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Noh H, Nam SW, Yoon JM, Ham DI. Choroidal venous overload in Vogt‒Koyanagi‒Harada disease. Eye (Lond) 2024; 38:2960-2967. [PMID: 38951674 DOI: 10.1038/s41433-024-03198-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 04/11/2024] [Accepted: 06/20/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to investigate the change of choroidal venous overload in Vogt‒Koyanagi‒Harada (VKH) disease. Clinical records of 52 patients with VKH disease (52 eyes) and 24 control subjects (24 eyes) who underwent multimodal imaging, including fluorescein angiography (FA) and indocyanine green angiography (ICGA), were retrospectively reviewed. SUBJECTS/METHODS Imaging data were assessed for signs associated with choroidal venous overload, e.g., choroidal perfusion delay, choroidal vascular hyperpermeability, dilated choroidal veins, and intervortex venous anastomosis (IVA). Dual FA and ICGA scoring for active posterior segment inflammation was performed. Clinical and imaging features associated with choroidal venous overload were compared between early- and late-stage VKH disease. RESULTS Choroidal perfusion delay, choroidal vascular hyperpermeability, dilated choroidal veins, and IVA were more prevalent in eyes with VKH disease (69.2%, 67.3%, 61.5%, and 65.4%, respectively) than in control eyes (25.0%, 20.8%, 25.0%, and 37.5%, respectively) (p < 0.05). All eyes with IVA in the early-stage of VKH disease had got other 3 signs. All choroidal venous overload signs were more prevalent in patients with early-stage (20 eyes) than in those with late-stage VKH disease (32 eyes) (p < 0.05). The number of choroidal venous overload signs were inversely related to disease duration (p < 0.001) and proportionally related to the total ICGA score (p < 0.001). IVA was significantly associated with the total ICGA score in logistic regression (p = 0.014). CONCLUSIONS Choroidal venous overload occurs early in VKH disease. Angiographic signs of choroidal venous overload may be useful markers to assess the status of VKH disease.
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Affiliation(s)
- Hoon Noh
- Department of Ophthalmology, HanGil Eye Hospital, Incheon, Republic of Korea
| | - Seung Wan Nam
- Department of Ophthalmology, HanGil Eye Hospital, Incheon, Republic of Korea
- Department of Ophthalmology, Catholic Kwandong University College of Medicine, Gangneung, Republic of Korea
| | - Je Moon Yoon
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Don-Il Ham
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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2
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Abu El-Asrar AM, AlBloushi AF, Alzubaidi A, Gikandi PW, Stefánsson E. Pretreatment ocular blood flow and retinal oxygen metabolism in the acute uveitic phase is associated with final outcome in Vogt-Koyanagi-Harada disease. Acta Ophthalmol 2024; 102:720-727. [PMID: 38470990 DOI: 10.1111/aos.16669] [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: 12/20/2023] [Revised: 01/22/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE To investigate the association between pretreatment blood flow velocity in the choroid and optic nerve head (ONH) and retinal oxygen metabolism in the acute uveitic phase and the development of 'sunset glow fundus' in Vogt-Koyanagi-Harada (VKH) disease. METHODS Retrospective analysis of 41 patients (82 eyes). Laser speckle flowgraphy and retinal oximetry measurements were performed at the presentation. The main outcome measure was the development of 'sunset glow fundus'. RESULTS Twenty patients (40 eyes) presented in the phase preceding anterior segment inflammation (early presentation), and 21 patients (42 eyes) presented with anterior segment inflammation (late presentation). In ONH, mean blur rate (MBR)-vessel, representing blood flow velocity in retinal vessels, was significantly lower in the late presentation group, while choroidal MBR was not significantly different. The late presentation group had significantly lower oxygen saturation in retinal venules, a higher arteriovenous oxygen saturation difference and a smaller calibre of retinal arterioles compared with the early presentation group. Eyes that subsequently developed 'sunset glow fundus' had significantly lower ONH MBR-vessels, lower oxygen saturation in retinal venules, a higher arteriovenous oxygen saturation difference and a smaller calibre of retinal arterioles compared with eyes without 'sunset glow fundus'. ONH MBR-vessel had a significant negative correlation with arteriovenous oxygen saturation difference and a significant positive correlation with calibre of retinal arterioles. CONCLUSIONS In the acute uveitic phase of VKH disease, the development of 'sunset glow fundus' is associated with pretreatment reduced retinal blood flow velocity, calibre of retinal arterioles and oxygen saturation in retinal venules, as well as an increased arteriovenous oxygen saturation difference.
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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
| | - Abdulrahman F AlBloushi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alzubaidi
- 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
| | - Einar Stefánsson
- Department of Ophthalmology and Physiology, University of Iceland, Reykjavik, Iceland
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Oshiro A, Imanaga N, Terao N, Koizumi H. CHANGES IN SCLERAL THICKNESS IN THE ACUTE PHASE OF VOGT-KOYANAGI-HARADA DISEASE. Retina 2024; 44:1344-1350. [PMID: 39047128 DOI: 10.1097/iae.0000000000004129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
PURPOSE To evaluate changes in scleral thickness in Vogt-Koyanagi-Harada (VKH) disease. METHODS This study included 34 eyes of 17 treatment-naïve patients with acute-phase VKH disease. Scleral thickness and the presence of ciliochoroidal effusion were examined using anterior segment optical coherence tomography at baseline and 1 week, 2 weeks, and 12 weeks after the start of corticosteroid treatment. Scleral thickness was measured 6 mm posterior to the scleral spur in four directions. RESULTS Twenty-eight eyes (82.4%) initially had ciliochoroidal effusion, but this rapidly decreased to nine eyes (26.5%) after 1 week. The sclera with ciliochoroidal effusion became thinner from baseline to 1 week at the superior (400.2 ± 46.9-353.5 ± 47.9 µm), temporal (428.4 ± 53.6-387.8 ± 56.1 µm), inferior (451.5 ± 71.0-400.5 ± 50.5 µm), and nasal (452.4 ± 78.0-407.6 ± 62.9 µm) points (P < 0.01 for all), and no further changes were observed. The sclera without ciliochoroidal effusion remained unchanged. CONCLUSION In VKH disease, eyes with ciliochoroidal effusion exhibited the maximum scleral thickness during the acute phase. This thickening responded rapidly to treatment and became thinner within 1 week. Inflammation in VKH disease may affect not only the choroid but also the sclera.
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Affiliation(s)
- Ayano Oshiro
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Tanikawa A, Maruyama K, Liu S, Mao Z, Wang Z, Shiraki N, Hashida N, Kawasaki R, Chan K, Nishida K. Unveiling Key Pathological Indicators for Disease Progression in Vogt Koyanagi Harada Disease and Sympathetic Ophthalmia Through Advanced Choroidal Volume Analysis. Ocul Immunol Inflamm 2024:1-9. [PMID: 38709183 DOI: 10.1080/09273948.2024.2337836] [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: 08/24/2023] [Accepted: 03/27/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To evaluate the association between quantitative parameters derived from volume analysis of optical coherence tomography (OCT) data and disease worsening in Vogt-Koyanagi-Harada disease (VKHD) and sympathetic ophthalmia (SO). METHODS This retrospective study, conducted at Osaka University Hospital, employed swept-source OCT scans from patients diagnosed with VKHD or SO between October 2012 and January 2021. The choroidal vessel structure was segmented and visualized in three dimensions, generating quantitative vessel volume maps. Region-specific choroidal vessel volume (CVV), choroidal volume (CV), and vessel index (VI) were scrutinized for their potential correlation with disease severity. RESULTS Thirty-five eyes of 18 VKHD and 2 SO patient (8 females, 10 males) were evaluated. OCT-derived CVV maps revealed regional CV alterations in VKHD and SO patients. Two parameters, i.e. CV at 3- and 6-month follow-ups (p = 0.044, p = 0.040, respectively, with area under the ROC curve of 0.70) and CVV at 6 months (p = 0.046, area under the ROC curve of 0.71), were significantly higher in recurrent VKHD and SO compared to effectively treated cases. CONCLUSIONS The volume analysis of OCT images facilitates a three-dimensional visualization of choroidal alterations, which may serve as a reflection of disease severity in VKHD and SO patients. Furthermore, noninvasive initial CVV or CV measurements may serve as potential biomarkers for predicting disease recurrence in VKHD and SO.
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Affiliation(s)
- Akira Tanikawa
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Kazuichi Maruyama
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
- Department of Vision Informatics, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Osaka, Japan
| | - Shiyi Liu
- Topcon Advanced Biomedical Imaging Laboratory, Oakland, New Jersey
| | - Zaixing Mao
- Topcon Advanced Biomedical Imaging Laboratory, Oakland, New Jersey
| | - Zhenguo Wang
- Topcon Advanced Biomedical Imaging Laboratory, Oakland, New Jersey
| | - Nobuhiko Shiraki
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Noriyasu Hashida
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Ryo Kawasaki
- Artificial Intelligence Center for Medical Research and Application, Osaka University Hospital, Suita, Osaka, Japan
- Graduate Scholl of Medicine/Division of Environmental Medicine and Population Science/Department of Social and Environmental Medicine, Osaka University, Suita, Osaka, Japan
| | - Kinpui Chan
- Topcon Advanced Biomedical Imaging Laboratory, Oakland, New Jersey
| | - Kohji Nishida
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Osaka, Japan
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Sanjay S, Acharya I, Kawali A, Chitturi SP, Mahendradas P. Choroidal and central macular thickness before and after treatment in post fever retinitis. Indian J Ophthalmol 2024; 72:728-734. [PMID: 38648435 PMCID: PMC11168547 DOI: 10.4103/ijo.ijo_1557_23] [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: 06/14/2023] [Revised: 10/11/2023] [Accepted: 11/01/2023] [Indexed: 04/25/2024] Open
Abstract
PURPOSE To study the choroidal thickness (CT) and central macular thickness (CMT) in post-fever retinitis (PFR) and their correlation with visual acuity and treatment. METHODS A retrospective, observational study of patients presenting with PFR from 2013 to 2021 and with spectral domain optical coherence tomography (SD-OCT) (Heidelberg®, SpectralisTM, Heidelberg, Germany) images were included. The CT and CMT were measured at presentation and at the final visit. The CT was measured subfoveally and at points 2000 µm superior, inferior, medial, and lateral from the fovea using the caliper tool. RESULTS Seventy-nine eyes of 65 patients were included for this study. The mean age was 39.03 (±16.00) years with female preponderance of 53.84% (n = 35). Mean follow-up duration was 30 days. Mean CT at presentation and at follow-up was 254.12 µm and 241.51 µm, respectively. CT was decreased in majority of the eyes 67.1% (n = 53) from their baseline value. Mean CMTs at presentation and final visit were 454.8 µm and 223.7 µm, respectively. Best corrected visual acuity had a positive correlation with CMT (r = 0.340; P = 0.002) and negligible correlation with CT. A significant decrease in the mean CT was noted in patients who received doxycycline either alone or in combination with a steroid as compared to those who did not receive any treatment (P < 0.001). The significance of which is unknown presently. CONCLUSION CMT has a greater role in determining the final visual outcome than CT. CT can be reduced post-treatment with no effect on vision.
