Publications by authors named "Pinar Cakar-Ozdal"

33 Publications

Comparison of pediatric patients with noninfectious idiopathic uveitis and noninfectious uveitis associated with an underlying systemic disease: from a referral center in Turkey.

Postgrad Med 2021 Mar 31:1-5. Epub 2021 Mar 31.

Department of Pediatric Rheumatology, University of Health Sciences Turkey, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey.

: The aim of this study was to determine the demographic, clinical, treatment, and outcome features of pediatric noninfectious uveitis patients at a Turkish tertiary center.: This retrospective cohort study included 101 pediatric patients with noninfectious uveitis. Location of uveitis, laterality, age at onset of uveitis, complications of uveitis, duration of follow-up, associated systemic diseases, laboratory findings, medications used, and status of uveitis at the time of data collection were obtained from the patients' files. The patients were divided into two groups according to etiology of uveitis, as follows; group 1: idiopathic noninfectious uveitis; group 2: noninfectious uveitis in association with an underlying systemic disease. Clinical findings were compared between the two groups.: Mean age at diagnosis of uveitis was 9.36 ± 4.24 years and mean duration of follow-up was 48.4 ± 9.2 months. Anterior uveitis was the most common form, accounting for 69.3% (n = 70) of the patients. There were 67 (66.3%) patients in group 1 and 34 (33.7%) patients in group 2. Mean age at diagnosis of uveitis was lower in group 2 (p < 0.05). Although gender, type of inflammation, laterality of eye involvement, and mean age at initiation of biological treatment did not differ between the groups; symptomatic uveitis was more common in group 1, whereas anterior uveitis was also more common in group 2 (p < 0.05). At the time of data collection 16 (15.8%) of the patients had active uveitis. Ocular complications were observed fewer in idiopathic noninfectious uveitis group than noninfectious uveitis associated with an underlying systemic disease (p < 0.05). Biological therapy was administered in 26.8% of the patients in group 1, versus 67.6% of those in group 2. Ocular complications were observed in 22.8% of the patients at presentation or during the follow-up.: Herein a large retrospective cohort of noninfectious pediatric uveitis has been described. The findings indicate that noninfectious idiopathic uveitis is characterized by more symptomatic, later onset, and fewer complications than noninfectious uveitis associated with an underlying systemic disease.
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http://dx.doi.org/10.1080/00325481.2021.1902684DOI Listing
March 2021

An Unusual Presentation of Vogt-Koyanagi-Harada.

J Ophthalmic Vis Res 2021 Jan-Mar;16(1):140-144. Epub 2021 Jan 20.

Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey.

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http://dx.doi.org/10.18502/jovr.v16i1.8263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841286PMC
January 2021

Inflammatory markers of complete blood count in Fuchs uveitis syndrome.

Can J Ophthalmol 2020 Nov 21. Epub 2020 Nov 21.

Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey.

Objective: To evaluate inflammatory indices of complete blood count (CBC) in patients with Fuchs uveitis syndrome (FUS), and to compare the results with healthy individuals.

Design: Cross-sectional, comparative study.

Participants: A total of 140 participants were included in the study and divided into 2 groups: 70 patients diagnosed with FUS (FUS group) and 70 healthy individuals (control group).

Methods: The groups were compared in terms of ocular examination findings and CBC parameters. The independent samples t test was used to examine variables between the groups. The Pearson correlation test was performed to analyze correlation among the severity of anterior chamber reaction, duration of FUS, and CBC indices.

Results: The mean lymphocyte count and lymphocyte-to-monocyte ratio (LMR) were significantly higher in the FUS group than in the control group (p = 0.001 and p < 0.001, respectively). The mean monocyte count and neutrophil-to-lymphocyte ratio (NLR) were significantly lower in the FUS group than in the control group (p = 0.010 and p = 0.003, respectively). In the receiver operating characteristic curve analysis, the area under the curve (AUC) for LMR was 0.834, with a sensitivity of 82.6% and a specificity of 80.0%. The AUC for NLR was 0.789, with a sensitivity of 71.2% and a specificity of 70.0%. LMR was positively correlated with duration of FUS (p = 0.001, r = 0.574).

Conclusions: Our findings suggest that decreased NLR and increased LMR values may be markers indicating impaired blood-aqueous barrier function in FUS.
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http://dx.doi.org/10.1016/j.jcjo.2020.10.016DOI Listing
November 2020

Behçet's disease uveitis: is there a need for new emerging drugs?

Expert Opin Emerg Drugs 2020 12 30;25(4):531-547. Epub 2020 Nov 30.

Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Education and Research Hospital , Ankara, Turkey.

: Behçet's disease uveitis (BDU) is a potentially blinding disorder. Systemic treatment with disease-modifying anti-rheumatic drugs (DMARDs) is mandatory in patients with intraocular inflammation involving the posterior segment of the eye. : This article discusses existing systemic treatment with corticosteroids and conventional and biologic DMARDs as well as adjunctive local therapy in BDU. An overview is provided for a wide range of biologic DMARDs that have shown promise or investigated in clinical trials. Most recently introduced biologic DMARDs and targeted synthetic DMARDs are also reviewed for their potential in the treatment of BDU. : The prognosis of patients with BDU has remarkably improved after the introduction of biologic DMARDs. An expanding therapeutic armamentarium will allow treatment of most refractory cases. The ultimate goal is to provide drug-free remission with preservation of 20/20 vision.
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http://dx.doi.org/10.1080/14728214.2020.1847271DOI Listing
December 2020

Unilateral Acute Macular Toxoplasmic Chorioretinitis Associated with White Dot-Like Choroidal Involvement Demonstrated on Indocyanine Green Angiography

Turk J Ophthalmol 2020 08;50(4):248-251

Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey.

