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Altıntaş H, Kardeş E. Treatment Impact on the Long-Term Ocular Outcomes in Behçet's-Related Uveitis. Ocul Immunol Inflamm 2024:1-6. [PMID: 38900582 DOI: 10.1080/09273948.2024.2366906] [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: 07/20/2023] [Accepted: 06/06/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE To examine the demographic characteristics, findings and complication rates in patients with Behçet's uveitis (BU) and to investigate the effect of early biological therapy on the development of complications. METHODS Medical records of 94 patients with BU were retrospectively reviewed. Demographic data, ocular findings and complications at presentation, complications during follow-up, and treatments received during follow-up were analyzed. Patients who were followed for at least 24 months were divided into two groups according to the time of presentation as Group 1 (between 2009 and 2015) and Group 2 (between 2016 and 2021). Complications at the time of presentation and during follow-up, and treatments were compared. RESULTS We enrolled 94 patients with a male-to-female ratio of 1.94 with a mean age of 30 ± 12 years. Median follow-up was 58.1(12-163) months. There were 35 patients (66 eyes) in Group 1 and 33 patients (61 eyes) in Group 2. At the time of presentation, end-stage disease, cataract, epiretinal membrane, and optic atrophy were significantly more common in Group 1 than in Group 2 (p < 0.05). A significantly higher proportion of eyes in Group 1 developed macular edema, cataract, epiretinal membrane, and macular atrophy during-follow-up (p < 0.05). Median time to initiation of biological treatment was 17.29 months in Group 1 and 3.33 months in Group 2 (p < 0.001). The overall complication rate was significantly lower in Group 2. CONCLUSIONS Prognosis of BU is improved after the introduction of biological treatment. Early use of biological agents in BU is effective in decreasing sight-threatening ocular complications.
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Affiliation(s)
- Hilmi Altıntaş
- Department of Ophthalmology, Erzurum Hınıs Şehit Yavuz Yurekseven State Hospital, Erzurum, Turkey
| | - Esra Kardeş
- Department of Ophthalmology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Mesen S, Ozer MD, Batur M. Comparative results of use and switching of anti-TNF-alpha agents in adult Behçet's uveitis. Indian J Ophthalmol 2024; 72:S521-S528. [PMID: 38317320 DOI: 10.4103/ijo.ijo_2011_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/25/2023] [Indexed: 02/07/2024] Open
Abstract
PURPOSE This study was planned to compare the clinical results and optical coherence tomography (OCT) data of patients who underwent adalimumab (ADA), infliximab (IFX) and switched protocols between these two methods in cases of Behçet's associated uveitis (BAU). METHODS The patients with BAU who were treated with anti-TNF- α agents for at least one year were qualified for the chart review. The outcome parameters were the steroid-free remission state, the best-corrected visual acuity (BCVA), the central macular thickness (CMT), and the subfoveal choroidal thickness (SFCT) of the patients at the last visit. RESULTS After a mean follow-up of 16.60 months, the rate of active inflammation decreased from 63.6% to 15.1%. Mean BCVA increased, mean CMT and mean SFCT decreased significantly at the last visit ( P < 0.001, P < 0.001, respectively). CONCLUSION Anti-TNF- α treatment and switching protocols between these two agents effectively and safely control intraocular inflammation in BAU patients.
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Affiliation(s)
- Selma Mesen
- Turkoglu Dr. Kemal Beyazit State Hospital Eye Clinic, Türkoğlu, Kahramanmaraş, İstanbul
| | - Muhammet D Ozer
- Gaziosmanpaşa Hospital Ophthalmology Department, Yeni Yüzyıl University, Zeytinburnu, İstanbul
| | - Muhammed Batur
- Faculty of Medicine, Ophthalmology Department, Van Yuzuncu Yil University, Tuşba, Van, Türkiye
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Kabaalioglu Guner M, Guner ME, Oray M, Tugal-Tutkun I. Correlation between Widefield Fundus Fluorescein Angiography Leakage Score and Anterior Chamber Flare in Behçet Uveitis. Ocul Immunol Inflamm 2024; 32:54-61. [PMID: 36538808 DOI: 10.1080/09273948.2022.2152700] [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: 10/07/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
AIMS To investigate the correlation between widefield fundus fluorescein angiography (WF-FA) and anterior chamber laser flare photometry (LFP-flare) in Behçet uveitis (BU). METHODS Patients with BU who underwent Heidelberg WF-FA between March 2016 and March 2018 were included. Demographics, ocular findings, LFP-flare, central macular thickness were retrospectively analyzed. RESULTS Eighty-six patients (162 eyes) were included. There was a high correlation between WF-FA leakage score and LFP-flare (rho: 0.691, p < .001). For a flare value of 5.75 ph/ms or higher, the sensitivity for predicting angiographic leakage was 70% and the specificity was 94% (AUC: 0.897, p < .001). Flare values that were equal or above 7.6 ph/ms were found to be 100% specific for leakage in the WF-FA. CONCLUSION A strong correlation was found between WF-FA leakage and LFP-flare in patients with BU. High LFP-flare levels indicate subclinical posterior segment inflammation in clinically inactive BU.
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Affiliation(s)
- Melis Kabaalioglu Guner
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Eren Guner
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Merih Oray
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Anti-TNF vs tocilizumab in refractory uveitic cystoid macular edema due to Behcet's disease. Multicenter study of 49 patients. Semin Arthritis Rheum 2023; 58:152153. [PMID: 36549244 DOI: 10.1016/j.semarthrit.2022.152153] [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: 09/06/2022] [Revised: 11/29/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare the efficacy of TNF inhibitors (adalimumab (ADA) and infliximab (IFX)) vs tocilizumab (TCZ) in patients with refractory cystoid macular edema (CME) due to Behçet's disease (BD). METHODS Multicenter study of patients with BD-associated CME refractory to conventional and/or biological immunosuppressive drugs. From a cohort of 177 patients treated with anti-TNF and 14 patients treated with TCZ, we selected those with CME at baseline. We analyzed the evolution of macular thickness (main outcome), best-corrected visual acuity (BCVA) and intraocular inflammation (Tyndall and vitritis) from baseline up to 4 years in the 3 groups mentioned. RESULTS 49 patients and 72 eyes with CME were included. ADA was used in 25 patients (40 eyes), IFX in 15 (21 eyes) and TCZ in 9 (11 eyes). No statistically significant baseline differences were observed between the 3 groups except for a lower basal BCVA in TCZ group and a higher basal degree of intraocular inflammation in ADA group. Most patients from all groups had received several conventional immunosuppressive drugs. In addition, most patients in the group of TCZ had also received anti-TNF agents. Biological therapy was used in monotherapy (n=8) or combined with conventional immunosuppressive drugs (n=41). Macular thickness progressively decreased in the 3 groups, with no signs of CME after 1 year of treatment. Similarly, BCVA improvement and inflammatory intraocular remission was achieved in all groups. CONCLUSION Refractory CME associated with BD uveitis can be effectively treated either with ADA, IFX or TCZ. Furthermore, TCZ is effective in patients resistant to anti-TNF therapy.
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Aboul Naga SH, Hassan LM, El Zanaty RT, Refaat M, Amin RH, Ragab G, Soliman MM. Behçet uveitis: Current practice and future perspectives. Front Med (Lausanne) 2022; 9:968345. [PMID: 36160151 PMCID: PMC9490079 DOI: 10.3389/fmed.2022.968345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Described as early as Hippocrates in his “Third Book of Endemic Diseases,” Behçet's Disease (BD), also known as “The Silk Road Disease” following its initial demographics, consists of a triad of recurrent oro-genital ulcers and associated uveitis. Current demographics and rising percentages of patients seen far beyond the Silk Road in Ocular Inflammatory Disease and Uveitis Clinics list BD uveitis as one of the frontliners of non-infectious autoinflammatory eye diseases. Clinical features of BD and juvenile-onset BD are detailed alongside various approaches in classification and suggested algorithms for diagnosis that are outlined in this review. With the ongoing Human Microbiome Project and studies such as the MAMBA study, the role of the human microbiome in BD is highlighted in the pathophysiology of BD to include the current research and literature perspective. Furthermore, with the advancement of recent diagnostic and investigative techniques, especially in the field of Optical Coherence Tomography (OCT), disease-related characteristics are updated to encompass SD, EDI and OCT-angiography characteristics of BD. Having entered the era of biologic therapy, the role of various specific cytokine-blocking biologic drugs, such as TNF-α inhibitors (e.g., adalimumab, infliximab), interferon α-2a inhibitors, IL-6 and IL-1 inhibitors are presented and contrasted alongside the conventional immunosuppressant drugs and the classic old gold standard: corticosteroids (systemic or local). Finally, with the ongoing SARS-CoV-2 pandemic, it was not possible to conclude the review without reviewing the latest evidence-based literature reporting BD morbidity in this era, the observed pattern and treatment recommendations as well as those related to reported post-vaccine complications and emergence of BD.
