Ocular Inflammation in Behçet Disease: Incidence of Ocular Complications and of Loss of Visual Acuity

Kaçmaz, R. Oktay; Kempen, John H.; Newcomb, Craig; Gangaputra, Sapna; Daniel, Ebenezer; Levy-Clarke, Grace A.; Nussenblatt, Robert B.; Rosenbaum, James T.; Suhler, Eric B.; Thorne, Jennifer E.; Jabs, Douglas A.; Foster, C. Stephen; Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study Group,

doi:10.1016/j.ajo.2008.06.019

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Volume 146, Issue 6 , Pages 828-836, December 2008

Ocular Inflammation in Behçet Disease: Incidence of Ocular Complications and of Loss of Visual Acuity

R. Oktay Kaçmaz
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts
John H. Kempen
- Ocular Inflammation Service, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, the University of Pennsylvania, Philadelphia, Pennsylvania
Craig Newcomb
- Ocular Inflammation Service, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, the University of Pennsylvania, Philadelphia, Pennsylvania
Sapna Gangaputra
- Department of Ophthalmology, the Johns Hopkins University, Baltimore, Maryland
Ebenezer Daniel
- Department of Ophthalmology, the Johns Hopkins University, Baltimore, Maryland
Grace A. Levy-Clarke
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland
Robert B. Nussenblatt
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland
James T. Rosenbaum
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
Eric B. Suhler
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon
- Portland Veteran's Affairs Medical Center, Portland, Oregon
Jennifer E. Thorne
- Department of Ophthalmology, the Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, the Johns Hopkins University, Baltimore, Maryland
Douglas A. Jabs
- Department of Ophthalmology, the Johns Hopkins University, Baltimore, Maryland
C. Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
- Inquiries to C. Stephen Foster, Massachusetts Eye Research and Surgery Institution, 5 Cambridge Center, 8th Floor, Cambridge, MA 21042
Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study Group

Accepted 17 June 2008. published online 19 August 2008.

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.