A 9-year-old otherwise healthy boy was examined due to a 4-day history of visual decline in his right eye. Ophthalmological examination revealed an area of active retinochoroiditis in the right macula. Indocyanine green angiography (ICGA) demonstrated multiple hypocyanescent dots surrounding the active lesion extending 360 degrees towards the equator. Optical coherence tomography angiography (OCTA) exhibited dark dots on the choriocapillaris slab over areas corresponding to the hypocyanescent dots detected with ICGA. Full systemic examination and laboratory investigations were carried out. serology was positive. The diagnosis of toxoplasmic chorioretinitis with white dot-like choroidal involvement was made. Trimethoprim/sulfamethoxazole, azithromycin, and oral prednisolone were administered orally. On repeated ICGA 2 weeks later, the scattered hypocyanescent dots were significantly fewer in number. A month later, right visual acuity was improved, the macular chorioretinitis focus had become inactive, an epiretinal membrane had formed, and the dark dots on the choriocapillaris slab of OCTA were markedly diminished. ICGA may be helpful to observe possible, subtle choroidal involvement in patients with toxoplasmic chorioretinitis.
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http://dx.doi.org/10.4274/tjo.galenos.2020.93636DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7469894PMC
August 2020

Behçet's Uveitis: Current Diagnostic and Therapeutic Approach

Turk J Ophthalmol 2020 06;50(3):169-182

University of Health Sciences Turkey, Ulucanlar Eye Training and Research Hospital, Clinic of Ophthalmology, Ankara, Turkey.

Behçet's disease is a chronic, multisystem inflammatory disorder characterized by relapsing inflammation. Although its etiopathogenesis has not yet been clarified, both the adaptive and innate immune systems, genetic predisposition, and environmental factors have all been implicated. It is more frequent and more severe in males in the third and fourth decades of life. The eye is the most frequently involved organ in the course of the disease. Ocular involvement (Behçet's uveitis) is characterized by bilateral recurrent non-granulomatous panuveitis and occlusive retinal vasculitis. Recurrent inflammatory episodes in the posterior segment may lead to permanent vision loss due to irreversible retinal damage and complications such as macular scarring, macular atrophy, and optic atrophy. Early and aggressive immunomodulatory treatment and the use of biologic agents when needed are crucial for preventing recurrences and improving visual prognosis.
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http://dx.doi.org/10.4274/tjo.galenos.2019.60308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7338748PMC
June 2020

Valsalva retinopathy: Long-term results and management strategies.

Eur J Ophthalmol 2020 Jun 25:1120672120936175. Epub 2020 Jun 25.

Ulucanlar Training and Research Hospital, Ophthalmology Department of Health Sciences University, Ankara, Turkey.

Purpose: To investigate the long-term results and efficacy of the treatment modalities for preretinal hemorrhage due to valsalva retinopathy.

Methods: Retrospective review was conducted on 24 eyes of 24 patients with valsalva retinopathy who were treated between 2004 and 2019. These patients were treated with Nd:YAG laser, argon laser and vitrectomy or were only observed. Nd:YAG laser hyaloidotomy was performed in 10 eyes, argon laser was applied to two of those following failed Nd:YAG laser, and vitrectomy was performed in one eye. A conservative approach was adopted in 13 eyes.

Results: There were 15 females and nine males with mean age of 41.08 ± 12.72 (21-65) years. Mean follow-up period was 42.83 ± 23.78 (range: 12-116) months. Patients with hemorrhage size smaller than or equal to 4-disc diameter were observed for spontaneous resorption and achieved 20/20 visual acuity within 6 months. Visual acuity of all patients treated with Nd:YAG and/or argon laser, increased within the first week after the treatment. Vitrectomy was performed in only one patient with hemorrhage located away from macula. The good visual outcomes were achieved in all treatment modalities.

Conclusions: Observation, Nd:YAG laser and argon laser seem to be safe and effective approaches for eyes with valsalva retinopathy. The size, volume and duration of hemorrhage are the most crucial factors for treatment choice, success and complications.
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http://dx.doi.org/10.1177/1120672120936175DOI Listing
June 2020

Analysis of Corneal Densitometry and Endothelial Cell Function in Fuchs Uveitis Syndrome.

Eye Contact Lens 2021 Apr;47(4):196-202

Department of Ophthalmology (M.S., P.C.O., M.C., U.E.), University of Health Sciences, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey; and Department of Ophthalmology (H.B.O.), Gazi University School of Medicine, Ankara, Turkey.

Objectives: To evaluate corneal densitometry and endothelial cell properties in patients with unilateral Fuchs uveitis syndrome (FUS), and to compare results with unaffected contralateral eyes and healthy control subjects.

Methods: A total of 90 participants were included in this prospective cross-sectional study. Forty-five affected eyes of patients with FUS were regarded as group 1 (FUSa), 45 fellow eyes were regarded as group 2 (FUSf), and 45 healthy-control eyes were regarded as group 3. Corneal densitometry was measured with densitometry software of Scheimpflug Corneal Topography (Pentacam HR, Oculus GmbH, Wetzlar, Germany), whereas endothelial cell measurement was evaluated with specular microscopy (Tomey, EM4000, GmbH, Germany).