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Affiliation(s)
- Shereen H. Aboul Naga
- Ophthalmology Department, Faculty of Medicine, Cairo University Hospital, Uveitis Subspecialty Clinic, Giza, Egypt
| | - Lameece Moustafa Hassan
- Ophthalmology Department, Faculty of Medicine, Cairo University Hospital, Uveitis Subspecialty Clinic, Giza, Egypt
| | - Radwa T. El Zanaty
- Ophthalmology Department, Faculty of Medicine, Cairo University Hospital, Uveitis Subspecialty Clinic, Giza, Egypt
| | - Mohammad Refaat
- Ophthalmology Department, Faculty of Medicine, Cairo University Hospital, Uveitis Subspecialty Clinic, Giza, Egypt
| | - Rana H. Amin
- Ophthalmology Department, Faculty of Medicine, Cairo University Hospital, Uveitis Subspecialty Clinic, Giza, Egypt
| | - Gaafar Ragab
- Rheumatology and Clinical Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
- *Correspondence: Gaafar Ragab
| | - Mahmoud M. Soliman
- Ophthalmology Department, Faculty of Medicine, Cairo University Hospital, Uveitis Subspecialty Clinic, Giza, Egypt
- Mahmoud M. Soliman
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Özgürtaş T, Yücel Ç, Sertoğlu E, Hayran Y, Çolak S, Tekgöz E, Omma A, Durukan AH. Evaluation of the relationship of lymphangiogenesis markers with disease pathogenesis in patients with Behçet's uveitis. Acta Clin Belg 2022; 77:387-395. [PMID: 33629934 DOI: 10.1080/17843286.2021.1890451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The present study aims to evaluate the relationship between Behçet's uveitis and lymphangiogenesis by determining levels of Vascular endothelial growth factor-C (VEGF-C, its receptors sVEGFR-2, sVEGFR-3 and lymphangiogenesis markers podoplanin (PDPN) and lymphatic vessel endothelial hyaluronan receptor 1(LYVE-1), and C-type lectin domain family 1 member B (CLEC2). MATERIALS AND METHODS 55 patients with BD uveitis and 31 healthy control subjects were enrolled in the study. RESULTS sVEGFR-2, sVEGFR-3, VEGF-C/sVEGFR-2 ratio, PDPN and LYVE-1 levels were higher in the patient group. A positive correlation was found between LYVE-1 and hsCRP levels. PDPN had a strong predictive value for progression with a cut-off value of 2 pg/mL, with 69% sensitivity and 68% specificity (p = 0.001). CONCLUSION LYVE-1 and PDPN can be good representatives of the ongoing inflammatory processes in BD uveitis and point out that the disease can be related to lymphangiogenesis.
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Affiliation(s)
- Taner Özgürtaş
- Department of Clinical Biochemistry, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Çiğdem Yücel
- Department of Clinical Biochemistry, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Erdim Sertoğlu
- Department of Clinical Biochemistry, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Yıldız Hayran
- Department of Dermatology, Ankara City Hospital, Ankara, Turkey
| | - Seda Çolak
- Department of Rheumatology, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Emre Tekgöz
- Department of Rheumatology, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ahmet Omma
- Department of Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Ali Hakan Durukan
- Department of Ophthalmology, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Retinal microvasculature features in patients with Behcet's disease: a systematic review and meta-analysis. Sci Rep 2022; 12:752. [PMID: 35031636 PMCID: PMC8760269 DOI: 10.1038/s41598-021-04730-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/29/2021] [Indexed: 12/22/2022] Open
Abstract
This meta-analysis aimed to analyze retinal microvasculature features in eyes with Behçet's disease (BD) using optical coherence tomography angiography (OCTA). Electronic databases, including PubMed, Web of Science, Embase, and Cochrane Library, were comprehensively searched for published studies comparing retinal microvasculature characteristics between eyes with BD and controls. Continuous variables were calculated using the mean difference (MD) with 95% confidence interval (CI). Review Manager software (version 5.30) was used to conduct statistical analysis. A total of 13 eligible studies involving 599 eyes with BD and 622 control eyes were included in the meta-analysis. The pooled results showed that the macular whole enface superficial and deep vessel density (VD) values measured by OCTA were significantly lower in eyes with BD than in control eyes (superficial VD: MD = - 3.05, P < 0.00001; deep VD: MD = - 4.05, P = 0.0004). The foveal superficial and deep VD values were also significantly lower in the BD group than in the control group (superficial VD: MD = - 1.50, P = 0.009; deep VD: MD = - 4.25, - = 0.03). Similarly, the analysis revealed a significant reduction in the parafoveal superficial and deep VD in eyes with BD than in control eyes (superficial VD: MD = - 3.68, P < 0.00001; deep VD: MD = - 4.95, P = 0.0007). In addition, the superficial and deep foveal avascular zones (FAZs) were significantly larger in patients with BD than in controls (superficial FAZ: MD = 0.06, P = 0.02; deep FAZ: MD = 0.12, P = 0.03). The present meta-analysis found that macular whole enface VD, foveal VD, and parafoveal VD were lower in eyes with BD, and the FAZ was larger in patients with BD. The findings suggest that OCTA can assist clinicians in diagnosing and monitoring the status of patients with BD.
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Karalezli A, Kaderli ST, Sul S, Pektas SD. Preclinical ocular features in patients with Behçet's disease detected by optical coherence tomography angiography. Eye (Lond) 2021; 35:2719-2726. [PMID: 33235340 PMCID: PMC8452614 DOI: 10.1038/s41433-020-01294-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/05/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the perifoveal and peripapillary microvascular structure in patients with Behçet's disease (BD) without clinically ocular involvement. METHODS Fifty-six eyes of 28 patients with Behçet's disease without clinically ocular involvement and 50 age-matched healthy eyes were included in this prospective study. Vessel densities (VD) of macula and optic nerve head, foveal avascular zone (FAZ), choroid capillary plexus (CCP) flow area, perifoveal capillary nonperfusion, capillary dilatation and/or telangiectasia and perifoveal capillary arcade disruption were analyzed with optical coherence tomography angiography (OCTA). The relationship between duration of disease and vessel densities was also evaluated. RESULTS The FAZ was significantly higher in the BD group (p < 0.001). VD of the foveal and parafoveal region in deep capillary plexus (DCP) were significantly lower in the BD group than in the control group (p < 0.001, p < 0.001). Total disc, peripapillary and inside-disc VD were significantly lower in BD group (p = 0.001, p = 0.002, p = 0.004). Perifoveal morphological changes in DCP were significantly higher in nonocular BD (p < 0.001, p < 0.001, p < 0.001). There was a mild negative correlation between disease duration and whole VD in DCP, total disc VD, peripapillary VD was determined (For whole VD in DCP, r = -0.400, p = 0.035; for total disc VD r = -0.396, p = 0.037; for peripapillary VD r = -0.442, p = 0.018). DISCUSSION Perifoveal and peripapillary microvascular changes that can be detected by OCTA may occur in Behçet's patients without clinically ocular involvement.
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Affiliation(s)
- Aylin Karalezli
- Department of Ophthalmology, Mugla Sitki Kocman University School of Medicine, Mugla, Turkey
| | - Sema Tamer Kaderli
- Department of Ophthalmology, Mugla Sitki Kocman Education and Training Hospital, Mugla, Turkey.
| | - Sabahattin Sul
- Department of Ophthalmology, Mugla Sitki Kocman University School of Medicine, Mugla, Turkey
| | - Suzan Demir Pektas
- Department of Dermatology, Mugla Sitki Kocman University School of Medicine, Mugla, Turkey
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Manandhar A, Paudyal BP. Clinicodemographic pattern and treatment outcome of Behcet's disease cases presenting in a tertiary eye center of Nepal. Int Ophthalmol 2021; 41:2861-2868. [PMID: 34218411 DOI: 10.1007/s10792-021-01845-7] [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: 10/30/2020] [Accepted: 04/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To know the clinical and demographic pattern, and the outcome of treatment of Behcet's disease (BD) cases in Nepal METHODS: Retrospective series of all the cases of BD who had come over the period of 12 years (Jan 2007-Dec 2015) Tilganga Institute of Ophthalmology. RESULT Twenty-one cases were included, 17 (81%) male and four (19%) female. Mean age was 28.88 ± 9.18 years. Mean follow-up period was 3.6 ± 2.6 years. All had nongranulomatous panuveitis. Hypopyon was seen in 13 (61.9%) cases. Small retinal infiltrates in 13 (61.9%) cases and retinal vasculitis in ten (47.6%) cases were seen. Cataract (in 13, 61.9%) and optic atrophy (in 11, 52.4%) cases were present. Oral ulcer was present in 20 (95.2%), genital ulcer in 15 (72%), and skin lesions in 13 (62%) cases. CONCLUSION BD affected mainly the most active age group and was predominant in male. Optic atrophy was the leading cause of irreversible vision loss. Despite being a less common condition, BD should be considered in the differential diagnosis of panuveitis cases in the Nepalese population.
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Affiliation(s)
- Anu Manandhar
- Tilganga Institute of Ophthalmology, G.P.O. Box: 561, Gaushala, Bagmati Bridge, Kathmandu, Nepal.
