Trabeculectomy with mitomycin-C in uveitic glaucoma associated with Behçet disease

PURPOSE: To determine the effect of intraoperative application of Mitomycin-C (MMC) with trabeculectomy in uveitic glaucoma associated with Beh?et disease. MATERIALS AND METHODS: Twenty-six eyes of 26 patients with uveitic glaucoma associated with Beh?et disease who underwent trabeculectomy with MMC between 1996 and 2001 were reviewed in this retrospective, noncomparative study. Trabeculectomy + MMC in concentration of 0.4 mg/mL for 3 minutes was performed to all patients. Main outcome measures were control of IOP, the number of antiglaucoma medications required to achieve the desired IOP, visual acuity and complications. The surgical success was defined as IOP less than 22 mm Hg and greater than 5 mm Hg without additional further glaucoma surgery or loss of light perception. RESULTS: The cumulative probability of success was 83.3% at 1 year, 76.2% at 2 years, 70% at 3 years, 66.7% at 4 years and 62.5% at 5 years after surgery. The mean follow-up was 40.0+/-18.0 months. At last follow-up 23% of the patients required no antiglaucoma medications. Best-corrected visual acuity improved or remained within two lines of preoperative visual acuity in 19 eyes (73.1%). Glaucomatous (1 eye 3.8%) and nonglaucomatous optic atrophy (3 eyes 11.5%) was the most frequent reason for visual decrease (total 4 eyes 15.2%). The most common complications were cataract formation in 6 eyes (23.1%), bleb leakage in 4 eyes (15.3%) and choroidal effusion in 3 eyes (11.5%). Phthisis bulbi was found in one (3.8%) patient. CONCLUSION: Trabeculectomy and intraoperative application of MMC appears to provide long term safety and effectiveness in uveitic glaucoma associated with Beh?et disease.     

【In Press】 Trabeculectomy with collagen matrix implant versus mitomycin C in congenital glaucoma secondary

AIM: To compare the efficacy and safety of collagen matrix implant [Ologen (OLO) implant] versus mitomycin C (MMC) with subscleral trabeculectomy (SST) for the surgical treatment of congenital glaucoma (CG) in Surge Weber Syndrome (SWS). METHODS: A prospective comparative randomized study of 20 eyes of 16 patients with congenital glaucoma associated with SWS were divided into two groups. The first group (MMC group) included 10 eyes that were subjected to SST with MMC. The second group (OLO group) included 10 eyes that were subjected to trabeculectomy with a collagen matrix implant (OLO implant). Postoperative evaluation included intraocular pressure (IOP) level, bleb evaluation, complications, and the need for further medication or surgical intervention. RESULTS: The mean preoperative IOP was 29 (±3.1) in MMC and 29.8(±3.08) in OLO eyes. Mean 12-month percentage reduction in IOP was significant in both groups [57.9% and 56.3% with P?>?0.05]. At the end of the 12 postoperative follow-up month, in the MMC group, 80% of eyes achieved the complete success, 20% of eyes had qualified success with no failed surgery in comparison to (OLO group) which 70% of eyes achieved the complete success, 20% of eyes had qualified success with 10% failed surgery. In terms of complications, the MMC group had a higher rate of complications than the OLO group in the form of thin polycystic bleb in 6 eyes (60%), blebitis in only one eye (10%) treated with topical antibiotics, shallow AC in two eyes (20%). CONCLUSION: This study proves that the use of a collagen matrix implant yields equally effective results as MMC when combined with trabeculectomy for the treatment of congenital glaucoma in SWS. Furthermore, OLO implantation is safe and has low incidences of complications.     

