Long-term outcome of ocular manifestations in Behcet's Disease.


Abstract: Introduction: The natural history of ocular manifestations is very poor in Behcet's Disease (BD). The lesions progress by successive attacks leading to sever loss of vision or blindness. Aggressive treatments, by the association of cytotoxic drugs and steroids, have dramatically changed the outcome. However, still some ophthalmologists are convinced that the improvement is temporary and in the long run the eyes progress toward blindness. The aim of this study was to evaluate the outcome of visual acuity (VA) in patients with more than 10 years of ocular manifestations and compare them to patients with less duration. Materials and Methods: From our database all patients having posterior uveitis and/or retinitis, and having received cytotoxic drugs (cyclophosphamide, methotrexate, chlorambucil, azathioprine, cyclosporine A) and prednisolone were selected. They were divided upon the duration of their eye lesions to 3 groups. Group 1: Less than 5 years. Group 2: Between 5 and 10 years. Group 3: More than 10 years. VA of the first and the last visit were compared in each group by the Student paired t test. Then the 3 groups were compared to each other to find if the duration of the disease had any effect on the outcome of the VA. Results: From 833 patients, 207 had received more than one treatment scheme. Group 1 comprised 593 patients. The mean duration of the eye disease (MDED) was 31.6 months. The mean VA improved from 4 to 5.1 (t=9.433, p<0.0001), 18% of the eyes aggravated (CI=3). Group 2 comprised 182 patients. The MDED was 82.7 months, the mean VA improved from 3.6 to 4 (t=2.735, p<0.007), where 24% of the eyes aggravated (CI=4.7). Group 3 comprised 58 patients. The MDED was 165.3 months, the mean VA improved from 2.9 to 4.2 (t=2.099, p<0.04), where 22% of the eyes aggravated (CI=8.l). Conclusion: The outcome of the eyes was not correlated to the duration of the lesions, if the treatment was pursued as long as the disease was active, and if the cytotoxic drug was changed in case of ineffectiveness.