الفهرس 
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Abstract
It was suggested that loss of VA and structural ocular complications are very frequent in BD-associated uveitis involving the posterior segment, but not that frequent when disease is limited to anterior uveitis or scleritis (Oktay etal., 2008).
BD-associated posterior uveitis (PU) with or without associated retinal vasculitis, has a relapsing and remitting clinical course with frequent occurrence of ocular complications such as cataract, cystoid macular edema, retinal detachment, papillitis, and intraretinal/subretinal hemorrhages, with progressive worsening of visual function leading to blindness in up to 25% of patients (Chung etal .,1986 ).
Over a 30-year period, a trend toward improvement of prognosis has been recorded by treating the disease with high -dose corticosteroids (CS) combined with traditional immunosuppressive drugs including methotrexate, cyclosporine (CsA), azathioprine (AZA), and cyclophosphamide. However, PU may be particularly resistant to CS and immunosuppressants with rapid progression to vision loss in 10%–25% of cases (Pato etal., 2010).
This study was designed to assess the efficacy and safety of Infliximab therapy in treatment of ocular manifestations in patients with Behcet’s disease, namely BD-associated refractory posterior uveitis .Twenty patients with refractory Behcet uveitis were included in this study, Seventeen of the Twenty involved patients (85%) were males, with female: male ratio 1:5.6 The mean age of all patients was 31.8 ± 9.1 years, the mean age of onset of other manifestations of BD were 23.8 ± 6.1 years, with mean disease duration of 8 ± 6 years, while the mean age on onset of the uveitis in those patients was 23.7 ± 6 years.
Our results showed that, Regarding visual acuity: by the end of week 8 ( induction), we observed a highly significant improvement inVA (right eyes: 0.10.09 vs 0.6 0.2, P 0.001) (Left eyes: 0.10.17 vs 0.6 0.3, P 0.001) , and by the end of week 32 there was further improvement in VA ,( right eyes: 0.60.2 vs 0.8 0.2, P 0.001) ,( Left eyes: 0.60.3 vs 0.8 0.2, P 0.001) ,but this improvement was nearly the same by the end of week 58,( right eyes: 0.80.2 vs 0.8 0.2) ( Left eyes: 0.80.2 vs 0.8 0.2).It was noted that improvement in VA was more evident in group A than in group B (P<0.05). At the end of a follow-up of 12 months, 16/20 (80%) patients showed a complete remission, 4/20(20%) showed partial response,none of the patients were non-responders. All of the patients (20) who were taking corticosteroids were able to stop it by week 22 during infliximab treatment, and all showed a reduction in extraocular manifestations of Behçet’s disease. None of the patients had worsening VA or new onset ocular complications.
We recommend that:
Infliximab seems to be a useful alternative therapy for patients with sight-threatening uveitis unresponsive to the standard immunosuppressive therapy.
Infliximab can be used as a pulse therapy for rapid control of acute attack of uveoretinitis .
Infliximab can be used as a first-line medication in bilateral OBD, unilateral cases with visual acuity below (6/60) may also need initial infliximab infusion as the first-line drug.
Repeated long-term infliximab infusions were proved to be more effective in reducing the number of episodes in refractory uveoretinitis with faster regression and complete remission of complications.
Azathioprine can be used as a long-term therapy to control recurrent attacks upon first suppression of ocular inflammation by biologicals. .
Further studies should be carried on a large scale in a prospective control manner
Limitations
we compared the patient retrospectively regarding VA and disease manifestations.
Cost of the drug, which is prohibitive in many circumstances.