Publications by authors named "Pinar Ozdal"

56 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

Fuchs' Uveitis: Is It Different from What We Know?

Ocul Immunol Inflamm 2020 Aug 24:1-6. Epub 2020 Aug 24.

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

Background: To describe ocular findings in Turkish patients with Fuchs' uveitis (FU).

Methods: The medical records of FU were retrospectively reviewed.

Results: The study included 281 eyes of 258 patients with FU. There were diffusely spread keratic precipitates (KPs)[(medium sized in 253 (90.0%) eyes, stellate-medium in 28 (10%) eyes)], Koeppe nodules (KN) in 64 (22.8%) eyes and cataract in 129 (45.9%) eyes. There was vitreous infiltration of varying grades in all eyes (100%) with grade 1 haze in 96 (34.2%) eyes, grade 2 haze in 69 (24.6%) eyes, and grade 3 haze in 63 (22.4%) eyes. Stellate-medium KPs were significantly more likely in eyes with KN than in eyes without KN (28.1 vs. 4.6%, <.001) and in eyes with +3 vitreous haze than in those without +3 vitreous haze (28.6 vs. 4.6%, <.001).

Conclusion: Vitreous involvement is the most frequent posterior segment finding. Posterior involvement is a feature that should not be ignored.Stellate-medium KPs and KN may be an indicator of increased and chronic inflammation.
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http://dx.doi.org/10.1080/09273948.2020.1795207DOI Listing
August 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

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

The Collaborative Ocular Tuberculosis Study (COTS) Consensus (CON) Group Meeting Proceedings.

Authors:
Rupesh Agrawal Ilaria Testi Sarakshi Mahajan Yew Sen Yuen Aniruddha Agarwal Andres Rousselot Dhananjay Raje Dinesh Visva Gunasekeran Onn Min Kon Talin Barisani-Asenbauer John H Kempen Amod Gupta Douglas A Jabs Justine R Smith Bahram Bodaghi Manfred Zierhut Marc DeSmet Peter Mc Cluskey Mamta Agarwal Manisha Agarwal Kanika Aggarwal Mukesh Agrawal Hassan Al-Dhibi Sofia Androudi Fatma Asyari Manohar Babu Balasundaram Kalpana Babu Murthy Edoardo Baglivo Alay Banker Reema Bansal Soumyava Basu Digamber Behera Jyotirmay Biswas Ester Carreño Laure Caspers Soon Phaik Chee Romi Chhabra Luca Cimino Luz Elena Concha Del Rio Emmett T Cunningham Andrè Luiz Land Curi Dipankar Das Ekaterina Denisova Alastair K Denniston Marie-Hélène Errera Alejandro Fonollosa Amala George Debra A Goldstein Yan Guex Crosier Avinash Gurbaxani Alessandro Invernizzi Hazlita M Isa Shah Md Islam Nicholas Jones Deeksha Katoch Moncef Khairallah Amit Khosla Michal Kramer Amitabh Kumar Atul Kumar Rina La Distia Nora Richard Lee Careen Lowder Saurabh Luthra Padmamalini Mahendradas Dorine Makhoul Shahana Mazumdar Salil Mehta Elisabetta Miserocchi Manabu Mochizuki Oli S Mohamed Cristina Muccioli Marion R Munk Somasheila Murthy Shishir Narain Heloisa Nascimento Piergiorgio Neri Myhanh Nguyen Annabelle A Okada Pinar Ozdal Alan Palestine Francesco Pichi S R Rathinam Ariel Schlaen Shobha Sehgal H Nida Sen Aman Sharma Kusum Sharma Samir S Shoughy Nirbhai Singh Ramandeep Singh Masoud Soheilian Sudharshan Sridharan Jennifer E Thorne Christoph Tappeiner Stephen Teoh Maria Sofia Tognon Ilknur Tugal-Tutkun Mudit Tyagi Harvey Uy Daniel Vitor Vasconcelos Santos Natasa Vidovic Valentincic Mark Westcott Ryoji Yanai Bety Yanez Alvarez Rahman Zahedur Quan Dong Nguyen Carlos Pavesio Vishali Gupta

Ocul Immunol Inflamm 2020 Apr 6:1-11. Epub 2020 Apr 6.

Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

An international, expert led consensus initiative was set up by the Collaborative Ocular Tuberculosis Study (COTS) group to develop systematic, evidence, and experience-based recommendations for the treatment of ocular TB using a modified Delphi technique process. In the first round of Delphi, the group identified clinical scenarios pertinent to ocular TB based on five clinical phenotypes (anterior uveitis, intermediate uveitis, choroiditis, retinal vasculitis, and panuveitis). Using an interactive online questionnaires, guided by background knowledge from published literature, 486 consensus statements for initiating ATT were generated and deliberated amongst 81 global uveitis experts. The median score of five was considered reaching consensus for initiating ATT. The median score of four was tabled for deliberation through Delphi round 2 in a face-to-face meeting. This report describes the methodology adopted and followed through the consensus process, which help elucidate the guidelines for initiating ATT in patients with choroidal TB.
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http://dx.doi.org/10.1080/09273948.2020.1716025DOI Listing
April 2020

Standardization of Nomenclature for Ocular Tuberculosis - Results of Collaborative Ocular Tuberculosis Study (COTS) Workshop.

Ocul Immunol Inflamm 2019 Dec 10:1-11. Epub 2019 Dec 10.

Advanced Eye Center, Department of Ophthamology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

: To standardize a nomenclature system for defining clinical phenotypes, and outcome measures for reporting clinical and research data in patients with ocular tuberculosis (OTB).: Uveitis experts initially administered and further deliberated the survey in an open meeting to determine and propose the preferred nomenclature for terms related to the OTB, terms describing the clinical phenotypes and treatment and reporting outcomes.: The group of experts reached a consensus on terming uveitis attributable to tuberculosis (TB) as tubercular uveitis. The working group introduced a SUN-compatible nomenclature that also defines disease "remission" and "cure", both of which are relevant for reporting treatment outcomes.: A consensus nomenclature system has been adopted by a large group of international uveitis experts for OTB. The working group recommends the use of standardized nomenclature to prevent ambiguity in communication and to achieve the goal of spreading awareness of this blinding uveitis entity.
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http://dx.doi.org/10.1080/09273948.2019.1653933DOI Listing
December 2019

The outcome of initial mitomycin C-augmented trabeculectomy with subconjunctival bevacizumab in the management of secondary glaucoma associated with Fuchs heterochromic iridocyclitis.

Int Ophthalmol 2020 Apr 3;40(4):795-802. Epub 2019 Dec 3.

Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Ulucanlar caddesi No:59, 06240, Altindag, Ankara, Turkey.

Purpose: To investigate the outcome of mitomycin C (MMC)-augmented trabeculectomy with subconjunctival bevacizumab in the management of Fuchs heterochromic iridocyclitis (FHI)-related glaucoma in 1-year follow-up period.

Methods: This retrospective study included 50 eyes with FHI-related glaucoma those had underwent initial trabeculectomy with MMC (0.2 mg/ml-3 min). Thirty-one of them had single-dose bevacizumab injection (1.25 mg/0.05 ml) into the bleb area just at the end of the surgery, while 19 eyes did not have. The intraocular pressure (IOP) and the mean number of anti-glaucomatous medications were evaluated. The IOP value ≤ 21 mmHg was defined as complete or qualified surgical success in terms of using medical anti-glaucomatous treatment. Bleb height and vascularity were evaluated with Indiana bleb grading system. Paired sample t test, t test, Chi-square and Kolmogorov-Smirnov tests were used for statistical analysis.

Results: The preoperative IOP values of bevacizumab and without bevacizumab groups were 32.8 ± 4.5 mmHg and 32.8 ± 4.5 mmHg, respectively, and they decreased to 17.5 ± 4.6 mmHg and 17 ± 5.2 mmHg at the final visit (p < 0.001 for all values). There were no significant differences in postoperative IOP and the number of medications between the groups at the final visit. In bevacizumab group, complete success was achieved in 100% within the third month but decreased to 22.5% (complete) and 74.1% (qualified) at the first year. In the other group (without bevacizumab group), complete success was achieved in 94.7% within the third month but decreased to 15.8% (complete) and 84.2% (qualified) at the first year.

