Publications by authors named "F Nilüfer Yalçındağ"

36 Publications

Spectral domain optical coherence tomography findings of patients with pars planitis and risk factors affecting visual acuity.

Int Ophthalmol 2021 Feb 9. Epub 2021 Feb 9.

Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey.

Purpose: To evaluate spectral domain optical coherence tomography (SD-OCT) findings of 42 eyes with pars planitis and to identify risk factors affecting visual acuity.

Methods: Medical records and SD-OCT findings were retrospectively reviewed.

Results: Mean best-corrected visual acuity (BCVA) was 0.248 ± 0.3 on the logMAR scale at baseline. SD-OCT findings included epiretinal membrane (ERM) in 16 (38.1%) eyes, loss of normal foveal contour appearance in 8 (19.0%), ellipsoid zone (EZ) damage in 5 (11.9%), external limiting membrane (ELM) damage in 3 (7.1%), disruption of retinal pigment epithelium (RPE) in 2 (4.8%), and macular atrophy in 1 (2.4%). There was macular edema in 10 (23.8%) eyes [cystoid macular edema (CME) in 8 (19.0%), diffuse macular edema (DME) in 6 (14.3%), and serous retinal detachment in 2 (4.8%)]. The mean central macular thickness (CMT) was 272.1 ± 319.5 μm. Patients were followed up for a mean of 50.6 ± 36.7 months. Mean BCVA was 0.210 ± 0.3 at the final evaluation. SD-OCT findings included ERM in 28 (66.7%) eyes, EZ damage in 6 (14.3%), ELM damage in 3 (7.1%), disruption of RPE in 4 (9.5%), loss of normal foveal contour appearance in 12 (28.6%), and macular atrophy in 2 (4.8%). There was CME and/or DME in 6 (14.3%) eyes. The mean CMT was 238 ± 220.9 μm and was significantly lower than the baseline (p < 0.001). According to multivariate linear regression analysis, the presence of DME, and loss of normal foveal contour appearance at baseline were the independent factors associated with BCVA at the final examination (B = 0.726, p < 0.001; B = 0.766, p < 0.001, respectively).

Conclusions: DME and loss of normal foveal contour appearance were more likely to have adverse effects on visual acuity.
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http://dx.doi.org/10.1007/s10792-021-01734-zDOI Listing
February 2021

Macular structural changes and factors affecting final visual acuity in patients with Behçet uveitis.

Graefes Arch Clin Exp Ophthalmol 2021 Mar 10;259(3):715-721. Epub 2020 Oct 10.

Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey.

Purpose: To evaluate macular structural changes during the active and remission periods in patients with Behçet uveitis and to further assess the factors affecting final visual acuity.

Methods: Clinical records and spectral domain-optical coherence tomography (SD-OCT) findings of patients with Behçet uveitis were retrospectively reviewed.

Results: Sixty-nine eyes of 35 patients were included in the study. SD-OCT findings in the active uveitis period included epiretinal membrane (ERM) in 26 (37.1%) eyes, ellipsoid zone (EZ) damage in 11 (15.7%), external limiting membrane (ELM) damage in 10 (14.3%), macular atrophy in 6 (8.6%), disruption of retinal pigment epithelium (RPE) in 11 (15.7%), a macular scar in 1 (1.4%), and loss of normal foveal contour appearance in 15 (21.4%). There was macular edema in 23 eyes (32.9%) in the active uveitis period (11 (15.7%) cystoid macular edema, 10 (14.3%) diffuse macular edema, and 7 (10.0%) serous retinal detachment). In the remission period, SD-OCT findings included ERM in 37 (52.9%) eyes, EZ damage in 14 (20%), ELM damage in 14 (20%), macular atrophy in 7 (10%), disruption of RPE in 14 (20.0%), macular scar in 1 (1.4%), and loss of normal foveal contour appearance in 17 (24.3%). The mean central macular thickness in the remission period was significantly lower than in the active uveitis period (p < 0.001). The presence of EZ damage and loss of normal foveal contour appearance in active uveitis period were the independent factors associated with final visual acuity (logMAR) (β = 0.736, p = 0.003; β = 0.682, p = 0.002, respectively).

Conclusion: Ellipsoid zone damage and loss of normal foveal contour appearance are important factors affecting visual acuity in Behçet uveitis.
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http://dx.doi.org/10.1007/s00417-020-04958-4DOI Listing
March 2021

An Algorithm for the Diagnosis of Behçet Disease Uveitis in Adults.

Ocul Immunol Inflamm 2020 Apr 14:1-10. Epub 2020 Apr 14.

Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

: To develop an algorithm for the diagnosis of Behçet's disease (BD) uveitis based on ocular findings.: Following an initial survey among uveitis experts, we collected multi-center retrospective data on 211 patients with BD uveitis and 207 patients with other uveitides, and identified ocular findings with a high diagnostic odds ratio (DOR). Subsequently, we collected multi-center prospective data on 127 patients with BD uveitis and 322 controls and developed a diagnostic algorithm using Classification and Regression Tree (CART) analysis and expert opinion.: We identified 10 items with DOR >5. The items that provided the highest accuracy in CART analysis included superficial retinal infiltrate, signs of occlusive retinal vasculitis, and diffuse retinal capillary leakage as well as the absence of granulomatous anterior uveitis or choroiditis in patients with vitritis.: This study provides a diagnostic tree for BD uveitis that needs to be validated in future studies.
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http://dx.doi.org/10.1080/09273948.2020.1736310DOI Listing
April 2020

Quantitative Evaluation of the Retinal Vascular Parameters With OCTA in Patients With Behçet Disease Without Ocular Involvement.

Ophthalmic Surg Lasers Imaging Retina 2019 12;51(1):31-34

Background And Objective: To evaluate the optical coherence tomography angiography (OCTA) features of patients with Behçet disease (BD) without ocular involvement.

Patients And Methods: Twenty-three patients with BD without ocular involvement and 29 healthy age/sex-matched control subjects were involved. The authors measured foveal avascular zone (FAZ) area, vessel density in the parafoveal region, and flow area (fovea-centered 3-mm radius area) in the superficial and deep capillary plexuses evaluated by OCTA.

Results: FAZ area was significantly larger in eyes with BD in both the superficial and deep capillary plexuses (0.331 vs. 0.240 mm [P = .004] and 0.352 vs. 0.257 mm [P = .003], respectively). Although mean capillary vessel density in parafoveal region and mean flow area were lower in eyes with BD for both superficial and deep capillary plexuses, these findings were not statistically significant.

Conclusion: Microvascular changes in macular region can be identified in patients with BD without ocular manifestation. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:31-34.].
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http://dx.doi.org/10.3928/23258160-20191211-04DOI Listing
December 2019

The Clinical Characteristics of Pediatric Non-Infectious Uveitis in Two Tertiary Referral Centers in Turkey.

Ocul Immunol Inflamm 2019 Nov 5:1-8. Epub 2019 Nov 5.

Department of Ophthalmology, Ankara University, Ankara, Turkey.

: To report the manifestations, patterns of disease, treatment strategies and outcomes in pediatric patients with noninfectious uveitis.: Demographic information of 76 cases was recorded. Symptoms, anatomic location, laterality, visual acuity (VA), intraocular pressure, associated systemic diseases, therapeutic strategies, side effects, complications were reviewed.: Thirty-one patients were diagnosed as uveitis on routine surveillance because of underlying systemic disease. The most common anatomic location was intermediate uveitis (34.2%). Juvenile idiopathic arthritis (JIA) was the most common underlying systemic disease (25%). Glaucoma was the most common complication (7.7%). The patients with refractory uveitis received adalimumab (26.5%), infliximab (4.6%) and tocilizumab (3.1%). The mean first-year VA was between 20/32 and 20/20 in 116/140 eyes.: Most pediatric noninfectious uveitis cases have bilateral intermediate uveitis. JIA was the most common systemic association. The first-year VA was good in most eyes which may be due to early use of corticosteroid-sparing agents.
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http://dx.doi.org/10.1080/09273948.2019.1674890DOI Listing
November 2019

Optical Coherence Tomography Angiography in Branch Retinal Artery Occlusion.

Turk J Ophthalmol 2018 Jun 28;48(3):150-154. Epub 2018 Jun 28.

Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey.

Optical coherence tomography angiography (OCTA) is a non-invasive alternative method used in the diagnosis and follow-up of acute branch retinal artery occlusion to show changes secondary to ischemia. We report a case with acute branch retinal artery occlusion. A 52-year-old man presented with a complaint of sudden-onset visual loss in the right lower quadrant of the left eye for the previous three days. Best-corrected visual acuity was 0.4 temporally. Inferonasal visual field deficit was detected with confrontation. Pupillary light reactions were normal in both eyes and there was no relative afferent pupillary defect. Dilated fundus examination revealed retinal lesion suggesting superior temporal branch retinal artery occlusion. He was treated with dextran 40 and pentoxifylline. Follow-up fundus fluorescein angiography could not performed because of chronic renal failure; OCTA demonstrated superficial and deep capillary non-perfusion areas and telangiectases in areas corresponding to the artery occlusion.
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http://dx.doi.org/10.4274/tjo.34270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6032954PMC
June 2018

Demographic and Clinical Characteristics of Uveitis in Turkey: The First National Registry Report.

Ocul Immunol Inflamm 2018 28;26(1):17-26. Epub 2016 Jul 28.

d Department of Ophthalmology , Istanbul University, Istanbul Faculty of Medicine , Istanbul , Turkey.

Purpose: To describe the demographic and clinical profiles of uveitis patients seen at secondary and tertiary care centers in Turkey.

Methods: A nationwide web-based registry of patients with uveitis was initiated in November 2008. We analyzed data from a single baseline registry-enrollment visit.

