silicone punctal plug procedures was 312. Dry eye syndrome was the most common indication for punctal plug treatment (127 eyes, 62.5%), followed by epitheliopathy after penetrating keratoplasty (32 eyes, 15.8%). The symptoms improved in 150 (73.9%) of 203 eyes at 4 +/- 2 weeks' follow-up. The mean score of the fluorescein staining of the cornea was reduced from 2.7 +/- 0.1 to 1.3 +/- 0.1 with silicone punctal plug treatment at 4 +/- 2 weeks' follow-up. This reduction was statistically significant (p< 0.01). The overall success rate at 4 +/- 2 weeks follow up was 76.8%. The frequency of the lubricant use was significantly decreased with punctal plug treatment (p< 0.001). Considering all plugs, the estimated probability of plug retention was 49.4% with 85.1 +/- 7.3 weeks as the mean survival time. There was no statistical difference in plug retention rates between lower (49.6%) and upper (48.7%) plugs (p= 0.15). Retention rate of first plugs (53.5%) was significantly higher than that of second plugs (32.0%) (p= 0.05). The spontaneous total extrusion of silicone punctal plug was the most common complication in our study (158 plugs, 50.7%). The plug was removed in 14 eyes (14 plugs, 6.9%) because of epiphora in 11 eyes and conjunctival erosion in three eyes. The percentage of punctum cauterization performed in our population was 10.8%. CONCLUSIONS: Punctal plug insertion is a simple, effective, safe, and reversible method to treat aqueous tear deficiency and other ocular surface diseases, such as epitheliopathy after penetrating keratoplasty, superior limbic keratoconjunctivitis, neurotrophic keratitis, recurrent corneal erosions, and toxic epitheliopathy not controlled by lubrication with preservative-free tears. However, spontaneous extrusion of silicone plug occurs commonly. Careful choosing of the optimal plug size and close follow-up are recommended to ensure the success of the treatment.

Tarsorrhaphy: clinical experience from a cornea practice.

PURPOSE: To evaluate indications, success rate, and complications of tarsorrhaphy in a cohort of cornea and external disease patients. METHODS: In this study, charts of patients who underwent tarsorrhaphies from January 1, 1995, to September 30, 2000, were retrospectively evaluated. Information reviewed included patient age and sex, indication for tarsorrhaphy, duration of signs and symptoms before tarsorrhaphy, time to epithelial healing after tarsorrhaphy, type of tarsorrhaphy (temporary/permanent), complications, timing of tarsorrhaphy removal, recurrence of signs and symptoms after complete or partial opening of the tarsorrhaphy, number of tarsorrhaphies needed to be replaced or extended, and duration of follow up. RESULTS: Seventy-seven patients were included in this study. Indications for a tarsorrhaphy were persistent epithelial defects or other ocular surface problems associated with neurotrophic ulcers, penetrating keratoplasty (PK), postinfection, exposure keratopathy, surgery other than PK, dry eye syndrome, radiation keratopathy, ocular cicatricial pemphigoid, Stevens-Johnson syndrome, entropion, and application of tissue adhesive. The epithelial defects in 70 (90.9%) of the 77 eyes completely resolved. Overall, the mean duration of signs and symptoms before tarsorrhaphy was 89.8 +/- 27.8 days, and time-to-healing after tarsorrhaphy was 18.0 +/- 2.0 days. The difference between the duration of the signs and symptoms before tarsorrhaphy and time-to-healing after tarsorrhaphy was statistically significant ( p = 0.01). Of the 77 tarsorrhaphies, 24 (31.2%) were temporary and 53 (68.8%) were permanent. Complications after tarsorrhaphy included trichiasis, adhesion between upper and lower lids after tarsorrhaphy lysis, premature opening of the temporary tarsorrhaphy, pyogenic granuloma, and keloid formation of the eyelid. CONCLUSION: Tarsorrhaphy is a very effective and safe procedure in the management of nonhealing epithelial defects and other surface problems, with a 90.9% success rate and only minor complications.

Indications for penetrating keratoplasty and associated procedures, 1996-2000.

PURPOSE: To identify current indications and trends in indications for penetrating keratoplasty and associated procedures. METHODS: Retrospective chart review of all patients who underwent penetrating keratoplasty at Wills Eye Hospital from January 1, 1996 to December 31, 2000. RESULTS: A total of 1,529 corneal transplants were performed during this 5-year period. The leading indications for penetrating keratoplasty were pseudophakic bullous keratopathy (PBK) in 416 (27.2%) cases, followed by regraft in 276 (18.1%), keratoconus in 236 (15.4%), and Fuchs endothelial dystrophy in 233 (15.2%) cases. Of the 416 PBK cases, 271 (65.1%) were associated with posterior chamber intraocular lenses (PC IOLs), 141 (33.9%) with anterior chamber intraocular lenses (AC IOLs), and four (1%) with iris-fixated lenses. Of these 141 AC IOLs, 107 (75.9%) were closed-loop and 34 (24.1%) were open-loop. Of the 416 PBK cases, in 281 (67.5%) cases, the IOL was not exchanged; in 127 (30.5%) cases, the IOL was exchanged; in six (1.5%) cases, the IOL was repositioned; and in two (0.5%) cases, the IOL was removed at the time of surgery. Of the 271 PC IOLs, 248 (91.5%) were not exchanged and 19 (7.1%) were exchanged. Of the 141 AC IOLs, 33 (23.4%) were not exchanged and 104 (73.7%) were exchanged (p = 0.001). CONCLUSIONS: Pseudophakic bullous keratopathy remains the leading indication for corneal transplantation at our institution followed by regraft. The percentage of PBK cases associated with PC IOLs has increased significantly, whereas the percentage associated with AC IOLs has decreased. The frequency of regraft has also increased significantly.

Lipoprotein (a) in Behçet's disease as an indicator of disease activity and in thrombotic complications.

PURPOSE: To evaluate the utility of plasma concentrations of lipoprotein (a) (Lp(a)) as an indicator of disease activity in Behçet's disease and to investigate its role in thrombotic complications of this disease. METHODS: 30 patients (19 male, 11 female) with Behçet's disease (8 active, 22 inactive) were enrolled in the study group and 30 healthy individuals (16 male, 14 female) in the control group. Seven of the inactive Behçet's disease patients had a history of thrombotic complications. The disease activity was evaluated by clinical manifestations (oral aphthous lesions, genital ulcerations, uveitis and vasculitis) and laboratory investigations (leucocyte count, lipoprotein (a), C-reactive protein (CRP), complement 3 (C3) and complement 4 (C4) concentrations). RESULTS: Plasma Lp(a) and other acute phase reactant concentrations were significantly higher in the study group than in the controls (p < 0.01). These concentrations were also higher during the active period of the disease than during the inactive phase (p < 0.01). Lp(a) concentrations were significantly correlated with concentrations of other acute phase reactants. There was no difference between the groups with and without thrombotic complications for any of these measurements. CONCLUSIONS. Plasma levels of Lp(a) might be an indicator of disease activity in Behçet's disease. There is no correlation between Lp(a) levels and thrombotic sequela in inactive Behçet's disease. However, further studies are needed on the thrombogenic role of Lp(a) during the active phase of thrombophlebitis, and in larger series.