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Affiliation(s)
- Srinivasan Sanjay
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, India
| | - Isha Acharya
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, India
| | - Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, India
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Sato S, Hashimoto Y, Sakamoto A, Nakano S, Yoshimura M, Yamanokuchi T, Yoshitomi T. Changes in Retinal Hemodynamics in the Optic Nerve Head of Healthy Participants Measured Using Laser Speckle Flowgraphy after a Cold Pressor Test. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:147-155. [PMID: 38476060 PMCID: PMC11016682 DOI: 10.3341/kjo.2023.0063] [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: 06/16/2023] [Revised: 12/08/2023] [Accepted: 03/11/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE Autoregulation of retinal vessels is stronger than that of choroidal vessels. This study aimed to use laser speckle flowgraphy to determine the time course of changes in retinal hemodynamics of healthy eyes after a cold pressor test. METHODS This prospective study included 44 right eyes of 44 healthy volunteers (age, 21.7 ± 5.0 years). The mean blur rate, which is a quantitative index of the relative blood flow velocity in the retina, was measured using laser speckle flowgraphy. The vessel average of mean blur rate at the optic nerve head, intraocular pressure, systolic blood pressure, diastolic blood pressure, mean blood pressure, heart rate, and ocular perfusion pressure were evaluated at baseline, immediately after the cold pressor test, and 10, 20, and 30 minutes after the test. RESULTS Immediately after the test (0 minutes), systolic blood pressure, diastolic blood pressure, mean blood pressure, and ocular perfusion pressure were significantly increased compared with those at baseline; however, no changes were observed at 10, 20, and 30 minutes after the test. In contrast, intraocular pressure, heart rate, and the vascular mean blur rate values at the optic nerve head did not change throughout the course of the study. CONCLUSIONS Sympathetic hyperactivity induced by the cold pressor test increased systemic circulatory dynamics, but not retinal circulatory hemodynamics, suggesting the involvement of vascular autoregulation.
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Affiliation(s)
- Shogo Sato
- Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka,
Japan
| | - Yuki Hashimoto
- Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka,
Japan
| | - Ami Sakamoto
- Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka,
Japan
| | - Suzuka Nakano
- Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka,
Japan
| | - Miki Yoshimura
- Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka,
Japan
| | - Toshitaka Yamanokuchi
- Department of Physical Therapy, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka,
Japan
| | - Takeshi Yoshitomi
- Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka,
Japan
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Gedik B, Yuksel O, Kazim Erol M, Duman F, Dogan B, Suren E, Yavuz S. Evaluation of the retina, choroid and optic disc vascular structures in individuals with a history of COVID-19. J Fr Ophtalmol 2024; 47:104014. [PMID: 37925322 DOI: 10.1016/j.jfo.2023.10.003] [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: 08/02/2023] [Revised: 10/05/2023] [Accepted: 10/08/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION In this study, we aimed to detect changes in posterior segment structures and vascular density caused by COVID-19 using an optical coherence tomography angiography (OCTA) device. MATERIALS AND METHODS The study included 20 eyes of 20 patients no systemic or ocular disease who were followed at the Ophthalmology Clinic of Health Sciences University Antalya Training and Research Hospital. The OCTA images of these individuals taken prior to contracting COVID-19 and six months after recovery were examined. RESULTS The mean choriocapillaris blood flow was 2.00±0.13mm2 before COVID-19 and 2.08±0.23mm2 after the disease, and the mean subfoveal choroidal thickness was 247.33±7.65μm before the disease and 273.08±4.92μm after the disease, indicating a statistically significant difference (P=0.003, P=0.001, respectively). The mean retinal nerve fiber layer thickness before and after COVID-19 were 119.33±3.88 and 117.50±3.92μm, respectively, representing a statistically significant decrease (P<0.001). CONCLUSION This is the first study in the literature to evaluate the post-COVID-19 changes in the vascular structures of the eye compared to the pre-disease values. In this study, we found statistically significant changes in choriocapillaris blood flow, subfoveal chroidal thickness and retinal nerve fiber layer thickness after COVID-19 infection. Further research with a greater sample size is needed to explore the effect of COVID-19 on these parameters.
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Affiliation(s)
- B Gedik
- Department of Ophthalmology, Antalya Serik State Hospital, Serik, Antalya 07500, Turkey.
| | - O Yuksel
- Department of Ophthalmology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - M Kazim Erol
- Department of Ophthalmology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - F Duman
- Department of Ophthalmology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - B Dogan
- Department of Ophthalmology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - E Suren
- Department of Ophthalmology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - S Yavuz
- Department of Ophthalmology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
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Toh N, Hashimoto Y, Kuwahara F, Yoshimura M, Imabayashi S, Yoshitomi T. Choroidal Thickness Increases During Parasympathetic Dominance After Immersion of the Foot in Warm Water. Cureus 2024; 16:e53194. [PMID: 38425624 PMCID: PMC10902740 DOI: 10.7759/cureus.53194] [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] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE This study aimed to assess the course of changes in choroidal morphology after immersion of the foot in warm water at 40°C using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS Forty-three right eyes of 43 healthy participants were included. Changes in choroidal morphology were determined using EDI-OCT to evaluate subfoveal choroidal thickness (SCT). Systolic, diastolic, and mean blood pressures (SBP, DBP, and MBP, respectively) were also measured to determine systemic circulatory dynamics at baseline, immediately after immersion (0 min), and 10, 20, and 30 min after immersion. RESULTS Immediately after immersion, SBP, DBP, and MBP were significantly declined versus baseline. In contrast, the SCT was significantly increased after warm water immersion. However, all these parameters did not change significantly compared to the baseline within 30 min. CONCLUSION In the normal eye, parasympathetic nerve activity induced by warming stimuli increases choroidal morphology in response to a decrease in systemic circulatory activity, which normalizes within 30 min. The findings of this study may provide basic data for the prevention and treatment of various choroidal diseases in which sympathetic hyperactivity is involved in the pathogenesis.
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Affiliation(s)
- Natsumi Toh
- Department of Orthoptics, Fukuoka International University of Health and Welfare, Fukuoka, JPN
| | - Yuki Hashimoto
- Department of Orthoptics, Fukuoka International University of Health and Welfare, Fukuoka, JPN
| | - Fuka Kuwahara
- Department of Orthoptics, Fukuoka International University of Health and Welfare, Fukuoka, JPN
| | - Miki Yoshimura
- Department of Orthoptics, Fukuoka International University of Health and Welfare, Fukuoka, JPN
| | - Sakurako Imabayashi
- Department of Orthoptics, Fukuoka International University of Health and Welfare, Fukuoka, JPN
| | - Takeshi Yoshitomi
- Department of Orthoptics, Fukuoka International University of Health and Welfare, Fukuoka, JPN
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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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Mitamura M, Kase S, Yamashita Y, Hirooka K, Ishida S. Alterations in choroidal circulatory dynamics and choroidal thickness before and after treatment in posterior scleritis. BMC Ophthalmol 2023; 23:382. [PMID: 37726746 PMCID: PMC10508002 DOI: 10.1186/s12886-023-03140-8] [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: 05/27/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Posterior scleritis is an inflammatory reaction of the sclera that occurs posterior to the ora serrata. The aim of this study was to present a case of posterior scleritis and to analyze choroidal circulatory and structural changes using laser speckle flowgraphy (LSFG) and optical coherence tomography (OCT), respectively. CASE PRESENTATION A 64-year-old man presented to our department because of hyperemia of the left eye for one week, diplopia, ocular pain, and distorted vision when looking leftward. At an initial examination, his best-corrected visual acuity was 1.0 Oculi uterque (OU), with mild conjunctival hyperemia oculus dexter (OD) and marked ciliary hyperemia oculus sinister (OS). Color fundus photographs revealed a cluster of choroidal folds extending from the macula to the inferior retinal region OS. Swept-Source OCT showed choroidal thickening OD, and bacillary layer detachment and paracentral middle maculopathy on the paracentral side of the optic nerve papilla, suggesting severe inflammation. Fluorescein angiography showed hyperfluorescence in the optic disc and window defects around the macula OU. Indocyanine green angiography showed mottled choroidal vascular hyperpermeability findings in the late stage. B-mode echography displayed thickening of the posterior wall of the left eye. Orbital magnetic resonance imaging showed the thickened posterior eyeball. The patient was diagnosed with posterior scleritis, and 30 mg of oral prednisolone was then given and tapered off over the next 4 months. The hyperemia and intraocular inflammation resolved after the treatment. The rate of change in macular blood flow assessed by the mean blur rate on LSFG was 20.5% and 20.2% decrease OD and OS, respectively, before and after treatment. The central choroidal thickness showed 8.8% and 37.8% decrease OD and OS, respectively. CONCLUSION Posterior scleritis complicated with choroiditis was suggested to show different choroidal circulatory dynamics from those in other choroidal inflammations.
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Affiliation(s)
- Mizuho Mitamura
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan.
| | - Yui Yamashita
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Kiriko Hirooka
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
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11
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Mitamura M, Kase S, Hirooka K, Ishida S. Alterations of choroidal circulation and choroidal thickness before and after chemoradiotherapy in a case of metastatic choroidal tumor. BMC Ophthalmol 2023; 23:270. [PMID: 37312082 DOI: 10.1186/s12886-023-03026-9] [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: 08/29/2022] [Accepted: 06/08/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Metastatic choroidal tumors are hematogenous intraocular metastases of malignant tumors in systemic organs; however, the details of choroidal circulation and morphological changes in the choroid are unknown. The aim of this study is to present a case of metastatic choroidal tumor and examine laser speckle flowgraphy (LSFG)-based choroidal circulation and central choroidal thickness (CCT) before and after chemoradiotherapy. CASE PRESENTATION A 66-year-old woman with a medical history of breast cancer 16 years ago was referred to our department struggling with blurred vision in her right eye. At the time of initial examination, her best-corrected visual acuity (BCVA) was 0.4 oculus dexter (OD) and 0.9 oculus sinister. Fundus revealed a yellowish-white choroidal elevated lesion measuring 8 papillary diameters with serous retinal detachment (SRD) in the posterior pole. Fluorescein angiography showed diffuse hyperfluorescence and fluorescent leakage due to SRD, and indocyanine green angiography demonstrated no abnormalities in the macula but hypofluorescence in the center of the tumor. Based on these clinical findings, she was diagnosed with metastatic choroidal tumor. After chemoradiotherapy, the metastatic choroidal tumor became scarred, and SRD disappeared. The rate of changes in macular blood flows assessed by mean blur rate on LSFG and CCT of her right eye were 33.8 and 32.8% decrease at 5 months after the initial visit, respectively. BCVA was 0.5 OD 27 months after the initial examination. CONCLUSION Chemoradiotherapy resulted in regression of the metastatic choroidal tumor and disappearance of SRD, with a decrease in central choroidal blood flow and CCT. The choroidal blood flow on LSFG could reflect an increased oxygen demand by cancer cells invading the choroid and substantial blood supply.