Results: In 33 centers, 6967 eyes of 4863 consecutive patients were registered. The mean age at presentation was 36.6 ± 15.7 (1-92) years; 51.3% were male. Behçet disease was the leading diagnosis (24.9%), followed by ankylosing spondylitis and/or HLA-B27-associated anterior uveitis (9.7%), toxoplasmosis (7.1%), Fuchs uveitis (6.3%), and presumed herpetic anterior uveitis (6.0%). Visual acuity was 0.1 or worse in 22% of eyes. The most common ocular complications were posterior synechiae (16.2%) and cataract formation (16.2%).

Conclusions: Behçet disease is still the most common non-infectious etiology in Turkish uveitis patients, while ocular toxoplasmosis and herpetic anterior uveitis are the most common infectious uveitic entities.
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http://dx.doi.org/10.1080/09273948.2016.1196714DOI Listing
August 2018

Evaluation of Intraocular Inflammation with Laser Flare Photometry in Behçet Uveitis.

Ocul Immunol Inflamm 2017 Feb 30;25(1):41-45. Epub 2016 Jan 30.

b Islahiye State Hospital , Gaziantep , Turkey.

Purpose: To evaluate the association between intraocular inflammation and laser flare photometry measurements in Behçet disease.

Methods: In total, 45 patients were included in the study. The retrospective chart reviews of patients were performed. The flare levels were compared with the grade of anterior chamber cells, the presence of vitreous cells, the complications of uveitis, and fluorescein angiography scores.

Results: The attack group had higher flare intensity; the flare levels were higher in both groups compared with the values of healthy controls. The flare levels were related to the grade of the anterior chamber cells, the presence of vitreous cells and the fluorescein angiography scores. Patients with optic atrophy and/or maculopathy also had higher values. Higher flare values were correlated with poor vision.

Conclusions: Laser flare photometry may reduce the necessity of fluorescein angiography in monitoring subclinical inflammation and may be an indicator of posterior segment activity when fluorescein angiography is not applicable.
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http://dx.doi.org/10.3109/09273948.2015.1108444DOI Listing
February 2017

Evaluation of Aqueous Flare Levels Following Intravitreal Ranibizumab Injection for Neovascular Age-related Macular Degeneration.

Ocul Immunol Inflamm 2017 Apr 30;25(2):229-232. Epub 2016 Jan 30.

b Ankara University, Faculty of Medicine , Department of Ophthalmology , Ankara , Turkey.

Purpose: To evaluate aqueous flare levels following intravitreal ranibizumab injection for neovascular age-related macular degeneration (AMD).

Methods: In total, 81 eyes of 79 patients who underwent intravitreal ranibizumab injection for neovascular AMD were included. Aqueous flare was evaluated before pupillary dilatation with Kowa FM-600 laser flare meter at baseline, and 1 day, and 1 month after intravitreal administration of ranibizumab 0.5 mg (0.05 mL).

Results: The mean anterior chamber flare was 10.7 ± 6.8 (range: 1.5-35.4) ph/ms before the injection, 12.5 ± 8.9 (range: 0.3-43) ph/ms on the first day, and 9.9 ± 5.7 (range: 0.2-28.4) ph/ms in the first month. On the first day, a subtle increasing of flare was observed. However, the difference between the mean aqueous flare levels at baseline and postoperative first day and first month was not statistically different (p>0.05).

Conclusions: No significant short-term intraocular inflammation was noted in these eyes receiving ranibizumab for the treatment of neovascular AMD.
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http://dx.doi.org/10.3109/09273948.2015.1108445DOI Listing
April 2017

Nocturnal lagophthalmos in children with urofacial syndrome (Ochoa): a novel sign.

Eur J Pediatr 2014 May 19;173(5):661-5. Epub 2013 Nov 19.

Department of Urology, University of Ankara, Ankara, Turkey,

The urofacial syndrome is a rare condition that occurs in both genders and characterized by uropathy and facial abnormalities. Early diagnosis is crucial for the management and prognosis of urinary problems. Paradoxical inversion of facial musculature when smiling, giving an appearance of crying associated with severe urinary tract dysfunction is typical in these patients. Although facial signs and symptoms are generally ignored and shadowed by the dominant bladder symptoms, we have recently realized a unique but constant finding in majority of these patients, nocturnal lagophthalmos which is described as inability to close the eyelids during sleep. We report 15 patients with urofacial syndrome (Ochoa) whom mostly had admitted with major urological symptoms and 12 of the cases had nocturnal lagophthalmos. Lagophthalmos may lead to keratitis, corneal abrasion, infection, vascularization, and in extreme cases, ocular perforation, endophthalmitis and loss of the eye. Basic modalities like lubricant drops during the day and ointments at night are usually enough to protect the cornea from exposure keratopathy. In moderate to severe cases, overnight taping of the lid or the use of a moisture chamber might be necessary. Majority of our patients responded to basic therapy. Conclusion Nocturnal lagophthalmos is a novel symptom described in patients with urofacial syndrome. The pediatricians and urologists should be careful about this symptom to prevent eye damage and quality of life problems.
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http://dx.doi.org/10.1007/s00431-013-2172-7DOI Listing
May 2014

Accommodation Paralysis after Pheniramine Maleate Injection: A Case Report.