Results: The mean corneal densitometry values were higher in the midstromal (zones; 2-6, 6-10 mm), posterior (all zones), and total thickness (zones; 2-6, 6-10 mm) layers in the FUSa compared with FUSf and control eyes (P<0.05 for all comparisons). The mean values of average cell area and cell size characteristics (minimum, maximum, SD, and coefficient of variation) were higher; endothelial cell density and percentage of hexagonal cells were lower in the FUSa than in the other two groups (P<0.05 for all comparisons). There was a significantly strong correlation between specular microscopy parameters and posterior corneal densitometry values in the FUSa group.

Conclusions: Impairment of endothelial cell function in affected eyes of patients with FUS resulted in increased values of corneal densitometry, especially posterior layer.
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http://dx.doi.org/10.1097/ICL.0000000000000717DOI Listing
April 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

Phacoemulsification in patients with uveitis: long-term outcomes.

BMC Ophthalmol 2020 Mar 17;20(1):109. Epub 2020 Mar 17.

Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey.

Background: To assess the long-term outcomes of phacoemulsification and intraocular lens (IOL) implantation in eyes with uveitis.

Methods: One hundred and five eyes of 81 patients, who underwent phacoemulsification and IOL implantation between January 2009 and July 2016, were included in this study. The demographic data, preoperative clinical findings, postoperative outcomes, and intraoperative and postoperative complications were recorded. All collected data and risk factors with regard to visual prognosis were analyzed with the help of the Statistical Package for the Social Sciences version 20.0 software program (IBM Corp., Armonk, NY, USA).

Results: During follow-up (mean: 35.2 ± 22.2 months), corrected distance visual acuity (CDVA) improved in 87.7% of all eyes and reached a level of 0.3 LogMAR or greater in 61.3% of eyes. Postoperative complications included posterior capsule opacification (50.9%), posterior synechiae (21.7%), cystoid macular edema (16%), epiretinal membrane (13.2%), glaucoma (11.3%), increased intraocular pressure (8.5%), and severe inflammation (6.6%). Uveitis recurred in 55.7% of all eyes. The risk for the development of cystoid macular edema was found to be associated with recurrence in the early postoperative period. Low visual acuity risk was 11.1-fold higher with macular scarring (p = 0.001) and 14-fold higher with optic atrophy (p < 0.001), respectively.

Conclusions: With appropriate management during the pre- and postoperative periods, phacoemulsification and IOL implantation surgery can be safe and effective in eyes with uveitis. However, great caution must be taken to prevent complications both before and after the surgery.
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http://dx.doi.org/10.1186/s12886-020-01373-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079372PMC
March 2020

Ultrastructural Analysis of the Anterior Lens Epithelium in Cataracts Associated with Uveitis.

Ophthalmic Res 2020 13;63(2):213-221. Epub 2019 Dec 13.

Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey.

Purpose: To investigate the transmission electron microscopic findings of lens epithelial cells (LECs) in patients with different subtypes of uveitis and to compare the findings with those in age-matched controls.

Methods: In this prospective case-control study, the anterior lens capsules were taken from 47 eyes of 47 patients with uveitis of different subtypes (17 with Fuchs uveitis syndrome [FUS], 13 with -Behçet's uveitis, 10 with idiopathic uveitis, and 7 with herpetic keratouveitis) and from 15 eyes of 15 control patients.

Results: In the FUS group, the LECs had homogeneous thickening and irregularity, with some small vacuoles and widespread, oval-shaped pigment clusters in some areas. In the Behçet uveitis group, there was evident thinning in the lens epithelium. The subepithelial tissue under the epithelium was thickened, and edematous areas were detected. In the idiopathic uveitis group, the LECs were thinner with small vacuoles, and the cubic structure of the LECs was transformed into a squamous one. Moreover, the LECs included some small vacuoles, similar to those in the FUS group. In the herpetic keratouveitis group, two prominent cell types were observed: (1) completely normal LECs and (2) degenerated-type LECs with pyknotic nuclei, condensation of chromatin, swelling in the cytoplasm, membrane ruptures, and intra-cytoplasmic inclusion bodies. In the control group, the LECs and all of their elements occurred in normal ultrastructural patterns, with the exception of a few small intraepithelial vacuoles, which were fewer in number and smaller than those in the FUS and idiopathic uveitis groups.

Conclusion: The electron microscopic analysis of LECs of patients with different subtypes of uveitis revealed significant ultrastructural alterations, which may be related to the summation of oxidative stress and intraocular inflammation.
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http://dx.doi.org/10.1159/000504497DOI Listing
January 2021

Fungal Endogenous Endophthalmitis during Pregnancy as a Complication of In-Vitro Fertilization.

Ocul Immunol Inflamm 2019 Oct 30:1-4. Epub 2019 Oct 30.

Byers Eye Institute, Stanford University, Palo Alto, California, USA.

: To report a Candida endogenous endophthalmitis in a pregnant woman with a prior history of in-vitro fertilization (IVF).: Case report.: 21-year-old healthy woman within the first trimester of her pregnancy of a successful IVF developed a focal retinitis and panuveitis. Ocular findings suggested fungal endophthalmitis. The patient was treated with pars plana vitrectomy and repeated intravitreal antifungal injections. No systemic therapy was given. Cultures showed . IVF procedure was the only identifiable risk factor for endogenous endophthalmitis.: In-vitro fertilization appeared as a possible risk factor for endogenous endophthalmitis during pregnancy. In the absence of systemic fungal infection, local intravitreal antifungal injections seem to be effective options to treat endogenous candida endophthalmitis, especially in the first trimester.
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http://dx.doi.org/10.1080/09273948.2019.1677917DOI Listing
October 2019

Tick- borne infection revealing human immunodeficiency virus (HIV) positivity in a young adult.