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Kadomoto S, Uji A, Arichika S, Muraoka Y, Kido A, Nishijima K, Akagi T, Kawai K, Tsujikawa A. Macular Cone Abnormalities in Behçet's Disease Detected by Adaptive Optics Scanning Light Ophthalmoscope. Ophthalmic Surg Lasers Imaging Retina 2021; 52:218-225. [PMID: 34039187 DOI: 10.3928/23258160-20210330-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Investigations of morphological changes in photoreceptors in Behçet's disease (BD) using adaptive optics scanning light ophthalmoscope (AOSLO) are lacking. The authors aimed to evaluate macular cone density and regularity in BD patients with or without a history of uveitis with good visual acuity (VA). PATIENTS AND METHODS The authors included 16 patients (29 eyes) with BD and 12 healthy volunteers (12 eyes) as controls. All subjects had VA of 20/20 or higher. Subjects underwent AOSLO to evaluate the photoreceptor status including cone density (numbers/mm2) and proportion of hexagonal Voronoi domains. RESULTS Hyporeflective patches that were not detected in color fundus photograph or optical coherence tomography were observed by AOSLO in BD patients both with and without past uveitis history; these were not detected in the control group. Cone density was significantly reduced in BD patients with a history of uveitis compared to controls (P = .002). The proportion of hexagonal Voronoi domains was significantly reduced in BD eyes both with and without history of uveitis relative to controls (P < .001). CONCLUSION Macular photoreceptor damage was observed in BD patients with and without a history of uveitis. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:218-225.].
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Hosseini SM, Morrovatdar N, Hemati A, Dolatkhah M, Bakhtiari E, Mirfeizi Z, Azimizadeh M. Evaluation and Comparison of Choroidal Thickness in Patients with Behçet Disease with versus without Ocular Involvement. J Ophthalmic Vis Res 2021; 16:195-201. [PMID: 34055257 PMCID: PMC8126733 DOI: 10.18502/jovr.v16i2.9083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 01/09/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the subfoveal choroidal thickness (SFCT) in patients with Behçet disease (BD) and compare the SFCT in patients with and without ocular BD (OBD) and between patients with active and quiescent phases of the Behçet's posterior uveitis. Methods This prospective cross-sectional study was conducted on patients with BD (n = 51) between October 2016 and October 2018. Complete ocular examinations including slit lamp biomicroscopy and fundus examination with dilated pupils were performed for all patients. The SFCT values were compared between patients with and without OBD. Enhanced depth imaging optical coherence tomography (EDI–OCT) was done to measure the SFCT, and wide field fundus fluorescein angiography (WF-FAG) was performed to evaluate the ocular involvement and determine the active or quiescent phases of the Behçet's posterior uveitis. The correlation between the changes of SFCT and the WF-FAG scores was assessed. Results One hundred and two eyes of 51 patients with BD, aged 29 to 52 years were studied. Of these, 23 patients were male. The mean age ± standard deviation in patients with OBD and patients without ocular involvement was 38.71 ± 7.8 and 36.22 ± 10.59 years (P = 0.259) respectively. The mean SFCT in patients with OBD was significantly greater than in patients without OBD (364.17 ± 93.34 vs 320.43 ± 56.70 µm; P = 0.008). The difference of mean SFCT between the active compared to quiescent phase was not statistically significant when only WF-FAG criteria were considered for activity (368.12 ± 104.591 vs 354.57 ± 58.701 µm, P = 0.579). However, when the disease activity was considered based on both WF-FAG and ocular exam findings, SFCT in the active group was higher than the inactive group (393.04 ± 94.88 vs 351.65 ± 58.63 µm, P = 0.060). This difference did not reach statistical significance, but it was clinically relevant. Conclusion Choroidal thickness was significantly increased in BD patients with ocular involvement; therefore, EDI-OCT could be a noninvasive test for evaluation of ocular involvement in patients with BD. The increased SFCT was not an indicative of activity in OBD; however, it could predict possible ocular involvement throughout the disease course.
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Affiliation(s)
| | - Negar Morrovatdar
- Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Armin Hemati
- Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mozghan Dolatkhah
- Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elham Bakhtiari
- Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Mirfeizi
- Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdieh Azimizadeh
- Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
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BOZALİ E, ERDOĞAN H, DURSUN A, VURAL ÖZEÇ A, TOKER İ, ARICI M. Evaluation Of Foveal Thickness And Macular Choroidal Thickness With Optical Coherence Tomography in Behçet's Disease. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.764833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kim BH, Park UC, Park SW, Yu HG. Ultra-Widefield Fluorescein Angiography to Monitor Therapeutic Response to Adalimumab in Behcet's Uveitis. Ocul Immunol Inflamm 2021; 30:1347-1353. [PMID: 33793368 DOI: 10.1080/09273948.2021.1872652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To investigate the role of ultra-widefield fluorescein angiography (UWFA) for monitoring therapeutic response to adalimumab in patients with Behcet's uveitis.Methods: Patients with Behcet's uveitis treated with adalimumab for ≥30 weeks were included. Intraocular inflammation, best-corrected visual acuity, systemic medications, and UWFA scores were evaluated.Results: Thirty-eight eyes of 20 patients were included. Significant decreases in grading of anterior chamber cells and vitreous haze were observed at 6, 14, and 30 weeks after adalimumab administration (p < .001 for all). UWFA scores on vascular and capillary leakage were decreased at week 6 and further improved at weeks 14 and 30. Moreover, UWFA score further decreased at 14 and 30 weeks, even after manifest inflammation became quiescent at 6 weeks. (p = .004 and 0.001, respectively).Conclusion: UWFA scores significantly improved in Behcet's uveitis patients treated with adalimumab, and further improvement of UWFA scores was found in patients with a clinically quiescent inflammatory state.
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Affiliation(s)
- Bo Hee Kim
- Department of Ophthalmology, Seoul National University College of Medicine and Seoul National University Hospital, Republic of Korea, Seoul, Korea.,Retinal Degeneration Laboratory, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Un Chul Park
- Department of Ophthalmology, Seoul National University College of Medicine and Seoul National University Hospital, Republic of Korea, Seoul, Korea.,Retinal Degeneration Laboratory, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Sung Wook Park
- Department of Ophthalmology, Seoul National University College of Medicine and Seoul National University Hospital, Republic of Korea, Seoul, Korea.,Retinal Degeneration Laboratory, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Hyeong Gon Yu
- Department of Ophthalmology, Seoul National University College of Medicine and Seoul National University Hospital, Republic of Korea, Seoul, Korea.,Retinal Degeneration Laboratory, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
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Consistency of Visual Evoked Potential in Extraocular Manifestations of Behcet Disease and Impact of Corticosteroid Treatment. J Clin Neurophysiol 2021; 38:43-46. [PMID: 31702710 DOI: 10.1097/wnp.0000000000000646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To study the ability of pattern reversal visual evoked potentials (VEPs) to detect subclinical visual pathway pathologic assessment in Behcet disease (BD) and correlate VEP results in BD with disease activity and response to corticosteroid treatment. METHODS This study included 18 patients (36 eyes) with BD without recent ocular manifestations and 20 healthy controls (40 eyes). Clinical history was taken, and clinical examinations were done. Visual evoked potential recordings were performed by an electromyographic evoked machine for patients and controls. Corticosteroids were given to patients with extraocular activity, and VEP was repeated after clinical and laboratory improvement of the manifestations. RESULTS p100 latency of VEP was prolonged in 8 patients (11 eyes) (44.4% of cases). Mean p100 latency showed statistically significant prolongations in BD group compared with the control group (106.7 ± 8.1 ms vs. 99.6 ± 1.9 ms) with P value < 0.001. There was a positive correlation between p100 latency and the disease activity score (r = 0.8673), whereas there was no correlation between p100 latency and the disease duration (r = 0.00072). Patients treated with corticosteroids showed statistically significant reduction in mean p100 latency after treatment (P < 0.001). CONCLUSIONS Visual evoked potential may be a valuable tool for detecting subclinical neurologic affection in BD.
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Citirik M, Ozdal P, Keles A, Haznedaroglu I. Platelet activation in ocular Behçet's patients with posterior segment involvement. Middle East Afr J Ophthalmol 2021; 28:203-207. [PMID: 35719287 PMCID: PMC9198532 DOI: 10.4103/meajo.meajo_324_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 12/16/2021] [Accepted: 03/24/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE: The aim of the present study was to assess platelet activation by analyzing three platelet activation parameters in ocular Behçet's disease (BD): mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT). METHODS: Twenty-nine patients with active ocular BD (Group 1), 40 patients with inactive ocular BD (Group 2), and 40 healthy adult individuals serving as controls (Group 3) were evaluated. All of the individuals had been performed the complete ophthalmologic evaluation. The levels of MPV, PDW, and PCT were measured in each group. RESULTS: The mean MPV level was 8.40 ± 0.97 in Group 1, 8.32 ± 1.04 in Group 2, and 7.77 ± 0.72 in Group 3. The mean PDW level was 15.12 ± 1.09 in Group 1, 14.97 ± 1.02 in Group 2, and 14.52 ± 0.82 in Group 3. The mean PCT level was 0.23 ± 0.07 in Group 1, 0.21 ± 0.04 in Group 2, and 0.18 ± 0.03 in Group 3. MPV, PDW, and PCT levels were significantly higher in ocular BD patients than controls (P < 0.05). CONCLUSION: Platelet activation may affect vascular occlusion in ocular Behçet's patients with posterior segment involvement. This result may be important in evaluating ocular BD patients.