Neuroophthalmology 2013 19;37(6):257-259. Epub 2013 Nov 19.

Department of Ophthalmology, Faculty of Medicine, Ankara University Dikimevi, Ankara Turkey.

We present a case in which Gilbert syndrome was diagnosed following a neuro-ophthalmic complaint. Adverse effects of drugs as well as various systemic, neurological, and local ocular pathologies can cause accommodative insufficiency and loss of accommodation. A 29-year-old man was admitted to an ophthalmology department with blurred vision and diagnosed as suffering from acute accommodation paralysis. He had a history of being given a pheniramine maleate injection for pruritus 20 days previously. Symptoms began immediately following the injection. After systemic evaluation and laboratory tests, he was diagnosed as having Gilbert syndrome. His complaints and symptoms recovered in approximately a further 10 days. Metabolism of pheniramine maleate can be impaired in Gilbert syndrome and anticholinergic effects can cause accommodation paralysis.
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http://dx.doi.org/10.3109/01658107.2013.830227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291063PMC
November 2013

Anterior uveitis associated with laser epilation of eyebrows.

J Ophthalmic Inflamm Infect 2013 Apr 15;3(1):45. Epub 2013 Apr 15.

Department of Ophthalmology, Faculty of Medicine, Ankara University, Mamak Cad, Dikimevi, Ankara, 06100, Turkey.

Background: The objective of the study is to report a case of unilateral anterior uveitis after laser hair removal of the eyebrows with an alexandrite laser.

Findings: A 36-year-old female presented with painful red eye and photophobia in her left eye 2 days after receiving alexandrite (755 nm) laser epilation of both eyebrows. Visual acuity was 20/20 in both eyes. Right eye examination was normal. Left eye examination showed conjunctival injection, 2+ cells in the anterior chamber, and local posterior synechiae. Intraocular pressure and fundus examination were normal in both eyes. Topical steroids and cycloplegic drops were prescribed. Three days after the initiation of topical treatment, there was a reduction in anterior chamber cells to 1+, but posterior synechiae was enhanced. One week after, there were 0.5+ cells in the anterior chamber and no further enlargement of posterior synechiae. At the 2-month follow-up, uncorrected visual acuity remained 20/20 in both eyes. Slit-lamp biomicroscopy of the right eye was normal. Intraocular pressure and fundus examination were still normal in both eyes. Although anterior chamber of the left eye was clear, posterior synechiae persisted. We are still following the patient.

Conclusion: Laser hair removal of the eyebrows can lead to ocular damage and should be avoided.
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http://dx.doi.org/10.1186/1869-5760-3-45DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3637527PMC
April 2013

The relationship between serum levels of angiogenin, bFGF, VEGF, and ocular involvement in patients with Behçet's disease.

Graefes Arch Clin Exp Ophthalmol 2013 Jul 4;251(7):1807-12. Epub 2013 Apr 4.

Department of Clinical Biochemistry, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.

Objectives: The aim of this study was to investigate the possible role of angiogenin, vascular endothelial growth factor, (VEGF) and basic fibroblast growth factor (bFGF) in the pathogenesis of BD.

Design And Methods: Sixty-five patients with BD and 21 healthy control subjects were included in the study, and serum angiogenin, bFGF, and VEGF concentrations were measured by using in-vitro enzyme immunoassay (ELISA) kits according to the manufacturer's instructions.

Results: The median serum angiogenin level was significantly higher in patients with BD (391.8; range:151.6-594.8 pg/ml) than controls (298.8; range:241.9-449.6 pg/ml) (p = 0.001). The levels were similar in both ocular and non-ocular BD patients (p = 0.537). The mean serum bFGF level was higher in patients with BD (38.8 ± 12.3 pg/ml) than controls (33.2 ± 11.3 pg/ml); the median serum VEGF level was also higher in BD patients (239.7; range:53-991.3 pg/ml) than controls (189.4; range:53.6-357.9 pg/ml). But these differences were not statistically significant. Serum bFGF and VEGF levels were also not different statistically in ocular and non-ocular Behçet's patients. There was no statistically significant relationship between serum angiogenin, bFGF, and VEGF levels and the presence of active eye disease or anatomic location of uveitis. While there was a correlation of borderline significance in angiogenin levels between the patients with anterior uveitis and panuveitis (p = 0.053), we did not obtain any correlation between serum angiogenin, bFGF, and VEGF levels and the duration of BD.

Conclusions: This study suggests that angiogenin may be associated with pathophysiology of BD, and highlights the need of further investigation of the role of angiogenin, bFGF, and VEGF serum levels in BD susceptibility and its clinical manifestations.
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http://dx.doi.org/10.1007/s00417-013-2322-7DOI Listing
July 2013

Bell's palsy during interferon alpha 2a treatment in a case with Behçet uveitis.

