CURRICULUM VITAE EDUCATION · 2. The clinical uveitis research award (Berlin, September 26, 2005)...

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CURRICULUM VITAE

Name, Surname: Sumru Onal

Date of Birth: November 14, 1971

Place of Birth: Istanbul, Turkey

Marital Status: Married

EDUCATION: 1979-1982 Paul Gerhardt Grundschule - Lingen (EMS), Germany 1983-1989 Erenköy High School - Istanbul, Turkey

(Graduated in the third rank) 1989-1990 English Preparatory Class - Marmara University, Istanbul, Turkey 1990-1996 Marmara University School of Medicine, Istanbul, Turkey

(Graduated in the fourth rank) RESIDENCY: 10/1997 - 03/2002 Istanbul University, Istanbul Faculty of Medicine, Department of

Ophthalmology, Istanbul, Turkey FELLOWSHIP: 10/2005 - 04/2006 Ocular Immunology at Harvard Medical School, the Massachusetts Eye

Research and Surgery Institution (MERSI), and the Ocular Immunology and Uveitis Foundation (OIUF), Boston, MA, USA

OBSERVERSHIP: September 13-30, 2010

Ophthalmic Plastic and Reconstructive Surgery Department, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

October 1-14, 2010 Ocular Immunology at Harvard Medical School, the Massachusetts Eye Research and Surgery Institution (MERSI), and the Ocular Immunology and Uveitis Foundation (OIUF), Boston, MA, USA

LICENSURE AND CERTIFICATION: 1996 United States Medical Licensing Examination

ECFMG CERTIFICATE NUMBER: 0-534-040-1 2008 Fellow of the European Board of Ophthalmology ACADEMIC APPOINTMENTS: 08/2002 - 06/2006 Attending Physician in Ophthalmology, Marmara University School of

Medicine, Department of Ophthalmology 06/2006 - 12/2007 Assistant Professor of Ophthalmology, Marmara University School of

Medicine, Department of Ophthalmology 12/2007 - 12/2010 Associate Professor of Ophthalmology, Marmara University School of

Medicine, Department of Ophthalmology 09/2012- Associate Professor of Ophthalmology, Koc University School of

Medicine, Department of Ophthalmology

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MEMBERSHIPS: 1997-present Turkish Ophthalmology Society (TOD) 1998-2002/2005-present

American Academy of Ophthalmology (AAO)

2005-present Association for Research in Vision and Ophthalmology (ARVO) 2005-present Foster Ocular Immunology Society (FOIS) 2007-present American Uveitis Society (AUS) 2009-present Uveitis and Behçet Disease Unit of the Turkish Ophthalmology Society EDITORIAL APPOINTMENTS: 2007-present Ophthalmic Surgery, Lasers and Imaging, Reviewer 2009-present Ocular Immunology and Inflammation, Reviewer 2010-present Rheumatology, Reviewer 2011-present 2011-present

Faculty of 1000 post-publication peer review, Faculty International Ophthalmology, Reviewer

2012-present Archives of Ophthalmology, Reviewer AWARDS: 1. TUBITAK (Turkish Scientific and Technological Research Council) encouragement award (November 2001) 2. The clinical uveitis research award (Berlin, September 26, 2005) BIBLIOGRAPHY:

Original Reports Articles published in international journals

1. Onal S, Tugal-Tutkun I, Urgancıoglu M, Gul A. Clinical course of ocular Behçet’s

disease in siblings. Ocular Immunol Inflamm. 2001,9: 111-124.

2. Peksayar G, Altan-Yaycıoglu R, Onal S. Excision and cryosurgery in the treatment of

conjunctival malignant epithelial tumours. Eye. 2003;17:229-232.

3. Onal S, Gozum N, Gucukoglu A. Visual results and complications of posterior

chamber intraocular lens implantation after capsular tear during

phacoemulsification. Ophthalmic Surg Lasers Imaging. 2004;35:219-224.

4. Tugal-Tutkun I, Onal S, Altan-Yaycioglu R, Altunbas HH, Urgancioglu M. Uveitis in

Behçet’s disease: an analysis of 880 cases. Am J Ophthalmol. 2004;138:373-380.

5. Onal S, Toker E. A rare ocular complication of mumps: Kerato-Uveitis. Ocular

Immunol Inflamm. 2005;13:395-397.

6. Onal S, Gozum N, Gucukoglu A. Effect of apraclonidine versus dorzolamide on

intraocular pressure after phacoemulsification. Ophthalmic Surg Lasers Imaging.

2005;36:457-462.

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7. Tugal-Tutkun I, Onal S, Altan-Yaycioglu R, Kir N, Urgancioglu M. Neovascularization

of the optic disc in Behçet disease. Jpn J Ophthalmol. 2006;50:256-265.

8. Yenice Ö, Öğüt MS, Onal S, Ozcan E. Conservative treatment of isolated medial

orbital wall fractures. Ophthalmic Surg Lasers Imaging. 2006;37: 497-501.

9. Onal S, Foster CS. Retinal vasculitis. Contemporary Ophthalmology. 2006;5(3):1-8.

10. Onal S, Kazokoglu H, Incili B, Eksioglu Demiralp E, Yavuz S. Prevalence and levels of

serum antibodies to Gram negative microorganisms in Turkish patients with HLA-

B27 positive acute anterior uveitis and controls. Ocul Immunol Inflamm. 2006;14:293-

9.

11. Onal S, Foster CS, Ahmed R. Efficacy of Intravenous Immunoglobulin Treatment in

Refractory Uveitis. Ocul Immunol Inflamm. 2006;14:367-74.

12. Yenice O, Onal S, Incili B, Temel A, Afşar N, Tanrıdağ T. Assessment of spatial-contrast

function and short-wavelength sensitivity deficits in patients with migraine. Eye.

2007;21: 218-223.

13. Onal S, Toker E, Akingol Z, Arslan G, Ertan S, Turan C, Kaplan O. Refractive errors of

medical students in Turkey: one year follow-up of refraction and biometry. Optom

Vis Sci. 2007;84:175-180.

14. Cordero Coma M, Sobrin L, Onal S, Christen W, Foster CS. Intravitreal bevacizumab

for treatment of uveitic macular edema. Ophthalmology. 2007;114;1574-1579.

15. Öğüt MS, Onal S, Demirtas S. Adjustable suture surgery for correction of various

types of strabismus. Ophthalmic Surg Lasers Imaging. 2007;38:196-202.

16. Yenice O, Onal S, Midi I, Ozcan E, Temel A, I-Gunal D. Visual field analysis in patients

with Parkinson's disease. Parkinsonism Relat Disord. 2008;14:193-8.

17. Onal S, Yenice O, Cakir S, Temel A. FACT contrast sensitivity as a diagnostic tool in

glaucoma: FACT contrast sensitivity in glaucoma. Int Ophthalmol. 2008;28:407-12.

18. Kazokoglu H, Onal S, Tugal-Tutkun I, Mirza E, Akova Y, Özyazgan Y, Soylu M, Batıoğlu

F, Apaydın C. Demographic and clinical features of uveitis in tertiary centers in

Turkey. Ophthalmic Epidemiol. 2008;15:285-93.

19. Toker E, Onal S, Eraslan M, Eyriparmak M. The Turkish Version of the National Eye

Institute Refractive Error Quality of Life Instrument: Translation, Validity and

Reliability. Qual Life Res. 2008;17:1269-1276.

20. Onal S, Kazokoglu H, Koc A, Yavuz S. Rituximab for remission induction in a patient

with relapsing necrotizing scleritis associated with limited Wegener’s

Granulomatosis. Ocul Immunol Inflamm. 2008;16:230-2.

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21. Onal S, Kazokoglu H, Direskeneli H, Yavuz S. Low-dose interferon alfa-2a therapy in

severe uveitis associated with Behçet disease. Am J Ophthalmol. 2009;147:1109-1110.

22. Onal S, Kazokoglu H, Koç A, Akman M, Bavbek T, Direskeneli H, Yavuz S. Low dose and

dose escalating therapy of interferon alfa-2a in the treatment of refractory and sight-

threatening Behçet’s uveitis. Clin Exp Rheumatol. 2009;27 (Suppl. 53):113-114.

23. Koc A, Onal S, Yenice O, Kazokoglu H. Pars plana vitrectomy and intravitreal

liposomal amphotericin B in the treatment of candida endophthalmitis. Ophthalmic

Surg Lasers Imaging. 2010 doi: 10.3928/15428877-20100215-35

24. Onal S, Asfuroglu E, Kazokoglu H. Subconjunctival triamcinolone acetonide injection

in the treatment of acute noninfectious nonnecrotizing anterior scleritis. Am J

Ophthalmol. 2010;149:1012.

25. Onal S, Savar F, Akman M, Kazokoglu H. Vision and health-related quality of life in

patients with Behçet uveitis. Arch Ophthalmol. 2010;128:1265-71.

26. Onal S, Kazokoglu H, Koç A, Akman M, Bavbek T, Direskeneli H, Yavuz S. Long-term

efficacy and safety of low-dose and dose-escalating interferon alfa-2a therapy in

refractory Behçet uveitis. Arch Ophthalmol. 2011;129:288-294.

27. Tugal-Tutkun I, Onal S, Garip A, Taskapili M, Kazokoglu H, Kadayifcilar S, Kestelyn P.

Bilateral acute iris transillumination. Arch Ophthalmol. 2011;129:1312-1319.

28. Cingu K, Onal S, Urgancioglu M, Tugal-Tutkun I. Improved early visual outcomes in

Turkish patients with Behçet uveitis who presented in the 2000s. Ocul Immunol

Inflamm. 2012;20:423-8.

29. Cordero-Coma M, Yilmaz T, Onal S. Anti-Tumor Necrosis Factor-Alpha therapy for

treatment of immune-mediated uveitis: Evidence-based update. Ocul Immunol

Inflamm. 2013;21:12-20.

30. Oray M, Kır N, Tuncer S, Onal S, Tugal-Tutkun I. Autoimmune retinopathies: A report

of 3 cases. Revision submitted to Ocul Immunol Inflamm.

Articles published in Turkish Journals

1. Gezer A., Altunbas H.H., Ozturk S., Sezen F. [Prognostic factors in acquired fourth

nerve palsy]. Medical Bulletin Istanbul. 1999; (62),2:162-166.

2. Gezer A., Altan-Yaycıoglu R., Ozturk S., Sezen F. [Late results of bimedial surgery for

convergence excess type of esotropia]. Medical Bulletin Istanbul. 1999; (62),2:167-170.

