Purpose <p>This study aimed to investigate the relationship between inflammatory hematological ratios, specifically the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR), and microvascular changes of the fundus in Behçet disease (BD) including non-ocular and quiescent ocular BD patients.</p> Methods <p>Conducted as a retrospective, single-center study, patients diagnosed with BD were categorized into non-ocular and quiescent ocular BD groups. Systemic inflammatory hematological ratios were assessed through laboratory evaluations, while retinal and choroidal parameters were measured using optical coherence tomography (OCT) and OCT angiography (OCTA).</p> Results <p>Twenty-five patients were included, with 12 in the non-ocular and 13 in the quiescent ocular BD group. The quiescent ocular BD group exhibited significantly higher minimum PLR, foveal avascular zone area (FAZa), and perimeter (FAZp). Additionally, significant correlations were observed between the minimum PLR and central retinal thickness (CRT), FAZa, and FAZp. No factors were significantly associated with visual acuity in regression analysis.</p> Conclusion <p>Inflammatory hematological ratios such as the minimum PLR may serve as a promising biomarker for detecting subclinical microvascular changes in BD. These findings highlight the importance of integrating inflammatory hematological ratios with OCT, OCTA metrics for early detection of ocular impairment in BD, potentially guiding proactive management to prevent irreversible ocular damage.</p>