Safety and effectiveness of interferon alpha-2a in treatment of patients with Behçet's uveitis refractory to conventional treatments.

PURPOSE: To evaluate the intermediate-term safety and effectiveness of interferon alpha-2a (IFNalpha2a) in patients with Behçet's uveitis (BU) refractory to corticosteroids and immunosuppressive agents. DESIGN: Open, nonrandomized, uncontrolled, interventional, prospective study. PARTICIPANTS: Fifty-three patients (106 eyes) with active, vision-threatening BU who failed to respond to conventional treatments. INTERVENTION: In 53 patients, acute inflammation was suppressed with effective prednisolone dosage (1-2 mg/kg/day, tapered to 10 mg within 4-6 weeks). The patients were treated with IFNalpha2a 4.5 million international units (MIU) 3 times per week for the first 3 months followed by IFNalpha2a 3 MIU 3 times per week for the next 3 months. Observation or other treatment methods were performed according to the decision tree developed for this study. MAIN OUTCOME MEASURES: Remission and complete response (primary outcome measures), frequency of uveitis attacks, visual acuity (VA), and adverse effects (secondary outcome measures). RESULTS: During 2 years of follow-up (median 65 months, range 12-130 months), compliance with the therapy was excellent. At the end of 1-year follow-up, treatment response was obtained in 45 of 53 patients (84.9%). The mean attack rate of 3.6+/-1.1 per year (range, 2-8) decreased to 0.56+/-0.75 (range, 0-4) per year (P=0.001). Visual acuity improved (> or = 0.2 logarithm of the minimum angle of resolution units from initial VA) in 30 eyes (28.3%) and worsened in 12 eyes (11.3%). Five patients (9.4%) did not respond to the initial treatment, and 3 patients (5.6%) developed severe adverse effects, including psoriasis, epileptic seizure, and extreme tiredness. Fifteen patients (28.3%) were off treatment for all the medications and disease free for 28+/-13.1 months (range, 12-50 months). CONCLUSIONS: These results suggest that IFNalpha2a may be a valuable treatment option in BU that is refractory to corticosteroids and conventional immunosuppressive agents. The possible role of IFNalpha2a as a first-line agent in BU should be validated in randomized controlled clinical trials against newly described biologic agents. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Outcomes of Nd:YAG laser treatment for Valsalva retinopathy due to intense military exercise.

BACKGROUND AND OBJECTIVE: Valsalva retinopathy may occur due to intense physical exercise. Soldiers must undergo vigorous physical training to sustain a high level of readiness. The aim of this study was to evaluate the recovery period and the outcomes of Valsalva retinopathy due to physical exercise in the Turkish Army. PATIENTS AND METHODS: Twelve soldiers had Valsalva retinopathy related to military exercise. All patients received Nd:YAG laser membranotomy and were observed for an average of 12.6 months. RESULTS: All eyes had visual acuities of 20/20 at the end of the first month of follow-up. Therefore, the soldiers could continue their training. No complications were observed and additional surgeries were not needed during the 1-year follow-up. CONCLUSIONS: Early visual recovery is important to continue training and reduce health costs in the Turkish Army, where military service is mandatory for a required period of time. For that reason, Nd:YAG laser treatment for Valsalva retinopathy related to military exercise is an effective and safe procedure.

Ocular trauma score in deadly weapon-related open-globe injuries.

PURPOSE: To assess prognostic value of the ocular trauma score (OTS) in deadly weapon-related open-globe injuries. DESIGN: Retrospective, interventional case series. METHODS: In 82 patients (88 eyes) with deadly weapon-related open-globe injuries, certain numerical values rendered to the OTS variables (visual acuity, rupture, endophthalmitis, perforating injury, retinal detachment, afferent pupillary defect) at presentation were summated and converted into OTS categories. The likelihood of the final visual acuities in the OTS categories were calculated and compared with those in the OTS study. RESULTS: The likelihood of the final visual acuities (no light perception NLP, light perception LP/hand motion HM, 1/200 to 19/200, 20/200 to 20/50, and > or = 20/40) in the OTS categories (1 through 5) in this group were similar to those in the OTS study group except for LP/HM in the category-2 (53% vs 26%, P < .001). No study eye was in the category-5 (the best prognosis). CONCLUSIONS: OTS calculated at initial examination may provide prognostic information in deadly weapon-related open-globe injuries.

Terror-related open-globe injuries: a 10-year review.

PURPOSE: To describe mechanisms and injury characteristics influencing visual outcomes in eyes with open-globe injuries sustained in terrorist acts. DESIGN: Retrospective, interventional case series. METHODS: The charts of 260 consecutive patients (285 eyes) who had open-globe injury caused by terrorist attack and admitted to the tertiary referral center for military in Turkey between March 1991 and April 2001 were reviewed, and 50 patients (56 eyes) with complete data were evaluated for predicting visual outcome according to the Ocular Trauma Classification System (OTCS). RESULTS: The mean age of patients was 22.6 years, and the mean follow-up was 5.8 months. Seventeen patients (6.54%) had traumatic amputation in the extremities. Forty-eight eyes (16.84%) were enucleated. Type A, grade V, zone III, and RAPD-positive injuries were associated with unfavorable visual outcome. Land mine and hand grenade injuries had the worst outcome. CONCLUSIONS: In terror-related open-globe injuries, unusual presentations and devastating visual results are common, and OTCS seems to predict visual outcomes.

Endophthalmitis after deadly-weapon-related open-globe injuries: risk factors, value of prophylactic antibiotics, and visual outcomes.

PURPOSE: To identify clinical and microbiologic factors influencing the prevalence and visual outcomes in endophthalmitis after deadly-weapon-related open-globe injuries. METHODS: In a retrospective study of 228 eyes of 212 patients with deadly-weapon-related open-globe injuries, clinical and microbiologic factors influencing the prevalence and visual outcome in endophthalmitis were analyzed in detail. RESULTS: Twenty-nine eyes enucleated for irreparable damages at presentation were excluded. Nineteen eyes (18 patients) of 199 (186 patients) were associated with culture-proven endophthalmitis. Presence of grade 4 injury, a variable of Ocular Trauma Classification System, and lens disruption at presentation were the significant risk factors for development of endophthalmitis (P =.001; odds ratio = 15.9 [2.0 to 122.1]), and ([P <.001; odds ratio = 17.7 [2.3 to 136.3]), respectively. Favorable outcome (visual acuity of 5/200 or better) was achieved in only four eyes (21%). Five eyes (26.3%) were phthisical, and five eyes (26.3%) were enucleated or eviscerated. All eyes were under the coverage of prophylactic intravenous antibiotics when culture positivity was obtained. Except two eyes with Acinetobactersp., all were infected by gram-positive micro-organisms (89.5%), the most common of which (42%) was Staphylococcus epidermidis. None of the clinical characteristics and treatment modalities affected final visual outcome. Favorable outcome was associated with infection by the less virulent micro-organism S. epidermidis (P =.018; odds ratio = 0.50 [0.25 to 1.00]). CONCLUSIONS: Endophthalmitis after deadly-weapon-related open-globe injuries has a dismal visual prognosis. Severity of injury and lens disruption are significant risk factors for development of endophthalmitis. Infection with a less virulent microbe is the only factor associated with favorable outcome.