How Much Improvement is Expected in Ocular Lesions of Behcet's Disease Treated with Pulse Cyclophosphamide?

Background: the natural history of ocular lesions in behcet'sdisease is toward severe loss of vision/blindness in few years,whereas cytotoxic drugs have changed the outcome, severalopen labeled cohort studies showed pulse cyclophosphamide(pcp) to be the best choice. since one third of these patientsare resistant to pcp it is important to know how muchimprovement one can expect from the responders. to addressthis question, we selected patients who improved or maintainedtheir baseline visual acuity after treatment.methods: from a cohort of 528 patients (1056 eyes), 753 eyeswere selected. at the beginning of the study pcp was given forone month as 0.75 to 1 g in perfusion, and then followed every 2to 3 months. prednisolone was also given as 0.5 mglkgldaily andthen tapered upon controlling inflammation. the mean±sd numberof pulses was 11.5±8.5/month with follow-up of 20.6±19.8months. different disease activity indices such as visual acuity,posterior uveitis, retinal vasculitis, total inflammatory activityindex (tiat), total adjusted disease activity index (tadai) werecalculated at baseline and at last evaluation.results: the mean visual acuity improved from 2.4 to 4.4.the mean indices for posterior uveitis, retinal vasculitis, tiaiand tadai improved from 2.2 to 1,2.7 to 1.4, 19.3 to 9. and27.2 to 20.5 respectively. the p value was less than 0.001 forall comparisons.conclusion: pulse cyclophosphamide is able to improveocular lesions of behcet's disease; therefore it may be used as afirst choice, especially in retinal vasculitis