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Tugal-Tutkun I, Çakar Özdal P. Behçet's disease uveitis: is there a need for new emerging drugs? Expert Opin Emerg Drugs 2020; 25:531-547. [PMID: 33147420 DOI: 10.1080/14728214.2020.1847271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Behçet's disease uveitis (BDU) is a potentially blinding disorder. Systemic treatment with disease-modifying anti-rheumatic drugs (DMARDs) is mandatory in patients with intraocular inflammation involving the posterior segment of the eye. Areas covered: This article discusses existing systemic treatment with corticosteroids and conventional and biologic DMARDs as well as adjunctive local therapy in BDU. An overview is provided for a wide range of biologic DMARDs that have shown promise or investigated in clinical trials. Most recently introduced biologic DMARDs and targeted synthetic DMARDs are also reviewed for their potential in the treatment of BDU. Expert opinion: The prognosis of patients with BDU has remarkably improved after the introduction of biologic DMARDs. An expanding therapeutic armamentarium will allow treatment of most refractory cases. The ultimate goal is to provide drug-free remission with preservation of 20/20 vision.
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Affiliation(s)
- Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University , Istanbul, Turkey
| | - Pinar Çakar Özdal
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Education and Research Hospital , Ankara, Turkey
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Abd El Latif E, Abdel Kader Fouly Galal M, Tawfik MA, Elmoddather M, Nooreldin A, Shamselden Yousef H. Pattern of Uveitis Associated with Behçet's Disease in an Egyptian Cohort. Clin Ophthalmol 2020; 14:4005-4014. [PMID: 33262566 PMCID: PMC7689355 DOI: 10.2147/opth.s287298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/10/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To report the clinical experience of uveitis associated with Behçet's disease in a cohort of Egyptian patients. Methods The present study is a retrospective analysis of the medical charts of patients with Behçet's disease, who were referred to a tertiary eye care center in Egypt between June 2010 and June 2018. Results The current study included 1301 eyes of 681 patients with Behçet's disease. The mean age of the patients at the time of referral was 27.2 ± 3.9 years. Panuveitis was the most common presentation. About 28% of all involved eyes had a final visual acuity <20/200, by the last follow-up visit. Conclusion Behçet's disease is an important cause of uveitis in Egypt, and despite the fact that the prognosis of Behçet's uveitis has globally improved in recent years, the visual outcome in Egypt is still not favorable especially in case of delayed referral to tertiary centers.
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Affiliation(s)
- Eiman Abd El Latif
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | | | - Mohamed Elmoddather
- Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Asaad Nooreldin
- Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
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Tekeli O, Elgin U, Takmaz T, Ekşioğlu Ü, Baş Z, Yarangümeli A, Karakurt A, Evren Kemer Ö, Mumcuoğlu T, Aktaş Z, Akman A, Bayer A. Characteristics of uveitic glaucoma in Turkish patients. Eur J Ophthalmol 2020; 31:1836-1843. [PMID: 32799547 DOI: 10.1177/1120672120950932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To evaluate the prevalence of uveitic glaucoma (UG) in the Turkish population and investigate the primary underlying diseases. METHODS This multicenter, cross-sectional, prospective study included patients who presented to the glaucoma units of 10 tertiary ophthalmology departments in Ankara, Turkey from 15th March to 16th May 2015 and fulfilled the criteria of UG. Patients were inspected for age, sex, medical history, best corrected visual acuity, biomicroscopic findings, intraocular pressure values, and visual field results. RESULTS During the study period, 4604 eyes of 2541 patients with glaucoma were screened and 145 eyes of 104 patients (4.1%) were identified as having UG. One hundred and thirty-four eyes (92.4%) had open-angle glaucoma and 11 eyes (7.6%) had closed-angle glaucoma. The mean patient age was 47 ± 16 (6-90) years. Idiopathic uveitis (54 eyes), Behçet's disease (26 eyes), Fuchs heterochromic cyclitis (21 eyes), Herpes Simplex virus infectious uveitis (14 eyes), and ankylosing spondylitis (six eyes) were the leading types of uveitis associated with glaucoma. Acute anterior uveitis was the most common type of uveitis diagnosed in 72 patients (105 eyes), whereas 21 patients (27 eyes) had panuveitis, eight patients (nine eyes) had intermediate uveitis, and three patients (four eyes) had posterior uveitis. The need for surgical intervention was 37.2% among all cases and the most common surgery was trabeculectomy in 45 eyes. CONCLUSION UG is a vision-threatening complication commonly seen in patients with uveitis. This study demonstrates the epidemiological features and underlying etiologies of UG in the Turkish population. The most common primary causes of UG were Behçet's disease and Fuchs heterochromic cyclitis.
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Affiliation(s)
- Oya Tekeli
- Ophthalmology Department, Ankara University Medical School, Ankara, Turkey
| | - Ufuk Elgin
- Ulucanlar Training and Research Hospital, Ankara, Turkey
| | - Tamer Takmaz
- Atatürk Training and Research Hospital, Ankara, Turkey
| | - Ümit Ekşioğlu
- Ankara Training and Research Hospital, Ankara, Turkey
| | - Zeynep Baş
- Ophthalmology Department, Ankara University Medical School, Ankara, Turkey
| | | | | | - Özlem Evren Kemer
- Ophthalmology Department, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Tarkan Mumcuoğlu
- Ophthalmology Department, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Zeynep Aktaş
- Ophthalmology Department, Gazi University Medical School, Ankara, Turkey
| | - Ahmet Akman
- Ophthalmology Department, Başkent University Medical School, Ankara, Turkey
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Çakar Özdal P. Behçet's Uveitis: Current Diagnostic and Therapeutic Approach. Turk J Ophthalmol 2020; 50:169-182. [PMID: 32631005 PMCID: PMC7338748 DOI: 10.4274/tjo.galenos.2019.60308] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
Behçet's disease is a chronic, multisystem inflammatory disorder characterized by relapsing inflammation. Although its etiopathogenesis has not yet been clarified, both the adaptive and innate immune systems, genetic predisposition, and environmental factors have all been implicated. It is more frequent and more severe in males in the third and fourth decades of life. The eye is the most frequently involved organ in the course of the disease. Ocular involvement (Behçet's uveitis) is characterized by bilateral recurrent non-granulomatous panuveitis and occlusive retinal vasculitis. Recurrent inflammatory episodes in the posterior segment may lead to permanent vision loss due to irreversible retinal damage and complications such as macular scarring, macular atrophy, and optic atrophy. Early and aggressive immunomodulatory treatment and the use of biologic agents when needed are crucial for preventing recurrences and improving visual prognosis.
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Affiliation(s)
- Pınar Çakar Özdal
- University of Health Sciences Turkey, Ulucanlar Eye Training and Research Hospital, Clinic of Ophthalmology, Ankara, Turkey
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Balt J, Jamyanjav B, Jav S, Dandii Z, Ganbold C, Horie Y, Lennikov A, Uehara O, Ohno S, Kitaichi N. Clinical features of Behcet's disease in Mongolia: a multicenter study. Clin Rheumatol 2020; 39:2697-2706. [PMID: 32157471 DOI: 10.1007/s10067-020-05019-1] [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: 12/18/2019] [Revised: 02/18/2020] [Accepted: 02/28/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of the present study is to investigate the clinical features of patients with Behcet's disease (BD) in Mongolia. METHODS Patients were identified and examined from six medical institutions in Mongolia from January 2015 to January 2019. BD was diagnosed according to the diagnostic criteria for BD established by the International Study Group. RESULTS There were sixty-five patients (22 males and 43 females) recoded, the ratio of 1:1.95, with a marked female predominance. The age of disease onset was 22.2 ± 10.0 (mean ± SD), ranging from 11 to 66 years old. Oral aphthous ulcers, ocular lesions, skin lesions, genital ulcers, pathergy test positivity, articular lesions, superficial vasculitis, deep vein thrombosis, and epididymitis (male only) were observed in 100.0%, 63.1%, 81.5%, 89.2%, 7.7%, 86.2%, 32.3%, 4.6%, and 13.6% of the patients, respectively. The incidence of poor visual prognosis, ≤ 20/200, was significantly higher in males than in females (31.8 vs. 9.3%, incidence rate ratio 4.55 (95% CI 1.16-17.82), p < 0.05). The pathergy test was positive only in 7.7% of cases and only in female subjects. Nasal mucous ulcers were frequently seen in 55.4% of patients that may also be attributed to the environmental conditions of Mongolia. Headache was observed 76.9% of patients in this study. CONCLUSIONS Clinical manifestations of BD in Mongolia are presented for the first time. The visual prognosis was significantly worse in males. Nasal mucous membrane ulcers and recurrent headaches were frequent among Mongolian patients with BD. Key Points • First results of the examination of the clinical features of Behcet's disease patients in Mongolia. • Nasal ulcerations and recurrent headaches are frequent symptoms in Mongolia Behcet's disease patients, potentially attributed to climate. • Male Behcet's disease patients in Mongolia have a significantly worse prognosis for eye-related complications and vision.