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Affiliation(s)
- Mizuho Mitamura
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan.
| | - Kiriko Hirooka
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
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Abu El-Asrar AM, AlBloushi AF, Gikandi PW, Alzubaidi A, Stefánsson E. Acute uveitic phase of Vogt-Koyanagi-Harada disease: optic nerve head swelling, ocular blood flow and retinal oxygen metabolism. Eye (Lond) 2023; 37:1432-1438. [PMID: 35768722 PMCID: PMC10169851 DOI: 10.1038/s41433-022-02141-z] [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: 03/01/2022] [Revised: 05/11/2022] [Accepted: 06/10/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To investigate the association of optic nerve head (ONH) swelling in the acute uveitic phase of Vogt-Koyanagi-Harada (VKH) disease with blood flow velocity in the choroid and ONH and oxygen saturation and diameter of retinal vessels. METHODS In this prospective study, 25 patients (50 eyes) were studied. Thirteen patients (26 eyes) had ONH swelling and 12 patients (24 eyes) had no ONH swelling. Laser speckle flowgraphy (LSFG) and retinal oximetry measurements were performed at presentation. RESULTS In the ONH, mean blur rate (MBR)-vessel, representing blood flow velocity in retinal vessels, was significantly lower in the eyes affected by ONH swelling, while choroidal MBR was not significantly different. Eyes with ONH swelling had a significantly lower oxygen saturation in retinal venules, a significantly higher arteriovenous oxygen saturation difference and a significantly smaller calibre of retinal arterioles compared with eyes without ONH swelling. There were significant positive correlations between the MBR-vessel of the ONH and venular oxygen saturation and calibre of retinal arterioles. In addition, MBR-vessel of the ONH had a significant negative correlation with arteriovenous oxygen saturation difference. CONCLUSIONS The occurrence of ONH swelling in the acute uveitic phase of VKH disease is associated with lower retinal blood flow velocity and smaller calibre of retinal arterioles as well as lower oxygen saturation in retinal venules and higher arteriovenous difference in oxygen saturation.
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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.
| | - Abdulrahman F AlBloushi
- 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
| | - Abdullah Alzubaidi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Einar Stefánsson
- Department of Ophthalmology and Physiology, University of Iceland, Reykjavik, Iceland
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Mitamura M, Kase S, Hirooka K, Ishida S. A case of choroidal melanocytosis observed by multimodal imaging with laser speckle flowgraphy. BMC Ophthalmol 2023; 23:180. [PMID: 37101259 PMCID: PMC10131401 DOI: 10.1186/s12886-023-02933-1] [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: 11/07/2022] [Accepted: 04/21/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Choroidal melanocytosis is characterized by congenital diffuse melanin pigmentation with extensive parenchymal infiltration of spindle cells in the choroid; however, little is known about the choroidal circulation and morphological changes. We herein report a case of choroidal melanocytosis observed by multimodal imaging with laser speckle flowgraphy (LSFG). CASE PRESENTATION A 56-year-old woman was referred to our hospital because of serous retinal detachment (SRD) in her left eye. At the initial examination, her best-corrected visual acuity (BCVA) was 1.5 oculus dexter (OD) and 0.8 oculus sinister (OS). An irregular, flat, brownish lesion was noted around the macula OS. Optical coherence tomography showed a choroidal structure with marked hyporeflectivity and SRD where the retinal thickness was preserved. Indocyanine green angiography demonstrated fluorescence blockade throughout. Fundus autofluorescence revealed enlarged macular hypofluorescence, suggesting chronic retinal pigment epithelium damage associated with prolonged SRD. B-mode echography showed no choroidal elevation. Based on the clinical findings, the left eye was diagnosed with choroidal melanocytosis. Four years and 10 months after the initial visit, her BCVA was 0.5 and SRD remained. During the entire period of observation, the mean blur rate (MBR) (mean ± standard deviation) of choroidal blood flow velocity on LSFG was 10.15 ± 0.72 arbitrary units (AU) OD and 1.31 ± 0.06 AU OS. CONCLUSION Choroidal melanocytosis presented with chronic minor circulatory disturbances due to melanocyte proliferation in the choroid, but the markedly low MBR values by LSFG were dissociated from her retinal thickness and visual function. The proliferation of melanocytes may be a cause of overestimating the cold-color signal of LSFG due to their pigmentation.
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Affiliation(s)
- Mizuho Mitamura
- Department of Ophthalmology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Kiriko Hirooka
- Department of Ophthalmology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
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Haneda M, Hashimoto Y, Mishima A, Saito D, Yoshitomi T. Changes in choroidal circulation hemodynamics during the menstrual cycle in young, healthy women. PLoS One 2022; 17:e0270501. [PMID: 35759478 PMCID: PMC9236247 DOI: 10.1371/journal.pone.0270501] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/10/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose The current study aimed to investigate the time course of changes in choroidal circulation hemodynamics and their relationship to systemic circulation dynamics during the normal menstrual cycle in young, healthy women using laser speckle flowgraphy (LSFG). Methods This prospective study included 26 eyes from 13 young, healthy women (21.3 ± 4.0 years) with a normal menstrual cycle and 24 eyes from 12 young, healthy men (21.8 ± 4.4 years) as a control group. The macular mean blur rate (MBR), a quantitative index of relative blood flow velocity in the choroid, was measured using LSFG. MBR, intraocular pressure (IOP), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and ocular perfusion pressure (OPP) were evaluated in the late follicular phase and mid-luteal phase in women and at baseline and 10 days after baseline in men, respectively. Results In the female group, IOP, SBP, DBP, MBP, and OPP values were significantly higher in the mid-luteal phase than those observed in the late follicular phase (P = 0.035, P < 0.001, P = 0.041, P = 0.001, P = 0.014, respectively). The average macular MBR values in the late follicular phase and mid-luteal phase were 12.7 ± 5.3 and 13.7 ± 6.6 (+7.7 ± 19.4%), representing a significant increase in the mid-luteal phase (P = 0.041). The rate of change in MBR exhibited a significant positive correlation with changes in DBP and MBP (R = 0.456, P = 0.019 and R = 0.474, P = 0.014). However, there were no significant changes in any of the factors in the male group during the study period. Conclusions Our results suggest that in young, healthy women with a normal menstrual cycle, choroidal blood flow velocity decreases during the late follicular phase and increases during the mid-luteal phase, depending on systemic circulatory dynamics.
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Affiliation(s)
- Mayumi Haneda
- Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Yuki Hashimoto
- Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka, Japan
- * E-mail:
| | - Airi Mishima
- Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Daichi Saito
- Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Takeshi Yoshitomi
- Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka, Japan
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15
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Mitamura M, Kase S, Hirooka K, Endo H, Ito Y, Cho Y, Ishida S. Alterations of choroidal circulation and vascular morphology in a patient with chronic myeloid leukemia before and after chemotherapy. BMC Ophthalmol 2022; 22:160. [PMID: 35392846 PMCID: PMC8991782 DOI: 10.1186/s12886-022-02380-4] [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] [Received: 11/19/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Chronic myeloid leukemia (CML) is known to cause leukemic retinopathy due to leukemia cell invasion into the choroid; however, details of the circulatory dynamics and morphological changes in the choroid are unknown. The aim of this study was to present a case of leukemic retinopathy and examine choroidal circulatory and structural analyses using laser speckle flowgraphy (LSFG) and optical coherence tomography with a binarization method, respectively. Case presentation A 15-year-old male diagnosed with CML complained of blurred vision in his right eye. He was ophthalmologically diagnosed with leukemic retinopathy due to retinal hemorrhage in both eyes. Tyrosine kinase inhibitors achieved complete cytogenetic remission and resolution of retinal hemorrhages at 6 months after treatment. After the treatment, the best-corrected visual acuity had recovered from 0.1 to 1.2 oculus dexter (OD) and remained at 1.5 oculus sinister (OS). The rate of change in macular blood flow assessed by the mean blur rate on LSFG was 18.3% increase OD and 25.2% decrease OS 19 months after treatment. The central choroidal thickness showed 0.4 and 3.1% reductions OD and OS, respectively. The binarization technique demonstrated that the rate of luminal areas in choroidal areas exhibited 3.2% increase OD but 4.8% decrease OS. Conclusion Choroidal blood flow improved OD after treatment for CML, while it deteriorated OS, together with choroidal thinning due to reduction of luminal areas. The degrees of leukemia cell invasion into the choroidal tissue and tissue destruction might be different between the eyes in this case.
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Affiliation(s)
- Mizuho Mitamura
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Kiriko Hirooka
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroaki Endo
- Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Yuki Ito
- Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Yuko Cho
- Department of Pediatrics, Hokkaido University, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
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Abu El‐Asrar AM, AlBloushi AF, Gikandi PW, Alzubaidi A, Stefánsson E. Changes in ocular blood flow and retinal oxygen metabolism during immunosuppressive therapy for initial-onset acute uveitis associated with Vogt-Koyanagi-Harada disease. Acta Ophthalmol 2022; 100:707-712. [PMID: 35235253 DOI: 10.1111/aos.15122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/03/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022]
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
| | | | - Priscilla W. Gikandi
- Department of Ophthalmology, College of Medicine King Saud University Riyadh Saudi Arabia
| | - Abdullah Alzubaidi
- Department of Ophthalmology, College of Medicine King Saud University Riyadh Saudi Arabia
| | - Einar Stefánsson
- Department of Ophthalmology and Physiology University of Iceland Reykjavik Iceland
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Baharani A, Errera MH, Jhingan M, Samanta A, Agarwal A, Singh SR, Reddy P RR, Grewal DS, Chhablani J. Choroidal Imaging in uveitis: an update. Surv Ophthalmol 2022; 67:965-990. [PMID: 35007618 DOI: 10.1016/j.survophthal.2022.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/27/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
An important goal of advancements in ocular imaging algorithms and devices has been to improve the image acquisition and resolution of deeper ocular tissues, namely the choroid and its vasculature that are otherwise inaccessible to direct clinical examination. These advancements have contributed to the understanding of the pathophysiology of a number of ocular inflammatory conditions. We focuse on the imaging characteristics of clinical conditions where imaging the choroid has improved or radically changed the understanding of the disease, has helped in differentiation of phenotypically similar but distinct lesions, and where imaging features have proven vital formonitoring disease activity. The last two decades have seen some major developments in ocular imaging relevant to uveitis. The current review addresses both the imaging characteristics and their interpretation on conventional modalities such as fundus photography, fluorescein angiography, indocyanine green angiography and fundus autofluorescence and the recent additions in the armamentarium including optical coherence tomography (OCT) with enhanced depth imaging, swept-source OCT, and OCT angiography.
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Affiliation(s)
- Abhilasha Baharani
- Uveitis Services, Neoretina Eyecare Institute, Ramchander House, Chapel Road, Nampally, Hyderabad, India. 500001
| | - Marie-Helen Errera
- Department of Ophthalmology, Department of Ophthalmology, University of Pittsburgh Medical Center, 203 Lothrop Street, Pittsburgh, PA, 15213
| | - Mahima Jhingan
- Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, CA, USA
| | - Anindya Samanta
- Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Aniruddha Agarwal
- Department of Ophthalmology, Advanced Eye Center, PGIMER, Chandigarh, India
| | - Sumit Randhir Singh
- Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, CA, USA
| | - Raja Rami Reddy P
- Retina Services, Neoretina Eyecare Institute, Ramchander House, Chapel Road, Nampally, Hyderabad, India. 500001
| | - Dilraj S Grewal
- Department of Ophthalmology, Duke University School of Medicine, 2351 Erwin Rd Durham, NC 27705-4699
| | - Jay Chhablani
- Department of Ophthalmology, Department of Ophthalmology, University of Pittsburgh Medical Center, 203 Lothrop Street, Pittsburgh, PA, 15213.
