PREVALENCE OF BEHCET'S DISEASE AND OTHER UVEITIC ONDITIONS IN SECONDARY EYE CARE: A PRELIMINARY STUDY

WOS: 00038806590007

Takayasu Arteriti’nde göz bulguları ve oküler dolaşımın değerlendirilmesi

ÖZET Amaç: Takayasu arteriti hastalarında oküler dolaşımdaki bozukluklara veya kullanılan ilaçlara bağlı olarak çeşitli göz komplikasyonları gelişebilmektedir. Bu çalışmanın amacı romatoloji kliniğinde takipli Takayasu arteriti hastalarında oküler komplikasyon durumu ile oküler kan akımı parametrelerini değerlendirmek ve bu parametreler ile klinik bulgular arasındaki ilişkiyi tanımlamaktır. Gereç ve Yöntemler: Marmara Üniversitesi Tıp Fakültesi, Romatoloji Bilim Dalı’nda takipli 65 Takayasu arteriti hastası (60 kadın, 5 erkek, ortalama yaş: 41.8 ±12.9) ve 51 (50 kadın, 1 erkek, ortalama yaş: 37.4 ±12.9) sağlıklı gönüllü çalışmamıza katıldı. Çalışma kapsamında tüm katılımcılara detaylı bir göz muayenesi, optik koherens tomografi (OKT) ile maküla, retina sinir lifi tabakası analizi ve cihazın EDI-OKT modunda koroid görüntülemesi yapıldı. Koroid kalınlığı değerlendirilebilmesi için retina pigment epitelinin dış sınırı ile skleral hiperreflektif bantın iç sınırı arasındaki mesafe manuel olarak ölçüldü. Hastaların sağ gözlerinde renkli Doppler ultrasonografi ile oftalmik arter ve santral retinal arter kan akım parametreleri değerlendirildi. Hastaların göz muayenesine yönlendirildikleri son romatoloji muayenelerindeki kan basıncı ölçümleri, hastalık süreleri istatistiksel analizler için kullanıldı. Hastalık süreleri ile yukarıda belirtilen ölçüm ve muayene bulguları arasında ilişki olup olmadığı incelendi. Bulgular: Hastalarda en sık izlenen oküler komplikasyon hipertansif retinopati (%33.9) olarak saptandı. Dört hastada (%6.2) Takayasu retinopatisi ile uyumlu bulgular izlendi. 13 gözde (%10) posteriyor subkapsüler katarakt saptandı ve 7 gözün psödofakik olduğu izlendi. Hiçbir hastada iskemik neovasküler komplikasyonlara bağlı görme azalması izlenmedi. Takayasu arteriti ile sağlıklı kontroller arasından santral maküla kalınlığı, fovea hacmi, retina sinir lifi tabakası kalınlığı ve subfoveal koroid kalınlığı açısından istatistiksel anlamlı farklılık izlenmedi. Takayasu arteriti hastalarının Doppler ile yapılankan akımı analizlerinde rezistivite indeksinin oftalmik arterde (0.75 vs. 0.66, p=0.002) ve santral retinal arterde (0.75 vs. 0.67, p=0.001) daha yüksek olduğu izlendi. Hipertansif retinopati gelişen hastaların hastalık süreleri gelişmeyen hastalara kıyasla anlamlı olarak daha uzun bulunurken (7.9 yıl vs. 4.7 yıl, p=0.016), üst ekstemite kan basınçları arasında anlamlı bir fark saptanmadı. Radiyal arterede nabızsızlık bulgusu olan hastaların aynı gözlerindeki oftalmik arter rezisitivite indeksi, radiyal arterde nabızsızlık olmayan hastalara kıyasla daha yüksek bulunurken (0.77 vs. 0.68, p=0.031), karotis üfürümü olan veya olmayan hastaların oküler kan akım parametreleri arasında anlamlı bir fark saptanmadı. Hastalık süresi 5 yıldan uzun olan veya 5 yıldan kısa olan olguların oküler kan akımı parametreleri arasında anlamlı bir fark izlenmedi. Katılımcıların subfoveal koroid kalınlıkları ile oküler kan akımı parametreleri arasında anlamlı bir korelasyon saptanmadı. Sonuç: Marmara Üniversitesi Tıp Fakültesi Hastanesi’nde takipli hastalarda Takayasu retinopatisi gelişme oranı literatüre göre daha düşük bulunmuştur. Hiçbir hastada görme ile ilgili şikayet izlenmezken, Doppler bulguları oküler kan akımında subklinik bir azalmaya işaret etmektedir. Anahtar Kelimeler: oküler kan akımı, oküler komplikasyon, renkli Doppler ultrasonografi, retinopati, Takayasu arteritiSUMMARY Ocular Findings and Ocular Blood Flow Changes in Takayasu Arteritis Purpose: Ocular involvement in Takayasu arteritis mainly arises due to complications related with altered ocular blood flow or side effects of the treatments. In this study, we aimed to document ocular complication rate, ocular blood flow status and the association of ocular blood flow parameters with clinical outcome of the Takayasu arteritis patients followed in the rheumatology clinic. Material and Methods: We have included 65 Takayasu arteritis patients followed at Marmara University Medical School, Rheumatology Division (60 female, 5 male, mean age: 41.8 ±12.9) and 51 healthy subjects (50 female, 1 male, mean age: 37.4 ±12.9) in this study. All of the participants had a detailed ophthalmological examination, optical coherence tomography scan of the macula, retinal nerve fiber layer and choroid. Ocular blood flow in ophthalmic artery and central retinal artery was evaluated with Color Doppler ultrasonography. The rheumatology examination data was reached from the last rheumatology visit at which the patients were referred to the ophthalmology clinic. Results: The most common ocular complication was hypertensive retinopathy (33.9%). Four patients had retinal findings related with Takayasu retinopathy (6.2%). Thirteen eyes had posteriyor subcapsular cataract (%10) and 7 eyes were pseudophacic (5.4%). None of the patients suffered a loss in visual acuity due to ischemic and/or neovascular complications. There was no statistically significant difference between the Takayasu arteritis patients and healthy subjects for the central macular thickness, foveal volume, retinal nerve fiber layer thickness and subfoveal choroideal thickness. Takayasu arteritis patients had increased resistivity index in ophthalmic artery (0.75 vs. 0.66, p=0.002) andcentral retinal artery (0.75 vs. 0.67, p=0.001). The patients with hypertensive retinopathy had a significantly longer disease duration compared to the no retinopathy group (7.9 years vs. 4.7 years, p=0.016), while there was no statistically significant difference between the groups for upper extremity blood pressure values. The resistivity index of the ophthalmic artery was higher in patients with ipsilateral radial artery pulselessness compared to the patients who had no pulselessness (0.77 vs. 0.68, p=0.031). The patients with carotid artery bruits did not have a significant change in the ocular blood flow parameters compared to the patients who did not have carotid artery bruits. There was no significant difference for ocular blood flow parameters between the patients with long disease duration (>5 years) and short disease duration (<5 years). There was no correlation between the subfoveal choroideal thickness values and ocular blood flow parameters of the participants. Conclusion: The prevalence of Takayasu arteritis was lower in our study compared with previous studies. While none of the patients complained about visual disturbances, Doppler findings indicate a subclinical reduction in ocular blood flow in Takayasu arteritis. Key words: color Doppler ultrasonography, ocular blood flow, ocular complication, retinopathy, Takayasu arteriti

