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Wu J, Pang S, Guo X, Peng W, Lin D, Dai M, Liu R, Wang Y. Comparison of the Three Sets of Diagnostic Criteria for Vogt-Koyanagi-Harada Disease in Southeast China - A Retrospective Case-Control Study. Ocul Immunol Inflamm 2024; 32:376-383. [PMID: 36442050 DOI: 10.1080/09273948.2022.2146592] [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: 06/01/2022] [Revised: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the utility of the Chinese diagnostic criteria for Vogt-Koyanagi-Harada (VKH) disease (CDCV), the revised diagnostic criteria (RDC) and the classification criteria by SUN (SUN-C). METHODS Two groups of patients (VKH group and non-VKH group) were assessed in this retrospective case-control study. Sensitivity, specificity and area under receiver operating characteristic curve (AUC) were evaluated among these criteria. RESULTS 258 patients were included after propensity score matching. The sensitivities were 92.2% in CDCV, 66.7% in RDC, and 54.3% in SUN-C. In different disease stages (early and late), similar sensitivity results were observed. The specificities were 96.1% in CDCV, 97.7% in RDC, and 99.2% in SUN-C. The AUCs were 0.942 in CDCV, 0.822 in RDC and 0.767 in SUN-C. CONCLUSION A higher sensitivity value and larger AUC in CDCV were found. CDCV are highly useful in the diagnosis and classification of VKH disease in Chinese patients.
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Affiliation(s)
- Jiaqing Wu
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, People's Republic of China
| | | | - Xingneng Guo
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Wenqing Peng
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Dan Lin
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Mali Dai
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Ruru Liu
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Yuqin Wang
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, People's Republic of China
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2
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Tayal A, Daigavane S, Gupta N. Vogt-Koyanagi-Harada Disease: A Narrative Review. Cureus 2024; 16:e58867. [PMID: 38800227 PMCID: PMC11116741 DOI: 10.7759/cureus.58867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Vogt-Koyanagi-Harada (VKH) disease is an idiopathic immune-related sickness that affects multiple systems and melanocytes in organs such as the uvea, ear, and meninges. The primary cause of activity is cellular immunological responses. Vogt-Koyanagi disease is identified primarily by skin abnormalities and anterior uveitis. Harada's illness is distinguished by neurological symptoms and exudative retinal detachments, which are associated with the HLA-DR4 and HLA-DRw53 genes. Pigmented races, such as Hispanics and Native Americans, are more likely to have VKH disease. Clinical features are blurred vision, floaters, alopecia, vitiligo, diffuse choroidal inflammation with disc edema, and exudative retinal detachment. Differential diagnoses include posterior scleritis, uveal effusion syndrome, central serous chorioretinopathy, and sympathetic ophthalmitis. The investigations used are optical coherence tomography (OCT), fundus fluorescein angiography (FA), and B-scan ultrasonography (USG). Treatment is done by using systemic steroids, cycloplegics, and immunosuppressants.
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Affiliation(s)
- Ayushi Tayal
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sachin Daigavane
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nivesh Gupta
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Outcomes of patients with acute Vogt-Koyanagi-Harada disease treated with intravenous corticosteroid pulse followed by the slow tapering of oral corticosteroid therapy. Int Ophthalmol 2023; 43:431-440. [PMID: 35869402 DOI: 10.1007/s10792-022-02440-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To elucidate the intravenous corticosteroid pulse treatment outcomes of patients with acute Vogt-Koyanagi-Harada (VKH) disease and assess the differences between patients with no inflammation worsening and those with persistent or worsening inflammation. Potential factors responsible for eyes with low visual outcomes were also investigated. METHODS We retrospectively reviewed the clinical records of patients with acute VKH disease who first visited us between 2009 and 2018 and were followed up for > 300 days. Clinical characteristics, treatments, and posttreatment conditions were assessed. Patients were classified into no inflammation worsening (acute-resolved [AR]) and inflammation worsening (chronic-recurrent [CR]) groups based on conditions after 6 months from disease onset. RESULTS This study included 60 eyes from 30 patients (mean age: 52.7 years). Patients were treated with methylprednisolone pulse followed by the slow tapering of oral prednisolone; 73% of patients developed AR and 27% CR, and the best-corrected visual acuity (BCVA) was ≥ 1.0 in 83% of eyes at 6 months following the introduction of treatment. Although the total prednisolone dose was higher in patients with CR disease, no significant difference was noted in the final BCVA. Among the patients, five eyes had a final BCVA of ≤ 0.5 due to anisometropic amblyopia, diabetic maculopathy, pre-existing macular hole, epiretinal membrane, and ellipsoid zone loss. CONCLUSIONS Patients with acute VKH disease treated with corticosteroid pulse appear to demonstrate good visual outcomes, including patients with CR; the majority of eyes with low visual outcomes have pre-existing conditions that explain the low vision.
