The Experience of Ibrutinib in Chronic Graft-Versus-Host Disease in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation: Single Center Experience

Introduction:Chronic graft-versus host disease (GVHD) is a serious complication that develops in 35-50% of patients in the late period after allogeneic hematopoetic stem cell transplantation. About half of the patients are resistant to corticosteroids, which is the first-line treatment of chronic GVHD, and therefore new treatment options that can be effective in chronic GVHD are needed. In the present study, we aimed to share our experience with the use of ibrutinib therapy in patients with steroid-resistant chronic GVHD who have previously received multiple lines of systemic therapy.Methods:The characteristics and clinical outcomes of steroid-resistant chronic patients with GVHD receiving ibrutinib were retrospectively reviewed.Results:A total of 10 steroid resi-stant chronic patients with GVHD who received ibrutinib was included. While 50% of the patients had more than one organ involvement, 50% had a single organ involvement. The most commonly affected organs were the skin and liver. The patients received a median of three lines of systemic therapy before ibrutinib. After a median of 210 days of ibrutinib usage, the complete response rate of patients was 40% and the partial response rate was 40%. Corticosteroids were completely discontinued in 30% of patients after ibrutinib were initiated. Before ibrutinib, patients were given a median of 0.3 mg/kg methylprednisolone. The median methylprednisolone dose after ibrutinib was 0.03 mg/kg.Conclusion:Ibrutinib therapy causes a quite high overall response in steroid resistant chronic patients with GVHD and appears to be a good option in these patients

New Imaging Methods in Eye Tumors - Ultrasound Biomicroscopy, Optic Coherence Tomography, and Fundus Autofluorescence

Several ancillary tests could be used in the diagnosis, treatment, and management of complications of eye tumors. Among those, ultrasound biomicroscopy has a particular role in the evaluation of anterior segment tumors. Optic coherence tomography and fundus autofluorescence have values in determining the architecture of posterior segment tumors and the effects of tumors on the adjacent structures. However, it should be noted that those tests have a meaning when they are evaluated together with the clinical features of the lesions. (Turk J Ophthalmol 2014; 44: Supplement 66-70

Efficacy and safety of intra-vitreal bevacizumab (Avastin®) using pro re nata regimen in treatment of macular edema due to retinal vein occlusion

Amaç: Retina ven dal tıkanıklığı (RVDT) ve santral retina ven tıkanıklığına (SRVT) bağlı maküla ödemi tedavisinde Pro Re Nata (PRN) protokolünde intravitreal bevacizumab (İVB) enjeksiyonun görme keskinliği, maküla kalınlığına etkisini ve yan etkisini değerlendirmek.Gereç ve Yöntem: Bu retrospektif çalışmada RVDT ve SRVT'ye bağlı maküla ödemi tedavisi için İVB uygulanan hastaların enjeksiyon öncesi, enjeksiyon sonrası 1. ay, 4. ay, 6. ay, 12. ay, 24. ay ve son ay en iyi düzeltilmiş görme keskinliği (EİDGK), maküla kalınlığı, göz içi basınç (GİB) değişikleri, demografik verileri ve komplikasyonları değerlendirildi.Bulgular: Yaş ortalamaları 59.24±12.26 yıl (34-82 yıl) olan 45 hastanın (26 kişi RVDT; 19 kişi SRVT hastası) 45 gözü çalışmaya dahil edildi. Hastalar ortalama 24.36±29.09 ay (4-120 ay) takip edildi ve ortalama enjeksiyon sayısı 4.62±2.89 (3-16 enjeksiyon) olarak tespit edildi. Hipertansiyon (%59.9) en sık eşlik eden sistemik hastalık, glokom (%11.1) en sık göz hastalığıydı. RVDT hastalarında İVB sonrası tüm izlem aylarında EİDGK ölçümlerinde anlamlı artış ve maküla kalınlığında anlamlı azalma izlenirken (p0.05). Hem RVDT hem de SRVT hastalarında İVB sonrası tüm izlem aylarında GİB ölçümlerinde anlamlı fark izlenmedi (p>0.05). Sonuç: RVDT ve SRVT hastalarında sistemik ve oküler risk faktörlerinin tetkiki önemlidir. RVDT hastalarında tekrarlayan İVB enjeksiyonları ile EİDGK ve maküla kalınlığında anlamlı düzelme izlenirken; SRVT hastalarında değişiklik izlenmemesi SRVT'ye bağlı maküla ödeminde PRN protokolünde İVB etkisinin daha kısıtlı olduğunu düşündürebilir.Purpose: The objectives were to evaluate visual acuity, macular thickness and side effects after intravitreal bevacizumab (IVB) administered Pro Re Nata (PRN) for macular edema due to branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO)Materials and Methods: We retrospectively studied the patients with macular edema secondary to BRVO and CRVO, who were treated with IVB. Best corrected visual acuity (BCVA), central macular thickness and intraocular pressure (IOP) measurements before, 1 month, 4 month, 6 month, 12 month, 24 month and the last injection were recorded. Also risk factors and complications were recorded.Results: Forty-five eyes of 45 patients (26 BRVO, 19 CRVO) were included. The mean age was 59.24±12.26 years (range, 34-82 years) and mean follow-up time was 24.36±29.09 months ( range, 4-120 months). The average injection number was determined to be 4.62±2.89 . Hypertension was the most common systemic disease (59.9%) and glaucoma was the most common eye disease (11.1%). In BRVO group after IVB both BCVA and mean central foveal thickness significantly improved (p<0.05) at each follow-up but in CRVO group, there was no statistically significant improvement of BCVA and mean central foveal thickness (p>0.05). Both BRVO and CRVO group, there was no statistically significant change of IOP (p>0.05).Conclusion: The results indicate that specialized systemic and ocular diagnostic examinations are necessary in light of the potential risk factors. For macular edema secondary to BRVO and CRVO, IVB administered PRN seem to be more effective in BRVO patients than CRVO

