Tracing pattern of Behçet’s uveitis over 25 years

Baltimore-Bilateral panuveitis associated with retinal vasculitis has been found to be the most common ocular manifestation-and administration of oral systemic corticosteroids was the most common intervention-according to a 25-year study of the uveitic patterns in Behçet’s disease in Saudi Arabian patients presented by J. Fernando Arevalo, MD.

The investigators-of the King Khaled Eye Specialist Hospital Uveitis Study Group, Riyadh, Saudi Arabia-conducted a retrospective chart review of 888 patients (1,455 eyes) with uveitis in a tertiary care center. Of these, 132 (14.9%) patients (232 eyes; 102 men) with Behçet’s disease evaluated from January 1986 through December 2011 were included.

The mean patient age was 36.9 years and they were followed for a mean of 94.1 months (range, 1 to 294 months). Bilateral disease was seen in 100 (75.8%) patients. The mean baseline best-corrected visual acuity (BCVA) was 20/125, and 37.5% of eyes had a baseline BCVA of 20/50 or better and 38.4% had a mean BCVA or 20/200 or worse in the effected eyes. The mean IOP was normal bilaterally. Retinal vasculitis was found at baseline in 26.3% of eyes, with most having occlusive vasculitis in 25.4% of eyes, and macular edema in 18.1% of eyes.

Occlusive vasculitis associated with Behçet’s disease resulted from branch retinal vein occlusion (RVO) (20.3% of eyes), central RVO (3.4% of eyes), neovascularization on the disc and elsewhere (6.8% of eyes each), and peripheral vasculitis (62.7% of eyes).

“Panuveitis was the most common form of ocular presentation in 89.4% of eyes followed by anterior uveitis in 7.6% of eyes and intermediate uveitis in 3%,” said Dr. Arevalo, Edmund F. and Virginia Ball professor of ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore.

A retinal detachment developed in 9.4% of eyes, most (50%) of which were exudative retinal detachments.

Various treatments were administered over 25 years to treat Behçet’s disease. These included oral prednisone in the vast majority (93.2%) of patients combined with cyclosporine in 74.2%, azathioprine in 49.2%, intravenous steroid in 26.5%, local sub-Tenon’s triamcinolone in 10.6%, infliximab in 9.1%, methotrexate in 4.5%, and intravitreal triamcinolone in 3.8%.

Glaucoma was the most common anterior segment complication, occurring in 19% of eyes, cataracts in 14.7%, and posterior synechiae in 6%. Optic nerve atrophy was the most common posterior segment complication in 8.2% of eyes.

In this patient population, 71.7% of eyes underwent cataract surgery, 11.7% glaucoma surgery, 13.3% vitrectomy, and superficial keratectomy in 3.3%.

At the final visit, the BCVA exceeded 20/50 in 56.5% of eyes, and 20/200 or worse in 22% of eyes.

“In Saudi Arabia, Behçet’s uveitis affects predominantly young men,” Dr. Arevalo said. “Bilateral panuveitis associated with retinal vasculitis was the most common ocular manifestation. More than 50% of patients maintained a visual acuity of 20/50 or better at the end of follow-up, (and) immunosuppressive therapy with oral systemic corticosteroids was the primary management in these patients.”

For more articles in this issue of Ophthalmology Times eReport, click here.

To receive weekly clinical news and updates in ophthalmology, subscribe to the Ophthalmology Times eReport.