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Nakai S, Takeuchi M, Usui Y, Namba K, Suzuki K, Harada Y, Kusuhara S, Kaburaki T, Tanaka R, Takeuchi M, Mizuki N, Nakai K, Goto H, Herbort CP. Efficacy and Safety of Adalimumab for Exacerbation or Relapse of Ocular Inflammation in Patients with Vogt-Koyanagi-Harada Disease: A Multicenter Study. Ocul Immunol Inflamm 2024; 32:367-375. [PMID: 35748779 DOI: 10.1080/09273948.2022.2092007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 06/02/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE We investigated efficacy and safety of adalimumab (ADA) treatment for exacerbation or recurrence of Vogt-Koyanagi-Harada (VKH) patients. METHODS Medical records of 70 VKH patients who received ADA treatment for more than 6 months were retrospectively investigated. RESULTS The mean age of VKH patients was 54.8 ± 15.1 years, and male/female ratio was 34/36, and sunset glow fundus was observed in 71.4%. Subfoveal choroidal thickness, indocyanine green angiography scores, and corticosteroid and cyclosporine doses were significantly reduced by ADA treatment for 6 months compared to baseline, while LogMAR and flare counts were also improved without being statistically significant. Adverse events were observed in 17.1%, in which tuberculosis was at 7.14% and psoriasis was at 2.86%; however, ADA treatment was continued in 91.4%. CONCLUSIONS ADA was shown to be effective to achieve remission of VKH disease refractory to conventional treatments and was generally well tolerated with few serious adverse events.
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Affiliation(s)
- Shunsaku Nakai
- Department of Ophthalmology, National Defense Medical College, Saitama, Japan
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Saitama, Japan
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kayo Suzuki
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Higashihiroshima, Japan
| | - Sentaro Kusuhara
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Rie Tanaka
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kei Nakai
- Department of Ophthalmology, Yodogawa Christian Hospital, Osaka, Japan
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Carl P Herbort
- Centre for Ophthalmic Specialized Care, Lausanne, Switzerland
- Jichi Medical University Saitama Medical Center, Saitama, Japan
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Tayal A, Daigavane S, Gupta N. Vogt-Koyanagi-Harada Disease: A Narrative Review. Cureus 2024; 16:e58867. [PMID: 38800227 PMCID: PMC11116741 DOI: 10.7759/cureus.58867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Vogt-Koyanagi-Harada (VKH) disease is an idiopathic immune-related sickness that affects multiple systems and melanocytes in organs such as the uvea, ear, and meninges. The primary cause of activity is cellular immunological responses. Vogt-Koyanagi disease is identified primarily by skin abnormalities and anterior uveitis. Harada's illness is distinguished by neurological symptoms and exudative retinal detachments, which are associated with the HLA-DR4 and HLA-DRw53 genes. Pigmented races, such as Hispanics and Native Americans, are more likely to have VKH disease. Clinical features are blurred vision, floaters, alopecia, vitiligo, diffuse choroidal inflammation with disc edema, and exudative retinal detachment. Differential diagnoses include posterior scleritis, uveal effusion syndrome, central serous chorioretinopathy, and sympathetic ophthalmitis. The investigations used are optical coherence tomography (OCT), fundus fluorescein angiography (FA), and B-scan ultrasonography (USG). Treatment is done by using systemic steroids, cycloplegics, and immunosuppressants.
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Affiliation(s)
- Ayushi Tayal
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sachin Daigavane
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nivesh Gupta
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Li L, Yuan L, Zhou X, Hua X, Yuan X. Bibliometric analysis of the Vogt‒Koyanagi‒Harada disease literature. Int Ophthalmol 2023; 43:4137-4150. [PMID: 37552428 PMCID: PMC10520158 DOI: 10.1007/s10792-023-02815-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/17/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE As an autoimmune disease, Vogt‒Koyanagi‒Harada disease (VKHD) is a main type of uveitis in many countries and regions, significantly impacting patient vision. At present, information regarding VKHD is still limited, and further research is needed. We conducted a bibliometric analysis to characterize the overall status, current trends, and current focus of VKHD research. METHOD Literature published from 1975 to 2022 was obtained from the Web of Science core collection and analysed with the R-language packages Bibliometrix, VOSviewer, and CiteSpace software. RESULTS A total of 1050 papers on VKHD were retrieved from 261 journals, and 16,084 references were obtained from the papers in the original search. The average annual number of published articles was approximately 21.9, and the number of publications rapidly increased after 2004. The journal Ocular Immunology and Inflammation published the most papers on VKHD, while the American Journal of Ophthalmology has the highest citation frequency. The leading countries were Japan, China (PRC), and the United States of America (USA). Yang PZ from Chongqing Medical University was the most prolific and cited author. The most frequently cited study discussed revision of VKHD diagnostic criteria. An analysis of the highest frequency keywords showed that most research focused on the treatment, diagnosis, and pathogenesis of VKHD and its relationship with other related diseases. At present, the most urgent research direction is in the relationship between COVID-19 or COVID-19 vaccines and VKHD and the corresponding mechanisms underlying it. CONCLUSION Utilizing dynamic and visualization tools, bibliometrics provides a clear depiction of the research history, development trends, and research hotspots in VKHD It serves as a valuable tool for identifying research gaps and areas that necessitate further exploration. Our study revealed potential directions for future VKHD research, including investigating specific molecular mechanisms underlying the disease, exploring the clinical utility of optical coherence tomography angiography and other diagnostic techniques, and conducting clinical research on novel therapeutic drugs.
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Affiliation(s)
- Liangpin Li
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, China
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, 300020, China
| | - Liyun Yuan
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, 300020, China
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Xueyan Zhou
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, 300020, China
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Xia Hua
- Tianjin Aier Eye Hospital, Tianjin University, Tianjin, 300190, China.
| | - Xiaoyong Yuan
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, China.
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, 300020, China.
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Ruiz-Lozano RE, Rodriguez-Garcia A. Regarding Kaya P et al. "Predictive Factors for the Prognosis of Vogt-Koyanagi-Harada Disease". Ocul Immunol Inflamm 2023; 31:1736-1737. [PMID: 36821377 DOI: 10.1080/09273948.2023.2179500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION VKH is a primary stromal choroiditis. Studies with indocyanine green angiography (ICGA) have shown that inflammation begins at the choroid and may persist without clinically apparent inflammation. Thus, systemic therapy must target choroidal inflammation and be maintained until the choroiditis resolves, as proven by ICG and/or EDI-OCT imaging studies. DISCUSSION Aggressive therapy with oral corticosteroids, with or without "pulsed" intravenous methylprednisolone, has been the mainstay of VKH therapy in the acute phase for many years. However, there is convincing evidence that corticosteroid monotherapy is insufficient to prevent progression onto the chronic recurrent form of the disease, which is associated with poor visual outcomes. CONCLUSION Numerous studies suggest that combined therapy with systemic corticosteroids and immunosuppressants is necessary to prevent the progression toward chronic recurrent disease, avoiding complications, get a better control of inflammation and visual outcomes in VKH patients seen at the uveitic phase of the disease.
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Affiliation(s)
- Raul E Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
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Kaya P, İnanç Tekin M, Özdal PÇ. Authors Reply to Letter to the Editor - In Response to Comment on Raul E. Ruiz-Lozano et al.'s "Predictive Factors for the Prognosis of Vogt-Koyanagi-Harada Disease". Ocul Immunol Inflamm 2023; 31:1738-1739. [PMID: 36800559 DOI: 10.1080/09273948.2023.2178940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/19/2023]
Abstract
An aggressive treatment, including immunomodulatory therapy, is very important in preventing the development of the chronic recurrent stage in Vogt-Koyanagı-Harada (VKH) disease. However, the way of treatment is not the only factor determining the prognosis, and there are other factors that affect the outcome.
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Affiliation(s)
- Pınar Kaya
- Department of Ophthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Merve İnanç Tekin
- Department of Ophthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Pınar Çakar Özdal
- Department of Ophthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
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Kwak JJ, Lee J, Byeon SH. CLINICAL FEATURES AND PROGNOSTIC VALUE OF BACILLARY LAYER DETACHMENT IN ACUTE VOGT-KOYANAGI-HARADA DISEASE. Retina 2023; 43:1700-1707. [PMID: 37315551 DOI: 10.1097/iae.0000000000003858] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE To evaluate the characteristics of bacillary layer detachment (BALAD) in acute Vogt-Koyanagi-Harada (VKH) disease and determine its prognostic value. METHODS Seventy patients with acute VKH disease with a minimum follow-up of 6 months were studied. The primary outcomes were clinical characteristics associated with BALAD, including features on multimodal imaging at baseline and follow-up. The secondary outcomes included best-corrected visual acuity and VKH with recurrence features. RESULTS Of 70 eyes (36 patients), 41 (58.6%) showed BALAD. The mean baseline best-corrected visual acuity and mean best-corrected visual acuity after resolution of serous retinal detachment were significantly lower in the BALAD group than in the no-BALAD group (0.90 ± 0.49 vs. 0.35 ± 0.35 log minimum angle of resolution, P < 0.001 and 0.39 ± 0.27 vs. 0.20 ± 0.20 log minimum angle of resolution, P = 0.020). The loss of ellipsoid zone integrity at baseline, proportion of serous retinal detachment, duration of serous retinal detachment, loss of ellipsoid zone integrity at 1 month, and subfoveal choroidal thickness at baseline were significantly higher in the BALAD group ( P = 0.017, P = 0.006, P = 0.023, P = 0.002, and P = 0.046, respectively). The mean best-corrected visual acuity and subfoveal choroidal thickness did not differ between the two groups at 6 months ( P = 0.380 and P = 0.180, respectively). Bacillary layer detachment at baseline was found to be a significant prognostic factor for VKH with recurrence features ( P = 0.007). CONCLUSION Vogt-Koyanagi-Harada with BALAD featured more severe clinical characteristics than VKH without BALAD during the acute phase. Patients with baseline BALAD require more vigilant monitoring as they are more likely to show recurrence features within the first 6 months.
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Affiliation(s)
- Jay Jiyong Kwak
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; and
| | - Junwon Lee
- Department of Ophthalmology, Institute of Human Barrier Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; and
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Manni P, Saturno MC, Accorinti M. Vogt-Koyanagi-Harada Disease and COVID. J Clin Med 2023; 12:6242. [PMID: 37834885 PMCID: PMC10573236 DOI: 10.3390/jcm12196242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/26/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Vogt-Koyanagi-Harada (VKH) is a rare multisystem inflammatory disease affecting the eyes, ears, brain, skin, and hair. The Coronavirus Disease 2019 (COVID-19) is a new contagious infection that might trigger the onset of VKH disease, as previously proposed for other viruses. Moreover, after the mass vaccination against SARS-CoV-2 worldwide, cases of VKH disease associated with COVID-19 vaccination have been reported. We present an overview of VKH and a comprehensive literature revision of all the VKH cases described after COVID-19 infection and vaccination, adding our experience. No differences have been found considering epidemiology and clinical findings of the disease compared to those reported in the no-COVID era. All of the patients promptly responded to systemic and local corticosteroid therapy with a good final visual prognosis. Different possible pathogenetic mechanisms underlying the onset of VKH after COVID-19 vaccination are discussed, while the presence of the HLA DR4 antigen as a genetic predisposition for the onset of the disease after COVID-19 infection and vaccination is proposed. VKH disease is one of the most frequently reported uveitic entities after COVID-19 vaccination, but a good response to therapy should not discourage vaccination. Nevertheless, ophthalmologists should be alerted to the possibility of VKH occurrence or relapse after COVID-19 vaccination, especially in genetically predisposed subjects.