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Abe S, Nakamura T, Okumura E, Oiwake T, Okada AA, Hayashi A. Long-term changes of choroidal blood flow velocity in Vogt-Koyanagi-Harada disease. Graefes Arch Clin Exp Ophthalmol 2022; 260:1933-1939. [PMID: 34982220 DOI: 10.1007/s00417-021-05540-2] [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: 10/10/2021] [Revised: 12/13/2021] [Accepted: 12/22/2021] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To evaluate changes in choroidal blood flow in patients with Vogt-Koyanagi-Harada (VKH) disease after initiation of corticosteroid treatment. METHODS Fourteen patients (10 men and 4 women) with acute VKH disease followed for 2 years were retrospectively reviewed; only right eyes were included in the analysis. Mean blur rate (MBR) in the macula was measured by laser speckle flowgraphy (LSFG) and central choroidal thickness (CCT) was measured by optical coherence tomography (OCT), both prior to treatment and over 2 years after initiation of corticosteroid treatment. RESULTS Of 14 patients included in this study, 13 received initial treatment consisting of intravenous corticosteroid pulse therapy and one patient was treated using bilateral sub-Tenon injections of triamcinolone acetonide. Mean percentage change in MBR was significantly increased after initiation of treatment compared to pretreatment values (P < 0.001). Mean CCTs were significantly decreased after initiation of treatment, compared to pretreatment thicknesses (P < 0.001). There was no significant change in either MBR change or CCT at 1 month after initiation of treatment through 2 years of follow-up. The mean MBR percentage change was significantly higher in eyes with sunset glow fundus (SGF) compared to eyes without SGF at 1 year. CONCLUSION With initiation of corticosteroid treatment in VKH disease patients, choroidal blood flow improved and was maintained for 2 years. However, the presence of SGF should be taken into consideration when interpreting MBR results in VKH disease patients.
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Affiliation(s)
- Shinya Abe
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
| | - Tomoko Nakamura
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
| | - Erika Okumura
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
| | - Toshihiko Oiwake
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
| | - Annabelle A Okada
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2 Shinkawa Mitaka, Tokyo, 181-8611, Japan
| | - Atsushi Hayashi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan.
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Mimura M, Nishikawa Y, Inagaki K, Sato Y, Fujita Y, Kikkawa D. Change of intraocular blood flow during treatment for thyroid eye disease. Taiwan J Ophthalmol 2022; 12:97-100. [PMID: 35399966 PMCID: PMC8988972 DOI: 10.4103/tjo.tjo_2_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
To report a sequential observational study of changes in the retinal and choroidal blood flow during medical and surgical treatments for a thyroid eye disease (TED) patient, using optical coherence tomography angiography (OCTA) and laser speckle flowgraphy (LSFG). A 28-year-old man with a history of Graves’ disease diagnosed 8 months prior was presented in the active phase of TED. His clinical activity score (CAS) was 6, but without diplopia or visual loss. Intraocular pressure measurement was OD 20 mmHg and OS 24 mmHg. Thyrotropin receptor antibody (TRAb) and thyroid-stimulating antibody levels were 18.8 IU/L and 4347%. Magnetic resonance imaging revealed enlargement of both extraocular muscles and fat compartments in both orbits. The patient underwent IV pulsed steroid therapy (1 g/day, 3 days) followed by an oral prednisone for 1 month. His CAS score decreased to 4. Bilateral orbital fat decompression decreased his final CAS score to 1 in both eyes. Intraocular blood flow was measured using laser speckle flowgraphy (LSFG), and OCTA was performed. Retinal blood flow increased slightly, but choroidal blood flow showed a robust increase. Choroidal blood flow measured using both LSFG and OCTA was negatively correlated with the CAS score and TRAb. In our case report, the ocular perfusion, especially choroidal blood flow, may decrease in active TED, which may be reversed by medical and surgical treatment.
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Yamashita Y, Hashimoto Y, Namba K, Mizuuchi K, Ishida S. Optic Nerve Head Microcirculation in Eyes with Vogt-Koyanagi-Harada Disease Accompanied by Anterior Ischemic Optic Neuropathy. Case Rep Ophthalmol 2021; 12:899-908. [PMID: 34950018 PMCID: PMC8647108 DOI: 10.1159/000520036] [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] [Received: 07/28/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022] Open
Abstract
Anterior ischemic optic neuropathy (AION) is infrequently complicated with Vogt-Koyanagi-Harada (VKH) disease. We quantitatively examined sequential changes in the morphology and circulation hemodynamics, using a C-scan of optical coherence tomography (OCT) and laser speckle flowgraphy (LSFG) in a patient with VKH disease accompanied by AION. A 65-year-old female complained of blurred vision in both of her eyes. The patient presented with optic disc swelling and remarkable choroidal thickening detected by OCT bilaterally. The diagnosis of VKH disease was established based on the presence of pleocytosis detected in the cerebrospinal fluid and hypofluorescent dark dots scattered all around the fundus, detected by indocyanine green angiography. Goldmann perimetry detected visual field defects, similar to superior altitudinal hemianopsia in the right eye and similar to inferior altitudinal hemianopsia in the left eye. The patient was suspected to have developed AION in both eyes. The patient received methylprednisolone pulse therapy, followed by oral prednisolone. With these treatments, the optic disc swelling disappeared. However, optic disc atrophy with visual field defects remained in both eyes. An OCT C-scan showed the ganglion cell complex (GCC) and circumpapillary retinal nerve fiber layer (cpRNFL) thickness getting thinner below the normal range, and LSFG showed the decrease in optic nerve head (ONH) tissue microcirculation. These results supported the occurrence of AION in this patient with VKH disease. The analysis of GCC and cpRNFL thickness and ONH microcirculation would be useful for supporting the occurrence of AION in a case of VKH disease.
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Affiliation(s)
- Yui Yamashita
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuki Hashimoto
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuomi Mizuuchi
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Abu El‐Asrar AM, Alsarhani W, Alzubaidi A, Gikandi PW. Effect of immunosuppressive therapy on ocular blood flow in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada disease. Acta Ophthalmol 2021; 99:e1405-e1414. [PMID: 33719161 DOI: 10.1111/aos.14842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 02/23/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the effect of immunosuppressive therapy on blood flow and waveform parameters in the choroid and optic nerve head (ONH) in patients with initial-onset acute uveitis associated with Vogt-Koyanagi-Harada (VKH) disease. METHODS In this prospective study, 18 patients (36 eyes) were studied. Laser speckle flowgraphy was performed at baseline and at 4 weeks, 8 weeks and 12 weeks after treatment. We analysed longitudinal changes in mean blur rate (MBR), blow-out time, blow-out score (BOS), acceleration time index (ATI), flow acceleration index (FAI), resistivity index (RI) and blood flow fluctuation. RESULTS After immunosuppressive therapy, MBR, representing blood flow velocity, in the choroid and ONH significantly increased at each post-treatment time point compared to baseline values. Among the analysed pulse waveform parameters, BOS significantly increased, while RI and fluctuation significantly decreased. Increased BOS and decreased RI indicate decreased vascular resistance following treatment. There was a strong negative correlation between BOS and RI. Additionally, FAI increased in the choroid and ATI increased in ONH. CONCLUSIONS Immunosuppressive therapy in the acute uveitic phase of VKH disease improved inflammation-related impairment in choroidal and ONH blood flow.
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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
| | - Waleed Alsarhani
- Department of Ophthalmology College of Medicine King Saud University Riyadh Saudi Arabia
| | - Abdullah Alzubaidi
- 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
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Takamatsu Y, Higashide T, Takeshima S, Sasaki M, Manbo Y, Udagawa S, Ohkubo S, Sonoda S, Sakamoto T, Sugiyama K. Relationship Between Changes in the Choroidal Structure and Blood Flow of the Macula After Trabeculectomy. Transl Vis Sci Technol 2021; 10:30. [PMID: 34964835 PMCID: PMC8727312 DOI: 10.1167/tvst.10.14.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To elucidate the relationship between changes in the choroidal structure and blood flow of the macula after trabeculectomy. Methods A prospective study of 30 eyes of 30 patients with glaucoma who underwent trabeculectomy. Enhanced depth imaging optical coherence tomography with choroidal image binarization and laser speckle flowgraphy of the macula were performed at baseline and 1, 3, and 6 months postoperatively. Mixed-effects models with adjustment for confounders were used to analyze longitudinal changes in the mean choroidal thickness (mCT), mean choroidal vascular thickness (mCVT), mean choroidal interstitial thickness (mCIT), and mean blur rate (MBR). Results The decrease in the intraocular pressure (IOP; 45%–51%) and axial length (0.5%–0.8%) and the increase in ocular perfusion pressure (OPP; 34%–38%), mCT (16%–19%), mCVT (16%–20%), mCIT (17%–20%), and MBR (22%–25%) were significant at each postoperative time point (all P < 0.001). In the multivariate analysis, the mCVT changes were positively correlated with the OPP and MBR changes (P = 0.04 and P < 0.001, respectively), whereas the mCIT changes were negatively correlated with IOP changes (P = 0.005). The MBR changes correlated significantly with changes in mCVT but not mCIT (P < 0.001 and P = 0.39, respectively). Conclusions Thickness changes in the intraluminal and extraluminal parts of the choroid were closely associated with changes in blood flow and IOP, respectively, although both parts thickened comparably after IOP reduction by trabeculectomy. Translational Relevance The choroid reacts to IOP reduction differently between the intraluminal and extraluminal areas, blood flow dependence in the vascular area, and IOP dependence in the stromal area.
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Affiliation(s)
- Yuki Takamatsu
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.,Department of Ophthalmology, Toyama City Hospital, Toyama, Japan
| | - Tomomi Higashide
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Satoshi Takeshima
- Department of Ophthalmology, Toyama Red Cross Hospital, Toyama, Japan
| | - Makoto Sasaki
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Yoshimi Manbo
- Department of Ophthalmology, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Sachiko Udagawa
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Shinji Ohkubo
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.,Ohkubo Eye Clinic, Kanazawa, Japan
| | - Shozo Sonoda
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kazuhisa Sugiyama
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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Ramtohul P, Engelbert M, Malclès A, Gigon E, Miserocchi E, Modorati G, Cunha de Souza E, Besirli CG, Curcio CA, Freund KB. BACILLARY LAYER DETACHMENT: MULTIMODAL IMAGING AND HISTOLOGIC EVIDENCE OF A NOVEL OPTICAL COHERENCE TOMOGRAPHY TERMINOLOGY: Literature Review and Proposed Theory. Retina 2021; 41:2193-2207. [PMID: 34029276 DOI: 10.1097/iae.0000000000003217] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To clarify the histologic basis of bacillary layer detachment (BALAD) through a review of the current literature and an analysis of retinal imaging. METHODS The literature for previous reports of BALAD were reviewed. An analysis of retinal images was performed to support anatomical conclusions. RESULTS A total of 164 unique patients with BALAD on optical coherence tomography (OCT) were identified from the published literature. Twenty-two underlying etiologies, all associated with subretinal exudation, were identified. Forty-one different OCT terminologies were found. The defining OCT feature of BALAD was a split at the level of the photoreceptor inner segment myoid creating a distinctive intraretinal cavity. Resolution of BALAD was followed by a rapid restoration of the ellipsoid zone. Histology of age-related macular degeneration eyes suggests that individual photoreceptors can shed inner segments. Furthermore, detachment of the entire layer of inner segments is a common postmortem artifact. It is proposed that BALAD occurs when outwardly directed forces promoting attachment of photoreceptor outer segments to the retinal pigment epithelium exceed the tensile strength of the photoreceptor inner segment myoid. CONCLUSION This review serves to strengthen the OCT nomenclature "bacillary layer detachment," based on specific reflectance information obtained by OCT and previously published histologic observations.
