Biomedical subjects

Y A Akova

Publications and source records attributed to Y A Akova.

15 recordsLinked to original sources

PubMed1997

Phacoemulsification and intraocular lens implantation in a patient with Mooren's ulcer.

A 61-year-old man with progressive, bilateral Mooren's ulcer had subjective symptoms of pain, discomfort, and blurred vision. Biomicroscopic examination showed 360 degrees of peripheral ulceration of the cornea. There were 1+ cells in the anterior chamber, and nuclear sclerosis of the lens was present. He was treated with topical and systemic steroids, perilimbal conjunctival resection, and systemic cyclophosphamide therapy. After the complete control of inflammation, the patient remained in remission for 14 months. When a cataract developed in the right eye, reducing the visual acuity to light perception, the authors performed a scleral tunnel incision and phacoemulsification with intraocular lens implantation. After 18 months of postoperative follow-up, the vision improved to 20/30, and the eye was stable. Phacoemulsification and scleral tunnel incision with intraocular lens implantation can be successfully performed after the complete control of inflammation with medical therapy.

Anti-Bacterial Agents↗

PubMed1996

Referral patterns of uveitis in a tertiary eye care center.

OBJECTIVE: To analyze the referral patterns and diagnosis of uveitis during the past decade in a large tertiary eye center. DESIGN: The records of 1237 patients with uveitis referred to the Immunology Service of the Massachusetts Eye and Ear Infirmary from 1982 to 1992 were classified and analyzed. Data regarding sex, race, nationality, referral site, ages at presentation and onset of uveitis, ocular involvement, clinical characteristics, ocular condition, and systemic disease associations were obtained. RESULTS: The mean age at onset of uveitis was 37.2 years; the male-to-female ratio was 1:1.4. Most patients were white (85.8%), born in the United States (83.1%), and referred from within New England (84.7%). Anterior uveitis was most common (51.6%), followed by posterior uveitis (19.4%), panuveitis (16.0%), and intermediate uveitis (13.0%). Chronic (58.3%), nongranulomatous (77.7%), and noninfectious (83.1%) were the most frequent types of uveitis. The most common entities included idiopathic (34.9%), seronegative spondyloarthropathies (10.4%), sarcoidosis (9.6%), juvenile rheumatoid arthritis (5.6%), systemic lupus erythematosus (4.8%), Behçet's disease (2.5%), and the acquired immunodeficiency syndrome (2.4%). CONCLUSION: The appearance of new uveitic entities, such as the acute retinal necrosis syndrome, multifocal choroiditis and panuveitis, birdshot retinochoroidopathy, and acquired immunodeficiency syndrome-related uveitis, and the reemergence of the classic infectious causes of uveitis, tuberculosis and syphilis, have changed the way we approach the diagnosis and management of posterior and panuveitis at the Massachusetts Eye and Ear Infirmary.

Adolescent↗

PubMed1996

Systemic drug toxicity trends in immunosuppressive therapy of immune and inflammatory ocular disease.

PURPOSE: To compare the relative toxicities of six systemic immunosuppressive drugs and systemic corticosteroids used to treat patients with severe ocular inflammatory disease and to identify factors influencing their occurrence. METHODS: The authors reviewed the clinical records of 602 patients with ocular inflammatory disease treated with immunosuppressive drug therapy and/or systemic corticosteroids for adverse systemic effects while undergoing therapy. Proportional hazards regression analysis was performed to identify demographic and clinical factors that influence the occurrence of drug toxicity in these patients. RESULTS: Immunosuppressive drug treatment was more likely to result in discontinuation of therapy because of toxic side effects than was corticosteroid treatment. However, unlike many of the side effects of corticosteroid treatment, the side effects of immunosuppressive therapy were reversible with reduction in dosage or discontinuation of the drug. Gastrointestinal symptoms and hematologic abnormalities accounted for the majority of reported side effects of the immunosuppressive medications. Neuro-psychiatric and endocrine side effects were common in patients taking prednisone. In 17 patients treated with prednisone, pathologic fractures developed, which involved the hips and the spine. Female sex and age older than 60 years also were identified as factors associated with intolerance to drug therapy in the authors' study population. Race and type of systemic ocular disease were not significant factors influencing tolerance to drug therapy. CONCLUSION: These findings suggest that when properly administered and monitored for adverse effects, most immunosuppressive agents used in the current study have similar risk profiles with relatively few serious therapeutic mishaps and largely reversible side effects. In contrast, corticosteroids can result in permanent disabilities as a result of long-term treatment.

Adult↗

PubMed1995

Systemic immunosuppressive therapy and the occurrence of malignancy in patients with ocular inflammatory disease.

