Vasculitis in Ocular Lesions Of Behcet’s Disease, Impact on Outcome.


Abstract: Introduction: Ocular lesions are the leading cause of morbidity in Behcet’s disease (BD). Many factors contribute to the loss of vision in BD, as uveitis, retinal vasculitis, and their secondary complications such as cataract, hemorrhage, vessel necrosis, neovascularization, optic atrophy, etc. The purpose of this study was to determine the impact of retinal vasculitis on the evaluation of ocular Behcet’s (OB) and its outcome after an early or late treatment. Materials & Methods: From patients attending regularly the special Eye Clinic of the Behcet's Unit during the years 1996 to 1998, two hundred and fifty patients were selected. They fulfilled the Classification Tree criteria, but had enough symptoms to fulfill all other major diagnosis criteria for BD. The 250 patients were selected randomly from all patients attending the Eye Clinic. Two subgroups were determined according to the time of starting the treatment: Group A, including 131 patients with early treatment; Group B, including 119 patients who were treated with few years delay (late diagnosis). All. patients received immunosuppressor drugs and corticosteroids. A confidence Interval (CI) was calculated for percentages. The results were compared by the chi square test. Results: The mean age of the patients was 27.6±10.6. The mean follow up time was 5.7+3.7 years, ranging between I to 16 years. The most common symptom at the first consultation was hyalitis (41.2% of patients, CI=6.1). In group A it was 45%+8.5 and in group B 37%±8.7. Retinal perivasculitis was present in 22.8%+5.2 of patients. In group A it was 21.4%+7 and in group B 24.4%±7.7. A total of 199 patients (79.6%±5) ­had retinal vasculitis (RV). In these patients, RV was present in 42.7%+6.9 at the first visit (group A: 39.4%±8.4, group B:46.7%±9). It appeared later in the course of the disease, in 57.3%+6.9 of patients (group A: 60.5%±9.2, group B:53.3%±9). Eyes with visual impairment were 291, 58.2%±4.3 .(A: 50%±8.6, B: 32.8%±6). Symptoms causing the impairment were the followings. Vascular necrosis and optic atrophy 18.8%+3.4 of the eyes (A: 19.I%±4.8, B: 18.5±5), edema 20.8%±3.6 (A: 17.6%+4.7, B: 24.4%+5.4), i cataract 6.4%±2.1. (A: 5±2.6, B: 8±3.4), macular scare 5.2%+1.9.(A: 2.7+2.1, B: 8+3.4). Only two cases of retinal detachment (one in each group) and one case of central retinal artery occlusion in group B was observed. There was no statistically significant difference between group A and B, except for the macular scar which was more frequent in group B (delayed treatment). The p value was 0.004. Conclusion: The early treatment of ocular Behcet did not prevent the occurrence of vasculitis. The rate of complications were the same in early treated patients and those with delayed treatment except for maculae scar which was less seen in the early treated group.