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Affiliation(s)
- Prithvi Ramtohul
- Centre Hospitalier Universitaire de l'Hôpital Nord, Marseille, France
| | - Michael Engelbert
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, NYU Langone School of Medicine, New York, New York
| | - Ariane Malclès
- Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland
| | - Edward Gigon
- Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland
| | - Elisabetta Miserocchi
- Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | - Giulio Modorati
- Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | | | - Cagri G Besirli
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; and
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, NYU Langone School of Medicine, New York, New York
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Yılmaz M, Polat OA, Karayiğit DZ, Ayyıldız T. Choroidal vascularity index and choroidal thickness changes in patients with allergic asthma. Photodiagnosis Photodyn Ther 2021; 36:102494. [PMID: 34450328 DOI: 10.1016/j.pdpdt.2021.102494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND This study aimed to investigate whether the choroidal vascularity index (CVI), choroidal thickness (ChT), and retinal nerve fiber thickness (RNFL) of patients with allergic asthma change compared to the healthy control group. METHODS This cross-sectional, observational study comprised 59 eyes of 59 patients with allergic asthma (Group 1) and 50 eyes of 50 age and sex-matched healthy volunteers as a control group (Group 2). CVI was measured by binarization of images obtained from choroidal enhanced depth imaging (EDI) mode optic coherence tomography. CVI was defined as the ratio of the choroidal luminal area to the total circumscribed choroidal area. ChT was measured manually at 3 points, subfoveal and 1000 microns nasal and temporal to the fovea (SFCT, N1000, and T1000 respectively). RNFL measurements were subdivided as global, nasal, temporal, superonasal, superotemporal, inferonasal, and inferotemporal quadrants. RESULTS Subfoveal CVI and ChT were significantly lower in asthma patients (p:0,043 and p: 0.034, respectively). N1000 and T1000 ChT and RNFL thicknesses were lower in asthma patients compared to the control group, though no significant difference was found between them (p> 0.05). CONCLUSION Our findings suggest that asthma patients have choroidal structural changes. In the literature, there are not enough studies regarding the effects of asthma on ocular parameters.
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Affiliation(s)
- Mevlüt Yılmaz
- Ulucanlar Eye Research and Training Hospital, Ophthalmology Department, 06100 Altındag, Ankara, Turkey.
| | - Osman Ahmet Polat
- Erciyes University Medical Faculty Ophthalmology Department Kayseri, Turkey
| | - Duygu Zorlu Karayiğit
- Ahi Evran University Medical Faculty, Department of Pulmonary Diseases Kırşehir, Turkey
| | - Taha Ayyıldız
- Bursa City Hospital, Ophthalmology Department, Bursa, Turkey
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Vingopoulos F, Cui Y, Katz R, Le R, Zhu Y, Wang JC, Lu Y, Sobrin L, Miller JB. Widefield Swept-Source OCTA in Vogt-Koyanagi-Harada Disease. Ophthalmic Surg Lasers Imaging Retina 2021; 51:407-412. [PMID: 32706899 DOI: 10.3928/23258160-20200702-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/08/2020] [Indexed: 11/20/2022]
Abstract
Herein, the authors describe an initial case report of widefield swept-source optical coherence tomography angiography (SS-OCTA) in Vogt-Koyanagi-Harada (VKH) disease. When compared to fluorescent angiography, indocyanine green angiography, and enhanced-depth OCT - upon which the revised criteria for VHK are based - widefield SS-OCTA enables detection of vitreous inflammation, noninvasive identification of characteristic areas of flow void at the level of choriocapillaris in the acute phase and may be a novel valuable tool not only for noninvasive diagnosis and monitoring of disease progression, persistence, resolution, and recurrence to guide therapy in VKH disease in the future. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:407-412.].
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Gedik B, Suren E, Bulut M, Durmaz D, Erol MK. Changes in choroidal blood flow in patients with macular hole after surgery. Photodiagnosis Photodyn Ther 2021; 35:102428. [PMID: 34217870 DOI: 10.1016/j.pdpdt.2021.102428] [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: 03/14/2021] [Revised: 06/07/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION A macular hole (MH) is a defect that occurs in the retina and involves all layers. In this study, we aimed to investigate the preoperative and postoperative choriocapillaris blood flow (CBF) changes in patients with MH and the role of CBF in the pathogenesis of the disease using optical coherence tomography angiography (OCTA). MATERIAL METHOD This is a retrospective study examining eyes with MH. The study included 25 operated eyes of 25 patients and contralateral eyes of 18 patients. CBF and subfoveal choroidal thickness were examined using the OCTA images of the patients before surgery and at the first, third and sixth months after surgery. RESULTS The mean CBF value of the patients was 1.57±0.20 mm² preoperatively, 1.94±0.13 mm² at the postoperative first month, 1.98±0.12 mm² at the third month, and 2.00±0.10 mm² at the sixth month. The increases in the CBF values between the preoperative period and the postoperative measurements were statistically significant (p<0.0001 for all). In the preoperative period, the CBF value of the contralateral eyes was 2.07±0.10 mm². The preoperative CBF value of the contralateral eyes was higher compared to that of the eyes with MH (p<0.0001). There was no significant difference between the preoperative CBF value of the contralateral eyes and the postoperative sixth-month value of the eyes with MH (p = 0.065). CONCLUSION The preoperative and postoperative third-month CBF values of the eyes with MH were found to be lower than those of the contralateral eyes, but there was no difference between the postoperative sixth-month CBF value of the eyes with MH and the preoperative CBF value of the contralateral eyes. We consider that the eyes with MH achieve similar CBF values to the contralateral eyes in an average of six months after successful surgery.
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Affiliation(s)
- Birumut Gedik
- University of Health Sciences, Antalya Education and Research Hospital, Department of Ophthalmology, Antalya, Turkey.
| | - Elcin Suren
- University of Health Sciences, Antalya Education and Research Hospital, Department of Ophthalmology, Antalya, Turkey
| | - Mehmet Bulut
- University of Health Sciences, Antalya Education and Research Hospital, Department of Ophthalmology, Antalya, Turkey
| | - Doğan Durmaz
- University of Health Sciences, Antalya Education and Research Hospital, Department of Ophthalmology, Antalya, Turkey
| | - Muhammet Kazim Erol
- University of Health Sciences, Antalya Education and Research Hospital, Department of Ophthalmology, Antalya, Turkey
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Kumashiro S, Takagi S, Itokawa T, Tajima A, Kobayashi T, Hori Y. Decrease in choroidal blood flow after half and one-third dose verteporfin photodynamic therapy for chronic central serous chorioretinopathy. BMC Ophthalmol 2021; 21:241. [PMID: 34053440 PMCID: PMC8165776 DOI: 10.1186/s12886-021-01980-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/19/2021] [Indexed: 12/05/2022] Open
Abstract
Background The effect of various reduced doses of verteporfin photodynamic therapy (PDT) on choroidal blood flow in chronic central serous chorioretinopathy (CSC) remains unclear. Therefore, this study aimed to evaluate choroidal blood flow after half-dose PDT (1/2PDT) and one-third dose PDT (1/3PDT) with verteporfin for chronic CSC using laser speckle flowgraphy and spectral-domain optical coherence tomography. Methods Twenty-seven eyes of 27 patients with serous retinal detachment (SRD) caused by chronic CSC for more than 6 months were included in this study. Patients were divided into the 1/2PDT (n = 12; January 2018 to July 2019) and 1/3PDT (n = 15; August 2016 to December 2017) groups based on the treatment period. The best-corrected visual acuity (BCVA), central retinal thickness (CRT), central choroidal thickness (CCT), and mean blur rate in the macular area (m-MBR) and optic nerve head (ONH-MBR) were obtained using laser speckle flowgraphy and evaluated at baseline (pre-treatment), and 2 weeks, 1 month, 3 months, and 6 months after treatment. Results We found that SRD disappeared after 1 month in 92 and 93% of patients’ eyes in the 1/2PDT and 1/3PDT groups, respectively. Recurrence of SRD was observed in one eye at the 6-month follow-up after 1/2PDT and two eyes at the 3-month follow-up after 1/3PDT. No significant improvement was observed in baseline BCVA in the 1/3PDT and 1/2PDT groups. The average m-MBR against baseline significantly decreased at 2 weeks and 1, 3, and 6 months in the 1/2PDT group. The average m-MBR against baseline decreased significantly only at the 2 weeks follow-up in the 1/3PDT group. The average rate of change in the CCT against baseline decreased significantly throughout for up to 6 months in the 1/2PDT group and for up to 3 months in the 1/3PDT group. No significant fluctuation was observed in the ONH-MBR. Conclusions: Here, PDT significantly affected choroidal blood flow depending on the verteporfin dose in chronic CSC. Trial registration This trial was retrospectively registered (UMIN000026850; Approval date 03/04/2017).
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Affiliation(s)
- Shun Kumashiro
- Department of Ophthalmology, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Seiji Takagi
- Department of Ophthalmology, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Takashi Itokawa
- Department of Ophthalmology, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Akiko Tajima
- Department of Ophthalmology, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Tatsuhiko Kobayashi
- Department of Ophthalmology, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Yuichi Hori
- Department of Ophthalmology, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
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Sahin AK, Etgü F, Uzun A. Assessment of central retinal thickness, choroidal thickness, and retinal nerve fiber layer in psoriasis: a spectral-domain optical coherence tomography study. BMC Ophthalmol 2021; 21:233. [PMID: 34039314 PMCID: PMC8152133 DOI: 10.1186/s12886-021-02000-7] [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] [Received: 03/16/2021] [Accepted: 05/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background This study aims to evaluate choroidal thickness (CT), retinal thickness, ganglion cell-inner plexiform layer (GCIPL), and retinal nerve fiber layer (RNFL) structures in psoriasis patients using optical coherence tomography (OCT). Methods This study included 33 psoriasis patients and 33 healthy individuals. Moreover, psoriasis patients who did not use any systemic anti-inflammatory treatment were evaluated. Retinal and choroidal images of the participants were obtained with spectral-domain OCT. Furthermore, CT was measured in the subfoveal, temporal, and nasal positions at 500-µm intervals to a distance of 1,500 μm from the foveal center. Results The mean psoriasis area and severity index (PASI) score was 5.70 (range, 2.40–9.00). No significant differences were found in subfoveal (p = 0.659), temporal, and nasal CT values in psoriasis patients compared with the control group (p > 0.05). Similarly, no statistically significant differences were found between the groups in terms of central retinal thickness, macular GCIPL, and RNFL (p > 0.05). Moreover, no significant correlation exists between the duration of psoriasis disease and PASI scores and OCT parameters (p > 0.05). Conclusions No significant changes in CT, ganglion cell layer, RNFL, and retinal thickness values were noted in psoriasis patients with mild to moderate mean PASI score.