PURPOSE: To compare the occurrence of malignancy in patients with severe ocular inflammatory disease treated with systemic corticosteroids alone or with systemic immunosuppressive drugs with or without systemic corticosteroids. METHODS: The clinical records of 543 patients with ocular inflammatory disease treated with systemic corticosteroids and/or immunosuppressive chemotherapy were reviewed in a retrospective cohort study. Characteristics of patients treated with corticosteroids alone were compared with characteristics of patients treated with immunosuppressive agents with or without preceding corticosteroid treatment. The rates of malignancy after initiation of drug therapy were compared using an exact test for incidence rate data. RESULTS: Compared with patients treated with corticosteroids alone, patients treated with immunosuppressants with or without corticosteroid treatment were older and had more severe systemic disease. During a total of 1261 person-years of follow-up, a malignancy developed in five patients. The rate of malignancy in the immunosuppressant group (4 malignancies during 968 person-years of follow-up) was not significantly different from the rate in the corticosteroids alone group (1 malignancy during 293 person-years of follow-up) (P > 0.90, exact test for incidence rate data). CONCLUSION: These findings do not support the hypothesis of an increased risk of malignancy in patients with severe ocular inflammatory disease who are treated with systemic immunosuppressive agents compared with patients treated with systemic corticosteroids.

Adult↗

PubMed1995

Penetrating keratoplasty in cicatrizing conjunctival diseases.

PURPOSE: The outcome of successful penetrating keratoplasty (PK) typically is poor in eyes with end-stage chronic cicatrizing conjunctival diseases such as ocular cicatricial pemphigoid (OCP), Stevens-Johnson syndrome, and toxic epidermal necrolysis due to immunologically driven conjunctival inflammation associated with conjunctival cicatrization and lid abnormalities, severe dry eye, and extensive corneal neovascularization. The authors report the results of their experience with PK in 13 patients with OCP, Stevens-Johnson syndrome, and toxic epidermal necrolysis. METHODS: The authors reviewed the records of patients with OCP, Stevens-Johnson syndrome, or toxic epidermal necrolysis seen between 1976 and 1992. Patients who underwent PK were examined for the purpose of this study. Initial and final visual acuity, indications for PK, surgical procedure, postoperative therapy, complications, total number of repeat PKs, length of follow-up, and the final outcome were recorded. RESULTS: Thirty-two PKs were performed in 16 eyes of 13 patients with advanced OCP (6 patients), OCP as a sequela of Stevens-Johnson syndrome (2 patients), Stevens-Johnson syndrome (3 patients), and toxic epidermal necrolysis (2 patients). The indications for the first PK were corneal perforation in six eyes (37.5%) and extensive corneal scarring in ten eyes (62.5%). Preoperative visual acuity was counting fingers in five eyes, hand motions in eight, and light perception in three. Preoperative therapy included systemic chemotherapy (8 patients), mucous membrane grafting (9 eyes), lamellar keratoplasty (2 eyes), superficial keratectomy (1 eye), and corneal dye laser photocoagulation (6 eyes). The mean follow-up period was 4.6 years (3 months-13 years). Eight eyes (50%) had clear grafts, and three eyes (18.7%) had 20/200 or better visual acuity at last visit. The major causes of graft failure were epithelial defect formation/persistence, stromal ulceration, perforation, and graft rejection. CONCLUSIONS: These results indicate that PK may be performed for tectonic reasons, but prospects for restoration of sight in patients with advanced cicatrizing conjunctival diseases, even after extensive preoperative medical and surgical therapy, are limited.

Adolescent↗

PubMed1995

Penetrating keratoplasty in atopic keratoconjunctivitis.

Penetrating keratoplasty (PK) may be required for visual rehabilitation or tectonic purposes in patients with severe keratopathy due to atopic keratoconjunctivitis (AKC). The outcome of PK is often poor in such patients because of adnexal and ocular surface abnormalities. We studied nine AKC patients requiring PK and evaluated the visual outcome and prognostic factors in 11 eyes. The mean follow-up was 87.2 months (range, 30-180 months). Preoperatively all patients had visual acuity of hand motion to 20/200. Eighteen grafts were performed. Final visual acuity was 20/40 or better in 46% of the eyes. Ten eyes retained clear grafts and improved an average of 4.5 Snellen acuity lines.

Adult↗

PubMed1994

Posterior segment ocular manifestations in patients with HLA-B27-associated uveitis.

