Seyhan Sonar Ozkan

Inflammatory mediators and posterior segment involvement in ocular Behcet disease.

Purpose To assess the serum level of mediators and their relation with posterior ocular involvement in patients with Behçet disease (BD). Methods This study was a prospective, institutional clinical trial including 43 patients with ocular BD. Patients were divided into two subgroups: those with active posterior segment involvement (Group A) and those with inactive ocular BD (Group B). Group A included patients with posterior uveitis (vitritis or chorioretinal involvement), while Group B included patients with no active intraocular inflammation within the last 3 months. Serum levels of interleukin (IL)-6, IL-8, tumor necrosis factor alpha (TNF-α), vascular endothelial growth factor (VEGF), and malondialdehyde (MDA) were measured by sandwich enzyme-linked immunosorbent assay and spectrophotometric assay and compared among the groups by independent sample t test and Mann-Whitney U-test. Results Serum levels of the mediators in Group A (IL-6 [23.1 pg/mL], IL-8 [161.1 pg/mL], TNF-α [30.5 pg/mL], VEGF [455.9 pg/mL], MDA [10.7 μm]) were found to be significantly higher than those in Group B (IL-6 [12.2 pg/mL], IL-8 [48.4 pg/mL], TNF-α [18.6 pg/mL], VEGF [138.0 pg/mL], MDA [5.1 μm]). Conclusions This study demonstrated that increased serum levels of inflammatory mediators including IL-6, IL-8, TNF-α, VEGF, and MDA were possibly involved in the development of posterior uveitis in BD.

Is there a correlation between diabetes mellitus and central corneal thickness

PurposeTo evaluate the association of central corneal thickness (CCT) with diabetes mellitus and compare it with age and sex-matched healthy controls. Materials and MethodsThis study included 245 eyes of 245 subjects (one eye per subject). One hundred diabetic patients constituted the study group and 145 were healthy controls. The study group was subdivided into 3 subgroups: subgroup 1 (no diabetic retinopathy), subgroup 2 (nonproliferative diabetic retinopathy), and subgroup 3 (proliferative diabetic retinopathy). CCT was determined with ultrasonic pachymeter. None of the patients had glaucoma, retinal laser treatment, and history of ocular surgery. Statistical analyses were performed by analysis of variance and Kruskall-Wallis tests. Correlation analysis was performed to assess the association between disease duration and glycosylated hemoglobin levels among subgroups. ResultsDemographic characteristics of study and control groups were similar (P>0.05). The mean CCT was significantly greater in study group (564±30 &mgr;m) compared with control group (538±35 &mgr;m) (P=0.001). In addition, mean CCT was found to be greater in subgroup 3 (582±23 &mgr;m) compared with subgroups 1 (565±32 &mgr;m) and 2 (558±31 &mgr;m); but the difference did not reach statistical significance (P=0.056). Also, there was no significant correlation in respect to the level of glycosylated hemoglobin and disease duration among the subgroups. ConclusionsWe found that the central cornea of diabetic patients is thicker when compared with nondiabetic patients. Thicker central cornea associated with diabetes mellitus should be taken into consideration while obtaining accurate intraocular pressure measurements in diabetics.

Is there a change of corneal thickness in uveitis with Behçet disease

Purpose: To report the measurements of central corneal thickness (CCT) in uveitic eyes with Behçet disease (BD) and compare it with age- and sex-matched healthy controls. Materials and Methods: This study included 69 eyes with ocular BD with no history of corneal disease, glaucoma, or ocular surgery and 50 eyes of healthy controls. Eyes with ocular BD were subdivided into active and inactive groups. Active group was defined as the presence of anterior uveitis or panuveitis, whereas inactive group was defined as having had at least 1 previous attack and absence of any active inflammation in the eye within the last 3 months. CCT was measured with ultrasonic pachymeter. Statistical analyses were performed, and P < 0.05 was considered statistically significant. Results: Active group had 24 patients and inactive group had 45 patients. Demographic characteristics of patients with ocular BD and control subjects were similar (P > 0.05). There was no significant difference in respect to the disease duration between active and inactive groups (P = 0.160). The mean CCT was significantly greater in active group (584.75 ± 20.94 μm) than in inactive group (540.55 ± 36.16 μm) and control group (543.04 ± 25.35 μm) (P = 0.0001). Conclusions: We found that eyes with active BD had increased CCT because of active inflammation when compared with inactive and control groups, and mean CCT of inactive BD was normal. Therefore, we assume that CCT is in normal range in the inactive phase, and recurrent uveitis does not lead to a permanent change in CCT in BD.

Vogt-Koyanagi-Harada Syndrome in Children: Report of a Case and Review of the Literature

This article reviews the therapeutic approaches in children with Vogt-Koyanagi-Harada (VKH) syndrome, and reports on a 9-year-old girl with progressive visual loss due to VKH syndrome in spite of treatment. In previous reports, corticosteroids were found to be the most effective agents in the treatment of VKH syndrome, while combination therapies with cyclosporine, methotrexate, or azathioprine were used with favorable results in refractory cases. In the current case, none of the treatments sufficiently stabilized the vision, but triple combination of corticosteroids, cyclosporine, and methotrexate suppressed the relapses of intraocular inflammation. Treatment of children with VKH syndrome is challenging. Various treatment modalities have been reported with various responses, but there is still no definite treatment regimen, and the treatment is usually individualized in pediatric VKH cases.

