TREATMENT OF OCCULAR MANIFESTATIONS OF BEHCET’S DISEASE.


Abstract: Ocular manifestations like other manifestations of Behcet’s Disease (BD) progress by repetitive attacks followed by remission. However, the remission is much slower in posterior uveitis, and practically absent in retinal vasculitis. Usually the healing process do not complete before the next attack. Therefore, lesions will accumulate during successive attacks and lead to severe loss of vision or blindness. An inflammatory index and visual acuity has to be calculated for each eye before the treatment and during the follow-up to evaluate the treatment response. The treatment has 2 goals. 1- To make disappear the inflammation. Prednisolone is the best choice, 1/2 to 1 mg/kg/daily is the necessary dose. 2- To control the autoimmune disorder and prevent from further attacks. There is a large choice of drugs for this purpose. Immunomodulators such as cyclosporine, many cytotoxic drugs (cyclophosphamide, chlorambucil, azathioprine, methotrexate), and recently biologic agents (Interferon α, anti TNF drugs) can address that issue. There is not much difference between them regarding their efficacy. We presented in the past several studies showing approximately the same similarity in their outcome. Therefore, the choice for the treatment will depend greatly upon the drug’s side effects, the price, the ease of use, and the cost of periodical controls. Methotrexate is the treatment of choice for posterior uveitis and cyclophosphamide for retinal vasculitis. We demonstrated in a previous work that near 25% of patients will not respond to the treatment. There is no way to predict which patients will be non-responder. They have to switch to another cytotoxic drug. Among them 1/3 will respond, 1/3 will remain unchanged and 1/3 will aggravate. Non-responders have to switch to a 3rd. drug.