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Ganesh SK, Mistry S, Nair N. Role of Swept source optical coherence tomography in management of acute Vogt-Koyanagi-Harada's disease. Indian J Ophthalmol 2022; 70:2458-2463. [PMID: 35791133 PMCID: PMC9426143 DOI: 10.4103/ijo.ijo_1944_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: To evaluate the role of swept-source optical coherence tomography (SS-OCT) in the management of acute Vogt–Koyanagi–Harada’s (VKH) disease. Methods: Retrospective analysis of SS-OCT images of acute VKH patients between January 2015 and February 2020 in a tertiary eye care hospital. Results: We studied 34 eyes of 17 patients with acute probable VKH disease. The mean age was 31.6 ± 10.4 years. Twelve patients were women. The mean follow-up was 17.1 ± 9.3 months. The mean visual acuity was 0.86 logMAR (Snellen equivalent: 6/45) at presentation and 0.18 logMAR (Snellen equivalent: 6/9) at the last follow-up. The mean subfoveal choroidal thickness (SFCT) was 784.97 microns at presentation, 431.40 microns at the first month of therapy, 453.94 microns at six months of therapy, and 405.83 microns at the last follow-up. Qualitative features noted on SS-OCT on presentation was subretinal fluid (SRF) in 29 (85%) eyes, subretinal hyperreflective dots in 34 (100%) eyes, subretinal septa in 33 (97%) eyes, RPE undulations in 21 (61.7%) eyes, posterior vitreous cells in 34 (100%) eyes, SRF around disc in 9 (26%) eyes, and disc swelling in 34 (100%) eyes. At the end of 1 year of follow-up, RPE undulations were absent in 30 eyes (88%) and disc swelling was notably absent in all 34 eyes (100%), though SRF around disc was noted in 4 eyes (11.7%) of 2 patients who had recurrences. Conclusion: SFCT, SRF around disc, RPE undulation, and disc swelling may be important indicators on SS-OCT to guide therapy and prognosticate recurrences in acute VKH.
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Affiliation(s)
- Sudha K Ganesh
- Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Saurabh Mistry
- Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Nivedita Nair
- Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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5
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Iwata D, Namba K, Yamamoto T, Mizuuchi K, Saito W, Ohno S, Kitaichi N, Ishida S. Recent Clinical Features of Intraocular Inflammation in Hokkaido, Japan - Comparison with the Previous Decade. Ocul Immunol Inflamm 2021; 30:848-854. [PMID: 33571416 DOI: 10.1080/09273948.2020.1836565] [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] [Indexed: 01/27/2023]
Abstract
PURPOSE This study aimed to investigate the clinical features of intraocular inflammation (uveitis) in Hokkaido and to assess the etiology trends in comparison with those of our previous survey. METHODS We retrospectively reviewed the medical records of 1,616 new referral uveitis patients (1,020 females and 596 males) in Hokkaido University Hospital between 2004 and 2014. RESULTS Sarcoidosis was the most frequent etiology (17.4%), followed by Vogt-Koyanagi-Harada disease (8.1%), Behçet's disease (4.5%), and human leukocyte antigen B27 -associated uveitis (2.5%). The etiologies in 48.7% of the patients were unclassified. Compared to the previous survey between 1994 and 2003, the rate of Behçet's disease decreased and that of sarcoidosis increased. The rates of infectious uveitis and vitreoretinal lymphoma increased. CONCLUSION Although the order of the top four etiologies was the same in the two surveys, the rate of sarcoidosis increased and that of Behçet's disease decreased.