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3. Gezer A., Ozturk S., Altunbas H.H., Sezen F. [The effect of prematurity on the clinical

characteristics of infantile esotropia]. Turk J Ophthalmol. 1999;29:280-283.

4. Onal S, Gozum N, Gucukoglu A. [The distribution of corneal astigmatism with respect

to age]. Turk J of Ophthalmol. 2000;30:610-614.

5. Onal S, Gezer A, Altan-Yaycıoglu R, Sezen F. [The comparison of two surgical methods

used in the treatment of infantile esotropia]. Turk J Ophthalmol. 2001;31:67-70.

6. Onal S, Gozum N, Gucukoğlu A. [The effect of 0.5% Ketorolac Tromethamine

ophthalmic solution on early postoperative inflammation when applied before

phacoemulsification]. Turk J Ophthalmol. 2001;31: 365-369.

7. Gunay G, Gucukoglu A, Gozum N, Onal S. [Topographic evaluation of temporal

corneal incision]. Turk J Ophthalmol. 2001;31:553-556.

8. Onal S, Sezen F, Akarcay K, Gozum N. [Reversibility of toxic optic neuropathy

associated with ethambutol: Case presentation]. Turk J Ophthalmol. 2002;32:785-790.

9. Onal S, Izgi B, Altunbas HH, Turker G. [Comparison of the Humphrey Swedish

interactive thresholding algorithm (SITA) and full threshold strategies in patients

with glaucoma]. Turk J Ophthalmol. 2003;33:122-126.

10. Onal S, Tugal-Tutkun I, Saylik M, Urgancıoglu M. [Primary Retinal Vasculitis: Clinical

characteristics and prognosis]. Turk J Ophthalmol. 2003;33:285-290.

11. Onal S, Kazokoglu H, Bavbek T. [Anterior uveitis associated with HLA-B27:

demographic and clinical characteristics]. Turk J Ophthalmol. 2004;34:74-80.

12. Bavbek T, Onal S. [Small pupil phacoemulsification]. Turk J Ophthalmol. 2005;35:177-

184.

13. Onal S, Bavbek T. Aging and Eye. Marmara Medical Journal 2005,18:43-52.

14. Incili B, Onal S, Demirtas S, Öğüt MS. [Botulinum toxin chemodenervation combined

with transposition surgery for chronic sixth nevre palsy: a presentation of three

cases]. Turk J Ophthalmol. 2006;36:321-325.

15. Demirtas S, Toker E, Onal S, Belirgen M, Türker K. [The efficacy of contrast sensitivity

testing for detecting early visual dysfunction in patients with pituitary adenoma].

Turk J Ophthalmol. 2006;36:326-331.

16. Onal S, Kazokoğlu H, Ozcan E. [Papillitis and juxtapapillary retinochoroiditis

associated with toxoplasmosis]. Turk J Ophthal. 2007;37:30-37

17. Onal S, Kazokoglu H. [Episcleritis and scleritis]. Turkiye Klinikleri J Ophthalmol. 2007,

16:192-203.

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18. Umuroglu T, İnci F, Onal S, Göğüş FY, Kazokoglu H, Dogan V. Papillitis: A rare

complication of severe sepsis. Marmara Medical Journal. 2008;21: 175-178.

19. Onal S, Tugal-Tutkun I. [Ocular tuberculosis I: Epidemiology, pathophysiology and

clinical features]. Turk J Ophthalmol. 2011;41:171-181.

20. Onal S, Tugal-Tutkun I. [Ocular tuberculosis II: Diagnosis and treatment]. Turk J

Ophthalmol. 2011;41:182-90.

21. Kayiran SM, Onal S. A significant screening test: Red reflex examination. Izmir Dr.

Behçet Uz Pediatric Hospital Journal 2012;2:51-54.

Book Chapters

In International Books

1. Foster CS, Onal S, O’Brien JM. Chapter 322, Childhood arthritis and anterior uveitis.

Section 16. The Eye and Systemic Disease. Ed. Quillen D, In: Principles and Practice

of Ophthalmology, ed. Albert and Jakobiec. 3rd edition. Philadelphia, PA:

Saunders/Elsevier; 2008: p4401-4416. ISBN: 9781416000167; ISBN: 141600016X

2. Onal S, Foster CS. Chapter 12, Ocular manifestations of systemic vasculitis. Part 3.

Clinical manifestations common to vasculitis. In: Vasculitis, ed. Ball G, Bridges SL.

2nd edition. Oxford, New York: Oxford University Press; 2008: p141-148. ISBN:

9780198570196.

3. Tugal-Tutkun I, Onal S, Foster CS. Imaging studies for uveitis. In: Foster CS, Vitale

AT, eds. Diagnosis and Treatment of Uveitis. 2nd edition. New Delhi, Jay Pee Brothers

Medical Publishers; 2013: p131-191.

In Turkish Books

1. Tugal-Tutkun I, Onal S. [Antimetabolite treatment in Ophthalmology-systemic

antimetabolite treatment for inflammatory diseases]. In: [Ophthalmic drugs], ed. Oto S,

Yilmaz G, Aydin P. Ankara, Gunes Publisher. 2003:259-267.

2. Onal S. Chapter 32, [Intermediate uveitis]. Section 11. Uveal tract. In: [Basic Eye

Diseases], ed Aydın O’Dwyer P, Akova Y. 2nd edition. Gunes Medical Publisher. 2011:

417-424. ISBN:9789752773318

3. Onal S. Chapter 34, [Treatment principles]. Section 11. Uveal tract. In: [Basic Eye

Diseases], ed Aydın O’Dwyer P, Akova Y. 2nd edition. Gunes Medical Publisher. 2011:

441-453. ISBN:9789752773318

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PRESENTATIONS:

1. Ozturk S, Gozum N, Gucukoglu A. [The distribution of astigmatism with respect to

age]. Turkish Ophthalmology Society XXXII. National Congress on Ophthalmology,

Bursa, September 15-20,1998; TURKEY

2. Ozturk S, Gezer A, Altunbas HH, Sezen F. [The effect of prematurity on the clinical

characteristics of infantile esotropia]. Turkish Ophthalmology Society XXXII. National

Congress on Ophthalmology, Bursa, September 15-20,1998; TURKEY

3. Ozturk S, Tugal Tutkun I, Urgancıoğlu M. Clinical course of ocular Behçet’s disease in

siblings. 8th Congress on Behçet’s Disease, Reggio Emilia, October 7-8, 1998; ITALY

4. Ozturk S, Tugal-Tutkun I, Altan-Yaycıoglu R, Altunbas HH, Kır N, Ongor E, Urgancıoglu

M. Retinal and disc neovascularization in ocular Behçet’s disease. The XII Congress

of European Society of Ophthalmology, Stockholm, June 27- July 1, 1999; SWEDEN

5. Ozturk S, Gozum N, Gucukoglu A. Effect of apraclonidine versus dorzolamide on the

intraocular pressure after phacoemulsification. The XII Congress European Society of

Ophthalmology, Stockholm, June 27- July 1, 1999; SWEDEN

6. Ozturk S, Tugal Tutkun I, Urgancıoglu M. Clinical course of ocular Behçet’s disease in

siblings. The XII Congress of European Society of Ophthalmology, Stockholm, June 27-

July 1, 1999; SWEDEN

7. Ozturk S, Gezer A, Altunbas HH, Sezen F. The effect of prematurity on the clinical

characteristics of infantile esotropia. The XII Congress of European Society of


8. Altan-Yaycıoglu R, Ozturk S, Peksayar G. Excision and cryotherapy in the treatment of

conjunctival malignant epithelial tumors: Long-term results. The XII Congress of

European Society of Ophthalmology, Stockholm, June 27- July 1, 1999; SWEDEN

9. Altunbas HH, Gezer A, Ozturk S, Sezen F. Prognostic factors in acquired fourth nerve

palsy. The XII Congress of European Society of Ophthalmology, Stockholm, June 27-

July 1, 1999; SWEDEN

10. Altan-Yaycıoglu R, Tugal-Tutkun I, Ozturk S, Altunbas HH, Urgancıoglu M. Ocular

involvement of Behçet’s disease: An analysis of 880 patients. The XII Congress of

European Society of Ophthalmology, Stockholm, June 27- July 1, 1999; SWEDEN

11. Altan-Yaycıoglu R, Gezer A, Ozturk S, Sezen F. Late results of bimedial surgery for

convergence excess type of esotropia. The XII Congress of European Society of


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12. Ozturk S, Sezen F, Gezer A, Altan-Yaycıoglu R. [The comparison of two surgical

methods used in the treatment of infantile esotropia]. Turkish Ophthalmology Society

XXXIII. National Congress on Ophthalmology, Izmir, October 1-6, 1999; TURKEY

13. Altunbas HH, Sezen F, Gezer A, Ozturk S. [The role of accomodation in esotropia

below the age of one years]. Turkish Ophthalmology Society XXXIII. National Congress

on Ophthalmology, Izmir, October 1-6, 1999; TURKEY

14. Ozturk S. ‘Treatment Approaches in Behçet’s disease’ session. [Treatment approaches

in eye involvement of Behçet’s disease] (Case presentation) as lecturer, VII. National

Behçet’s Disease Congress, Istanbul, December 2-3, 1999, Turkey

15. Onal S, Tugal-Tutkun I, Altunbas HH, Altan-Yaycıoglu R, Urgancıoglu M. Late-onset

ocular Behçet’s disease. VI. International Symposium on Ocular Inflammation, Istanbul,

June 18-23, 2000; TURKEY

16. Altunbas HH, Tugal-Tutkun I, Onal S, Altan-Yaycıoglu R, Urgancıoglu M. Isolated

papilitis in Behçet’s disease. VI. International Symposium on Ocular Inflammation,

Istanbul, June 18-23, 2000; TURKEY

17. Onal S, Gozum N, Gucukoğlu A. [The effect of 0.5% Ketorolac Tromethamine

ophthalmic solution on early postoperative inflammation when applied before

phacoemulsification]. Turkish Ophthalmology Society XXXIV. National Congress on

Ophthalmology, Antalya, September 30-October 4, 2000; TURKEY

18. Gunay G, Gucukoglu A, Gozum N, Onal S. [Topographic evaluation of temporal

corneal incision]. Turkish Ophthalmology Society XXXIV. National Congress on

Ophthalmology, Antalya, September 30-October 4, 2000; TURKEY

19. Onal S, Izgı B, Altunbas H.H, Turker G. Comparison of the Humphrey Swedish

Interactive Thresholding Algorithm (SITA) and Full threshold Strategies in patients

with Glaucoma. The XIII Congress European Society of Ophthalmology, Istanbul, June

