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Azri C, Dusser P, Eid L, Barreau E, Kone-Paut I, Borocco C, Galeotti C, Saad S, Labetoulle M, Rousseau A. Ocular involvement in pediatric Behçet's disease: is it different than in adults? (a short case series and mini review). BMC Ophthalmol 2023; 23:474. [PMID: 37990307 PMCID: PMC10664259 DOI: 10.1186/s12886-023-03197-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/01/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Pediatric Behçet's disease (PBD) is rarer than BD and can be a challenging diagnosis as clinical picture may be incomplete. As in adult patients, sight-threatening ocular manifestations may lead to diagnosis. In this study, we aimed to report a series of cases of PBD with ocular manifestations and provide a review of the literature. METHODS Retrospective case series of PBD patients with ocular manifestations. Demographic, ophthalmological and systemic data at presentation and during follow-up were collected and analyzed. RESULTS Four patients, aged 13.0 ± 2.9 years (9-16) were included. Posterior uveitis with retinal vasculitis, papillitis and macular edema was present in all patients, with associated anterior uveitis in 2 cases. Other features included occlusive vasculitis (2/4) and necrotizing retinitis (2/4). All patients were improved by systemic treatments except one patient with severe bilateral optic neuropathy. Ocular manifestations were the presenting symptoms in 3/4 cases. CONCLUSION Ocular manifestations and systemic associations of PBD are comparable to those encountered in adult patients. The lack of complains in pediatric patients may lead to a longer diagnosis delay, especially in unilateral uveitis. Aggressive and long-term treatment is mandatory to prevent vision loss and recurrences.
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Affiliation(s)
- Casem Azri
- Service d'Ophtalmologie, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris-Saclay. Centre de Référence Pour Les Maladies Rares en Ophtalmologie (OPHTARA), Hôpital Bicêtre, 78, Rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - Perrine Dusser
- Paediatric Rheumatology Department, APHP, Bicêtre Hospital, Le Kremlin-Bicêtre, 94270, France
- Centre de Référence Des Maladies Auto-Inflammatoires Et Des Amyloses Inflammatoire (CEREMAIA), Le Kremlin-Bicêtre, France
| | - Laura Eid
- Service d'Ophtalmologie, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris-Saclay. Centre de Référence Pour Les Maladies Rares en Ophtalmologie (OPHTARA), Hôpital Bicêtre, 78, Rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - Emmanuel Barreau
- Service d'Ophtalmologie, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris-Saclay. Centre de Référence Pour Les Maladies Rares en Ophtalmologie (OPHTARA), Hôpital Bicêtre, 78, Rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - Isabelle Kone-Paut
- Paediatric Rheumatology Department, APHP, Bicêtre Hospital, Le Kremlin-Bicêtre, 94270, France
- Centre de Référence Des Maladies Auto-Inflammatoires Et Des Amyloses Inflammatoire (CEREMAIA), Le Kremlin-Bicêtre, France
| | - Charlotte Borocco
- Paediatric Rheumatology Department, APHP, Bicêtre Hospital, Le Kremlin-Bicêtre, 94270, France
- Centre de Référence Des Maladies Auto-Inflammatoires Et Des Amyloses Inflammatoire (CEREMAIA), Le Kremlin-Bicêtre, France
| | - Caroline Galeotti
- Paediatric Rheumatology Department, APHP, Bicêtre Hospital, Le Kremlin-Bicêtre, 94270, France
- Centre de Référence Des Maladies Auto-Inflammatoires Et Des Amyloses Inflammatoire (CEREMAIA), Le Kremlin-Bicêtre, France
| | - Sami Saad
- Service d'Ophtalmologie, Centre Hospitalier National Ophtalmologique des 15-20, Paris, France
| | - Marc Labetoulle
- Service d'Ophtalmologie, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris-Saclay. Centre de Référence Pour Les Maladies Rares en Ophtalmologie (OPHTARA), Hôpital Bicêtre, 78, Rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - Antoine Rousseau
- Service d'Ophtalmologie, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris-Saclay. Centre de Référence Pour Les Maladies Rares en Ophtalmologie (OPHTARA), Hôpital Bicêtre, 78, Rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
- Department of Immunology of Viral, Auto-Immune Disease, Hematological and Bacterial Diseases (IMVA-HB), UMR1184, CEA, Fontenay-Aux-Roses, France.