Am J Ophthalmol Case Rep 2019 Dec 25;16:100559. Epub 2019 Sep 25.

Byers Eye Institute, Stanford University, Palo Alto, CA, United States.

Purpose: To describe a patient whose retinal findings suggestive of tick-borne disease but evaluations led to early diagnosis and treatment of human immunodeficiency virus (HIV) infection.

Observation: A young patient presented with bilateral uveitis, branch retinal artery occlusion and retinal findings suggestive of infective/inflammatory etiology. Laboratory evaluations revealed that the patient was positive for co-infection with and . On further investigation, the patient tested positive for HIV infection. The patient was treated with doxycycline as well as highly active anti-retroviral therapy (HAART) to control both opportunistic infections as well as HIV infection.

Conclusion And Importance: Patients with HIV infection are at risk for multiple, simultaneous opportunistic co-infections, including those with tick-borne diseases.
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http://dx.doi.org/10.1016/j.ajoc.2019.100559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6804791PMC
December 2019

Evaluation of radial peripapillary capillary density in patients with Fuchs uveitis syndrome.

Graefes Arch Clin Exp Ophthalmol 2019 Dec 22;257(12):2735-2742. Epub 2019 Oct 22.

Merzifon Kara Mustafa Pasa State Hospital, Amasya, Turkey.

Purpose: To quantitatively analyze the microcirculation in the peripapillary sectors in the affected eyes and fellow unaffected eyes of individuals with unilateral Fuchs uveitis syndrome (FUS) using optical coherence tomography angiography (OCTA), and to compare the radial peripapillary capillary vessel density (RPCvd) with normal and age-matched individuals.

Methods: Eyes were divided into three groups based on the involvement of the FUS: FUS-positive eye of patients (study eye), fellow eye of FUS-positive patients (fellow eye), and the control eye for the control group (control eye). RPCvd (%) and peripapillary retinal nerve fiber layer (RNFL) thickness (μm) at eight equal sectors and two equal hemispheres were automatically calculated in peripapillary region via OCTA.

Results: This study included 105 eyes of 71 patients: 34 FUS-positive eyes of 34 patients, 34 fellow eyes of FUS-positive patients, and 37 control eyes of 37 patients. RPCvd was significantly lower in study eyes than in fellow and control eyes in the peripapillary region (p = 0.044 and p = 0.005, respectively). There was no significant difference between fellow eyes and control eyes regarding RPCvd in any region (p > 0.05 for all). There were no significant differences between the three groups regarding peripapillary RNFL values (p > 0.05 for all).

Conclusion: OCTA is a novel technology for imaging of the RPC network in patients with FUS. Lower radial peripapillary capillary vessel density in FUS could induce capillary insufficiency and impairment of ocular blood flow to optic nerve head.
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http://dx.doi.org/10.1007/s00417-019-04491-zDOI Listing
December 2019

Human Adenovirus: An Unusual Causative Agent for Acute Retinal Necrosis Presented with Central Retinal Vascular Occlusion.

Ocul Immunol Inflamm 2020 Jul 14;28(5):749-753. Epub 2019 Aug 14.

Ulucanlar Eye Training and Research Hospital, University of Health Sciences , Ankara, Turkey.

Purpose: We describe a case of acute retinal necrosis (ARN) with central retinal vascular occlusion caused by human adenovirus (HAdV).

Case Report: A 41-year-old man presented with a sudden decrease of visual acuity in his right eye since seven days. Visual acuity was hand movements and ophthalmic examination of the right eye revealed diffuse hemorrhagic retinal vasculitis with panuveitis. He was clinically diagnosed as ARN with central retinal vascular occlusion. An anterior chamber paracentesis and intravitreal ganciclovir injection were performed and intravenous ganciclovir has been initiated immediately. Polymerase chain reaction (PCR) analysis of aqueous humor identified HAdV DNA as a causative agent. Oral prednisolone was added to treatment 5 days after antiviral therapy. After 10 days of intravenous ganciclovir therapy, oral valganciclovir was given for 6 months. No recurrence or retinal detachment occurred during follow-up.

Conclusion: HAdV known to cause acute epibulbar infections of the eye may also cause intraocular inflammation such as ARN.
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http://dx.doi.org/10.1080/09273948.2019.1624780DOI Listing
July 2020

Multimodal imaging of type 1 aneurysmal telangiectasia in a Turkish female with giant arteriovenous aneurysmal malformation.

Ther Adv Ophthalmol 2019 Jan-Dec;11:2515841419848945. Epub 2019 May 14.

Yalova State Hospital, Yalova, Turkey.