3-7, 2001 ; TURKEY

20. Onal S, Gozum N, Altunbas H.H, Gucukoglu A. Demographic data on patients with

senile cataract. The XIII Congress European Society of Ophthalmology, Istanbul, June 3-

7, 2001; TURKEY

21. Onal S, Tugal-Tutkun I, Saylik M, Urgancioglu M. [Our patients with primary retinal

vasculitis]. Turkish Ophthalmology Society XXXV. National Congress on

Ophthalmology, Izmir, September 23-26, 2001; TURKEY

22. Onal S, Gozum N, Gucukoglu A. [Prognosis in patients having phacoemulsification and

posterior chamber intraocular lens implantation in the presence of posterior capsule

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rupture]. Turkish Ophthalmology Society XXXV. National Congress on Ophthalmology,

Izmir, September 23-26, 2001; TURKEY

23. Saylik M, Gucukoglu A, Onal S, Gozum N. [Foldable intraocular lenses]. Turkish

Ophthalmology Society XXXV. National Congress on Ophthalmology, Izmir, September

23-26, 2001; TURKEY

24. Onal S, Kazokoglu H, Bavbek T. Outcomes of HLA-B27 positive and HLA-B27

negative acute anterior uveitis. The 14th Congress European Society of Ophthalmology,

Madrid, June 7-12, 2003; SPAIN

25. Onal S, Kazokoglu H, Bavbek T. [Outcomes of HLA-B27 positive and HLA-B27

negative acute anterior uveitis]. Turkish Ophthalmology Society XXXVII. National

Congress on Ophthalmology, Istanbul, October 4-8, 2003; TURKEY

26. Onal S, Kazokoglu H, Bavbek T. [Retinal tear as a complication in patients with acute

anterior uveitis]. Turkish Ophthalmology Society XXXVII. National Congress on

Ophthalmology, Istanbul, October 4-8, 2003; TURKEY

27. Onal S, Ogut MS, Demirtas S. Botulinum toxin chemodenervation combined with

transposition surgery in chronic sixth nerve palsy: case presentation. 29th Meeting of

the European Strabismological Association, Izmir, June 1-4, 2004, TURKEY

28. Demirtas S, Ogut MS, Onal S. The results of adjustable suture technique for

correction of strabismus. 29th Meeting of the European Strabismological Association,

Izmir, June 1-4, 2004, TURKEY

29. Tugal-Tutkun I, Onal S, Altan-Yaycioglu R, Altunbas HH, Urgancioglu M. Uveitis in

Behçet’s Disease: an analysis of 880 patients. Sixth International Symposium on

Uveitis. Venezia-Mestre, 20-22 September 2004, ITALY

30. Onal S, Kazokoglu H, Incili B, Yavuz S, Eksioglu Demiralp E. Prevalence of serum

antibodies against gram negative microorganisms in Turkish patients with HLA-B27

positive and negative acute anterior uveitis. Sixth International Symposium on Uveitis.

Venezia-Mestre, 20-22 September 2004, ITALY

31. Onal S, Kazokoglu H, Yilmaz Y, Bavbek T, Kurtkaya O, Dagcınar A, Ekinci G, Onultan O.

Primary intraocular-central nervous system lymphoma in a twelve years old child.

Sixth International Symposium on Uveitis. Venezia-Mestre, 20-22 September 2004,

ITALY

32. Onal S, Kazokoglu H, Ozcan E. [Papillitis and juxtapapillary chorioretinitis due to

toxoplasmosis]. Turkish Ophthalmology Society XXXVIII. National Congress on

Ophthalmology, Antalya, October 9-13, 2004; TURKEY

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33. Onal S, Kazokoglu H, Yilmaz Y, Bavbek T, Kurtkaya O, Dagcınar A, Ekinci G, Onultan O.

[Primary intraocular-central nervous system lymphoma: case presentation]. Turkish

Ophthalmology Society XXXVIII. National Congress on Ophthalmology, Antalya,

October 9-13, 2004; TURKEY

34. Demirtas S, Onal S, Öğüt MS. [The results of adjustable suture technique for

correction of different types of strabismus]. Turkish Ophthalmology Society XXXVIII.

National Congress on Ophthalmology, Antalya, October 9-13, 2004; TURKEY

35. Kazokoglu H, Onal S, Toker E. [Keratouveitis secondary to mumps infection: Case

presentation]. Turkish Ophthalmology Society XXXVIII. National Congress on


36. Bavbek T, Onal S, Toker E. [Phacoemulsification in patients with small pupil: which

method?] Turkish Ophthalmology Society XXXVIII. National Congress on


37. Toker E, Onal S, Demirtas S, Kılıc T, Belirgen M, Pamir N. [Contrast sensitivity

function in patients with pituitary adenoma]. Turkish Ophthalmology Society

XXXVIII. National Congress on Ophthalmology, Antalya, October 9-13, 2004; TURKEY

38. Toker E, Onal S, Akingol Z, Arslan G, Ertan S, Turan C. [Evaluation of refractive

errors of medical students at the Marmara University]. Turkish Ophthalmology

Society XXXVIII. National Congress on Ophthalmology, Antalya, October 9-13, 2004;

TURKEY

39. Cakır S, Toker E, Onal S. [Effect of artificial tear preparations with different

retention time on contrast sensitivity in dry eyes]. Turkish Ophthalmology Society

XXXVIII. National Congress on Ophthalmology, Antalya, October 9-13, 2004; TURKEY

40. Incili B, Öğüt MS, Onal S, Demirtas S. [Botulinum toxin chemodenervation combined

with transposition surgery in chronic sixth nerve palsy]. Turkish Ophthalmology

Society XXXVIII. National Congress on Ophthalmology, Antalya, October 9-13, 2004;

TURKEY

41. Incili B, Cerman E, Kazokoglu H, Onal S, Sav A. [Scleritis with different etiologies].

Turkish Ophthalmology Society XXXVIII. National Congress on Ophthalmology,

Antalya, October 9-13, 2004; TURKEY

42. Onal S, Kazokoglu H, Bavbek T, Direskeneli H. Changes in the course of Behçet uveitis:

is it getting milder? XI International Congress on Behçet’s Disease. Clinical and

Experimental Rheumatology. 2004; 22(4) (Suppl 34):S-115.

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43. Tugal-Tutkun I, Onal S, Altan-Yaycioglu R, Urgancioglu M. Optic disc

neovascularization in Behçet’s disease. XI International Congress on Behçet’s Disease.

Clinical and Experimental Rheumatology. 2004; 22(4) (Suppl 34):S-115.

44. Toker E, Onal S, Cakir S, Kazokoglu H. Effect of different artificial tear preparations

on contrast sensitivity in dry eyes. American Academy of Ophthalmology and European

Society of Ophthalmology Joint Meeting. New Orleans, LA. October 23-26, 2004; USA

45. Onal S, Yavuz S, Kazokoglu H, Sav A. [Nectrotizing scleritis as the initial manifestation

of Wegener Granulomatosis]. Rheumatology. Antalya, 31 October-03 November 2004;

TURKEY

46. Temel A, Onal S, Incili B, Yenice O, Afsar N, Tanridag T. Assessment of spatial-contrast

sensitivity and short wavelength automated perimetry (SWAP) in patients with

migraine. 5th International Glaucoma Symposium. Cape Town, March 30-April 2, 2005;

SOUTH AFRICA

47. Temel A, Onal S, Cakir S, Yenice O. Comparison of visual acuity, visual field testing

and contrast sensitivity in patients with Glaucoma. 5th International Glaucoma

Symposium. Cape Town, March 30-April 2, 2005; SOUTH AFRICA

48. Toker E, Onal S, Cerman E, Incili B. Comparison of the clinical performance of two

multi-purpose solutions with daily wear of a new silicone hydrogel contact lens. 35th

European Contact Lens Society of Ophthalmologists Congress. London, June 23-26,

2005; ENGLAND

49. Onal S, Kazokoglu H, Demirtas S. [Candida endophthalmitis after total colectomy:

case presentation]. Turkish Ophthalmology Society 39th National Congress on

Ophthalmology, Antalya, September 17-21, 2005; TURKEY

50. Onal S, Yenice O, Cakir S, Temel A. [Comparison of visual acuity, visual field testing

and contrast sensitivity in patients with Glaucoma]. Turkish Ophthalmology Society

39th National Congress on Ophthalmology, Antalya, September 17-21, 2005; TURKEY

51. Cerman E, Onal S, Ogut MS. [Caracteristics of patients who are followed-up with the

diagnosis of Duane’s Syndrome]. Turkish Ophthalmology Society 39th National

Congress on Ophthalmology, Antalya, September 17-21, 2005; TURKEY

52. Demirtas S, Onal S, Kazokoglu H, Ogut MS. [Radiotherapy in the treatment of orbital

pseudotumor]. Turkish Ophthalmology Society 39th National Congress on


12

53. Orum O, Onal S, Toker E, Kaplan O, Erten I, Ozdamar K, Eser S, Sayın S. [Refractive

changes of medical students within one year]. Turkish Ophthalmology Society 39th

National Congress on Ophthalmology, Antalya, September 17-21, 2005; TURKEY

54. Yenice O, Onal S, Incili B, Temel A, Afsar N, Tanridag T. [Assessment of spatial-

contrast sensitivity and short wavelength automated perimetry (SWAP) in patients

with migraine]. Turkish Ophthalmology Society 39th National Congress on


55. Toker E, Onal S, Demirtas S, Cerman E. [Comparison of the clinical performance of

two silicone hydrogel contact lenses used on a daily wear basis]. Turkish

Ophthalmology Society 39th National Congress on Ophthalmology, Antalya, September

17-21, 2005; TURKEY

56. Demirtas S, Onal S, Toker E, Belirgen M, Kılıc T. [Contrast sensitivity as a means of

early diagnosis of visual dysfunction in patients with pituitary adenoma]. Turkish

Ophthalmology Society 39th National Congress on Ophthalmology, Antalya, September

17-21, 2005; TURKEY

57. Incili B, Onal S, Kazokoglu H, Eksioglu Demiralp E, Yavuz S. [Prevalence and levels of

serum antibodies against gram negative microorganisms with HLA-B27 positive and

negative acute anterior uveitis]. Turkish Ophthalmology Society 39th National Congress

on Ophthalmology, Antalya, September 17-21, 2005; TURKEY

58. Cerman E, Toker E, Onal S, Incili B. [Comparison of the clinical performance of two

multi-purpose solutions with daily wear of a new silicone hydrogel contact lens].