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Li B, Li H, Huang Q, Zheng Y. Optimizing glucocorticoid therapy for Behçet's uveitis: efficacy, adverse effects, and advances in combination approaches. Int Ophthalmol 2023; 43:4373-4381. [PMID: 37420127 PMCID: PMC10520171 DOI: 10.1007/s10792-023-02808-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023]
Abstract
Behçet's uveitis (BU) is a debilitating manifestation of Behçet's disease, often requiring prompt and aggressive treatment to prevent vision loss. Glucocorticoids (GCS) serve as a first-line therapy for BU; however, their long-term, high-dose use can result in significant adverse effects. This review summarizes the efficacy, adverse effects, and advances in combination therapy involving GCS for the management of BU. We discuss the benefits and drawbacks of various GCS administration routes, including periocular and intravitreal injections, intravitreal sustained-release devices, and systemic therapy, highlighting the role of fluocinolone acetonide and dexamethasone as primary sustained-release formulations. Moreover, we underscore the importance of combining GCS with immunosuppressive drugs and biological agents to minimize adverse reactions and optimize therapeutic outcomes. The review concludes that, while GCS remain a crucial component of BU treatment, careful consideration of their administration and combination with other therapies is essential to achieve long-term remission and improved visual outcomes for patients with BU.
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Affiliation(s)
- Biao Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Haoran Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qun Huang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yanlin Zheng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Zhong Z, Su G, Yang P. Risk factors, clinical features and treatment of Behçet's disease uveitis. Prog Retin Eye Res 2023; 97:101216. [PMID: 37734442 DOI: 10.1016/j.preteyeres.2023.101216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023]
Abstract
Behçet's disease is a systemic vasculitis frequently associated with intraocular inflammation. Recent findings identified independent clinical clusters in Behçet's disease, each involving distinct combinations of affected organs. Ocular Behçet's disease, mainly manifested as uveitis, is characterized as an independent cluster with a low likelihood of association with other system involvements, such as intestinal, cardiovascular, or central nervous system. A prevailing theory suggests that the pathogenesis of the disease is multifactorial, where a variety of genetic and infectious agents may interact with each other to cause the disease. Among sporadic cases, the human leukocyte antigen (HLA) genes, including HLA-B51, HLA-A26, HLA-B15, and HLA-B5701, have been found to be a key component conferring genetic susceptibility. Outside the HLA region, a set of susceptibility variants are identified, closely related to interleukin (IL)-23/IL-17 pathway, tumor necrosis factor (TNF) signaling, and pattern recognition receptor systems. Microbial infections, such as Streptococcus sanguinis, Mycobacterium tuberculosis, and Herpes simplex virus (HSV), are linked to play the triggering of disease in immunogenetically predisposed individuals. Clinically, due to the notable relapsing-remitting course of ocular Behçet's disease, the prevention of recurrent attack would be the primary treatment goal. Combination of corticosteroids and immunomodulatory drugs, such as anti-TNF agents, interferon, and conventional immunosuppressants (e.g. cyclosporine, azathioprine), have been the mainstream regimen for the disease. Future research may focus on comparing the effectiveness of immunomodulatory drugs and identifying the most suitable subgroups for a specific drug on the basis of the knowledge of the molecular heterogeneity of the disease.
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Affiliation(s)
- Zhenyu Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China.
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Pannetier P, Poulsen R, Gölz L, Coordes S, Stegeman H, Koegst J, Reger L, Braunbeck T, Hansen M, Baumann L. Reversibility of Thyroid Hormone System-Disrupting Effects on Eye and Thyroid Follicle Development in Zebrafish (Danio rerio) Embryos. ENVIRONMENTAL TOXICOLOGY AND CHEMISTRY 2023; 42:1276-1292. [PMID: 36920003 DOI: 10.1002/etc.5608] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/13/2022] [Accepted: 03/10/2023] [Indexed: 05/27/2023]
Abstract
Early vertebrate development is partially regulated by thyroid hormones (THs). Environmental pollutants that interact with the TH system (TH system-disrupting chemicals [THSDCs]) can have massively disrupting effects on this essential phase. Eye development of fish is directly regulated by THs and can, therefore, be used as a thyroid-related endpoint in endocrine disruptor testing. To evaluate the effects of THSDC-induced eye malformations during early development, zebrafish (Danio rerio) embryos were exposed for 5 days postfertilization (dpf) to either propylthiouracil, a TH synthesis inhibitor, or tetrabromobisphenol A, which interacts with TH receptors. Subsequently, one half of the embryos were exposed further to the THSDCs until 8 dpf, while the other half of the embryos were raised in clean water for 3 days to check for reversibility of effects. Continued THSDC exposure altered eye size and pigmentation and induced changes in the cellular structure of the retina. This correlated with morphological alterations of thyroid follicles as revealed by use of a transgenic zebrafish line. Interestingly, effects were partly reversible after a recovery period as short as 3 days. Results are consistent with changes in TH levels measured in different tissues of the embryos, for example, in the eyes. The results show that eye development in zebrafish embryos is very sensitive to THSDC treatment but able to recover quickly from early exposure by effective repair mechanisms. Environ Toxicol Chem 2023;42:1276-1292. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.
