The Impact of the Treatment Delay on the Outcome of Vision in Ocular Lesions of Behcet's Disease.


Abstract: Introduction: Ocular lesions of Behcet’s disease (BD) progress by recurrent attacks and remission. Their natural history, without treatment, is toward severe loss of vision or blindness. We presented last year a work to the ACR meeting on the long-term outcome of visual acuity (VA) in BD. The data showed that the final VA was related to the baseline VA (before the treatment), suggesting that a delay in aggressive treatment may cause poorer outcome. The aim of this study was to address this issue by reviewing the data of all patients who had an aggressive treatment for their eye lesion. Materials and Methods: The data of the treatment registry for ocular lesions of BD were used for this analysis, regardless of the kind of cytotoxic drugs that were used. Apart the cytotoxic drug, the treatment protocol and the data evaluation (different activity indexes) was the same for all patients, which were 1016 by May 1, 2002. They were divided in 5 subgroups according to the delay in aggressive treatment: Group G1 (up to one year delay), G2 (1 to 2 years), G3 (2 to 3 years), G4 (3 to 4 years), G5 (4 to 5 years). Results: In group G1 there were 552 eyes from which 438 eyes had impaired VA; the mean VA at the entry was 4.5, it improved to 5.6, t score by the student paired t test was 6.562, p<0.0001. In group G2 there were 432 eyes from which 343 eyes had impaired VA; the mean VA at the entry was 3.9, it improved to 4.6, the t score was 4.063, p<0.0001. In group G3 there were 251 eyes from which 220 eyes had impaired VA; the mean VA at the entry was 3.4, it improved to 3.9, t was 2.429, p=0.016. In group G4 there were 132 eyes from which 119 eyes had impaired VA; the mean VA at the entry was 3.4, it improved to 4.2, t was 2.680, p=0.009. In group G5 there were 100 eyes from which 78 eyes had impaired VA; the mean VA at the entry was 3.7, it improved to 4.8, t score by the student paired t test was 2.691, p=0.009. Conclusion: The mean VA before the aggressive treatment decreased gradually from group G1 to G3, showing the harmful impact of the delay on the vision. The aggressive treatment by cytotoxic drugs was beneficial as shown by the mean VA after the treatment (in all groups). However, the improvement was partial and the final VA depended to the entry value. As a result, the mean VA after the treatment decreased from G1 to G3. The delay in aggressive treatment did not mean no treatment at all, which would have resulted in much sever loss of vision or blindness.