Posterior Segment Changes

Changes of the posterior segment include white cell infiltration of the vitreous body, ranging from a moderate number of cells suspended on the vitreous fibrils to a dense plasmoid reaction with sheets of inflammatory cells, especially during the acute phase. An isolated vitreous inflammation is not characteristic of BD.

The essential finding of the posterior pole changes in patients with ocular BD is an occlusive, necrotizing, retinal vasculitis [i35, i56]. In most patients retinal vasculitis occurs mainly affecting the retinal veins, which is pathogno-monic for BD as it is the only systemic vasculitis affecting small and medium sized arteries and also veins. Other typical findings are venous and capillary dilation with engorgement. Involvement of the retinal vessels in the form of acute periphlebitis or thrombangiitis obliterans may lead to massive retinal (Fig. i2.5) and vitreous haemorrhage [i35, i56]. Patchy perivascular sheathing (Fig. i2.6) with inflammatory whitish yellow exudates surrounding retinal haemorrhages may be seen. They usually accumulate in the deeper retinal layers during acute episodes, while the overlying retina shows turbidity and edema. Retinal edema is present in 20-75% of cases, especially in the macula [156]. Retinal atrophy is frequently present after the retinal exu-dates and haemorrhage resolve, offering testimony to the prior ischaemia. Sheathing of the veins often precedes sheathing of the arteries. Choroidal vascular involvement occurs as well, and choroidal infarcts are probably more common than is generally appreciated [156].

Severe retinal vasculitis may lead to is-chaemic changes because of vascular occlusion.

The optic nerve is affected in at least one-fourth of BD patients [156]. Hyperaemia of the optic disc with blurring of the margins (papillitis) is the most frequently observed lesion of the

Fig. 12.5. BD patient with retinal haemorrhage due to a venous branch occlusion

Fig. 12.6. Yellowish-white perivascular sheathing and narrowing of the retinal veins in a BD patient optic nerve. Papilledema is not frequent, but it may occur as a result of microvasculitis of the arterioles supplying the optic disc [156].

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