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Affiliation(s)
- Pauline Pannetier
- Aquatic Ecology & Toxicology, Center for Organismal Studies, University of Heidelberg, Heidelberg, Germany
| | - Rikke Poulsen
- Environmental Metabolomics Laboratory, Department of Environmental Science, University of Aarhus, Aarhus, Denmark
| | - Lisa Gölz
- Aquatic Ecology & Toxicology, Center for Organismal Studies, University of Heidelberg, Heidelberg, Germany
| | - Sara Coordes
- Aquatic Ecology & Toxicology, Center for Organismal Studies, University of Heidelberg, Heidelberg, Germany
| | - Hanna Stegeman
- Aquatic Ecology & Toxicology, Center for Organismal Studies, University of Heidelberg, Heidelberg, Germany
| | - Johannes Koegst
- Aquatic Ecology & Toxicology, Center for Organismal Studies, University of Heidelberg, Heidelberg, Germany
| | - Luisa Reger
- Aquatic Ecology & Toxicology, Center for Organismal Studies, University of Heidelberg, Heidelberg, Germany
| | - Thomas Braunbeck
- Aquatic Ecology & Toxicology, Center for Organismal Studies, University of Heidelberg, Heidelberg, Germany
| | - Martin Hansen
- Environmental Metabolomics Laboratory, Department of Environmental Science, University of Aarhus, Aarhus, Denmark
| | - Lisa Baumann
- Aquatic Ecology & Toxicology, Center for Organismal Studies, University of Heidelberg, Heidelberg, Germany
- Amsterdam Institute for Life and Environment (A-LIFE), Section on Environmental Health & Toxicology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Keorochana N, Homchampa N, Vongkulsiri S, Choontanom R. Fluorescein angiographic findings and Behcet's disease ocular attack score 24 (BOS24) as prognostic factors for visual outcome in patients with ocular Behcet's disease. Int J Retina Vitreous 2021; 7:48. [PMID: 34454608 PMCID: PMC8403365 DOI: 10.1186/s40942-021-00318-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 08/17/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose To determine the application of fluorescein angiographic (FA) findings and Behcet’s disease ocular attack score 24 (BOS24) scoring system in predicting poor visual outcome in patients with ocular Behcet’s disease. Study design Retrospective cohort study. Methods We included 73 eyes of 38 patients with ocular Behcet’s disease who underwent FA and reviewed FA images, anterior chamber cells, vitreous opacity, retinal and optic disc lesions, which are parameters in BOS24. The correlation between FA findings, BOS24, and visual acuity was assessed. Results Optic disc hyperfluoresence (74%), diffuse posterior pole leakage (52%) and diffuse peripheral leakage (52%) were the three most common findings. Common complications were peripheral capillary nonperfusion (29%), arterial narrowing (22%), and macular ischemia (19%). BOS24 scores of ≥ 6 (p < 0.0001), arterial narrowing (p < 0.0001), and severe posterior pole leakage (p = 0.004) were significantly associated with poor visual outcome. Combining significant FA findings: arterial narrowing and severe posterior pole leakage, to BOS24 ≥ 6 results in an increased relative risk of developing poor visual acuity from 7.30 to 10.43 and 1.89 to 2.02 respectively. Conclusion Fluorescein angiography is an important investigation for predicting poor visual outcome. BOS24 may be a useful alternative when fluorescein angiographic is unavailable.
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Affiliation(s)
- Narumon Keorochana
- Ocular Inflammatory and Uveitis Division, Department of Ophthalmology, Phramongkutklao Hospital, 315 Ratchvidhi Rd. Thung Phayathai, Ratchathewi, Bangkok, 10400, Thailand.
| | - Nathamon Homchampa
- Department of Ophthalmology, Phramongkutklao Hospital, 315 Ratchvidhi Rd. Thung Phayathai, Ratchathewi, Bangkok, 10400, Thailand
| | - Sritatath Vongkulsiri
- Retina Division, Department of Ophthalmology, Phramongkutklao Hospital, 315 Rajawithi Rd, Thung Phayathai, Ratchathewi, Bangkok, 10400, Thailand
| | - Raveewan Choontanom
- Oculoplastic and Reconstructive Surgery Division, Department of Ophthalmology, Phramongkutklao Hospital, 315 Rajawithi Rd, Thung Phayathai, Ratchathewi, Bangkok, 10400, Thailand
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6
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Francois J, Moulinet T, Neiter E, Ehrardt A, Conart JB, Angioi-Duprez K. [Behçet's disease : Description and analysis of a French single-center retrospective study of 51 patients]. J Fr Ophtalmol 2021; 44:711-717. [PMID: 33741217 DOI: 10.1016/j.jfo.2020.04.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate if the presence of uveitis in Behçet's disease (BD) is associated with a particular clinical phenotype and to analyze the prognostic impact of a missed diagnosis of BD at the time the uveitis is diagnosed. MATERIEL AND METHODS Ophthalmologic and systemic clinical features of 51 patients with BD were recorded retrospectively. We compared the clinical phenotype of patients with ocular manifestations with those without ocular manifestations. The patients were divided into two groups depending on the progression of their visual acuity: "decreased visual acuity" versus "stable or improved visual acuity." RESULTS In the group of patients with ocular involvement, there was a mean 2.3 systemic manifestations, vs. 3.2 in the group without ocular manifestations (P=0.004). When BD was diagnosed prior to the onset of uveitis, we counted fewer patients in the "decreased visual acuity" group in comparison with the patients who had no prior diagnosis of BD at the onset of the uveitis (91.3% in the "decreased visual acuity" group, P=0.04). The time before initiation of immunosuppressive treatment or a biological agent was shorter for these patients (4.4 vs. 39.3 months, P=0.007). CONCLUSION It appears that different phenotypes exist according to whether or not the BD patient has ocular involvement. Moreover, the visual prognosis is better if the uveitis occurs in patients who have already been diagnosed with BD, due to earlier initiation of immunosuppressive therapy.
