Yuksel Sullu

T helper 1 type cytokines polymorphisms: association with susceptibility to Behçet’s disease

The pathogenesis of Behçet’s disease (BD) is not fully understood and immunological abnormalities and genetic factors have been investigated. Because serum concentrations of mainly T helper 1 (Th1) type cells have been reported to be increased in BD, we aimed to investigate whether certain cytokine polymorphisms might represent a risk factor for developing BD. We genotyped 80 patients with BD and 105 healthy controls for interleukin (IL)-1 α (T/C −889), IL-1 β (C/T −511, T/C +3962), IL-1R (C/T pst11970), IL-1RA (T/C mspa111100), IL-2 (T/G −330), IL-12 (C/A −1188), interferon (IFN)-γ (A/T UTR 5644), and TNF-α (G/A −238) polymorphisms. Analyses of cytokine polymorphisms were performed with PCR-SSP. The genotype and allele frequencies of the patients and controls were compared and the association between the polymorphisms of the cytokines with the clinical findings was investigated. Genotype distribution showed significant differences between the patients and the controls for the IL-1 α −889, IL-1 β −511, IL-1 β +3962, IL-1R, IL-12, IFN- γ, and TNF-α cytokines. We didn’t observe significant difference in genotypic frequencies of IL-1RA and IL-2 in our study. Comparison of the IL-1 α −889, IL 1 β −511, and IL 1 β +3962 genotype frequencies showed significant increase in CC genotype between the patients and the controls. The individuals with IL-1R TT polymorphism had a higher risk for BD compared to patients with CT/CC polymorphism. Comparison of IL-12, IFN- γ, and TNF-α, genotype frequencies showed significant increase in CA, AA, and AA genotypes between the patients and controls, respectively. The frequencies of genotypes according to the clinical features of the patients with BD did not show a significant difference (p > 0.05). Our study suggests that development of BD might be determined by various cytokine gene polymorphisms. However, further studies on larger numbers of cases are needed before definite conclusions can be drawn.

Submacular surgery for choroidal neovascularization secondary to optic nerve drusen

PURPOSE To report a case of bilateral choroidal neovascularization (CNV) secondary to optic nerve drusen (OND). DESIGN Interventional case report. METHODS A 9-year-old girl presented with peripapillary CNV of the right eye and peripapillary and subfoveal CNV of the left eye secondary to OND. The CNV was excised with submacular surgery in the left eye. RESULTS Visual acuity increased from 0.05 to 0.3 in the left eye after submacular surgery and did not change from 0.3 in the right eye during 6-month follow-up. Partial retinal pigment epithelial atrophy, but no recurrence of CNV, was observed after CNV excision. CONCLUSION Subfoveal CNV is an uncommon complication of OND and surgical excision may be useful in selected cases.

Expression of bcl-2 protein in active skin lesions of Behçet's disease

Abstract

Pars plana vitrectomy for ocular complications of Behçet's disease.

BACKGROUND AND OBJECTIVES To evaluate the outcomes of vitreoretinal surgery for the ocular complications of Behcets disease. PATIENTS AND METHODS This retrospective study included 20 eyes of 15 patients with Behçets disease (9 men, 6 women; mean age at surgery, 31.0 +/- 1.8 years; range, 21-44 years) who had undergone vitreoretinal surgery for Behcets disease at Ondokuz Mayis University, Faculty of Medicine, Department of Ophthalmology, Samsun, Turkey, between January 2000 and September 2003. Postoperative visual acuity outcome, course of uveitis, and complications were evaluated in all patients. RESULTS Indications for surgery were vitreous opacities in 10 eyes (50%), cystoid macular edema in 5 eyes (25%), epiretinal membrane in 3 eyes (15%), and vitreous hemorrhage in 2 eyes (10%). At the last postoperative follow-up, visual acuity had increased 2 Snellen lines or more in 10 (50%) of 20 eyes. Cystoid macular edema completely improved in 3 (60%) of 5 eyes after vitrectomy. Uveitis attacks significantly decreased during follow-up (P = .015). Immunosuppressive treatment was stopped in 11 (73%) of 15 patients. Retinal detachment and phthisis were not observed in any eye. CONCLUSION Vitreoretinal surgery may be useful in the treatment of posterior segment complications of Behcets disease.

Dexamethasone Implant in Chronic Diabetic Macular Edema Resistant to Intravitreal Ranibizumab Treatment

Purpose: The aim of this study was to assess the efficacy of a single intravitreal dexamethasone implant (IDI) over 6 months in eyes with chronic diabetic macular edema (DME) that were resistant to intravitreal ranibizumab (IR) treatment. Methods: This retrospective study was conducted at the Ondokuz Mayis University Hospital, Samsun, Turkey. Efficacy outcomes were considered as the change from baseline in best corrected visual acuity (BCVA) and central macular thickness (CMT). Results: Thirty eyes of 20 patients with a mean age of 61.6 ± 8.8 (45-85) years were included in the study. The mean BCVA significantly increased from 0.68 ± 0.27 to 0.56 ± 0.30 logMAR (p = 0.001) and 0.57 ± 0.30 logMAR (p = 0.002) at months 1 and 2, respectively. The proportion of patients who gained 3 or more lines in BCVA was 20%. The mean CMT significantly decreased from 578.93 ± 17.95 µm at baseline to 282.10 ± 21.42, 292.26 ± 19.69, 371.70 ± 21.23, and 463.60 ± 23.16 µm at months 1, 2, 3, and 4, respectively (p = 0.001). Intraocular pressure (IOP) increase occurred in 5 (16.7%) eyes. Cataract surgery was required in 3 (13%) out of 23 phakic eyes. Conclusion: IDI provides significant benefits in visual acuity gains and anatomic improvements in eyes with chronic DME that are resistant to IR treatment. Increases in IOP and cataract progression can be observed in IDI-treated patients. However, its safety profile is acceptable.

