Association of Immunomodulatory Treatment with Long-Term Visual Outcomes in Behçet Uveitis: A Single-Center Retrospective Study

Purpose: To describe clinical characteristics and treatment patterns in Behçet disease-associated uveitis at a tertiary center and to explore the association between immunomodulatory treatment (IMT) and long-term visual outcomes. Methods: This single-center retrospective study included adults diagnosed with Behçet disease-associated uveitis/retinal vasculitis. Demographics, anatomical uveitis classification, ocular inflammatory grades, logMAR best-corrected visual acuity (BCVA), complications, surgeries, and systemic therapies were extracted from medical records. Overall ocular outcomes were summarized at the affected-eye level. Comparative analyses according to IMT exposure were performed at the patient level using one eye per patient; in bilateral cases, the eye with worse baseline logMAR BCVA was selected. IMT exposure was defined as documented use of antimetabolite therapy, a T-cell inhibitor, or a TNF-α inhibitor during follow-up. Group comparisons and multivariable analyses were exploratory. Results: Thirty patients were included (66.7% male; mean age 39.5 ± 11.9 years). Panuveitis was the most common anatomical subtype (56.7%). A total of 42 affected eyes were analyzed descriptively. Mean logMAR BCVA changed from 0.613 ± 0.935 at baseline to 0.894 ± 1.158 at final follow-up. Systemic therapy included oral prednisone in 73.3% of patients, antimetabolite therapy in 40.0%, a T-cell inhibitor in 20.0%, and a TNF-α inhibitor in 13.3%. In patient-level analyses, 13 patients had IMT exposure and 17 did not. Final logMAR BCVA was lower in the IMT-exposed group than in the non-exposed group (0.587 ± 0.870 vs. 1.498 ± 1.303, p=0.050). In an exploratory multivariable linear regression model adjusted for baseline logMAR BCVA, age at visit, and panuveitis, IMT exposure was associated with lower final logMAR BCVA (coefficient, -1.192; 95% CI, -2.131 to -0.253; p=0.015). Conclusions: In this Korean tertiary-center cohort, Behçet uveitis commonly involved panuveitis with substantial long-term visual morbidity and surgical burden despite systemic therapy. IMT exposure showed a favorable association with final logMAR BCVA in patient-level analyses, although causal inference is limited by the retrospective design and potential confounding. Larger multicenter studies with standardized activity, relapse, and treatment-exposure metrics are warranted.