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Affiliation(s)
- Javzandulam Balt
- Department of Ophthalmology, School of Medicine, Mongolian National University of Medical Sciences (MNUMS), Ulaanbaatar, Mongolia.,Glaucoma Clinic, Zalaa Khukh Tolgoi LLC, Ulaanbaatar, Mongolia
| | - Baasankhuu Jamyanjav
- Department of Ophthalmology, School of Medicine, Mongolian National University of Medical Sciences (MNUMS), Ulaanbaatar, Mongolia
| | - Sarantuya Jav
- Department of Molecular Biology and Genetics, School of Bio-Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Zulgerel Dandii
- Department of Rheumatology, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Chimedlkhamsuren Ganbold
- Department of Molecular Biology and Genetics, School of Bio-Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Yukihiro Horie
- Immunoregulation Section, Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.,Department of Ophthalmology, Health Sciences University of Hokkaido Hospital, Ainosato 2-5, Kita-ku, Sapporo, 002-8072, Japan
| | - Anton Lennikov
- Department of Ophthalmology, University of Missouri, Columbia, MO, USA
| | - Osamu Uehara
- Department of Oral Growth and Development, Division of Disease Control and Molecular Epidemiology, School of Dentistry, Health Sciences University of Hokkaido, Tobetsu, Japan
| | - Shigeaki Ohno
- Department of Ophthalmology, Health Sciences University of Hokkaido Hospital, Ainosato 2-5, Kita-ku, Sapporo, 002-8072, Japan.,Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuyoshi Kitaichi
- Department of Ophthalmology, Health Sciences University of Hokkaido Hospital, Ainosato 2-5, Kita-ku, Sapporo, 002-8072, Japan. .,Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
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Ucar D, Mergen B, Gonen B, Ozguler Y, Seyahi E, Hamuryudan V, Ozyazgan Y. Investigation of clinical profile of Behçet's syndrome-related versus idiopathic branch retinal vein occlusion. Indian J Ophthalmol 2020; 68:1876-1880. [PMID: 32823407 PMCID: PMC7690483 DOI: 10.4103/ijo.ijo_217_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: To compare the long-term results of the patients with branch retinal vein occlusion (BRVO) secondary to Behçet's syndrome (BS) with the patients with unknown etiology. Methods: Medical records and optical coherence tomography (OCT) imaging results of the patients with BRVO secondary to BS and with unknown etiology were reviewed retrospectively between 2016 and 2018 at a single center. The anatomical location of the BRVO, involvement of the macula, application of laser photocoagulation, and intravitreal injection were evaluated. Results: Twenty-eight eyes of 23 patients with BRVO secondary to BS as the study group and 22 eyes of 19 idiopathic BRVO patients as the control group were included in the study. The mean duration of follow-up after the development of BRVO was 74.6 ± 57.4 months in the study group and 63.6 ± 59 months in the control group. The rate of bilaterality, macular involvement, and application of laser photocoagulation was not statistically significantly different between the groups. However, the frequency of injection requirement was significantly lower in the patients with BRVO secondary to BS in comparison to the control group (P = 0.009). Conclusion: Although the treatment of BRVO is laser photocoagulation and intravitreal injection of anti-VEGF agents or dexamethasone implant, the patients with BS might respond very well to systemic immunomodulatory agents in case of BRVO. Thus, rearrangement of the immunomodulatory treatment before starting intravitreal injections should be considered in the patients with BRVO secondary to BS.
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Yalçindag N, Köse HC. Comparison of the Treatment Results for Behçet Uveitis in Patients Treated with Infliximab and Interferon. Ocul Immunol Inflamm 2019; 28:305-314. [PMID: 31268743 DOI: 10.1080/09273948.2019.1606256] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose: To compare the efficacy and safety of infliximab and interferon in patients with refractory Behçet uveitis.Methods: Medical records of 20 patients treated with infliximab (IFX) and 33 patients treated with interferon (IFN) were retrospectively analyzed by evaluating the number of uveitis attacks, visual acuity and ocular inflammation at 6 and 12 months after initiation of treatment.Results: Mean duration of treatment was 22 ± 18 months in IFX group and 30.3 ± 22.5 months in IFN group. Sixteen patients of IFX group (80%) and 28 patients of IFN group (85%) achieved remission. In both groups, the mean best-corrected visual acuity and all inflammatory parameters improved. In terms of these parameters, there was no significant difference between the two groups.Conclusion: Infliximab and interferon improve control of ocular inflammation and efficiently decrease the relapse rate. Our results determined no significant difference between two agents in controlling intraocular inflammation.
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Affiliation(s)
- Nilüfer Yalçindag
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Helin Ceren Köse
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
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Emre S, Güven-Yılmaz S, Ulusoy MO, Ateş H. Optical coherence tomography angiography findings in Behcet patients. Int Ophthalmol 2019; 39:2391-2399. [DOI: 10.1007/s10792-019-01080-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
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Spectral domain optical coherence tomography as an adjunctive tool for screening Behçet uveitis. PLoS One 2018; 13:e0208254. [PMID: 30533014 PMCID: PMC6289405 DOI: 10.1371/journal.pone.0208254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022] Open
Abstract
Background This study investigated the association of central macular thickness (CMT) and macular volume (MV) with severity of Behçet uveitis in the absence of macular edema (ME). Methods This retrospective, interventional study included a total 131 treatment-naïve Behçet patients with varying degree of uveitis in the absence of ME. The mean CMT and MV were obtained by spectral domain optical coherence tomography (SD ODT). The patients were classified according to the anatomical classification of Behçet uveitis. The main outcome measure was comparison of mean CMT and MV with the types of Behçet uveitis. Results Sixty patients (45.8%) with no uveitis, 41 patients (31.3%) with anterior uveitis, 18 patients (13.7%) with posterior uveitis, and 12 patients (9.2%) with panuveitis. The mean CMT were 261.6±22.2 μm in no uveitis, 268.1±17.8 μm in anterior uveitis, 306.4±32.9 μm in posterior uveitis, and 300.4±44.0 μm in panuveitis (P < 0.001). The mean MV was 8.7±0.3 mm3 in those without uveitis, 8.8±0.3 mm3 in anterior uveitis, 9.9±1.1 mm3 in those with posterior uveitis, and 9.7±0.4 mm3 in panuveitis (P < 0.001). Types of Behçet uveitis was the only significant factor correlated with the mean CMT (B = 18.170, β = 0.408, P < 0.001) and the mean MV (B = 0.328, β = 0.652, P < 0.001). Conclusions The mean CMT and MV were significantly thicker in the Behçet uveitis with posterior involvement. SD OCT can be used for an adjunctive tool for screening Behçet uveitis, especially for the presence of posterior involvement.
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Goker YS, Yılmaz S, Kızıltoprak H, Tekin K, Demir G. Quantitative Analysis of Optical Coherence Tomography Angiography Features in Patients with Nonocular Behcet’s Disease. Curr Eye Res 2018; 44:212-218. [DOI: 10.1080/02713683.2018.1530361] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Sedat Yılmaz
- Department of Rheumatology, Gülhane Training and Research Hospital, Ankara, Turkey
| | | | - Kemal Tekin
- Ophthalmology Department, Ercis State Hospital, Van, Turkey
| | - Gokhan Demir
- Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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Atienza-Mateo B, Calvo-Río V, Beltrán E, Martínez-Costa L, Valls-Pascual E, Hernández-Garfella M, Atanes A, Cordero-Coma M, Miquel Nolla J, Carrasco-Cubero C, Loricera J, González-Vela MC, Vegas-Revenga N, Fernández-Díaz C, Demetrio-Pablo R, Domínguez-Casas LC, Luis Martín-Varillas J, Palmou-Fontana N, Hernández JL, González-Gay MÁ, Blanco R. Anti-interleukin 6 receptor tocilizumab in refractory uveitis associated with Behçet's disease: multicentre retrospective study. Rheumatology (Oxford) 2018; 57:856-864. [PMID: 29471416 DOI: 10.1093/rheumatology/kex480] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Indexed: 12/14/2022] Open
Abstract
Objective To assess the efficacy of tocilizumab (TCZ) in refractory uveitis of Behçet's disease (BD). Methods Multicentre study of patients with BD-associated uveitis. Patients were refractory to conventional and biologic immunosuppressive drugs. The main outcome measures were intraocular inflammation, macular thickness, visual acuity and corticosteroid-sparing effects. Results We studied 11 patients (7 men) (20 affected eyes); median age 35 years. Uveitis was bilateral in nine patients. The patterns of ocular involvement were panuveitis (n = 8, with retinal vasculitis in 4), anterior uveitis (n = 2) and posterior uveitis (n = 1). Cystoid macular oedema was present in seven patients. The clinical course was recurrent (n = 7) or chronic (n = 4). Before TCZ, patients had received systemic corticosteroids, conventional immunosuppressants and the following biologic agents: adalimumab (n = 8), infliximab (n = 4), canakimumab (n = 1), golimumab (n = 3), etanercept (n = 1). TCZ was used as monotherapy or combined with conventional immunosuppressants at 8 mg/kg/i.v./4 weeks (n = 10) or 162 mg/s.c./week (n = 1). At TCZ onset the following extraocular manifestations were present: oral and/or genital ulcers (n = 7), arthritis (n = 4), folliculitis/pseudofolliculitis (n = 4), erythema nodosum (n = 2), livedo reticularis (n = 1) and neurological involvement (n = 2). TCZ yielded rapid and maintained improvement in all ocular parameters of the patients, with complete remission in eight of them. However, this was not the case for the extraocular manifestations, since TCZ was only effective in three of them. After a mean (s.d.) follow-up of 9.5 (8.05) months, TCZ was withdrawn in two cases, due to a severe infusion reaction and arthritis impairment, respectively. Conclusion TCZ could be a therapeutic option in patients with BD and refractory uveitis.