Nd:YAG laser iridotomy in the management of secondary glaucoma associated with Behçet's disease

PURPOSE: To report the outcome of Nd:YAG laser iridotomy in the management of secondary glaucoma associated with Beh?et's disease (BD). METHODS: In this prospective study, Nd:YAG laser iridotomy was performed on eyes with secondary angle-closure and pupillary block glaucoma associated with BD. The pretreatment and post-treatment intraocular pressures (IOP) and the number of antiglaucoma medications were compared by Mann-Whitney U test. RESULTS: The study consisted of 16 eyes of 11 patients (2 female, 9 male, mean age 39.2+/-8.9 years). Post-treatment follow-up ranged from 6 to 36 months (mean 13.8+/-8.9). The mean IOP was 21.6+/-2.5 mmHg on 2.5+/-0.6 medications before iridotomy. IOP reduced to 17.7+/-2.5 mmHg on 1+/-0.6 medications at the first month and 17.1+/-3.2 mmHg on 1.7+/-0.9 medications at the sixth month of treatment. The differences between IOP and number of antiglaucoma medications at baseline and at the sixth month of the treatment was statistically significant (p<0.00001). For four eyes trabeculectomy with mitomycin C and for one eye Ahmed valve implantation were performed in the follow-up period. CONCLUSIONS: Nd:YAG laser iridotomy can provide reduction of IOP and the number of antiglaucoma medications in selected cases with secondary glaucoma associated with Behcet's disease.     

Controversies in Behçet disease

Beh?et disease (BD) is a common, complex, and severely debilitating systemic vasculitis. Despite an increasing understanding of BD overall, there remain many critical questions to be addressed in terms of the epidemiology, pathophysiology, and treatment of this condition. The opinions of uveitis experts related to these issues were recently surveyed and are summarized herein. The survey results revealed significant disparities between responders in terms of important concepts regarding the clinical features, diagnosis, and treatment of this important inflammatory eye disease.     

Behçet disease

The authors show this multisystem inflammatory illness and present history, epidemiology, prevalence, symptoms, diagnostic criteria proposed by "The Beh?et's Disease Research Committee of Japan" and "The International Study Group for Beh?et Disease", evolution, prognosis and the most new drugs in the treatment.     

Orbital inflammation associated with Behçet's disease

Herein a case of a 35‐year‐old woman with a history of Behçet's disease, who presented with swelling and redness of her right eye with increasing pain, is reported. Computed tomography and magnetic resonance imaging showed enlargement of the right lacrimal gland and contrast enhancement of the extraocular muscles. A diagnosis of orbital inflammation was made and the patient was treated with corticosteroids, with prompt resolution of symptoms and clinical signs. Orbital inflammation should be considered as an ophthalmic manifestation of Behçet's disease.     

Choroidal tuberculoma in a patient with ocular Behçet disease

Behçet disease is a chronic relapsing inflammatory disease affecting many different organs. Ocular involvement is quite common in the course of Behçet disease and is frequently manifested by bilateral panuveitis and retinal vasculitis. Medications such as corticosteroids and immunosuppressive agents are used to reduce inflammation in patients with posterior or panuveitis. Chronic immunosuppression is a risk factor for systemic infections. We report a case of choroidal tuberculoma associated with tuberculosis in a patient with ocular Behçet disease. A 25-year-old female with known ocular Behçet disease contracted tuberculosis 3 months earlier. She had been receiving methotrexate and oral steroids. Funduscopy of the left eye revealed a choroidal tuberculoma located superonasally to the optic disc. Fluorescein angiography showed a central area of hypofluorescence surrounded by a hyperfluorescent zone. Since she was already receiving antituberculosis treatment combined with oral steroids, the same treatment was continued. Diagnosis of the other diseases that may cause uveitis in patients with Behçet disease should not be missed. This is especially important since immunosuppressive drugs, that cause an increased incidence of systemic infections, are the common treatment of choice for patients with Behçet disease.     

Retinal vein involvement in 2 patients with Behçet disease

Two patients with Behçet disease had retinal vein involvement, an uncommon finding. A 23-year-old man had dilated, tortuous retinal veins and uveitis in the left eye; oral aphthae; and ulceration of the colon. A 52-year-old man had a swollen optic disc, yellowish exudates around the retinal vessels, retinal hemorrhages, and uveitis in the right eye; oral aphthae; skin lesions; and genital ulceration.     