Benign joint hypermobility syndrome: A cause of childhood asthma?

Benign joint hypermobility syndrome (BJHS) is a hereditable disorder of connective tissue, which is characterized by the occurrence of multiple musculoskeletal problems in hypermobile individuals who do not have a systemic rheumatological disease. Rectal, uterine and mitral prolapses, varicose veins, myopia and recurrent urinary tract infections are more common in patients with BJHS, which indicates a diffuse anomaly in the structure of connective tissue rather than a limited involvement of the musculoskeletal system. Asthma, as a complex trait disease, develops after environmental exposure to innocuous allergens, infectious agents and air pollutants in susceptible individuals on the basis of their genetics. However, genetic factors cannot explain the recent rise in the prevalence, morbidity, or mortality of asthma. Asthma may also be caused by a connective tissue defect. Changes in the mechanical properties of the bronchial airways and lung parenchyma may underlie the increased tendency of the airways to collapse in asthmatic children. In this paper, we postulate that BJHS may lead to persistent childhood wheezing by causing airway collapse through a connective tissue defect that affects the structure of the airways. (C) 2009 Elsevier Ltd. All rights reserved

Influence of Apical Clearance on Mini-Scleral Lens Settling, Clinical Performance, and Corneal Thickness Changes

WOS: 000404148100007PubMed: 27171130Purpose: The purpose of this work was to define the timing and magnitude of scleral contact lens settling, the factors influencing settling, and to examine whether the amount of apical clearance has an impact on clinical performance or is associated with hypoxia-induced corneal changes. Methods: Eleven patients (22 eyes) with keratoconus were fitted with a mini-scleral lens (Esclera, Brazil). Three different lenses with successively greater sagittal depths were applied to achieve 3 levels of initial apical clearance: 100 to 200 mu m (low), 200 to 300 mu m (medium), and greater than 300 mu m (high). Corneal apical clearance was measured at 15 min, 1, 2, 4, 6, and 8 hr with optical coherence tomography (OCT). Central corneal thickness was measured with OCT and Pentacam, in the morning and immediately after removal of the contact lens. Results: Mean settling was 26.8 +/- 18.8 mu m (42.7%) at 1 hr, 39.5 +/- 26.5 mu m (62.9%) at 2 hr, 50.7 +/- 31.6 mu m (80.8%) at 4 hr, 57.4 +/- 34.6 mu m (91.4%) at 6 hr, and 62.8 +/- 38.4 mu m (100%) at 8 hr. Settling rate was significantly lower in low apical clearance group (P = 0.01). The smaller diameter lenses settled more (P = 0.03). There was a slight statistically significant increase of 1.3% in central corneal thickness measured with OCT (P = 0.03). Central corneal thickness measured with Pentacam at three locations increased slightly (P = 0.001). Settling showed significant intrasubject and intersubject variations. The amount of corneal swelling and comfort scores did not differ significantly according to apical clearance. Conclusions: The average amount of settling was 62.8 mu m after 8 hr, 80% of which occurred during the first 4 hr. Slight corneal swelling (1.3%) occurred after 8 hr of wear