Tugal-Tutkun Ilknur, Onal Sumru, Altan-Yaycioglu Rana, Kir Nur, Urgancioglu Meri
Department of Ophthamology, Istanbul University, Istanbul Faculty of Medicine, Turkey.
Jpn J Ophthalmol. 2006 May-Jun;50(3):256-65. doi: 10.1007/s10384-005-0307-8.
To investigate the mechanisms involved in the development of neovascularization of the optic disc (NVD) in Behçet's disease and to evaluate the effects of medical and laser treatments.
This is a retrospective study of 26 consecutive Behçet's patients (38 eyes) with NVD who presented between 1990 and 2004 at our university hospital. Information on age at presentation, sex, disease duration, laterality of NVD, ocular findings, fluorescein angiographic findings, visual acuity, medical treatment, laser photocoagulation, surgical procedures, and the follow-up period was collected. Eyes with diffuse capillary leakage on fluorescein angiography were defined as having inflammation-induced NVD, and eyes with extensive retinal capillary nonperfusion were defined as having ischemia-induced NVD.
Eighteen patients were male, and eight were female. Mean age at presentation was 25.4 +/- 4.9 years. Median disease duration was 5.5 months. Median follow-up was 24 months. Twelve patients had bilateral NVD; 14 had unilateral NVD. Inflammation-induced NVD was seen in 87% of the eyes, and ischemia-induced NVD in 13%. Initial treatment with high-dose corticosteroids combined with conventional immunosuppressive agents was effective in 45% of the eyes with inflammation-induced NVD. Retinal laser photocoagulation was effective in three of five eyes with ischemia-induced NVD. Treatment with interferon alpha-2a resulted in resolution of NVD in all seven patients who received this agent for inflammation- or ischemia-induced persistent NVD. Final visual acuity was less than 0.1 in 24% of the eyes.
Inflammatory mechanisms seem to predominate in the pathogenesis of NVD in Behçet's disease. The results of this study suggest that the response to intensive anti-inflammatory and conventional immunosuppressive treatment is not satisfactory; retinal laser photocoagulation may be ineffective even in eyes with retinal ischemia, but interferon alpha-2a seems to be effective for the treatment of Behçet's patients with NVD.
研究白塞病视盘新生血管形成（NVD）的发病机制，并评估药物及激光治疗的效果。
这是一项对1990年至2004年间在我校医院就诊的26例连续白塞病患者（38只眼）合并NVD的回顾性研究。收集了患者就诊时的年龄、性别、病程、NVD的单侧或双侧情况、眼部表现、荧光素血管造影结果、视力、药物治疗、激光光凝、手术操作及随访时间等信息。荧光素血管造影显示弥漫性毛细血管渗漏的眼被定义为炎症性NVD，视网膜毛细血管广泛无灌注的眼被定义为缺血性NVD。
18例为男性，8例为女性。就诊时的平均年龄为25.4±4.9岁。病程中位数为5.5个月。随访中位数为24个月。12例患者为双侧NVD；14例为单侧NVD。87%的眼为炎症性NVD，13%为缺血性NVD。高剂量皮质类固醇联合传统免疫抑制剂的初始治疗对45%的炎症性NVD眼有效。视网膜激光光凝对5只缺血性NVD眼中的3只有效。干扰素α-2a治疗使所有7例因炎症性或缺血性持续性NVD接受该药物治疗的患者的NVD消退。24%的眼最终视力低于0.1。
炎症机制似乎在白塞病NVD的发病机制中占主导地位。本研究结果表明，强化抗炎和传统免疫抑制治疗的反应并不令人满意；视网膜激光光凝即使在视网膜缺血的眼中也可能无效，但干扰素α-2a似乎对白塞病合并NVD的患者有效。