Turkish Ophthalmology Society 39th National Congress on Ophthalmology, Antalya,

September 17-21, 2005; TURKEY

59. Onal S, Sobrin L, Foster CS. Long-term immunosuppressive therapy for sympathetic

ophthalmia. The Association for Research in Vision and Ophthalmology (ARVO).

Annual Meeting in Fort Lauderdale, Florida, April 30-May 4, 2006; USA

60. İncili B, Onal S, Kazokoğlu H, Direskeneli H. [Fluorescein angiography findings in

patients with Behçet’s disease without ocular involvement]. Turkish Ophthalmology

Society 40th National Congress on Ophthalmology, Antalya, October 28-November 1,

2006.

61. Toker E, Onal S, Eyriparmak M, Eraslan M. Preliminary results of validation of the

Turkish version of the National Eye Institute Refractive Error Quality of Life

Instrument (NEI-RQL-42). The Association for Research in Vision and Ophthalmology

(ARVO). Annual Meeting in Fort Lauderdale, Florida, May 6-10, 2007; USA

13

62. Koc A, Onal S, Kazokoglu H. Primary central nervous system lymphoma presenting

as uveitis. 8th European Neuro-Ophthalmology Society (EUNOS) Meeting, ıstanbul, May

26-29, 2007; TURKEY

63. Onal S, Kazokoglu H, Bavbek T, Direskeneli H, Yavuz S. Safety and efficacy of

interferon alfa-2a in the treatment of refractory and sight-threatening uveitis. Joint

Congress of European Ophthalmology Society and American Academy of Ophthalmology

(SOE/AAO), Vienna, June 9-12, 2007; AUSTRIA

64. Onal S, Kazokoglu H, Yavuz S. Rituximab for remission induction in a patient with

relapsing necrotizing scleritis associated with limited Wegener’s granulomatosis.

Joint Congress of European Ophthalmology Society and American Academy of

Ophthalmology (SOE/AAO), Vienna, June 9-12, 2007; AUSTRIA

65. Koc A, Onal S, Kazokoglu H. Ocular toxoplasmosis: clinical features and prognosis of

23 Turkish patients. Joint Congress of European Ophthalmology Society and American

Academy of Ophthalmology (SOE/AAO), Vienna, June 9-12, 2007; AUSTRIA

66. Incili B, Onal S, Kazokoglu H. Fluorescein angiography among Behçet’s disease

patients without ocular involvement. Joint Congress of European Ophthalmology

Society and American Academy of Ophthalmology (SOE/AAO), Vienna, June 9-12,

2007; AUSTRIA

67. Toker E, Onal S. Sutureless amniotic membrane transplantation using fibrin glue for

descemetocele formation in a patient with herpetic sclerokeratouveitis. Joint Congress

of European Ophthalmology Society and American Academy of Ophthalmology

(SOE/AAO), Vienna, June 9-12, 2007; AUSTRIA

68. Altan-Yaycioglu R, Peksayar G, Onal S. Long-term results of combined treatment with

excision and cryosurgery for malignant epithelial tumors of the conjunctiva.

European Association for Vision and Eye Research (EVER), Portoroz, October 3-6, 2007;

SLOVENIA

69. Eraslan M, Toker E, Onal S, Eyriparmak M. [NEI-RQL-42 (National Eye Institute

Refractive Error Quality of Life Instrument): Turkish Translation, Validity and

Reliability]. Turkish Ophthalmology Society 41st National Congress on Ophthalmology,

Antalya, October 30-November 2, 2007; TURKEY

70. Koc A, Onal S, Kazokoglu H. [Primary central nervous system lymphoma presenting

as uveitis]. Turkish Ophthalmology Society 41st National Congress on Ophthalmology,

Antalya, October 30-November 2, 2007; TURKEY

14

71. Onal S, Kazokoglu H, Koc A, Bavbek A, Direskeneli H, Yavuz S. Safety and efficacy of

interferon alfa-2a in the treatment of refractory and sight-threatening Behçet’s

uveitis: a prospective study of 16 cases. The Second Meeting of the Society for

Ophthalmo-Immunoinfectiology in Europe (SOIE). Cappadocia, June 12-15, 2008,

TURKEY

72. Onal S, Kazokoglu H, Koc A, Bavbek A, Direskeneli H, Yavuz S. [Safety and efficacy of

interferon alfa-2a in the treatment of refractory and sight-threatening Behçet’s

uveitis: a prospective study of 16 cases]. Turkish Ophthalmology Society 42nd National

Congress on Ophthalmology, Antalya, November 19-23, 2008; TURKEY

73. Onal S, Kazokoglu H, Koç A, Yavuz S. [Rituximab for remission induction in a patient

with relapsing necrotizing scleritis associated with limited Wegener’s

granulomatosis]. Turkish Ophthalmology Society 42nd National Congress on

Ophthalmology, Antalya, November 19-23, 2008; TURKEY

74. Koc A, Onal S, Yenice O, Kazokoglu H. [Pars plana vitrectomy and intravitreal

liposomal amphotericin B in the treatment of candida endophthalmitis]. Turkish

Ophthalmology Society 42nd National Congress on Ophthalmology, Antalya, November

19-23, 2008; TURKEY

75. Eraslan M, Ogut MS, Yenice O, Onal S. [Surgical treatment results of third nerve

paralysis]. Turkish Ophthalmology Society 42nd National Congress on Ophthalmology,

Antalya, November 19-23, 2008; TURKEY

76. Savar F, Onal S, Toker E. [Immunosuppressive treatment for atypical Cogan

syndrome: case presentation]. Turkish Ophthalmology Society 42nd National Congress

on Ophthalmology, Antalya, November 19-23, 2008; TURKEY

77. Onal S, Oray M, Kazokoglu H, Koc A, Direskeneli H, Yavuz S. Efficacy of low dose

interferon alfa-2a in refractory and sight-threatening uveitis: A prospective study of

six cases. The 17th Congress of the European Society of Ophthalmology, Amsterdam,

June 13-16, 2009; THE NETHERLANDS

78. Oray M, Onal S, Kazokoglu H, Yavuz S. Immunomodulatory therapy for corticosteroid

dependent and resistant chronic anterior uveitis in children. The 17th Congress of the

European Society of Ophthalmology, Amsterdam, June 13-16, 2009; THE

NETHERLANDS

79. Koc A, Onal S, Kazokoglu H, Bavbek T, Direskeneli H, Yavuz S. Long-term efficacy of

low-dose interferon alfa-2a treatment in refractory and sight-threatening Behçet’s

15

uveitis. The 17th Congress of the European Society of Ophthalmology, Amsterdam, June

13-16, 2009; THE NETHERLANDS

80. Onal S, Kazokoglu H, Oray M, Koc A, Direskeneli H, Yavuz S. [Efficacy of low dose

interferon alfa-2a in refractory and sight-threatening uveitis]. The 17th Turkish

Ophthalmology Society 43rd National Congress on Ophthalmology, Antalya, November

11-15, 2009; TURKEY

81. Eyriparmak M, Onal S, Kazokoglu H, Yavuz S. [Immunomodulatory therapy for

corticosteroid dependent and resistant chronic anterior uveitis in children]. Turkish

Ophthalmology Society 43rd National Congress on Ophthalmology, Antalya, November

11-15, 2009; TURKEY

82. Koc A, Onal S, Kazokoglu H, Bavbek T, Direskeneli H,Yavuz S. [Long-term efficacy of

low-dose interferon alfa-2a treatment in refractory and sight-threatening Behçet’s

uveitis]. Turkish Ophthalmology Society 43rd National Congress on Ophthalmology,

Antalya, November 11-15, 2009; TURKEY

83. Akman Savar F, Onal S, Kazokoğlu H. [Vision and health-related quality of life in

patients with Behçet’s uveitis]. Turkish Ophthalmology Society 43rd National Congress

on Ophthalmology, Antalya, November 11-15, 2009; TURKEY

84. Savar F, Onal S, Kazokoglu H. [Vision and health-related quality of life in patients

with Behçet’s uveitis]. 11. National Behçet’s Disease Congress, Istanbul, December 18-

20, 2009; TURKEY

85. Onal S, Koc A, Kazokoglu H, Bavbek T, Direskeneli H, Yavuz S. [Long-term safety and

efficacy of low dose interferon alfa-2a therapy in refractory and sight-threatening

Behçet’s uveitis]. 11. National Behçet’s Disease Congress, Istanbul, December 18-20,

2009; TURKEY

86. Koc A, Onal S, Kazokoglu H, Tulunay A, Eksioglu Demiralp E, Direskeneli H, Yavuz S.

Effect of interferon alfa-2a therapy on peripheral blood CD4+CD25+ T regulatory

cells in patients with Behçet’s uveitis. 14th International Conference on Behçet’s Disease

(ICBD), London, July 8-10, 2010; ENGLAND

87. Onal S, Kazokoglu H, Koc A, Akman M, Bavbek T, Direskeneli H, Yavuz S. Long-term

efficacy and safety of low dose and dose escalating interferon alfa-2a therapy in

refractory Behçet’s uveitis. 14th International Conference on Behçet’s Disease (ICBD),

London, July 8-10, 2010; ENGLAND

16

88. Guler A, Onal S, Eraslan M, Ogut MS. Horizontal recession-resection surgery with

superior oblique transposition in third nerve palsy. 11th Meeting of the International

Strabismological Association, Istanbul; September 22-25, 2010; TURKEY

89. Guler A, Onal S, Ogut MS. Botulinum toxin chemodenervation and transposition

surgery in chronic sixth nerve palsy. 11th Meeting of the International Strabismological

Association, Istanbul; September 22-25, 2010; TURKEY

90. Onal S, Koc A, Kazokoglu H, Tulunay A, Eksioglu Demiralp E, Direskeneli H, Yavuz S.

Effect of interferon alfa-2a therapy on peripheral blood CD4+CD25+ T regulatory

cells in patients with Behçet uveitis. The American Academy of Ophthalmology (AAO)

and Middle East African Council of Ophthalmology (MEACO) Joint Meeting, Chicago,

IL; October 16-19, 2010; USA

91. Onal S, Kazokoglu H, Koc A, Akman M, Bavbek T, Direskeneli H, Yavuz S. Long-term

efficacy and safety of low dose and dose escalating interferon alfa-2a therapy in

refractory Behçet uveitis. The American Academy of Ophthalmology (AAO) and

Middle East African Council of Ophthalmology (MEACO) Joint Meeting, Chicago, IL;