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Affiliation(s)
- Asena Keles Sahin
- Department of Ophthalmology, Training and Research Hospital, Ordu University, 52000, Ordu, Turkey.
| | - Fatma Etgü
- Department of Dermatology, Training and Research Hospital, Ordu University, Ordu, Turkey
| | - Aslihan Uzun
- Department of Ophthalmology, Training and Research Hospital, Ordu University, 52000, Ordu, Turkey
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BACILLARY LAYER DETACHMENT IN ACUTE VOGT-KOYANAGI-HARADA DISEASE: A Novel Swept-Source Optical Coherence Tomography Analysis. Retina 2021; 41:774-783. [PMID: 32833410 DOI: 10.1097/iae.0000000000002914] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the frequency, optical coherence tomography (OCT) findings, and visual and anatomic outcomes of patients with acute Vogt-Koyanagi-Harada disease presenting with the bacillary layer detachment (BLD) (intraretinal split at the photoreceptor inner segment myoid). METHODS This was a retrospective analysis of a consecutive series of patients with Vogt-Koyanagi-Harada disease having a minimum follow-up of 6 months. All patients had swept-source OCT, fluorescein angiography, and indocyanine green angiography performed at baseline. The characteristics of serial swept-source OCT were recorded and analyzed. RESULTS Sixty-two subjects (42 women; age: 34.2 ± 12 years) with Vogt-Koyanagi-Harada disease were included. 118 eyes (95.2%) had serous retinal detachment at presentation. 112 eyes (94.9%) showed the BLD at baseline. In 8 of 112 (7.1%) eyes with the BLD, the external limiting membrane at the anterior aspect of the BLD showed focal discontinuity. The interdigitation zone at the base of the BLD showed discontinuity in 53 of 112 (47.3%) eyes with the BLD. The ellipsoid zone could not be identified as a separate hyperreflective line at the base of the BLD in 102 of 112 eyes (91.1%). Bacillary layer detachments resolved within 3.4 ± 1.3 days after intravenous methylprednisolone therapy with improvement in the best-corrected visual acuity from 0.96 to 0.4 logarithm of the minimum angle of resolution (20/184 Snellen's equivalent) (P < 0.001). Resolution of serous retinal detachment was observed after 5.9 ± 2.6 days. CONCLUSION In eyes with acute Vogt-Koyanagi-Harada disease, the BLD is a common finding and represents a split in the photoreceptor layer at the inner segment myoid and can be differentiated from serous retinal detachment using swept-source OCT. In addition, resolution of the BLD and photoreceptor recovery can be evaluated using serial swept-source OCT.
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Abu El‐Asrar AM, Alotaibi MD, Gikandi PW, Stefánsson E. Effect of immunosuppressive therapy on oxygen saturation and diameter of retinal vessels in initial onset acute uveitis associated with Vogt-Koyanagi-Harada disease. Acta Ophthalmol 2021; 99:75-82. [PMID: 32592327 DOI: 10.1111/aos.14531] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/01/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE To demonstrate changes in oxygen saturation and calibre of retinal vessels in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada (VKH) disease at baseline and during immunosuppressive therapy. METHODS In this prospective study, 22 patients (44 eyes) were studied. Retinal oximetry measurements were performed using the noninvasive spectrophotometric retinal oximeter (Oxymap T1) at baseline and at 1-3 months, 4-6 months, 5-7 months and more than 9 months after treatment. RESULTS At baseline, mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) was 1.12 ± 0.78 (Snellen equivalent, 20/265). Arteriolar and venular oxygen saturations were 108 ± 7% and 70 ± 9%, respectively and calibres of arterioles and venules were 12.1 ± 1.1 pixels and 16.9 ± 1.4 pixels, respectively. At 4-6 months of follow-up, logMAR BCVA was almost maximum (0.08 ± 0.1, Snellen equivalent 20/24; p < 0.001) and thereafter remained almost unchanged. After immunosuppressive therapy, arteriolar and venular oxygen saturation values continued to decrease up to >9 months of follow-up (92 ± 7% and 56 ± 10%, respectively; p < 0.001 for both arterioles and venules). Similarly, arteriolar and venular calibres continued to decrease up to >9 months of follow-up to 11.4 ± 0.9 pixels (p = 0.006) and 15.6 ± 1.3 pixels (p = 0.001), respectively. CONCLUSIONS Eyes with initial-onset acute uveitis associated with VKH disease have increased oxygen saturation and calibres of retinal vessels at baseline. Immunosuppressive therapy normalizes these changes and in a similar pattern improves BCVA.
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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
| | - Mohammed D. Alotaibi
- 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
| | - Einar Stefánsson
- Department of Physiology University of Iceland Reykjavik Iceland
- Department of Ophthalmology Aarhus University Hospital Aarhus Denmark
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Matsumoto M, Suzuma K, Akiyama F, Yamada K, Harada S, Tsuiki E, Kitaoka T. Retinal Microvascular Resistance Estimated from Waveform Analysis Is Significantly Higher With a Threshold Value in Central Retinal Vein Occlusion. Transl Vis Sci Technol 2020; 9:4. [PMID: 33288991 PMCID: PMC7571322 DOI: 10.1167/tvst.9.11.4] [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: 07/01/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose Evaluation of blood flow is useful for understanding the severity of central retinal vein occlusion (CRVO). Actual blood flow may be determined by the resistivity of the retinal vein in CRVO. We have previously evaluated mean blur rate (MBR) to reflect total retinal blood flow velocity in CRVO cases using laser speckle flowgraphy (LSFG). This study evaluated retinal total vascular resistance in CRVO cases using the new index of total capillary resistance (TCR) from LSFG. Methods We measured the TCR of 68 CRVO patients who visited Nagasaki University Hospital between 2009 and 2016 and 42 age-matched controls without systemic disease. We compared TCRs among control eyes, CRVO fellow eyes, and CRVO affected eyes. A CRVO threshold value was then obtained from the receiver operating characteristic curve. Results MBR was significantly lower for CRVO affected eyes (20.3 ± 8.2) than for control eyes (37.5 ± 8.4; P < 0.01) and CRVO fellow eyes (36.4 ± 10.0; P < 0.01, Dunn's test). TCR was significantly higher for CRVO affected eyes (1.20 ± 0.55) than for control eyes (0.68 ± 0.2; P < 0.01) and CRVO fellow eyes (0.81 ± 0.28; P < 0.01, Dunn's test). The threshold for the presence of CRVO was 0.93 and area under the curve was 0.84. Conclusions By measuring TCR in addition to MBR, more detailed information regarding CRVO pathology can be obtained. Translational Relevance Comparison of values before and after treatment may be useful for evaluating the effects of treatment.
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Affiliation(s)
- Makiko Matsumoto
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Kiyoshi Suzuma
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Kagawa University, Kagawa, Japan
| | - Fumito Akiyama
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Kanako Yamada
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Shiori Harada
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Eiko Tsuiki
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takashi Kitaoka
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Mizuuchi K, Saito W, Namba K, Ishida S. Multiple evanescent white dot syndrome and panuveitis: a case report. J Ophthalmic Inflamm Infect 2020; 10:26. [PMID: 33123841 PMCID: PMC7596130 DOI: 10.1186/s12348-020-00221-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022] Open
Abstract
Aim To report a patient with multiple evanescent white dot syndrome (MEWDS) complicated by iridocyclitis and vitritis. Case description A 70-year-old woman developed multiple subretinal white dots, iritis, and diffuse vitreous opacity. Angiographic and macular morphological features were consistent with those of MEWDS. Inflammatory findings including the white dots improved following only topical dexamethasone within 1 month after the initial visit. Best-corrected visual acuity recovered to 1.0 with restored photoreceptor structure. Conclusion The presence of iridocyclitis and vitritis, atypical to MEWDS, indicates the concurrent development of panuveitis associated with MEWDS. These results suggest that MEWDS is a clinical entity of uveitis.
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Kataoka K, Kase S, Noda K, Ishida S. Laser Speckle Flowgraphy Findings in a Patient with Choroidal Macrovessel. ACTA ACUST UNITED AC 2020; 4:1123-1124. [DOI: 10.1016/j.oret.2020.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
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Dutta Majumder P. Commentary: Optical coherence tomography in sympathetic ophthalmia. Indian J Ophthalmol 2020; 68:2023-2024. [PMID: 32823466 PMCID: PMC7690494 DOI: 10.4103/ijo.ijo_886_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Changes in choroidal blood flow velocity in patients diagnosed with central serous chorioretinopathy during follow-up for pachychoroid pigment epitheliopathy. Am J Ophthalmol Case Rep 2020; 18:100651. [PMID: 32215340 PMCID: PMC7090241 DOI: 10.1016/j.ajoc.2020.100651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/23/2019] [Accepted: 03/03/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate chronological changes in choroidal blood flow velocity in two patients with pachychoroid pigment epitheliopathy (PPE) and central serous chorioretinopathy (CSC) in the same eye. Observations Two males aged 36 and 43 years old with PPE were diagnosed with CSC in the same eyes during follow-up. Using laser speckle flowgraphy, the macular mean blur rate (MBR), an index of relative blood flow velocity, was sequentially evaluated in the affected and unaffected eyes. In the affected eye, the macular MBR values at the onset of PPE and CSC were higher, at 25% and 33% in Case 1 and 21% and 51% in Case 2, respectively, than those on PPE regression; but the same trends were not observed in their fellow eyes. The increases in MBR changing rates were 1.3 and 2.5 times higher in Cases 1 and 2, respectively, at the onset of CSC than those at the onset of PPE. Conclusion and importance In the affected eyes, the rates of MBR change increased at the alternate onsets of PPE and CSC. The increased MBR changing rates were 1.3-2.5 times higher at the onset of CSC than those at the onset of PPE. Our data suggest that choroidal hyperperfusion is involved in the pathogenesis of both diseases and that its severity may differ between CSC and PPE. These results may support the hypothesis that PPE and CSC clinically overlap and have a common pathogenic background.
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Fukutsu K, Namba K, Iwata D, Mizuuchi K, Kase S, Suzuki K, Shimizu H, Shibata Y, Yamawaki F, Onozawa M, Ishida S. Pseudo-inflammatory manifestations of choroidal lymphoma resembling Vogt-Koyanagi-Harada disease: case report based on multimodal imaging. BMC Ophthalmol 2020; 20:94. [PMID: 32156266 PMCID: PMC7065374 DOI: 10.1186/s12886-020-01353-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 02/20/2020] [Indexed: 12/01/2022] Open
Abstract
Background Hematologic malignancies occasionally cause serous retinal detachment (SRD); however, its pathogenesis remains unclear. Here we present the imaging characteristics of metastatic choroidal lymphoma masquerading as Vogt-Koyanagi-Harada (VKH) disease. Case presentation A 45-year-old Japanese woman was referred to our clinic because of bilateral SRD with blurred vision. Fluorescein angiography revealed multiple pinpoint leakage followed by pooling OU. Enhanced depth imaging optical coherence tomography showed marked choroidal thickening OU. Laser speckle flowgraphy detected choroidal circulation impairment OU. Although these results totally agreed with the inflammatory manifestations of acute VKH disease, indocyanine green angiography demonstrated various sizes of sharply marginated hypofluorescent lesions that seemed atypical for the finding of VKH disease, i.e., vaguely marginated hypofluorescent small dots. Cerebrospinal fluid pleocytosis was not detected. Blood tests revealed leukocytosis together with elevation of lactate dehydrogenase and soluble interleukin-2 receptor levels. Corticosteroid pulse therapy did not improve any ocular findings. Bone marrow biopsy was then performed, leading to a definite diagnosis of diffuse large B-cell lymphoma. After starting systemic chemotherapy, both SRD and choroidal thickening resolved rapidly with visual recovery. However, choroidal hypoperfusion persisted, which contrasted distinctly with the inflammatory pattern of VKH disease, i.e., the restoration of choroidal blood flow in parallel with normalization of choroidal thickness. Conclusions Our detailed multimodal observations highlighted the differential imaging features of choroidal lymphoma despite close resemblance to VKH disease especially at the initial stage. Impaired circulation in the thickened choroid marked the pseudo-inflammatory pathogenesis of SRD due to choroidal involvement with neoplastic, but not inflammatory cells.