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Affiliation(s)
- Julie Francois
- Département d'ophtalmologie, Centre Hospitalier Universitaire de Nancy, Vandœuvre-lès-Nancy, France.
| | - Thomas Moulinet
- Département de médecine interne, Centre Hospitalier Universitaire de Nancy, Vandœuvre-lès-Nancy, France
| | - Estelle Neiter
- Département d'ophtalmologie, Centre Hospitalier Universitaire de Nancy, Vandœuvre-lès-Nancy, France
| | - Alix Ehrardt
- Département d'ophtalmologie, Centre Hospitalier Universitaire de Nancy, Vandœuvre-lès-Nancy, France
| | - Jean-Baptiste Conart
- Département d'ophtalmologie, Centre Hospitalier Universitaire de Nancy, Vandœuvre-lès-Nancy, France
| | - Karine Angioi-Duprez
- Département d'ophtalmologie, Centre Hospitalier Universitaire de Nancy, Vandœuvre-lès-Nancy, France
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Yalçındağ FN, Temel E, Şekkeli MZ, Kar İ. Macular structural changes and factors affecting final visual acuity in patients with Behçet uveitis. Graefes Arch Clin Exp Ophthalmol 2020; 259:715-721. [PMID: 33037921 DOI: 10.1007/s00417-020-04958-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate macular structural changes during the active and remission periods in patients with Behçet uveitis and to further assess the factors affecting final visual acuity. METHODS Clinical records and spectral domain-optical coherence tomography (SD-OCT) findings of patients with Behçet uveitis were retrospectively reviewed. RESULTS Sixty-nine eyes of 35 patients were included in the study. SD-OCT findings in the active uveitis period included epiretinal membrane (ERM) in 26 (37.1%) eyes, ellipsoid zone (EZ) damage in 11 (15.7%), external limiting membrane (ELM) damage in 10 (14.3%), macular atrophy in 6 (8.6%), disruption of retinal pigment epithelium (RPE) in 11 (15.7%), a macular scar in 1 (1.4%), and loss of normal foveal contour appearance in 15 (21.4%). There was macular edema in 23 eyes (32.9%) in the active uveitis period (11 (15.7%) cystoid macular edema, 10 (14.3%) diffuse macular edema, and 7 (10.0%) serous retinal detachment). In the remission period, SD-OCT findings included ERM in 37 (52.9%) eyes, EZ damage in 14 (20%), ELM damage in 14 (20%), macular atrophy in 7 (10%), disruption of RPE in 14 (20.0%), macular scar in 1 (1.4%), and loss of normal foveal contour appearance in 17 (24.3%). The mean central macular thickness in the remission period was significantly lower than in the active uveitis period (p < 0.001). The presence of EZ damage and loss of normal foveal contour appearance in active uveitis period were the independent factors associated with final visual acuity (logMAR) (β = 0.736, p = 0.003; β = 0.682, p = 0.002, respectively). CONCLUSION Ellipsoid zone damage and loss of normal foveal contour appearance are important factors affecting visual acuity in Behçet uveitis.
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Affiliation(s)
- F Nilüfer Yalçındağ
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Mamak Street, 06620, Ankara, Turkey
| | - Emine Temel
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Mamak Street, 06620, Ankara, Turkey.
| | - Mehmet Zahid Şekkeli
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Mamak Street, 06620, Ankara, Turkey
| | - İrem Kar
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
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Al-Fakhri AS, Alsulaiman SM. Recovery of the Ellipsoid and Interdigitation Zones in Acute Behcet’s Uveitis after Therapy. Ocul Immunol Inflamm 2019; 28:1129-1132. [DOI: 10.1080/09273948.2019.1644351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Sulaiman M. Alsulaiman
- Vitreoretinal Division and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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