Successful repair of combined tractional and rhegmatogenous retinal detachment with pars plana vitrectomy without scleral buckle in severe Behçet's disease

Abstract

Behçet's disease (BD) is amultisystemic, immune-mediated occlusive vasculitis of unknown etiology with a chronic, relapsing remitting course. Ocular involvement is characterized by recurrent nongranulomatous uveitis with necrotizing obliterative vasculitis affecting both the anterior and posterior segments of the eye and often leads to blindness. We describe successful surgicalmanagement of a rare case of combined rhegmatogenous retinal detachment (RRD) and tractional retinal detachment (TRD) in a patient with Behçet's disease. A 28-year-old Hispanic women with known Behcet's disease presented with loss of vision of both eyes. She was found to have extensive bilateral necrotizing vasculitis with severe ischemia. Despite aggressive antivascular endothelial growth factor (VEGF) therapy and pan retinal photocoagulation, patient progressed to total blindness from development of combined rhegmatogenous and tractional funnel retinal detachment. Small gauge pars plana vitrectomy (PPV) with silicone oil tamponade was performed for retinal detachment repair (without scleral buckle). Combined RRD and TRD was successfully treated with standard PPV with silicone oil placement without use of scleral buckle. Visual acuity 1 year postoperatively improved from ability to perceive light to 20/400.Combined forms of retinal detachment, a rare development in Behçet's disease may be effectively treated with PPV (without scleral buckling) with favorable visual and anatomic outcomes.