Abstract
PurposeTo determine the application of fluorescein angiographic (FA) findings and Behcet’s disease ocular attack score 24 (BOS24) scoring system in predicting poor visual outcome in patients with ocular Behcet’s disease.Study designRetrospective cohort study.MethodsWe included 73 eyes of 38 patients with ocular Behcet’s disease who underwent FA and reviewed FA images, anterior chamber cells, vitreous opacity, retinal and optic disc lesions, which are parameters in BOS24. The correlation between FA findings, BOS24, and visual acuity was assessed.ResultsOptic disc hyperfluoresence (74%), diffuse posterior pole leakage (52%) and diffuse peripheral leakage (52%) were the three most common findings. Common complications were peripheral capillary nonperfusion (29%), arterial narrowing (22%), and macular ischemia (19%). BOS24 scores of ≥ 6 (p < 0.0001), arterial narrowing (p < 0.0001), and severe posterior pole leakage (p = 0.004) were significantly associated with poor visual outcome. Combining significant FA findings: arterial narrowing and severe posterior pole leakage, to BOS24 ≥ 6 results in an increased relative risk of developing poor visual acuity from 7.30 to 10.43 and 1.89 to 2.02 respectively.ConclusionFluorescein angiography is an important investigation for predicting poor visual outcome. BOS24 may be a useful alternative when fluorescein angiographic is unavailable.
Highlights
Behcet’s disease(BD) is a chronic relapsing inflammatory disease of unknown origin
Fluorescein angiography is an important investigation for predicting poor visual outcome
This study aims to assess the application of fluorescein angiographic (FA) findings and the Behcet’s disease ocular attack score 24 (BOS24) scoring system in predicting poor visual outcomes in patients with ocular BD
Summary
Behcet’s disease(BD) is a chronic relapsing inflammatory disease of unknown origin. Its pathophysiology is suggested to be caused by an immune-mediating etiology resulting in vasculitis and subsequently damaging blood vessels throughout the body including the retina [1]. The rates of ocular manifestations and visual prognosis differ in each country with India, Iran, and Japan having a higher rate of poor vision [6]. This is one of the few studies in Thailand to study the prognostic factors in ocular BD patients. There is no standard treatment or indication of when to initiate therapy with biological agents and of which drug, dosage, and duration Due to their high cost, availability, and limited experience with these new drugs, they are most often reserved for refractory cases which are already in advanced stages with little potential for improvement, resulting in unsatisfying results [14]. The ability to predict a patient’s visual prognosis will be very important, as eligible patients may be good candidates for initiating biological agents or at best receive the most appropriate treatment available to preserve maximum vision
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