J Korean Ophthalmol Soc.  2019 Feb;60(2):195-200. 10.3341/jkos.2019.60.2.195.

Intravitreal Dexamethasone Implantation in a Behcet's Disease Patient with Macular Edema, Vasculitis after Cataract Surgery

• Lee JY
• Ra H
• Kim EC
• Kang NY
• Baek JW

• KMID: 2438081
• DOI: http://doi.org/10.3341/jkos.2019.60.2.195

Abstract

PURPOSE
To report a case of macular edema and retinal vasculitis treated with intravitreal dexamethasone implantation in a Behcet's disease patient after cataract surgery.
CASE SUMMARY
A 26-year-old male with Behcet's disease, without recurrence of uveitis for 3 months, underwent phacoemulsification and posterior chamber intraocular lens implantation for a cataract in the left eye. The preoperative best corrected visual acuity (BCVA) of the left eye was 0.15. At day 1 after surgery, his BCVA was 0.4, and slit lamp examination of his left eye revealed a mild anterior chamber reaction. At 1 week after surgery, he presented with left vision impairment, his BCVA was 0.04, and mild inflammation was observed in both the anterior chamber and the vitreous in his left eye. Unilateral macular edema was confirmed with optical coherence tomography, and fluorescein angiography revealed retinal vasculitis on the fovea and peripheral retina. Intravitreal dexamethasone implantation was performed in his left eye, 1 month after treatment, the macular edema and retinal vasculitis had improved, and the BCVA of his left eye was 0.8.
CONCLUSIONS
In patients with Behcet's disease, intravitreal dexamethasone implantation can be an effective treatment option for macular edema and retinal vasculitis after cataract surgery.

Keyword

Behcet disease; Dexamethasone; Macular edema; Vasculitis

MeSH Terms

Adult
Anterior Chamber
Behcet Syndrome
Cataract*
Dexamethasone*
Fluorescein Angiography
Humans
Inflammation
Lens Implantation, Intraocular
Macular Edema*
Male
Phacoemulsification
Recurrence
Retina
Retinal Vasculitis
Slit Lamp
Tomography, Optical Coherence
Uveitis
Vasculitis*
Visual Acuity
Dexamethasone

Figure

• 

  Figure 1 Ultra-widefield fundus photographs and ultra-widefield fluorescein angiographic images in both eyes. Fundus photographs shows vitreous opacity (A, B). Fluorescein angiographic images shows diffuse perivascular leakage (fern-like appearance) (C, D).

• 

  Figure 2 Ultra-widefield fundus photograph, optical coherence tomographic image and ultra-widefield fluorescein angiographic images in left eyes. (A) Fundus photograph shows vitreous opacity and retinal hemorrhage at parafovea and ischemia in the left eye. (B) Optical coherence tomography shows severe macular edema in the left eye. (C-E) Fluorescein angiograph shows diffuse perivascular leakage.

• 

  Figure 3 Ultra-widefield fundus photograph, optical coherence tomographic image in left eye. Fundus photograph (A) and optical coherence tomography (B) of the left eye show improved macular edema and vasculitis after 1 month after intravitreal dexamethasone implantation.

Reference

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

2. Bang D, Lee JH, Lee ES, et al. Epidemiologic and clinical survey of Behcet's disease in Korea: the first multicenter study. J Korean Med Sci. 2001; 16:615–618.

3. Park JW, Koh HJ, Kim HB. Behcet's disease in Korean. J Korean Ophthalmol Soc. 2002; 43:67–74.

4. Kadayifçilar S, Gedik S, Eldem B, Irkeç M. Cataract surgery in patients with Behçet’s disease. J Cataract Refract Surg. 2002; 28:316–320.

5. Khairallah M, Accorinti M, Muccioli C, et al. Epidemiology of Behçet disease. Ocul Immunol Inflamm. 2012; 20:324–335.

6. Zierhut M, Abu El-Asrar AM, Bodaghi B, Tugal-Tutkun I. Therapy of ocular Behçet disease. Ocul Immunol Inflamm. 2014; 22:64–76.

7. Yazici H, Pazarli H, Barnes CG, et al. A controlled trial of azathioprine in Behcet's syndrome. N Engl J Med. 1990; 322:281–285.

8. Masuda K, Nakajima A, Urayama A, et al. Double-masked trial of cyclosporin versus colchicine and long-term open study of cyclosporin in Behcet's disease. Lancet. 1989; 1:1093–1096.

9. Coşkun E, Celemler P, Kimyon G, et al. Intravitreal dexamethasone implant for treatment of refractory Behçet posterior uveitis: one-year follow-up results. Ocul Immunol Inflamm. 2015; 23:437–443.

10. Hu K, Lei B, Kijlstra A, et al. Male sex, erythema nodosum, and electroretinography as predictors of visual prognosis after cataract surgery in patients with Behçet disease. J Cataract Refract Surg. 2012; 38:1382–1388.

11. Ram J, Gupta A, Kumar S, et al. Phacoemulsification with intraocular lens implantation in patients with uveitis. J Cataract Refract Surg. 2010; 36:1283–1288.

12. Alfawaz A, Alrashidi S, Kalantan H, et al. Cataract surgery under systemic infliximab therapy in patients with refractory uveitis associated with Behcet disease. Ann Saudi Med. 2014; 34:328–333.

13. Süllü Y, Oge I, Erkan D. The results of cataract extraction and intraocular lens implantation in patients with Behcet's disease. Acta Ophthalmol Scand. 2000; 78:680–683.

14. Bang DS, Oh SH, Lee KH, et al. Influence of sex on patients with Behcet's disease in Korea. J Korean Med Sci. 2003; 18:231–235.

15. 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.