Acute optic neuropathy in Behçet disease

PURPOSE: To report a patient with Behcet disease presenting with acute optic neuropathy. METHODS: A 47-year-old man was admitted to the authors' clinic owing to sudden visual loss in the left eye. Ophthalmologic and systemic examinations were performed. RESULTS: Visual acuity was 4/10 in the left eye. Fundus examination demonstrated swollen optic disc with blurred margins. There was relative afferent pupil defect in the same eye. Mega-dose corticosteroid treatment was started with the diagnosis of acute optic neuropathy. Ocular findings resolved within 2 weeks. CONCLUSIONS: Beh?et disease rarely presents with acute optic neuropathy.     

Behçet disease presenting with frosted branch angiitis

The authors present a case of Beh?et disease presenting with frosted branch angiitis. Frosted branch angiitis is a rare clinical finding and there are only two reported cases in the literature associated with Beh?et disease.     

Aqueous humor nitric oxide levels in patients with Behçet disease

PURPOSE: The purpose of this study was to quantify aqueous humor nitric oxide levels in patients with Beh?et uveitis and age-matched controls to assess how nitric oxide is involved in this ocular condition. METHODS: Samples of aqueous humor were collected from 11 patients with Beh?et uveitis who were undergoing cataract surgery. Sampling was done by paracentesis at the beginning of the operation. Similar samples were collected from 20 age-matched normal patients (controls). For each sample, we used the spectrophotometric method based on the Griess reaction to determine the amount of nitrite, which is the stable metabolite of nitric oxide. RESULTS: The amount of nitrite in aqueous humor samples from patients with Beh?et disease was above the detection limit in 8 of 11 cases; the mean level +/- SEM was 2.13 +/- 0.621 micromol/L. Levels in the control group were below the detection limit in all cases (<0.08 micromol/L). There was a statistically significant difference between the aqueous humor nitrite levels in patients with Beh?et disease and those in controls (P = 0.00002). CONCLUSIONS: Aqueous humor nitric oxide levels are elevated in patients with a history of Beh?et disease.     

Retinal tears associated with panuveitis and Behçet's disease

To report retinal tears formation in 3 eyes of 2 patients with active panuveitis and Beh?et's disease. We describe 2 patients that were diagnosed and treated for Beh?et's disease with active panuveitis. Retinal tears developed while the inflammation was active. The patients were treated with topical, oral steroids, and cyclosporine therapy for bilateral panuveitis. One patient presented with a retinal tear located at the periphery of the active retinal lesion. The other had multiple tears associated with active retinal lesions in both eyes. Argon laser photocoagulation was performed in both patients as soon as the tears were detected. Ocular inflammation was controlled with this therapy, and only a few mild flare-ups occurred. The patients have been followed up for 8 and 16 months, respectively. During this period no new retinal tears have developed. Although retinal tear formation is rarely associated with Beh?et's panuveitis, the clinician should be aware of this as a possible complication. When structural changes are present in the vitreous, detailed ophthalmoscopy is indicated to assess for retinal tears. If a tear is detected in a patient with panuveitis and Beh?et's disease, laser photocoagulation therapy should be performed immediately to prevent retinal detachment.     

Serum haptoglobin levels in ocular Behçet disease and acute phase proteins in the course of Behçet disease

PURPOSE: Changes in concentrations of acute phase proteins in the serum of patients might be significant in the pathogenesis of Beh?et disease. This report investigates the association between ocular disease activity and serum haptoglobin levels in patients with Beh?et disease, and summarizes the current understanding of the correlation between acute phase proteins and Beh?et disease based on both personal studies and data from the literature. METHODS: Thirty patients with Beh?et disease with ocular involvement and 15 healthy subjects were included in the study. Of the 30 patients, 14 had acute uveitis and 16 had inactive ocular involvement at the time of enrollment. RESULTS: There was a significant difference in haptoglobin levels between the patients with active ocular disease and controls (p=0.0005). There was also a significant difference in haptoglobin levels between the patients with inactive ocular disease and control subjects (p<0.0001). However, no significant difference was observed among patients with active versus inactive uveitis with regard to serum haptoglobin levels. CONCLUSIONS: Higher serum haptoglobin levels in patients with Beh?et disease compared to control subjects were obtained. However, elevated serum haptoglobin levels do not seem to be a risk factor for uveitis activity. Beh?et disease is generally diagnosed by physical examinations and no laboratory marker has been widely accepted for follow-up of disease activity.