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Affiliation(s)
- Belén Atienza-Mateo
- Rheumatology Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Vanesa Calvo-Río
- Rheumatology Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Emma Beltrán
- Rheumatology and Ophthalmology Divisions, Hospital General Universitario de Valencia, Spain
| | | | - Elia Valls-Pascual
- Rheumatology and Ophthalmology Divisions, Hospital Peset Valencia, Spain
| | | | | | | | - Joan Miquel Nolla
- Rheumatology Division, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Javier Loricera
- Rheumatology Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - María C González-Vela
- Rheumatology Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Nuria Vegas-Revenga
- Rheumatology Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Carlos Fernández-Díaz
- Rheumatology Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Rosalía Demetrio-Pablo
- Rheumatology Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Lucía C Domínguez-Casas
- Rheumatology Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - José Luis Martín-Varillas
- Rheumatology Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Natalia Palmou-Fontana
- Rheumatology Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - José L Hernández
- Internal Medicine Division, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Miguel Á González-Gay
- Rheumatology Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Ricardo Blanco
- Rheumatology Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
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Cankaya C, Cumurcu T, Gunduz A, Fırat I. Corneal Endothelial Changes in Behçet's Patients with Inactive Ocular Involvement. Curr Eye Res 2018; 43:965-971. [PMID: 29715058 DOI: 10.1080/02713683.2018.1472285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this article is to evaluate alterations in the corneal endothelial layer in Behçet's disease (BD) with inactive ocular involvement using specular microscopy. MATERIALS AND METHODS Thirty-three eyes of 33 BD patients who had at least one anterior segment involvement and no active inflammation in the last 3 months were included in the study (group 1). Twenty-seven of the 33 BD patients had an anterior uveitis attack and six of them had a panuveitis (both anterior and posterior involvement) attack. Thirty-three eyes of 33 age- and sex-matched healthy subjects were enrolled in the control group (group 2). Corneal endothelial cell density (CD), coefficient of variation (CV), hexagonal cell ratio (HEX), and central corneal thickness (CCT) were measured using specular microscopy (Konan Medical, Nishinomiya, Japan), and the results were compared between groups. RESULTS The mean CD was 2739 ± 164.18 cells/mm2 in group 1 and 2922 ± 107.60 cells/mm2 in group 2 (p = 0.001). The mean CV was 32.9 ± 4.76 in group 1 and 28.5 ± 3.06 in group 2 (p = 0.001). The mean HEX was 44.7 ± 6.51 in group 1 and 49.7 ± 6.10 in group 2 (p = 0.019). The mean CCT was 545.75 ± 40.89 μ in group 1 and 545.66 ± 30.09 μ in group 2 (p > 0.05). CONCLUSIONS Ocular attacks in our BD patients may have caused permanent changes in the corneal endothelial layer. However, these changes did not lead to corneal decompensation, but further studies are necessary to confirm these results.
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Affiliation(s)
- Cem Cankaya
- a Department of Ophthalmology , Inonu University School of Medicine , Malatya , Turkey
| | - Tongabay Cumurcu
- a Department of Ophthalmology , Inonu University School of Medicine , Malatya , Turkey
| | - Abuzer Gunduz
- a Department of Ophthalmology , Inonu University School of Medicine , Malatya , Turkey
| | - Ilknur Fırat
- a Department of Ophthalmology , Inonu University School of Medicine , Malatya , Turkey
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Evaluation of efficacy of infliximab for retinal vasculitis and extraocular symptoms in Behçet disease. Jpn J Ophthalmol 2018; 62:390-397. [DOI: 10.1007/s10384-018-0589-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 03/02/2018] [Indexed: 12/13/2022]
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Ozdamar Y, Berker N, Bahar G, Soykan E, Bicer T, Ozkan SS, Karakaya J. Inflammatory mediators and posterior segment involvement in ocular Behçet disease. Eur J Ophthalmol 2018; 19:998-1003. [DOI: 10.1177/112067210901900616] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Yasemin Ozdamar
- Department of Retinal and Uveal Diseases, Ankara Ulucanlar Eye Research Hospital, Ankara
| | - Nilufer Berker
- Department of Retinal and Uveal Diseases, Ankara Ulucanlar Eye Research Hospital, Ankara
| | - Gul Bahar
- Department of Microbiology, Ankara Diskapi Education and Research Hospital, Ankara
| | - Emel Soykan
- Department of Retinal and Uveal Diseases, Ankara Ulucanlar Eye Research Hospital, Ankara
| | - Tolga Bicer
- Department of Retinal and Uveal Diseases, Ankara Ulucanlar Eye Research Hospital, Ankara
| | - Seyhan Sonar Ozkan
- Department of Retinal and Uveal Diseases, Ankara Ulucanlar Eye Research Hospital, Ankara
| | - Jale Karakaya
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara - Turkey
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Tugal-Tutkun I, Pavesio C, De Cordoue A, Bernard-Poenaru O, Gül A. Use of Gevokizumab in Patients with Behçet’s Disease Uveitis: An International, Randomized, Double-Masked, Placebo-Controlled Study and Open-Label Extension Study. Ocul Immunol Inflamm 2018; 26:1023-1033. [DOI: 10.1080/09273948.2017.1421233] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Carlos Pavesio
- Moorfields Eye Hospital and Biomedical Research Center, NHS Foundation Trust, London, UK
| | - Agnès De Cordoue
- Institut de Recherches Internationales Servier, Suresnes, France
| | | | - Ahmet Gül
- Department of Internal Medicine, Division of Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Tugal-Tutkun I, Ozdal PC, Oray M, Onal S. Review for Diagnostics of the Year: Multimodal Imaging in Behçet Uveitis. Ocul Immunol Inflamm 2016; 25:7-19. [DOI: 10.1080/09273948.2016.1205100] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | | | - Merih Oray
- Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sumru Onal
- Department of Ophthalmology, Koc University, School of Medicine, Istanbul, Turkey
- Department of Ophthalmology, Vehbi Koc Foundation, American Hospital, Istanbul, Turkey
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Bazvand F, Zarei M, Ebrahimiadib N, Karkhaneh R, Davoudi S, Soleimanzadeh M, Sharifian E, Roohipoor R, Modjtahedi BS. Ocular Manifestations, Conventional Fundus Fluorescein Angiographic Findings, and Relationship Between Angiographic Findings and Visual Acuity in Behçet's Disease. Semin Ophthalmol 2016; 32:764-771. [PMID: 27715380 DOI: 10.1080/08820538.2016.1178310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Evaluating the ocular manifestation and fundus fluorescein angiography (FA) findings of patients with Behçet's disease as well as the relationship between visual acuity and angiographic findings. METHODS Retrospective chart review of patients with Behçet's disease seen at the Farabi Eye Hospital. RESULTS Forty-six patients (92 eyes) with mean age of 33.41 ± 10.67 were included. The most frequent presenting symptom and sign were reduced vision (76%) and uveitis (87%), respectively. Panuveitis was the most frequent type of uveitis (76%). Among patients with FA, vasculitis was the most common finding (87%) and it was significantly more severe among patients with visual acuity less than 20/200. Macular leakage (P = 0.001), arterial narrowing (P = 0.000), and posterior retinal vasculitis (P = 0.002) on FA were all associated with worsening final visual acuity. CONCLUSION The most common ocular findings in Behçet's disease were panuveitis and vasculitis. Location of vasculitis, arterial narrowing, and macular leakage on initial FA may predict visual prognosis.
