Researcher: Önal, Sumru
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Önal, Sumru
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Publication Metadata only Quantitative analysis of structural alterations in the choroid of patients with active Behçet uveitis(Lippincott Williams and Wilkins (LWW), 2018) Oray, Merih; Herbort, Carl P.; Akman, Mehmet; Tugal-Tutkun, Ilknur; Department of Mathematics; N/A; N/A; N/A; N/A; Mengi, Emre; Önal, Sumru; Uludağ, Günay; Metin, Mustafa Mert; Akbay, Aylin Koç; Faculty Member; Other; Doctor; Undergraduate Student; Doctor; Department of Mathematics; College of Sciences; School of Medicine; N/A; School of Medicine; N/A; N/A; N/A; Koç University Hospital; N/A; Koç University Hospital; 113760; 52359; N/A; N/A; N/APurpose: To quantitatively analyze in vivo morphology of subfoveal choroid during an acute attack of Behcet uveitis. Methods: In this prospective study, 28 patients with Behcet uveitis of <= 4-year duration, and 28 control subjects underwent enhanced depth imaging optical coherence tomography. A novel custom software was used to calculate choroidal stroma-to-choroidal vessel lumen ratio. Subfoveal choroidal thickness was measured at fovea and 750 mu m nasal, temporal, superior, and inferior to fovea. Patients underwent fluorescein angiography and indocyanine green angiography. Receiver operating characteristic curve and area under the curve were computed for central foveal thickness. The eye with a higher Behcet disease ocular attack score 24 was studied. The main outcome measures were choroidal stromato-choroidal vessel lumen ratio and choroidal thickness. Results: The mean total Behcet disease ocular attack score 24, fluorescein angiography, and indocyanine green angiography scores were 7.42 +/- 4.10, 17.42 +/- 6.03, and 0.66 +/- 0.73, respectively. Choroidal stroma-to-choroidal vessel lumen ratio was significantly higher in patients (0.413 +/- 0.056 vs. 0.351 +/- 0.063, P = 0.003). There were no significant differences in subfoveal choroidal thickness between patients and control subjects. Choroidal stroma-tochoroidal vessel lumen ratio correlated with retinal vascular staining and leakage score of fluorescein angiography (r = 0.300, P = 0.036). Central foveal thickness was significantly increased in patients (352.750 +/- 107.134 mu m vs. 263.500 +/- 20.819 p.m, P < 0.001). Central foveal thickness showed significant correlations with logarithm of minimum angle of resolution vision, Behcet disease ocular attack score 24, total fluorescein angiography score, retinal vascular staining and/or leakage and capillary leakage scores of fluorescein angiography, and total indocyanine green angiography score. At 275 mu m cutoff, diagnostic sensitivity and specificity of central foveal thickness for acute Behcet uveitis were 89% and 72%, respectively (area under the curve = 0.902; 95% CI = 0.826-0.978, P < 0.001). Conclusion: There was choroidal stromal expansion which was not associated with thickening of the choroid. Central foveal thickness may be used as a noninvasive measure to assess inflammatory activity in early Behcet uveitis.Publication Metadata only Interferon alpha for the treatment of cystoid macular edema associated with presumed ocular tuberculosis(Mary Ann Liebert, Inc, 2017) Oray, Merih; Tuğal Tutkun, İlknur; N/A; Önal, Sumru; Uludağ, Günay; Akbay, Aylin Koç; Other; Doctor; Doctor; N/A; Koc University Hospital; Koc University Hospital; Koc University Hospital; 52359; N/A; N/APurpose: To report the efficacy and safety of interferon (IFN) alpha-2a in patients with cystoid macular edema (CME) associated with presumed ocular tuberculosis (TB). Methods: We reviewed the clinical records of 5 patients with presumed ocular TB who had been treated with IFN alpha-2a for recurrent CME during or after completion of anti-tubercular therapy. IFN alpha-2a was administered at an initial dose of 3 million IU per day and then tapered after the initial response. Treatment efficacy was assessed by central macular thickness (CMT) measurement using spectral-domain optical