Publications by authors named "Nilüfer Yalçındağ"

42 Publications

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

Penetration of topically applied tacrolimus into the aqueous humor in Behçet's disease.

Ann Ophthalmol (Skokie) 2007 ;39(1):15-7

Ophthalmology Department, Ankara University Faculty of Medicine, Esat Caddes i 74/3 Küçükesat, Ankara, 06660, Turkey.

We investigated the concentration of tacrolimus in aqueous humor, and serum of patients with ocular Behçet's disease after topical application in 11 patients. All received 1 drop of isotonic tacrolimus solution 0.3% every 6 hours for 3 days. The mean tacrolimus concentration in the aqueous and serum, as measured by microparticle enzyme immunoassay, were 12.49 and 0.76 ng/mL, respectively. Tacrolimus may be a promising treatment modality in anterior uveitis in Behçet's disease by topical application.
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http://dx.doi.org/10.1007/BF02697321DOI Listing
November 2007

Serum leptin levels in patients with ocular and nonocular Behçet's disease.

Mediators Inflamm 2007 ;2007:31986

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

Aims: To investigate serum leptin levels in Behçet's patients with or without ocular involvement compared with healthy subjects and the relationship between serum leptin and uveitis activity in patients with ocular involvement.

Methods: Fifty-seven patients with Behçet's disease and 20 healthy control subjects were included in this study. While 27 patients had ocular involvement (18 had acute uveitis, 9 had inactive ocular involvement), 30 did not have ocular disease. C-reactive protein, alpha 1-antitrypsin, and serum leptin levels were measured in all samples.

Results: There was a significant difference between the patients with Behçet's disease and control group for both logarithm of leptin (P = .000) and logarithm of CRP (P = .031). Logarithm of leptin in non-ocular Behçet's patients was significantly higher compared to its level in ocular Behçet's disease and controls (P = .009). There was a significant difference between the patients with active ocular disease and control group (P = .03).

Conclusions: Leptin might have a possible role in the pathogenesis of Behçet's disease.
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http://dx.doi.org/10.1155/2007/31986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1906708PMC
July 2008

Aqueous humor and serum penetration of tacrolimus after topical and oral administration in rats: an absorption study.

Clin Ophthalmol 2007 Mar;1(1):61-4

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

Purpose: To investigate the penetration of tacrolimus to the aqueous and serum after topical and oral administration.

Methods: Thirty Wistar rats were divided into three groups. In the first group (n = 12), a single dose of 0.3 % isotonic tacrolimus solution was applied topically to the rat eyes. The second group (n = 12), received 0.1 mg/kg/day tacrolimus for three days. In control group (n = 6), the rats were administered a single drop of 0.3% salin solution topically. Following collection of samples, the amounts of tacrolimus in aqueous and serum samples were compared with each other.

Results: In group I, the mean concentration of tacrolimus was 35.16 ng/ml in aqueous and 2.22 ng/ml in serum. In group II, the mean concentration of tacrolimus was 13.08 ng/ml in aqueous and 13.45 ng/ml in serum. There was no significant difference in the serum concentration levels of tacrolimus between group I and control group. However there was a significant difference of the drug concentrations in aqueous between the groups (p < 0.001). The mean aqueous and serum concentrations of tacrolimus in group II, differed significantly from the mean concentrations in group I (p < 0.001) and the control group (p < 0.001).

Conclusion: Tacrolimus may be a promising treatment modality in intraocular inflammation by topical application besides systemic administration.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699987PMC
March 2007

Intravitreal triamcinolone acetonide in the management of cystoid macular edema in Behçet's disease.

Graefes Arch Clin Exp Ophthalmol 2007 Mar 17;245(3):451-6. Epub 2007 Jan 17.

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

Purpose: To determine the efficacy of intravitreal triamcinolone acetonide (ivTA) injection in the management of cystoid macular edema (CME) due to uveitis in patients with Behçet's disease.

Methods: Ten eyes of seven patients with CME associated with Behçet's disease were included in the study. A quantity of 4 mg of triamcinolone acetonide was injected intravitreally in all of the eyes. The maculas of the patients were evaluated with optical coherence tomography (OCT) and fluorescein angiography (FA). The change in visual acuity, fluorescein leakage, macular thickness, and potential complications were assessed.

Results: The mean follow-up was 15.6 months (range 7-19 months). There was an increase of more than two Snellen lines in the visual acuity in seven of the ten eyes (70%) at the last examination. Macular edema regressed completely in eight of the ten eyes (80%) at the last visit on OCT and FA. The mean central macular thickness assessed by OCT was 406 mum before treatment and 186.9 mum at the last visit. The intraocular pressure (IOP) exceeded 21 mmHg in six eyes of five patients (60%) during the follow-up. At the last visit, the IOP was less than 21 mmHg in five eyes with medication. One eye underwent glaucoma filtration surgery. Four eyes of three patients had cataract progression. In four eyes of four patients (40%), a second ivTA injection was given due to relapsing CME.