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Affiliation(s)
- Daiju Iwata
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Taku Yamamoto
- 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
| | - Wataru Saito
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigeaki Ohno
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuyoshi Kitaichi
- Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Shimizu H, Usui Y, Asakage M, Nezu N, Wakita R, Tsubota K, Sugimoto M, Goto H. Serum Metabolomic Profiling of Patients with Non-Infectious Uveitis. J Clin Med 2020; 9:jcm9123955. [PMID: 33291298 PMCID: PMC7762156 DOI: 10.3390/jcm9123955] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/21/2022] Open
Abstract
The activities of various metabolic pathways can influence the pathogeneses of autoimmune diseases, and intrinsic metabolites can potentially be used to diagnose diseases. However, the metabolomic analysis of patients with uveitis has not yet been conducted. Here, we profiled the serum metabolomes of patients with three major forms of uveitis (Behҫet's disease (BD), sarcoidosis, and Vogt-Koyanagi-Harada disease (VKH)) to identify potential biomarkers. This study included 19 BD, 20 sarcoidosis, and 15 VKH patients alongside 16 healthy control subjects. The metabolite concentrations in their sera were quantified using liquid chromatography with time-of-flight mass spectrometry. The discriminative abilities of quantified metabolites were evaluated by four comparisons: control vs. three diseases, and each disease vs. the other two diseases (such as sarcoidosis vs. BD + VKH). Among 78 quantified metabolites, 24 kinds of metabolites showed significant differences in these comparisons. Four multiple logistic regression models were developed and validated. The area under the receiver operating characteristic (ROC) curve (AUC) in the model to discriminate disease groups from control was 0.72. The AUC of the other models to discriminate sarcoidosis, BD, and VKH from the other two diseases were 0.84, 0.83, and 0.73, respectively. This study provides potential diagnostic abilities of sarcoidosis, BD, and VKH using routinely available serum samples that can be collected with minimal invasiveness.
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Affiliation(s)
- Hiroyuki Shimizu
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
- Correspondence: ; Tel.: +81-3-3342-6111
| | - Masaki Asakage
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
| | - Naoya Nezu
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
| | - Ryo Wakita
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
| | - Kinya Tsubota
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
| | - Masahiro Sugimoto
- Health Promotion and Preemptive Medicine, Research and Development Center for Minimally Invasive Therapies, Institute of Medical Sciences, Tokyo Medical University, Tokyo 160-8402, Japan;
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
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7
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Yang P, Zhong Y, Du L, Chi W, Chen L, Zhang R, Zhang M, Wang H, Lu H, Yang L, Zhuang W, Yang Y, Xing L, Feng L, Jiang Z, Zhang X, Wang Y, Zhong H, Jiang L, Zhao C, Li F, Cao S, Liu X, Chen X, Shi Y, Zhao W, Kijlstra A. Development and Evaluation of Diagnostic Criteria for Vogt-Koyanagi-Harada Disease. JAMA Ophthalmol 2019; 136:1025-1031. [PMID: 29978190 DOI: 10.1001/jamaophthalmol.2018.2664] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance To our knowledge, a set of well-defined diagnostic criteria is not yet developed for the diagnosis of Vogt-Koyanagi-Harada (VKH) disease. Objective To develop and evaluate a set of diagnostic criteria for VKH disease using data from Chinese patients. Design, Setting, and Participants This case-control study reviewed medical records of patients from a tertiary referral center between October 2011 and October 2016. Data from 634 patients with VKH disease and 623 patients with non-VKH uveitis from southern China were used to develop the Diagnostic Criteria for VKH Disease (DCV). Data from an additional group of 537 patients with a definite VKH disease diagnosis and 525 patients with non-VKH uveitis from northern China were used to evaluate the diagnostic criteria. Main Outcomes and Measures Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic. Results Of the 1257 patients used to construct the DCV, 665 (52.9%) were male, and the mean (SD) age at disease onset was 38.6 (13.6) years. The 3-class model and 21 clinical findings were selected by latent class analysis. Variables with a high positive rate in the early-phase or late-phase VKH