October 16-19, 2010; USA

92. Guler A, Onal S, Kazokoglu H, Yavuz S. [Characteristics of pediatric uveitis cases in a

tertiary eye-care center.] Turkish Ophthalmology Society 45rd National Congress on

Ophthalmology, Girne, October 5-9, 2011; North Cyprus Turkish Republic

93. Cingu K, Onal S, Tugal-Tutkun I. [Comparison of Behçet uveitis patients who

presented in the early 1990s and 2000s.] Turkish Ophthalmology Society 45rd National

Congress on Ophthalmology, Girne, October 5-9, 2011; North Cyprus Turkish Republic

94. Bulut A, Guler A, Onal S, Kazokoglu H, Inanc N, Direskeneli H, Yavuz S. [Clinical

characteristics and treatment of scleritis cases in a tertiary eye-care center.] Turkish

Ophthalmology Society 45rd National Congress on Ophthalmology, Girne, October 5-9,

2011; North Cyprus Turkish Republic

95. Bankeroglu F, Kohen D, Onal S. [Intraoperative Floppy Iris Syndrome during

cataract surgery.] Turkish Ophthalmology Society 45rd National Congress on

Ophthalmology, Girne, October 5-9, 2011; North Cyprus Turkish Republic

96. Oray M, Onal S, Ashour A, Koc A, Ogut MS. Diverse clinical presentations of ocular cat

scratch disease in a tertiary eye care center in Turkey. The 3rd World Congress on

Controversies in Ophthalmology (COPHy), Istanbul, March 22-25, 2012; Turkey

17

97. Oray M, Onal S, Guler A, Kazokoglu H, Yavuz S. Characteristics of pediatric uveitis

patients in a tertiary eye care center in Turkey. The 3rd World Congress on

Controversies in Ophthalmology (COPHy), Istanbul, March 22-25, 2012; Turkey

VISITING APPOINTMENTS AND SPECIAL LECTURES:

May 13, 2009 Istanbul University, Istanbul Faculty of Medicine, Department of

Ophthalmology, Invited Speaker

Vogt-Koyanagi-Harada Disease-Lecture

November 12-14, 2010 6th Panhellenic Congress of Ocular Inflammations and Infections,

Ionnina, Greece, Invited Speaker

Vogt-Koyanagi-Harada Disease-Lecture

Controversies in Uveitis-Controversies in the medical treatment of

uveitis-Round Table Panelist

May 2, 2011 Monday Conferences, V.K. Foundation American Hospital,

Istanbul, Turkey

Allergic Conjunctivitis-Lecture

May 30-June 3, 2011

Symposium of the Society for Ophthalmo-Immunoinfectiology in

Europe (SOIE) within White Nights Ophthalmology Congress

Saint Petersburg, Russia, Invited Speaker

Ocular Tuberculosis-Lecture

Practical Cases (“How can we learn from our mistakes”)

October 5-8, 2011 Symposium of the Society for Ophthalmo-Immunoinfectiology in

Europe (SOIE) within European Association for Vision and Eye

Research (EVER), Crete, Greece, Invited Speaker

Behçet uveitis: why biologics are predestined to become the first-

line treatments?-Lecture

May 18-20, 2012 Turkish Ophthalmology Society, Spring Symposium; Istanbul,

Turkey, Invited Speaker

[Treatment of uveitis, “Complications”]

October 17-21, 2012 Turkish Ophthalmology Society 46th National Congress on

Ophthalmology; Antalya, Turkey

Course Instructor

“Imaging modalities”, Diagnostic tests in uveitis, Uveitis and

18

Behçet disease Course

November 9-13, 2012 The American Academy of Ophthalmology (AAO) and Asia-

Pacific Academy of Ophthalmology (APAO) Joint Meeting,

Chicago, IL, USA

Uveitis Subspecialty Day 2012: The Challenges Continue … But

the Future Is Bright – Invited Speaker

Managing Glaucoma in Patients With Uveitis

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Citation Report Author=(Onal S)Refined by: Web of Science Categories=( OPHTHALMOLOGY )

Timespan=All Years. Databases=SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH.

This report reflects citations to source items indexed within Web of Science. Perform a Cited Reference Search to include citations to items not indexed within Web of Science.

Published Items in Each Year Citations in Each Year

Results found: 23

Sum of the Times Cited [?] : 304

Sum of Times Cited without self-citations [?] : 296

Citing Articles[?] : 282

Citing Articles without self-citations [?] : 277

Average Citations per Item [?] : 13.22

h-index [?] : 9

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50 62 41 59 10 304 33.78

1. Title: Uveitis in Behcet disease: An analysis of 880 patients.Author(s): Tugal-Tutkun, I; Onal, S; Altan-Yaycioglu, R; et al.

Source: AMERICAN JOURNAL OF OPHTHALMOLOGY Volume: 138 Issue: 3 Pages: 373-380 DOI: 10.1016/j.ajo.2004.03.022 Published:

SEP 2004

15 24 16 21 2 129 12.90

2. Title: Intravitreal bevacizumab for treatment of uveitic macular edema14 13 8 3 0 43 6.14

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Author(s): Cordero Coma, Miguel; Sobrin, Lucia; Onal, Sumru; et al.

Source: OPHTHALMOLOGY Volume: 114 Issue: 8 Pages: 1574-1579 DOI: 10.1016/j.ophtha.2006.11.028 Published: AUG 2007

3. Title: Refractive errors of medical students in Turkey: One year follow-up of refraction and biometryAuthor(s): Onal, Sumru; Toker, Ebru; Akingol, Ziya; et al.

Source: OPTOMETRY AND VISION SCIENCE Volume: 84 Issue: 3 Pages: 175-180 DOI: 10.1097/OPX.0b013e3180335c52 Published: MAR

2007

5 5 2 7 2 24 3.43

4. Title: Excision and cryosurgery in the treatment of conjunctival malignant epithelial tumoursAuthor(s): Peksayar, G; Altan-Yaycioglu, R; Onal, S

Source: EYE Volume: 17 Issue: 2 Pages: 228-232 DOI: 10.1038/sj.eye.6700331 Published: MAR 20032 3 1 2 1 16 1.45

5. Title: Rituximab for Remission Induction in a Patient with Relapsing Necrotizing Scleritis Associated with Limited Wegener's

GranulomatosisAuthor(s): Onal, Sumru; Kazokoglu, Haluk; Koc, Aylin; et al.

Conference: Joint Congress of the European-Society-of-Ophthalmology/American-Academy-of-Ophthalmology Location: Vienna,

AUSTRIA Date: JUN 08-12, 2007

Sponsor(s): European Soc Ophthalmol; Amer Acad Ophthalmol

Source: OCULAR IMMUNOLOGY AND INFLAMMATION Volume: 16 Issue: 5-6 Pages: 230-232 Article Number: PII 906499035 DOI:

10.1080/09273940802331643 Published: 2008

1 5 4 3 1 14 2.33

6. Title: Neovascularization of the optic disc in Behcet's diseaseAuthor(s): Tugal-Tutkun, I; Onal, S; Altan-Yaycioglu, R; et al.

Source: JAPANESE JOURNAL OF OPHTHALMOLOGY Volume: 50 Issue: 3 Pages: 256-265 DOI: 10.1007/s10384-005-0307-8 Published:

MAY-JUN 2006

2 3 1 4 0 14 1.75

7. Title: Long-term Efficacy and Safety of Low-Dose and Dose-Escalating Interferon Alfa-2a Therapy in Refractory Behcet

UveitisAuthor(s): Onal, Sumru; Kazokoglu, Haluk; Koc, Aylin; et al.

Source: ARCHIVES OF OPHTHALMOLOGY Volume: 129 Issue: 3 Pages: 288-294 Published: MAR 2011

0 0 1 9 1 11 3.67

8. Title: Demographic and Clinical Features of Uveitis in Tertiary Centers in TurkeyAuthor(s): Kazokoglu, Haluk; Onal, Sumru; Tugal-Tutkun, Ilknur; et al.

Source: OPHTHALMIC EPIDEMIOLOGY Volume: 15 Issue: 5 Pages: 285-293 DOI: 10.1080/09286580802262821 Published: SEP-OCT 20083 2 1 4 0 11 1.83

9. Title: Visual results and complications of posterior chamber intraocular lens implantation after capsular tear during

phacoemulsificationAuthor(s): Onal, S; Gozum, N; Gucukoglu, A

Source: OPHTHALMIC SURGERY LASERS & IMAGING Volume: 35 Issue: 3 Pages: 219-224 Published: MAY-JUN 2004

2 1 1 1 1 11 1.10

10. Title: Assessment of spatial-contrast function and short-wavelength sensitivity deficits in patients with migraineAuthor(s): Yenice, O.; Onal, S.; Incili, B.; et al.

Source: EYE Volume: 21 Issue: 2 Pages: 218-223 DOI: 10.1038/dj.eye.6702251 Published: FEB 20072 3 0 1 1 9 1.29

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CLINICAL SCIENCES

Long-term Efficacy and Safety of Low-Dose andDose-Escalating Interferon Alfa-2a Therapyin Refractory Behcet UveitisSumru Onal, MD, FEBOphth; Haluk Kazokoglu, MD; Aylin Koc, MD; Mehmet Akman, MD, MPH;Tayfun Bavbek, MD; Haner Direskeneli, MD; Sule Yavuz, MD

Objective: To investigate the long-term efficacy andsafety of low-dose and dose-escalating therapy of inter-feron alfa-2a in the treatment of Behcet uveitis.

Methods: This study included 37 patients with refrac-tory Behcet panuveitis unresponsive to conventional im-munosuppressive therapy. Induction interferon alfa-2atherapy was given as a daily dose of 3.0 million IU (MIU)subcutaneously for 14 days. Maintenance dose wasachieved with 3.0 MIU 3 times per week given subcuta-neously. The dosage was increased sequentially to 4.5,6.0, and 9.0 MIU 3 times per week if uveitis relapses oc-curred. Total therapy duration was 24 months. Primaryoutcome measure was control of uveitis with quies-cence during maintenance therapy. Ocular relapses perpatient-year before and after initiation of interferon alfa-2atherapy and a corticosteroid-sparing effect were second-ary outcomes. We also estimated the rate of remissionafter discontinuing interferon alfa-2a therapy.