Lateral canthal dynamics, correlation with periorbital anthropometric measurements, and effect of age and sleep preference side on eyelid metrics and lateral canthal tendon.

Purpose To evaluate dynamic and static properties of lateral canthal tendon and involutional periorbital anthropometric and lateral canthal changes with any possible effect of sleep preference side on these changes. Methods Ninety-two healthy adult subjects with a mean age of 43.5 years were enrolled in the study. Lateral canthal tendon lengths (LCT), canthal movement amplitudes, and other periorbital anthropometric parameters were measured. Any effects of age and sleep preference side on anthropometric and particularly lateral canthal tendon measurements were evaluated. Pearson correlation analysis, one-way analysis of variance, and t-test for paired samples were used for statistical evaluation. Results LCT length was weakly correlated with age, lower lid tractability, horizontal palpebral fissure length, and interpupillary distance and also inversely correlated with margin reflex distance, but not with other measurements. Age was also correlated with lower lid tractability, and with the ratio of LCT to the horizontal palpebral fissure length (LCT/HPFL). No correlation between age and horizontal palpebral fissure length was detected. Age was weakly and inversely correlated with canthal height but not with canthal movement amplitudes. No effect of sleep preference side on LCT length, canthal height, or lower lid tractability was detected. Conclusions Lateral canthus has a dynamic structure that is not correlated with any other periorbital anthropometric measurements. LCT length is correlated with lower lid tractability, and increases with age, unlike horizontal palpebral fissure that stays constant with increasing LCT/HPFL ratio. Sleep preference side has no effect on the eyelid metrics and LCT. (Eur J Ophthalmol 2007; 17: 143–50)

Bcl-2 Expression in Skin Pathergy Reaction of Behçet’s Disease

Background: Bcl-2 expression in leukocytes plays an important role in autoimmune and inflammatory disease. Objective: In the present study, we investigated the Bcl-2 expression in the skin pathergy reaction (SPR) of Behçet’s disease (BD). Methods: The skin pathergy test (SPT) was performed on 23 patients with BD and 7 healthy controls. After 48 h, SPT specimens were taken by punch biopsy. Control samples were also obtained from the normal skin of 7 patients with BD and 11 patients with BD-unrelated leukocytoclastic vasculitis. Biopsy specimens were evaluated by routine histopathological examination and immunohistochemical Bcl-2 staining. Results: The SPT was clinically positive in 9 of 23 patients and histopathologically positive in 13 but never in the healthy controls. The majority of leukocytes in 12 of 13 histopathologically positive specimens were stained with Bcl-2. Only 3 BD-unrelated leukocytoclastic vasculitis samples showed Bcl-2 positivity. No Bcl-2 staining was found in healthy controls and normal skin samples of patients with BD. Conclusion: Our data may suggest a role of Bcl-2-mediated inflammation in the pathogenesis of the SPR in BD.

Surgical management of intraocular lens dislocations

PURPOSE To report and compare the surgical, visual, and anatomical outcomes following treatment of dislocated intraocular lenses (IOLs). METHODS The medical records of 28 eyes of 28 patients were evaluated. Age, gender, pre-and postoperative best-corrected visual acuity (BCVA), surgical methods, and complications were recorded. RESULTS Pre-and postoperative BCVA ranged from counting fingers to 20/32 and from counting fingers to 20/25, respectively. Late-onset dislocations were the most frequently observed complication. The most frequent surgical method was IOL repositioning in 15 of 28 patients, followed by IOL exchange in 11 patients, and IOL removal in 2 patients. Only 1 patient required surgical re-intervention with IOL capture. CONCLUSIONS Visual acuity improved following the use of either IOL repositioning or IOL exchange. No superiority of one method over the other was observed. In the present retrospective case series, management of dislocated IOLs with repositioning or exchange of the primary implant conferred comparable surgical and visual outcomes.

Retinal pigment epithelium tears following intravitreal ranibizumab injection for neovascular age-related macular degeneration.

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Orbital Drainage of Different Sizes of Colloids in Rabbits: A Dynamic Scintigraphic Study

PURPOSE To investigate the drainage patterns of radiolabeled colloids of different sizes injected into the orbital cavity in an animal model. METHODS Twenty-one orbits of 11 rabbits were included in the study. In group 1, human serum macroaggregates with particle sizes of 10 to 100 microm, labeled with 10 mL of 1480 MBq (40 mCi) technetium pertechnetate Tc 99m (99mTc), were used. In group 2, human serum albumin colloidal particles with particle sizes of 50 to 80 nm, labeled with 5 mL of 740 MBq (20 mCi) 99mTc, were used. In group 3, colloidal tin with particle sizes of 300 to 600 nm, labeled with 9 mL of 1665 MBq (45 mCi) 99mTc, were used. The dynamic acquisition of liver for 10 minutes (120 frames for 5 seconds) in a 128 x 128 matrix was acquired immediately after intraorbital injection and at the end of the second hour. RESULTS The liver in groups 2 and 3 and the lung in group 1 were visualized in 10 seconds or less in six, five, and four rabbits, respectively. The injected activity persisted in the orbits in varying percentages in all rabbits at the end of acquisition. CONCLUSIONS Intraorbital injections have a great potential for systemic absorption and should not be considered as local pharmaceutical administration.