group or high specificity constituted essential parameters. Constellations of these essential parameters constructed the DCV. The sensitivity and NPV of the DCV were higher than those of the Revised Diagnostic Criteria for VKH Disease (RDC) (sensitivity: 94.6% vs 71.9%; difference, 22.7%; 95% CI, 18.5-27.0; NPV: 94.3% vs 76.6%; difference, 17.7%; 95% CI, 13.9-21.5). The specificity and PPV of the DCV were not different from that of the RDC (specificity: 92.2% vs 93.9%; difference, 1.7%; 95% CI, -1.4 to 4.8; PPV: 89.3% vs 92.3%; difference, 3.0%; 95% CI, -1.4 to 4.8). The area under the receiver operating characteristic curve of the DCV and the RDC were 0.934 (95% CI, 0.917-0.951) and 0.829 (95% CI, 0.803-0.855), respectively. Conclusions and Relevance The DCV were developed and evaluated using data from Chinese patients with VKH disease and showed a high sensitivity, NPV, and area under the receiver operating characteristic curve in comparison with the RDC. However, they were developed using a retrospective analysis and should be evaluated in prospective studies in other racial/ethnic populations.
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Affiliation(s)
- Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, People's Republic of China
| | - Yuanyuan Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, People's Republic of China
| | - Liping Du
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, People's Republic of China
| | - Wei Chi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ling Chen
- The Eye and ENT Hospital of Fudan University, Shanghai, People's Republic of China
| | - Rui Zhang
- The Eye and ENT Hospital of Fudan University, Shanghai, People's Republic of China
| | - Meifen Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hong Wang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hong Lu
- Department of Ophthalmology, Beijing Chao-Yang Hospital of Capital Medical University, Beijing, People's Republic of China
| | - Liu Yang
- Department of Ophthalmology, Peking University First Hospital, Beijing, People's Republic of China
| | - Wenjuan Zhuang
- Department of Ophthalmology, Ningxia People's Hospital, Yinchuan, People's Republic of China
| | - Yan Yang
- Department of Ophthalmology, the Second Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Lin Xing
- Department of Ophthalmology, the First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Lei Feng
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Zhengxuan Jiang
- Department of Ophthalmology, the Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Xiaomin Zhang
- Tianjin Medical University Eye Hospital, Tianjin, People's Republic of China
| | - Yuqin Wang
- The Eye Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Hui Zhong
- Department of Ophthalmology, Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Liqiong Jiang
- Shenzhen Eye Hospital, Shenzhen Key Ophthalmic Laboratory, the Second Affiliated Hospital of Jinan University, Shenzhen, People's Republic of China
| | - Changlin Zhao
- Department of Ophthalmology, Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Fuzhen Li
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Henan Province Eye Hospital, Zhengzhou, People's Republic of China
| | - Shuang Cao
- Department of Ophthalmology, Xi'an No. 4 Hospital, Xi'an, People's Republic of China
| | - Xiaoli Liu
- Ophthalmic Center of the Second Hospital, Jilin University, Changchun, People's Republic of China
| | - Xuan Chen
- Department of Ophthalmology, the Second People's Hospital of Jinan City, Jinan, People's Republic of China
| | - Yanyun Shi
- Shanxi Eye Hospital, Taiyuan, People's Republic of China
| | - Weizhong Zhao
- College of Information Engineering, Xiangtan University, Xiangtan, People's Republic of China
| | - Aize Kijlstra
- University Eye Clinic Maastricht, Maastricht, Limburg, the Netherlands
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8
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Hedayatfar A, Khochtali S, Khairallah M, Takeuchi M, El Asrar AA, Herbort CP. "Revised diagnostic criteria" for Vogt-Koyanagi-Harada disease fail to improve disease management. J Curr Ophthalmol 2018; 31:1-7. [PMID: 30899839 PMCID: PMC6407152 DOI: 10.1016/j.joco.2018.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/09/2018] [Accepted: 10/31/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Alireza Hedayatfar
