Publications by authors named "Pınar C Özdal"

13 Publications

  • Page 1 of 1

Increased levels of circulating CD34+ cells in neovascular age-related macular degeneration: relation with clinical and OCT features.

Eur J Ophthalmol 2018 Jan 19;28(1):80-86. Epub 2018 Feb 19.

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

Purpose: To investigate the levels of circulating CD34+ stem cells in patients with neovascular type age-related macular degeneration (AMD) and its relation with clinical and optical coherence tomography (OCT) findings.

Methods: The study consisted of 55 patients: 28 patients (18 male and 10 female) with neovascular type AMD as a study group and 27 patients (12 male and 15 female) scheduled for cataract surgery as a control group. The level of CD34+ stem cells was measured by flow cytometry. Demographic and clinical data were recorded.

Results: The mean ages of patients in the study and control groups were 71 ± 8 and 68 ± 6 years, respectively. There was no statistically significant difference in terms of age, sex, or systemic disease association between study and control groups. However, smoking status was significantly higher in the study group (67.9% vs 37.0%; p = 0.02). Stem cell levels were significantly higher in the study group (1.5 ± 0.9 vs 0.5 ± 0.3; p<0.001), but there was no relation between stem cell levels and clinical and OCT findings.

Conclusions: Increased circulating CD34+ stem cell levels were observed in patients with choroidal neovascular membrane associated with AMD, but no significant relation was found between cell levels and clinical and OCT findings.
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January 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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August 2018

Clinical and Demographic Characteristics of Patients with Uveitis Starting Later in Life.

Ocul Immunol Inflamm 2015 Aug 1;23(4):304-310. Epub 2014 Aug 1.

a Ulucanlar Eye Training and Research Hospital , Ankara , Turkey and.

Purpose: To evaluate uveitis cases presenting at older ages for the first time.

Methods: We retrospectively analyzed the clinical data related to the 90 eyes of 68 patients who presented with a first episode of uveitis at the age of ≥60 years and were seen at the Uveitis Division of the Ulucanlar Eye Hospital from 1996 to 2013.

Results: The location of the uveitis was anterior in 51 (75%) patients. Nine patients (13.2%) presented with panuveitis, 5 (7.3%) with posterior uveitis, and 3 (4.4%) patients with intermediate uveitis. Idiopathic uveitis in 23 (33.8%) and presumed herpetic anterior uveitis in 23 (33.8%) patients were the most common diagnoses, while other diagnostic entities accounted for 22 (32.3%) patients. The most common complications were elevation of intraocular pressure in 17.7%, cystoid macular edema (CME) in 11.1%, and corneal scar in 11.1% of eyes.

Conclusions: While idiopathic uveitis and presumed herpetic anterior uveitis were the most common causes, although in an endemic country, Behçet disease was not a common cause of uveitis in the elderly population.
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August 2015

Presumed herpetic anterior uveitis: a study with retrospective analysis of 79 cases.

Eur J Ophthalmol 2014 Jan-Feb;24(1):14-20. Epub 2013 Jun 24.

1 Ulucanlar Eye Training and Research Hospital, Ankara - Turkey.

Purpose: To describe the clinical features, visual outcome, medical treatment, and complications of presumed herpetic anterior uveitis.

Methods: We retrospectively analyzed the clinical data related to 79 eyes of 77 patients with presumed herpetic anterior uveitis seen at the Uveitis Unit of the Ulucanlar Eye Training and Research Hospital from 1996 to 2011. Age at onset of disease, sex, follow-up duration, existence of corneal involvement, posterior synechiae, distorted pupil, iris atrophy, characteristic of keratic precipitates, elevated intraocular pressure (IOP), medical treatment, recurrence rate, complications, visual acuities (VA), and surgery for complications were recorded. The complication rates in patients with and without corneal involvement were compared.

Results: There were 38 (49.4%) female and 39 (50.6%) male patients. The mean age at presentation was 48.5 ± 14.8 (20-82) years. The follow-up period was 26.5 (2-127) months. Two patients had bilateral involvement. Ocular findings were a corneal scar or active keratitis in 37 (46.8%) eyes, secondary glaucoma in 14 (17.7%), iris atrophy in 39 (49.4%), distorted pupil in 16 (20.3%), posterior synechiae in 23 (29.1%), and granulomatous anterior uveitis in 30 (40%) eyes. Eight (10.1%) eyes had a posterior subcapsular cataract. Glaucoma surgery was required for uncontrolled IOP with maximum medical treatment in 2 (2.4%) eyes. Long-term oral acyclovir was used in 9 (11.3%) patients. Final VA was ≤ 0.1 in 8 (10.1%) eyes; of these, 6 had either corneal scarring or cataract and 2 preexisting amblyopia.

