Tracing pattern of Behçet’s uveitis over 25 years

Feb 19, 2014

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.

 

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.”

 

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