Suat Karagül

Deadly weapon-related open-globe injuries: outcome assessment by the ocular trauma classification system.

PURPOSE To describe mechanisms and injury characteristics influencing visual outcomes in eyes with open-globe injuries caused by deadly weapons and to apply the classification system introduced by the Ocular Trauma Classification Group. METHODS Two-hundred-twenty-eight eyes of 212 consecutive patients, who were mostly injured in military confrontation, were analyzed. Mechanism and injury characteristics were evaluated for predicting visual outcome according to the recently studied classification system as well as other variables pertinent to this specific clinical setting of severe eye trauma. Final visual acuities were defined as favorable (5/200 or better) or unfavorable (less than 5/200, including enucleation). RESULTS The mean age of patients was 23 years, and the mean follow-up was 5.7 months. The predictors for favorable visual outcome were type B, grade 1, zone I, and relative afferent pupillary defect-negative injuries. The predictors for unfavorable outcome were type A, grade 5, zone III, and relative afferent pupillary defect-positive injuries. Land mine and hand grenade injuries had the worst outcome among causative agents. Proliferative vitreoretinopathy, comprising 30.4% of postoperative failures, was the most common complication. CONCLUSION Deadly weapon-related open-globe injuries, especially those associated with land mines and hand grenades, have devastating visual results. Evaluation of trauma mechanism and injury characteristics according to the Ocular Trauma Classification System seems to predict visual outcomes in this series of severe open-globe injuries.

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.

Outcomes of Nd:YAG Laser Treatment for Valsalva Retinopathy Due to Intense Military Exercise

BACKGROUND AND OBJECTIVE Valsalva retinopathy may occur due to intense physical exercise. Soldiers must undergo vigorous physical training to sustain a high level of readiness. The aim of this study was to evaluate the recovery period and the outcomes of Valsalva retinopathy due to physical exercise in the Turkish Army. PATIENTS AND METHODS Twelve soldiers had Valsalva retinopathy related to military exercise. All patients received Nd:YAG laser membranotomy and were observed for an average of 12.6 months. RESULTS All eyes had visual acuities of 20/20 at the end of the first month of follow-up. Therefore, the soldiers could continue their training. No complications were observed and additional surgeries were not needed during the 1-year follow-up. CONCLUSIONS Early visual recovery is important to continue training and reduce health costs in the Turkish Army, where military service is mandatory for a required period of time. For that reason, Nd:YAG laser treatment for Valsalva retinopathy related to military exercise is an effective and safe procedure.

Toluene Related Toxic Optic Neuropathy

ABSTRACT Toxic optic neuropathy presenting as bilateral painless visual loss causing central or caecocentral scotoma has a wide differential diagnosis. In this report, we present a rare cause of toxic optic neuropathy presenting as almost indistinct optic disc margins in both eyes in a 30-year old man with blurred vision and difficulty in walking and in writing with a history of adhesive glue sniffing. Caecocentral scotomas in the visual fields; increased total error scores on Farnsworth-Munsell (FM) 100 Hue testing; P100 reduced amplitude in the pattern visually evoked potentials; and N95 reduced amplitude in the pattern electroretinogram associated with normal serum electrolytes and vitamin levels suggested acute toxic optic neuropathy related to toluene. Upon cessation of toluene use, the caecocentral scotomas almost disappeared, total error scores in the FM 100 Hue test decreased and visual acuity improved.