Korean J Ophthalmol.  2018 Aug;32(4):290-295. 10.3341/kjo.2017.0139.

Choroidal Thickness Indicates Subclinical Ocular and Systemic Inflammation in Eyes with Behçet Disease without Active Inflammation

• Chung YR
• Cho EH
• Jang S
• Lee SY
• Lee ES
• Lee K

• KMID: 2418149
• DOI: http://doi.org/10.3341/kjo.2017.0139

Abstract

PURPOSE
To investigate whether subfoveal choroidal thickness, measured using enhanced depth imaging optical coherence tomography (EDI-OCT), is an indicator of subclinical ocular or systemic inflammation in eyes with Behçet disease (BD) without active ocular inflammation.
METHODS
A retrospective analysis was used to examine clinical features of non-uveitic patients with BD (NUBD group), patients with a previous history of Behçet uveitis in an inactive state (IUBD group), and healthy controls were evaluated from October 2014 to September 2015. Subfoveal choroidal thickness was measured using EDI-OCT.
RESULTS
The NUBD group included 46 eyes in 24 patients; the IUBD group included 16 eyes in 11 patients; and the control group included 35 eyes in 23 individuals. The mean subfoveal choroidal thicknesses differed significantly among these groups. Choroidal thickness was significantly greater in the NUBD (310.5 ± 81.0 µm) than in the IUBD (263.1 ± 56.6 µm, p = 0.013) and control (256.9 ± 67.9 µm, p = 0.002) groups. The disease activity score was significantly higher in the NUBD than in the IUBD group (p < 0.001), while the use of cyclosporine was significantly associated with choroidal thickness in eyes with NUBD (p = 0.039).
CONCLUSIONS
Subfoveal choroidal thickness, as measured by EDI-OCT, may be a clinical indicator of subclinical ocular inflammation and systemic inflammation in BD patients without active ocular inflammation.

Keyword

Behcet syndrome; Choroidal thickness; Inflammation

MeSH Terms

Behcet Syndrome*
Choroid*
Cyclosporine
Humans
Inflammation*
Retrospective Studies
Tomography, Optical Coherence
Uveitis
Cyclosporine

Figure

• 

  Fig. 1 Subfoveal choroidal thicknesses in the three groups of eyes. Mean choroidal thickness was significantly greater in the non-uveitic Behçet disease (NUBD) than in the inactive uveitic Behçet disease (IUBD) and control groups.

Reference

1. Tugal-Tutkun I, Onal S, Altan-Yaycioglu R, et al. Uveitis in Behcet disease: an analysis of 880 patients. Am J Ophthalmol. 2004; 138:373–380.

2. Deuter CM, Kotter I, Wallace GR, et al. Behcet's disease: ocular effects and treatment. Prog Retin Eye Res. 2008; 27:111–136.

3. Cingu AK, Onal S, Urgancioglu M, Tugal-Tutkun I. Comparison of presenting features and three-year disease course in Turkish patients with Behcet uveitis who presented in the early 1990s and the early 2000s. Ocul Immunol Inflamm. 2012; 20:423–428.

4. Kazokoglu H, Onal S, Tugal-Tutkun I, et al. Demographic and clinical features of uveitis in tertiary centers in Turkey. Ophthalmic Epidemiol. 2008; 15:285–293.

5. Chung YR, Lee ES, Kim MH, et al. Changes in ocular manifestations of Behcet disease in Korean patients over time: a single-center experience in the 1990s and 2000s. Ocul Immunol Inflamm. 2015; 23:157–161.

6. Yoshida A, Kawashima H, Motoyama Y, et al. Comparison of patients with Behcet's disease in the 1980s and 1990s. Ophthalmology. 2004; 111:810–815.

7. George RK, Chan CC, Whitcup SM, Nussenblatt RB. Ocular immunopathology of Behcet's disease. Surv Ophthalmol. 1997; 42:157–162.

8. Charteris DG, Barton K, McCartney AC, Lightman SL. CD4+ lymphocyte involvement in ocular Behcet's disease. Autoimmunity. 1992; 12:201–206.

9. Atmaca LS, Sonmez PA. Fluorescein and indocyanine green angiography findings in Behcet's disease. Br J Ophthalmol. 2003; 87:1466–1468.

10. Bouchenaki N, Cimino L, Auer C, et al. Assessment and classification of choroidal vasculitis in posterior uveitis using indocyanine green angiography. Klin Monbl Augenheilkd. 2002; 219:243–249.

11. Kim M, Kim H, Kwon HJ, et al. Choroidal thickness in Behcet's uveitis: an enhanced depth imaging-optical coherence tomography and its association with angiographic changes. Invest Ophthalmol Vis Sci. 2013; 54:6033–6039.

12. Ishikawa S, Taguchi M, Muraoka T, et al. Changes in subfoveal choroidal thickness associated with uveitis activity in patients with Behcet's disease. Br J Ophthalmol. 2014; 98:1508–1513.

13. International Study Group for BehCet's Disease. Criteria for diagnosis of Behcet's disease. Lancet. 1990; 335:1078–1080.

14. Suzuki Kurokawa M, Suzuki N. Behcet's disease. Clin Exp Med. 2004; 4:10–20.

15. Mizushima Y. Recent research into Behcet's disease in Japan. Int J Tissue React. 1988; 10:59–65.

16. Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005; 140:509–516.

17. Choi HJ, Seo MR, Ryu HJ, Baek HJ. Validation and reliability of a Behcet's syndrome activity scale in Korea. Korean J Intern Med. 2016; 31:170–175.

18. Nickla DL, Wallman J. The multifunctional choroid. Prog Retin Eye Res. 2010; 29:144–168.

19. Iaccarino G, Cennamo G, Forte R, Cennamo G. Evaluation of posterior pole with echography a nd optical coherence tomography in patients with Behcet's disease. Ophthalmologica. 2009; 223:250–255.

20. Arevalo JF, Lasave AF, Al Jindan MY, et al. Uveitis in Behcet disease in a tertiary center over 25 years: the KKESH Uveitis Survey Study Group. Am J Ophthalmol. 2015; 159:177–184.

21. Grzesk E, Malinowski B, Wicinski M, et al. Cyclosporine-A, but not tacrolimus significantly increases reactivity of vascular smooth muscle cells. Pharmacol Rep. 2016; 68:201–205.

22. Pandey R, Botros MA, Nacev BA, Albig AR. Cyclosporin a disrupts notch signaling and vascular lumen maintenance. PLoS One. 2015; 10:e0119279.

23. Akay F, Gundogan FC, Yolcu U, et al. Choroidal thickness in systemic arterial hypertension. Eur J Ophthalmol. 2016; 26:152–157.

24. Chung YR, Kim JW, Kim SW, Lee K. Choroidal thickness in patients with central serous chorioretinopathy: Assessment of Haller and Sattler Layers. Retina. 2016; 36:1652–1657.

25. Coskun E, Gurler B, Pehlivan Y, et al. Enhanced depth imaging optical coherence tomography findings in Behcet disease. Ocul Immunol Inflamm. 2013; 21:440–445.