Results: During maintenance therapy, interferon alfa-2acontrolled uveitis in 35 patients (95%). In 15 patients (41%),a maintenance dosage of 3.0 MIU 3 times per week con-trolled uveitis without any relapse. The rate of uveitis re-lapses decreased from 3.52 per patient-year before to 0.75per patient-year after initiating interferon alfa-2a therapy.Seventeen patients were receiving systemic cortico-steroids at the time of initiation of interferon therapy. Dur-ing the maintenance stage, 9 patients were able to discon-tinue and 8 to taper systemic corticosteroid therapy. Survivalanalysis estimated that the rate of remission after discon-tinuation of interferon alfa-2a therapy was 76% by 3 months.The rate of remission remained stable thereafter.

Conclusion: A treatment protocol using a low-dose anddose-escalating therapy with interferon alfa-2a was ableto control and achieve remission of uveitis in most pa-tients with refractory ocular Behcet disease.

Arch Ophthalmol. 2011;129(3):288-294

B EHCET DISEASE (BD) IS A

multisystem vasculitis of un-known etiology, affecting ar-teries and veins of all sizes.Ocular involvement is char-

acterized by a bilateral intraocular inflam-mation mostly affecting the posterior seg-ment of the eye as panuveitis and retinalvasculitis. It has a relapsing-remittingcourse. Recurrent episodes of intraocularinflammation may eventually lead to blind-ness. Prognosis for eye disease in BD hasimproved substantially with the use of con-ventional immunosuppressive agents suchas azathioprine sodium and/or cyclospor-ine.1 However, despite aggressive treat-ment with conventional immunosuppres-sive agents, some patients still experiencerelapses of uveitis. Refractory and sight-threatening uveitis in this particular groupof patients with BD is challenging for theophthalmologist.

In recent years, biologic agents have be-come popular in the management of in-

flammatory eye disease.2 Interferons are agroup of cytokines that include inter-feron alfa-2a. To date, there are several re-ports on the use of interferon alfa-2a in thetreatment of patients with Behcet uveitisrefractory to conventional immunosup-pressive agents.3-8 Some authors also re-ported on the use of interferon alfa-2a inother refractory and sight-threatening uve-itis entities.9-11 However, there is no con-sensus about the ideal dose and durationof treatment for Behcet uveitis. In addi-tion, adverse effects, including develop-ment of autoantibodies, thyroid hor-mone disturbances, severe depression, andleukopenia, have been reported as fre-quent and some as dose dependent.3,4 Theoccurrence of adverse effects with a higher-dose regimen may limit the use of theagent. Therefore, use of a low-dose regi-men would also be expected to have feweradverse effects. We report herein the long-term efficacy of interferon alfa-2a in thetreatment of Behcet uveitis when using the

Author Affiliations: UveitisService, Department ofOphthalmology (Drs Onal,Kazokoglu, Koc, and Bavbek),Department of Family Medicine(Dr Akman), and Division ofRheumatology, Department ofInternal Medicine(Drs Direskeneli and Yavuz),Marmara University, School ofMedicine, Istanbul, Turkey.

(REPRINTED) ARCH OPHTHALMOL / VOL 129 (NO. 3), MAR 2011 WWW.ARCHOPHTHALMOL.COM288

©2011 American Medical Association. All rights reserved. on March 15, 2011 www.archophthalmol.comDownloaded from

http://www.archophthalmol.com

minimal effective dose of interferon alfa-2a through a low-dose and dose-escalating regimen in patients otherwiseunresponsive to conventional immunosuppressivetherapy.

METHODS

A total of 37 patients with severe, refractory, sight-threateninguveitis due to BD were recruited into this prospective study fromDecember 1, 2005, to April 30, 2010. Refractory and sight-threatening uveitis due to BD was defined as the presence ofintraocular inflammation involving the posterior segment inthe form of posterior uveitis or panuveitis and failing to re-spond to 1 or more conventional immunosuppressive agents.Patients with posterior or panuveitis due to BD who did nottolerate conventional immunosuppressive agents or in whomtheir use was contraindicated also started interferon alfa-2atherapy (Roferon-A; Roche Pharmaceuticals, Whitehouse Sta-tion, New Jersey). Patients with documentation of past immu-nosuppressive therapy and no control of intraocular inflam-mation before presentation were also accepted as having uveitisrefractory to treatment.

A new treatment protocol that aimed to use a minimal doseof interferon alfa-2a was adjusted before the initiation of thestudy. Schematic illustration of the treatment protocol is shownin Figure 1. Other treatments with immunosuppressiveagents, except for corticosteroids, were discontinued the daybefore the initiation of interferon alfa-2a therapy. The treat-ment protocol also included premedication with acetamino-

phen (paracetamol), 500 mg 4 times per day, and antihista-mines during the induction of interferon alfa-2a therapy. Forthe induction of interferon alfa-2a therapy, the drug was givensubcutaneously at a dosage of 3.0 million IU (MIU) per day for14 days. A maintenance dose of interferon alfa-2a was achievedwith subcutaneous administration of 3.0 MIU 3 times per week.During maintenance therapy, oral corticosteroid therapy wastapered to no more than 10 mg/d prednisone equivalent or, ide-ally, discontinued whenever control of intraocular inflamma-tion was achieved. Any relapse of uveitis required an increaseof the dosage of interferon alfa-2a in a sequence of 4.5, 6.0, and9.0 MIU administered subcutaneously 3 times per week for eachrelapse. To take rapid control of the intraocular inflammationduring a relapse, periocular or systemic corticosteroids (1 mg/kg/d) were also used along with an increase in the dose of in-terferon alfa-2a. After control of intraocular inflammation wasachieved, the dosage of systemic corticosteroids was again rap-idly tapered to a maximum of 10 mg/d prednisone equivalentor discontinued.

Patients with BD who fulfilled the criteria established by theInternational Study Group for Behcet’s Disease12 and met theinclusion criteria were included in the study. A complete medi-cal history, including onset of ocular and systemic symptoms,was obtained at the start. All patients underwent complete oph-thalmological examinations, along with complete blood cellcount, liver function test, and evaluation of blood urea nitro-gen and serum creatinine levels at the initiation of the treat-ment. These variables were reviewed at 6-week intervals in pa-tients who showed control of intraocular inflammation withquiescence. Otherwise, these variables were evaluated as dic-

Induction treatment(All immunosuppressive agents are discontinued the day before the initiation of therapy. Induction with interferon alfa-2a is started during the tapering of systemic corticosteroid therapy when a dosage of 0.5 mg/kg/d or less of corticosteroids is reached. All patients receive premedication during the course of induction treatment.)

Interferon alfa-2a, 3.0 MIU/d, subcutaneously, for 14 d

Maintenance treatment

Interferon alfa-2a, 3.0 MIU, subcutaneously, 3 times per wk

Control of uveitis with quiescence Relapse

Continue for a total of 24 mo and discontinue thereafter







Interferon alfa-2a 9.0 MIU, subcutaneously, 3 times per wk

Control of uveitis with quiescence


Relapse

Switch to anti–tumor necrosis factor or alkylating agents

Figure 1. Flowchart for induction and maintenance therapy with interferon alfa-2a. MIU indicates million international units.




tated by the clinical status. Complete ophthalmological exami-nation included best-corrected visual acuity in logMAR units,slitlamp biomicroscopy, tonometry, and indirect ophthalmos-copy. We recorded best-corrected visual acuity and the degreeof intraocular inflammation specifically from dates when in-terferon alfa-2a therapy was initiated and at the last clinic visit.Fluorescein angiography and optical coherence tomography wereused whenever necessary. All patients also underwent evalu-ation by rheumatologists at the initiation and follow-up of in-terferon alfa-2a treatment.

Outcomes and results were reported as described by the Stan-dardization of Uveitis Nomenclature (SUN) Working Group13

and by Harper et al.14 Inactive anterior uveitis was defined as0.5 cells or less.13 Vitritis, evidenced by the presence of cells,not haze, was graded from 0 to 4 and considered inactive whenthere were 0.5 cells or less.14 Inflammation of the posterior seg-ment was documented by the presence of retinal vasculitis, reti-nitis, cystoid macular edema, and papillitis. Control of intra-ocular inflammation reported as quiescence was defined asinactivity of anterior chamber and vitreous inflammation alongwith absence of posterior segment intraocular inflammatorysigns. Based on the recommendations of the SUN WorkingGroup,13 remission after discontinuation of interferon alfa-2atherapy was defined as inactive disease for at least 3 monthsafter discontinuation of therapy. Improvement of visual acuity

was also defined according to the recommendations of the SUNWorking Group13 as a doubling of the visual angle.

The primary outcome measure was control of intraocularinflammation with quiescence during interferon alfa-2a main-tenance therapy using the described protocol. The rate of ocu-lar relapses per patient-year before and after initiation of in-terferon alfa-2a therapy was reported as a secondary outcome.The ability to taper systemic corticosteroid therapy, with nomore than a 10-mg/d prednisone equivalent dosage beingconsidered as a successful taper, was also reported as a sec-ondary outcome.13 We evaluated visual acuity in terms of im-provement of visual acuity, as described previously.13 Unex-pected complaints and complications were recorded asadverse effects. The ability to maintain remission after discon-tinuation of therapy was determined by using survival analy-sis. The Kaplan-Meier method was used to estimate the sur-vival curve.

The study was approved by the ethics committee of theSchool of Medicine, Marmara University, and conducted ac-cording to the tenets of the Declaration of Helsinki. Informedconsent was obtained from all patients.

RESULTS

A total of 37 patients were included in the study. Me-dian age at presentation was 29 (range, 18-52) years.Eleven patients (30%) were female and 26 (70%) weremale. All patients were of white Turkish ethnicity. Thecharacteristics of patients, extraocular manifestations, as-sociated medical conditions, previous immunosuppres-sive therapies, number of previous methylprednisoloneinfusions, and total follow-up are given in Table 1.

Table 2 and Table 3 provide the ocular clinicalfeatures of the patients and outcomes of interferonalfa-2a therapy. Ocular involvement was bilateral in 31patients (84%) and unilateral in 6 (16%), with a totalof 68 eyes undergoing treatment. All patients hadpanuveitis that was characterized by retinal vasculitisin 29 patients (78%), retinitis in 30 (81%), vitritis in37 (100%), papillitis in 8 (22%), and cystoid macularedema in 23 (62%). Of the 46 eyes with retinal vascu-litis, 12 (26%) had vasoocclusive features revealed byfluorescein angiography as the presence of areas ofcapillary nonperfusion.