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Affiliation(s)
- Fatemeh Bazvand
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Mohammad Zarei
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Nazanin Ebrahimiadib
- b Retina Service, Department of Ophthalmology , Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
| | - Reza Karkhaneh
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Samaneh Davoudi
- b Retina Service, Department of Ophthalmology , Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
| | - Mahyar Soleimanzadeh
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Elaheh Sharifian
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Ramak Roohipoor
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Bobeck S Modjtahedi
- b Retina Service, Department of Ophthalmology , Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
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Thickness Changes in Foveal, Macular, and Ganglion Cell Complex Regions Associated with Behçet Uveitis during Remission. Eur J Ophthalmol 2015; 26:347-50. [DOI: 10.5301/ejo.5000728] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2015] [Indexed: 12/14/2022]
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This issue at a glance. J Curr Ophthalmol 2015; 27:1-3. [PMID: 27239566 PMCID: PMC4877720 DOI: 10.1016/j.joco.2015.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Tanaka R, Murata H, Takamoto M, Ohtomo K, Okinaga K, Yoshida A, Kawashima H, Nakahara H, Fujino Y, Kaburaki T. Behçet's disease ocular attack score 24 and visual outcome in patients with Behçet's disease. Br J Ophthalmol 2015; 100:990-994. [PMID: 26553921 DOI: 10.1136/bjophthalmol-2015-307362] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/10/2015] [Accepted: 10/15/2015] [Indexed: 11/04/2022]
Abstract
AIMS To investigate the ability of the Behçet's disease ocular attack score 24 (BOS24) scoring system to predict visual acuity (VA) in patients with ocular Behçet's disease. DESIGN This is a retrospective study. METHODS We included 91 eyes of 50 patients with ocular Behçet's disease (33 males, 17 females) who were referred to our hospital between 1986 and 2008 with >5 years follow-up. Total BOS24 scores over a 5-year period, BOS24-5Y, were calculated as the sum of BOS24 scores for each attack over the 5-year study period for each eye. Change in VA was defined as change in best-corrected visual acuity (BCVA) from the first remission to the last remission at the end of the target period. Factors related to change in VA (age, gender, BCVA at the first remission, total number of immunosuppressive medications and total number of ocular attacks during the 5-year period and BOS24-5Y) were evaluated using a linear mixed model. RESULTS BCVA (logarithm of the minimal angle resolution) deteriorated from 0.16±0.30 (mean±SD) to 0.21±0.37 over the 5-year study period, but there was no statistical difference. The total number of ocular attacks during the 5-year period and BOS24-5Y scores were 10.0±7.9 and 36.8±40.8, respectively. Linear mixed-model analysis revealed that BOS24-5Y was the most important index for VA deterioration, followed by BCVA at the first remission. CONCLUSIONS BOS24-5Y was found to be a significant positive prognostic index for VA deterioration in patients with ocular Behçet's disease.
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Affiliation(s)
- Rie Tanaka
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Mitsuko Takamoto
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Kazuyoshi Ohtomo
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Kimiko Okinaga
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Atsushi Yoshida
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hidetoshi Kawashima
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hisae Nakahara
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yujiro Fujino
- Department of Ophthalmology, Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Shinjyuku-ku, Tokyo, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
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Chams H, Mohtasham N, Davatchi F, Shahram F, Naji A, Aalami Harandi Z, Karimi N. Ophthalmic findings in Behcet׳s disease: Cases without apparent ocular signs. J Curr Ophthalmol 2015; 27:46-50. [PMID: 27239575 PMCID: PMC4877727 DOI: 10.1016/j.joco.2015.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Purpose To evaluate the fluorescein angiography and infrared autofluorescence finding in patients with confirmed Behcet׳s disease (BD) but without clinical ocular signs. Methods In this prospective, non-interventional case series, montage fluorescein angiography (MFA) and infrared autofluorescence imaging were performed for all patients with confirmed BD but without ocular signs in clinical examination. Results Fifty BD patients (100 eyes) without clinical ocular manifestations were investigated. In MFA, we found fluorescein angiography (FA) leakage in 22 cases (44%) in both eyes, mostly at the periphery of retina. In infrared autofluorescence, profound changes were found in 43 patients, 86 eyes (86%). Twenty-five patients, 50 eyes (50%), presented retinal vascular branching modifications, straightening, tortuosity, and shunt. Conclusion MFA of retina may be useful in patients with presumed BD for early diagnosis, early treatment, and follow-up of patients.
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Affiliation(s)
- Hormoz Chams
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Negin Mohtasham
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereydoun Davatchi
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Shahram
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolhadi Naji
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Aalami Harandi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Karimi
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Yüksel H, Türkcü FM, Hamidi C, Cingü AK, Çinar Y, Şahin M, Özkurt Z, Çaça İ. Ocular Blood Flow Changes in Behçet Disease Patients with/without Thrombotic Disease. Neuroophthalmology 2014; 38:122-126. [DOI: 10.3109/01658107.2014.894536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 02/04/2014] [Accepted: 02/04/2014] [Indexed: 11/13/2022] Open
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Kang HM, Lee SC. Long-term progression of retinal vasculitis in Behçet patients using a fluorescein angiography scoring system. Graefes Arch Clin Exp Ophthalmol 2014; 252:1001-8. [DOI: 10.1007/s00417-014-2637-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/11/2014] [Accepted: 04/07/2014] [Indexed: 12/14/2022] Open
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Dabour SA, Ghali MA. Outcome of surgical management for rhegmatogenous retinal detachment in Behçet's disease. BMC Ophthalmol 2014; 14:61. [PMID: 24886487 PMCID: PMC4016621 DOI: 10.1186/1471-2415-14-61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 04/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of the current study is to evaluate the surgical outcome for rhegmatogenous retinal detachment (RD) associated with Behçet's disease (BD). METHODS The current retrospective study included all patients operated for rhegmatogenous RD associated with BD in our institution from June 2007 to June 2012. Surgical repair was done either by scleral buckling (SB) or pars plana vitrectomy (PPV) according to the topography and clinical criteria of the detachment. RESULTS The current study included 7 eyes of 7 patients (6 males and one female). The mean age was 34.3 ± 4.9 years and all patients showed systemic features of BD. In 3 eyes, intravitreal triamcinolone acetonide (IVTA) was injected within 8 weeks prior to the occurrence of rhegmatogenous RD. Five eyes were treated with SB (segmental buckle in 4 cases and encircling buckle in one case) and 2 cases were treated by PPV. One case was initially treated by SB but showed recurrence of RD which was surgically repaired by PPV with successful closure of the retinal break. The retina was successfully reattached in all cases at the end of follow up period (22.0 ± 6.7 months). CONCLUSIONS Rhegmatogenous RD in BD can be effectively treated by scleral buckling in selected cases and PPV in more complex cases. Intravitreal injections may be a precipitating factor for rhegmatogenous RD.
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Affiliation(s)
- Sherif A Dabour
- Department of Ophthalmology, Zagazig University, Zagazig, Egypt.
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Evaluation of the Macular, Peripapillary Nerve Fiber Layer and Choroid Thickness Changes in Behçet's Disease with Spectral-Domain OCT. J Ophthalmol 2014; 2014:865394. [PMID: 24868459 PMCID: PMC4020218 DOI: 10.1155/2014/865394] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/04/2014] [Accepted: 04/04/2014] [Indexed: 12/14/2022] Open
Abstract
Purpose. To assess the macular, choroid, and peripapillary nerve fiber layer thickness (RNFL) in Behçet's disease (BD) patients with and without ocular involvement by means of optical coherence tomography (OCT) and compare these findings with healthy controls.
Design. Eighty patients with BD and 40 healthy controls who were followed up at the Uveitis and Retina Clinic of the Kayseri Research and Education Hospital in Turkey were enrolled in this prospective study.
Subjects and Controls. The patients with BD were divided into two groups according to the presence of ocular involvement. Group 1 consisted of 40 eyes of 40 patients with ocular involvement and group 2 consisted of 40 eyes of 40 patients without ocular involvement.
Methods. All of the patients and controls underwent macular, choroid, and peripapillary nerve fiber layer thickness analysis with Spectralis domain OCT (Spectralis OCT Heidelberg Engineering, Dossenheim, Germany).
Main Outcome Measures. The differences in macular, choroid, and peripapillary nerve fiber layer thicknesses between groups were analyzed statistically.
Results. Macular thickness was thinner in patients with BD than in the control group; this result was statistically significant (P = 0.05). There was no statistically significant difference in thickness between RNFL analysis of the patients with BD and control subjects. However, the BD patients with ocular involvement had statistically significant thinning in RNFL compared with BD patients without ocular involvement. Although the choroid was thicker in patients with BD than in the control group, it did not reach a statistically significant level (P = 0.382).
Conclusions. BD with ocular involvement may be associated with decreased macular and RNFL thickness measured with spectral-domain OCT.
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Moschos MM, Gouliopoulos NS, Kalogeropoulos C. Electrophysiological examination in uveitis: a review of the literature. Clin Ophthalmol 2014; 8:199-214. [PMID: 24453476 PMCID: PMC3894140 DOI: 10.2147/opth.s54838] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Uveitis is the inflammation of the uveal tract, which usually also affects the retina and vitreous humor. The electrophysiological examination is an objective ocular examination that includes the electroretinogram, visual evoked potentials, the electrooculogram, the multifocal electroretinogram, and multifocal visual evoked potentials. Our aim is to review the literature of the use of the electrophysiological examination in cases of uveitis. Methods We performed a systematic search of the literature of published papers until October 2012 using the PubMed search engine. The key terms that were used were “uveitis”, “electrophysiological examination”, “electroretinogram”, “visual evoked potentials”, “electrooculogram”, “multifocal electroretinogram”, and “multifocal visual evoked potentials” in multiple combinations. To the best of our knowledge, this is the first review concerning the assessment of electrophysiology in uveitis. Results Our search of the literature demonstrated that the electrophysiological examination, mainly by means of electroretinogram, multifocal electroretinogram, and visual evoked potentials, is performed in several cases of uveitis for many purposes, including diagnosis and monitoring of disease progression and treatment efficacy. The electrophysiological examination is more useful in patients with multiple evanescent white dot syndrome, acute posterior multifocal placoid pigment epitheliopathy, birdshot chorioretinopathy, Vogt–Koyanagi–Harada disease, Adamantiades–Behçet disease, ocular syphilis, and Fuchs heterochromic cyclitis. Conclusion This review summarizes the use of the electrophysiological examination in uveitic patients and underlines its value as a useful tool in the objective assessment and the monitoring of the disease.
