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Background/aims: Behcet's disease (BD) is a systemic inflammatory vasculitis of young adults with unknown aetiology, characterised by endothelial dysfunction and occlusion in both deep venous and retinal circulation. Ocular involvement [...]

BackgroundTo evaluate the efficacy of intravitreal triamcinolone acetonide injection on persistent macular oedema in branch retinal vein occlusion that fails to respond to previous laser photocoagulation.Material and methodsA total of 19 eyes of 19 patients with persistent macular oedema due to branch retinal vein occlusion were treated with 8 mg/0.2 ml of intravitreal triamcinolone acetonide injection. The main outcome measures included best-corrected visual acuity, intraocular pressure, and macular oedema map values of Heidelberg Retinal Tomograph II (HRT II) before and after intravitreal triamcinolone injection.ResultsThe mean follow-up time was 6.2±1.0 months. The mean baseline best-corrected logarithm of minimal angle of resolution (LogMAR) value for visual acuities of the patients before intravitreal triamcinolone injection was 1.01±0.16. After treatment, it was 0.55±0.22 at the 1-month, 0.56±0.22 at 3-month, and 0.62±0.22 at the last visits and the differences were statistically significant when compared with baseline values (for each, P<0.001). The mean oedema map values on HRT II significantly decreased by 28.5% at 1-month, 23.8% at 3-month, and 23.8% at the last visit when compared with preinjection values (for each, P<0.001). Intraocular pressure elevation exceeding 21 mmHg was observed in 26.3% of eyes at 1-month, 15.7% at 3-month, and 5.2% at the last visit, but was controlled with topical antiglaucomatous medications in all eyes.ConclusionIntravitreal triamcinolone acetonide application is a promising approach in the treatment of persistent macular oedema due to branch retinal vein occlusion nonrespondent to laser photocoagulation.Eye (2006) 20, 13–17. doi:10.1038/sj.eye.6701803; published online 18 February 2005 [ABSTRACT FROM AUTHOR]

Background: Increased serum levels of homocysteine (Hcy) have been reported in patients with Behçet's disease (BD) with an established risk factor for vascular involvement. Recently, the authors demonstrated that elevated Hcy levels are associated with ocular involvement in such patients. On the other hand, elevated levels of Hcy can result from genetic errors. Indeed, a mutation in the 5,10-methylenetetrahydrofolate reductase (MTHFR C677T) gene influences Hcy metabolism and, therefore, MTHFR C677T polymorphism provokes hyperhomocysteinaemia. Aim: To investigate the possible genetic factor for the elevation of plasma Hcy level in patients with BD by examining gene interaction with the MTHFR C677T polymorphism, a crucial factor of the Hcy metabolism. In addition, the authors aimed to evaluate if there is an association between the C677T polymorphism and the presence of ocular involvement in such patients. Method: A total of 59 patients with BD (25 men, 34 women) with a mean age of 34.9 years and 42 age and sex matched healthy control subjects (19 men, 23 women; mean age 32.2) were included in this investigation. MTHFR gene polymorphism was investigated by the polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) of a genomic DNA fragment at nucleotide 677 in all subjects in both groups. The genetic equilibrium is assumed for the gene frequencies of the MTHFR polymorphism in both samples. Results: The genotype of the MTHFR gene differed between the Behçet's patients and control subjects (TT: 11.9 v 2.4%; CT: 55.9 v 61.9%; CC: 32.2 v 35.7 %). TT homozygous genotype was more frequently in BD patients than the controls, though the difference was not significant (p = 0.063). In BD patients with ocular involvement, however, the frequencies of MTHFR TT homogenetic type (27.8%) were significantly and statistically higher than those in BD patients without ocular involvement (4.9%, p = 0.022, odds ratio = 7.5), or the controls (2.4%, p = 0.003, odds ratio = 20.0). TT homozygous genotype was associated with an increased risk for ocular involvement. Conclusion: Elevated serum levels of Hcy seem to be a result of C677T polymorphism of the MTHFR gene, with increased TT individuals over CC and CT genotype BD patients. Although no association was shown between the MTHFR reductase C677T polymorphism and the increased risk of oral aphtahe or genital ulcers, a mutation in this gene was associated with an increased risk of ocular involvement, suggesting genetic instability with a potential initiation of Hcy lowering therapy in this patient group. [ABSTRACT FROM AUTHOR]

