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Behçet's Uveitis.

Tugal-Tutkun I - Middle East Afr J Ophthalmol (2009)

Bottom Line: Corticosteroids combined with azathioprine and/or cyclosporine is used initially.Biologic agents, including interferon alfa and infliximab, are used in resistant cases.Visual prognosis has improved in recent years with an earlier and more aggressive use of immunomodulatory therapy and the use of biologic agents in resistant cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.

ABSTRACT
Behçet's disease is a multisystem inflammatory disorder that is most common in countries along the ancient "Silk Road". The eye is the most commonly involved vital organ in Behçet's patients and the typical form of involvement is a relapsing remitting panuveitis and retinal vasculitis. Uveitis is the initial manifestation of the disease in 10-15% of the patients. Anterior uveitis is always nongranulomatous. Diffuse vitritis, retinal infiltrates, sheathing of predominantly retinal veins, and occlusive vasculitis are the typical signs of posterior segment inflammation. Spontaneous resolution of acute inflammatory signs is a diagnostic feature. Fundus fluorescein angiography is the gold standard in monitoring inflammatory activity. Laser flare photometry is a useful noninvasive tool since flare readings correlate with fluorescein angiographic leakage. The most common complications are cataract, maculopathy, and optic atrophy. Male patients have a more severe disease course and worse visual prognosis. Immunomodulatory therapy is indicated in all patients with posterior segment involvement. Corticosteroids combined with azathioprine and/or cyclosporine is used initially. Biologic agents, including interferon alfa and infliximab, are used in resistant cases. Visual prognosis has improved in recent years with an earlier and more aggressive use of immunomodulatory therapy and the use of biologic agents in resistant cases.

No MeSH data available.


Related in: MedlinePlus

(a) A 27 year-old pregnant woman with Behçet's disease presented with a hypopyon panuveitis;
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F001a: (a) A 27 year-old pregnant woman with Behçet's disease presented with a hypopyon panuveitis;

Mentions: At a given episode of activation, acute inflammatory signs may be seen in the anterior or posterior segments of the eye or more commonly in both. Ciliary injection is not a constant feature in eyes with anterior segment inflammation. It may be disproportionately mild in eyes with severe anterior uveitis. A “cold” hypopyon resembling the pseudohypopyon, seen in masquerade syndromes, is not uncommon. Endothelial dusting is seen in eyes with a high grade of anterior chamber cells. Granulomatous keratic precipitates are not compatible with the diagnosis of Behçet's uveitis. A hypopyon is reported in 10–30% of the patients [Figure 1a]. Its incidence may be higher than the reported Figures because it may be missed if the patient is not seen at the onset of the uveitis attack. The hypopyon forms and dissolves rapidly. It typically forms a smooth layer and shifts freely with head positioning. In eyes with a hypopyon, there is almost always severe inflammation in the posterior segment. These features help differentiate Behçet hypopyon from HLA-B27 hypopyon, which is always “hot” and sticky, and with inflammation confined to the anterior segment.


Behçet's Uveitis.

Tugal-Tutkun I - Middle East Afr J Ophthalmol (2009)

(a) A 27 year-old pregnant woman with Behçet's disease presented with a hypopyon panuveitis;
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2855662&req=5

F001a: (a) A 27 year-old pregnant woman with Behçet's disease presented with a hypopyon panuveitis;
Mentions: At a given episode of activation, acute inflammatory signs may be seen in the anterior or posterior segments of the eye or more commonly in both. Ciliary injection is not a constant feature in eyes with anterior segment inflammation. It may be disproportionately mild in eyes with severe anterior uveitis. A “cold” hypopyon resembling the pseudohypopyon, seen in masquerade syndromes, is not uncommon. Endothelial dusting is seen in eyes with a high grade of anterior chamber cells. Granulomatous keratic precipitates are not compatible with the diagnosis of Behçet's uveitis. A hypopyon is reported in 10–30% of the patients [Figure 1a]. Its incidence may be higher than the reported Figures because it may be missed if the patient is not seen at the onset of the uveitis attack. The hypopyon forms and dissolves rapidly. It typically forms a smooth layer and shifts freely with head positioning. In eyes with a hypopyon, there is almost always severe inflammation in the posterior segment. These features help differentiate Behçet hypopyon from HLA-B27 hypopyon, which is always “hot” and sticky, and with inflammation confined to the anterior segment.

Bottom Line: Corticosteroids combined with azathioprine and/or cyclosporine is used initially.Biologic agents, including interferon alfa and infliximab, are used in resistant cases.Visual prognosis has improved in recent years with an earlier and more aggressive use of immunomodulatory therapy and the use of biologic agents in resistant cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.

ABSTRACT
Behçet's disease is a multisystem inflammatory disorder that is most common in countries along the ancient "Silk Road". The eye is the most commonly involved vital organ in Behçet's patients and the typical form of involvement is a relapsing remitting panuveitis and retinal vasculitis. Uveitis is the initial manifestation of the disease in 10-15% of the patients. Anterior uveitis is always nongranulomatous. Diffuse vitritis, retinal infiltrates, sheathing of predominantly retinal veins, and occlusive vasculitis are the typical signs of posterior segment inflammation. Spontaneous resolution of acute inflammatory signs is a diagnostic feature. Fundus fluorescein angiography is the gold standard in monitoring inflammatory activity. Laser flare photometry is a useful noninvasive tool since flare readings correlate with fluorescein angiographic leakage. The most common complications are cataract, maculopathy, and optic atrophy. Male patients have a more severe disease course and worse visual prognosis. Immunomodulatory therapy is indicated in all patients with posterior segment involvement. Corticosteroids combined with azathioprine and/or cyclosporine is used initially. Biologic agents, including interferon alfa and infliximab, are used in resistant cases. Visual prognosis has improved in recent years with an earlier and more aggressive use of immunomodulatory therapy and the use of biologic agents in resistant cases.

No MeSH data available.


Related in: MedlinePlus