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Affiliation(s)
- Marilita M Moschos
- Laboratory of Electrophysiology, First Department of Ophthalmology, University of Athens, Athens, Greece
| | - Nikolaos S Gouliopoulos
- Laboratory of Electrophysiology, First Department of Ophthalmology, University of Athens, Athens, Greece
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Reiff A, Kadayifcilar S, Özen S. Rheumatic Inflammatory Eye Diseases of Childhood. Rheum Dis Clin North Am 2013; 39:801-32. [DOI: 10.1016/j.rdc.2013.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abu-Ameerh MA, Mohammed SF, Mohammad MT, Ababneh OH, Al-Bdour MD. Ocular manifestations of Behçet's disease in Jordanian patients. Saudi J Ophthalmol 2013; 27:247-51. [PMID: 24371419 DOI: 10.1016/j.sjopt.2013.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 05/02/2013] [Accepted: 06/17/2013] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To study the prevalence, manifestations and severity of ocular involvement of Behçet's disease in Jordanian patients. METHODS The study population consisted of 43 patients diagnosed to have Behçet's disease through Rheumatologist's examinations conducted at Jordan University Hospital between January 2002 and July 2009. The sample involved patients who displayed ocular manifestations. This included 18 patients; 12 males and 6 females with a mean age of 35 years (SD = 17.26). Ophthalmological examinations and retrospective analysis of medical files were carried on. RESULTS Ocular manifestations were seen in 41.9% of patients. The most common manifestation for Behçet's disease was vitritis with a prevalence of 55.6%, followed by anterior uveitis and retinal vasculitis (50% for each). On the other hand, the most frequent complications involved were cataract, cystoid macular edema (CMO), posterior synechiae and glaucoma with a prevalence of (44.4%), (33.3%), (11.1%) and (5.6%), respectively. CONCLUSION The prevalence and severity of ocular lesions in Behçet's disease is relatively low in Jordanian patients. This result indicates that early diagnoses and intervention might delay or even prevent vision loss for those patients.
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Affiliation(s)
| | | | - Mona T Mohammad
- Ophthalmology Department, Jordan University Hospital, Amman, Jordan
| | - Osama H Ababneh
- Ophthalmology Department, Jordan University Hospital, Amman, Jordan
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Al Rashidi S, Al Fawaz A, Kangave D, Abu El-Asrar AM. Long-term Clinical Outcomes in Patients with Refractory Uveitis Associated with Behçet Disease Treated with Infliximab. Ocul Immunol Inflamm 2013; 21:468-74. [DOI: 10.3109/09273948.2013.779727] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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46
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47
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Kneifel CE, Köhler AK, Altenburg A, Zouboulis CC, Krause L. [Epidemiology of ocular involvement in Adamantiades-Behçets disease]. Ophthalmologe 2012; 109:542-7. [PMID: 22699944 DOI: 10.1007/s00347-011-2503-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Epidemiological studies demonstrate a prevalence of Adamantiades-Behçets disease (MAB) in the range of 0.12-420 per 100,000 inhabitants with the highest rates in Istanbul, Turkey and the lowest rates in the USA. Ophthalmological data on the prevalence of ocular involvement are limited for MAB in Germany because most epidemiological studies are based on rheumatological or dermatological data. Berlin is the city with the highest number of non-native German inhabitants and its multiethnic character renders it uniquely appropriate for epidemiological studies on MAB. This article summarizes the most important epidemiological data of 140 patients (63 female and 77 male) with a mean follow-up of 6.4 years (range 0.5-22 years) which we have recently published. The mean age was 23 years at the first manifestation and 32 years when the fully developed disease was recorded. The mean age at onset of ocular involvement was 30 years, 56% of patients developed ocular involvement, which was the first manifestation in 8.6% and the second manifestation in 19.3%. More than half the patients developed ocular involvement. The calculated prevalence of ocular involvement in MAB is 1.77/100,000 inhabitants for the population of Berlin.
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Affiliation(s)
- C E Kneifel
- Klinik für Augenheilkunde, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau, Deutschland
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Kahloun R, Ben Yahia S, Mbarek S, Attia S, Zaouali S, Khairallah M. Macular involvement in patients with Behçet's uveitis. J Ophthalmic Inflamm Infect 2012; 2:121-4. [PMID: 22549340 PMCID: PMC3438295 DOI: 10.1007/s12348-012-0075-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE The purpose of this study is to assess macular involvement in patients with Behçet's uveitis. METHODS The study included 65 patients (120 eyes) with Behçet's uveitis. All patients underwent detailed ophthalmic examination, including dilated biomicroscopic fundus examination, fundus photography, fluorescein angiography, and optical coherence tomography. Follow-up ranged from 6 to 46 months (mean 20 months). RESULTS At initial examination, 29 eyes (24.1 %) had macular involvement including macular edema (16 eyes, 13.3 %), serous retinal detachment (SRD; five eyes, 4.1 %), active retinitis (three eyes, 2.5 %), macular hole (three eyes, 2.5 %), macular atrophy (two eyes, 1.6 %), macular ischemia (one eye, 0.8 %), epiretinal membrane (one eye, 0.8 %), branch retinal vein occlusion involving the macula (three eyes, 2.5 %), and branch retinal artery occlusion involving the macula (two eyes, 1.6 %). During follow-up, 22 eyes (18.3 %) developed macular complications including macular edema (ten eyes, 8.3 %), SRD (four eyes, 3.3 %), active retinitis (two eyes, 1.6 %), severe macular atrophy (two eyes, 1.6 %), macular ischemia (three eyes, 2.5 %), macular hole (one eye, 0.8 %), epiretinal membrane (two eyes, 1.6 %), and subretinal fibrosis (one eye, 0.8 %). Branch retinal vein occlusion involving the macula developed in two eyes (1.6 %). Final best corrected visual acuity in patients with macular involvement ranged from 20/400 to 20/25 (mean 20/80). CONCLUSIONS Macular edema and other vision-threatening macular complications are common in Behçet's uveitis. Macular damage is often irreversible, causing permanent visual impairment. Early and appropriate treatment of Behçet's uveitis is mandatory to reduce the risk of visual impairment due to macular involvement.
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Affiliation(s)
- Rim Kahloun
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, 5019, Monastir, Tunisia
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Hazirolan D, Sungur G, Duman S. Demographic, Clinical, and Ocular Features in Patients with Late-onset Behçet Disease. Ocul Immunol Inflamm 2012; 20:119-24. [DOI: 10.3109/09273948.2012.655882] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Taylor SRJ, Singh J, Menezo V, Wakefield D, McCluskey P, Lightman S. Behçet disease: visual prognosis and factors influencing the development of visual loss. Am J Ophthalmol 2011; 152:1059-66. [PMID: 21872204 DOI: 10.1016/j.ajo.2011.05.032] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 05/19/2011] [Accepted: 05/24/2011] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess the visual prognosis of patients with ocular Behçet disease and to determine factors predictive of visual loss and severe visual loss. DESIGN Retrospective case series. METHODS One hundred seventy-five eyes of 107 patients diagnosed with ocular Behçet disease were included. The main outcome measures were visual loss (best-corrected visual acuity, worse than 20/40) and severe visual loss (best-corrected visual acuity, 20/200 or worse). RESULTS The mean duration of follow-up was 6.5 years. Presenting visual acuity was worse than 20/40 in 50% of eyes and 20/200 or worse in 21% of eyes; approximately one third of this was reversible with treatment. The most common cause of irreversible severe visual loss was ischemic maculopathy. At 10 years, there was a 39% risk of visual loss and a 24% risk of severe visual loss, the latter figure being reduced to 13% if patients with irreversible visual loss at presentation were excluded. After controlling for potentially confounding variables, male sex, unilateral disease, and left eye involvement all were statistically significant risk factors for severe visual loss at 5 and 10 years. Patients who were treated with biologic agents were less likely to have severe visual loss in either eye at both 5 and 10 years. CONCLUSIONS Many patients with ocular Behçet disease still have irreversible visual loss at presentation. However, the visual prognosis is otherwise improved, with a 10-year risk of severe visual loss of 13% in this cohort. The use of biologic agents is associated with a lower risk of severe visual loss at 5 and 10 years.
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Affiliation(s)
- Simon R J Taylor
- Institute of Ophthalmology, University College London, United Kingdom.
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