coherence tomography and visual acuity. Results: Three patients were men, and 2 were women. Patients were aged between 38 and 66 years. Mean CMT was 483 +/- 178.6 mm at baseline, 302.3 +/- 56 mm at 1 week, 312.3 +/- 49.5 mm at 1 month, and 286.2 +/- 31.9 mm at 3 months. Mean LogMAR visual acuity was 0.6 +/- 0.4 at baseline, 0.4 +/- 0.3 mm at 1 week, 0.3 +/- 0.3 at 1 month, and 0.3 +/- 0.3 at 3 months. The treatment was interrupted for 10 days because of neutropenia after 2 weeks in 1 patient and discontinued in another after 10 days because of intolerance. Total treatment duration was 3-24 months in the remaining 4 patients. Conclusion: The present small case series suggests that IFN alpha-2a may be an effective and safe therapeutic option for CME that is associated with presumed ocular TB.Publication Metadata only Autoimmune retinopathies: a report of 3 cases(Taylor and Francis Inc, 2013) Oray, Merih; Kir, Nur; Tuncer, Samuray; Onal, Sumru; Tugal-Tutkun, Ilknur; N/A; Önal, Sumru; Other; School of Medicine; 52359Purpose: To describe 3 representative cases of autoimmune retinopathy (AIR). Methods: Clinical records of patients with a diagnosis of AIR were analyzed for demographic data, clinical findings, ancillary and laboratory tests, and treatment employed. Results: Three female patients diagnosed with AIR had bilateral reduction of electroretinogram amplitudes and elevation of visual field threshold within the central 30 degrees of the visual field that was disproportionately more severe than the clinical findings of retinal degeneration. The diagnoses were cancer-associated retinopathy, non-neoplastic AIR, and hereditary retinal dystrophy with secondary inflammation. Optic nerve involvement was also present in all cases. The patient with non-neoplastic AIR was successfully treated with systemic corticosteroids and immunomodulatory agents. Conclusion: High index of suspicion is essential for an early diagnosis of AIR. Visual function and electrophysiological tests should be included in the initial workup of patients who present with suggestive clinical signs and symptoms of AIR.Publication Metadata only Electroretinographic improvement after rituximab therapy in a patient with autoimmune retinopathy(Elsevier, 2016) Arf, Serra; Sayman Muslubaş, Işıl; N/A; N/A; N/A; N/A; N/A; Uludağ, Günay; Önal, Sumru; Selçukbiricik, Fatih; Akbay, Aylin Koç; Mandel, Nil Molinas; Doctor; Other; Faculty Member; Doctor; Faculty Member; N/A; School of Medicine; School of Medicine; N/A; School of Medicine; Koc University Hospital; N/A; N/A; Koc University Hospital; N/A; N/A; 52359; 202015; N/A; 194197Purpose: To describe the effect of rituximab on full-field electroretinography (ERG) in a patient with nonparaneoplastic autoimmune retinopathy (npAIR). Observations: A 58-year-old male patient with visual complaints, positive anti-retinal antibodies and negative work-up for cancer was diagnosed with npAIR. Visual acuity and ancillary tests were normal except abnormal ERG in both eyes. The patient was given one course of rituximab 375 mg/m2/week for 4 weeks and cyclophosphamide 1 gr/m2/month for 6 months. A second course of rituximab was necessary as autoantibody titers showed no change and as new antibodies were noted after treatment with rituximab and cyclophosphamide. Electroretinography was repeated after the first course of rituximab, after cyclophosphamide, and the second course of rituximab therapy. Conclusions and Importance: Rituximab therapy led to marked improvement in full-field ERG readings and regression of symptoms was reported by the patient after rituximab infusions. The effect of rituximab in npAIR was objectively demonstrated with ERG.Publication Metadata only Behçet disease(Springer India, 2015) Tugal-Tutkun, Ilknur; N/A; Önal, Sumru; Faculty Member; School of Medicine; 52359Behçet disease is a multisystem disorder characterized by relapsing inflammation of unknown origin [1, 2]. The disease has first been described as a distinct clinical entity by a Turkish dermatologist, Prof. Hulusi Behçet, as a triple symptom complex