Conclusions: Presumed herpetic anterior uveitis with or without keratitis has characteristic clinical findings that enable the diagnosis. Long-term prophylactic antiviral therapy should be considered especially in patients <50 years old.
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February 2014

Congenital simple hamartoma of retinal pigment epithelium: clinical and imaging findings.

Case Rep Ophthalmol Med 2012 9;2012:654502. Epub 2012 Apr 9.

Retina Department, Ulucanlar Eye Research and Training Hospital, 06460 Ankara, Turkey.

Congenital simple hamartoma of retinal pigment epithelium (CSHRPE) is a rare, asymptomatic, and incidentally detected benign lesion. However, it is very important to do the differential diagnosis from other pigmented retinal lesions. Its clinical presentation and imaging findings are very helpful in doing this differentiation. This paper presents clinical and imaging findings of a 56-year-old woman with incidentally detected CSHRPE. The lesion was small, heavily pigmented, well circumscribed, and slightly elevated. Optical coherence tomography (OCT) scanning was diagnostic and showed an elevated retina at the site of the lesion, increased optical reflectivity on its inner surface, optical shadowing of deeper structures, and clearly cut tumor margins. Ocular ultrasonography, fluorescein angiography, and fundus autofluorescence imaging which is firstly described in this report did not show any characteristic finding.
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August 2012

Patterns of childhood-onset uveitis in a referral center in Turkey.

J Ophthalmic Inflamm Infect 2012 Mar 16;2(1):13-9. Epub 2011 Oct 16.

Ulucanlar Eye Hospital, Ankara, Turkey,

Purpose: This study aimed to investigate the frequency and characteristics of childhood-onset uveitis and evaluate the rate and specific causes of visual loss in this population.

Methods: The data of 121 patients (179 eyes) with uveitis starting before ≤16 years and followed up for at least 6 months were retrospectively evaluated. Age at onset, sex, laterality, associated systemic disease, laboratory data, therapeutic strategies, surgeries, final visual acuity, and causes leading to visual acuity ≤20/200 were analyzed.

Results: Childhood-onset uveitis made up 9.6% of our uveitis patients. The mean age at onset was 11.7 years (1-16) and the mean follow-up period was 38.5 months (6-148). Forty-three patients (35.5%) were female and 78 were male (64.5%). The disease was bilateral in 58 (47.9%) and unilateral in 63 (52.1%) patients. Uveitis was mostly (59.5%) seen between 12 and 16 years of age. Pars planitis, observed in 29 (24%) patients, was the leading cause of childhood-onset uveitis. Uveitis was idiopathic in 20 (16.5%) of patients. The most frequently associated diseases were Behcet's disease (BD) in 20 (16.5%), toxoplasmosis in 16 (13.2%), and juvenile idiopathic arthritis (JIA) in 8 (6.6%) patients. Anterior uveitis was observed in 38 (31.4%), intermediate uveitis in 31 (25.6%), posterior uveitis in 30 (24.8%), and panuveitis in 22 (18.2%) patients. The final visual acuity was ≤20/200 in 32/179 eyes (17.9%) of 27/121 patients (22.3%). The most often ocular complication leading to visual acuity ≤20/200 was optic atrophy and had been observed in 14 of 32 eyes (43.7%). Macular scar observed in five eyes (15.6%) was the second most often complication. Etiological distribution of 27 patients with visual acuity ≤20/200 was as follows: 12 had BD (44.4%), 5 had idiopathic uveitis (18.5%), 4 had pars planitis (14.8%), 3 had toxoplasmosis (11.1%), 2 had JIA (7.4%), and 1 had toxocara (3.7%).

Conclusions: Although rare, childhood-onset uveitis has a blinding potential and causes visual loss in up to 22.3% of the patients. In endemic areas like Turkey, BD may be the most common uveitis-associated systemic disease and the leading cause of visual loss in childhood uveitis as adulthood.
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March 2012

Cyclooxygenase-2 expression in human irradiated uveal melanomas.

Int Ophthalmol 2008 Feb 30;28(1):1-6. Epub 2007 Jun 30.

Sehit Cevdet Ozdemir Mah., Seftali Sok.74/17, Dikmen, Ankara, 06450, Turkey.

Aim: Previous studies have shown that radiotherapy is a stimulus for cyclooxygenase-2 (COX-2) expression and that use of COX-2 inhibitors enhances the radio sensitivity of tumor cells. The objective of this study was to evaluate COX-2 expression, and its correlation with tumor regrowth after irradiation, in enucleated eyes with uveal melanomas.

Methods: Fifteen tissue samples from patients who underwent enucleation after radiotherapy between 1988 and 2001 were used. Nine cases (60%) were enucleated because of tumor regrowth and six (40%) because of severe complications of radiotherapy. Specimens were immunostained for COX-2, and tumor cells were evaluated for specific cytoplasmic and granular immunostaining. COX-2 expression for these cases was compared with that in the previous study including 40 non-irradiated uveal melanoma cases. COX-2 expression was also correlated with tumor regrowth after radiotherapy.

