Donald Tran, Sophie Rogers, Lyndell L. Lim

Purpose: Persistent, blinding uveitis is a frequent mani- festation of Behcet’s disease (BD), a multisystem vasculi- tis. However, the diagnosis may be delayed if other systemic features are not apparent at first ocular presentation. Here, we assessed how often this occurs and whether this resulted in poorer visual outcomes.

Method: Retrospective case series of patients from the Royal Victorian Eye and Ear Hospital from 1990 – 2018 who met the revised International Criteria for Behcet’s Disease (ICBD).

Results: Forty-two patients (33 males; median age 30 years) were followed-up for a median of 6.4 years. Most patients (N = 28) developed ocular disease prior to non-ocular symptoms. Twenty-seven patients met ICBD criteria at first ocular presentation (Group A) and the commonest systemic manifestations were oral (N = 25) and genital ulcers (N = 8). During follow-up, oral ulcers (N = 14) was the most frequent feature leading to ICBD fulfilment in fourteen patients (Group B) over a median of 14 days (interquartile range 5 – 438). Mean logMAR visual acuity of the worse eye at initial presentation, and at one and five years thereafter was 0.651, 0.466 and 0.812 in Group A vs 0.685, 0.329 and 0.996 in Group B (p > 0.5 for all).

Conclusion: Oral ulcers was the commonest systemic manifestation leading to BD diagnosis at first ocular presentation and thereafter. Delayed BD diagnosis did not result in a poorer outcome, however our study was under- powered in this regard. Nonetheless, initial ocular involvement in BD caused significant vision impairment, although good recovery was noted by 5 years of follow-up.