PURPOSE: To describe a series of patients with seronegative arthritic syndromes and HLA-B27-associated uveitis with severe, sight-threatening, posterior segment ocular manifestations. METHODS: The authors reviewed the records of 29 patients (17.4%) with posterior segment involvement from a cohort of 166 patients with HLA-B27-associated uveitis. The inclusion criteria included individuals with a positive HLA-B27 who had at least one of the following findings: (1) severe vitreous inflammation; (2) papillitis; (3) retinal vasculopathy; or (4) pars plana exudates. The study population comprised 13 men and 16 women with a mean age at onset of uveitis of 35.2 years. The average duration of the uveitis was 5.3 years, and the median follow-up time was 26 months. FINDINGS: Posterior segment involvement occurred in 34 eyes of the 29 patients. The most common findings included severe and diffuse vitritis in 93.1% of the patients and papillitis in 24 patients (82.7%). Retinal vasculitis occurred in seven patients (24.1%), and pars plana exudates were present in two patients (6.8%). Cystoid macular edema (37.9%) and epiretinal membrane (17.2%) were common causes of visual impairment. Systemic immunosuppressive therapy was required for control of inflammation in 32% of the patients. CONCLUSION: HLA-B27-associated uveitis may be related to severe, sight-threatening posterior segment manifestations in some patients; this is an under-recognized phenomenon. These patients may require the use of aggressive systemic immunosuppressive therapy to control inflammation and preserve vision.

Adolescent↗

PubMed1994

Cataract surgery in patients with sarcoidosis-associated uveitis.

PURPOSE: The authors analyzed the incidence of cataract development and the visual outcome of cataract surgery performed on patients with sarcoidosis-associated uveitis who were treated at the Immunology Service at the Massachusetts Eye and Ear Infirmary during a 17-year period. METHODS: The records of 102 patients with sarcoidosis-associated uveitis who were treated with topical and regional corticosteroids, systemic nonsteroidal anti-inflammatory drugs, systemic steroids, or with systemic immunosuppressive chemotherapy were reviewed. Cataract surgery was performed on those eyes in which cataract developed, resulting in decreased visual acuity of 20/100 or less. The incidence of cataract development and visual results of cataract extraction and intraocular lens implantation were analyzed. RESULTS: In this cohort of 102 patients, visually significant cataracts that warranted surgery developed in 10 (16 eyes). In addition, four patients (5 eyes) had a visually significant cataract at the time of first evaluation. A total of 14 patients (21 eyes) underwent cataract surgery. Posterior chamber lens implantation accompanied cataract surgery in 19 (90.5%) of 21 eyes. The average final visual acuity of the 21 eyes after cataract surgery was 20/51, and 61% of the eyes achieved a stable visual acuity of 20/40 or better. The major causes of the decreased visual acuity in patients who had less than 20/40 visual acuity were sequelae of chronic posterior uveitis, cystoid macular edema, epiretinal membrane, and glaucomatous optic nerve damage. CONCLUSION: Posterior chamber lens implantation and cataract surgery in patients with sarcoidosis-associated uveitis can be well tolerated when absolute control of the inflammation is achieved. Pre-existing retinal pathology and glaucoma as a result of uncontrolled inflammation resulting in permanent ocular structural damage were found to be the most important factors for determining the postoperative final visual acuity.

Adult↗

PubMed1994

Macular subretinal neovascular membrane associated with pseudotumor cerebri.

We report on the development of juxtapapillary subretinal neovascular membrane and permanent severe visual loss in a patient with pseudotumor cerebri. The patient was managed by a lumboperitoneal shunt. After surgery, despite resolving papilledema and intracranial pressure control, the membrane had enlarged rapidly to involve the foveal avascular zone, and resulted in rapid visual loss. The membrane slowly regressed, and was replaced by fibrous tissue at the ninth month, causing permanent severe visual loss.

Adult↗

PubMed1993

Ocular presentation of polyarteritis nodosa. Clinical course and management with steroid and cytotoxic therapy.

BACKGROUND: Polyarteritis nodosa is a necrotizing vasculitis affecting medium and small-sized arteries throughout the body, including ocular tissues. Untreated polyarteritis nodosa carries a very poor prognosis. Treatment with steroids increases the 5-year survival to 48%, whereas addition of cytotoxic immunosuppressive treatment improves the outcome dramatically. METHODS: The authors reviewed five cases of polyarteritis nodosa with a spectrum of ocular findings which preceded and contributed to its diagnosis. RESULTS: The ophthalmic manifestations of polyarteritis nodosa in these patients included scleritis, peripheral ulcerative keratitis, nongranulomatous uveitis, retinal vasculitis, pseudotumor of the orbit, and central retinal artery occlusion associated with temporal arteritis. In four patients, cytotoxic immunosuppressive therapy was begun promptly, and elimination of inflammation was achieved. CONCLUSIONS: The authors' presentation of these cases is intended to emphasize the fact that ocular inflammation can be the earliest presenting manifestation of polyarteritis nodosa and that its recognition may lead to the early institution of therapy, which can decrease morbidity and mortality in this disease.

Adult↗

PubMed1993

Atypical ocular atopy.