Glutathione S transferase M1 and T1 genetic polymorphisms are related to the risk of primary open‐angle glaucoma: a study in a Turkish population

Background: Genetic factors and oxidative damage have been shown to have a role in the development of primary open angle glaucoma (POAG)

Evaulation of Incidence and Risk Factors for Intraocular Pressure Elevation After Intravitreal Triamcinolone Acetonide Injection

Objectives: To investigate the effect of intravitreal triamcinolone acetonide (IVTA) used for the macular edema on intraocular pressure (IOP) and to determine the risk factors for IOP elevation. Materials and Methods: This retrospective study included 93 eyes of 85 patients who had 4 mg intravitreal triamcinolone injection. Of the 85 patients, 56 (65.8%) had diabetic macular edema, 22 (25.8%) had branch retinal, and 7 (8.2%) had central retinal vein occlusion. IOP changes after injection as well as the relation between IOP elevation and age, sex, lens status, etiology of macular edema, baseline IOP were evaluated. Results: Fourty-six male and 39 female patients with mean age 61.58±9.5 years were evaluated. IOP was recorded to be >24 mmHg in 30 eyes (32.2%) at follow-up visit after an average of 7.5 weeks. Normalization of IOP with medication was achieved in all IOP elevated eyes. Fifteen of 29 eyes (51.7%) with vein occlusion and 15 of 64 eyes (23.3%) with diabetic macula edema had IOP elevation (p=0.01). Twenty-six of 73 phakic (35.6%) and 4 of 20 pseudophakic eyes (20%) had IOP >24 mmHg (p=0.16). There was no association between IOP elevation and sex (p=0.33). Baseline IOP was 16.47±2.8 mmHg in eyes which had elevated IOP and 14.78±2.4 mmHg in the remaining. There was significant relation between IOP elevation and baseline IOP level (p=0.01). Conclusion: Elevated IOP is common side effect after IVTA, but normalization is usually achieved by topical medication. Patients with baseline IOP ≥15 mmHg and vein occlusion have higher risk for IOP elevation. (Turk J Ophthalmol 2015; 45: 86-91

Evaulation of Incidence and Risk Factors for Intraocular Pressure Elevation After Intravitreal Triamcinolone Acetonide Injection

Objectives: To investigate the effect of intravitreal triamcinolone acetonide (IVTA) used for the macular edema on intraocular pressure (IOP) and to determine the risk factors for IOP elevation. Materials and Methods: This retrospective study included 93 eyes of 85 patients who had 4 mg intravitreal triamcinolone injection. Of the 85 patients, 56 (65.8%) had diabetic macular edema, 22 (25.8%) had branch retinal, and 7 (8.2%) had central retinal vein occlusion. IOP changes after injection as well as the relation between IOP elevation and age, sex, lens status, etiology of macular edema, baseline IOP were evaluated. Results: Fourty-six male and 39 female patients with mean age 61.58±9.5 years were evaluated. IOP was recorded to be >24 mmHg in 30 eyes (32.2%) at follow-up visit after an average of 7.5 weeks. Normalization of IOP with medication was achieved in all IOP elevated eyes. Fifteen of 29 eyes (51.7%) with vein occlusion and 15 of 64 eyes (23.3%) with diabetic macula edema had IOP elevation (p=0.01). Twenty-six of 73 phakic (35.6%) and 4 of 20 pseudophakic eyes (20%) had IOP >24 mmHg (p=0.16). There was no association between IOP elevation and sex (p=0.33). Baseline IOP was 16.47±2.8 mmHg in eyes which had elevated IOP and 14.78±2.4 mmHg in the remaining. There was significant relation between IOP elevation and baseline IOP level (p=0.01). Conclusion: Elevated IOP is common side effect after IVTA, but normalization is usually achieved by topical medication. Patients with baseline IOP ≥15 mmHg and vein occlusion have higher risk for IOP elevation. (Turk J Ophthalmol 2015; 45: 86-91