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Affiliation(s)
| | | | - Massimo Accorinti
- Ocular Immunovirology Service, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.M.); (M.C.S.)
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Wang K, Zheng C, Zhao G, Zhang M, Liu T, Li H, Tao Q, Cheng Z, Li X, Zhang X. HIGH LONG-TERM DRUG-FREE REMISSION RATE FOR ACUTE VOGT-KOYANAGI-HARADA DISEASE WITH AN APPROPRIATE IMMUNOSUPPRESSIVE REGIMEN. Retina 2023; 43:1496-1505. [PMID: 37224445 PMCID: PMC10442124 DOI: 10.1097/iae.0000000000003837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To report the clinical profile and outcomes of acute Vogt-Koyanagi-Harada disease with a strict immunosuppression regimen and investigate the risk factors for a prolonged disease course. METHODS A total of 101 patients with acute Vogt-Koyanagi-Harada (202 eyes) with more than 24 months of follow-up were recruited from January 2011 to June 2020. They were divided into two groups according to the interval between the onset of Vogt-Koyanagi-Harada and treatment. Oral prednisone was gradually tapered off by a diminished dose according to a relatively strict protocol. Patient responses to the treatment regimen were classified as long-term drug-free remission or chronic recurrent. RESULTS Ninety-six patients (95.0%) achieved long-term drug-free remission without recurrence, while 5 (5.0%) had chronic recurrence. Most patients achieved good best-corrected visual acuity (90.6% ≧20/25). A generalized estimation equation model demonstrated that time of visit, ocular complications, and cigarette smoking were independent risk factors for a longer disease course, and smokers required a higher drug dose and longer treatment course than nonsmokers. CONCLUSION An immunosuppressive regimen with an appropriate tapering speed can lead to long-term drug-free remission in patients with acute Vogt-Koyanagi-Harada. Cigarette smoking significantly affects ocular inflammation.
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Affiliation(s)
- Kaixuan Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and
| | - Chuanzhen Zheng
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and
| | | | - Mi Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and
| | - Tong Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and
| | - Huan Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and
| | - Qingqin Tao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and
| | - Zhaohui Cheng
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and
| | - Xiaomin Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and
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Zhong Z, Dai L, Wu Q, Gao Y, Pu Y, Su G, Lu X, Zhang F, Tang C, Wang Y, Zhou C, Yang P. A randomized non-inferiority trial of therapeutic strategy with immunosuppressants versus biologics for Vogt-Koyanagi-Harada disease. Nat Commun 2023; 14:3768. [PMID: 37355662 PMCID: PMC10290648 DOI: 10.1038/s41467-023-39483-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/15/2023] [Indexed: 06/26/2023] Open
Abstract
Biologics are increasingly used to treat Vogt-Koyanagi-Harada disease, but head-to-head comparisons with conventional immunosuppressants are lacking. Here in this randomized trial (Chinese Clinical Trial Registry, ChiCTR2100043061), we assigned 110 patients (27 early-phase and 83 late-phase) to cyclosporine-based immunosuppressant strategy (N = 56) or adalimumab-based biologic strategy (N = 54), each combined with a modified corticosteroid regimen. The primary outcome is change from baseline in best-corrected visual acuity at week 26. The margin of non-inferiority for cyclosporine is -7 letters. The primary outcome is 11.2 letters (95% CI, 7.5 to 14.9) in the cyclosporine group and 6.3 letters (95% CI, 3.1 to 9.6) in the adalimumab group (difference, 4.9; 95% CI, 0.2 to 9.5; P < 0.001 for non-inferiority). The between-group difference is -0.8 letters (95% CI, -6.1 to 4.5) in early-phase disease and 5.7 letters (95% CI, 0.2 to 11.2) in late-phase. Serious adverse events are reported less frequently in the cyclosporine group than in the adalimumab group (0.70 vs. 1.21 events per patient-year). Here, we report that combined with a non-standard corticosteroid regimen, cyclosporine-based immunosuppressant strategy is non-inferior to adalimumab-based biologic strategy by 26 weeks for visual improvement in a cohort of patients with Vogt-Koyanagi-Harada disease, 75% of whom have a late-phase disease.
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Affiliation(s)
- Zhenyu Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Lingyu Dai
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Qiuying Wu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Yu Gao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Yanlin Pu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Xiaorong Lu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Fuxiang Zhang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Chong Tang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Yao Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Chunjiang Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China.
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10
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Abu El-Asrar AM, Al Rashed FA, AlBloushi AF, Tobaigy MF, Gikandi PW, Herbort CP, Opdenakker G. Therapeutic window of opportunity in the acute uveitic phase of Vogt-Koyanagi-Harada disease: Prevention of late autoimmune complications by early intervention. Acta Ophthalmol 2023; 101:e236-e245. [PMID: 36128841 DOI: 10.1111/aos.15254] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/07/2022] [Accepted: 09/03/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine relationship between timing of treatment initiation and disease outcomes and whether a therapeutic window of opportunity exists in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada disease. METHODS Retrospective analysis of 112 patients (224 eyes). Main outcome measures were final visual acuity, progression to chronic recurrent evolution, development of complications, particularly 'sunset glow fundus', and drug-free remission cure of uveitis. RESULTS Forty-six patients (92 eyes) presented in the phase preceding anterior segment (AS) inflammation (early presentation) and 66 patients (132 eyes) had AS inflammation at presentation (late presentation). In significantly more eyes in the early presentation group (85.9%), final visual acuity of 20/20 was achieved compared with those in the late presentation group (66.7%) (p = 0.001). None of the eyes in the early presentation group progressed to chronic recurrent evolution and none developed 'sunset glow fundus', whereas in the late presentation group, 28.8% of the eyes progressed to chronic recurrent evolution (p < 0.001) and 56.1% developed 'sunset glow fundus' (p < 0.001). Patients in the early presentation group were able to discontinue treatment without relapse of inflammation at significantly shorter time intervals compared to patients in the delayed presentation group (p < 0.001). In the late presentation group, logistic regression analysis demonstrated that presenting clinical features predicting unfavourable outcomes were posterior synechiae (odds ratio = 4.03; 95% confidence interval [CI] = 1.29-12.23), bullous exudative retinal detachment extending to the periphery (odds ratio = 3.35; 95% CI = 1.53-7.32) and female gender (odds ratio = 2.05; CI = 1.08-3.90). CONCLUSIONS Our findings suggest that the window of opportunity lies in the phase preceding AS inflammation and initiation of effective treatment during this phase results in cure of uveitis and prevents blinding complications.
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Affiliation(s)
- Ahmed M Abu El-Asrar
- Department of Ophthalmology; College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Faisal A Al Rashed
- Department of Ophthalmology; College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman F AlBloushi
- Department of Ophthalmology; College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohannad F Tobaigy
- Department of Ophthalmology; College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Priscilla W Gikandi
- Department of Ophthalmology; College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Carl P Herbort
- Department of Ophthalmology, Clinic Montchoisi Teaching Centre, Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), University of Lausanne, Lausanne, Switzerland
| | - Ghislain Opdenakker
- Department of Ophthalmology; College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Rega Institute for Medical Research, Department of Microbiology and Immunology and Transplantation, University of Leuven, KU Leuven, Leuven, Belgium and University Hospitals UZ Gasthuisberg, Leuven, Belgium
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11
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Outcomes of patients with acute Vogt-Koyanagi-Harada disease treated with intravenous corticosteroid pulse followed by the slow tapering of oral corticosteroid therapy. Int Ophthalmol 2023; 43:431-440. [PMID: 35869402 DOI: 10.1007/s10792-022-02440-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To elucidate the intravenous corticosteroid pulse treatment outcomes of patients with acute Vogt-Koyanagi-Harada (VKH) disease and assess the differences between patients with no inflammation worsening and those with persistent or worsening inflammation. Potential factors responsible for eyes with low visual outcomes were also investigated. METHODS We retrospectively reviewed the clinical records of patients with acute VKH disease who first visited us between 2009 and 2018 and were followed up for > 300 days. Clinical characteristics, treatments, and posttreatment conditions were assessed. Patients were classified into no inflammation worsening (acute-resolved [AR]) and inflammation worsening (chronic-recurrent [CR]) groups based on conditions after 6 months from disease onset. RESULTS This study included 60 eyes from 30 patients (mean age: 52.7 years). Patients were treated with methylprednisolone pulse followed by the slow tapering of oral prednisolone; 73% of patients developed AR and 27% CR, and the best-corrected visual acuity (BCVA) was ≥ 1.0 in 83% of eyes at 6 months following the introduction of treatment. Although the total prednisolone dose was higher in patients with CR disease, no significant difference was noted in the final BCVA. Among the patients, five eyes had a final BCVA of ≤ 0.5 due to anisometropic amblyopia, diabetic maculopathy, pre-existing macular hole, epiretinal membrane, and ellipsoid zone loss. CONCLUSIONS Patients with acute VKH disease treated with corticosteroid pulse appear to demonstrate good visual outcomes, including patients with CR; the majority of eyes with low visual outcomes have pre-existing conditions that explain the low vision.
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12
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Elhamaky TR. Long-term efficacy of dexamethasone intravitreal implant in the treatment of Vogt-Koyanagi-Harada disease relapsing posterior uveitis. Indian J Ophthalmol 2022; 70:2465-2470. [PMID: 35791135 PMCID: PMC9426163 DOI: 10.4103/ijo.ijo_260_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: To investigate the efficacy and safety of dexamethasone intravitreal implant in the treatment of relapsing posterior uveitis in patients with chronic recurrent Vogt–Koyanagi–Harada (VKH) disease. Methods: This was a prospective study of 29 eyes of 16 patients with posterior uveitis in chronic recurrent VKH disease. All patients received previous systemic steroid and immunosuppressive regimens. All patients underwent a comprehensive ophthalmic examination, including best-corrected visual acuity (BCVA), Indocyanine green angiography (ICGA), fundus fluorescein angiography (FFA), and spectral-domain optical coherence tomography (SD-OCT). All patients underwent intravitreal injection with sustained-release dexamethasone 0.7 mg implant (Ozurdex®). Primary outcome measures included mean change in BCVA and central foveal thickness (CFT) at 24 months of follow-up compared to the baseline. Results: At 24 month of follow-up, the mean BCVA improved from 0.82 ± 0.13 to 0.38 ± 0.06 logMAR (P < 0.0001). The mean CFT reduced from 505 ± 29 to 244 ± 23 um (P < 0.0001). The mean intraocular pressure (IOP) changed from 15.1 ± 2.2 to 16.9 ± 3.1 mmHg with no significant value (P-value = 0.0955). Twenty-one eyes (72.4%) received one injection, whereas eight eyes (27.6%) required two injections. The mean number of injections was 1.2 ± 0.60. The mean follow-up time was 24.75 ± 0.9 months. No serious ocular or systemic adverse events were noted during the follow-up period. Ocular hypertension was recorded in three (10.3%) eyes and controlled by IOP lowering medications. Cataract progression occurred in 11 (37.9%) eyes. Conclusion: Our cohort highlights the beneficial effects of the dexamethasone implant of 0.7 mg in the treatment of VKH disease relapsing posterior uveitis improving visual acuity, reducing macular edema, and minimizing the burden of systemic steroids in this sample study.