F1000Res 2013 15;2:245. Epub 2013 Nov 15.

Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey.

Purpose: To present a case who developed Bell's palsy while using interferon alpha 2a for Behçet uveitis.

Methods: A patient with Behçet disease presented with decreased vision in his right eye. Ophthalmic examination, fundus fluorescein angiography and optical coherence tomography were performed. After developing facial paralysis while on interferon therapy, the patient was referred to our neurology service for differential diagnosis and treatment.

Results: Examination of right eye revealed panuveitis with branch retinal vein occlusion, so high dose steroids were prescribed. In three days there was no improvement in terms of vitreous inflammation and so steroids were replaced with interferon. At the seventh month, patient experienced a facial paralysis. After eliminating other causes, including viral infections, trauma, cold exposure and neurological evaluation with cranial MRI, the patient was diagnosed to have Bell's palsy by a neurologist. Interferon was replaced with mycophenolate mofetil and the Bell's palsy was treated with oral steroids.

Conclusion: It is important to be alert to both common and rare complications while treating with interferon.
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http://dx.doi.org/10.12688/f1000research.2-245.v1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962000PMC
April 2014

Intron F G79A polymorphism of the protein Z gene in Turkish Behçet patients.

Curr Eye Res 2012 Jul 4;37(7):630-2. Epub 2012 May 4.

Department of Ophthalmology, Gaziosmanpasa University, Tokat, Turkey.

Purpose: Vasculitis is one of the major findings of Behçet's disease (BD). Protein Z (PZ) is a glycoprotein that acts as a cofactor of PZ-dependent protease inhibitor and suppresses trombus formation by inhibiting activated factor Xa. Polymorphism of the PZ gene was mentioned as a genetic risk factor for various thrombotic events. The aim of this study is to investigate the intron F G79A polymorphism of the PZ gene in Behçet patients with and without ocular involvement.

Methods: Seventy-six patients and 70 controls were included in the study. Intron F G79A polymorphism of PZ gene was determined by polymerase chain reaction based DNA analysis. The frequency of A allele and the distribution of genotypes were assessed by χ(2) test and the genotype distribution and Hardy-Weinberg equilibrium were tested with the χ(2) test for quality of fit.

Results: The frequency of the A allele was significantly higher in overall Behçet patients than in controls (odds ratio [OR] = 6.8; 95% CI, 2.6 to 17.9; p = 0.0001). It was also significantly higher in patients with (OR = 5.3; 95% CI, 1.83 to 15.6; p = 0.0024) or without (OR = 8.2; 95% CI, 2.95 to 22.5; p = 0.0001) ocular involvement compared to controls. However, A allele frequency was not significantly different between patients with eye involvement versus patients without eye involvement (OR = 0.65; 95% CI, 0.3 to 1.4; p = 0.28).

Conclusions: Although thrombosis in BD is multifactorial, intron F G79A polymorphism of PZ gene in BD may be one of the factors that contribute to this pathological process.
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http://dx.doi.org/10.3109/02713683.2012.669004DOI Listing
July 2012

Results of interferon alpha-2a therapy in patients with Behcet's disease.

J Ocul Pharmacol Ther 2012 Aug 28;28(4):439-43. Epub 2012 Mar 28.

Department of Ophthalmology, Faculty of Medicine, Ankara University, Mamak Cad. Dikimevi, Ankara, Turkey.

Purpose: Corticosteroids, the main treatment option in acute attacks of ocular Behcet's disease (BD), are ineffective in preventing recurrent inflammation. Even combined therapy with systemic corticosteroids and azathioprine, cyclosporine, chlorambucil, or cyclophosphamide may be ineffective in controlling the disease in severe cases. We report our clinical experience with the efficacy and tolerability of interferon alpha-2a (IFN-α-2a) monotherapy in patients with Behcet uveitis refractory to conventional immunosuppressive agents.

Methods: We retrospectively analyzed the medical records of 12 Turkish Behcet patients who had been treated with IFN-α-2a between February 2009 and October 2011 because of severe uveitis refractory to traditional immunosuppressants. IFN-α-2a was initially administered at 4.5×10(6) IU/day subcutaneously; then, the dosage was tapered gradually depending on the clinical response. Previous immunosuppressive drugs such as systemic corticosteroids, azathioprine, and cyclosporine were stopped 1 day before the initiation of IFN-α-2a treatment.

Results: The mean duration of IFN-α-2a use was 13.3 months (range: 3-28 months). Eighty-three percent of patients with ocular BD achieved partial or complete response. Best-corrected visual acuity improved or remained stable in all of patients. All patients experienced flu like symptoms responding to oral acetaminophen, hair loss was also developed in 7 of them (58%), and psoriatic skin rash was seen in 3 patients (25%) during treatment with IFN-α-2a. No other side effects were observed.

Conclusions: IFN-α-2a treatment is effective in Behcet uveitis refractory to traditional treatment regimens and provides significant improvement in visual prognosis.
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http://dx.doi.org/10.1089/jop.2011.0238DOI Listing
August 2012

Choroidal tuberculoma in a patient with ocular Behçet disease.

