Behçet uveitis: Current practice and future perspectives

Area of Science:

• Ophthalmology and Immunology
• Autoinflammatory Diseases
• Microbiome Research

Background:

• Behçet's Disease (BD), historically known as 'The Silk Road Disease,' is characterized by recurrent oral and genital ulcers, and uveitis.
• BD uveitis is a leading cause of non-infectious autoinflammatory eye disease, with increasing prevalence beyond its traditional demographics.
• Understanding the pathophysiology, particularly the role of the human microbiome, is crucial for advancing BD research.

Purpose of the Study:

• To provide a comprehensive review of Behçet's Disease (BD), focusing on ocular manifestations and recent advancements.
• To detail diagnostic approaches, including updated classification criteria and imaging techniques.
• To explore current and emerging therapeutic strategies, including biologic agents and their comparison with conventional treatments.

Main Methods:

• Literature review of clinical features, pathophysiology, diagnostic methods, and treatment strategies for Behçet's Disease.
• Inclusion of recent research on the human microbiome's role in BD pathogenesis.
• Analysis of advanced diagnostic imaging, specifically Optical Coherence Tomography (OCT) variants (SD, EDI, OCT-angiography).

Main Results:

• Detailed clinical features of BD, including juvenile-onset forms, and updated diagnostic algorithms.
• Emphasis on the evolving understanding of BD pathophysiology, incorporating microbiome research.
• Overview of therapeutic options, contrasting biologic agents (TNF-α, IL-6, IL-1 inhibitors) with corticosteroids and immunosuppressants.

Conclusions:

• Recent advancements in diagnostics (OCT) and therapeutics (biologics) have significantly improved BD management.
• The human microbiome is increasingly recognized as a key factor in BD pathogenesis.
• The review addresses the impact of the SARS-CoV-2 pandemic on BD, including morbidity, treatment, and post-vaccine complications.