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Affiliation(s)
- Tarek R Elhamaky
- Department of Ophthalmology, Faculty of Medicine, Benha University, Benha, Egypt
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13
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Treatment and Prognosis of Vogt-Koyanagi-Harada Disease: Real-Life Experience in Long-Term Follow-Up. J Clin Med 2022; 11:jcm11133632. [PMID: 35806916 PMCID: PMC9267436 DOI: 10.3390/jcm11133632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Vogt−Koyanagi−Harada (VKH) disease is a form of uveitis that is rare in Western countries. The aim of this study was to report on the long-term real-life treatment and prognosis of VKH in Italy. Methods: The clinical features, complications, and final visual acuity were retrospectively evaluated in 38 patients with VKH (mean follow-up: 120 months) globally, according to oral or intravenous corticosteroid treatment at onset and subsequent immunosuppressive therapy. Results: The mean final visual acuity was 0.13 ± 0.4 logMAR, which was a significant increase from the baseline (p < 0.0001). The patients who received intravenous rather than oral corticosteroids relapsed less (p = 0.026), with fewer relapses/patient/month of follow-up (p < 0.0001), and showed less frequent sunset glow fundus (33.3% versus 55%) and more relapse-free cases after induction therapy (p = 0.007). Delayed immunosuppressive therapy (median: 180 days from the onset of symptoms) reduced the rate of sunset glow fundus. The onset of sunset glow fundus was associated with a worse final visual acuity (p = 0.006). Conclusion: The long-term prognosis of VKH is quite good. Intravenous corticosteroids given at the onset of VKH are more effective than oral corticosteroids. Even if it is not given immediately after symptoms onset, immunosuppressive therapy is able to reduce the incidence of sunset glow fundus and to improve the final visual prognosis.
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Urzua CA, Herbort CP, Takeuchi M, Schlaen A, Concha-Del-Rio LE, Usui Y, Cuitino L, Papasavvas I. Vogt-Koyanagi-Harada disease: the step-by-step approach to a better understanding of clinicopathology, immunopathology, diagnosis, and management: a brief review. J Ophthalmic Inflamm Infect 2022; 12:17. [PMID: 35553272 PMCID: PMC9098759 DOI: 10.1186/s12348-022-00293-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/07/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Appraisals of Vogt-Koyanagi-Harada disease (VKH) have become progressively more complete, since its first description in 1906. The availability of new investigational methods has improved our knowledge of the immunopathology, clinicopathology, diagnosis, and management of VKH disease. This review aimed to describe some of the steps that led to better characterization of VKH as a clinical entity. METHODS We searched on PubMed for articles that described the history of VKH disease and analyzed the progress in disease appraisal with new investigational and imaging methods. In particular, we searched for articles that investigated the clinicopathology, diagnosis, and management of VKH. FINDINGS The following developments were considered essential for improving the appraisal and understanding of VKH: (1) the history of the disease, (2) immunopathological mechanisms, (3) clinicopathology, (4) the importance of distinguishing initial-onset from chronic disease, (5) relevant imaging modalities, among which indocyanine green angiography is crucial, (6) diagnostic criteria that facilitate early diagnosis, and (7) the need for early, prolonged, aggressive treatment that combines steroidal and non-steroidal immunosuppression. CONCLUSION Based on these findings, the definition of VKH has improved. VKH disease starts in the choroidal stroma and later involves other structures when it is not diagnosed and treated early. Indocyanine green angiography and enhanced depth imaging optical coherence tomography facilitate early diagnosis and precise monitoring of choroidal inflammation. ICGA is clearly the gold standard for appraisals and follow-ups in VKH disease, however EDI-OCT should be especially considered in those areas where ICGA is not fully available. These modalities have contributed substantially to a "cure" for VKH, when treatment is introduced within the therapeutic window of opportunity.
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Affiliation(s)
- Cristhian A Urzua
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile. .,Department of Ophthalmology, University of Chile, Santiago, Chile. .,Facultad de Medicina, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile.
| | - Carl P Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialised Care (COS), Lausanne, Switzerland
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Ariel Schlaen
- Hospital Universitario Austral, Hospital de Clinicas de Buenos Aires, Buenos Aires, Argentina
| | - Luz E Concha-Del-Rio
- Inflammatory Eye Disease Clinic, Dr. Luis Sanchez Bulnes Hospital, Asociación para Evitar la Ceguera en México (APEC), Mexico City, CDMX, Mexico
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Loreto Cuitino
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile.,Servicio de Oftalmología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialised Care (COS), Lausanne, Switzerland
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15
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Skalicky N, Jesse M, Hatz-Wurziger K, Katamay R. [Topical Corticosteroid Monotherapy of a Patient with Vogt-Koyanagi-Harada Syndrome (VKH)]. Klin Monbl Augenheilkd 2022; 239:545-547. [PMID: 35472802 DOI: 10.1055/a-1774-4466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - Katja Hatz-Wurziger
- Vista Augenklinik, Binningen, Schweiz.,Augenklinik, Universitätsspital Basel, Schweiz
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16
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Papasavvas I, Tugal-Tutkun I, Herbort CP. Mechanisms, Pathophysiology and Current Immunomodulatory/Immunosuppressive Therapy of Non-Infectious and/or Immune-Mediated Choroiditis. Pharmaceuticals (Basel) 2022; 15:ph15040398. [PMID: 35455395 PMCID: PMC9031533 DOI: 10.3390/ph15040398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 12/19/2022] Open
Abstract
Non-infectious choroiditis comprises immune-mediated diseases resulting from diverse pathophysiological mechanisms. These conditions are sub-divided into two main groups, (1) diseases of the choriocapillaris and (2) diseases of the choroidal stroma. The purpose of this study is to expose the pathophysiology of the most common diseases of both these groups and recommend the optimal immunomodulatory/immunosuppressive therapy of each analyzed condition based on literature data and data from our own centers. Material and Methods: Narrative review. In the group of choriocapillaritis entities or primary inflammatory choriocapillaropathies (PICCPs) including multiple evanescent white dot syndrome (MEWDS), acute posterior multifocal placoid pigment epitheliopathy (APMPPE), idiopathic multifocal choroiditis (MFC) and serpiginous choroiditis (SC), as well as secondary choriocapillaritides including acute syphilitic posterior multifocal placoid chorioretinitis (ASPMPC) and tuberculosis-related SC (TB-SC), were analyzed. In the group of stromal choroidites, HLA-A29 birdshot retinochoroiditis (BRC) and Vogt-Koyanagi-Harada (VKH) disease were included. For each entity a literature search, in the PubMed database, on treatment was performed and analyzed and the therapeutic attitudes of our own centers were presented. Management of immune-mediated choroiditis implies vigorous immunosuppressive therapy given in a prompt and prolonged fashion in most of these entities.
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Affiliation(s)
- Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Rue Charles-Monnard 6, CH-1003 Lausanne, Switzerland;
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey;
| | - Carl P. Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Rue Charles-Monnard 6, CH-1003 Lausanne, Switzerland;
- Correspondence:
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17
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Herbort CP, Tugal-Tutkun I, Abu-El-Asrar A, Gupta A, Takeuchi M, Fardeau C, Hedayatfar A, Urzua C, Papasavvas I. Precise, simplified diagnostic criteria and optimised management of initial-onset Vogt-Koyanagi-Harada disease: an updated review. Eye (Lond) 2022; 36:29-43. [PMID: 34145419 PMCID: PMC8727674 DOI: 10.1038/s41433-021-01573-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
Vogt-Koyanagi-Harada (VKH) disease is a primary autoimmune stromal choroiditis. This review aimed to provide a novel perspective of the disease. We took into account recent developments in the understanding of the disease and crucial progress in investigational modalities of the choroid, which has led to new, simpler diagnostic criteria. We analysed recent novel notions in the literature and new diagnostic tools for VKH. We identified the following updates for VKH disease: (1) A crucial differentiation between the acute initial-onset and the chronic forms of the disease; (2) the integration of new, precise imaging methods to assess choroidal inflammation; (3) the promotion of simplified, more reliable diagnostic criteria for acute initial-onset of the disease, based on the sine qua non presence of diffuse choroiditis, detected with indocyanine green angiography (ICGA) and/or Enhanced Depth Imaging OCT (EDI-OCT); and (4) treatment optimisation through early, vigorous, sustained corticosteroid and nonsteroidal immunosuppression, as the first line of treatment for initial-onset VKH disease, and monitoring subclinical choroidal inflammation during follow-ups. Several studies have shown that most patients could discontinue treatment without an inflammation relapse. ICGA and EDI-OCT represented the methods of choice for precisely monitoring disease evolution. Simplified, precise, new diagnostic criteria allow early diagnosis of VKH. In VKH disease, inflammation exclusively originates in the choroidal stroma. Therefore, in many cases, early, sustained treatment, with dual corticosteroid and nonsteroidal immunosuppressive therapy can result in full "healing", which obviates chronic, uncontrolled, subclinical choroidal inflammation.
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Affiliation(s)
- Carl P Herbort
- Inflammatory and Retinal Eye Diseases, , Centre for Ophthalmic Specialised care, Lausanne, Switzerland.
