ABSTRACT
INTRODUCTION: Behçet's disease is a systemic disease of unknown etiology. Its ocular manifestations are multiple and polymorphic, with uveitis at the top of the list. Classically, uveitis in Behçet's disease does not cause elevation of intraocular pressure. However, this may be found in 10 to 20% of cases, secondary to trabeculitis, trabecular obstruction by inflammatory cells, anterior or posterior synechiae, or induced by prolonged use of corticosteroids. Its occurrence is a major complication, the management of which is especially delicate when glaucoma occurs. The purpose of this study was to study the factors predictive of glaucoma in Behçet's disease. MATERIALS AND METHODS: This is a retrospective study of all the charts of patients consecutively hospitalized for Behçet's disease over a period of 8years in the ophthalmology A department of the specialty hospital of Rabat university medical center. RESULTS: Fifty patients were treated for Behçet's disease during the study period. There were 41 men (82%), and 9 women (18%). Glaucoma was diagnosed in 11 patients (22%). The mean age of this subgroup was 31years, with a gender ratio of 6 women/5 men. The glaucoma was associated with anterior synechiae in 4 cases, primary open-angle glaucoma in 5 cases, neovascular glaucoma in 1 case and seclusio pupillae in 1 case. Therapeutically, all patients were on glaucoma eye drops, and five underwent filtering surgery. Statistically, on univariate analysis, ocular hypertension was observed particularly in patients with low initial visual acuity (less than 1/10) (P=0.001), with severe posterior segment involvement, especially retinal vasculitis (29% vs. 6%, P=0.04), macular edema (40% vs. 4%, P=0.001), and optic disc edema (50% vs. 15%, P=0.02). A high number of recurrences was also associated with glaucoma (1.0 vs. 3.0, P<0.0001). On multivariate analysis, low baseline visual acuity, presence of retinal vasculitis, and high number of recurrences were independent risk factors for ocular hypertension in our patients followed for Behçet's disease. CONCLUSION: Glaucoma can complicate the management of Behçet's disease. This glaucoma will be more difficult to manage in this delicate pathological context. It requires special vigilance in patients with severe posterior segment inflammation, to institute effective management to avoid its potentially blinding complications.
Subject(s)
Behcet Syndrome/complications , Behcet Syndrome/epidemiology , Glaucoma/epidemiology , Glaucoma/etiology , Uveitis/epidemiology , Uveitis/etiology , Adrenal Cortex Hormones/therapeutic use , Adult , Behcet Syndrome/drug therapy , Female , Glaucoma/drug therapy , Humans , Immunosuppressive Agents/therapeutic use , Male , Morocco/epidemiology , Prevalence , Retrospective Studies , Uveitis/drug therapy , Vision, Ocular/drug effects , Young AdultABSTRACT
INTRODUCTION: Behçet's disease is an idiopathic systemic inflammatory disease. Ocular involvement is part of the classification criteria for this disease. The uveitis is potentially severe. The goal of our study was to study the prognostic factors associated with low final visual acuity (VA) of less than 1/10 during the follow-up of patients with Behçet's disease. MATERIALS AND METHODS: This is a retrospective study including all consecutive patients hospitalized for Behçet's disease from January 2009 to December 2017 on a university hospital service. The age of onset, initial visual acuity, ophthalmologic manifestations, therapeutic management and progression were recorded. The prognostic factors associated with a final AV less than 1/10 were subjected to univariate analysis. Variables with p less than 0.05 were then included in a multivariate analysis. RESULTS: Fifty patients were included. The mean age was 30, with a male predominance of 82 %. The univariate analysis showed that there was a statistically significant difference between the group of patients with a final VA less than 1/10 (n=28) and those with a final VA greater than 1/10 (n=22) with regard to young age at onset of the disease (95 % CI 0.80-0.94, P=0.001), high number of ocular recurrences (95 % CI 1.67-10, 12, P=0.002), and the presence of occlusive vasculitis (62.9 % vs. 21.4 %, P=0.002). Multivariate analysis confirmed that young age of onset of the disease and the number of recurrences were independent prognostic factors of final visual acuity less than 1/10. CONCLUSION: Severe uveitis is a progressive step in Behçet's disease which may compromise the functional prognosis of these patients. Young age at onset of the disease as well as a high number of recurrences appear to be major prognostic factors in these patients.
