Materials And Methods

All BD patients having ocular manifestations and being treated consequently, are registered in the Behget's Disease Ocular Treatment Registry (BDOTR). In January 2002, there were 1009 patients who received 1274 different treatment protocols. Patients resistant to one treatment protocol were switched to another one, and further, if still non-responding. These treatment protocols were: High dose pulse cyclophosphamide (PCP) 359 patients, low dose pulse cyclophosphamide (LDP) 181 patients, oral cyclophosphamide (OCP) 41 patients, methotrexate (MTX) 348 patients, chlorambucil (CHL) 89 patients, cyclosporine A (CyA) 24 patients, azathioprine (AZA) 106 patients, combination with LDP-MTX (LDP-MTX) 91 patients, high dose MTX (HMTX) 23 patients, and combination of LDP and AZA (LDP-AZA) 12 patients.

It was previously demonstrated that all different protocols had approximately the same efficacy on ocular lesions in BD3-5. Therefore, all patients of the registry were enrolled in this study.

Patients were divided into male and female. In each group the visual acuity (VA) before and after the treatment was calculated by the Snellen chart on a scale of 10/10. An activity index was calculated for anterior uveitis (AU), posterior uveitis (PU), and retinal vasculitis (RV) upon the inflammatory state of each eye. Each of the inflammatory parameters was graded from zero (none) to 4 (highest degree of inflammation). These indices were determined as follows. For AU: cells, flares, keratic precipitates, and hypopyon. For PU: cells, snow ball and snow banking. For RV: periarteritis, periphlebitis, edema of disk, edema of macula, edema of retina, papillitis, and active peripheral lesions.

Student t test was used to compare the mean VA and different activity indices.

The mean VA, AU, PU, and RV before the treatment were compared in male and female patients to investigate if males presented a more severe involvement than females. Then, the mean improvement for each parameter was compared in male and females patients to find if males had the more resistant disease to treatment than females.

3. RESULTS

3.1 Group comparison at the entry

Both groups were similar regarding the mean duration of the eye disease (33 months for men versus 32.9 months for women) and the mean treatment time (18.5 months for men versus 20.6 months for women).

3.2 Severity of eye lesions in men and women before the treatment

In men, 212 eyes had a normal visual acuity (VA) before the treatment and remained normal during the treatment, while 946 eyes had an impaired VA and were selected for the calculations. The mean VA before the treatment was 3.6/10, the standard deviation (SD) was 3.6, and the confidence interval (CI) at 95% was 0.2. In women, 128 eyes had a normal VA before the treatment and remained normal during the treatment, while 643 eyes had an impaired VA and were selected for the calculations. The mean VA was 4.2/10, SD was 3.6, and CI was 0.3. Comparison of the VA between men and women by the Student t test demonstrated a t value of 3.259 with a degree of freedom (DF) of 1587. The difference was statistically significant with a p value of 0.0012 (Table 1).

Table 1. Severity of eye lesions in men and women

MEN

WOMEN

P

Visual Acuity

3.6

4.2

0.0012

Anterior Uveitis

2.5

2.4

0.51

Posterior Uveitis

2.1

2,0

0,20

Retinal Vasculitis

2.5

2.3

0.19

Anterior uveitis (AU) was absent in men in 575 eyes before the treatment and remained absent during the treatment, while 577 eyes had AU and were selected for the calculations. In women, AU was absent in 381 eyes before the treatment and remained absent during the treatment, while 391 eyes had AU and were selected for the calculations. In men the mean activity index for AU before the treatment was 2.5, SD was 2.4, and CI was 0.2. In women the mean AU was 2.4, SD was 2.2, and CI was 0.2. Comparison of AU between men and women by t test showed a t value of 0.657 with a DF of 966. The difference was not statistically significant, the p value was 0.51.

Posterior uveitis (PU) was absent in men in 245 eyes before the treatment and remained absent during the treatment, while 809 eyes had PU and were selected for the calculations. In women, PU was absent in 184 eyes before the treatment and remained absent during the treatment, while 526 eyes had PU and were selected for the calculations. In men the mean activity index for PU before the treatment was 2.1, SD was 1.5, and CI was 0.1. In women the mean PU was 2, SD was 1.2, and CI was 0.1. Comparison of PU between men and women by t test showed a t value of 1.284 with a DF of 1333. The difference was not statistically significant, the p value was 0.20.

Retinal vasculitis (RV) was absent in men in 299 eyes before the treatment and remained absent during the treatment, while 649 eyes had RV and were selected for the calculations. In women, RV was absent in 237 eyes before the treatment and remained absent during the treatment, while 410 eyes had RV and were selected for the calculations. In men the mean activity index for RV before the treatment was 2.5, SD was 2.4, and CI was 0.2. In women the mean RV was 2.3, SD was 2.5, and CI was 0.2. Comparison of RV between men and women by t test showed a t value of 1.298 with a DF of 1057. The difference was not statistically significant, the p value was 0.19.

3.3 Improvement of eye lesions in men and women after the treatment

The mean VA in men improved from 3.6 to 4.4. Comparison of the VA before and after the treatment by the Student paired t test demonstrated a t value of 7.332. The difference was statistically significant with a p value <0.000001 (Table 2). The mean VA in women improved from 4.2 to 5.2. Comparison of the VA before and after the treatment by the Student paired t test demonstrated a t value of 6.838. The difference was statistically significant with a p value <0.000001. The mean improvement in VA for men was 0.8 and for women 1.

Table 2, Mean improvement after the treatment in men and women

MEN

WOMEN

Visual Acuity

0.8

1

Anterior Uveitis

1.7

1.7

Posterior Uveitis

1.1

1.2

Retinal Vasculitis

1

0.9

The mean AU in men improved from 2.5 to 0.8. Comparison of AU before and after the treatment by the Student paired t test demonstrated a t value of 14.027. The difference was statistically significant with a p value <0.000001. The mean AU in women improved from 2.4 to 0.7. Comparison of AU before and after the treatment by the Student paired t test demonstrated a t value of 12.31. The difference was statistically significant with a p value <0.000001. The mean improvement in AU for men was 1.7 and for women 1.7.

The mean PU in men improved from 2.1 to 1. Comparison of PU before and after the treatment by the Student paired t test demonstrated a t value of 19.47. The difference was statistically significant with a p value <0.000001. The mean PU in women improved from 2 to 0.8. Comparison of PU before and after the treatment by the Student paired t test demonstrated a t value of 19.612. The difference was statistically significant with p<0.00000l. The mean improvement in PU for men was 1.1 and for women 1.2.

The mean RV in men improved from 2.5 to 1.5. Comparison of RV before and after the treatment by the Student paired t test demonstrated a t value of 8.759. The difference was statistically significant with a p value <0.000001. The mean RV in women improved from 2.3 to 1.4. Comparison of RV before and after the treatment by the Student paired t test demonstrated a t value of 6.552. The difference was statistically significant with a p value <0.000001. The mean improvement in RV for men was 1 and for women 0.9.

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