Behçet's disease (BD) is a chronic disorder characterized by relapsing uveoretinitis, oral and genital ulceration, and skin lesions. Long-term complications of ocular BD include vitreous hemorrhage, vitreous opacification, retinal pigmentary epithelium atrophy, cystoid macular edema, macular hole, optic disc neovascularization, and optic nerve atrophy.1, 2 Retinal tear is a rare consequence of ocular BD.3 Here, we report a case of BD presenting with retinal tear and panuveitis.
A 31–year-old male admitted for an acute visual loss accompanying photopsias. He had a history of oral and genital ulcers, arthralgia, and erythema nodosum. Snellen visual acuity was 0.3 (OD) and hand motions (OS). Refractive error was low myopic astigmatism. Ophthalmic examination of both eyes revealed keratic precipitates, 2+ cells in the anterior chamber and vitreous. Fundus examination showed retinal vasculitis and a fresh horseshoe retinal tear at the 10 o'clock position in the right eye (Figure 1a). A small amount of subretinal fluid was observed around the tear. No vitreous traction was detected at the edges of the tear. Detailed fundus examination revealed no retinal degenerations. Topical and oral steroids with oral cyclosporine were started. Prophylactic laser treatment was applied around the tear (Figure 1b). On the follow-up, no additional tear formation was detected.
The characteristic posterior segment lesion of BD is retinal vasculitis, which may involve both veins and arteries. Occasionally, secondary neovascularization and rhegmatogenous/traction breaks and/or exudative and rhegmatogenous/traction retinal detachment may develop. Retinal breaks associated with uveitis have been shown in a few cases, including BD besides toxoplasmic chorioretinitis, and familial Mediterranean fever.3, 4, 5 As known, retinal tears may occur when the vitreous detaches posteriorly and reaches a point of firm attachment to the retina. Vitritis and posterior vitreous detachment are both frequent findings of ocular BD. Akova et al3 have demonstrated retinal tears in two cases during the active phase of panuveitis in BD. In our case, retinal tear and panuveitis were detected at the initial examination. To conclude, in severe panuveitis or vitritis, peripheral retina and vitreous base examination should be performed to exclude retinal breaks whose symptoms may be masked by the uveitis.
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Örnek, K., Onaran, Z., Ergin, A. et al. Ocular Behçet's disease presenting with retinal tear and panuveitis. Eye 22, 1450–1451 (2008) doi:10.1038/eye.2008.56
BMC Ophthalmology (2014)