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Affiliation(s)
- Kanae Fukutsu
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Daiju Iwata
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Kazuomi Mizuuchi
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Kayo Suzuki
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroshi Shimizu
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Yukiko Shibata
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Fumihiko Yamawaki
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masahiro Onozawa
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
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Choroidal and retinal displacements after vitrectomy with internal limiting membrane peeling in eyes with idiopathic macular hole. Sci Rep 2019; 9:17568. [PMID: 31772247 PMCID: PMC6879574 DOI: 10.1038/s41598-019-54106-0] [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: 09/09/2019] [Accepted: 11/10/2019] [Indexed: 11/21/2022] Open
Abstract
It has been reported that the macular region of the retina is displaced after vitrectomy with internal limiting membrane (ILM) peeling in eyes with macular hole (MH), but the displacements of the deeper layers of the eye, e.g. RPE and choroid are unclear following the surgery. We used optical coherence tomography (OCT) and OCT angiography (OCTA) to obtain 3 mm × 3 mm en face images before, and 2, 4, and 8 weeks following the vitrectomy with internal limiting membrane (ILM) peeling from 22 eyes of 22 patients with a MH. The OCT and OCTA images showed displacements of the fovea and choroidal intermediate vessels postoperatively. The degree of displacement of the choroid was significantly less than that of the retina (P < 0.001). The displacements of the choroidal bifurcations were significantly correlated to their preoperative distance from the optic disc (r = −0.467, P < 0.001) and they were significantly correlated with the retinal displacements (r = 0.535, P < 0.001). The retina was displaced inferiorly and centripetally, but these localized displacements were not observed in the choroid. In conclusion, clinicians need to be aware of these displacements when evaluating the subfoveal choroid following the surgery because the displacement is different between the retina and the choroid.
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Agrawal R, Jain M, Khan R, Jaisankar D, Xin W, Ding J, Testi I, Raman R, Biswas J. Choroidal Structural Changes in Sympathetic Ophthalmia on Swept-Source Optical Coherence Tomography. Ocul Immunol Inflamm 2019; 29:537-542. [PMID: 31743045 DOI: 10.1080/09273948.2019.1685110] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose: To analyze choroidal angioarchitecture in sympathetic ophthalmia (SO) using swept-source optical coherence tomography (SS-OCT) images.Methods: Case-control study of six patients with SO. Qualitative changes and quantitative parameters, including choroidal thickness (CT) and choroidal vascularity index (CVI), were analyzed.Results: Qualitative findings in the acute phase of SO on SS-OCT included retinal serous detachment with hyperreflective septa, choroidal folds, alterations in angioarchitecture with loss of vascular lacunae, and Dalen-Fuchs nodules. There was significantly higher CT in SO (284.05 ± 24.12 µm) compared to healthy controls (229.57 ± 46.67 µm, p = 0.04) and also increased CVI in SO (62.06 ± 2.07% vs 56.79 ± 3.15%, p = 0.006).Conclusions: CVI was significantly increased in SO, representing a novel noninvasive biomarker of disease activity. SS-OCT provides a useful qualitative and quantitative parameter, which can be potentially explored in the diagnosis and monitoring of patients with SO.
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Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Medical Retina and Uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Mukesh Jain
- Medical Research Foundation, Sankara Netralaya, Chennai, India
| | - Rehana Khan
- Medical Research Foundation, Sankara Netralaya, Chennai, India
| | | | - Wei Xin
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jianbin Ding
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ilaria Testi
- Department of Medical Retina and Uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Rajiv Raman
- Medical Research Foundation, Sankara Netralaya, Chennai, India
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Eghtedari M, Afarid M, Ashraf H, Maalhagh M. Choroidal changes after intravitreal injection of interferon alpha-2b. Exp Biol Med (Maywood) 2019; 244:1144-1148. [PMID: 31426682 DOI: 10.1177/1535370219870783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Intravitreal injection of interferon alpha-2b (IFN-α2b) is used to treat uveitis but its effect on the choroid is unknown. We histologically evaluated the choroidal changes after intravitreal injection of IFN-α2b. We compared histological samples of IFN-α2b-injected eyes to eyes with lipopolysaccharide (LPS)-induced uveitis and eyes injected with balanced salt solution (BSS) as controls. Rabbit eyes received intravitreal injections of BSS, IFN-α2b, or LPS, and enucleation was done seven days later. Choroidal changes were evaluated on histological cut sections. The thickness of the choroid was measured in micrometer and the severity of inflammation was scored. The mean maximum choroidal thickness was significantly greater in the IFN-α2b group in comparison to the LPS and BSS groups ( P < 0.001). The mean minimum choroidal thickness was also significantly greater in the IFN group compared to the BSS group ( P = 0.009). The observed changes were mainly due to vasodilation rather than interstitial fluid retention or inflammation. Mild inflammatory cell infiltration was observed in the choroid of four eyes in the IFN group and of three eyes in the LPS group. No inflammation was seen in the control group. The difference in inflammatory cell infiltration between the LPS and IFN groups was not statistically significant. Significant choroidal hyperemia was present after injection of IFN-α2b. This fact may suggest for some pharmacological applications of IFN-α2b when increased choroidal circulation is needed. However, further studies are required to elucidate the mechanisms involved. Impact statement Type I interferons are proteins that are naturally secreted by cells in response to certain stimuli. They are approved for medical use to regulate immune responses in many disease states. Our findings of increased choroidal circulation after treatment of the eye with interferon alpha-2b indicate a possible effect of this cytokine on blood circulation. This is a novel finding that needs further investigation to elucidate mechanisms and applications.
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Affiliation(s)
- Masoomeh Eghtedari
- Pathology Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Ophthalmology Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Poostchi Ophthalmology Research Center, Shiraz, Iran
| | - Mehrdad Afarid
- Ophthalmology Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Poostchi Ophthalmology Research Center, Shiraz, Iran
| | - Hossein Ashraf
- Ophthalmology Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Poostchi Ophthalmology Research Center, Shiraz, Iran
| | - Mehrnoosh Maalhagh
- Ophthalmology Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Poostchi Ophthalmology Research Center, Shiraz, Iran
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Hashimoto Y, Saito W, Saito M, Hasegawa Y, Ishida S. Increased thickness and decreased blood flow velocity of the choroid in a patient with acute macular neuroretinopathy. BMC Ophthalmol 2019; 19:109. [PMID: 31088423 PMCID: PMC6518730 DOI: 10.1186/s12886-019-1123-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/08/2019] [Indexed: 11/18/2022] Open
Abstract
Background The involvement of choroidal lesions in acute macular neuroretinopathy (AMN) is not yet fully understood. We quantitatively examined sequential changes in the morphology and circulation hemodynamics of the choroid using enhanced depth imaging optical coherence tomography (EDI-OCT) and laser speckle flowgraphy (LSFG) in a patient with AMN. Case presentation A 15-year-old boy was referred to our hospital due to AMN in his right eye alone. The next day AMN developed in his left eye. Three months later, AMN lesions in both eyes spontaneously resolved and the morphology of macular photoreceptors improved. Using EDI-OCT, central choroidal thickness (CCT) was examined for a period of three months, starting from the initial visit. Using LSFG, macular mean blur rate (MBR) was examined for three months, starting 1 week after the initial visit. At the first visit, CCT of the right eye with AMN was 82 μm higher than that of the left eye, which had not yet developed AMN, and decreased by 86 μm after three months. In the left eye, similarly, CCT increased by 16 μm after the AMN onset at 1 week compared with a pre-onset value at the first visit and thereafter decreased by 57 μm at 3 months. Macular MBR increased by 20–55% OD and 51–71% OS during the follow-up until 3 months. Conclusions We found that the choroid at the macula thickened at the onset of AMN and became thin with the regression of disease. Therefore, in concert with MBR data, these results further strengthened our hypothesis that choroidal circulation impairment plays a role in the pathogenesis of AMN.
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Affiliation(s)
- Yuki Hashimoto
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan
| | - Wataru Saito
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan. .,Kaimeido Eye and Dental Clinic, Sapporo, Japan.
| | - Michiyuki Saito
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan
| | - Yuka Hasegawa
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan
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Hashimoto Y, Saito W, Namba K, Mizuuchi K, Iwata D, Noda K, Kanda A, Ishida S. Comparison of clinical characteristics in patients with Vogt-Koyanagi-Harada disease with and without anti-retinal antibodies. Graefes Arch Clin Exp Ophthalmol 2019; 257:1751-1758. [DOI: 10.1007/s00417-019-04330-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/07/2019] [Accepted: 04/16/2019] [Indexed: 12/19/2022] Open
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Involvement of circulatory disturbance in optic disk melanocytoma with visual dysfunction. Graefes Arch Clin Exp Ophthalmol 2019; 257:835-841. [DOI: 10.1007/s00417-019-04257-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/16/2019] [Accepted: 01/24/2019] [Indexed: 01/03/2023] Open
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Kim KL, Choi YJ, Shin SH, Park SP, Kim YK. Choroidal volume changes following blow-out fracture repair. Int Ophthalmol 2018; 39:1995-2004. [PMID: 30341549 DOI: 10.1007/s10792-018-1033-9] [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: 07/30/2018] [Accepted: 10/01/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the serial choroidal volume change following orbital blow-out fracture (BOF) repair. METHODS The choroidal volume was measured by optical coherence tomography in patients who underwent BOF repair, preoperatively and postoperatively at 1, 4, 12 and 24 weeks. The orbital volume ratio (OVR) was obtained by dividing the orbital volume of the traumatized orbit by that of the contralateral side using three-dimensional computed tomography imaging. The choroidal volume change was compared between both eyes using a linear mixed model. RESULTS We analyzed the choroidal volume of 11 patients. Choroidal volume showed a trend of slight increase during the immediate postoperative period, and then, choroidal volume decreased abruptly between postoperative 1 to 4 weeks (β-coefficient - 0.22, P < 0.001). Choroidal volume also showed gradual decrease between postoperative 4 to 24 weeks (β-coefficient - 0.02, P < 0.001). During the study period, there were no significant differences in choroidal volume change between BOF and contralateral unaffected eyes (β-coefficient - 0.20, P = 0.711). The hyperopic refractive errors (β-coefficient 0.27, P = 0.028) and the larger preoperative OVR (β-coefficient 10.37, P = 0.013) were associated with larger choroidal volume. CONCLUSIONS Choroidal volume showed a similar decreasing change following BOF repair between the BOF and the contralateral unaffected eyes. Moreover, choroidal volume of both eyes was associated with the degree of orbital volume expansion due to BOF, suggesting that choroidal volume change after BOF repair was affected not only by trauma-associated local hemodynamic changes but also by systemic influences such as inflammatory response.
