Visual prognosis in Behçet's disease

In the pre-cyclosporin therapy era, BenEzra and Cohen(1) reported an appalling visual prognosis of patients with Behçet's disease, with 74% of eyes losing useful vision six to ten years after diagnosis. This experience was in a population largely of Mediterranean origin and it has been suggested that different ethnic groups may have different rates of ocular disease progression. In addition, newer immunosuppressive agents, e.g. cyclosporin, have been widely used in the last few years in the acute management of patients with Behçet's disease though their long term effect on the visual prognosis has not been established. The authors report the visual findings in a cohort of 28 patients of mixed ethnic extraction with Behçet's disease and ocular involvement who have been followed-up for an average of six years. Posterior segment disease relapse was treated aggressively with high dose corticosteroids, cyclosporin, azathioprine, cyclophosphamide, or chlorambucil in varying combinations. At present, approximately 60% of patients have visual acuity of ± 6/9 in the better eye, 21% are 6/12 to 6/60, and 18% worse than 6/60. These findings, albeit relatively short term at present, are encouraging enough to continue this aggressive therapeutic management in the belief that the depressing figures in the literature reflect the past and not the present.