Nur Kir

Use of laser flare-cell photometry to quantify intraocular inflammation in patients with Behçet Uveitis

PurposeTo assess the usefulness of laser flare-cell photometry to quantify intraocular inflammation in patients with Behçet disease.MethodsThe study comprised 47 healthy individuals, 78 Behçet patients without ocular involvement, 54 Behçet patients with a uveitis attack and 53 Behçet patients with uveitis in clinical remission. A single observer assigned clinical scores to anterior chamber cells, vitreous haze, and fundus lesions in the attack group. Laser flare-cell photometry measurements were performed by another observer who was masked to the clinical findings. Fundus fluorescein angiography was performed only in the remission group, and fluorescein leakage was scored by a masked retina specialist. The risk of recurrent uveitis attack was analyzed in eyes with high versus low flare values in the remission group. Main outcome measures were anterior chamber flare in Behçet patients compared to the control group, and correlations of flare with clinical scores of intraocular inflammation and with fluorescein leakage. Mann-Whitney U-test, Spearman’s bivariate correlation test, linear regression method, and Kaplan-Meier method were used for statistical analyses.ResultsMean flare was not increased in Behçet patients without ocular involvement. It was significantly higher in patients with Behçet uveitis both during attacks and in remission (P < 0.001 for each). A significant correlation was found between anterior chamber flare and anterior chamber cell score (rho = 0.705), vitreous haze score (rho = 0.588), and fundus score (rho = 0.464) in the attack group. In the remission group, there was a significant correlation between flare and fluorescein angiography leakage score, and the risk of recurrent uveitis attack was significantly higher in eyes with flare values >6 photons/msec than in eyes with flare values ≤6 photons/msec (right eyes, P < 0.001; left eyes, P = 0.0184).ConclusionsLaser flare-cell photometry is a useful objective method in the quantitative assessment of intraocular inflammation in patients with Behçet uveitis. The use of this quantitative technique in clinical trials of Behçet uveitis may provide comparable data, as it gives an objective measure of intraocular inflammation. In clinical practice, it may reduce the need for fluorescein angiography because it seems to be especially useful in monitoring persistent retinal vascular leakage in patients who are clinically in remission.

Retrospective analysis of children with uveitis treated with infliximab

Tumor necrosis factor-alpha (TNF-alpha) antagonists have been successfully used in refractory cases of pediatric uveitis.(1-7) We report our experience with the monoclonal anti-TNF-alpha antibody infliximab in the treatment of uveitis in 20 children. Twenty children with noninfectious uveitis were treated with infliximab as an initial line of immunomodulatory therapy (4 children) or for uncontrolled intraocular inflammation despite aggressive immunosuppressive therapy (16 children). Intraocular inflammation was controlled in the short term in all children; resistance developed in 4 children after long-term therapy.

Neovascularization of the Optic Disc in Behçet's Disease

PurposeTo investigate the mechanisms involved in the development of neovascularization of the optic disc (NVD) in Behçets disease and to evaluate the effects of medical and laser treatments.MethodsThis is a retrospective study of 26 consecutive Behçets patients (38 eyes) with NVD who presented between 1990 and 2004 at our university hospital. Information on age at presentation, sex, disease duration, laterality of NVD, ocular findings, fluorescein angiographic findings, visual acuity, medical treatment, laser photocoagulation, surgical procedures, and the follow-up period was collected. Eyes with diffuse capillary leakage on fluorescein angiography were defined as having inflammation-induced NVD, and eyes with extensive retinal capillary nonperfusion were defined as having ischemia-induced NVD.ResultsEighteen patients were male, and eight were female. Mean age at presentation was 25.4 ± 4.9 years. Median disease duration was 5.5 months. Median follow-up was 24 months. Twelve patients had bilateral NVD; 14 had unilateral NVD. Inflammation-induced NVD was seen in 87% of the eyes, and ischemia-induced NVD in 13%. Initial treatment with high-dose corticosteroids combined with conventional immunosuppressive agents was effective in 45% of the eyes with inflammation-induced NVD. Retinal laser photocoagulation was effective in three of five eyes with ischemia-induced NVD. Treatment with interferon α-2a resulted in resolution of NVD in all seven patients who received this agent for inflammation- or ischemia-induced persistent NVD. Final visual acuity was less than 0.1 in 24% of the eyes.ConclusionsInflammatory mechanisms seem to predominate in the pathogenesis of NVD in Behçets disease. The results of this study suggest that the response to intensive anti-inflammatory and conventional immunosuppressive treatment is not satisfactory; retinal laser photocoagulation may be ineffective even in eyes with retinal ischemia, but interferon α-2a seems to be effective for the treatment of Behçets patients with NVD. Jpn J Ophthalmol 2006;50:256–265

