A.Hakan Durukan

Safety and Effectiveness of Interferon Alpha-2a in Treatment of Patients with Behçet's Uveitis Refractory to Conventional Treatments

PURPOSE To evaluate the intermediate-term safety and effectiveness of interferon alpha-2a (IFNalpha2a) in patients with Behçets uveitis (BU) refractory to corticosteroids and immunosuppressive agents. DESIGN Open, nonrandomized, uncontrolled, interventional, prospective study. PARTICIPANTS Fifty-three patients (106 eyes) with active, vision-threatening BU who failed to respond to conventional treatments. INTERVENTION In 53 patients, acute inflammation was suppressed with effective prednisolone dosage (1-2 mg/kg/day, tapered to 10 mg within 4-6 weeks). The patients were treated with IFNalpha2a 4.5 million international units (MIU) 3 times per week for the first 3 months followed by IFNalpha2a 3 MIU 3 times per week for the next 3 months. Observation or other treatment methods were performed according to the decision tree developed for this study. MAIN OUTCOME MEASURES Remission and complete response (primary outcome measures), frequency of uveitis attacks, visual acuity (VA), and adverse effects (secondary outcome measures). RESULTS During 2 years of follow-up (median 65 months, range 12-130 months), compliance with the therapy was excellent. At the end of 1-year follow-up, treatment response was obtained in 45 of 53 patients (84.9%). The mean attack rate of 3.6+/-1.1 per year (range, 2-8) decreased to 0.56+/-0.75 (range, 0-4) per year (P=0.001). Visual acuity improved (> or = 0.2 logarithm of the minimum angle of resolution units from initial VA) in 30 eyes (28.3%) and worsened in 12 eyes (11.3%). Five patients (9.4%) did not respond to the initial treatment, and 3 patients (5.6%) developed severe adverse effects, including psoriasis, epileptic seizure, and extreme tiredness. Fifteen patients (28.3%) were off treatment for all the medications and disease free for 28+/-13.1 months (range, 12-50 months). CONCLUSIONS These results suggest that IFNalpha2a may be a valuable treatment option in BU that is refractory to corticosteroids and conventional immunosuppressive agents. The possible role of IFNalpha2a as a first-line agent in BU should be validated in randomized controlled clinical trials against newly described biologic agents. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Assessment of optic nerve head topographic parameters with a confocal scanning laser ophthalmoscope

Aim: To assess the disc area, age, sex, laterality (side of the eyes) and refractive error dependent differences in optic nerve head topographic parameters in a normal population.

Combined retinal artery and vein occlusion in a patient with systemic lupus erythematosus and antiphospholipid syndrome.

Systemic lupus erythematosus (SLE) is an autoimmune disease that primarily affects women, particularly those of childbearing age. Consequently, pregnancy and its outcome are of particular importance in this condition. Despite recent advances in the treatment of obstetric complications in women with SLE, the disease remains associated with significant fetal and maternal morbidity. 1 Retinopathy is one of the most important manifestations of SLE, with a reported incidence of 7% 2 to 26%. 3 Histologic evidence of immune-mediated vasculitis has also been reported in lupus retinopathy. 4

The Effect of the Menstrual Cycle on the Optic Nerve Head Analysis of Migrainous Women

Purpose: To determine the effect of the menstrual cycle on the optic nerve head topographic analysis of normally menstruating migrainous women.Material and Methods: Randomly selected one eye of 44 migrainous and 49 healthy control women with regular menstrual cycles were included in the study. All subjects underwent complete ocular examination. Optic nerve head topographic analysis were performed using a confocal scanning laser ophthalmoscope, HRT II (Heidelberg Retinal Tomograph II, software version 1.6; Heidelberg Engineering, Heidelberg, Germany). They were repeated for two times during the menstrual cycle: in follicular phase (7th to 10th day of the cycle) and in the luteal phase (days 3 to 4 before the menstrual bleeding). Serum estradiol, progesterone, and luteinizing hormone measurements were repeated at each menstrual phase. Results: The mean age of migrainous and control subjects were 31.5 ± 5.1 years and 33.4 ± 3.7 years, respectively (P > 0.05). Their mean disc areas were 2.26 ± 0.46 mm2 and 1.95 ± 0.39 mm2, respectively (P < 0.05). Control subjects did not demonstrate any difference in the disc topography (P > 0.05). The parameter rim volume decreased, while the parameters cup volume and cup shape measure increased significantly in the luteal phase of the migrainous women (all P values < 0.05). Mean intraocular pressure of the migrainous women decreased significantly in luteal phase (P < 0.05). Conclusion: Significant differences exist in the optic rim and cup parameters during the menstrual cycle of the migrainous women. Further clinical trials on ocular blood flow changes during the menstrual cycle of the migrainous women may highlight the role of sex steroids in the optic nerve head of the migrainous women.

Intravitreal bevacizumab treatment of macular edema due to optic disc vasculitis.

Purpose: To report the efficacy of intravitreal bevacizumab injection in treatment of macular edema in a case of optic disc vasculitis. Design: Retrospective case review. Methods: A patient diagnosed with macular edema due to optic disc vasculitis was treated with intravitreal bevacizumab injection. Results: One week after injection, fundus appearance dramatically improved and macular edema regressed. The patient was followed up for 1 year after injection and there was no recurrence of macular edema. Conclusions: This case suggests that intravitreal bevacizumab treatment might be effective in the management of macular edema in patients with optic disc vasculitis.

Lamellar Macular Hole Formation in a Patient With Diabetic CME Treated by Intravitreal Bevacizumab Injections

A 49-year-old woman with a diagnosis of diabetic cystoid macular edema in both eyes presented with the appearance of a macular hole in the left eye 1 month after intravitreal bevacizumab injection. Optical coherence tomography demonstrated a lamellar macular hole in the left eye. Although vitreomacular traction and epiretinal membrane are the possible underlying causes for the development of lamellar macular hole formation in eyes with cystoid macular edema, in this case previous optical coherence tomography scans revealed the complete separation of the posterior hyaloid membrane and the absence of an epiretinal membrane. The exact mechanism involved in the progression of cystoid macular edema to lamellar macular hole and the contribution of the intravitreal bevacizumab injections to this transformation remain unclear.