Conclusion: Intravitreal triamcinolone acetonide (ivTA) may be beneficial in the management of CME in patients with Behçet's disease. Repeated ivTA injections might be required if CME reoccurs.
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http://dx.doi.org/10.1007/s00417-006-0514-0DOI Listing
March 2007

Causes of chemoreduction failure in retinoblastoma and analysis of associated factors leading to eventual treatment with external beam radiotherapy and enucleation.

Ophthalmology 2004 Oct;111(10):1917-24

Ocular Oncology Service, Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey.

Purpose: To evaluate the causes of chemoreduction failure in retinoblastoma and to analyze the associated factors for eventual treatment with external beam radiotherapy and enucleation.

Design: Prospective noncomparative case series.

Participants: Seventy-one patients with 105 eyes with intraocular retinoblastoma that underwent chemoreduction therapy between October 1998 and January 2003.

Intervention: A 6-treatment cycle of chemoreduction therapy with vincristine, etoposide, and carboplatin was administered at monthly intervals. Unresponsive disease was defined as persistence of retinal tumors, vitreous seeds, or subretinal seeds after the second treatment cycle, with no appreciable sign of regression. Eyes with unresponsive disease were enucleated after the second treatment. Eyes that responded to chemoreduction therapy received focal treatment, including indirect laser photocoagulation, transpupillary thermotherapy, cryotherapy, and ruthenium 106 episcleral plaque radiotherapy after the second chemoreduction treatment, if necessary, to achieve complete tumor regression. Recurrence was defined as the regrowth of retinal tumors, vitreous or subretinal seeds after an initial favorable response, and regression. Recurrent retinal tumor, vitreous seeds, or subretinal seeds were treated with focal treatments and 2 to 3 additional chemoreduction treatments. When these methods failed or were not applicable, external beam radiotherapy and/or enucleation was administered.

Main Outcome Measures: The use of external beam radiotherapy and enucleation for chemoreduction failure, which was defined as unresponsive or recurrent disease.

Results: The mean follow-up was 25.7 months (range: 6-49). Ten of 105 eyes (9.5%) with unresponsive disease were enucleated after the second treatment. Of the remaining 95 eyes, 42 (44.2%) developed recurrence after chemoreduction. Recurrent disease failing to be treated successfully by other methods was treated with external beam radiotherapy in 26 of 95 eyes (27.4%) and enucleation in 22 of 95 eyes (23.2%). External beam radiotherapy was successful in preventing enucleation in 20 of 26 eyes (76.9%). Overall, the globe salvage rate was 69.5%, ranging from 36.1% for Reese-Ellsworth group V disease to 87.0% for groups I to IV disease. Histopathologically, 29 of 31 enucleated eyes (93.5%) had poorly differentiated or moderately differentiated retinoblastoma. Using multivariate logistic regression analysis, factors predictive of eventual treatment with external beam radiotherapy were female gender (P = 0.010), presence of subretinal seeds (P = 0.023), and a greater number of chemoreduction treatments (P = 0.027). By multivariate analysis, the factors associated with the need for eventual treatment with enucleation were recurrence of retinal tumors (P = 0.004), presence of vitreous seeds (P = 0.008), greater tumor thickness (P = 0.015), presence of subretinal fluid (P = 0.040), and older patient age (P = 0.042).

Conclusions: Chemoreduction failure in this article was defined as unresponsive or, more commonly, recurrent retinoblastoma. Older patient age, greater tumor thickness, presence of vitreous seeds and subretinal fluid at baseline, and retinal tumor recurrence after chemoreduction were factors associated with the need for enucleation.
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http://dx.doi.org/10.1016/j.ophtha.2004.04.016DOI Listing
October 2004

Corneal topographic changes after retinal detachment surgery.

Cornea 2002 Nov;21(8):803-6

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

Purpose: To evaluate the changes in corneal topography after scleral buckling surgery for retinal detachment.

Methods: Twenty-one eyes of 21 patients with the diagnosis of retinal detachment were included in this prospective study. Scleral buckling surgery was performed on all patients. The corneal topography of each was measured before surgery and at 1 week and 1 and 6 months after surgery by computer-assisted videokeratoscopy using the EyeSys 2000 Corneal Analysis System. Changes in corneal videokeratographies were analyzed using the Holladay Diagnostic Summary (HDS) software package.

Results: A statistically significant central corneal steepening (average, 1.8 diopter) was noted 1 week after surgery. The total and irregular astigmatic components both revealed a significant but transient increase in the first postoperative month. All these topographic changes persisted for as long as 6 months but returned to preoperative values afterward.

Conclusion: Scleral buckling was found to induce transient changes in corneal topography producing both myopia and corneal astigmatism. Videokeratography is helpful for documenting such corneal changes after scleral buckling surgery for retinal detachment.
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http://dx.doi.org/10.1097/00003226-200211000-00015DOI Listing
November 2002