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmed Abu-El-Asrar
- Department of Ophthalmology, Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amod Gupta
- Professor Emeritus, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defence Medical College, Tokorozawa, Saitama, Japan
| | - Christine Fardeau
- Department of Ophthalmology, Reference center for rare diseases, La Pitié-Salpêtrière Hospital, Paris-Sorbonne University, Paris, France
| | - Alireza Hedayatfar
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Cristhian Urzua
- Laboratory of Ocular and Systemic Autoimmune Diseases, Department of Ophthalmology, Faculty of Medicine, University of Chile, Santiago, Chile
- Facultad de Medicina, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Ioannis Papasavvas
- Inflammatory and Retinal Eye Diseases, , Centre for Ophthalmic Specialised care, Lausanne, Switzerland
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18
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Abu El-Asrar AM, Van Damme J, Struyf S, Opdenakker G. New Perspectives on the Immunopathogenesis and Treatment of Uveitis Associated With Vogt-Koyanagi-Harada Disease. Front Med (Lausanne) 2021; 8:705796. [PMID: 34869409 PMCID: PMC8632721 DOI: 10.3389/fmed.2021.705796] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/11/2021] [Indexed: 01/24/2023] Open
Abstract
Uveitis associated with Vogt-Koyanagi-Harada (VKH) disease is a bilateral, chronic, granulomatous autoimmune disease associated with vitiligo, poliosis, alopecia, and meningeal and auditory manifestations. The disease affects pigmented races with a predisposing genetic background. Evidence has been provided that the clinical manifestations are caused by a T-lymphocyte-mediated autoimmune response directed against antigens associated with melanocytes in the target organs. Alongside of T lymphocytes, autoreactive B cells play a central role in the development and propagation of several autoimmune diseases. The potential role of B lymphocytes in the pathogenesis of granulomatous uveitis associated with VKH disease is exemplified within several studies. The early initial-onset acute uveitic phase typically exhibits granulomatous choroiditis with secondary exudative retinal detachment and optic disc hyperemia and swelling, subsequently involving the anterior segment if not adequately treated. The disease eventually progresses to chronic recurrent granulomatous anterior uveitis with progressive posterior segment depigmentation resulting in "sunset glow fundus" appearance and chorioretinal atrophy if not properly controlled. Chronically evolving disease is more refractory to treatment and, consequently, vision-threatening complications have been recognized to occur in the chronic recurrent phase of the disease. Conventional treatment with early high-dose systemic corticosteroids is not sufficient to prevent chronic evolution. Addition of immunomodulatory therapy with mycophenolate mofetil as first-line therapy combined with systemic corticosteroids in patients with acute initial-onset disease prevents progression to chronic evolution, late complications, vitiligo, and poliosis. Furthermore, patients under such combined therapy were able to discontinue treatment without relapse of inflammation. These findings suggest that there is a therapeutic window of opportunity for highly successful treatment during the early initial-onset acute uveitic phases, likely because the underlying disease process is not fully matured. It is hypothesized that early and aggressive immunosuppressive therapy will prevent remnant epitope generation in the initiation of the autoimmune process, the so-called primary response. B cell depleting therapy with the anti-CD20 monoclonal antibody rituximab is effective in patients with refractory chronic recurrent granulomatous uveitis. The good response after rituximab therapy reinforces the idea of an important role of B cells in the pathogenesis or progression of chronic recurrent uveitis associated with VKH disease.
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Affiliation(s)
- Ahmed M Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jo Van Damme
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
| | - Sofie Struyf
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
| | - Ghislain Opdenakker
- Laboratory of Immunobiology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
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Abstract
PURPOSE OF REVIEW Here, we provide an overview of Vogt-Koyanagi-Harada disease (VKH), including recent updates in our understanding of disease pathophysiology, classification and therapeutics. RECENT FINDINGS Advancements in bioinformatics, metabolomics and genomics investigations continue to illuminate VKH pathogenesis, and may provide insight into future therapeutic options. Multimodal imaging is indispensable in the initial evaluation of VKH, and is becoming increasingly important in understanding disease pathogenesis, as well as monitoring therapeutic response. Enhanced VKH classification criteria, released in 2021, provide standardized guidelines and terminology for clinical and research purposes. SUMMARY Modern research and imaging techniques continue to improve our understanding of VKH; more work is needed to further elucidate pathogenic mechanisms and establish optimal therapeutic recommendations.
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Affiliation(s)
- Ashlin Joye
- Casey Eye Institute, Oregon Health and Science University
| | - Eric Suhler
- Department of Ophthalmology - Casey Eye Institute, Oregon Health and Science University, VA Portland Healthcare System, Portland, Oregon, USA
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20
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Comparison of combination therapy of prednisolone and cyclosporine with corticosteroid pulse therapy in Vogt-Koyanagi-Harada disease. Jpn J Ophthalmol 2021; 66:119-129. [PMID: 34689288 DOI: 10.1007/s10384-021-00878-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare the efficacy and safety of a combination therapy of prednisolone and cyclosporine and corticosteroid pulse therapy in Vogt-Koyanagi-Harada (VKH) disease. STUDY DESIGN A prospective, multicenter, randomized, non-inferiority trial. METHODS Patients of new-onset acute VKH disease at 11 centers in Japan between 2014 and 2018 were randomized to a combination (oral prednisolone 60 mg daily with gradual taper-off to 35 mg/day and cyclosporine 3 mg/kg/day) and corticosteroid (methylprednisolone 1000 mg for 3 days followed by oral prednisolone) groups, and were followed for 1 year. RESULTS Thirty-four were assigned to the combination and thirty-six patients to the corticosteroid group. Recurrence/worsening risk was 0.15 (95% confidence-interval [CI] 0.03-0.27) in the combination group and 0.25 (95% CI 0.11-0.39) in the corticosteroid group, with a risk difference of - 0.10 (90% CI - 0.27 to 0.06), demonstrating non-inferiority of the combination group with a non-inferiority margin of 0.20 (P = 0.0013). Serious adverse events occurred in three patients (two with hyponatremia and one with severe headaches) in the combination group and none in the corticosteroid group. Sunset glow fundus grades and cataract rates at 1 year were 0.57 (95% CI 0.42-71) and 4.3% in the combination group and 0.91 (95% CI 0.78-1.04) and 34.0% in the corticosteroid group, respectively. CONCLUSIONS Combination therapy was noninferior to corticosteroid therapy with respect to recurrence/worsening risk. Notably, the recurrence/worsening risk, sunset glow fundus grade, and cataract rate were lower in the combination group than in the corticosteroid group.
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21
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Chen Z, Zhong Z, Zhang W, Su G, Yang P. Integrated Analysis of Key Pathways and Drug Targets Associated With Vogt-Koyanagi-Harada Disease. Front Immunol 2021; 11:587443. [PMID: 33384687 PMCID: PMC7769821 DOI: 10.3389/fimmu.2020.587443] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/11/2020] [Indexed: 11/27/2022] Open
Abstract
Background Vogt-Koyanagi-Harada (VKH) disease is a complex disease associated with multiple molecular immunological mechanisms. As the underlying mechanism for VKH disease is unclear, we hope to utilize an integrated analysis of key pathways and drug targets to develop novel therapeutic strategies. Methods Candidate genes and proteins involved in VKH disease were identified through text-mining in the PubMed database. The GO and KEGG pathway analyses were used to examine the biological functions of the involved pathways associated with this disease. Molecule-related drugs were predicted through Drug-Gene Interaction Database (DGIdb) analysis. Results A total of 48 genes and 54 proteins were associated with VKH disease. Forty-two significantly altered pathways were identified through pathway analysis and were mainly related to immune and inflammatory responses. The top five of significantly altered pathways were termed as “inflammatory bowel disease,” “cytokine-cytokine receptor interaction,” “allograft rejection,” “antigen processing,” and “presentation and Herpes simplex infection” in the KEGG database. IFN-γ and IL-6 were identified as the key genes through network analysis. The DGIdb analysis predicted 48 medicines as possible drugs for VKH disease, among which Interferon Alfa-2B was co-associated both with IFN-γ and IL-6. Conclusions In this study, systematic analyses were utilized to detect key pathways and drug targets in VKH disease via bioinformatics analysis. IFN-γ and IL-6 were identified as the key mediators and possible drug targets in VKH disease. Interferon Alfa-2B was predicted to be a potentially effective drug for VKH disease treatment by targeting IFN-γ and IL-6, which warrants further experimental and clinical investigations.
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Affiliation(s)
- Zhijun Chen
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, China
| | - Zhenyu Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, China
| | - Wanyun Zhang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, China
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22
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Papasavvas I, Tugal-Tutkun I, Herbort CP. Vogt-Koyanagi-Harada is a Curable Autoimmune Disease: Early Diagnosis and Immediate Dual Steroidal and Non-Steroidal Immunosuppression are Crucial Prerequisites. J Curr Ophthalmol 2020; 32:310-314. [PMID: 33553831 PMCID: PMC7861101 DOI: 10.4103/joco.joco_190_20] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/07/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose: It is crucial to subdivide Vogt–Koyanagi–Harada (VKH) disease into two subentities, initial-onset disease versus chronically evolving disease. For early diagnosis and precise follow-up of VKH choroiditis, the “Revised criteria for VKH” are no more sufficient for the appraisal of VKH and new biomarkers for disease activity are needed. It has been shown that, if initial-onset disease is treated promptly within the “therapeutic window of opportunity” and long enough with dual steroidal and non-steroidal immunosuppression, the disease can be cured in a large proportion of cases, an approach still contested. The proportion of chronic evolution and/or sunset-glow fundus (SGF) following steroidal monotherapy versus dual steroidal and non-steroidal immunosuppression was compared. Methods: A literature search was performed, identifying studies on initial-onset VKH treated either by steroidal monotherapy or dual immunosuppression. Evolution toward chronicity and/or SGF was compared in both groups. Results: Twenty studies were identified with reported long-term outcomes. In 16 studies, 802 patients received steroidal monotherapy, while in 4 studies, 172 patients received dual steroidal and non-steroidal immunosuppression. Chronic evolution and SGF occurred, respectively, in 44% and 59% in the corticosteroid-alone group versus 2.3% and 17.5% in the dual therapy group with no chronic evolution in three studies and no SGF in two studies. Conclusions: Chronic evolution and SGF are significantly less frequent in initial-onset VKH when treated with immediate dual steroidal and non-steroidal immunosuppression with a high proportion of healed cases. This combined approach seems recommended in the management of initial-onset VKH disease.
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Affiliation(s)
- Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre For Ophthalmic Specialised Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland
| | | | - Carl P Herbort
- Retinal and Inflammatory Eye Diseases, Centre For Ophthalmic Specialised Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland
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Diallo K, Revuz S, Clavel-Refregiers G, Sené T, Titah C, Gerfaud-Valentin M, Seve P, Jaussaud R. Vogt-Koyanagi-Harada disease: a retrospective and multicentric study of 41 patients. BMC Ophthalmol 2020; 20:395. [PMID: 33028239 PMCID: PMC7539440 DOI: 10.1186/s12886-020-01656-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/23/2020] [Indexed: 11/18/2022] Open
Abstract
Background East and South East Asian subjects as well as Amerindians and Hispanic subjects are predominantly affected by Vogt-Koyanagi-Harada disease. In Europe, only few studies have described the clinical features and treatment of this disease, especially in France. Methods This retrospective case series was based on data collected from patients with a VKH disease diagnosed from January 2000 to March 2017, provided by three French Tertiary Centers. Results Forty-one patients (16 men and 25 women) were diagnosed: average age at diagnosis was 38.7 years. Patients were mainly from Maghreb (58%), but ethnic origins were multiple. Pleiocytosis was observed in 19 cases (63%) and 17 out of 41 patients showed audio vestibular signs (41%), and 11 showed skin signs (27%). Thirty-four were treated with corticosteroids (83%), 11 with an immunosuppressant treatment (27%) and 5 with biological therapy drugs (13%). Relapse was observed in 41% patients, even though final average visual acuity had improved. We did not find any significant clinical difference in the population from Maghreb compared to other populations, but for age and sex trends, since there was a majority of younger women. Conclusion We report here the second largest French cohort reported to date to our knowledge. The multiethnicity in our study suggests that VKH disease should be evoked whatever patients’ ethnicity.