As seen in Table 3, the median duration of follow-upbefore recruitment was 6 (range, 1-69) months. The me-dian exposure to interferon alfa-2a was 21 (range, 2-24)

Table 1. Demographic Features and GeneralCharacteristics of Patientsa

Feature Data

Age at presentation, median (SEM) [range], y 29 (1.15) [18-52]Total follow-up, median (SEM) [range], mo 25 (3.48) [8-77]Sex

Female 11 (30)Male 26 (70)

Extraocular manifestationsb

Recurrent oral ulcers 37 (100)Genital ulceration 21 (57)Arthritis 8 (22)Pseudofolliculitis 22 (59)Erythema nodosum 19 (51)Thrombophlebitis 7 (19)Behcet disease with CNS involvement 5 (14)Epididymo-orchitis 1 (3)

Previous therapyc

Systemic corticosteroids 36 (97)d

Intravenous pulse methylprednisolone infusions 14 (38)Azathioprine sodium 33 (89)Cyclosporine 6 (16)Azathioprine and cyclosporin combination 6 (16)Mycophenolate mofetil 2 (5)Methotrexate sodium 1 (3)Cyclophosphamide 2 (5)

Associated medical conditionsAseptic bone necrosis 2 (5)Iatrogenic Cushing syndrome 1 (3)Severe osteoporosis with vertebral fracture 1 (3)Thalassemia trait 2 (5)Chronic hepatitis B virus infection 1 (3)Condyloma acuminatum 1 (3)Pulmonary tuberculosis 2 (5)

Abbreviation: CNS, central nervous system.aUnless otherwise indicated, data are expressed as number (percentage) of

patients.bBased on history and follow-up data.cAn individual patient may have received more than 1 mode of therapy.dBecause of chronic hepatitis B infection, 1 patient was given periocular

corticosteroid injections.

Table 2. Ocular Features

Feature

No. (%)

Patients(N=37)

Eyes(N=68)

LateralityBilateral 31 (84)Unilateral 6 (16)

Ocular manifestationsRetinal vasculitis 29 (78) 46 (68)Retinitis 30 (81) 49 (72)Vitritis 37 (100) 68 (100)Papillitis 8 (22) 9 (13)Cystoid macular edema 23 (62) 34 (50)




months. With the protocol, interferon alfa-2a therapy con-trolled intraocular inflammation with achievement of qui-escence in 35 of 37 patients (95%) (Figure 2). In 15patients (41%), a maintenance interferon alfa-2a dosageof 3.0 MIU 3 times per week controlled inflammationwithout any relapse. Relapse of inflammation occurredin 22 patients (59%) requiring an increase in the dose ofinterferon alfa-2a during maintenance therapy. As de-scribed, the dose of interferon alfa-2a was increased foreach uveitis relapse that occurred during maintenancetherapy. The final maintenance dosage to achieve qui-escence was 9.0 MIU 3 times per week in 3 patients (8%),6.0 MIU 3 times per week in 8 (22%), and 4.5 MIU 3 timesper week in 9 (24%). The 2 patients who experienceduveitis relapses despite a maintenance interferon alfa-2adosage of 9.0 MIU 3 times per week switched to inflix-imab therapy.

Of the remaining 35 patients, 13 completed the pre-determined total of 24 months of therapy. Discontinua-tion of interferon alfa-2a therapy resulted in remissionin 10 patients (77%). The median duration of remissionof Behcet uveitis after the termination of interferon alfa-2atherapy was 12 (range, 3-35) months. Three patients hada relapse of uveitis after discontinuation of therapy andrestarted interferon alfa-2a therapy. Reinstitution of in-terferon alfa-2a therapy at a dosage of 3.0 MIU 3 timesper week controlled intraocular inflammation with qui-escence in all patients. Kaplan-Meier survival analysis es-timated the rate of remission after discontinuation of in-terferon alfa-2a therapy as 84% by 1.5 months and as 76%by 3 months. The rate of remission remained stable there-after.

Eighteen patients continue to receive interferon alfa-2atherapy with control of their uveitis. Two patients dis-continued interferon alfa-2a therapy themselves after atotal duration of therapy of 9 and 14 months. One hadno flare-up of uveitis at the fourth month of discontinu-ation of therapy and was lost to follow-up thereafter. Theother patient discontinued therapy owing to pregnancy.This patient had a relapse of uveitis right after she gavebirth, and restarting interferon alfa-2a therapy was rec-ommended; however, the patient was also lost to follow-up. Two patients were lost to follow-up after 21 and 16months of therapy with interferon alfa-2a. Those pa-tients were free of intraocular inflammation while re-ceiving 4.5 MIU of interferon alfa-2a 3 times per weekfor 19 and 14 months.

The rate of uveitis relapses decreased from 3.52 perpatient-year before to 0.75 per patient-year after initiat-ing interferon alfa-2a therapy. Seventeen patients werereceiving systemic corticosteroids at the time of initia-tion of interferon alfa-2a therapy. While they were re-ceiving conventional immunosuppressive agents, themean dosage of concomitant systemic corticosteroids was27.0 (range, 10-60) mg/d prednisone equivalent. Twelvewere taking more than 10 (range, 20-60) mg/d, and 5 weretaking 10 mg/d. During interferon alfa-2a maintenancetherapy, 9 patients (53%) were able to discontinue sys-temic corticosteroid therapy completely, and the remain-ing 8 patients (47%) were able to taper systemic corti-costeroid therapy to no more than 10 (range, 5-10) mg/dprednisone equivalent. Improvement of visual acuity as

assessed by doubling of the visual angle occurred in 28of 68 eyes (41%).

The adverse effects observed during therapy are sum-marized in the following tabulation.

Adverse Effect No. (%) of Patients(N=37)

Flulike illness 37 (100)Alopecia 3 (8)Elevation of serum liver enzymes 2 (5)Myalgia 1 (3)Dermatitis 2 (5)Leukopeniaa 2 (5)Weight loss 9 (24)

aLeukocyte count less than 4000/µL (to convert to number of cells �109

per liter, multiply by 0.001).

All patients experienced a flulike syndrome associ-ated with myalgia and fever in the first week of initia-tion of therapy. However, it was well controlled with pre-medication using acetaminophen in all but 6 patients whorequired the addition of systemic nonsteroidal anti-inflammatory agents. The second most common com-plication observed was weight loss, which we believe isattributable to interferon alfa-2a and the low cortico-steroid threshold after the initiation of therapy. Depres-sion was not encountered. No adverse effect required ma-nipulation of the dose or discontinuation of interferonalfa-2a therapy.

Table 3. Visual Acuity, Number of Relapses, andConcomitant Systemic Corticosteroid Dosage Before andDuring Interferon Alfa-2a Therapy

BeforeInterferonTherapy

At the FinalVisit DuringInterferonTherapy

LogMAR visual acuityRight eye (n=33)

Mean (SD) 0.6 (0.7) 0.4 (0.6)Median (SEM) 0.3 (0.1) 0.1 (0.1)Range 0-3 0-1

Left eye (n=35)Mean (SD) 0.5 (0.7) 0.3 (0.6)Median (SEM) 0.2 (0.1) 0 (0.1)Range 0-3 0-3

Ocular relapses per patient-year 3.52 0.75No. of relapses (n=37)

Mean (SD) 3.4 (3.0) 1.1 (1.1)Median (SEM) 2 (0.5) 1 (0.2)Range 1-17 0-3

Months of follow-up (n=37)Mean (SD) 11.6 (15.4) 17.1 (7.2)Median (SEM) 6 (2.5) 21 (1.2)Range 1-69 5-24

Concomitant systemiccorticosteroid therapy, mg/dprednisone equivalenta

(n=17) (n=8)

Mean (SD) 27.0 (15.3) 9.4 (1.8)Median (SEM) 20 (3.7) 10 (0.6)Range 10-60 5-10

aIncludes 17 patients before interferon therapy and 8 at the last visit duringinterferon therapy.




COMMENT

Recent publications have reported a beneficial effect ofthe use of interferon alfa-2a in the treatment of refrac-tory and sight-threatening uveitis associated with BD.3-8

However, there is no consensus about the ideal dose andduration of the treatment for Behcet uveitis. We pro-posed to use a minimal effective dose of interferon alfa-2ain the treatment of refractory uveitis associated with BD.For the purpose of the study, a new treatment protocolof low-dose interferon alfa-2a with dose escalation wasadjusted. This treatment protocol uses 3.0 MIU of inter-feron alfa-2a for 14 days during the induction phase and3.0 MIU of interferon alfa-2a 3 times per week duringmaintenance therapy. The dosage is sequentially in-creased to 4.5, 6.0, and 9.0 MIU 3 times per week for eachindividual uveitis relapse. The dose of systemic cortico-steroids is rapidly tapered and ideally discontinued. Thetotal duration of interferon alfa-2a therapy is 24 months.

In some previous studies, the induction therapy thatis given for the initial 28 days usually involved a higherdose of interferon alfa-2a starting with 6.0 MIU, as firstsuggested by Kötter et al.3,4 The dose of interferon alfa-2awas then gradually tapered to 3.0 MIU if there was im-

provement. The main difference of our strategy is the ap-proach of starting at a lower dose, with increases in casesthat require it because of relapses of intraocular inflam-mation. In this way the patient avoids a higher dose, whichwould be expected to have more adverse effects. In-deed, we were able to control the inflammation with a3.0-MIU maintenance dose in 41% of cases, all of whichwere refractory to previous treatment with conven-tional immunosuppressive agents. In their initial re-port, Kötter et al3 observed an overall response of ocularmanifestations of 92% with their previously described pro-tocol. The rate of control intraocular inflammation withquiescence was determined as 95% in our series, whichis similar to that described by the other authors. Ocularrelapses occurred in 18% of patients, and the mean num-ber of relapses in the responders was 0.4 (range, 0-15).In our study population, 59% of patients had relapses ofuveitis that required an increase in the dose of inter-feron alfa-2a. We calculated the relapse rate in patient-years and concluded that the relapse rate declined from3.52 per patient-year before to 0.75 per patient-year af-ter initiating interferon alfa-2a therapy. In addition, byusing lower doses of interferon alfa-2a, the adverse ef-fects were fewer than those reported by Kötter et al,3 who

B

D

A

C

Figure 2. Fluorescein angiograms of a woman, aged 32 years. Cystoid macular edema (CME) and staining of the optic disc (A) and diffuse peripheral capillaryleakage (B) are evident before initiation of interferon alfa-2a therapy. Fluorescein angiography reveals resolution of CME and optic disc staining (C) and capillaryleakage from the peripheral retina (D) 4 months after the initiation of therapy. The patient received maintenance therapy consisting of interferon alfa-2a, 3.0 MIU(million IU) 3 times per week.




reported leukopenia in 40%, depression in 8%, thyroid-itis in 4%, and occurrence of autoantibodies in 22% oftheir patients. Again similar to our findings, in their lat-est publication, Kötter et al4 reported a 94% partial or com-plete response of uveitis with the use of interferon alfa-2atherapy.

