[Uveitic glaucoma in Behçet's disease: When everything gets complicated]. / Glaucome uvéitique dans la maladie de Behçet : quand tout se complique .

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.

[Prognostic factors of ocular involvement in Behçet's disease]. / Facteurs pronostiques de l'atteinte oculaire dans la maladie de Behçet.

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.