Visual prognosis of Behçet's uveitis patients in China and its associated factors

Behçet's disease (BD) is a chronic, relapsing, multisystem inflammatory disorder, with ocular involvement being a major cause of irreversible visual impairment. Behçet's uveitis (BU) often presents as bilateral, recurrent, non-granulomatous panuveitis with occlusive retinal vasculitis. Despite advances in immunosuppressive and biologic therapies, long-term visual outcomes remain variable, and factors associated with poor prognosis, particularly in Chinese populations, are not well defined.

We conducted a retrospective cohort study of 153 Chinese patients (268 eyes) with BU at Peking Union Medical College Hospital from February 2003 to February 2023. Clinical records, ocular examinations, and systemic manifestations were reviewed. The primary endpoint was severe visual impairment (best-corrected visual acuity [BCVA] <20/200) at the final follow-up. Secondary endpoints included ocular complications and their impact on visual outcomes. Kaplan-Meier survival analysis and mixed-effects logistic regression (accounting for inter-eye correlation) were used to evaluate risk factors for poor visual prognosis.

Among the cohort, 77.8% were male, and bilateral involvement occurred in 84.3%. Median follow-up was 30 months. Panuveitis was the predominant form (90.3%), and cataract (64.9%) and macular edema (63.1%) were the most common complications. At final follow-up, 25.4% of eyes had BCVA <20/200. Kaplan-Meier analysis showed cumulative risk of severe visual loss of 3.5% at 1 year, 11.0% at 2 years, 19.2% at 5 years, and 41.4% at 10 years. Male patients experienced visual impairment earlier than females. Mixed-effects logistic regression identified macular damage (p=0.027, OR = 3.70) and optic nerve atrophy (p<0.001, OR = 6.47) as significant predictors of poor visual outcomes, while complete-type BD showed a trend toward association (p=0.072, OR = 2.00). Systemic disease severity was not significantly associated with visual prognosis.

In this Chinese cohort with BU, irreversible ocular structural damage, particularly macular damage and optic nerve atrophy, was the primary determinant of long-term visual outcomes. Systemic disease severity had limited predictive value. Despite improvements compared with historical data, these findings highlight the critical importance of early recognition and effective management of posterior segment inflammation to prevent permanent visual impairment.