Conclusion: Initial trabeculectomy with MMC and subconjunctival bevacizumab injection was found to have lower rates of complete success with relatively acceptable qualified success rates in the management of FHI-related glaucoma. Subconjunctival bevacizumab was not found to have additional effect to improve the surgical success.
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http://dx.doi.org/10.1007/s10792-019-01240-3DOI Listing
April 2020

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

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

Corneal Biomechanical Properties and Central Corneal Thickness in Pediatric Noninfectious Uveitis: A Controlled Study.

Eye Contact Lens 2018 Nov;44 Suppl 2:S60-S64

Department of Ophthalmology (E.S., P.O.), Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Ankara, Turkey; and Department of Ophthalmology (M.B.-Y.), Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey.

Objective: To compare the corneal biomechanics, intraocular pressure (IOP), and central corneal thickness (CCT) of 37 patients with pediatric noninfectious uveitis with 36 healthy children.

Methods: Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated and corneal-compensated IOP (IOPg and IOPcc, respectively), and CCT were measured.

Results: The mean CRF was significantly lower in the pediatric uveitic eyes than controls (9.7±1.9 vs. 10.8±1.5 mm Hg, P=0.009), whereas there was no significant difference for mean CH, IOPg, IOPcc, and CCT between the two groups (10.1±1.9 vs. 10.8±1.7, 12.9±3.3 vs. 13.9±3.1, 13.8±2.8 vs. 13.6±3.2 mm Hg, and 550.7±49.5 vs. 555.1±33.5 μm, respectively, all P>0.05). The CCT values correlated with CH and CRF, with a Pearson correlation of 0.511 and 0.670 (P=0.013 and P<0.001, respectively), whereas disease duration did not correlate with any corneal biomechanics or CCT in pediatric uveitic eyes (all P>0.05).

Conclusions: Pediatric noninfectious uveitic eyes have lower CRF than controls but the CH, IOPg, IOPcc, and CCT values are similar.
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http://dx.doi.org/10.1097/ICL.0000000000000465DOI Listing
November 2018

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

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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http://dx.doi.org/10.5301/ejo.5001012DOI Listing
January 2018

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

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

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

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

Safety and Efficacy of Gevokizumab in Patients with Behçet's Disease Uveitis: Results of an Exploratory Phase 2 Study.

Ocul Immunol Inflamm 2017 Feb 30;25(1):62-70. Epub 2016 Jan 30.

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

Purpose: To evaluate the safety and efficacy of gevokizumab for the treatment of Behçet's disease uveitis in a prospective, open-label, randomized phase 2 trial.

Methods: Behçet's disease patients with new acute ocular exacerbation or at risk of exacerbation received 30 or 60 mg gevokizumab every 4 weeks intravenously or subcutaneously, on top of a stable regimen of immunosuppressives and corticosteroids (≤20 mg/day equivalent prednisolone). Patients withdrew in cases of ocular exacerbation.

Results: A total of 21 patients were included (17 acute and 4 at-risk; mean duration of uveitis 45.6 ± 37.4 months). There were no serious adverse events related to gevokizumab. Recorded adverse events were mostly associated with exacerbation of uveitis or its complications. Response was evaluated for 14 acute patients and all showed rapid control of acute ocular exacerbation, mostly within 1 week, without any increase in corticosteroid dosage.

Conclusions: Gevokizumab was well tolerated and rapidly controlled acute ocular exacerbations of Behçet's disease uveitis without the need for high-dose corticosteroid.
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http://dx.doi.org/10.3109/09273948.2015.1092558DOI Listing
February 2017

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

Are There Any Changes in Corneal Biomechanics and Central Corneal Thickness in Fuchs' Uveitis?

Ocul Immunol Inflamm 2016 Oct 23;24(5):561-7. Epub 2015 Sep 23.

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

Purpose: To compare corneal biomechanics, intraocular pressure (IOP) and central corneal thickness (CCT) of 38 patients with unilateral Fuchs' uveitis (FU) with 42 healthy controls.

