Pattern and Visual Prognostic Factors of Behcet's Uveitis in Northwest Iran

Abstract

Purpose: To investigate the pattern of ocular involvement in Behcet's disease (BD) with predictors of patients' final state of vision.

Methods: This historical cohort encompassed the clinical records of 200 patients diagnosed according to the International Criteria for BD (ICBD), over a period of 17 years between 2004 and 2021.

Results: The prevalence of Behcet's uveitis (BU) was more common in females and patients in the fourth decade of life. Ninety-five patients (47.5%) had evidence of ocular involvement in the initial ophthalmologic evaluation, and 171 patients (85.5%) manifested evidence of BU during the follow-up visits of which bilateral non-granulomatous panuveitis was the most common anatomical pattern of involvement (32.9%) followed by posterior (27.6%), anterior (26.5%), and intermediate (13.8%) uveitis. The prevalent accompanying signs were oral aphthous (67%), skin lesions (29%), and genital ulcers (19.5%). Cystoid macular edema (CME) was the most frequent ocular complication (62%), followed by cataract (57.5%) and epiretinal membranes (ERM) (36.5%). Univariate analysis showed the following determinants: male gender, younger age at onset, panuveitis, posterior uveitis, retinal vasculitis, and longer duration of uveitis as poorer visual prognostic factors of the disease. Multivariate analysis demonstrated a higher chance of poor visual prognosis of BD in patients with panuveitis, posterior uveitis, retinal vasculitis, and longer duration of uveitis.

Conclusion: This cohort study demonstrated an overview on epidemiological patterns of BU along with the visual prognostic factors in Iranian patients.

Keywords: Behcet's Syndrome; Behcet's Uveitis; Iran; Prognosis; Uveitis; Behcet's Disease.

Figure 1

Frequency of BD (blue color) and BU (red color) in different age groups at first ophthalmologic visit. As shown, most patients with BU were in the age group of 31–40 years (62.1%). BD, Behcet's disease; BU, Behcet's uveitis.

Figure 2

Frequency of uveitis type in study patients at first (left chart) and last (right chart) ophthalmic visits. As shown, panuveitis was the most common anatomical pattern of ocular involvement, followed by posterior uveitis. Ant. Uveitis, anterior uveitis; Int. Uveitis, intermediate uveitis; Post. Uveitis, posterior uveitis.

Figure 3

Frequency of ocular uveitic signs (left) and accompanying systemic symptoms and findings (right) at the first ophthalmologic visit in patients with BU. HLA, human leukocyte antigen.

Figure 4

Frequency of the BCVA separately in the right (blue color) and left (red color) eyes at final ophthalmologic visit. The ophthalmologic examination of 400 eyes of 200 cases at the final visit showed that 9 eyes (2.25%) were no light perception (NLP), 9 (2.25%) had light perception (LP), and 123 (30.75%) had a 20/20 best corrected visual acuity (BCVA). Generally, frequencies of $\le$ 20/40 and $\le$ 20/200 BCVA at last follow-up were 53.75% and 35.75%, respectively. NLP, no light perception; LP, light perception; HM, hand motion; F.C, fingers counting.

Figure 5

Frequency of ocular complications in patients with BU in the follow-up. As shown CME (62%) was the most common complication, followed by cataract (57.5%) and ERM (36.5%). (CME: cystoids macular edema, ERM: epiretinal membrane, RD: retinal detachment).