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Affiliation(s)
- K Diallo
- Department of Internal Medicine, Nancy University Hospital, Nancy, France.
| | - S Revuz
- Department of Internal Medicine, Metz Private Hospital, Metz, France
| | - G Clavel-Refregiers
- Department of Internal Medicine, Rothschild Hospital Foundation, Paris, France
| | - T Sené
- Department of Internal Medicine, Rothschild Hospital Foundation, Paris, France
| | - C Titah
- Department of Ophthalmology, Rothschild Hospital Foundation, Paris, France
| | | | - P Seve
- Department of Internal Medicine, Lyon University Hospital, Lyon, France
| | - R Jaussaud
- Department of Internal Medicine, Nancy University Hospital, Nancy, France
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Urzua CA, Herbort C, Valenzuela RA, Abu El-Asrar AM, Arellanes-Garcia L, Schlaen A, Yamamoto J, Pavesio C. Initial-onset acute and chronic recurrent stages are two distinctive courses of Vogt-Koyanagi-Harada disease. J Ophthalmic Inflamm Infect 2020; 10:23. [PMID: 32924094 PMCID: PMC7487280 DOI: 10.1186/s12348-020-00214-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 08/13/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To describe distinctive stages of Vogt-Koyanagi-Harada (VKH) disease: initial-onset acute versus chronic recurrent disease. METHODS A comprehensive literature review regarding stages and clinical presentations of VKH disease was conducted. RESULTS Despite a list of signs that has been described as characteristic features of early or late phases of VKH disease, the current classification -developed by an international committee and published in 2001- does not consider a distinction regarding the time from onset of disease symptoms, and specific findings observed at certain time point from the symptoms presentation and outcomes related to the stage of VKH disease. In that sense, chronic recurrent VKH disease is more refractory to treatment and is associated with a higher rate of complications. Accordingly, this subset of VKH patients has poorer functional and anatomical outcomes than patients with an initial-onset acute disease. CONCLUSIONS An early clear distinction of VKH phenotype [Initial-onset acute versus chronic recurrent disease] should be considered in each clinical scenario, evaluating the delay in diagnosis and the clinical presentation, since it may help clinicians to perform a correct disease prognosis categorization and thus to make treatment decisions in terms of potential refractoriness or expected clinical outcomes.
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Affiliation(s)
- Cristhian A Urzua
- Department of Ophthalmology, Faculty of Medicine, University of Chile, Independencia, 1027, Santiago, Chile. .,Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile. .,Facultad de Medicina, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile.
| | - Carl Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.,Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
| | - Rodrigo A Valenzuela
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile.,Departamento de Ciencias Quimicas y Biologicas, Facultad de Salud, Universidad Bernardo O Higgins, Santiago, Chile
| | - Ahmed M Abu El-Asrar
- Department of Ophthalmology, Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lourdes Arellanes-Garcia
- Inflammatory Eye Diseases Clinic, "Dr. Luis Sanchez Bulnes" Hospital Asociación para Evitar la Ceguera en México (APEC), Mexico DF, Mexico
| | - Ariel Schlaen
- Hospital Universitario Austral, Hospital de Clinicas de Buenos Aires, Buenos Aires, Argentina
| | - Joyce Yamamoto
- Department of Ophthalmology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carlos Pavesio
- National Institute for Health Research, Biomedical Research Centre at Moorfields Eye Hospital, NHS Foundation Trust and UCL, Institute of Ophthalmology, London, UK
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Herbort CP, Tugal-Tutkun I, Khairallah M, Abu El Asrar AM, Pavésio CE, Soheilian M. Vogt-Koyanagi-Harada disease: recurrence rates after initial-onset disease differ according to treatment modality and geographic area. Int Ophthalmol 2020; 40:2423-2433. [PMID: 32418076 DOI: 10.1007/s10792-020-01417-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/05/2020] [Indexed: 12/30/2022]
Abstract
Background/Purpose Vogt-Koyanagi-Harada (VKH) disease is a primary autoimmune stromal choroiditis producing a spill-over panuveitis. For initial-onset VKH disease, it is increasingly thought that corticosteroid therapy is not sufficient and additional non-steroidal immunosuppressive therapy is needed. At the 11th workshop on VKH, the disease was said to be well controlled with corticosteroids alone in Japanese patients. The aim of this study was to review the literature to determine whether different levels of severity exist in different geographical areas. METHODS Literature was reviewed for studies on the evolution of initial-onset VKH disease, looking at treatment modalities and proportion of cases with chronic evolution and/or sunset-glow fundus (SGF). RESULTS PubMed search yielded 1249 references containing the term of Vogt-Koyanagi-Harada. Twenty references (15 from outside of Japan and 5 from Japan) contained information on the evolution of treated initial-onset disease. For the "international" group, percentage of chronic evolution after systemic corticosteroid monotherapy was 61%, and after combined steroidal and non-steroidal therapy it fell to 2% (0% in 3/4 studies). In the Japanese studies where all patients received systemic corticosteroids alone, chronic evolution was reported in 25%; however, SGF amounted to 61%. CONCLUSION In the world at large, chronic evolution of initial-onset VKH disease treated with corticosteroids alone concerned two-thirds of patients. Japanese studies showed that chronic evolution was substantially less frequent, indicating possibly less severe disease in Japan. This proportion fell to almost zero when dual steroidal and non-steroidal immunosuppression was given at onset.
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Affiliation(s)
- Carl P Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Rue Charles-Monnard 6, CH-1003, Lausanne, Switzerland. .,Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland.
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Moncef Khairallah
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Ahmed M Abu El Asrar
- Department of Ophthalmology, Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Carlos E Pavésio
- National Institute for Health Research, Biomedical Research Centre at Moorfields Eye Hospital, NHS Foundation Trust and UCL, Institute of Ophthalmology, London, UK
| | - Masoud Soheilian
- Department of Ophthalmology and Ophthalmic Research Centre, Labbafinejad Medical Centre, Shahid Beheshti Medical University, Teheran, Iran
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Hosseini SM, Dourandish M, Mazouchi M. Unilateral Presentation of Vogt-Koyanagi-Harada Syndrome. J Ophthalmic Vis Res 2020; 15:99-103. [PMID: 32128086 PMCID: PMC7001015 DOI: 10.18502/jovr.v15i1.5954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/20/2018] [Indexed: 11/26/2022] Open
Abstract
Purpose To report a case of acute Vogt-Koyanagi-Harada (VKH) disease with unilateral clinical manifestations followed by late fellow eye involvement. Case Report This case report reviews the 12-month follow-up observation of a 44-year old woman who presented to the emergency department with unilateral progressive and painless visual blurring. Ophthalmoscopic findings, best-corrected visual acuity (BCVA), fluorescein angiography (FAG), enhanced-depth optical coherence tomography (EDI-OCT), indocyanine green angiography, and response to treatment were evaluated. Her BCVA was 20/50 (logMAR: 0.4) in the right eye and 20/20 (logMAR: 0) in the left eye. Eye examination revealed optic disc swelling and multiple serous retinal detachments in the right eye and a normal left eye. She had headache, dysacusia, and mild hearing problem. Her past ocular and drug histories were unremarkable. Retinal imaging revealed characteristic features of VKH in the right eye. All laboratory testing results were inconclusive. VA and OCT findings significantly improved following the treatment with methylprednisolone 1 g/day continued by tapering dose of oral prednisolone. Two months after the presentation and during prednisolone tapering, VA of the left eye decreased and fundus examination revealed multiple serous retinal detachments in this eye. Conclusion Ophthalmologists should recognize unilateral and asymmetrical VKH disease with subtle systemic involvement.
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Affiliation(s)
| | - Maryam Dourandish
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Marjan Mazouchi
- Eye Research Center, Matini Eye Hospital, Kashan University of Medical Sciences, Kashan, Iran
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Identification of Underlying Inflammation in Vogt-Koyanagi-Harada Disease with Sunset Glow Fundus by Multiple Analyses. J Ophthalmol 2019; 2019:3853794. [PMID: 31687197 PMCID: PMC6794978 DOI: 10.1155/2019/3853794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/26/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate underlying subclinical ocular inflammation in Vogt-Koyanagi-Harada (VKH) disease with sunset glow fundus (SGF) by multiple analyses. Study Design Retrospective observational study. Methods Clinical records of 34 eyes of 17 VKH patients with SGF in whom laser flare photometry (LFP), enhanced depth imaging optical coherence tomography (EDI-OCT), and indocyanine green angiography (ICGA) were performed on the same day were reviewed. The mean age was 57.3 ± 16.3 years, and the mean duration from the initial onset of uveitis was 47.1 ± 22.1 months. Flare counts, ICGA scores, and subfoveal choroidal thickness (SFCT) were compared between eyes. Results Although clinical ocular inflammation was observed only in 4 eyes (11.8%), inflammatory signs were observed in 23 out of 34 eyes by LFP (67.6%), in 27 eyes by ICGA (79.4%), and in 10 eyes by SFCT (29.4%). Active inflammatory signs detected by ICGA were observed in 77.8% by LFP and in 25.9% by SFCT. The strength of agreement (Cohen's kappa coefficient) between positive ICGA score and positive flare score was 0.406 (95% CI: 0.076-0.7359, P < 0.01), but there was no association between positive ICGA score and increased SFCT. In addition, positive flare count was the significant prognostic factor of positive ICGA score with odds ratio 11.7. Conclusions Subclinical ocular inflammation signs were detected in most VKH patients with SGF by ICGA and a substantial proportion of which were also detected by LFP, whereas SFCT was less sensitive to detect subclinical inflammation.
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Kim JS, Kim DY, Kim KT, Chae JB. Clinical Features of Recurred Vogt-Koyanagi-Harada Syndrome during Oral Steroids Tapering Therapy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.4.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ji Soo Kim
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Dong Yoon Kim
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kyung Tae Kim
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ju Byung Chae
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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Girasoli L, Cazzador D, Padoan R, Nardello E, Felicetti M, Zanoletti E, Schiavon F, Bovo R. Update on Vertigo in Autoimmune Disorders, from Diagnosis to Treatment. J Immunol Res 2018; 2018:5072582. [PMID: 30356417 PMCID: PMC6178164 DOI: 10.1155/2018/5072582] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/03/2018] [Indexed: 12/18/2022] Open
Abstract
The prevalence of autoimmune diseases has been increasing over the last 20 years. The clinical presentation of this large and heterogeneous group of disorders depends on whether the involvement is organ-specific or non-organ-specific. Dizziness, vertigo, and disequilibrium are common symptoms reported by patients with vestibulocochlear involvement. The association of vertigo and autoimmune diseases has been largely documented, suggesting that autoimmune disorders could be overrepresented in patients with vertigo in comparison to the general population. The aim of this review is to present the recent literature findings in the field of autoimmune-mediated diseases with cochleovestibular involvement, focusing on the clinical presentation, diagnosis, and treatment of immune-mediated inner ear diseases including autoimmune inner ear disease (AIED), Meniere's disease, and bilateral vestibulopathy, as well as of systemic autoimmune diseases with audiovestibular disorders, namely, Behçet's disease, Cogan's syndrome, sarcoidosis, autoimmune thyroid disease, Vogt-Koyanagi-Harada syndrome, relapsing polychondritis, systemic lupus erythematosus, antiphospholipid syndrome, IgG4-related disease, and ANCA-associated vasculitides.