Subject(s)
Behcet Syndrome/complications , Uveitis/etiology , Visual Acuity , Adrenal Cortex Hormones/therapeutic use , Adult , Age of Onset , Analysis of Variance , Behcet Syndrome/drug therapy , Disease Progression , Female , Humans , Immunosuppressive Agents/therapeutic use , Male , Methylprednisolone/therapeutic use , Prognosis , Recurrence , Retrospective Studies , Uveitis/drug therapySubject(s)
Anesthesia , Carotid Artery, Internal/abnormalities , Corneal Diseases/congenital , Corneal Ulcer/etiology , Eye Abnormalities/complications , Sensation Disorders/congenital , Vascular Malformations/complications , Atrophy/complications , Atrophy/diagnosis , Carotid Artery Diseases/complications , Carotid Artery Diseases/diagnosis , Carotid Artery, Internal/pathology , Chronic Disease , Corneal Diseases/diagnosis , Corneal Diseases/etiology , Corneal Ulcer/diagnosis , Eye Abnormalities/diagnosis , Humans , Infant , Male , Papilledema/complications , Papilledema/diagnosis , Retinal Dysplasia/complications , Retinal Dysplasia/diagnosis , Sensation Disorders/diagnosis , Sensation Disorders/etiology , Vascular Malformations/diagnosisSubject(s)
Retinoschisis/diagnosis , Retinoschisis/pathology , Vitreous Body/abnormalities , Vitreous Body/diagnostic imaging , Child , Fundus Oculi , Humans , Male , Morocco , Retina/abnormalities , Retina/diagnostic imaging , Retina/pathology , Tomography, Optical Coherence , Vitreous Body/pathologySubject(s)
Cataract/diagnosis , Cataract/pathology , Fundus Oculi , Humans , Male , Morocco , Treatment Refusal , Young AdultSubject(s)
AIDS-Related Opportunistic Infections/diagnosis , Acquired Immunodeficiency Syndrome/diagnosis , Cytomegalovirus Retinitis/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/drug therapy , Adult , Antiretroviral Therapy, Highly Active/methods , Antiviral Agents/administration & dosage , Cytomegalovirus Retinitis/drug therapy , HIV , Humans , Intravitreal Injections , MaleSubject(s)
Hyperopia/complications , Hyperopia/diagnosis , Scleral Diseases/complications , Scleral Diseases/diagnosis , Atrophy/complications , Atrophy/diagnosis , Female , Humans , Hyperopia/pathology , Middle Aged , Retinal Diseases/complications , Retinal Diseases/diagnosis , Scleral Diseases/pathologyABSTRACT
PURPOSE: To evaluate prognostic factors of vision loss among patients with uveitis. MATERIAL AND METHODS: This descriptive and retrospective study included all patients diagnosed with uveitis who were seen at the teaching hospital of Rabat, Morocco, over a 5-year period. Information regarding demographic data, uveitis type, bilaterality of the disease, etiology and complications were gathered from patients' records. Statistical analysis was performed using SPSS software. RESULTS: One hundred and thirty-nine eyes of 89 patients were included. There were 60.7 % men and 39.3 % women. The mean age (years) was 31.1±16.8. Median follow-up was 11 months. Median visual acuity (logMAR) on admission was 1.7 [0.7-2] and 1 [0.4-1.7] on the last visit (P<0.001). Fifty-nine percent of eyes had final visual acuity (VA) equal to or less than 1/10. Panuveitis (85.4 %) and posterior uveitis (72.7 %) were responsible for final VA equal to or less than 1/10 (P<0.001). Cataract, posterior synechiae, vitreous opacities, epimacular membrane (ERM) and cystoid macular edema (CME) were the most frequent complications. Using multivariate logistic regression, the prognostic factors associated with severe vision loss were the type of uveitis (posterior and panuveitis), CME, ERM, macular scarring and optic atrophy (P<0.05). CONCLUSION: Although this study included a limited number of subjects, the results showed that final VA was equal or less than 1/10 in 59 % of eyes diagnosed with uveitis and was associated with risk factors including posterior segment involvement (panuveitis and posterior uveitis), CME and ERM.
Subject(s)
Uveitis/diagnosis , Uveitis/etiology , Adolescent , Adult , Cataract/complications , Cataract/epidemiology , Female , Humans , Macular Edema/complications , Macular Edema/epidemiology , Male , Middle Aged , Morocco/epidemiology , Panuveitis/complications , Panuveitis/epidemiology , Prognosis , Retrospective Studies , Risk Factors , Uveitis/epidemiology , Uveitis, Posterior/complications , Uveitis, Posterior/epidemiology , Young AdultABSTRACT
PURPOSE: To study the prevalence of exfoliation syndrome (XFS) and its association with cardiovascular disease in patients scheduled for cataract surgery. MATERIAL AND METHODS: This is a retrospective, single center, descriptive study of 260 patients admitted to a tertiary teaching hospital in Rabat, Morocco, between January 2015 and March 2016 and scheduled for cataract surgery. All patients had a preoperative cardiovascular exam, an electrocardiogram and, if needed, echocardiography. Statistical analysis was performed using SPSS software. Results with a P-value<0.05 were considered statistically significant. RESULTS: This study included 246 patients: 146 women (59.3 %) and 100 men (40.7 %). The mean age (years) was 67.6±10.1. The percentage of XFS increased with age (P=0.02). Sixty-two percent of patients with cardiovascular disease also had exfoliation syndrome (P<0.001). Patients with XFS had hypertension in 46.5 % of cases. 14 subjects (19.7 %) had ischemic heart disease and XFS. Using multivariate logistic regression and after adjusting for age, diabetes mellitus, hypertension, ischemic heart disease and arrhythmias, smoking was the only factor associated with exfoliation syndrome (P=0.01, odds ratio=5.2, confidence interval 95 %=1.35-20.15). CONCLUSION: Exfoliation syndrome is a common condition in the aging cataract population. Ischemic heart disease and hypertension are frequently associated with XFS. Smoking could be another factor associated with this syndrome.