Silicone Oil for Recurrent Vitreous Hemorrhage in Previously Vitrectomized Diabetic Eyes

AIMS To investigate the clinical course of vitrectomized patients with recurrent diabetic vitreous hemorrhage who were treated by revitrectomy with silicone oil (SO) as a hemostyptic tamponade. PATIENTS AND METHODS Fifteen patients with recurrent vitreous hemorrhage due to proliferative diabetic vitreoretinopathy were included in this retrospective study. All eyes had had at least one vitrectomy prior to use of SO and the retina was completely attached at any time before revitrectomy with SO instillation. Thirteen patients had a blind fellow eye. There were 6 males and 9 females (mean age 62.7 years, range 45-76 years). The mean duration of SO tamponade was 25.8 months (range 9-35 months). The average follow-up period was 30.4 months (range 20-48 months). RESULTS Ten out of 15 eyes (66.6%) improved postoperatively, 9 eyes had a visual acuity of > or = 0.02 at the latest follow-up visit. Secondary glaucoma occurred in 4 eyes, leading to phthisis in 1 eye. All 5 phakic eyes developed a cataract. CONCLUSION A revitrectomy combined with a long-term hemostyptic SO tamponade offers a chance for restoration of useful visual acuity in diabetic eyes with persistent vitreous-hemorrhage that fails to subside after cryocoagulation and vitrectomy without tamponade. Because of possible visual loss from secondary glaucoma related to intraocular SO this treatment should mainly be considered in patients with a blind fellow eye.

Ocular involvement in primary antiphospholipid syndrome. Ocular involvement in primary APS.

AbstractThe purpose of this study is to evaluate the ocular findings in patients with the primary antiphospholipid syndrome (APS). Patients and methods: Twenty-two patients (44 eyes) with primary APS (17 women, 5 men) were examined. All patients were younger than 50 years (median age; 37.5 years). In 18 patients, fundus flourescein angiography was performed in addition to the ophthalmologic examination. Results: Sixteen patients (72.7%) described visual symptoms. Anterior segment was normal in 19 patients (86.4%). Posterior segment abnormalities were observed in 15 patients (68.2%). Venous dilatation and tortuosity were the most common ocular findings. Retinal vascular occlusive disease was detected in 5 patients (22.7%). Flourescein angiography abnormalities were noted in 14 of the 18 patients (77.8%). The most common angiographic finding was pigment epithelial window defects. Conclusions: Our results indicate that posterior eye segment involvement is relatively common in the primary APS. It also seems that the screening for APS is important in young patients with retinal vascular occlusion, especially in those without conventional risk factors.

Epidemiological analysis of retinopathy of prematurity in a referral centre in Turkey

Purpose To collect data towards the establishment of a guideline to predict the population under risk for the development of retinopathy of prematurity (ROP) in Turkey. Methods Medical reports of 2950 preterm infants who underwent screening examinations for ROP between 1996 and 2010 at Istanbul Faculty of Medicine, Department of Ophthalmology were reviewed. The study population was classified as inpatient infants and referred infants. A risk factor analysis was performed limited to the 788 inpatient infants. The demographical variables regarding birth weight (BW), gestational age (GA) and postnatal age at the time of treatment were compared independently between 403 referred and 64 inpatient infants who were treated for severe ROP. Results The mean GA of the infants with severe ROP was 31.2±2.7 weeks, mean BW was 1543.4±508.3 g. The risk factor analysis of inpatient infants revealed BW<1500 g, GA<32 weeks; intraventricular haemorrhage, respiratory distress syndrome, sepsis, apnoea and phototherapy were associated with a higher incidence of ROP. In addition, sepsis, male gender, multiple gestations, BW<1500 g were associated with a higher incidence of progression to severe ROP, whereas maternal pre-eclampsia was associated with a lower incidence. On the other hand, comparison of demographic features revealed that the referred infants with ROP were born at a significantly higher BW and needed significantly earlier treatment than inpatient infants with ROP. Conclusions The high BW and GA of infants with severe ROP indicate wider screening criteria should be used in our country. BW might be a more important criterion than GA for ROP screening.

