Phacoanaphylaxis in Behcet's disease - A clinicopathologic and immunohistochemical study

Purpose: To describe the occurrence of phacoanaphylaxis in enucleated eyes of patients with Behcet's disease. Design: Retrospective, observational, case series and human tissue study. Participants: Twenty-six patients with Behcet's disease who underwent enucleation. Methods. Histopathologic analysis was performed on 28 enucleated eyes of 26 patients with Behcet's disease. The eyes were divided into two groups, based on the absence or presence of tractional retinal detachment associated with cyclitic membrane formation. Selected eyes with tractional retinal detachment were stained for immunohistochemical examination. Main Outcome Measures: Histopathologic examination of enucleated eyes, including routine histopathologic and immunohistochemical studies. Results: None of the five eyes without retinal detachment showed phacoanaphylaxis. Nine of the 23 eyes with detachment exhibited phacoanaphylaxis, 10 showed no inflammation of the lens, and four were aphakic. There was marked inflammatory cell infiltration in the cyclitic membrane of all nine eyes with phacoanaphylaxis. Immunohistochemical examination demonstrated positive staining for the macrophage markers in the epithelioid and giant cells. The average interval between onset of the ocular manifestations of Behcet's disease and enucleation was 63 months for eyes with phacoanaphylaxis and 35 months for eyes without phacoanaphylaxis (P<0.005). Conclusions: In Behcet's disease, eyes with long-standing intraocular inflammation complicated by cyclitic membrane formation may develop phacoanaphylaxis. Such patients may benefit from surgical removal of the cyclitic membrane along with the lens in eyes with significant visual function. (C) 2003 by the American Academy of Ophthalmology.