Int Ophthalmol 2012 Feb 4;32(1):93-6. Epub 2012 Feb 4.

Department of Ophthalmology, Faculty of Medicine, Ankara University, 06100 Ankara, Turkey.

Behçet disease is a chronic relapsing inflammatory disease affecting many different organs. Ocular involvement is quite common in the course of Behçet disease and is frequently manifested by bilateral panuveitis and retinal vasculitis. Medications such as corticosteroids and immunosuppressive agents are used to reduce inflammation in patients with posterior or panuveitis. Chronic immunosuppression is a risk factor for systemic infections. We report a case of choroidal tuberculoma associated with tuberculosis in a patient with ocular Behçet disease. A 25-year-old female with known ocular Behçet disease contracted tuberculosis 3 months earlier. She had been receiving methotrexate and oral steroids. Funduscopy of the left eye revealed a choroidal tuberculoma located superonasally to the optic disc. Fluorescein angiography showed a central area of hypofluorescence surrounded by a hyperfluorescent zone. Since she was already receiving antituberculosis treatment combined with oral steroids, the same treatment was continued. Diagnosis of the other diseases that may cause uveitis in patients with Behçet disease should not be missed. This is especially important since immunosuppressive drugs, that cause an increased incidence of systemic infections, are the common treatment of choice for patients with Behçet disease.
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http://dx.doi.org/10.1007/s10792-012-9526-4DOI Listing
February 2012

Urokinase plasminogen activator receptor levels in Behcet's disease.

Thromb Res 2011 Sep 6;128(3):274-6. Epub 2011 Apr 6.

Ankara University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey.

Purpose: To determine urokinase plasminogen activator receptor (uPAR) concentrations in Behcet patients with and without ocular involvement; and to investigate the associations between uPAR levels and clinical manifestations of Behcet's disease.

Methods: Sixty-four patients with Behcet's disease (31 patients with and 33 patients without ocular involvement) and 23 healthy control subjects were included in this study. A complete ophthalmologic examination was performed. Venous blood was collected from all patients and control subjects. Serum uPAR levels were determined by using human uPAR immunoassay (Quantikine) kits.

Results: There was no statistically significant difference in serum uPAR levels between the patients and the control subjects (p>0.05). There were no statistically significant correlations between uPAR levels and age, gender, duration of the disease, clinical manifestations (genital ulcer, arthritis, skin lesions, ocular and vascular involvements) and activity of the disease.

Conclusion: This finding is important since this is the first study regarding uPAR levels in Behcet's disease.
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http://dx.doi.org/10.1016/j.thromres.2011.03.003DOI Listing
September 2011

Behçet disease in children.

Ocul Immunol Inflamm 2011 Apr;19(2):103-7

Department Ophthalmology, Ankara University Medical School, Ankara, Turkey.

Purpose: To investigate the incidence and clinical characteristics of Behçet disease in children.

Methods: The authors retrospectively reviewed the charts of 3382 patients with Behçet disease from October 1986 to December 2005 at Ankara University Medical School Behçet Unit and/or Atmaca private clinic.

Results: 110 children were diagnosed with Behçet disease. The 110 children represented 3.3% of the total number of Behçet patients that were reviewed. 62.7% were girls and 37.3% were boys. The mean age at initial manifestation was 11.63 ± 3.46 years and at diagnosis was 14.15 ± 2.13 years. Ocular involvement was found in 30.9% of the children. Of these, 61.8% were bilateral and 38.2% were unilateral. Anterior uveitis was found in 18 eyes (32.8%), posterior uveitis in 24 eyes (43.6%), and panuveitis in 13 eyes (23.6%).

Conclusion: Behçet disease should be considered in the differential diagnosis of childhood uveitis, particularly in endemic areas. The collaboration of pediatricians, rheumatologists, dermatologists, ophthalmologists, and other specialists when necessary is required in the diagnosis and management of children with Behçet disease.
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http://dx.doi.org/10.3109/09273948.2011.555592DOI Listing
April 2011

Optical coherence tomography findings of retinal folds in nanophthalmos.

Case Rep Ophthalmol Med 2011 23;2011:491894. Epub 2012 Jan 23.

Department of Ophthalmology, Faculty of Medicine, Ankara University, 06100 Ankara, Turkey.

Aim. To report the optical coherence tomography (OCT) findings in three members of the same family with nanophthalmos associated with elevated papillomacular retinal fold. Methods. Complete ophthalmic examination as well as ultrasonography and OCT was performed in all patients. Results. Axial lengths ranged from 16.75 mm to 17.48 mm and refractive errors ranged from +17.50 D to +20.50 D. Main fundus findings were the hyperopic crowded, cupless optic disc, and retinal fold through papillomacular region. Macular OCT scans revealed retinal fold with normal retinal pigment epithelium and choriocapillaris. Interpretation. It is presumed that the retinal folds in nanophthalmos result from a redundancy of the retinal layer caused by retarded growth of the scleral, choroidal, and retinal pigment epithelial layers. The anatomic information provided by the current study is consistent with this thesis.
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http://dx.doi.org/10.1155/2011/491894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3350234PMC
August 2012

Effectiveness of tacrolimus in high-risk limbal allo-graft transplantation.