With regard to discontinuation of therapy and remis-sion rate after discontinuation, Kötter et al4 were able todiscontinue therapy in 40% of patients. The mean dura-tion of observation after discontinuation of therapy was29.5 months. In our series, 13 patients (37%) com-pleted 24 months of therapy as determined by the studyprotocol. Discontinuation of interferon alfa-2a therapyresulted in remission in 10 of the 13 patients (77%). Themedian duration of remission of Behcet uveitis after thetermination of interferon alfa-2a therapy was 12 months.Kaplan-Meier survival analysis estimated the rate of re-mission after discontinuation of interferon alfa-2a therapyas 76% by 3 months. The rate of remission remained stablethereafter.

Wechsler et al6 previously used a similar dose of in-terferon alfa-2a for the treatment of severe and refrac-tory uveitis associated with BD. In their retrospective andpreliminary report, 8 patients were described. The dos-age of interferon alfa-2a was 3 MIU given 3 times per weekthroughout the treatment. The treatment controlled in-traocular inflammation with improvement of visual acu-ity. The authors were able to taper the dose of systemiccorticosteroids, similar to our conclusions. In a recentretrospective study, Gueudry et al8 reported on the long-term efficacy of the same treatment protocol used byWechsler et al.6 The authors were able to control intra-ocular inflammation in 88% of their patients, with sig-nificant improvement in visual acuity and decrease in therelapse rate of uveitis. Our treatment protocol differs fromthat one: we used a low-dose regimen and dose escala-tion. Because Behcet uveitis is characterized by relapsing-remitting courses of intraocular inflammation, the aimshould be complete inactivity or quiescence rather thanimprovement. Therefore, we switched to a higher doseof interferon alfa-2a in cases of partial response and ifquiescence could not be achieved. We have also previ-ously reported the differences between the 2 regimenselsewhere.15,16 We assume that a higher rate of controlof uveitis (95% vs 88%) may be related to dose escala-tion by increasing the dose of interferon alfa-2a whenneeded because of relapses of uveitis during the main-tenance therapy.

The ability to taper systemic corticosteroid therapy,which was a secondary outcome measure in this study,is an important variable when judging the efficacy of animmunosuppressive therapy. We were able to com-pletely discontinue (53% of patients) or to taper sys-temic corticosteroid therapy to no more than 10 mg/dprednisone equivalents (47% of patients) in all patientswho formerly received long-term systemic cortico-steroid therapy. The mean systemic corticosteroid dos-age decreased from 27.0 mg/d before to 9.4 mg/d afterinitiation of interferon alfa-2a therapy.

In addition to allowing the patient to avoid potentialadverse effects that occur with higher doses, a low-doseinterferon alfa-2a regimen has a lower overall cost com-

pared with regimens using higher doses. We calculatedthe overall cost of interferon alfa-2a therapy for 2 differ-ent maintenance regimens for Turkey. Although the ap-proximate cost of maintenance therapy with interferonalfa-2a given as 3.0 MIU 3 times per week is US $3500per year, it would be approximately US $9400 per yearfor a maintenance regimen using 9.0 MIU 3 times perweek. Thus, using a minimal effective dose of interferonalfa-2a with dose escalation would affect the overall costmarkedly.

There is obviously a need to conduct randomized con-trolled trials. However, the study population herein is ofa particular type, with refractory and sight-threateninguveitis associated with BD. As a measure of disease se-verity, 38% of our patients who were receiving conven-tional immunosuppressive therapy needed at least 1 in-fusion of methylprednisolone because of severe uveitisflare-up. Another shortcoming may be the lack of evalu-ation of extraocular manifestations of the disease. It haspreviously been reported that the frequency of extraocu-lar manifestations of the disease is lower in patients withocular involvement than in those without.1 Further-more, it has also been shown that the use of systemic in-terferon was effective in the treatment of arthritis and mu-cocutaneous lesions of BD.17

We would like to point out the associated medical con-ditions of the patients reported herein. Two of our pa-tients had aseptic bone necrosis necessitating discon-tinuation of systemic corticosteroid therapy. In 1 patient,conventional immunosuppressive agents had to be with-held owing to severe anemia associated with thalasse-mia. Extensive condyloma acuminatum encountered inanother patient completely resolved after the initiationof interferon alfa-2a therapy. Two of our patients had ac-tive pulmonary tuberculosis and were treated with an-tituberculosis agents. Uveitis specialists may encounterpatients with associated systemic medical conditions suchas these or viral diseases such as chronic hepatitis infec-tion due to hepatitis B or C virus. We speculate that theuse of interferon alfa-2a in the treatment of uveitis mayalso result in beneficial effects for the associated medi-cal conditions, especially those caused by viral diseases,and may circumvent certain adverse effects of other im-munosuppressive treatments.

We conclude that, at a lower dose, interferon alfa-2ais an effective and well-tolerated agent in controlling se-vere sight-threatening Behcet uveitis resistant to con-ventional immunosuppressive agents. This approach alsohas the advantage of a lower overall cost and avoids po-tential adverse effects of higher-dose regimens. A partialresponse or unresponsiveness can be managed by in-creasing the dose of interferons with a dose-escalationregimen.

Submitted for Publication: March 26, 2010; final revi-sion received June 12, 2010; accepted June 15, 2010.Correspondence: Sumru Onal, MD, FEBOphth, UveitisService, Department of Ophthalmology, Marmara Uni-versity, School of Medicine, Altunizade Mah, Okul-cikmazi Sok, No. 11/6, Uskudar, Istanbul, Turkey 34660([email protected]).Financial Disclosure: None reported.




REFERENCES

1. Tugal-Tutkun I, Onal S, Altan-Yaycioglu R, Huseyin Altunbas H, Urgancioglu M.Uveitis in Behcet disease: an analysis of 880 patients. Am J Ophthalmol. 2004;138(3):373-380.

2. Lim L, Suhler EB, Smith JR. Biologic therapies for inflammatory eye disease. ClinExperiment Ophthalmol. 2006;34(4):365-374.

3. Kötter I, Zierhut M, Eckstein AK, et al. Human recombinant interferon alfa-2a forthe treatment of Behcet’s disease with sight threatening posterior or panuveitis.Br J Ophthalmol. 2003;87(4):423-431.

4. Kötter I, Günaydin I, Zierhut M, Stübiger N. The use of interferon alpha in Behcetdisease: review of the literature. Semin Arthritis Rheum. 2004;33(5):320-335.

5. Tugal-Tutkun I, Güney-Tefekli E, Urgancioglu M. Results of interferon-alfa therapyin patients with Behcet uveitis. Graefes Arch Clin Exp Ophthalmol. 2006;244(12):1692-1695.

6. Wechsler B, Bodaghi B, Huong DL, et al. Efficacy of interferon alfa-2a in severeand refractory uveitis associated with Behcet’s disease. Ocul Immunol Inflamm.2000;8(4):293-301.

7. Hamuryudan V, Ozyazgan Y, Fresko Y, Mat C, Yurdakul S, Yazici H. Interferonalfa combined with azathioprine for the uveitis of Behcet’s disease: an open study.Isr Med Assoc J. 2002;4(11)(suppl):928-930.

8. Gueudry J, Wechsler B, Terrada C, et al. Long-term efficacy and safety of low-dose interferon alpha2a therapy in severe uveitis associated with Behcet disease.Am J Ophthalmol. 2008;146(6):837.e1-844.e1. doi:10.1016/j.ajo.2008.08.038.

9. Plskova J, Greiner K, Forrester JV. Interferon-� as an effective treatment for non-infectious posterior uveitis and panuveitis. Am J Ophthalmol. 2007;144(1):55-61.

10. Bodaghi B, Gendron G, Wechsler B, et al. Efficacy of interferon alpha in the treat-ment of refractory and sight threatening uveitis: a retrospective monocentric studyof 45 patients. Br J Ophthalmol. 2007;91(3):335-339.

11. Becker MD, Heiligenhaus A, Hudde T, et al. Interferon as a treatment for uveitisassociated with multiple sclerosis. Br J Ophthalmol. 2005;89(10):1254-1257.

12. International Study Group for Behcet’s Disease. Criteria for diagnosis of Beh-cet’s disease. Lancet. 1990;335(8697):1078-1080.

13. Jabs DA, Nussenblatt RB, Rosenbaum JT; Standardization of Uveitis Nomencla-ture (SUN) Working Group. Standardization of uveitis nomenclature for report-ing clinical data: results of the First International Workshop. Am J Ophthalmol.2005;140(3):509-516.

14. Harper SL, Chorich LJ, Foster CS. Principles of diagnosis and therapy. In: FosterCS, Vitale AT, eds. Diagnosis and Treatment of Uveitis. Philadelphia, PA: WB Saun-ders Co; 2002:79-103.

15. Onal S, Kazokoglu H, Direskeneli H, Yavuz S. Low-dose interferon alfa-2a therapyin severe uveitis associated with Behcet disease [letter]. Am J Ophthalmol. 2009;147(6):1109-1110.

16. Onal S, Kazokoglu H, Koc A, et al. Low dose and dose escalating therapy of in-terferon alfa-2a in the treatment of refractory and sight-threatening Behcet’s uveitis.Clin Exp Rheumatol. 2009;27(2)(suppl 53):S113-S114.

17. Hamuryudan V, Moral F, Yurdakul S, et al. Systemic interferon alpha 2b treat-ment in Behcet’s syndrome. J Rheumatol. 1994;21(6):1098-1100.

Correction

Error in Figure Legend. In the Editorial titled “ArnallPatz, MD: The Spirit of Collaboration” by Ferris, pub-lished in the December 2010 issue of the Archives (2010;128[12]:1602-1603), the Figure legend should have ap-peared as follows: “Arnall Patz, MD. Portrait of Dr Patzby Howard Schatz, first fellow on Arnall Patz’s RetinalVascular Service.” This article was corrected online.




CURRICULUM VITAE EDUCATION · 2. The clinical uveitis research award (Berlin, September 26, 2005)...

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