of oral and genital ulcers and hypopyon iritis in 1937 [3]. The disease is now accepted as an obliterative and necrotizing systemic vasculitis involving different organ systems and leading to a wide range of clinical manifestations. The usual course of the disease is characterized by recurrent inflammatory episodes. The eye is the most commonly involved vital organ [1]. Uveitis associated with Behçet disease, which will be referred to as Behçet uveitis throughout this chapter, represents one of the most difficult forms of uveitis to treat. Despite the use of robust medical therapy with corticosteroids and conventional immunomodulatory and biologic agents, some patients with Behçet uveitis still end up with poor vision, and Behçet uveitis remains as a potentially blinding disease.Publication Metadata only Validity and agreement of uveitis experts in interpretation of ocular photographs for diagnosis of Behcet uveitis(Taylor & Francis, 2014) Tugal-Tutkun, Ilknur; Ozyazgan, Yilmaz; Soylu, Merih; Akman, Mehmet; N/A; Önal, Sumru; Other; School of Medicine; 52359Purpose: To evaluate agreement and estimate sensitivity and specificity of uveitis specialists' interpretation of ocular photographs in diagnosing Behcet uveitis. Methods: Fourteen Turkish uveitis specialists, masked to demographic and clinical features of patients, independently labeled ocular photographs (29 Behcet/30 other diagnoses) as "Behcet uveitis" or "non-Behcet." Level of agreement was evaluated using kappa statistics. Photographs were categorized based on ocular signs captured and performance of observers. Results: Exact agreement with the correct diagnosis was 56-81%. Seven reviewers correctly labeled more than 70% of photographs. Interobserver agreement among those 7 reviewers revealed moderate (kappa = 0.41-0.60) or substantial (kappa = 0.61-0.80) agreement in 76% of pairs. Smooth layered hypopyon, superficial retinal infiltrate with retinal hemorrhages, and branch retinal vein occlusion with vitreous haze were correctly recognized as Behcet uveitis by majority of reviewers. Conclusions: There are ocular signs of Behcet disease that can be considered diagnostic even in the absence of any other clinical information.Publication Metadata only Screening for depression and anxiety in patients with active uveitis(Taylor and Francis Inc, 2018) Oray, Merih; Akman, Mehmet; Tugal-Tutkun, Ilknur; N/A; Önal, Sumru; Yasa, Çağla; Uludağ, Günay; Akbay, Aylin Koç; Other; N/A; Doctor; Doctor; N/A; Koc University Hospital; Koc University Hospital; Koc University Hospital; Koc University Hospital; 52359; N/A; N/A; N/APurpose: To screen for psychological disorders in patients with active uveitis. Methods: Patients were screened for depression (BDI-II), state anxiety (STAI-I), VR-QOL (NEI-VFQ-25), and HR-QOL (SF-36). Association of depression and anxiety with sociodemographic and clinical parameters and with VR-QOL and HR-QOL were analyzed. Multivariate linear regression models were constructed for NEI-VFQ-25 and SF-36 subscales. Results: of 99 patients, 37.3% screened positive for depression and 52.5% for anxiety. Depressed patients had lower visual acuity in the better seeing eye (p = 0.013) and more frequently panuveitis (p = 0.018). Anxious patients were younger (p = 0.009), had earlier onset of uveitis (p = 0.015), and had more frequently panuveitis (p = 0.016). Bivariate comparisons showed significant associations between psychological disorders and VR-QOL and HR-QOL. Significant bivariate associations were mostly lost in multivariate analyses for anxiety, but were preserved for depression. Conclusions: A positive screening test for depression and anxiety is common in patients with uveitis. Low vision and panuveitis are associated with depression. Depression is associated with impairment of VR-QOL and HR-QOL.Publication Metadata only Unilateral paraneoplastic optic disc edema and retinal periphlebitis in pineal germinoma(Elsevier, 2018) N/A; N/A; N/A; Uludağ, Günay; Onay, Aslıhan; Önal, Sumru; Doctor; Doctor; Other; N/A; N/A; School of Medicine; Koc University