Ann Ophthalmol (Skokie) 2008 Fall-Winter;40(3-4):152-6

Ankara University Faculty of Medicine, Ophthalmology Department, Ankara, Turkey.

We evaluated the efficacy and safety of tacrolimus in prevention of allograft rejection in high-risk allo-limbal grafts. Six eyes of six patients with severe limbal stem cell deficiency were included. All patients were started 0.1 mg x kg 1 x day(-1) tacrolimus orally 3 days before the surgery. Limbal allo-graft transplantation for ocular surface reconstruction had a successful outcome with using systemic tacrolimus for immunosuppression.
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March 2009

Serum haptoglobin levels in ocular Behçet disease and acute phase proteins in the course of Behçet disease.

Eur J Ophthalmol 2008 Sep-Oct;18(5):787-91

Department of Ophthalmology, Ankara University, Faculty of Medicine, Ankara - Turkey.

Purpose: Changes in concentrations of acute phase proteins in the serum of patients might be significant in the pathogenesis of Behçet disease. This report investigates the association between ocular disease activity and serum haptoglobin levels in patients with Behçet disease, and summarizes the current understanding of the correlation between acute phase proteins and Behçet disease based on both personal studies and data from the literature.

Methods: Thirty patients with Behçet disease with ocular involvement and 15 healthy subjects were included in the study. Of the 30 patients, 14 had acute uveitis and 16 had inactive ocular involvement at the time of enrollment.

Results: There was a significant difference in haptoglobin levels between the patients with active ocular disease and controls (p=0.0005). There was also a significant difference in haptoglobin levels between the patients with inactive ocular disease and control subjects (p<0.0001). However, no significant difference was observed among patients with active versus inactive uveitis with regard to serum haptoglobin levels.

Conclusions: Higher serum haptoglobin levels in patients with Behçet disease compared to control subjects were obtained. However, elevated serum haptoglobin levels do not seem to be a risk factor for uveitis activity. Behçet disease is generally diagnosed by physical examinations and no laboratory marker has been widely accepted for follow-up of disease activity.
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October 2008

Repair of anterior staphyloma with dehydrated dura mater patch graft.

Ophthalmic Surg Lasers Imaging 2008 Jul-Aug;39(4):346-7

Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey.

A case of postoperative large anterior staphyloma of the sclera was treated with a dehydrated cadaveric dura mater patch graft. Structural integrity of the globe and a good cosmetic result were obtained after the surgery. During the follow-up of 2 years, no recurrence of staphyloma developed.
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http://dx.doi.org/10.3928/15428877-20080701-19DOI Listing
September 2008

Pathergy-like reaction following intravitreal triamcinolone acetonide injection in a patient with Behçet disease.

Ocul Immunol Inflamm 2008 Jul-Aug;16(4):181-3

Faculty of Medicine, Ophthalmology Department, Ankara University, Ankara, Turkey.

Purpose: To describe a patient with Behcet disease who developed a pathergy-like reaction following intravitreal triamcinolone acetonide injection.

Methods: Case report.

Results: A 30-year-old man with a history of Behçet disease received an intravitreal injection of triamcinolone acetonide for the treatment of cystoid macular edema. The following day, he was noted to have erythematous swelling around the injection site. The lesion disappeared spontaneously within 2 weeks.

Conclusion: Pathergy-like reaction to minor trauma may develop not only on the skin but also in the mucous membranes such as conjunctiva in patients with Behçet disease.
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http://dx.doi.org/10.1080/09273940802204543DOI Listing
November 2008

Evaluation of serum resistin levels in patients with ocular and non-ocular Behçet's disease.

Can J Ophthalmol 2008 Aug;43(4):473-5

Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey.

Background: Resistin, a recently identified adipocytokine, has been found to play an important role in inflammation and the processes of inflammation-related diseases. Serum resistin levels in patients with Behçet's disease (BD) have not yet been investigated. We aimed to evaluate the relation between resistin and interleukin-6 (IL-6) in Behçet patients with or without ocular involvement and in normal controls.

Methods: Twenty-two patients with BD and 19 healthy control subjects were included in this study. While 14 patients had posterior segment involvement of the eye, the other 8 did not have ocular disease. Serum resistin and interleukin-6 (IL-6), levels were measured in all samples. Data from all groups were tested for statistical significance.

Results: The mean resistin and IL-6 concentrations were significantly higher in patients with BD than the control subjects (p = 0.011 and p = 0.0001, respectively). There was a significant difference in resistin and IL-6 levels between the patients with non-ocular BD and controls (p = 0.013 and p = 0.0001, respectively), as well as resistin and IL-6 levels between the ocular BD group and the control group (p = 0.05 and p = 0.0001, respectively). However, there was no significant difference between patients with ocular versus non-ocular BD.