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Affiliation(s)
- Laura Girasoli
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Diego Cazzador
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Roberto Padoan
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Ennio Nardello
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Mara Felicetti
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Elisabetta Zanoletti
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Franco Schiavon
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Roberto Bovo
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
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Herbort CP, Abu El Asrar AM, Takeuchi M, Pavésio CE, Couto C, Hedayatfar A, Maruyama K, Rao X, Silpa-Archa S, Somkijrungroj T. Catching the therapeutic window of opportunity in early initial-onset Vogt-Koyanagi-Harada uveitis can cure the disease. Int Ophthalmol 2018; 39:1419-1425. [PMID: 29948499 DOI: 10.1007/s10792-018-0949-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Vogt-Koyanagi-Harada (VKH) disease is a primary autoimmune granulomatous choroiditis that begins in the choroidal stroma. The aim of this review was to gather a body of evidence for the concept of a window of therapeutic opportunity, defined as a time interval following initial-onset disease during which adequate treatment will substantially modify the disease outcome and possibly even lead to cure, similar to what has been described for rheumatoid arthritis. METHODS We reviewed the literature and consulted leading experts in VKH disease to determine the consensus for the notion of a therapeutic window of opportunity in VKH disease. RESULTS We found a substantial body of evidence in the literature that a therapeutic window of opportunity exists for initial-onset acute uveitis associated with VKH disease. The disease outcome can be substantially improved if dual systemic steroidal and non-steroidal immunosuppressants are given within 2-3 weeks of the onset of initial VKH disease, avoiding evolution to chronic disease and development of "sunset glow fundus." Several studies additionally report series in which the disease could be cured, using such an approach. CONCLUSIONS There is substantial evidence for a therapeutic window of opportunity in initial-onset acute VKH disease. Timely and adequate treatment led to substantial improvement of disease outcome and prevented chronic evolution and "sunset glow fundus," and very early treatment led to the cure after discontinuation of therapy in several series, likely due to the fact that the choroid is the sole origin of inflammation in VKH disease.
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Affiliation(s)
- Carl P Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Rue Charles-Monnard 6, 1003, Lausanne, Switzerland. .,Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland.
| | - Ahmed M Abu El Asrar
- Department of Ophthalmology and Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Masuru Takeuchi
- Department of Ophthalmology, National Defence Medical College, Tokorozawa, Saitama, Japan
| | - Carlos E Pavésio
- National Institute for Health Research, Biomedical Research Centre at Moorfields Eye Hospital, NHS Foundation Trust and UCL, Institute of Ophthalmology, London, UK
| | - Cristobal Couto
- Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
| | - Alireza Hedayatfar
- Noor Eye Hospital and Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Kazuichi Maruyama
- Department of Innovative Visual Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Xi Rao
- Department of Ophthalmology, General Police Hospital, University of Chile, Santiago, Chile
| | - Sukhum Silpa-Archa
- Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Thanapong Somkijrungroj
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Yoshino N, Kawamura A, Ishii A, Yoshida K, Watanabe T, Yamashita T, Fukuchi T, Toyoda F, Kakehashi A, Sugawara H. Vogt-Koyanagi-Harada Disease Associated with Influenza A Virus Infection. Intern Med 2018; 57:1661-1665. [PMID: 29321438 PMCID: PMC6028674 DOI: 10.2169/internalmedicine.9819-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/10/2017] [Indexed: 11/14/2022] Open
Abstract
We herein report a case of a 31-year-old Japanese man who simultaneously had a positive influenza A virus antigen test result and Vogt-Koyanagi-Harada disease (VKHD), demonstrated by both diffuse multiple early hyperfluorescent points on fluorescein fundus photography and serous retinal detachments on optical coherence tomography. He had meningitis. It was difficult to determine whether the main cause of meningitis was influenza A or VKHD. After initial treatment with peramivir for influenza A and then methylprednisolone pulse with subsequent corticosteroid therapy for VKHD, his symptoms improved gradually. These findings suggest that influenza A virus infection contributes to the onset or exacerbation of VKHD.
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Affiliation(s)
- Nozomu Yoshino
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
| | - Ai Kawamura
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
| | - Akira Ishii
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
| | - Katsuyuki Yoshida
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
| | - Tamami Watanabe
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
| | - Takeshi Yamashita
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
| | - Takahiko Fukuchi
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
| | - Fumihiko Toyoda
- Divisions of Ophthalmology, Department of Comprehensive Medicine 2, Saitama Medical Center, Jichi Medical University, Japan
| | - Akihiko Kakehashi
- Divisions of Ophthalmology, Department of Comprehensive Medicine 2, Saitama Medical Center, Jichi Medical University, Japan
| | - Hitoshi Sugawara
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
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Ney Y, Jawad Nasim M, Kharma A, Youssef LA, Jacob C. Small Molecule Catalysts with Therapeutic Potential. Molecules 2018; 23:E765. [PMID: 29584669 PMCID: PMC6017662 DOI: 10.3390/molecules23040765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 03/22/2018] [Accepted: 03/24/2018] [Indexed: 01/21/2023] Open
Abstract
Catalysts are employed in many areas of research and development where they combine high efficiency with often astonishing selectivity for their respective substrates. In biology, biocatalysts are omnipresent. Enzymes facilitate highly controlled, sophisticated cellular processes, such as metabolic conversions, sensing and signalling, and are prominent targets in drug development. In contrast, the therapeutic use of catalysts per se is still rather limited. Recent research has shown that small molecule catalytic agents able to modulate the redox state of the target cell bear considerable promise, particularly in the context of inflammatory and infectious diseases, stroke, ageing and even cancer. Rather than being "active" on their own in a more traditional sense, such agents develop their activity by initiating, promoting, enhancing or redirecting reactions between biomolecules already present in the cell, and their activity therefore depends critically on the predisposition of the target cell itself. Redox catalysts, for instance, preferably target cells with a distinct sensitivity towards changes in an already disturbed redox balance and/or increased levels of reactive oxygen species. Indeed, certain transition metal, chalcogen and quinone agents may activate an antioxidant response in normal cells whilst at the same time triggering apoptosis in cancer cells with a different pre-existing "biochemical redox signature" and closer to the internal redox threshold. In pharmacy, catalysts therefore stand out as promising lead structures, as sensor/effector agents which are highly effective, fairly selective, active in catalytic, i.e., often nanomolar concentrations and also very flexible in their structural design.
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Affiliation(s)
- Yannick Ney
- Division of Bioorganic Chemistry, School of Pharmacy, Saarland University, D-66123 Saarbruecken, Germany.
| | - Muhammad Jawad Nasim
- Division of Bioorganic Chemistry, School of Pharmacy, Saarland University, D-66123 Saarbruecken, Germany.
| | - Ammar Kharma
- Division of Bioorganic Chemistry, School of Pharmacy, Saarland University, D-66123 Saarbruecken, Germany.
| | - Lama A Youssef
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, Damascus University, Damascus, Syria.
| | - Claus Jacob
- Division of Bioorganic Chemistry, School of Pharmacy, Saarland University, D-66123 Saarbruecken, Germany.
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Yang P, Ye Z, Du L, Zhou Q, Qi J, Liang L, Wu L, Wang C, Kijlstra A. Novel treatment regimen of Vogt-Koyanagi-Harada disease with a reduced dose of corticosteroids combined with immunosuppressive agents. Curr Eye Res 2017; 43:254-261. [PMID: 29111815 DOI: 10.1080/02713683.2017.1383444] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the effectiveness, visual outcome, and prognostic factors of Vogt-Koyanagi-Harada (VKH) disease treatment with a reduced dose of corticosteroids combined with immunosuppressive agents. METHODS The clinical characteristics, auxiliary examinations, treatment result, visual outcome, and prognostic factors in VKH patients were analyzed. RESULTS A total of 998 VKH patients were divided into posterior uveitis group (Group1), anterior uveal involvement group (Group 2), and recurrent granulomatous anterior uveitis group (Group 3). Reduced doses of corticosteroids combined with immunosuppressive agents were used for 1-1.5 years. Uveitis was controlled in 100%, 100%, and 96.8% of these three groups, respectively. Visual improvement and stability was observed in 98.1%, 96.5%, and 88.3%, respectively. Treatment after disease onset, visual acuity at first visit, and 1 month after treatment was positively associated with BCVA at last visit (p < 0.05). CONCLUSION A reduced dose of corticosteroids combined with immunosuppressive agents effectively controlled the intraocular inflammation and improved visual acuity in most Chinese VKH patients.
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Affiliation(s)
- Peizeng Yang
- a The First Affiliated Hospital of Chongqing Medical University , Ophthalmology Department, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute , Chongqing , P.R. China
| | - Zi Ye
- a The First Affiliated Hospital of Chongqing Medical University , Ophthalmology Department, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute , Chongqing , P.R. China
| | - Liping Du
- a The First Affiliated Hospital of Chongqing Medical University , Ophthalmology Department, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute , Chongqing , P.R. China
| | - Qingyun Zhou
- a The First Affiliated Hospital of Chongqing Medical University , Ophthalmology Department, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute , Chongqing , P.R. China
| | - Jian Qi
- a The First Affiliated Hospital of Chongqing Medical University , Ophthalmology Department, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute , Chongqing , P.R. China
| | - Liang Liang
- a The First Affiliated Hospital of Chongqing Medical University , Ophthalmology Department, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute , Chongqing , P.R. China
| | - Lili Wu
- a The First Affiliated Hospital of Chongqing Medical University , Ophthalmology Department, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute , Chongqing , P.R. China
| | - Chaokui Wang
- b University Eye Clinic Maastricht , Maastricht , The Netherlands
| | - Aize Kijlstra
- b University Eye Clinic Maastricht , Maastricht , The Netherlands
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Guayacán CL, Galindo-Mendez B, de-la-Torre A. Vogt-Koyanagi-Harada Syndrome in a Group of Patients in Two Ophthalmology Referral Centers in Bogotá, Colombia. Ocul Immunol Inflamm 2017; 26:1123-1127. [PMID: 28910557 DOI: 10.1080/09273948.2017.1341536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe the clinical presentation of Vogt-Koyanagi-Harada (VKH) syndrome in a group of patients in Colombia. METHODS Retrospective review of 2638 medical records of patients with uveitis in two centers during 17 years. RESULTS A total of 25 patients with uveitis were diagnosed with VKH syndrome (0.95%), 23 patients were included in the data analysis (0.87%), 78.3% females, and mean age of diagnosis was 37 years (SD ± 29). Main complaints: blurred vision (87%), headaches (47.8%), tinnitus (26.1%), and hearing impairments (21.7%). Ophthalmic findings: bilateral serous retinal detachment (73.9%) and non-granulomatous uveitis (52.3%). Most of the patients were diagnosed with probable disease (56.5%). Mean duration of follow-up was 14 months; disease relapse was encountered in 26% of patients despite treatment. CONCLUSION Patients in Colombia with VKH had clinical features similar to those reported in other Hispanic populations, except for the non-granulomatous uveitis. This disease may be considered as having variation of clinical manifestations across population groups.
