Anterior segment parameters in Behçet's patients with ocular involvement

Case-control study of corneal topography and specular microscopy parameters in JIA patients with and without ocular involvement

PURPOSE

To assess corneal topography and specular microscopy values in juvenile idiopathic arthritis-related uveitis (JIA-U).

METHODS

This case-control study included 30 eyes from JIA-U patients, 20 eyes from JIA patients, and 50 eyes from age- and gender-matched healthy subjects. Patients with a history of ocular diseases or intraocular surgery were excluded. Corneal topography maps (Pentacam HR) and specular microscopy images (CellChek SL) were obtained. The measurements of the groups were compared.

RESULTS

Keratometric astigmatism was higher in the JIA-U group than in the control group (p = 0.040). Patients with astigmatism greater than 1.50D were more common in the JIA-U group than in the control group (p = 0.026). The JIA-U group had higher anterior and posterior elevation values than the control group (p = 0.006, p = 0.025). The density of endothelial cells, coefficient of variation, and hexagonality did not change across groups (p = 0.465, p = 0.096, p = 0.869). The total number of exacerbations and the duration of anterior chamber inflammation were both positively correlated with posterior elevation (r = 0.600, p 0.001; r = 0.583, p 0.001). The age of diagnosis was found to be negatively correlated with anterior elevation (r = -0.412, p = 0.021).

CONCLUSION

Corneal astigmatism, as well as anterior and posterior elevation values, were all higher in JIA-U patients. Endothelial cell density and morphology, on the other hand, did not differ significantly between groups. Chronic inflammation's impact on stromal remodelling could explain these corneal alterations. The positive correlation between posterior elevation and the number of flares and duration of inflammation represents the importance of early diagnosis and effective treatment.

Enhanced Ectasia Screening in Patients with Uveitis and Isolated Systemic Inflammatory Disease

PURPOSE

To investigate corneal topographic alterations in patients with uveitis and isolated systemic inflammatory disease (SID).

METHODS

This retrospective cross-sectional study included 44 patients with uveitis with anterior chamber inflammation (uveitis group), 39 subjects with isolated SID, and 91 healthy controls (control group). Topographic images were classified as "normal," "keratoconus (KC) suspect" and "KC" based on maps of axial curvature, corneal thickness, front and back elevation in combination with Belin/Ambrósio Enhanced Ectasia Display (BAD).

RESULTS

The uveitis and SID groups had higher incidence of KC (6.8% and 10.2%, respectively) and KC suspect (45.5% and 33.3%, respectively), whereas 2.2% of the control subjects had KC and 26.4% represented KC suspect (p < .05).

CONCLUSIONS

Patients with uveitis with or without SID, and isolated SID without intraocular inflammation seem to be more likely to have KC and KC suspect, which might be due to systemic and/or local inflammatory background triggering pathophysiological mechanisms underlying KC.

Ocular Manifestations of Behçet's Disease: An Update on Diagnostic Challenges and Disease Management

Behçet's disease is a systemic vasculitis that affects multiple organs. The most common manifestations are oral and genital ulcerations and recurrent uveitis. Uveitis can be an initial symptom in 10-20% of cases and leads to blindness in 16-25% of patients. The management of this disease is evolving due to the clinical phenotypes recently described in the literature and increasing focus on the detection of subclinical inflammation to enable correct therapeutic decisions. The first line treatment is azathioprine, followed by various immunosuppressive and biological agents as alternatives in severe or refractory cases. This review summarizes scientific articles about the etiology of, diagnostic tools for and treatment of the ocular manifestations of Behçet's disease available in the PubMed database from 1 January 2016 to 1 May 2021. A multidisciplinary approach is necessary to effectively prevent permanent damage and thus improve the life quality of the patients. Therefore, it is crucial to raise awareness of the common clusters of symptoms, use of modern imaging methods, such as ocular computed tomography and fluorescein angiography, and novelty treatment algorithms to enable early diagnosis and appropriate management.