OCULAR MANIFESTATIONS OF LATE-ONSET BEHCET DISEASE

Purpose: To describe the demographic characteristics and ocular manifestations of patients with late-onset Behçet disease (BD). Patients and Methods: The patients for this retrospective study were selected using the data obtained from the medical records of 16 patients with late-onset BD between January 2000 and May 2008. Results: Twelve (75%) of the cases were male and 4 (25%) were female. The mean age of patients was 53.8 ± 2.9 years (range, 51–60 years). The mean follow-up period was 4.3 ± 1.1 years (range, 3–8 years). Throughout the follow-up period, panuveitis, posterior uveitis, and anterior uveitis were detected in 11 (68.7%), 4 (25%) and 1 (6.2%) of 16 patients, respectively. Conclusion: In our series, the most frequent type of uveitis was panuveitis and male sex seems to be a significant risk factor for developing panuveitis. Late-onset BD showed a marked preponderance of males with a sex ratio of 3:1.

Impact of Panretinal Photocoagulation on Optic Nerve Head Parameters

Background: To investigate the impact of panretinal photocoagulation (PRP) on quantitative optic nerve head (ONH) assessment in patients with diabetic retinopathy. Methods: Eighty eyes of 80 diabetic patients who did not undergo PRP and 45 eyes of 45 subjects with diabetes who underwent PRP were enrolled in the prospective, cross-sectional study. Participants were evaluated by confocal scanning laser ophthalmoscopy (CSLO). The global values of ONH parameters were compared among the groups. Results: The eyes that had been treated with PRP had a significantly greater rim area (1.84 ± 0.45 vs. 1.68 ± 0.30 mm2), smaller cup/disc area ratio (0.14 ± 0.12 vs. 0.19 ± 0.12), smaller linear cup/disc ratio (0.34 ± 0.17 vs. 0.42 ± 0.14) and shallower cup depth (0.15 ± 0.09 vs. 0.18 ± 0.07 mm) than controls (p = 0.021, p = 0.019, p = 0.007, p = 0.04, respectively). On the other hand, PRP-treated eyes were found to have a significantly thinner mean peripapillary retinal nerve fibre layer compared with the eyes in the control group (0.21 ± 0.08 vs. 0.25 ± 0.09 mm; p = 0.029). Conclusions: These results suggest that the ONH morphology in eyes treated with PRP may be altered to mask glaucomatous cupping due to PRP itself. Therefore caution must be taken to interpret the CSLO parameters obtained from eyes that have been treated with PRP.

Choroidal neovascular membrane in radiation retinopathy

Radiation retinopathy can occur years after the initial radiotherapy of the cancers of head and neck. It generally has a fulminant course, and can cause a variety of severe retinal abnormalities. Choroidal neovascularization has been rarely reported in radiation retinopathy. In this case report, a 21‐year‐old boy is presented who developed fulminant radiation retinopathy and choroidal neovascular membrane 4 years after receiving radiotherapy for his nasopharyngeal carcinoma.

Topographic optic disc analysis by Heidelberg retinal tomography in ocular Behçet's disease

Aim: To compare the topographic characteristics of the optic discs in patients with severe and mild ocular Behçet’s disease by using Heidelberg retinal tomographaphy (HRT). Methods: This prospective study included 47 eyes of 47 patients with ocular BD who were being followed-up at the Uveitis Clinic of the Ankara Ulucanlar Eye Research Hospital, Ankara, Turkey. The patients were divided into two groups. Group 1 consisted of 21 eyes with mild uveitis, and group 2 consisted of 26 eyes with severe uveitis. All patients underwent topographic optic disc analysis by HRT II, and the quantitative optic disc parameters of both groups were compared by non-parametric Mann-Whitney U test. Results: The mean cup volume, rim volume, cup area, disc area and cup depth in group 1 were found to be statistically significantly greater than those in group 2 (p<0.0001, p = 0.03, p = 0.021, p = 0.01 and p = 0.017, respectively), while the difference between the mean cup-to-disc ratios in group 1 and group 2 were found to be statistically insignificant (p = 0.148). Conclusion: A relationship was found between the severity of ocular BD and optic disc topography determined by HRT. In eyes with smaller optic discs, uveitis was observed to have a more severe course with more frequent relapses than those with larger discs.

Comparative study of brain magnetic resonance imagings in normal tension glaucoma, primary open-angle glaucoma, and normal subjects

Purpose : To evaluate and compare the presence and extent of ischemic findings in brain magnetic resonance images (MRI) of patients with normal tension glaucoma (NTG), primary open-angle glaucoma (POAG), and control subjects. Method : Seventeen patients with NTG underwent MRI. Cortical atrophy and cerebral infarcts were graded in a masked fashion by a neuroradiologist and findings were compared with age- and sex-matched POAG patients and controls. Results : In terms of CNS ischemia, patients with NTG showed more pathological findings compared to POAG and controls. The latter two were found to be statistically similar. Also, these findings were not related to age.

Papillitis as the Initial Presentation of Behçet Disease

Papillitis can rarely develop secondary to Behçet disease (BD). Even less commonly, it might be the initial finding of BD. The authors report four cases with papillitis, who were diagnosed as BD during their investigations. The visual acuities of the affected eyes were counting fingers in 3 cases, and 20/40 in 1 case, accompanied by optic disc edema with blurred margins in all of them. Two out of 4 cases also had occlusive vasculitis accompanying papillitis. Neurological examinations and cranial MRI were unremarkable, while the dermatologic examinations revealed findings consistent with BD. Following treatment with high-dose corticosteroids, optic disc edema resolved and visual acuities increased within 4 weeks in all cases. Recurrent papillitis was not recorded during the follow-up period of 6 months to 1.5 years.