We present a case with giant arteriovenous aneurysmal malformation with different imaging modalities, including fundus photography, fundus fluorescein angiography, spectral domain optical coherence tomography, and optical coherence tomography angiography. A 43-year-old Turkish female presented with gradual blurred vision in her left eye. Her best-corrected visual acuity was 20/200. The fundoscopic examination revealed hard exudates and microaneurysms around the macula. Spectral domain optical coherence tomography showed cystoid macular edema and serous macular detachment. Fundus fluorescein angiography and optical coherence tomography angiography showed bean-like arteriovenous anastomosis between the inferior venous vascular arcade and the superior arterial vascular arcade. An en face angiogram using optical coherence tomography angiography within the deep capillary plexus also showed venous collateral channels across the horizontal raphe. The patient was diagnosed with arteriovenous aneurysmal malformation in association with type 1 aneurysmal telangiectasia. Ophthalmologists should note that giant aneurysmal lesions can occur in type 1 aneurysmal telangiectasia patients.
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http://dx.doi.org/10.1177/2515841419848945DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537067PMC
May 2019

Aqueous humor IL-8, IL-10, and VEGF levels in Fuchs' uveitis syndrome and Behçet's uveitis.

Int Ophthalmol 2019 Nov 7;39(11):2629-2636. Epub 2019 May 7.

Department of Ophthalmology, Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Kale Mahallesi, Ulucanlar Caddesi, No:59, 06250, Altındağ/Ankara, Turkey.

Purpose: This study investigated the levels of interleukin (IL)-8, IL-10, and vascular endothelial growth factor (VEGF) in the aqueous humor (AqH) of patients with Behçet's uveitis (BU) and Fuchs' uveitis syndrome (FUS) during an inactive period and compared these levels with those in the AqH of noninflammatory healthy control subjects.

Methods: This prospective and case-control study included 33 patients (16 patients with BU and 17 patients with FUS) and 35 control subjects. IL-8, IL-10, and VEGF levels in the AqH were quantified by performing sandwich enzyme-linked immunosorbent assay. Kruskal-Wallis test was used to compare the cytokine levels in the different groups, and statistical significance was set at p < 0.05.

Results: IL-8 levels were significantly higher in the AqH of patients with BU and FUS than in the AqH of control subjects (p < 0.001 and p < 0.001, respectively). IL-10 levels were significantly lower in the AqH of patients with BU than in the AqH of patients with FUS and of control subjects (p = 0.001 and p < 0.001, respectively). Although VEGF levels were higher in the AqH of patients with FUS than in the AqH of patients with BU and of control subjects, the difference was significant only between patients with FUS and control subjects (p < 0.001).

Conclusions: We observed a significant decrease in IL-10 levels in the AqH of patients with BU and a significant increase in VEGF levels in the AqH of patients with FUS compared to controls. IL-8 and VEGF levels showed no significant difference among uveitis patients.
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http://dx.doi.org/10.1007/s10792-019-01112-wDOI Listing
November 2019

Optic nerve involvement in ocular toxoplasmosis: 12 year data from a tertiary referral center in Turkey.

Arq Bras Oftalmol 2019 Jul-Aug;82(4):302-309. Epub 2019 Apr 8.

Department of Ophthalmology, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey.

Purpose: To evaluate the prevalence, clinical characteristics, and types of optic nerve involvement in patients with ocular toxoplasmosis.

Methods: For this retrospective cross-sectional study, we examined all patients with active ocular toxoplasmosis referred to our Uveitis Section during the last 12 years, and we included patients with optic nerve involvement in the study. The primary outcome was the prevalence of optic nerve involvement, and secondary outcomes included the types of optic nerve involvement and the final best-corrected visual acuity after treatment.

Results: The prevalence of optic nerve involvement was 14.4%, with the leading cause being the activation of a juxtapapillary lesion (70.5%). We found papillitis in two eyes and neuroretinitis in two eyes (11.7% for each). We only detected one optic nerve involvement secondary to a distant active lesion (5.8%). Sixteen patients (94.1%) had unilateral ocular toxoplasmosis. The overall final best-corrected visual acuity after treatment was 10/10 (LogMAR = 0.0) excluding the three patients with a juxtapapillary scar involving the macula.

Conclusions: Optic nerve involvement was common in patients with ocular toxoplasmosis. The main type of optic nerve involvement was caused by activation of an old juxtapapillary lesion. Treatment was quickly effective, but the best-corrected visual acuity was dependent on the presence of a scar in the papillomacular bundle.
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http://dx.doi.org/10.5935/0004-2749.20190058DOI Listing
January 2020

Effects of Fuchs uveitis syndrome on the ultrastructure of the anterior lens epithelium: A transmission electron microscopic study.

Indian J Ophthalmol 2017 Dec;65(12):1459-1464

Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey.

Purpose: The purpose of the study was to investigate the electron microscopic findings of the lens epithelial cells (LECs) in patients with Fuchs uveitis syndrome (FUS) who suffered from cataracts and to compare those with age-matched controls.

Methods: This study was a prospective, comparative case series. The anterior lens capsules (ALC: basement membrane and associated LECs) were taken from 12 eyes of 12 cases of FUS and ten eyes of ten control patients. The ALCs were obtained from cataract surgery and prepared for transmission electron microscopy (TEM).

Results: There were no statistically significant differences regarding the age or gender between the FUS group and the control group (P > 0.05). In the TEM examinations of the ALCs, all of the FUS cases revealed similar significant ultrastructural changes when compared to the control patients. In the FUS group, the LECs showed homogeneous thickening and irregularity which included some small vacuoles in different areas of the epithelial tissue. Moreover, in some areas of the LECs, widespread, oval-shaped, pigment clusters were detected. Conversely, in the control group, the LECs and all of their elements were in normal ultrastructural patterns, with the exception of some small intraepithelial vacuoles which were fewer and smaller than those in the FUS group.