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Affiliation(s)
- Carol L Guayacán
- a Fundación Oftalmológica Nacional (FUNDONAL), Uveitis Service, Bogotá, Columbia
| | - Brahyan Galindo-Mendez
- b Escuela de Medicina y Ciencias de la Salud, Grupo de Investigación en Neurociencias (NeURos), Bogotá, Columbia
| | - Alejandra de-la-Torre
- a Fundación Oftalmológica Nacional (FUNDONAL), Uveitis Service, Bogotá, Columbia.,b Escuela de Medicina y Ciencias de la Salud, Grupo de Investigación en Neurociencias (NeURos), Bogotá, Columbia
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Abu El-Asrar AM, Dosari M, Hemachandran S, Gikandi PW, Al-Muammar A. Mycophenolate mofetil combined with systemic corticosteroids prevents progression to chronic recurrent inflammation and development of 'sunset glow fundus' in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada disease. Acta Ophthalmol 2017; 95:85-90. [PMID: 27535102 DOI: 10.1111/aos.13189] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 06/13/2016] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the effectiveness and safety of mycophenolate mofetil (MMF) as first-line therapy combined with systemic corticosteroids in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada (VKH) disease. METHODS This prospective study included 38 patients (76 eyes). The main outcome measures were final visual acuity, corticosteroid-sparing effect, progression to chronic recurrent granulomatous uveitis and development of complications, particularly 'sunset glow fundus'. RESULTS The mean follow-up period was 37.0 ± 29.3 (range 9-120 months). Visual acuity of 20/20 was achieved by 93.4% of the eyes. Corticosteroid-sparing effect was achieved in all patients. The mean interval between starting treatment and tapering to 10 mg or less daily was 3.8 ± 1.3 months (range 3-7 months). Twenty-two patients (57.9%) discontinued treatment without relapse of inflammation. The mean time observed off of treatment was 28.1 ± 19.6 months (range 1-60 months). None of the eyes progressed to chronic recurrent granulomatous uveitis. The ocular complications encountered were glaucoma in two eyes (2.6%) and cataract in five eyes (6.6%). None of the eyes developed 'sunset glow fundus', and none of the patients developed any systemic adverse events associated with the treatment. CONCLUSIONS Use of MMF as first-line therapy combined with systemic corticosteroids in patients with initial-onset acute VKH disease prevents progression to chronic recurrent granulomatous inflammation and development of 'sunset glow fundus'.
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Affiliation(s)
- Ahmed M. Abu El-Asrar
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
- Dr. Nasser Al-Rashid Research Chair in Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
| | - Mona Dosari
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
| | - Suhail Hemachandran
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
| | - Priscilla W. Gikandi
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
| | - Abdulrahman Al-Muammar
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
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Giordano VE, Schlaen A, Guzmán-Sánchez MJ, Couto C. Spectrum and visual outcomes of Vogt-Koyanagi-Harada disease in Argentina. Int J Ophthalmol 2017; 10:98-102. [PMID: 28149784 DOI: 10.18240/ijo.2017.01.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 05/23/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To review all cases of Vogt-Koyanagi-Harada (VKH) disease in an Inflammatory Eye Disease Service in Argentina and to describe the clinical profile and outcomes of treatment. METHODS The records from patients with VKH disease between January 1980 and December 2008 were retrospectively analyzed for clinical profile, complications, and treatment. Patients were classified according to their initial treatment in group 1: high corticosteroid dose [≥1 mg/(kg·d)] within 2wk of illness onset; group 2: high corticosteroid dose, 2 to 4wk of onset and group 3: patients who received the high dose after 1mo of illness onset, patients who received lower oral doses than 1 mg/(kg·d) without regarding the time of beginning of the disease. RESULTS A total of 210 eyes of 105 patients were included. The mean age at presentation was 32.6±13y (range: 10-74y), and 86.7% were female. The mean duration of follow up was 144±96.6mo. Patients in the group 1 had significantly higher visual acuity than the other groups (P<0.0001), none had (loss of, or no) light perception at the end of follow up, whereas 24.7% patients in group 3 ended in light perception (P<0.004). CONCLUSION Patients with early high dose corticosteroid treatment have better visual acuity and fewer complications. Proper timing in referral and treatment is critical for better visual outcome in VKH disease.
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Affiliation(s)
- Verónica E Giordano
- Department of Ophthalmology, Inflammatory Eye Diseases Service, Hospital de Clínicas Jose de San Martin, Buenos Aires C1120AAR, Argentina
| | - Ariel Schlaen
- Department of Ophthalmology, Inflammatory Eye Diseases Service, Hospital de Clínicas Jose de San Martin, Buenos Aires C1120AAR, Argentina
| | - Martín J Guzmán-Sánchez
- Department of Ophthalmology, Oculoplastic Service, Association for the Prevention of Blindness in Mexico, Vicente García Torres 46, San Lucas 04030, Coyoacán, Mexico City, Mexico
| | - Cristobal Couto
- Department of Ophthalmology, Inflammatory Eye Diseases Service, Hospital de Clínicas Jose de San Martin, Buenos Aires C1120AAR, Argentina
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Morita C, Sakata VM, Rodriguez EEC, Abdallah SF, Lavezzo MM, da Silva FT, Machado CG, Oyamada MK, Hirata CE, Yamamoto JH. Fundus autofluorescence as a marker of disease severity in Vogt-Koyanagi-Harada disease. Acta Ophthalmol 2016; 94:e820-e821. [PMID: 27368955 DOI: 10.1111/aos.13147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Celso Morita
- Department of Ophthalmology; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo SP Brazil
| | - Viviane Mayumi Sakata
- Department of Ophthalmology; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo SP Brazil
| | - Ever Ernesto Caso Rodriguez
- Department of Ophthalmology; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo SP Brazil
| | - Smairah Frutuoso Abdallah
- Department of Ophthalmology; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo SP Brazil
| | - Marcelo Mendes Lavezzo
- Department of Ophthalmology; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo SP Brazil
| | - Felipe T. da Silva
- Department of Ophthalmology; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo SP Brazil
| | - Cleide Guimarães Machado
- Department of Ophthalmology; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo SP Brazil
| | - Maria Kiyoko Oyamada
- Department of Ophthalmology; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo SP Brazil
| | - Carlos Eduardo Hirata
- Department of Ophthalmology; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo SP Brazil
| | - Joyce Hisae Yamamoto
- Department of Ophthalmology; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo SP Brazil
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Baltmr A, Lightman S, Tomkins-Netzer O. Vogt-Koyanagi-Harada syndrome - current perspectives. Clin Ophthalmol 2016; 10:2345-2361. [PMID: 27932857 PMCID: PMC5135404 DOI: 10.2147/opth.s94866] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Vogt–Koyanagi–Harada syndrome is a cause of noninfectious panuveitis, leading to significant vision loss in many patients. It is an autoimmune disease occurring in genetically susceptible individuals and clinically presents as bilateral panuveitis with serous retinal detachments and hyperemic, swollen optic discs, which are associated with neurological and auditory manifestations. Early diagnosis and prompt and adequate treatment with immunosuppressive agents (corticosteroids and other immunosuppressive drugs) may halt disease progression and prevent recurrences and vision loss. This review summarizes the current knowledge on the variable clinical aspects of this disease, highlighting diagnostic and treatment strategies.
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Affiliation(s)
- Abeir Baltmr
- Uveitis Service, Moorfields Eye Hospital, London, UK
| | - Sue Lightman
- Uveitis Service, Moorfields Eye Hospital, London, UK; Department of Clinical Ophthalmology, UCL Institute of Ophthalmology, London, UK
| | - Oren Tomkins-Netzer
- Uveitis Service, Moorfields Eye Hospital, London, UK; Department of Clinical Ophthalmology, UCL Institute of Ophthalmology, London, UK; Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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Herbort CP, Abu El Asrar AM, Yamamoto JH, Pavésio CE, Gupta V, Khairallah M, Tugal-Tutkun I, Soheilian M, Takeuchi M, Papadia M. Reappraisal of the management of Vogt-Koyanagi-Harada disease: sunset glow fundus is no more a fatality. Int Ophthalmol 2016; 37:1383-1395. [PMID: 27844182 PMCID: PMC5660833 DOI: 10.1007/s10792-016-0395-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/05/2016] [Indexed: 12/22/2022]
Abstract
Purpose Vogt–Koyanagi–Harada (VKH) disease is a primary autoimmune stromal choroiditis. Aim of the study was to gather a body of evidence from the literature and from experts that systemic corticosteroid combined with non-steroidal immunosuppressive therapy should become the standard of care in initial-onset VKH disease. Methods Literature was reviewed and leading experts in VKH were consulted in different parts of the world in order to put forward a consensus attitude in the management of initial-onset VKH disease. Results There was a substantial body of evidence in the literature that early aggressive and sustained corticosteroid and non-steroidal immunosuppressive therapy in initial-onset VKH disease allows to achieve full control of choroidal inflammation, eliminating any subclinical choroidal inflammation, and substantially reduces recurrences with improvement of anatomical and functional outcomes. This was in agreement with experts’ opinion and practice. ICGA was the method of choice to monitor disease evolution. Conclusion Since the choroidal space is easily accessible to systemic therapy and because inflammation in VKH disease is exclusively originating from the choroidal stroma, early and sustained treatment right at the onset of the disease process with dual corticosteroid and non-steroidal immunosuppressive therapy can result in full “healing” in many cases preventing sunset glow fundus which results from depigmentation from chronic uncontrolled inflammation.
