OCTA and microperimetry in Behçet’s retinal vasculitis: subgroup analysis, structure–function correlation, and 12-month follow-up evaluation

BACKGROUND: In Behçet's syndrome (BS)-associated retinal vasculitis, optical coherence tomography (OCT) angiography (OCTA) and microperimetry allow noninvasive assessment of retinal microvascular integrity and macular function, but integrated structure-function analyses across all retinal vascular plexuses during inactive disease remain limited. This study evaluated age- and sex-related differences, structure-function associations, and 12-month changes in inactive retinal vasculitis. METHODS: This observational study included 14 patients (23 eyes; mean age 40.6 ± 11.7 years) with inactive BS-associated retinal vasculitis, followed every 4 months for 12 months. Retinal thickness, retinal nerve fiber layer and ganglion cell layer thickness on OCT, foveal avascular zone (FAZ) area and vascular density (VD) on OCTA, and macular sensitivity (MS) on microperimetry were analyzed. Exploratory subgroup analyses were performed according to sex, age, and qualitative OCTA findings. Associations were assessed using generalized estimating equations, and correlations were evaluated using Spearman's coefficient. RESULTS: Male sex, age < 45 years, and qualitative OCTA findings (perifoveal arcade disruption, non-perfusion areas, and microvascular abnormalities in any vascular plexus) were associated with more pronounced quantitative changes on OCT and OCTA (P < 0.05). VD showed strong inverse and direct correlations (r > 0.7) with FAZ area and retinal thickness, respectively, which should be interpreted with caution given the limited sample size. In the superficial vascular plexus (SVP), superior sector VD correlated directly with central MS (r = 0.722; P < 0.001). Structural and functional biomarkers remained stable throughout the 12-month follow-up in patients under clinical remission. CONCLUSIONS: Male sex and younger age appeared to be associated with patterns suggestive of greater macular structural and functional involvement in BS-associated retinal vasculitis. Qualitative OCTA findings, particularly involving the SVP and intermediate capillary plexus, were also associated with more pronounced structural and functional alterations. However, given the exploratory nature of the analyses and the limited sample size, these findings should be considered preliminary and warrant further investigation in larger, controlled studies.