Recurrent Exudative Retinal Detachment in a Case of Vogt-Koyanagi-Harada

Amaç:Tedavi altındaki takibi sırasında eksudatif retina dekolmanı tekrarlayan bir Vogt-Koyanagi-Harada (VKH) hastasının olgu raporunu sunmak. Yöntem:Hastanın klinik kayıtları retrospektif olarak incelendi. Sonuç:18 yaşında bayan hasta unilateral eksudatif retina dekolmanı ile başvurdu. Sistemik steroid başlanmasına rağmen iki gün sonra bilateral eksudatif retina dekolmanı gelişti. İndosiyanin yeşili anjiyografi (İSYA) bulgularının diffuz koroiditi desteklemesi ve beyin omurilik sıvısında saptanan lenfositik pleositoz ile VKH hastalığı tanısı konuldu. 9 günlük 750 mg/gün pulse metilprednizolon tedavisinden sonra bilateral eksudatif retina dekolmanı yatıştı. 3. haftada tedaviye 250mg/gün siklosporin eklendi. 3 ay sonra steroid dozunun 5mg/gün’e inilmesi üzerine bilateral eksudatif retina dekolmanı tekrarladı. Tekrar 1000 mg/gün pulse metilprednizolon uygulanan hastanın tedavisine 100 mg/gün azatiyopirin de eklendi. Eksudatif retina dekolmanı yatışan hastanın 1.yıl sonundaki takibinde tam görme korundu ve yeni komplikasyon görülmedi. Tartışma: Kortikosteroid tedavisinin erken azaltılması VKH hastalığında tekrarlayan eksudatif retina dekolmanına neden olabilmektedir. Erken başlanan immunsupresif tedaviye rağmen rekürrens görülebilmektedir. Hastalığın tanı ve takibinde, özellikle tedaviye cevabın monitorizasyonunda, subklinik koroid inflamasyonunu göstermesi nedeniyle, rutin İSYA incelemesi önerilmektedir

Results of interferon-alfa therapy in patients with Behcet uveitis

Purpose: To report on the results of interferon-alpha 2a (IFN alpha) treatment in patients with Behcet uveitis unresponsive to conventional immunosuppressive therapy. Methods: We retrospectively analyzed the medical records of 44 patients who had been treated with IFN alpha between September 2001 and May 2005. The initial dose of IFN alpha was 6 MU/day in 37 patients (84.1%) and 3 MU/day in 7 patients (15.9%), and was gradually tapered after ocular inflammation was suppressed. Immunosuppressive agents were discontinued. Oral corticosteroids were discontinued or maintained at a dosage of less than 10 mg prednisone equivalent per day. Main outcome measures were recurrence of posterior or panuveitis attacks and changes in visual acuity. Results: Sixteen patients (36.4%) remained relapse free during treatment, whereas 28 (63.6%) patients had recurrent uveitis attacks. Four of these were considered treatment failures and were switched to other treatments. In the remaining 40 patients, the mean duration of treatment was 12.4 +/- 10.8 months (range 3-45 months). In 9 of 40 patients (22.5%) treatment could be discontinued 22.2 +/- 13.4 months after therapy, and 8 (20%) of these patients had sustained remission for up to 24 months. Three patients (7.5%) were switched to other therapies because of side effects. The frequency of uveitis attacks per 6 months was reduced from 1.6 +/- 1.2 to 0.8 +/- 0.9 in 26 patients who had a minimum follow-up of 6 months before and after IFN alpha therapy (p < 0.05). There was a significant improvement in visual acuity and this was preserved throughout follow-up in 38 (95%) of 40 patients. Conclusions: A partial or complete response was obtained with IFN alpha therapy in 91% of Turkish patients with Behcet uveitis refractory to conventional immunosuppressive treatment. Our results suggest that there may be differences in therapeutic efficacy and side-effect profile of IFN alpha in different patient populations. Comparative studies are needed to investigate this hypothesis

A Cross-sectional and Longitudinal Study of Fuchs Uveitis Syndrome in Turkish Patients

PURPOSE: To describe Turkish patients with Fuchs uveitis syndrome (FUS)

Multiple orbital venous malformations presenting with enophthalmos in a patient with presumed blue rubber bleb nevus syndrome

A 27-year-old white woman presented with enophthalmos in the right eye. The visual acuity was 20/20 in both eyes. External examination showed 7 mm of enophthalmos of the right eye with deepened superior palpebral sulcus compared with the left eye. After Valsalva maneuver, the right eye became 4-mm exophthalmic compared with the left eye. Extraocular movements were full. There was no palpable orbital mass or diplopia. MRI showed diffuse enhancing intraconal orbital and nasopharyngeal masses consistent with venous malformations in the right orbit. Systemic evaluation revealed bluish vascular lesions on the hard and soft palates, and the pretibial area of her right leg. These findings were suggestive of blue rubber bleb nevus syndrome. The patient was observed, and her clinical findings remained stable for 12 months. Enophthalmos can be a rare initial presentation of blue rubber bleb nevus syndrome and patients with ophthalmic involvement should undergo systemic evaluation including gastrointestinal, dermatologic, and otorhinolaryngologic examination

Clinical Features, Prognosis, and Treatment Results of Patients With Scleritis From 2 Tertiary Eye Care Centers in Turkey

Purpose: To evaluate the spectrum of scleritis from 2 tertiary eye care centers in Turkey