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Affiliation(s)
- Carl P Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Rue Charles-Monnard 6, 1003, Lausanne, Switzerland. .,Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland.
| | - Ahmed M Abu El Asrar
- Department of Ophthalmology, Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Joyce H Yamamoto
- Department of Ophthalmology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Carlos E Pavésio
- National Institute for Health Research, Biomedical Research Centre at Moorfields Eye Hospital, NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Vishali Gupta
- Department of Ophthalmology, Post-graduate Institute, Chandigarh, India
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourghiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Masoud Soheilian
- Department of Ophthalmology and Ophthalmic Research Centre, Labbafinejad Medical Centre, Shahid Beheshti Medical University, Teheran, Iran
| | - Masuru Takeuchi
- Department of Ophthalmology, National Defence Medical College, Tokorozawa, Saitama, Japan
| | - Marina Papadia
- Department of Ophthalmology, Ospedale Padre Antero Micone, Genoa, Italy
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Shen E, Rathinam SR, Babu M, Kanakath A, Thundikandy R, Lee SM, Browne EN, Porco TC, Acharya NR. Outcomes of Vogt-Koyanagi-Harada Disease: A Subanalysis From a Randomized Clinical Trial of Antimetabolite Therapies. Am J Ophthalmol 2016; 168:279-286. [PMID: 27296490 DOI: 10.1016/j.ajo.2016.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 01/23/2023]
Abstract
PURPOSE To report outcomes of Vogt-Koyanagi-Harada (VKH) disease from a clinical trial of antimetabolite therapies. DESIGN Subanalysis from an observer-masked randomized clinical trial for noninfectious intermediate, posterior, and panuveitis. METHODS setting: Clinical practice at Aravind Eye Hospitals, India. PATIENT POPULATION Forty-three of 80 patients enrolled (54%) diagnosed with VKH. INTERVENTION Patients were randomized to either 25 mg oral methotrexate weekly or 1 g mycophenolate mofetil twice daily, with a corticosteroid taper. MAIN OUTCOME MEASURES Primary outcome was corticosteroid-sparing control of inflammation at 5 and 6 months. Secondary outcomes included visual acuity, central subfield thickness, and adverse events. Patients were categorized as acute (diagnosis ≤3 months prior to enrollment) or chronic (diagnosis >3 months prior to enrollment). RESULTS Twenty-seven patients were randomized to methotrexate and 16 to mycophenolate mofetil; 30 had acute VKH. The odds of achieving corticosteroid-sparing control of inflammation with methotrexate were 2.5 times (95% CI: 0.6, 9.8; P = .20) the odds with mycophenolate mofetil, a difference that was not statistically significant. The average improvement in visual acuity was 12.5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. On average, visual acuity for patients with acute VKH improved by 14 more ETDRS letters than those with chronic VKH (P < .001), but there was no difference in corticosteroid-sparing control of inflammation (P = .99). All 26 eyes with a serous retinal detachment at baseline resolved, and 88% achieved corticosteroid-sparing control of inflammation. CONCLUSIONS The majority of patients treated with antimetabolites and corticosteroids were able to achieve corticosteroid-sparing control of inflammation by 6 months. Although patients with acute VKH gained more visual improvement than those with chronic VKH, this did not correspond with a higher rate of controlled inflammation.
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Affiliation(s)
- Elizabeth Shen
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | | | | | | | | | - Salena M Lee
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Erica N Browne
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Travis C Porco
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
| | - Nisha R Acharya
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California; Department of Ophthalmology, University of California San Francisco, San Francisco, California.
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Kuroda Y, So K, Goto K, Matsuda S. Extremely early stage osteonecrosis of the femoral head in a patient with hip pain secondary systemic steroid pulse therapy for Vogt-Koyanagi-Harada syndrome: A case report. Int J Surg Case Rep 2016; 25:97-101. [PMID: 27343734 PMCID: PMC4925909 DOI: 10.1016/j.ijscr.2016.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/06/2016] [Accepted: 06/08/2016] [Indexed: 12/31/2022] Open
Abstract
This was a case of hip osteonecrosis with onset during intravenous corticosteroid therapy for Vogt-Koyanagi-Harada syndrome. After seven weeks, the patient was diagnosed at extremely early stage of osteonecrosis of the femoral head. She was treated with joint-preserving regenerative therapy using growth factor.
Introduction Osteonecrosis of the femoral head (ONFH) is a corticosteroid-associated disease that mostly cause femoral head collapse and gait disturbance. At the final stage of ONFH, the most reliable treatment is total hip arthroplasty even in young patients. Although magnetic resonance imaging (MRI) is useful for early diagnosis, initial stages are asymptomatic, with pain intensifying after femoral head collapse. Presentation of case A 34-year-old female patient with rapid bilateral loss of vision was diagnosed Vogt-Koyanagi-Harada syndrome. She immediately received corticosteroid pulse therapy. While undergoing therapy, she complained of groin pain. The initial MRI of the hip did not show abnormal findings. As the right proximal thigh pain progressed, an MRI of the lumbar spine was performed. No compression of the spinal cord was observed, and right ONFH was suspected on the basis of a characteristic band image. The patient was diagnosed with Stage 1 ONFH 7 weeks after the initial symptoms. She was successfully treated by joint-preserving regenerative therapy using growth factor. After surgery, the patient completely recovered from pain. Discussion The occurrence of hip pain while receiving corticosteroid therapy was very rare. The present case was considered a result of reduction of the blood supply to the femoral head induced by hip pain that progressed to ONFH for unknown reasons. Conclusion It is difficult to identify cases of corticosteroid-associated ONFH even in patients with potential risk. In this case, we could identify the patient extremely early based on the ONFH image and could provide joint-preserving regenerative therapy.
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Affiliation(s)
- Yutaka Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Kazutaka So
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan
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Lavezzo MM, Sakata VM, Morita C, Rodriguez EEC, Abdallah SF, da Silva FTG, Hirata CE, Yamamoto JH. Vogt-Koyanagi-Harada disease: review of a rare autoimmune disease targeting antigens of melanocytes. Orphanet J Rare Dis 2016; 11:29. [PMID: 27008848 PMCID: PMC4806431 DOI: 10.1186/s13023-016-0412-4] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 03/16/2016] [Indexed: 12/18/2022] Open
Abstract
Vogt-Koyanagi-Harada disease (VKHD) is a rare granulomatous inflammatory disease that affects pigmented structures, such as eye, inner ear, meninges, skin and hair. This disease is mainly a Th1 lymphocyte mediated aggression to melanocytes after a viral trigger in the presence of HLA-DRB1*0405 allele. The absence of ocular trauma or previous intraocular surgery sets VKHD appart from sympathetic ophthalmia, its main differential diagnosis. The disease has an acute onset of bilateral blurred vision with hyperemia preceded by flu-like symptoms. The acute uveitic stage is characterized by a diffuse choroiditis with serous retinal detachment and optic disc hyperemia and edema. Fluorescein angiography in this phase demonstrates multiple early hyperfluorescent points. After the acute uveitic stage, ocular and integumentary system pigmentary changes may appear. Ocular findings may be accompanied by lymphocytic meningitis, hearing impairment and/or tinnitus in a variable proportion of patients. Prompt diagnosis followed by early, aggressive and long-term treatment with high-dose corticosteroids is most often ensued by good visual outcomes. However, some patients may experience chronic uveal inflammation with functional eye deterioration. The current review discusses the general features of VKHD, including epidemiology, classification into categories, differential diagnosis and current therapeutic approaches.
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Affiliation(s)
- Marcelo Mendes Lavezzo
- Uveitis Service, Department of Ophthalmology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Diana, 863 apto 91J, 05019-000, São Paulo, Brazil
| | - Viviane Mayumi Sakata
- Uveitis Service, Department of Ophthalmology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Diana, 863 apto 91J, 05019-000, São Paulo, Brazil
| | - Celso Morita
- Uveitis Service, Department of Ophthalmology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Diana, 863 apto 91J, 05019-000, São Paulo, Brazil
| | - Ever Ernesto Caso Rodriguez
- Uveitis Service, Department of Ophthalmology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Diana, 863 apto 91J, 05019-000, São Paulo, Brazil
| | - Smairah Frutuoso Abdallah
- Uveitis Service, Department of Ophthalmology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Diana, 863 apto 91J, 05019-000, São Paulo, Brazil
| | - Felipe T G da Silva
- Uveitis Service, Department of Ophthalmology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Diana, 863 apto 91J, 05019-000, São Paulo, Brazil
| | - Carlos Eduardo Hirata
- Uveitis Service, Department of Ophthalmology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Diana, 863 apto 91J, 05019-000, São Paulo, Brazil
| | - Joyce Hisae Yamamoto
- Uveitis Service, Department of Ophthalmology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Diana, 863 apto 91J, 05019-000, São Paulo, Brazil.
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Abu El-Asrar AM, Al Mudhaiyan T, Al Najashi AA, Hemachandran S, Hariz R, Mousa A, Al-Muammar A. Chronic Recurrent Vogt-Koyanagi-Harada Disease and Development of 'Sunset Glow Fundus' Predict Worse Retinal Sensitivity. Ocul Immunol Inflamm 2016; 25:475-485. [PMID: 27003480 DOI: 10.3109/09273948.2016.1139730] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate prognostic factors for retinal sensitivity assessed by microperimetry in patients with Vogt-Koyanagi-Harada (VKH) disease. METHODS In total, 34 patients with initial-onset acute disease and 19 patients with chronic recurrent disease were retrospectively evaluated. RESULTS The mean follow-up period was 40.4 ± 40.5 months. Sensitivity was significantly worse in eyes with more severe anterior segment inflammation at presentation, as indicated by the presence of mutton-fat keratic precipitates, anterior chamber reaction ≥2+, and posterior synechiae. Chronic recurrent presentation, development of complications, and 'sunset glow fundus' were significantly associated with worse sensitivity. Using logistic regression analysis, better sensitivity was significantly associated with initial-onset acute presentation (odds ratio, OR = 6.9; 95% confidence interval, CI = 1.53-9.66). CONCLUSIONS Chronic recurrent presentation and development of complications and 'sunset glow fundus' are associated with a worse sensitivity outcome.
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Affiliation(s)
- Ahmed M Abu El-Asrar
- a Department of Ophthalmology , College of Medicine, King Saud University , Riyadh , Saudi Arabia.,b Dr Nasser Al-Rashid Research Chair in Ophthalmology
| | - Tariq Al Mudhaiyan
- a Department of Ophthalmology , College of Medicine, King Saud University , Riyadh , Saudi Arabia
| | - AlHatoon A Al Najashi
- a Department of Ophthalmology , College of Medicine, King Saud University , Riyadh , Saudi Arabia
| | - Suhail Hemachandran
- a Department of Ophthalmology , College of Medicine, King Saud University , Riyadh , Saudi Arabia
| | - Rajab Hariz
- a Department of Ophthalmology , College of Medicine, King Saud University , Riyadh , Saudi Arabia
| | - Ahmed Mousa
- a Department of Ophthalmology , College of Medicine, King Saud University , Riyadh , Saudi Arabia
| | - Abdulrahman Al-Muammar
- a Department of Ophthalmology , College of Medicine, King Saud University , Riyadh , Saudi Arabia
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Abstract
PURPOSE OF REVIEW The purpose of this article is to review the current literature on Vogt-Koyanagi-Harada (VKH) disease, including current treatment options and new research directions. RECENT FINDINGS Recent publications on VKH disease show an increased focus on the immunogenetics and immune pathways associated with the development of VKH disease. There have also been advances in imaging modalities and techniques that may help to better elucidate the disease process in eyes with VKH disease. SUMMARY VKH disease is an autoimmune, multisystem inflammatory disorder, the cause of which is still incompletely understood. Continued research may elucidate the causes and triggers of immune dysregulation in this disease, and in doing so, identify novel therapeutic targets.
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