Results: Two cases (13.3%) were positive and thirteen (86.7%) were negative for COX-2 expression. One of the positive cases had been enucleated because of tumor regrowth and one because of radiotherapy complications. There was no relationship between tumor regrowth and COX-2 expression. COX-2 expression was significantly lower in irradiated cases than in non-irradiated cases in the previous study (p<0.001).

Conclusions: In contrast with studies showing an increase of COX-2 expression in other irradiated malignancies, irradiation was not a factor inducing COX-2 in uveal melanomas. Radiotherapy may, moreover, be a factor that reduces COX-2 expression in uveal melanomas.
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February 2008

Combination of azathioprine and corticosteroids in the treatment of serpiginous choroiditis.

Can J Ophthalmol 2006 Apr;41(2):183-9

Uveitis and Ocular Immunology Unit, Department of Ophthalmology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada.

Background: Although therapy with immunosuppressive agents is currently accepted as the best option for treating active serpiginous choroiditis (SC), there is no consensus on the most effective immunosuppressive drug to use. In this paper, we describe the clinical course of patients with active SC treated with azathioprine (AZA) in combination with corticosteroids.

Methods: This retrospective study included 4 patients (5 eyes) with active, vision-threatening SC who received systemic immunosuppression with AZA at 1.5 to 2.0 mg/kg per day. In combination with oral AZA, patients also received 1 mg/kg oral prednisone per day. Information collected included Snellen visual acuity (VA), clinical disease activity, duration of follow-up, rate of inflammation recurrence, and side effects of AZA.

Results: Within 3 weeks of treatment, all patients experienced decreased ocular inflammation and improved VA. One patient, however, had a recurrence in both eyes while oral prednisone was being tapered. In this case, once the dosage of oral prednisone was increased and methotrexate was added to the therapeutic scheme, inflammation was controlled within 1 month. The other 3 patients presented no further visual loss while on AZA and were able to taper and then discontinue oral prednisone. Nevertheless, SC recurred in 1 of these patients 40 months after the initial treatment. AZA was reintroduced but the patient complained of gastrointestinal problems, and it was then successfully replaced by mycophenolate mofetil. None of the 4 patients presented serious systemic side effects secondary to AZA.

Interpretation: This study suggests that when AZA is used in combination with corticosteroids it is a safe and acceptable option for treating patients with active SC. Side effects and recurrences while on AZA therapy can occur, requiring either replacement of the drug or addition of another immunosuppressive agent.
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April 2006

Chemoattraction of inflammatory cells by various intraocular lens materials.

Ocul Immunol Inflamm 2005 Dec;13(6):435-8

Department of Ophthalmology, McGill University, Montréal, Québec, Canada.

Purpose: To compare the chemotactic activity induced by polymethyl methacrylate (PMMA), acrylic, and silicone intraocular lens (IOL) materials, regardless of the surgical and host factors.

Methods: The chemotactic effect of five different IOLs was studied using a modified multi-well Boyden chamber. Two different non-coated PMMA IOLs, a heparin-coated PMMA IOL, an acrylic IOL, and a silicone IOL were assessed. Each mean migration distance of the IOLs was compared with the others using Student's t test.

Results: All IOLs induced some amount of leukocyte chemotaxis. There was no statistically significant difference between the chemotactic activity of PMMA IOLs. However, chemotactic activity was significantly higher in acrylic (p<0.05) and silicone (p<0.05) IOLs compared to one of the PMMA lenses.

Conclusions: This limited study has proven that chemotaxis assay is a useful tool to assess the biocompatibility of IOLs. The IOL material itself might attract inflammatory cells to its surface in the absence of surgical and host factors. As PMMA IOLs do not cause an increase in inflammatory reaction, they may be considered safe to use. Further improvement in chemical composition and surface characteristics of IOLs should reduce the inflammatory reaction and increase the biocompatibility and safety of IOLs.
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December 2005

Visual outcome of juvenile rheumatoid arthritis-associated uveitis in adults.

Ocul Immunol Inflamm 2005 Feb;13(1):33-8

McGill University, Department of Ophthalmology, Uveitis Service Montréal Canada.

Purpose: Juvenile rheumatoid arthritis (JRA) is the systemic disease most frequently associated in childhood uveitis. The disease may cause several ocular complications, visual impairment, and blindness. Recent studies revealed a more favorable ocular prognosis. Our purpose was to analyze the long-term visual outcome of JRA-associated uveitis.

Methods: Ocular complications and visual outcome in adult patients with JRA-associated uveitis were evaluated. Among 18 patients included in the study, uveitis was bilateral in 12 (66.7%) and unilateral in six (33.3%), for a total of 30 eyes with ocular involvement.