Vascular endothelial growth factor (VEGF) is a cytokine participating in inflammation with potent endothelial cell effects. It is produced by macrophages, neutrophils and vascular endothelial cells and can alter vessel permeability. Behçet's syndrome is a systemic inflammatory disorder with unknown etiology. Vascular endothelial dysfunction is one of the prominent features of the disease. We previously demonstrated the possible involvement of proinflammatory cytokines [tumor necrosis factor (TNF)-α, soluble interleukin-2 receptor (sIL-2R), interleukin (IL)-6 and IL-8], nitric oxide (NO) and adrenomedullin in the etiopathogenesis of Behçet's syndrome. Since VEGF expression is induced by these cytokines and VEGF itself is a potent stimulator of NO production with endothelial cell effects, this study aimed to investigate whether VEGF was affected during the course of Behçet's syndrome. We also assessed the possible involvement of VEGF in ocular Behçet's syndrome or in disease activity. This multicenter case–control study included a total of 39 patients with active ( n = 22) or inactive ( n = 17) Behçet's syndrome (mean age, 38.1 ± 10.4 years; 21 men and 18 women) satisfying International Study Group criteria, and 15 healthy hospital-based control volunteers (mean age, 39.2 ± 9.3 years; eight men and seven women) matched for age and gender from a similar ethnic background. Patients were examined by a dermatologist and an ophthalmologist with an interest in Behçet's syndrome. Plasma VEGF concentrations were measured using a newly established enzyme-linked immunosorbent assay. Clinical findings and acute-phase reactant parameters such as erythrocyte sedimentation rate, α1-antitrypsin, α2-macroglobulin, and neutrophil count were used to classify the disease in Behçet's patients as active or inactive. The Wilcoxon test or the Mann–Whitney U-test was used for statistical analysis as indicated and the results were expressed as mean ± SD, with range. The mean plasma VEGF level in patients with Behçet's syndrome (291.9 ± 97.1 pg/mL; range 121–532 pg/mL) was higher than that in control subjects (103.0 ± 43.6 pg/mL; range 25–187 pg/mL) and the difference was significant ( P < 0.001). Patients with active disease had significantly ( P < 0.001) higher VEGF levels than patients with inactive disease (347.6 ± 87.1 vs. 219.9 ± 51.6 pg/mL). In addition, ocular Behçet's patients ( n = 23) had higher VEGF levels (315.7 ± 92.1 pg/mL) than nonocular patients ( n = 16, 257.8 ± 96.6 pg/mL) and the difference was of borderline significance ( P = 0.041). The levels of all acute-phase reactant parameters were significantly higher in the active stage than in the inactive stage (for each, P < 0.01) or in control subjects (for each, P < 0.001). VEGF may participate in the course of Behçet's syndrome, especially in the active stage, and elevated levels of VEGF may be an additional risk factor for the development of ocular disease, contributing to poor visual outcome. [ABSTRACT FROM AUTHOR]

Behçet's disease is a systemic immunoinflammatory disease of young adults characterized by systemic vasculitis of arteries and veins. Although many studies have been published since its discovery in 1937, the etiopathogenesis of this unique disorder is still unclear. To assess the relationship between stress factors, psychological and somatic symptoms, and coping mechanisms in patients with Behçet's disease. Thirty-four patients with Behçet's disease and 43 control subjects were compared by using sociodemographic data collection forms, a psychosocial and environmental problems list, the Beck Anxiety Inventory (BAI), Hamilton Depression Rating Scale (HAM-D) and Toronto Alexithymia Scale (TAS). Twenty-four patients (70.6%) defined stress factors in the first stage of the disease. Twenty-seven (79.4%) out of 34 patients stated that the recurrence period of the disease was related to the stress factors. Fear was expressed by 10 (29.4%) patients, sadness by 11 (32.3%), and fear plus sadness by 13 (38.2%) when they first learnt the diagnosis. While coping with these emotions 14 (41.2%) revealed active-reliance strategy. A statistically significant difference was present between the Behçet's patients and control subjects regarding TAS ( P < 0.05), HAM-D ( P < 0.001) and BAI ( P < 0.001) scores. It seems that stressful life events have important implications in both relapsing and remission periods of Behçet's disease via secondary problems. [ABSTRACT FROM AUTHOR]

