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.MethodsThis 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.ResultsOne 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.
Highlights
Ocular involvement is a common consequence of Behçet disease (BD) as 70–90% of the patients experience ocular impairments that are presented in different forms including posterior uveitis, retinal vasculitis, anterior uveitis, and optic neuropathy.[6]
Seventyfour eyes had ocular involvement in wide field fundus fluorescein angiography (WF-FAG) or clinical examination; of these, twenty-eight eyes (37.8% ) demonstrated active ocular inflammation manifesting as posterior uveitis in ophthalmic examination, whereas the uveitis was quiescent in 46 eyes corresponding with 62.2% of patients with ocular involvement
Patients with ocular Behçet disease (OBD) had thicker choroid compared to patients without ocular involvement, and the subfoveal choroid was thicker in patients with active disease compared to those with quiescent disease
Summary
Behçet disease (BD) is a chronic, recurrent, inflammatory, multisystem disease characterized by occlusive and necrotizing vasculitis.[1,2,3] The prevalence of BD is estimated to be 10.3 per 100,000 individuals and is higher in Middle East, Far East, and Mediterranean countries.[4, 5] Different classification criteria exist for BD, including the new “international criteria for BD.” Ocular involvement is a common consequence of BD as 70–90% of the patients experience ocular impairments that are presented in different forms including posterior uveitis, retinal vasculitis, anterior uveitis, and optic neuropathy.[6]. Indocyanine green angiography (ICGA) has been proposed as an alternative modality which evaluates choroidal circulation; it does not disclose the retinal circulation or evidence of retinal vasculitis as clear as FFA does.[14,15,16] Several studies have investigated the choroidal thickness analysis with EDI-OCT in patients with OBD.[6, 8, 14, 17, 18] Their findings are controversial regarding the effects of OBD disease on choroidal thickness
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