Conclusion: Ultrastructural analysis of the ALC of the patients with FUS disclosed some significant alterations which may be related to the summation of oxidative stress, intraocular inflammation, and iris atrophy.
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http://dx.doi.org/10.4103/ijo.IJO_691_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742983PMC
December 2017

Efficacy of Oral Valacyclovir Treatment in a Case with Acute Retinal Necrosis.

Turk J Ophthalmol 2017 Jun 1;47(3):174-179. Epub 2017 Jun 1.

Ulucanlar Eye Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey.

Acute retinal necrosis (ARN) is a rapidly progressive disease with poor prognosis, leading to visual loss in most cases. Rapid diagnosis and early anti-viral treatment significantly affect the course and prognosis of the disease. In this case report, we present a 34-year-old female patient referred to our clinic with symptoms of blurred vision and ocular pain diagnosed as acute glaucoma elsewhere. A clinical diagnosis of ARN was made and anti-viral treatment was started immediately. We herein describe our treatment approach to this particular case and discuss previously reported treatment modalities.
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http://dx.doi.org/10.4274/tjo.14890DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468533PMC
June 2017

Frosted Branch Angiitis Secondary to Familial Mediterranean Fever Resembling Central Retinal Vein Occlusion.

Case Rep Ophthalmol Med 2016 4;2016:2916027. Epub 2016 Dec 4.

Ankara Ulucanlar Eye Education and Research Hospital, Ankara, Turkey.

. To report a case of unilateral frosted branch angiitis (FBA) resembling central retinal vein occlusion associated with Familial Mediterranean Fever (FMF). . A 32-year-old woman presented with progressive, painless vision loss in her left eye lasting for 2 days. She was clinically diagnosed with FMF 2 months ago. The best-corrected visual acuity (BCVA) was 20/20 in her right eye and there was light perception in the left. Ophthalmologic examination revealed severe retinal vasculitis showing clinical features of FBA in the left eye. 64 mg/day oral methylprednisolone was started. A significant improvement in retinal vasculitis was observed in two weeks. However, BCVA did not increase significantly due to subhyaloid premacular hemorrhage. Argon laser posterior hyaloidotomy was performed. One week after hyaloidotomy, visual acuity improved to 20/20 and intravitreal hemorrhage disappeared. Four months after the first attack, FBA recurred. Oral methylprednisolone dosage was increased to 64 mg/day and combined with azathioprine 150 mg. At the end of 12-month follow-up, the BCVA was 20/25 and development of epiretinal membrane was observed in the left eye. . Frosted branch angiitis may occur with gene abnormalities as an underlying condition. Our case showed that FMF might be a causative disease.
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http://dx.doi.org/10.1155/2016/2916027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5164904PMC
December 2016

Clinical Characteristics of Fuchs' Uveitis Syndrome.

Turk J Ophthalmol 2016 Apr 5;46(2):52-57. Epub 2016 Apr 5.

Ulucanlar Eye Training and Research Hospital, Ankara, Turkey.

Objectives: To evaluate the clinical and demographic properties of Fuchs' uveitis syndrome (FUS) in Turkish patients.

Materials And Methods: The medical records of 161 patients with FUS followed in the Uveitis Division of Ulucanlar Eye Hospital between 1996 and 2014 were respectively reviewed. The mean age at diagnosis, sex, the number of affected eyes, follow-up period, clinical findings at presentation, complications during the follow-up period, medical and surgical treatments, and best corrected visual acuity at the initial and final visits were recorded.

Results: The study included 171 eyes of 161 patients diagnosed with FUS. Of the patients, 94 (58.4%) were female and 67 (41.6%) were male. The mean age at presentation was 35.2±11.0 (11-65) years. The mean follow-up period was 23.5±32.8 (2-216) months. Ten (6.2%) patients had bilateral involvement. The most common symptoms at presentation were decreased visual acuity or blurred vision in 63 (39.1%) and floaters in 19 (11.8%) patients. Clinical findings at presentation included diffuse small, round, white keratic precipitates in 128 (74.8%) eyes, anterior chamber reaction in 82 (47.9%), vitreous cells in 122 (71.3%), heterochromia in 47 (27.4%) and iris nodules in 32 (18.7%) eyes. During the follow-up period, elevated intraocular pressure occured in 31 (18.1%) eyes and the most common complication was cataract development (89 eyes, 52.0%).

Conclusion: Heterochromia was observed in 27.4% of patients in our study. However, the diffuse small, round keratic precipitates, low-grade anterior chamber reaction and varying degrees of vitreous reaction are more common clinical characteristics that are helpful in making the diagnosis.
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http://dx.doi.org/10.4274/tjo.99897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5082249PMC
April 2016

Review for Diagnostics of the Year: Multimodal Imaging in Behçet Uveitis.

Ocul Immunol Inflamm 2017 Feb 19;25(1):7-19. Epub 2016 Aug 19.

c Department of Ophthalmology , Koc University, School of Medicine , Istanbul , Turkey.

