Behçet Disease: Visual Prognosis and Factors Influencing the Development of Visual Loss

• Published in: American journal of ophthalmology Vol. 152; no. 6; pp. 1059 - 1066
• Main Authors: Taylor, Simon R.J, Singh, Jasmin, Menezo, Victor, Wakefield, Denis, McCluskey, Peter, Lightman, Sue
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2011; Elsevier; Elsevier Limited
• Subjects: Adolescent; Adult; Aging; Behcet Syndrome - diagnosis; Behcet Syndrome - drug therapy; Behcet Syndrome - physiopathology; Biological and medical sciences; Blindness - diagnosis; Blindness - drug therapy; Blindness - physiopathology; Disease; Drug therapy; Female; Humans; Immunosuppressive Agents - therapeutic use; Macular degeneration; Male; Medical research; Medical sciences; Middle Aged; Miscellaneous; Ophthalmology; Prednisolone - therapeutic use; Prognosis; Retrospective Studies; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Vision disorders; Vision, Low - diagnosis; Vision, Low - drug therapy; Vision, Low - physiopathology; Visual Acuity - physiology; Young Adult; United States > US; Skin disease; Prognosis; Stomatology; Vision disorder; Cardiovascular disease; Behçet syndrome; Genital diseases; Vascular disease; Eye disease; Vasculitis; Visual impairment; Systemic disease; Blindness; Development; Ophthalmology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2011.05.032

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.