Use of Ultrasound Biomicroscopy, Indocyanine Green Angiography and HLA-B51 Testing as Adjunct Methods in the Appraisal of Behçet's Uveitis

Abstract

Purpose: Behçet's uveitis is not common in western Europe and thedisease presentation is less obvious than in ``endemic'' countries such as Turkeyand Japan. This makes the diagnosis more difficult. Early diagnosis is important,as the prognosis is better if therapy is started early. New methods such as ultrasoundbiomicroscopy (UBM) and indocyanine green angiography (ICGA) can improve thecharacterisation and diagnosis of uveitis. Our purpose was to present our experiencewith these new methods as well as HLA-B51 testing in the appraisal of patients withBehçet's uveitis.Patients and Methods: Patients seen by the authors between 1997 and 2001with Behçet's uveitis or suspected Behçet's uveitis and who underwentICG angiography or UBM were included. Symptoms and signs, results of laboratorywork-up including HLA-B51 antigen testing and the delay to diagnosis, were analysed.Fluorescein and ICG angiography and UBM testing were performed according tostandard protocols used for uveitis patients and their contribution towards diagnosisand management were analysed.Results: Uveitis was non granulomatous in all patients. Fluorescein angiography showed moderate to severe diffuse retinal vasculitis compatiblewith Behçet's uveitis in all cases. HLA-B51 testing was positive in 5 of 7tested cases, being useful to orient the diagnosis. UBM contributed to thediagnosis in all five tested cases, being the determining element in 3 patients.It allowed redirection of the diagnosis from pars planitis to Behçet's in 2patients with poorly transparent media because it failed to show the typicalpars planitis deposits. In a case originally diagnosed as Behçet's it allowedcorrection of the diagnosis to pars planitis because of the presence of the typicalUBM pars plana depositis. ICG angiography allowed detection of choroidalvasculitis in all five tested cases.Conclusions: In Behçet's patients who did not present with a full-blownclinical picture, as they are often seen in non-endemic areas, UBM examinationand HLA-B51 testing were valuable additional diagnostic elements helping toredirect the diagnosis correctly and to reduce the diagnostic delay in these patients.The hitherto unknown choroidal vasculitis shown by ICG angiography in all fiveinvestigated patients indicates that choroidal involvement probably occurs in mostnewly diagnosed Behçet's patients.