Methods: Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated and corneal-compensated IOP (IOPg and IOPcc, respectively) and CCT were measured.

Results: The mean CH, CRF, and IOPg of the involved FU eyes were significantly lower (9.5 ± 1.6, 9.0 ± 1.9 and 13.1 ± 4.3 mmHg) than contralateral eyes (10.1 ± 1.7, 9.9 ± 1.7 and 14.6 ± 3.4 mmHg), and controls (10.5 ± 1.5, 10.3 ± 1.5 and 14.8 ± 2.5 mmHg), respectively. There was no significant difference for mean IOPcc between involved FU or contralateral eyes and controls (14.8 ± 4.1, 15.5 ± 3.4 and 15.0 ± 2.7 mmHg). The CCT values correlated with CH and CRF in the involved and contralateral eyes.

Conclusions: Involved FU eyes had lower CH, CRF, and IOPg than contralateral eyes and controls, with no difference regarding IOPcc.
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http://dx.doi.org/10.3109/09273948.2015.1037459DOI Listing
October 2016

Face-to-face tracheal intubation in adult patients: a comparison of the Airtraq™, Glidescope™ and Fastrach™ devices.

J Anesth 2015 Dec 29;29(6):893-8. Epub 2015 Jul 29.

Anaesthesiology and Reanimation, Kocaeli University Medical Faculty, Umuttepe, Kocaeli, Turkey.

Purpose: Airway management in emergency settings can be difficult due to limited access to the patient. The use of video laryngoscopes along with the Fastrach™ device improves tracheal intubation; however, the use of such devices in a face-to-face intubation model has not been evaluated in adult patients.

Methods: After obtaining official approval from the Local Research Ethics Committee and written informed consent from the patients, 120 patients were enrolled in this prospective randomized study. The patients were ASA I and ASA II according to the American Society of Anesthesiologists Physical Status Classification System. Rocuronium was administered for neuromuscular blockade following standard anesthesia monitoring and induction. The patients were divided into three groups (40 patients per group) and their tracheas were intubated via a face-to-face approach with the Airtraq™, Glidescope™ or Fastrach™ devices.

Results: The intubation success rates of the Airtraq™, Glidescope™ and Fastrach™ devices were similar (100, 98 and 90 %; p = 0.07). The insertion time for the Airtraq™ [8.5 (6-11) s] was the shortest followed by the Glidescope™ [11 (7-19) s] and the Fastrach™ [16.5 (14.3-21.8) s; p < 0.001]. The intubation time for the Airtraq™ [14 (10.3-18.8) s] was shorter than the Glidescope™ [25 (18-45) s], and Fastrach™ devices [46.5 (40-65) s; p < 0.001]. The Glidescope™ device required a greater number of optimization maneuvers (p = 0.009) and intubation attempts than the Airtraq™ (p = 0.004). Esophageal intubation (p = 0.001) and mucosal damage were more common in the Fastrach™ group (p = 0.03).

Conclusions: The Airtraq™ device provided faster insertion and intubation times and enabled better Cormack-Lehane grades. Additionally, the Airtraq™ device required the minimum number of optimization maneuvers and was associated with fewer complications and fewer intubation attempts than the Glidescope™ and Fastrach™ devices during face-to-face tracheal intubation.
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http://dx.doi.org/10.1007/s00540-015-2052-6DOI Listing
December 2015

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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http://dx.doi.org/10.3109/09273948.2014.938761DOI Listing
August 2015

Comparison of autofluorescence and optical coherence tomography findings in acute and chronic central serous chorioretinopathy.

Int J Ophthalmol 2014 18;7(2):350-4. Epub 2014 Apr 18.

Ulucanlar Eye Research Hospital, Ankara 06240, Turkey.

Aim: To discuss and compare the fundus autofluorescence (FAF) and optical coherence tomography (OCT) in acute or chronic central serous chorioretinopathy (CSCR).