Behçet disease is a chronic relapsing multisystem inflammatory disorder. Ocular involvement is characterized by a bilateral recurrent non-granulomatous panuveitis and retinal vasculitis. Posterior segment findings vary during the course of the disease, in parallel with the relapsing and remitting intraocular inflammation. Structural alterations occur with increased disease duration. Fluorescein angiography is the gold standard in revealing the extent and severity as well as the leaky and/or occlusive nature of retinal vasculitis. Multimodal imaging using color fundus photography, fluorescein angiography, and optical coherence tomography is essential in visualizing diagnostic features, detecting structural changes, and monitoring disease activity and response to treatment in patients with Behçet uveitis.
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http://dx.doi.org/10.1080/09273948.2016.1205100DOI Listing
February 2017

Pars Planitis: Epidemiology, Clinical Characteristics, Management and Visual Prognosis.

J Ophthalmic Vis Res 2015 Oct-Dec;10(4):469-80

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

Pars planitis is an idiopathic chronic intermediate uveitis which predominantly affects children and adolescents, and accounts for 5-26.7% of pediatric uveitis. Although an autoimmune process with a genetic predisposition has been suggested, its etiology still remains unknown. The most common presenting symptoms are floaters and blurred vision. Diffuse vitreous cells, haze, snowballs and snowbanks are typical findings of pars planitis. Peripheral retinal vasculitis, optic disc edema and anterior segment inflammation are other well-known findings. Although pars planitis is known to be a benign form of uveitis in most cases, it may become a potentially blinding disease due to complications including cataract, cystoid macular edema, vitreous opacities and optic disc edema. Cystoid macular edema is the most common cause of visual morbidity. Band keratopathy, epiretinal membrane formation, vitreous condensation, neovascularizations, vitreous hemorrhage, retinal detachment, cyclitic membranes, glaucoma and amblyopia may develop as a consequence of the chronic course of the disease. Exclusion of infectious and non-infectious causes which may present with intermediate uveitis is of utmost importance before starting treatment. Treatment of pars planitis has been a controversial issue. There is no consensus specifically for treatment of cases with minimal inflammation and relatively good visual acuity. However, current experience shows that pars planitis may cause severe inflammation and needs an aggressive treatment. A stepladder approach including corticosteroids, immunosupressive agents, anti-tumor necrosis factor-alpha and pars plana vitrectomy and/or laser photocoagulation is the most commonly used method for treatment of pars planitis. Adequate control of inflammation and prompt detection of associated complications are crucial in order to improve the overall prognosis of the disease.
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http://dx.doi.org/10.4103/2008-322X.176897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795398PMC
April 2016

Alterations of Choroidal Thickness With Diabetic Neuropathy.

Invest Ophthalmol Vis Sci 2016 Apr;57(4):1518-22

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

Purpose: To evaluate the effect of diabetic polyneuropathy on choroidal thickness in type 2 diabetes patients.

Methods: Forty-one diabetic polyneuropathy (DPN) patients with no or mild retinopathy, 50 non-DPN diabetic patients with no or mild retinopathy, and 42 healthy controls without any retinal complaint were included in the study. All participants underwent detailed ophthalmic examinations. Choroidal thickness (CT) measurements were performed by the same independent technician in the morning between 9 and 11 AM to avoid diurnal variations. Perpendicular CT was measured from the outer edge of the hyperreflective retinal pigment epithelium to the inner sclera at seven locations: the fovea; and 500, 1000, and 1500 μm temporally and nasally to the fovea.

Results: The groups were age and sex matched (P > 0.05). The mean subfoveal CT values were significantly different in groups with a thickening trend from control to non-DPN and DPN (P < 0.01). The mean values for subfoveal CT in control, non-DPN, and DPN groups were 241.12 ± 52.71, 279.82 ± 51.42, and 304.71 ± 54.92 μm, respectively. The same thickening trend was also evident in all other six measurement points with statistical significance (P < 0.01).

Conclusions: Diabetic patients had increased CT compared to healthy controls. The presence of neuropathy in diabetes patients caused additional choroidal thickening, compared to nonneuropathic patients.
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http://dx.doi.org/10.1167/iovs.15-17966DOI Listing
April 2016

Fulminant Ocular Toxoplasmosis: The Hazards of Corticosteroid Monotherapy.

Ocul Immunol Inflamm 2016 Dec 8;24(6):637-646. Epub 2015 Dec 8.

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

Purpose: To describe fulminant toxoplasma retinochoroiditis induced by corticosteroid monotherapy.

Methods: Clinical records of nine patients were reviewed.

Results: All patients (five female, four male; aged 15-64 years) had been misdiagnosed as unilateral non-infectious uveitis and given systemic and/or local corticosteroid injections elsewhere. Mean disease duration before referral was 105.6 ± 71 (45-240) days. Visual acuity at presentation was <20/200 in six eyes. Average lesion size was 6.6 disc areas in eight eyes and all four quadrants were involved in one. Toxoplasma DNA was detected in eight tested eyes. Mean duration of anti-toxoplasmic therapy was 92.5 ± 37.1 days. Three eyes developed rhegmatogenous retinal detachment. Four patients underwent pars plana vitrectomy. Final visual acuity was <20/200 in five eyes.

Conclusions: Iatrogenic immunosuppression due to initial misdiagnosis may lead to an aggressive course and serious complications of ocular toxoplasmosis, a potentially self-limiting infection.
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http://dx.doi.org/10.3109/09273948.2015.1057599DOI Listing
December 2016

Fundus autofluorescence imaging of patients with idiopathic macular hole.

Int J Ophthalmol 2013 18;6(5):685-9. Epub 2013 Oct 18.

Ulucanlar Eye Research and Training Hospital, Ankara 06450, Turkey.

Aim: To investigate the role of fundus autofluorescence (FAF) both in the diagnosis and the preoperative and postoperative evaluation of patients with idiopathic macular hole (MH).

