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. METHODS: Data from 114 patients with scleritis (82 female and 32 male; mean age, 48 +/- 17.7 years; age range, 4-87 years; 47 diffuse, 49 nodular, 7 necrotizing, and 11 posterior) who had undergone treatment between 1995 and 2006 were recorded. RESULTS: Mean follow-up duration was 16.9 months. Thirteen patients (12%) had bilateral ocular disease at presentation, and 21 patients (19%) developed bilateral ocular disease during follow-up. Decreased visual acuity was most common (60%) in posterior scleritis and least common (2%) in diffuse scleritis. Thirty-six patients (32%) had associated systemic disease, and in 13 patients (11%), scleritis was the presenting symptom of a systemic disease. CONCLUSIONS: Scleritis is a form of ocular inflammation frequently associated with systemic autoimmune disease and ocular complications. Close follow-up, systemic evaluation, and timely treatment are necessary in all patients with scleritis.

A cross-sectional and longitudinal study of Fuchs uveitis syndrome in Turkish patients.

PURPOSE: To describe Turkish patients with Fuchs uveitis syndrome (FUS). DESIGN: Retrospective observational case series. METHODS: We reviewed the records of 172 patients with FUS seen at Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, between January 1995 and July 2007. The main outcome measures were demographic features, clinical findings at presentation, laser flare photometry values, risk of new complications, and rate of decreased vision. RESULTS: The mean age was 29.5 + 8.4 years. Male-to-female ratio was 1:1.3. Nine patients (5.2%) had bilateral involvement. The diagnosis of FUS had been made in only 10 of 115 (8.7%) referrals. Clinical findings at presentation included diffuse keratic precipitates (medium-sized round in 74.6%, fine-stellate in 22.1%), anterior chamber cells (74%), diffuse iris atrophy without hypochromia (48.6%), heterochromia (39.8%), iris nodules (32%), cataract/pseudophakia (69.1%), vitreous cells (71.8%), elevated intraocular pressure (12.7%), and chorioretinal scars (7.7%). The mean flare was 8.4 + 3.1 photons/ms in eyes with FUS and 3.7 + 0.8 photons/ms in the fellow eyes (P < .001). Hyperfluorescence of the optic disc was the only fluorescein angiographic finding, detected in 7 of 32 eyes (22%). Kaplan-Meier analysis estimated risks of cataract formation and intraocular pressure elevation as 42% and 17%, respectively, at 4 years. The rate of decreased visual acuity by 2 lines or more was 0.06/eye-year. CONCLUSIONS: The referral patterns suggest that FUS is frequently misdiagnosed in Turkish patients. Diffuse medium-sized round keratic precipitates, low flare readings, iris stromal atrophy without hypochromia, and vitreous opacities in the absence of macular edema are more often helpful clues to the diagnosis than heterochromia.

Referral patterns, demographic and clinical features, and visual prognosis of Turkish patients with sarcoid uveitis.

The purpose of this study was to investigate the referral patterns, demographic and clinical features, and visual prognosis of patients with sarcoid uveitis seen at 2 tertiary eye care centers in Turkey. A retrospective study was made of 44 patients with uveitis associated with biopsy-confirmed or presumed sarcoidosis. Thirty-four patients (77%) were female and 10 (23%) were male. The mean age at onset of uveitis was 39.8 years. Twenty-seven patients (61%) were referred without a diagnosis of sarcoidosis and 17 (39%) patients were referred with a diagnosis of systemic sarcoidosis. The duration of uveitis prior to referral was 2-15 years in 52% of the patients in the former group. At presentation, 37 patients (84%) had bilateral and 7 patients (16%) had unilateral uveitis, and 17 patients (39%) had only anterior uveitis. The most common ocular findings were granulomatous keratic precipitates, persistent posterior synechiae, and snowball vitreous opacities. Kaplan-Meier survival analysis estimated the risk of recurrence as 30% at 6 months and 61% at 5 years. New complications developed in 18 patients. Potential visual acuity was better than 0.4 in 80% of eyes. The estimated risk of losing potential visual acuity by at least 2 lines was 7% at 6 months and 43% at 5 years. None of the eyes lost useful vision (> 0.1) under the authors' care. The referral patterns suggest underrecognition of sarcoidosis as a cause of uveitis in Turkey. The demographic and clinical features of these patients were mostly similar to those reported from other countries, suggesting that the diagnosis may not be difficult in Turkish patients but requires an increased awareness of the disease in this population.

Results of interferon-alfa therapy in patients with Behçet uveitis.

PURPOSE: To report on the results of interferon-alpha 2a (IFNalpha) treatment in patients with Behçet uveitis unresponsive to conventional immunosuppressive therapy. METHODS: We retrospectively analyzed the medical records of 44 patients who had been treated with IFNalpha between September 2001 and May 2005. The initial dose of IFNalpha 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 IFNalpha 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 IFNalpha therapy in 91% of Turkish patients with Behçet uveitis refractory to conventional immunosuppressive treatment. Our results suggest that there may be differences in therapeutic efficacy and side-effect profile of IFNalpha in different patient populations. Comparative studies are needed to investigate this hypothesis.