Background: Vitreal interleukin (IL)-1beta (IL-1beta), IL-6, IL-8, tumor necrosis factor-alpha (TNF-alpha) and nitric oxide (NO) levels have previously been determined in patients with proliferative diabetic retinopathy (PDR). However, at present there is no cohort study linking serum levels of NO and many inflammatory cytokines such as TNF-alpha, IL-1beta, soluble IL-2 receptor (sIL-2R), IL-6 and IL-8 to the grade of the microvascular complications.Purpose: To determine the relation between the stages of DR and the levels of serum NO, TNF-alpha, IL-1beta, sIL-2R, IL-6 and chemokine IL-8 in patients with diabetes compared with healthy controls.Methods: Fifty-three consecutive patients with diabetes (25 men, 28 women) with or without DR and 15 non-diabetic healthy subjects (seven men, eight women) as controls were included in this prospective study. As an indicator for NO, serum total nitrite (NO2- + NO3-) levels (end-product of NO) were measured by the Griess reaction. Serum TNF-alpha, IL-1beta, sIL-2R, IL-6 and IL-8 levels were determined by a spectrophotometric technique using an Immulite chemiluminescent immunometric assay. The patients with diabetes were classified into three groups according to the stage of DR: no DR (NDR; n = 16), non-proliferative DR (NPDR; n = 18) and PDR (n = 19). The data were analysed using a Mann-Whitney U-test and the results were expressed as mean +/- SE (range).Results: The levels of IL-1beta and IL-6 were below the detection limits of the assay (for each, <5.0 pg/ml) in all patients with diabetes and controls. Soluble IL-2R levels ranged from 260 to 958 U/ml, with the highest values observed in the patients with PDR. In 47 of the 53 samples (89%) tested for diabetic patients, IL-8 levels were above the detection limits of the assay (5.0 pg/ml). IL-8 levels ranged from <5.0 to 25.0 pg/ml, with the highest mean values observed in PDR patients. TNF-alpha was detectable in 46 of 53 patients with diabetes (87%), ranging from <4.0 to 26.4 pg/ml, with again the highest values obtained in the patients with PDR. Serum NO levels ranged from 80 to 188 micromol/l, with the highest values obtained in patients with PDR. Taken together, the mean serum NO, sIL-2R, IL-8 and TNF-alpha levels increased with the stage of DR and the highest levels were found in patients with PDR. The PDR patients had significantly (for each, P < 0.001) higher serum NO (166.8 +/- 3.2 micromol/l), sIL-2R (807.9 +/- 33.3 U/ml), IL-8 (17.9 +/- 0.4 pg/ml) and TNF-alpha (15.0 +/- 0.8 pg/ml) levels compared with NPDR patients (149.5 +/- 2.1, 659.4 +/- 23.4, 12.9 +/- 1.1, 11.5 +/- 0.6, respectively), NDR patients (115.9 +/- 5.8, 373.8 +/- 15.0, 8.3 +/- 1.0, 6.6 +/- 0.9, respectively) and controls (116.6 +/- 2.3, 392.4 +/- 16.6, 7.2 +/- 0.3, 7.3 +/- 0.5, respectively). Serum levels of these parameters for NPDR patients were also significantly (for each, P < 0.01) higher compared with those of NDR patients and controls. On the other hand, serum NO, sIL-2R, IL-8 and TNF-alpha levels of patients with NDR were comparable with those of controls (for each, P > 0.05).Conclusion: The results of the present study suggest that NO, sIL-2R, IL-8 and TNF-alpha may play important roles in the pathophysiology and progression of DR. We think that these potentially inflammatory cytokines and NO with their endothelial implications may act together during the course and progression of DR. These molecules may serve as therapeutic targets for the treatment and/or prevention of diabetes with its systemic and ocular microvascular complications. [ABSTRACT FROM AUTHOR]