Results: The mean durations of JRA and its associated uveitis were 24.9 and 20.5 years, respectively. All eyes (100%) had at least one ocular complication. The most frequently observed ocular complications were cataract (83.3%), band keratopathy (60%), posterior synechia (46.7%), glaucoma (33.3%), hypotony (16.7%), and macular pathology (13.3%). Final visual acuity was impaired in 40% of the eyes, poor in 20%, and totally lost in 10%. Therefore, 70% of the eyes were either visually handicapped or totally blind. Most eyes underwent at least one surgical procedure. Inflammation was active at last examination in 63.3% of eyes. All patients were still treated topically and with systemic NSAID. Sixty-one percent of the patients were using an immunosuppressive agent.

Conclusion: JRA-associated uveitis still has a severe course and blinding potential. Patients suffer from uveitis and its complications even during the adulthood period. However, because our series represents a more severe subset of the disease, the outcome may be poorer than that of some other outcome studies.
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February 2005

Longterm follow-up of patients with multifocal choroiditis and panuveitis.

Acta Ophthalmol Scand 2004 Dec;82(6):748-53

Uveitis and Ocular Immunology Unit, Department of Ophthalmology, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada.

Purpose: To report the visual prognosis and longterm complications in patients with multifocal choroiditis and panuveitis (MCP).

Methods: A retrospective study was performed with patients who met inclusion criteria for MCP at the Uveitis Clinic, Royal Victoria Hospital, McGill University, Montreal, Canada. Information collected included duration of follow-up, visual acuity (VA) measured at each clinical visit, ocular and systemic treatment and ocular complications observed during follow-up.

Results: Nineteen patients (37 eyes) with MCP with a mean follow-up of 76.9 months were studied. Kaplan-Meier survival analysis showed a decrease in the proportion of patients with a final VA > or = 20/40 over time. Cystoid macular oedema was seen in 29.7% of the eyes and was the most frequent macular abnormality observed in our group. On the other hand, choroidal neovascularization was detected in only six (16.2%) of the eyes, but was related to VA < 20/200 in four of these eyes. Glaucoma was detected in 10.8% of the eyes. Cataract (posterior subcapsular and/or nuclear) was the most common longterm complication, occurring in 40% of affected eyes. Cataract surgery improved the VA in 83.3% of these eyes.

Conclusion: The visual acuity of patients with MCP decreases with time. Visual loss can occur from complications following the inflammation itself and/or iatrogenic induced by the chronic use of corticosteroids.
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December 2004

Capillary hemangioma of the caruncle.

Can J Ophthalmol 2004 Aug;39(5):560-2

SSK Eye Hospital, Ankara, Turkey.

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August 2004

Ultrasound biomicroscopy of pseudophakic eyes with chronic postoperative inflammation.

J Cataract Refract Surg 2003 Jun;29(6):1185-91

McGill University Health Center, Department of Ophthalmology, Montréal, Québec, Canada.

Purpose: To evaluate the ultrasound biomicroscopy (UBM) findings in pseudophakic eyes with chronic noninfectious postoperative inflammation and discuss the use of the technique in these cases.

Setting: Uveitis Service, Department of Ophthalmology, McGill University, Montréal, Québec, Canada.

Methods: Fifty-four eyes of 51 patients with chronic noninfectious postoperative inflammation were prospectively evaluated between January 1998 and September 2001. Patients with aphakia, a dislocated intraocular lens (IOL) in the posterior segment, and endophthalmitis were excluded. All patients had a UBM examination that comprised locating the IOL position, investigating the presence of lens remnants, and evaluating the anterior segment of the eye.

Results: Ultrasound biomicroscopic examination revealed IOL misplacement in 37 eyes (68.5%). Of these, 23 (62.2%) had a sulcus-implanted posterior chamber IOL (PC IOL), 9 (24.3%) an in-the-bag PC IOL, and 5 (13.5%) an anterior chamber IOL. Haptic misplacement was significantly higher with sulcus-implanted PC IOLs than with in-the-bag PC IOLs (P<.01). Other UBM findings included edematous ciliary body processes and hypoechogenic and/or thickened ciliary bodies in 11 eyes (20.4%), peripheral anterior synechias in 8 eyes (14.8%), a significant number of lens remnants (graded as severe) in 6 eyes (11.1%), a thick cyclitic membrane in 3 eyes (5.6%), and an early cyclitic membrane in 2 eyes (3.7%).

Conclusions: Irritation of ocular tissues by an IOL was the main cause of chronic postoperative noninfectious inflammation in pseudophakic eyes. Therefore, detecting the IOL position and its relationships to ocular tissues is very important in planning the treatment. Ultrasound biomicroscopy is a practical method that accurately provides this information.
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June 2003