Alteration of visual function in impaired glucose tolerance.

People with impaired glucose tolerance are considered to be prone to diabetes. To evaluate their visual function we investigated colour vision with the Farnsworth-Munsell 100 Hue test and contrast sensitivity with Ardens grating cards in people with impaired glucose tolerance (IGT), people with normal glucose tolerance (NGT) and others with type II diabetes (NIDDM). Eyes with low vision or any anterior or posterior segment abnormalities were excluded. Contrast sensitivity and color vision differed significantly between the groups (p<0.01). It thus appears that patients with IGT but without clinical diabetes could be followed up to see whether these alterations have any predictive value for the development of diabetes and diabetic retinopathy.

Preliminary Anatomical and Neurodevelopmental Outcomes of Intravitreal Bevacizumab As Adjunctive Treatment for Retinopathy of Prematurity

Abstract Purpose: To evaluate the two-year follow-up of patients with type 1 retinopathy of prematurity (ROP) who received intravitreal bevacizumab (IVB) as adjunctive treatment. Materials and methods: We conducted a longitudinal follow-up study of premature infants who received 0.625 mg IVB therapy in addition to standard laser photocoagulation therapy. For comparison of the ophthalmological and neurological assessment outcomes of these infants, a control group was formed with 13 birth weight- and gestational age-matched infants who were treated with laser therapy alone for type 1 ROP. The neurological status of the study group and the control group was examined systematically, and neurodevelopmental evaluation was assessed by the Bayley Scales of Infant Development (BSID-III). Results: A total of 18 eyes of 13 infants were included in the study. Anatomical success was obtained in 14 eyes (78%) and retinal detachment was observed in 4 eyes (22%). At two years of age, no significant difference was found in terms of spherical or cylindrical refractive errors compared to the control group. In control group, 2/13 patients’ and in study group, 3/13 patients’ neurological examinations were abnormal. No significant difference was found in the mean cognitive, language or motor BSID-III test scores of the groups. Conclusions: IVB appears to be useful for advanced ROP when laser treatment is precluded or not sufficient for preventing the progression of ROP. This pilot study indicates that IVB seems to contribute no further complications to the complications already present due to prematurity.

Dramatic Regression of Amelanotic Choroidal Melanoma With PDT Following Poor Response to Brachytherapy

Photodynamic therapy (PDT) has been used for treatment of choroidal neovascular membrane from exudative macular degeneration. Other applications include treatment of some intraocular tumors, such as choroidal hemangioma, vasoproliferative tumor, and choroidal osteoma. The authors report the effect of PDT for amelanotic choroidal melanoma. A 40-year-old woman with an amelanotic choroidal melanoma of 6.5 mm thickness showed poor response to iodine brachytherapy (80 Gy apical dose) with no reduction in thickness at 16 months of follow-up. There was prominent residual tumor. The amelanotic tumor was treated with verteporfin PDT using three overlapping spots (8,600 microns), with avoidance of the optic disc using standard treatment parameters. Dramatic tumor regression over 2 months to a completely flat scar (1.3 mm thickness) was documented and remained stable at 50 months of follow-up. Amelanotic choroidal melanoma with incomplete response following conventional plaque radiotherapy can be treated with verteporfin PDT for consolidation.

Internal Ophthalmomyiasis Presenting as Endophthalmitis Associated With an Intraocular Foreign Body

Ophthalmomyiasis interna infestation by fly larva can present in various forms. A 3-year-old girl with a 15-day history of pain, redness, and tearing of the right eye was referred to our clinic with the diagnosis of endophthalmitis associated with an intraocular foreign body, based on clinical and ultrasonographic findings. The patient underwent pars plana vitrectomy, during which an 8-mm long larva was encountered within the vitreous cavity. It was removed and identified as a cattle botfly. The patient developed a retinal detachment 1 month postoperatively, but the family refused further treatment and the patient was lost to follow-up. Ophthalmomyiasis should be included in the differential diagnosis of endophthalmitis and intraocular foreign bodies in patients from rural areas.