Methods: Medical records of 100 cases of CSCR were reviewed. Acute and chronic cases were evaluated according to the duration of decreased visual acuity, serous retinal detachment (RD) and focal leakage on fluorescein angiography (FA). Chi-square test was used for statistical analysis.

Results: Forty cases had acute and 60 cases had chronic CSCR. FAF showed focal hypo-autofluorescence in 34 (85%) and iso-autofluorescence in 6 (15%) of acute cases and hypo-autofluorescence in 51 (85%), hyper-autofluorescence in 6 (10%) and iso-autofluorescence in 3 (5%) of chronic cases. OCT showed serous RD with distinct borders correlated with FAF findings (hypo-autofluorescence) in all acute CSCR cases. In chronic CSCR group, OCT showed serous RD with indistinct borders correlated with FAF findings. The differences between the OCT and FAF findings of the two groups were significant (P=0.000).

Conclusion: OCT and FAF findings can support the clinical observations in differential diagnosis of acute and chronic CSCR and help clinicians to evaluate retinal pigment epithelium, outer segments of photoreceptors and the components of serous RD.
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http://dx.doi.org/10.3980/j.issn.2222-3959.2014.02.29DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003096PMC
May 2014

Ophthalmic manifestations in familial Mediterranean fever: a case series of 6 patients.

Eur J Ophthalmol 2014 Jul-Aug;24(4):593-8. Epub 2013 Dec 5.

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

Purpose: To describe the ocular involvement of patients with familial Mediterranean fever (FMF) followed in a tertiary referral center.

Methods: The data of 6 patients with FMF were retrospectively reviewed. Detailed ophthalmologic examinations, type of inflammation, course of the disease, number of recurrences, treatment regimens, complications, and comorbid ocular or systemic diseases were noted.

Results: The mean age ± SD at diagnosis was 29.3 ± 19.3 (4-53) years. A total of 66.7% of the patients were male and 66.7% of the patients had bilateral disease. The anatomical distribution of the ophthalmic involvement was as follows: posterior uveitis in 2 (33.3%), anterior uveitis in 2 (33.3%), posterior scleritis in 1 (16.7%), and intermediate uveitis in 1 (16.7%) patient. The course was recurrent in 50% of the patients. Final visual acuities were favorable except in the patients with chronic course uveitis. Cystoid macula edema, epiretinal membrane, retinal ischemia, cataract, glaucoma, and band keratopathy were complications noted in the follow-up period. Both cataract and glaucoma patients (50%) needed a surgical intervention. In 33.3% of patients, Behçet disease was present as a concurrent disease. In patients with posterior uveitis and the patient with intermediate uveitis (50%), systemic immunosuppression was required.

Conclusions: There was a male and bilateral involvement predominance. The course of the inflammation was recurrent in half of the patients. Since ocular involvement in FMF is very rare, it should be considered as diagnosis of exclusion.
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http://dx.doi.org/10.5301/ejo.5000398DOI Listing
October 2014

Vogt-Koyanagi-Harada disease: clinical and demographic characteristics of patients in a specialized eye hospital in Turkey.

Ocul Immunol Inflamm 2014 Aug 11;22(4):277-86. Epub 2013 Dec 11.

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

Purpose: To evaluate clinical and demographic features of Vogt-Kayanagi-Harada disease (VKH) disease in Turkish patients and compare them with previously published data.

Methods: Demographic and clinical features of 32 patients diagnosed as VKH in a tertiary referral center were retrospectively reviewed.

Results: The mean age at presentation was 33.6 ± 10.4 years. Seventy-five percent of the patients were female and 62.5% of the patients presented during the last 2 years. The disease was complete in 31.2%, incomplete in 50%, and probable in 18.8% of the patients. The clinical course was acute in 50%, chronic recurrent in 34.4%, and chronic in 15.6%. The most common findings were bilateral serous retinal detachment ± papillitis in acute cases and retinal pigment epithelial changes of the macula in chronic cases.

Conclusions: Although rare in Turkey, VKH disease seems to have increased during the last few years. The disease is incomplete and acute in half of the patients and has a quite good visual prognosis.
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http://dx.doi.org/10.3109/09273948.2013.856448DOI Listing
August 2014