Methods: Forty eyes of 40 patients diagnosed as idiopathic MH between May 2010 and May 2011 were included in this retrospective study. All patients underwent full ophthalmologic examinations and imagings including fluorescein angiography, fundus autofluorescence (FAF) and optical coherence tomography. Thirty of these patients underwent MH surgery. FAF findings were associated with duration of symptoms, visual acuity at presentation, stage of MH, and postoperative anatomical correction.

Results: The mean duration of patients' symptoms was 3.8±2.0 (1-9) months. The MH was stage 2 in 4 (10%), stage 3 in 24 (60%) and stage 4 in 12 (30%) eyes. The median preoperative best corrected visual acuity was 20/200 (between 20/800 and 20/100). Twenty-eight of cases (70%) showed a stellate appearance with dark radiating striae. Having a visual acuity ≥20/200 was significantly more common in eyes with stellate appearance (P<0.001). The mean duration of symptoms was significantly shorter in eyes with stellate appearance (2.75±0.8 vs 6.33±1.61 months) (P<0.001). The frequency of stage 4 MH was significantly higher in eyes with non-stellate appearance (P<0.001). Anatomical correction of MH was achieved in 91.3% (21/23) of eyes with stellate appearance and 71.4% (5/7) of eyes without this appearance (P=0.225).

Conclusion: Stellate appearance in FAF is associated with earlier stages of macular hole, better visual acuity at presentation, shorter duration of symptoms, thus more favorable prognosis.
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http://dx.doi.org/10.3980/j.issn.2222-3959.2013.05.26DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808922PMC
November 2013

The use of the QuantiFERON-tuberculosis gold test in the diagnosis of ocular tuberculosis.

J Pediatr Ophthalmol Strabismus 2010 Sep 22;47 Online:e1-3. Epub 2010 Sep 22.

Department of Retina, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey.

Ocular tuberculosis without systemic manifestations may rarely occur. The diagnosis of ocular tuberculosis is important because it has a wide spectrum of presentations and requires a multidisciplinary approach. The QuantiFERON-tuberculosis gold test is a new diagnostic test that may be useful in making a suitable diagnosis.
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http://dx.doi.org/10.3928/01913913-20100920-09DOI Listing
September 2010

Trimethoprim/Sulfamethoxazole and azithromycin combination therapy for ocular toxoplasmosis.

Ocul Immunol Inflamm 2009 Jul-Aug;17(4):289-91

Ulucanlar Eye Education and Research Hospital, Ankara, Turkey.

Purpose: To evaluate the efficacy and safety of trimethoprim/sulfamethoxazole and azithromycin combination for the treatment of ocular toxoplasmosis.

Methods: Nineteen ocular toxoplasmosis patients treated with trimethoprim/sulfamethoxazole and azithromycin +/- corticosteroid combination were retrospectively reviewed. Demographic data, clinical findings, the time interval until resolution of inflammation, recurrences, and drug side effects were collected.

Results: The mean follow-up time of the patients was 25.0 +/- 22.5 (range; 6 -66) months. Final visual acuity improved with a mean of 6 +/- 4 lines in 15 patients (78.9%). Inflammatory findings began to subside within 14.8 +/- 10.0 days. Three patients (15.8%) had recurrent attack. Only 1 patient (5.3%) had side effects from therapy.

Conclusions: Trimethoprim/sulfamethoxazole and azithromycin combination is an effective and safe treatment modality for the treatment of ocular toxoplasmosis.
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http://dx.doi.org/10.1080/09273940802687846DOI Listing
October 2009

The risk of other primary cancer in patients with uveal melanoma: a retrospective cohort study of a Canadian population.

Can J Ophthalmol 2004 Jun;39(4):397-402

Henry C. Witelson Ophthalmic Pathology Laboratory and Registry, McGill University Health Centre, Montreal, Que.

Background: The incidence of second primary malignant tumours has doubled during the last 2 decades. These tumours now represent the sixth most common group of cancers. Many authors have described the presence of multiple primary cancers in patients with uveal melanoma. However, no studies have been performed using Canadian data. The purpose of this study was to describe the occurrence of other primary cancers diagnosed before or after uveal melanoma and to calculate the incidence of subsequent primary cancer in a Canadian cohort with uveal melanoma.

Methods: We conducted a retrospective study of a cohort of patients with uveal melanoma diagnosed between 1990 and 2002 at a university-affiliated centre in Montreal. We reviewed medical records to identify patients in whom other, unrelated primary malignant disease had been diagnosed. We used the standardized incidence ratio to calculate the risk of development of a second, unrelated cancer following the diagnosis of uveal melanoma.

Results: A total of 129 cases of uveal melanoma were diagnosed. Eighteen patients (14%) also had a diagnosis of an unrelated primary cancer. In nine patients the other cancer had been diagnosed first, and in nine patients the other tumour had been diagnosed after the uveal melanoma. There was no increased risk of development of any particular form of cancer studied for females or males.

Interpretation: In our Canadian cohort, statistical analysis showed no increased risk of a second cancer, overall or by organ site, in male or female patients with uveal melanoma. As uveal melanoma is a rare type of cancer, analyses of a much larger cohort may be needed to accurately estimate the risk of development of a second primary cancer in patients with uveal melanoma.
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http://dx.doi.org/10.1016/s0008-4182(04)80011-5DOI Listing
June 2004