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Affiliation(s)
- Kyoung Lae Kim
- Department of Ophthalmology, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, #150 Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea
| | - Youn Joo Choi
- Department of Ophthalmology, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, #150 Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea
| | - Seong Hwan Shin
- Department of Ophthalmology, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, #150 Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea
| | - Sung Pyo Park
- Department of Ophthalmology, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, #150 Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea.
| | - Yong-Kyu Kim
- Department of Ophthalmology, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, #150 Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea.
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Takita A, Hashimoto Y, Saito W, Kase S, Ishida S. Changes in blood flow velocity and thickness of the choroid in a patient with leukemic retinopathy. Am J Ophthalmol Case Rep 2018; 12:68-72. [PMID: 30259004 PMCID: PMC6151848 DOI: 10.1016/j.ajoc.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 03/29/2018] [Accepted: 09/04/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose Choroidal circulation hemodynamics in eyes with leukemia has not been quantitatively examined yet. We quantitatively examined changes in choroidal blood flow velocity and choroidal thickness at the macula by using laser speckle flowgraphy (LSFG) and enhanced depth imaging optical coherence tomography (EDI-OCT) in a patient with leukemic retinopathy. Observations A 15-year-old boy presented with sudden central vision loss of his right eye. The patient's best-corrected visual acuity was 0.09 OD and 1.2 OS. Funduscopy revealed a sub-inner limiting membrane hemorrhage at the macula, intra-retinal hemorrhages with Roth spots, and dilatation and tortuosity of retinal veins OU. Leukocytosis with the Philadelphia chromosome was found in the peripheral blood, which led to a diagnosis of retinopathy associated with chronic myeloid leukemia. Retinal hemorrhages resolved after chemotherapy. Macular mean blur rates on LSFG increased by 24–38% OD and 13–26% OS, while macular choroidal thicknesses on EDI-OCT decreased by 7–60 μm OD and 8–46 μm OS during the 3-month follow-up period after the start of treatment. Conclusion and importance These results suggest that choroidal blood flow velocity decreased and choroidal thickness increased sub-clinically in the acute stage of a patient with leukemic retinopathy. LSFG and EDI-OCT may be useful to non-invasively evaluate the activity of choroidal involvement in leukemic retinopathy.
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Affiliation(s)
- Akari Takita
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuki Hashimoto
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Wataru Saito
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Kaimeido Eye and Dental Clinic, Sapporo, Japan
- Corresponding author. Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan.
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Nakayama M, Keino H, Watanabe T, Okada AA. Clinical features and visual outcomes of 111 patients with new-onset acute Vogt-Koyanagi-Harada disease treated with pulse intravenous corticosteroids. Br J Ophthalmol 2018; 103:274-278. [DOI: 10.1136/bjophthalmol-2017-311691] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/10/2018] [Accepted: 03/28/2018] [Indexed: 11/03/2022]
Abstract
PurposeTo describe the clinical features, treatment and visual outcomes of Japanese patients with new-onset acute Vogt-Koyanagi-Harada (VKH) disease.MethodsClinical records of 111 patients who presented between 1999 and 2015 to the Ocular Inflammation Service of the Kyorin Eye Center, Tokyo, were reviewed.ResultsOf the 111 patients (68 women, 43 men), 16 had complete, 90 had incomplete and 5 had probable VKH disease. The median follow-up period was 36 months (4–175 months). The mean age at presentation was 41 years (19–74 years). Serous retinal detachment (202 eyes) and optic disc hyperaemia (89 eyes) were observed at presentation. Of the patients tested, 45/48 (93.8%) were human leucocyte antigen-DR4 positive and 63/77 (81.8%) had cerebrospinal fluid pleocytosis. Initial corticosteroid treatment consisted of pulse intravenous therapy in all patients. Sunset glow fundus was observed in 49.5% of eyes, and anterior and/or posterior segment recurrence of inflammation was observed in 25 patients (22.5%). Treatment was transitioned to cyclosporine in 17 patients (15.3%) for steroid sparing (6 patients) or recurrent inflammation (11 patients), with good subsequent control. Ocular complications were observed in 47 of 222 eyes (21.2%) (mostly cataract), and systemic complications were observed in 8.1% of patients (mostly hypertension and diabetes mellitus). Ninety-three percent of eyes (167 of 178 eyes) had a visual acuity of ≥1.0 at 1 year after presentation.ConclusionsAn aggressive corticosteroid treatment strategy in a large number of patients with new-onset acute VKH disease, with transitioning to cyclosporine in selected cases, resulted in excellent visual outcomes and low rates of recurrence.
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Maruyama K, Noguchi A, Shimizu A, Shiga Y, Kunikata H, Nakazawa T. Predictors of Recurrence in Vogt-Koyanagi-Harada Disease. ACTA ACUST UNITED AC 2018; 2:343-350. [DOI: 10.1016/j.oret.2017.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 07/23/2017] [Accepted: 07/25/2017] [Indexed: 11/29/2022]
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FOVEAL EXUDATE AND CHOROIDAL NEOVASCULARIZATION IN ATYPICAL CASES OF MULTIPLE EVANESCENT WHITE DOT SYNDROME. Retina 2018; 37:2025-2034. [PMID: 28098736 DOI: 10.1097/iae.0000000000001486] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe atypical cases of multiple evanescent white dot syndrome (MEWDS) associated with foveal exudation, increased choroidal thickness, and secondary Type 2 (subretinal) neovascularization. METHODS Four cases of atypical MEWDS were studied at a retina referral center. Patients underwent evaluation with multimodal retinal imaging, including fluorescein angiography, indocyanine green angiography, spectral-domain and enhanced depth imaging optical coherence tomography (OCT). Two patients were imaged with OCT angiography. RESULTS Four patients (3 female, 1 male) with a median age of 23.5 years presented with acute onset, painless, decreased central vision. All cases demonstrated fundus findings consistent with MEWDS on color photography, indocyanine green angiography, fluorescein angiography, fundus autofluorescence, and structural OCT imaging. On structural OCT, all 4 patients were noted to have hyperreflective subretinal material and increased subfoveal choroidal thickness ranging from 307 μm to 515 μm. Type 2 neovascularization was diagnosed in all four patients using fluorescein angiography, indocyanine green angiography, and/or OCT angiography. Two patients had poor visual acuity at the last follow-up despite resolution of characteristic clinical findings of MEWDS. CONCLUSION A subset of patients with atypical MEWDS may develop persistent poor vision due to subfoveal exudation and secondary Type 2 neovascularization. Patients showing increased choroidal thickness at presentation may be more susceptible to this unusual presentation.
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Kuo YC, Chen N, Tsai RK. Acute Zonal Occult Outer Retinopathy (AZOOR): a case report of vision improvement after intravitreal injection of Ozurdex. BMC Ophthalmol 2017; 17:236. [PMID: 29207977 PMCID: PMC5718015 DOI: 10.1186/s12886-017-0638-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AZOOR was first described by Gass in 1993 as a syndrome with rapid loss of one or more extensive zones of the outer retinal segments. It is characterized by photopsia, minimal funduscopic changes, and electroretinographic abnormalities. The efficacy of systemic steroids in treating AZOOR has been previously described and advocated by the concept of autoimmune retinopathy. However, the use of intravitreal of sustained-released steroid had not been mentioned to date. CASE PRESENTATION A 34-year-old man had sudden onset of central scotoma and photopsia in the left eye. His visual acuity continued deteriorating. The visual field defect demonstrated bilateral enlarged blind spots and altitudinal defects. Fluorescein angiography (FA) showed nonspecific retinal inflammation, and an electroretinogram (ERG) illustrated decreased amplitude of the b wave in both eyes. Optical coherence tomography (OCT) examinations revealed parafoveal loss of the photoreceptor inner/outer segment (IS/OS) junction. Therefore, acute zonal occult outer retinopathy (AZOOR) was diagnosed. Although his vision did not improve under the initial treatment of systemic corticosteroid and calcium channel blocker, remarkable improvement was noticed after the intravitreal injection(IVI) of Ozurdex, consistent with the recovered IS/OS junction disruption. CONCLUSIONS We herein report a typical case of AZOOR, suggesting that the intravitreal injection of steroid may benefit in certain patients.
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Affiliation(s)
- Yi Chun Kuo
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Nancy Chen
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Rong Kung Tsai
- Institute of Eye Research, Buddhist Tzu Chi General Hospital, Tzu Chi University, 707, Sec. 3, Chung-Yang Rd., Hualien, 970, Taiwan. .,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
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Chen TC, Yeh CY, Lin CW, Yang CM, Yang CH, Lin IH, Chen PY, Cheng JY, Hu FR. Vascular hypoperfusion in acute optic neuritis is a potentially new neurovascular model for demyelinating diseases. PLoS One 2017; 12:e0184927. [PMID: 28926646 PMCID: PMC5605049 DOI: 10.1371/journal.pone.0184927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 09/02/2017] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Optic neuritis is highly correlated with multiple sclerosis and is a major cause of acute visual loss and long-term neuronal degeneration. Primary cerebral hypoperfusion has been reported in brain demyelinating diseases. This study investigated whether peripapillary perfusion is changed in patients with acute optic neuritis (AON). METHODS This three-year cohort study was conducted from September 1 2012, to August 31, 2015. Two hundred and forty-one patients with non-glaucomatous acute optic neuropathy were screened, and 42 non-highly myopic patients who had suffered their first episode of unilaterally idiopathic AON were studied. All cases received spectral-domain optical coherence tomography (OCT) examination, general survey, and standard corticosteroid therapy. OCT images were analyzed using a customized MATLAB program for measuring peripapillary choroidal thickness (PCT). Multivariate regression models were constructed to identify factors that are significantly related to peripapillary perfusion. RESULTS Decreased PCT was found in eyes experiencing AON combined with disc swelling (the ratio of lesion eye PCT/fellow eye PCT was 0.87 ± 0.08; range, from 0.75 to 1.00). In comparison to the healthy fellow eyes, approximately every 26% increase in the thickness of the retinal nerve fiber layer due to axonal swelling was associated with a 10% decreased thickness of PCT. Thinner PCT is also correlated with poorer trough vision, which may lead to poorer final vision. These findings were obvious in patients with optic papillitis but not in patients with retrobulbar neuritis. CONCLUSIONS Peripapillary vascular hypoperfusion was found in patients experiencing AON combined with disc swelling. These findings are unlike those for other ocular inflammatory diseases but are consistent with cerebral hypoperfusion, which is found in brain demyelinating diseases; thus, these findings may represent a new neurovascular model in this field.
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Affiliation(s)
- Ta-Ching Chen
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chao-Yuan Yeh
- Department of Pathology, University of Southern California, Los Angeles, California, United States of America
| | - Chao-Wen Lin
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - I-Hung Lin
- School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pao-Yang Chen
- Institute of Plant and Microbial Biology, Academia Sinica, Taipei, Taiwan
| | - Jung-Yu Cheng
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan
| | - Fung-Rong Hu
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
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Relationship between choroidal blood flow velocity and choroidal thickness in patients with regression of acute central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2017; 256:227-229. [DOI: 10.1007/s00417-017-3791-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022] Open
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