Objective: To evaluate optic nerve head changes in patients with thyroid orbitopathy (TO) and investigate the effects of intravenous methylprednisolone (IV MTP) on these changes., Methods: Eighty-two eyes of 41 patients with TO with and without dysthyroid optic neuropathy (DON) and 40 eyes of 40 healthy control subjects were included in the study. Lamina cribrosa thickness (LCT) and depth (LCD) measurements, peripapillary retinal nerve fibre layer thickness (RNFLT), and radial peripapillary capillary vascular density were measured using optical coherence tomography and optical coherence tomography angiography. Visual field examination and proptosis were evaluated. Patients with DON and active non-DON received IV MTP for 12 weeks, and the effect of this treatment was evaluated., Results: Peripapillary vascular density decreased in patients with DON compared with the other groups (p < 0.001 for all); there was no difference in the total, superior hemi-sector, and inferior hemi-sector of the RNFLT between the groups. LCT was decreased in the TO group (p < 0.001). After IV MTP treatment, the LCT and best-corrected visual acuity were increased. Thyroid-stimulating hormone receptor antibody levels, intraocular pressure, the superior hemi-sector of the RNFLT, and proptosis were decreased compared with the control subjects (p = 0.012, p = 0.008, p = 0.043, and p < 0.001, respectively)., Conclusions: The RNFLT may not always increase in DON. Lamina cribrosa morphology may change in patients with TO. IV MTP therapy has a positive effect on the LCT but not on radial peripapillary capillary vascular density or LCD., (Copyright © 2023 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate changes in the choroid using the choroidal vascularity index (CVI) and choroidal thickness (ChT) in patients with ocular (OBD) and non-ocular Behçet disease (non-ocular BD)., Methods: Sixty-eight OBD patients, 40 non-ocular BD patients, and 40 healthy control subjects were included. ChT was measured using optical coherence tomography (OCT) in enhanced-depth imaging (EDI) mode (EDI-OCT; sub-foveal ChT at 1000 μm, nasal ChT at 1000 μm temporal ChT). The CVI value (%) was calculated by dividing the luminal area by the sub-foveal total choroidal area., Results: The mean sub-foveal ChT (297 ± 68 µm), nasal ChT (261 ± 66 µm), and temporal ChT (272 ± 68 µm) in eyes with OBD and the mean sub-foveal ChT (286 ± 31 µm), nasal ChT (266 ± 29 µm), and temporal ChT (269 ± 32 µm) in eyes with non-ocular BD were significantly decreased compared with those regions in healthy control subjects (333 ± 69, 301 ± 75, and 312 ± 70 µm, respectively). Additional subgroup analysis was performed for active OBD, inactive OBD, non-ocular BD, and the control group, and in pairwise comparisons, the CVI value was significantly decreased in both active (64.3 ± 3.1) and inactive OBD groups (64.2 ± 4.5) compared with healthy control subjects (67.2 ± 3.6; p = 0.026 and p < 0.001, respectively). There was no significant difference between non-ocular BD (65.9 ± 3.4) and control subjects (67.2 ± 3.6) for CVI measurements (p > 0.05)., Conclusions: Decreased CVI values in OBD suggest that uveitis affects the choroidal vasculature and that perfusion is affected by uveitis, whereas systemic inflammation in non-ocular BD does not affect them. In addition, the choroid in uveitis is affected by the chronicity of the disease rather than disease activity. ChT measurements and CVI values may be a novel and robust prognosticating biomarker to evaluate choroidal vasculature and to monitor disease progression in OBD patients because EDI-OCT is a non-invasive imaging modality. However, CVI does not seem to be a biomarker for monitoring of disease activity or treatment efficacy., (Copyright © 2023 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Large congenital lid colobomas are traditionally repaired using 1- or 2-step vascularized flap-graft combinations. However, visual axis occlusion for weeks is a severe problem in small children and recent reports suggest that the flap pedicle does not contribute to blood perfusion. A "one-step" substitute for large lid defects has recently been reported in animals and humans, demonstrating the viability of a bilamellar autograft alone. We present an alternative "one-step" reconstructive approach in a 6-month-old infant who had a centrally-located large upper eyelid defect resulting from a congenital coloboma. The free full-thickness bilamellar autograft was harvested from the contralateral upper eyelid. The follow-up time was 48 months. Cosmetic and functional results were good, the bilamellar graft survived, and there was no graft ischemia, necrosis, or rejection. The boy developed madarosis, lid notching, and mild contour irregularity but needed no reoperation since the parent was satisfied with the surgical result. A free bilamellar eyelid autograft seems to be an outstanding alternative to both "conventional 2-step" and "modern 1-step" options for the reconstruction of large colobomatous eyelid openings, especially in young infants who cannot tolerate visual axis blockage. It is an easy, practical, fast, and effective technique that also saves cost in health care.

Objective: To evaluate the effect of adalimumab (ADA) on choroidal thickness (ChT) and choroidal vascularity index (CVI) in eyes with non-infectious uveitis (NIU)., Methods: Thirty-seven eyes with NIU including Behçet disease (BD), sarcoidosis, ankylosing spondylitis (AS), juvenile idiopathic arthritis and idiopathic arthritis, 38 eyes of non-uveitic (NU) patients including BD, AS and rheumatoid arthritis, and 40 healthy control eyes were included. ADA was used for anti-TNF-naive adult (80 mg) or paediatric (40 mg) patients with refractory NIU, then 40 mg every 2-week (20 mg in children<30 kg) with controls at weeks 1, 4, 12, and 24. Images were used to measure central, nasal, and temporal ChT, and the luminal area (LA), stromal area, and total choroidal area (TCA) were analysed using enhanced-depth imaging optical coherence tomography (EDI-OCT) by ImageJ software. The CVI was then calculated as the ratio of LA to TCA., Results: Mean ages were similar between the groups. Mean (SE) subfoveal ChT measurements for each location were also similar (for each, p > 0.05). However, calculated CVI values in eyes with NIU (0.63 ± 0.007) were significantly (p < 0.001) lower than NU eyes (0.66 ± 0.006) and controls (0.70 ± 0.007) (p < 0.001). Moreover, CVI was significantly lower in NU eyes compared to controls (p < 0.001). There were no significant CVI changes between the consecutive visits after ADA therapy in eyes with NIU (for each, p > 0.05)., Conclusions: Decreased CVI in NIU and NU eyes indicates that systemic inflammation affects the choroidal vasculature and perfusion both in the presence and absence of ocular involvement. Although CVI may be used as a possible novel tool in monitoring ocular involvement and progression of NIU, CVI does not seem to be a biomarker for treatment monitoring in NIU., (© 2024. The Author(s).)

