Ocular inflammation in Behçet disease: incidence of ocular complications and of loss of visual acuity

Abstract

Purpose: To estimate the risk of structural ocular complications and loss of visual acuity (VA) in cases of Behçet disease (BD) and to evaluate potential risk and protective factors for these events.

Design: Retrospective cohort study.

Methods: A total of 168 consecutive patients with BD-associated ocular inflammation treated at five academic center ocular inflammation subspecialty practices were included. Clinical data for these patients were ascertained by standardized chart review. Main outcome measures included VA, structural ocular complications of inflammation, and intraocular pressure (IOP).

Results: Over a median follow-up of 1.05 years, the incidence of specific structural complications and IOP disturbances were common: the incidence rate of any ocular complication was 0.45 per eye-year (EY). Rates of loss of VA to 20/50 or worse and to 20/200 or worse were 0.12 per EY and 0.09 per EY, respectively. Risk factors for loss of VA during follow-up were persistent inflammatory activity, presence of posterior synechiae, presence of hypotony, and presence of elevated IOP. In a time-dependent analysis, current activity of ocular inflammation was associated with an increased risk of loss of VA to 20/50 or worse (relative risk [RR], 2.45; 95% confidence interval [CI], 1.1 to 5.5; P = .03) and to 20/200 or worse (RR, 2.67; 95% CI, 1.2 to 5.8; P = .01).

Conclusions: Loss of VA and occurrence of ocular complications were common in patients with ocular inflammation associated with BD, even with aggressive therapy. Ongoing inflammation during follow-up, presence or occurrence of posterior synechiae, hypotony, and elevated IOP were associated with an increased risk of loss of VA.

Figure 1

Kaplan-Meier survival curve for loss of visual acuity to the 20/200 or worse level over time, in relationship to current (time-updated) overall activity of uveitis. Slightly active refers to minimal signs of activity, which cannot be properly graded as the absence of active inflammation according to SUN criteria. Follow-up is truncated at 5 years; events were rare after the first five years.

Figure 2

Kaplan-Meier survival curve for loss of visual acuity to the 20/200 or worse level over time, in relationship to current (time-updated) level of vitreous haze. Follow-up is truncated at 5 years; events were rare after the first five years