Treatment of Ophthalmologic Manifestations Of Behcet’s Disease Comparison Of 6 Methods.

Abstract: Introduction: Opthalmologic manifestations are the major cause of morbidity in Behcet’s Disease. If not treated, they usually progress toward sever loss of vision or blindness. Cytotoxic drugs are the main therapeutic agents. Materials & Methods: In an open, non randomized, control study, pulse cyclophosphamide (PCP), low dose pulse cyclophosphamide (LDP), weakly methtrexate (MTX), chlorambucil (CHL), oral cyclophosphamide (OCP), and cyclosporine A (CYA) were used in a standard protocol for 778 patients. Criteia for inclusion were: 1- Fulfilling the Iran criteria. 2- Having posterior uveitis (PU)and/or retinal vasculitis (RV). 3- To have an inflammatory lesion of the eye. For each section of each eye (anteroior chamber, uvea, retina) a Disease Activity Index (DAI) was calculated. The visual acuity (VA) was calculated for each eye. A Total Adjusted DAI (TADAI) was calculated for each patient upon the DAI and the VA. PCP group: Patients: 308, mean follow-up (MFU): 21.4 months, TADAI 40.5. LDP group: Patients: 115, MFU: 14.3, TADAI: 14.3. CHL group: Patients: 73, MFU: 22.9, TADAI: 36.4. CYA group: Patients: 19, MFU: 24.5. TADAI: 35.2. OCP group: Patients: 39, MFU: 16.5, TADAI: 34.3. MTX group: Patients: 224, MFU: 18.6, TADAI: 30.7. Results: The percentage of cured, improved, or stabilized eyes with their confidence interval calculated at 95% were: PU: PCP: 82+3.2, LDP: 83+5.1, CHL: 87+5.9, CYA: 93+8.7, OCP: 80+9.8, MTX: 86+3.3. RV: PCP 72+4, LDP: 72+6.5, CHL: 71+6.3, CYA: 68+16. OCP: 79+10.6, MTX: 65+4.7. VA: PCP: 68+3.7, LDP: 66+6.1, CHL: 72+7.3, CYA: 68+15.4, OCP: 71+10.1, MTX: 70+4.3. The percentage of patients in whom the TADAI improved or stabilized was: PCP: 73.4+4.9, LDP: 76.5+7.9, CHL: 82.2+9, CYA: 84.2+17.6, OCP: 69.2+15, MTX: 74.1+5.7. Side Effects: PCP: 19%, LDP: 27%, CHL: 30%, CYA: 90%. OCP: 22%, MTX: 9%. There was no statistically significant difference between results, except for side effects. Conclusion: As a first choice, We propose MTX in patients without RV, and PCP and LDP in those with RV. Cyclosporine A is left as the last resort.