Neovascularization of the optic disc in Behçet's disease.
OBJECTIVE
To investigate the mechanisms involved in the development of neovascularization of the optic disc (NVD) in Behçet's disease and to evaluate the effects of medical and laser treatments.


METHODS
This is a retrospective study of 26 consecutive Behçet's patients (38 eyes) with NVD who presented between 1990 and 2004 at our university hospital. Information on age at presentation, sex, disease duration, laterality of NVD, ocular findings, fluorescein angiographic findings, visual acuity, medical treatment, laser photocoagulation, surgical procedures, and the follow-up period was collected. Eyes with diffuse capillary leakage on fluorescein angiography were defined as having inflammation-induced NVD, and eyes with extensive retinal capillary nonperfusion were defined as having ischemia-induced NVD.


RESULTS
Eighteen patients were male, and eight were female. Mean age at presentation was 25.4 +/- 4.9 years. Median disease duration was 5.5 months. Median follow-up was 24 months. Twelve patients had bilateral NVD; 14 had unilateral NVD. Inflammation-induced NVD was seen in 87% of the eyes, and ischemia-induced NVD in 13%. Initial treatment with high-dose corticosteroids combined with conventional immunosuppressive agents was effective in 45% of the eyes with inflammation-induced NVD. Retinal laser photocoagulation was effective in three of five eyes with ischemia-induced NVD. Treatment with interferon alpha-2a resulted in resolution of NVD in all seven patients who received this agent for inflammation- or ischemia-induced persistent NVD. Final visual acuity was less than 0.1 in 24% of the eyes.


CONCLUSIONS
Inflammatory mechanisms seem to predominate in the pathogenesis of NVD in Behçet's disease. The results of this study suggest that the response to intensive anti-inflammatory and conventional immunosuppressive treatment is not satisfactory; retinal laser photocoagulation may be ineffective even in eyes with retinal ischemia, but interferon alpha-2a seems to be effective for the treatment of Behçet's patients with NVD.
Tugal-Tutkun
Ilknur
I
Department of Ophthamology, Istanbul University, Istanbul Faculty of Medicine, Turkey. itutkun@istanbul.edu.tr
Onal
Sumru
S
Altan-Yaycioglu
Rana
R
Kir
Nur
N
Urgancioglu
Meri
M
D000293:Adolescent; D000328:Adult; D001528:Behcet Syndrome / Q000150:complications* / Q000473:pathology; D004337:Drug Carriers; D004359:Drug Therapy, Combination; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D017075:Laser Coagulation; D008297:Male; D009389:Neovascularization, Pathologic / Q000209:etiology / Q000473:pathology / Q000628:therapy; D009898:Optic Disk / Q000098:blood supply*; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011994:Recombinant Proteins; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity
D004337:Drug Carriers; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; C100416:peginterferon alfa-2a