Objective In this study, we aimed to evaluate the choroidal thickness in patients with unilateral strabismic amblyopia by using spectral domain-enhanced depth imaging-optical coherence tomography (SD-EDI-OCT) (Heidelberg Engineering GmbH, Heidelberg, Germany). Methods Twenty-five children with strabismic amblyopia and 20 age- and sex-matched healthy controls were included in this study. Seven sections were obtained, each comprising 25 repetitive images from each section at 200-micron intervals, and measurements were taken from nine different points at vertical and horizontal lines (1 and 3 mm from the subfoveal, superior, inferior, temporal, and nasal regions), centered on the fovea, using SD-EDI-OCT. Choroidal thickness values were obtained by measuring the distance between the basal border of the retinal pigment epithelium and the choroidoscleral border. The Mann-Whitney U test was used to compare choroidal thickness between the amblyopic and the control groups. Results The mean age of children with amblyopia and that of controls were 8.4 ±2.7 and 9.9 ±3.3 years, respectively (p=0.120). The mean subfoveal choroidal thickness was 372.8 ±78.9 μm in amblyopic eyes and 372.4 ±79.3 μm in the fellow eyes, both of which were thicker than the control eyes (310.9 ±76.3 μm; p<0.05 for each). Similarly, the mean values for the choroidal thickness of the amblyopic children at 1 mm nasal (320 ±86 μm), 1 mm superior (363 ±70 μm), and 3 mm superior (336 ±62 μm) were also significantly thicker than those of the corresponding control eyes (p<0.05 for each). There was a negative correlation between the subfoveal choroidal thickness and axial length (r=-0.332, p=0.005). There were no correlations between the choroidal thickness, age, and visual acuity. Conclusions The choroidal thicknesses of strabismic and fellow eyes were similar in patients with strabismic amblyopia. However, the choroidal thickness of both eyes in strabismic children was significantly thicker than those of the healthy controls. Emmetropization may be defective in both eyes of strabismic amblyopic patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Evereklioglu et al.)

Purpose: Behçet's disease (BD) is an autoimmune chronic systemic inflammatory disease characterized by a versatile clinical spectrum. Growth arrest specific protein 6 (GAS6)/soluble AXL (sAXL) signaling pathway draws attention in the resolution of inflammation, and its deficiency is associated with chronic inflammatory, autoimmune diseases, as well as clearance of apoptotic cells by phagocytes - efferocytosis. In this study, it was aimed to investigate whether GAS6/sAXL, interleukin (IL)-10, nitric oxide (NO), and BCL-2 levels were associated with inflammation and efferocytosis contributes to the pathogenesis of BD., Methods: A total of 37 Behçet patients with ocular involvement and 30 healthy control subjects were included in this study. GAS6, sAXL, IL-10, NO, and BCL-2 levels were quantified using enzyme-linked immunosorbent assay (ELISA) method., Results: Serum GAS6, sAXL, IL-10, NO, and BCL-2 levels were significantly lower in patients with BD compared to the controls (P < 0.005, P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively). In correlation analysis, research parameters decreased in patients with BD was significantly correlated with each other: GAS6-IL-10 (r = 0.585, P < 0.001), GAS6-BCL-2 (r = 0.541, P < 0.001), sAXL-BCL-2 (r = 0.696, P < 0.001), IL-10-NO (r = 0.717, P < 0.001), IL-10-BCL-2 (r = 0.759, P < 0.001), and NO-BCL-2 (r = 0.541, P < 0.001)., Conclusion: In conclusion, decreased serum BCL-2 level may be an indicator of increased apoptosis in these patients and decreased levels of GAS6/sAXL, IL-10, and NO may indicate insufficient clearance of apoptotic bodies released as a result of increased apoptosis in BD patients., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)