BACKGROUND: Atopic keratoconjunctivitis (AKC) is defined as a chronic keratoconjunctivitis associated with atopic dermatitis, but severe progressive keratoconjunctivitis as a sole manifestation of atopy also may occur. The authors report three patients with a longstanding history of chronic conjunctivitis with bilateral pannus formation. These patients denied any history of major atopy at the time of presentation. METHODS: All patients were evaluated for collagen vascular disease and for evidence of atopy. Conjunctival biopsy was obtained in each case and was analyzed by light microscopy and by immunohistochemical techniques. RESULTS: Systemic evaluation for collagen vascular disease was negative. Serum IgE levels were elevated in one patient. Conjunctival biopsy suggested atopy in all patients with characteristic histopathologic findings. Referral to an allergist showed wheal and flare reactions to multiple ubiquitous environmental allergens. Two patients then disclosed a history of atopic dermatitis and another confessed a history of asthma. Each patient responded well to environmental control of allergens, topical cromolyn sodium 4%, and systemic antihistamine therapy with subsequent resolution of the chronic conjunctivitis. The corneal complications were managed with pannus resection and postoperative mitomycin C drops in two patients. CONCLUSION: These patients suffered from the progressive blinding consequences of a chronic keratoconjunctivitis, which we believe is an atypical form of AKC. In this report, it is suggested that atopy should be considered in some cases of external ocular inflammation, even in the absence of the characteristic findings of systemic atopy. Conjunctival biopsy is a valuable diagnostic tool in such cases.

Adult↗

PubMed1993

The role of Igh-1 disparate congenic mouse T lymphocytes in the pathogenesis of herpetic stromal keratitis.

The corneal destruction associated with herpes simplex keratitis (HSK) is primarily the result of the host's immune response to herpes simplex virus type-1 (HSV-1) infection. We examined the role of T cells and T cell subsets in the pathogenesis of HSK. Naive and immune T cells and HSV-1 immune CD4+ and CD8+ subsets from Igh-1 disparate BALB/c congenic mice were adoptively transferred into athymic BALB/c nude mice, which normally do not develop HSK. The results demonstrated that while the transfer of naive T cells from either HSK-susceptible C.AL-20 (Igh-1d) or HSK-resistant C.B-17 (Igh-1b) mice had little influence on HSK development, transfer of either CD3+ or CD4+ HSV-1 immune T cells from C.AL-20 mice resulted in the development of severe HSK in all of the recipients. Transfer of the same cell populations from C.B-17 mice resulted in the development of only a mild keratitis in 50% of the recipients. Transfer of CD8+ cells from either donor strain did not result in stromal disease in any recipient mouse. These results clearly demonstrate the pivotal role of CD4+ T cells in the development of necrotizing herpes stromal keratitis, and further demonstrate that CD8+ T cells are not essential in HSK development in the BALB/c system.

Animals↗

PubMed1993

Pseudotumor cerebri secondary to dural sinus thrombosis in neurosarcoidosis.

Pseudotumor cerebri as a presenting manifestation of neurosarcoidosis is rare. This case reported herein had pseudotumor cerebri secondary to dural sinus thrombosis as a presenting feature of neurosarcoidosis without known systemic sarcoidosis. Proper systemic steroid therapy resulted in ocular and systemic recovery. Neurosarcoidosis should be considered in the differential diagnosis of pseudotumor cerebri in patients with unusual neurological findings.

Adult↗

PubMed1990

Recurrent macular corneal dystrophy following penetrating keratoplasty.

The recurrence of macular corneal dystrophy within a corneal graft has been described in a number of case reports. In this study, we reviewed 41 transplants in 31 eyes of 16 patients undergoing keratoplasty for macular corneal dystrophy confirmed by histopathological examination. The follow-up time ranged between 25 and 408 months from initial diagnosis. Six eyes of four patients had repeat keratoplasty because of clinical recurrence and visual impairment. Pathological confirmation was available in five of the six eyes. Peripheral clinical recurrence was observed in two more eyes. The size of the graft used was inversely related to the recurrence.

Adult↗

PubMedDate not supplied

Fleck dystrophy of the cornea; a report of cases from three generations of a family.

Fleck dystrophy of the cornea is characterized by numerous, tiny, small opacities scattered throughout the entire corneal stroma. The mode of inheritance is autosomal dominant, and this dystrophy is considered to be bilaterally symmetric. This report describes five members from three-generations of the same family with corneal fleck dystrophy. Their clinical features and genetic inheritance pattern are discussed. Visual acuity in all patients was normal and the density of opacities were similar except for two patients with less density. Except for one who presented with mild photophobia all patients were asymptomatic. The inheritance pattern appeared as autosomal dominant with variable expression.

Adolescent↗