Treatment of ophthalmological lesions of Behcet's disease.


Abstract: Ophthalmologic lesions, specially posterior uveitis (PU) and retinal vasculitis (RV), are the leading cause of morbidity in BD. Despite many problems encountered in their treatment, it is accepted today that cytotoxic drugs are the preferred choice. Cyclosporin (CYC) is another effective drug and Corticosteroids only have a temporary effect on inflammatory state. Other conventional drugs (like Colchicine, levamisole and etc.) has no place in the treatment of these lesions. We present here our experience with 6 methods of treatment in these lesions: Cyclophosphamide as IV bolus 1-With conventional dose (PCP) in 297 patients, 2- With low dose (LDP) in 77, and 3- Orally (OCP) in 39, 4-Methotrexate (MTX) in 201, 5- Chlorambucil (LEU) in 73 and 6- CYC in 19 patients. Improvement or stabilization of the lesions was accepted as good results. Then these results for the visual acuity (VA) and for each section of the eyes was compared by Chi square test. The good results were between 85% (PCP) to 94% (CYC) in PU; between 80% (MTX & LEU) to 90% (OCP) for RV; and they were between 73% (OCP) to 84% (CYC) for VA. Concerning a total Adjusted Disease Activity Index in each patient the good results were between 69% (OCP) to 89% (CYC). Side effects were highest with CYC (90%) and lowest with MTX (9%) while 19% with PCP, 27% with LDP, 22% with OCP and 36% for LEU. In conclusion all these methods are approximately equal in efficacy and in each method there are some non responders. Although there is no way to guess the non responders to each method before starting the treatment, the important point is that today we have different treatment modalities to change over or perhaps combine in resistant cases.