Interpretation: Resistin levels were found to be raised in Behçet patients with or without ocular involvement compared with the control subjects.
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http://dx.doi.org/10.3129/i08-081DOI Listing
August 2008

Soluble endothelial protein C receptor levels in Behçet patients with and without ocular involvement.

Graefes Arch Clin Exp Ophthalmol 2008 Nov 5;246(11):1603-8. Epub 2008 Jul 5.

Department of Ophthalmology, Ankara University Faculty of Medicine, 06100, Ankara, Turkey.

Background: The protein C system is an important natural anticoagulant mechanism. Endothelial cell-activated protein C receptor (EPCR), which was discovered at the surface of endothelial cells, binds protein C and enhances its activation. The soluble form of EPCR (sEPCR) has been detected in plasma. Behçet's disease is a chronic inflammatory disorder affecting multiple organs. Arterial and venous thrombosis is a common clinical manifestation of Behçet's disease and the pathogenic mechanism of thrombotic tendency in the disease is not well known. The aim of this study is to determine sEPCR concentrations in Behçet patients with and without ocular involvement as well as to investigate the association between sEPCR levels and clinical manifestations of Behçet's disease.

Methods: Sixty patients with Behçet's disease and 67 healthy control subjects were included in this study. A complete ophthalmic examination was performed by ophthalmologists with an interest in Behçet's disease. Sixty patients with Behçet's disease were divided into two groups. Group 1 consisted of 30 patients with ocular involvement and Group 2 consisted of 30 patients without ocular involvement. Soluble EPCR levels were determined in plasma by using sEPCR Asserachrom enzyme-linked immunosorbent assay (ELISA) kits according to the manufacturer's instructions. Differences of the mean sEPCR levels between groups were evaluated using Mann-Whitney U-test. Pearson's correlation analysis was used for evaluating the correlation between sEPCR levels and age, gender, duration of the disease as well as different clinical manifestations of Behçet's disease.

Results: Age and gender ratio were not different between patients and controls. Plasma sEPCR concentrations were significantly higher in patients with Behçet's disease than those in controls (p<0.05). There was no statistically significant difference in serum sEPCR levels between the patients with versus the ones without ocular involvement. There were no statistically significant correlations between sEPCR levels and age, gender, duration of the disease or clinical manifestations.

Conclusions: Our data suggests a possible role of soluble EPCR in the pathogenesis of Behçet's disease. Further studies by possible mutations and polymorphisms in EPCR gene in patients with Behçet's disease would be useful to bring to light the pathogenic mechanism of ocular and systemic vascular complications of the disease.
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http://dx.doi.org/10.1007/s00417-008-0873-9DOI Listing
November 2008

Mycophenolate mofetil in the treatment of ocular inflammation in ANCA-associated vasculitis.

J Ocul Pharmacol Ther 2008 Apr;24(2):249-54

Department of Ophthalmology, University of Aberdeen Medical School, Aberdeen, UK.

Aim: The aim of this study was to describe the use of mycophenolate mofetil (MMF) in the treatment of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis with ocular involvement.

Methods: A retrospective review was performed. Ocular and systemic manifestations, history of previous immunosuppressive drug therapy, concurrent therapy with MMF, response to treatment, side effects related to the use of MMF, and follow-up period were recorded.

Results: Nine (9) eyes of 5 patients were evaluated. Ocular involvement included scleritis, choroidal and orbital granuloma, multifocal choroiditis, intermediate uveitis, and lacrimal gland involvement. Mycophenolate was started at 2 g daily. Mean follow-up after the initiation of MMF was 36 months. Mean prednisolone dose at onset of treatment with MMF was 27 mg daily and was reduced to 7 mg daily as disease control was achieved. Visual acuity was maintained or improved in all eyes, apart from 1 eye, which developed cataract formation. One (1) patient required a reduction in the dose of mycophenolate owing to diarrhea.

Conclusions: Our study suggests that mycophenolate mofetil may be a safe, effective therapeutic modality for ocular inflammation associated with ANCA-associated vasculitis.
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http://dx.doi.org/10.1089/jop.2007.0055DOI Listing
April 2008

Intravenous methylprednisolone pulse therapy for acute posterior segment uveitis attacks in Behçet's disease.

Ann Ophthalmol (Skokie) 2007 ;39(3):194-7

Department of Ophthalmology, Ankara University Medical School, Ankara, Turkey.

We evaluated the efficacy and safety of high-dose intravenous methylprednisolone (1 g x 3 days) pulse therapy followed in the management of acute posterior segment uveitis attacks in 25 patients with Behçet's disease. High-dose intravenous methylprednisolone pulse therapy may be beneficial in the prompt control of severe ocular inflammation and in preventing visual loss.
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http://dx.doi.org/10.1007/s12009-007-0018-5DOI Listing
December 2007