Hospital; Koc University Hospital; N/A; N/A; N/A; 52359Purpose: To describe a unilateral ocular paraneoplastic syndrome in pineal germinoma. Observations: A 24-year-old male presented with diplopia, excessive thirst, and frequent urination. Cranial MRI showed a mass in pineal gland. Dorsal midbrain syndrome signs were present. Examination showed optic disc edema and segmental retinal periphlebitis in right and normal fundus in left eye. Rheumatologic work-up was negative. Brain biopsy confirmed pineal germinoma. Retinal findings were attributed to paraneoplastic syndrome. Resolution of optic disc edema and retinal periphlebitis occurred following chemotherapy and focal irradiation. Conclusions and Importance: To date there are two published case reports on bilateral optic disc edema and retinal periphlebitis occurring as a paraneoplastic syndrome in pineal germinoma. This is the first report on a patient with pineal germinoma who had unilateral paraneoplastic involvement characterized by optic disc edema and retinal periphlebitis and who showed complete resolution of ocular disease after treatment of underlying tumor.Publication Metadata only Review for diagnostics of the year: multimodal imaging in Behçet uveitis(Taylor and Francis Inc, 2017) Tugal-Tutkun, Ilknur; Ozdal, Pinar Cakar; Oray, Merih; N/A; Önal, Sumru; Other; School of Medicine; 52359Behcet disease is a chronic relapsing multisystem inflammatory disorder. Ocular involvement is characterized by a bilateral recurrent non-granulomatous panuveitis and retinal vasculitis. Posterior segment findings vary during the course of the disease, in parallel with the relapsing and remitting intraocular inflammation. Structural alterations occur with increased disease duration. Fluorescein angiography is the gold standard in revealing the extent and severity as well as the leaky and/or occlusive nature of retinal vasculitis. Multimodal imaging using color fundus photography, fluorescein angiography, and optical coherence tomography is essential in visualizing diagnostic features, detecting structural changes, and monitoring disease activity and response to treatment in patients with Behcet uveitis.Publication Metadata only Analysis of age, refractive error and gender related changes of the cornea and the anterior segment of the eye with Scheimpflug imaging(2015) Oruçoğlu, Faik; Akman, Mehmet; N/A; Önal, Sumru; Other; School of Medicine; 52359Purpose: To assess age, refractive error and gender related changes occurring in the cornea and the anterior segment of the eye using a Scheimpflug system. Methods: The study included 666 healthy eyed subjects with a mean age of 39.3 +/- 19.7 years (range: 3-85 years). All analyses were based on the right eyes of the patients as all measured parameters correlated well between the right and left eyes. Each parameter was correlated with age and the right eye's spherical equivalent (SE) using Pearson correlations. Univariate linear regression models were constructed for analyses of parameters. Results: The anterior corneal surface asphericity showed significant positive correlations whereas posterior corneal surface asphericity showed significant negative correlations with age. Anterior chamber depth (ACD), volume (ACV) and angle (ACA) showed significant negative correlations with age and SE. Age explained 25% of the variance in anterior corneal surface asphericity, 22% of variance in posterior corneal surface asphericity, 26% of variance in ACV, 27% of variance in ACD, and 19% of variance in ACA. In the SE model SE was identified to account for 25% of variance in ACV, 22% of variance in ACD, each, and 17% of variance in ACA. Significant differences were detected in anterior and posterior keratometry values, ACV, ACD and ACA among gender groups (p <0.01). Conclusions: The cornea shows a tendency for a decrease in anterior corneal surface asphericity and an increase in posterior corneal surface asphericity with advancing age. Men have flatter corneas and women have shallower anterior chambers and narrower anterior chamber angles.