06/07/2025
A 42-year-old male presented with Behçet’s Disease and associated macular edema. Comprehensive systemic evaluation confirmed the diagnosis of Behçet’s Disease. Instead of standard anti-VEGF therapy, a suprachoroidal injection of triamcinolone (0.1 ml) was administered using a custom-made needle.
The patient was also started on systemic immunomodulators and corticosteroids under rheumatology supervision due to the diagnosis of occlusive vasculitis secondary to Behçet’s Disease.
Initial imaging, including fundus photography and OCT, revealed occlusive vasculitis with findings of branch retinal vein occlusion (BRVO) and vitritis.
After eight weeks of treatment, follow-up fundus images and OCT demonstrated resolution of active inflammation and macular edema.
However, OCT imaging at the baseline showed significant retinal thinning in the areas previously affected by vasculitis, indicating structural retinal damage despite the resolution of acute inflammatory signs. Ongoing monitoring is essential to assess for further structural changes and to guide long-term management.
Occlusive Vasculitis in Behçet’s Disease: Simplified Pathophysiology
Behçet’s disease is a chronic inflammatory vasculitis that causes blood vessel damage through immune system dysfunction. The disease occurs when overactive neutrophils (white blood cells) create inflammatory traps that damage blood vessel walls and trigger endothelial dysfunction. This inflammatory process leads to vessel narrowing and blockage, which is why it’s called “occlusive” vasculitis. The genetic predisposition (especially HLA-B51) combined with environmental triggers causes the immune system to attack blood vessels of all sizes. Immediate immunosuppressive treatment is essential because the inflammatory blockages can cause permanent tissue damage, particularly threatening vision when eye blood vessels are affected. Unlike typical blood clots, these occlusions are primarily inflammatory rather than thrombotic, which is why anti-inflammatory medications work better than blood thinners alone