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.,Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.,Department of Ophthalmology, Fattouma Bourghiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia.,Department of Ophthalmology, National Defence Medical College, Tokorozawa, Saitama, Japan.,Department of Ophthalmology, and Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.,Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourghiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia.,Department of Ophthalmology, National Defence Medical College, Tokorozawa, Saitama, Japan.,Department of Ophthalmology, and Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.,Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourghiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia.,Department of Ophthalmology, National Defence Medical College, Tokorozawa, Saitama, Japan.,Department of Ophthalmology, and Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.,Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defence Medical College, Tokorozawa, Saitama, Japan.,Department of Ophthalmology, and Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.,Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
| | - Ahmed Abu El Asrar
- Department of Ophthalmology, and Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.,Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
| | - Carl P Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.,Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
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9
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Saleem MD, Oussedik E, Schoch JJ, Berger AC, Picardo M. Acquired disorders with depigmentation: A systematic approach to vitiliginoid conditions. J Am Acad Dermatol 2018; 80:1215-1231.e6. [PMID: 30236516 DOI: 10.1016/j.jaad.2018.03.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/01/2018] [Accepted: 03/21/2018] [Indexed: 01/14/2023]
Abstract
Acquired disorders with depigmentation are commonly encountered by dermatologists and present with a wide differential diagnosis. Vitiligo, the most common disorder of acquired depigmentation, is characterized by well-defined depigmented macules and patches. Other conditions, such as chemical leukoderma, can present with similar findings, and are often easily mistaken for vitiligo. Key clinical features can help differentiate between acquired disorders of depigmentation. The first article in this continuing medical education series focuses on conditions with a vitiligo-like phenotype. Early recognition and adequate treatment of these conditions is critical in providing appropriate prognostication and treatment.
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Affiliation(s)
- Mohammed D Saleem
- Department of Internal Medicine, University of Florida College of Medicine and University of Florida Health, Gainesville, Florida.
| | | | - Jennifer J Schoch
- Department of Dermatology and Pediatrics, University of Florida, Gainesville, Florida
| | - Adam C Berger
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mauro Picardo
- Department of Dermatology and Pediatric Dermatology, Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
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10
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Affiliation(s)
- Douglas A. Jabs
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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11
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Fujiwara K, Morita S, Hoshino K, Fukuda A, Nakamaru Y, Homma A. Evaluation of Vestibular Functions in Patients with Vogt-Koyanagi-Harada Disease. Audiol Neurootol 2017; 22:190-195. [PMID: 29080887 DOI: 10.1159/000481426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/01/2017] [Indexed: 11/19/2022] Open
Abstract
Vogt-Koyanagi-Harada (VKH) disease is an idiopathic, multisystem autoimmune disorder characterized by bilateral, diffuse granulomatous uveitis associated with neurological, audiovestibular, and dermatological manifestations. The purpose of this study is to investigate vestibular functions in patients with VKH disease. A total of 43 patients with VKH disease in Hokkaido University Hospital were enrolled in this study. Subjective symptoms such as dizziness or vertigo and the results of various vestibular examinations including nystagmus testing, caloric testing, and vestibular-evoked myogenic potential (VEMP) testing were investigated. Eight of 42 patients (19.0%) complained of subjective vestibular symptoms. On the other hand, 12 of 28 patients (42.9%) showed nystagmus, and 7 of 15 patients (46.7%) showed unilateral or bilateral weakness in the caloric test. VEMP testing was performed for 16 patients. Seven (43.8%) and 8 (50.0%) patients were evaluated as abnormal in cervical VEMP and ocular VEMP testing, respectively. The rate of detection of nystagmus was significantly higher than that of subjective symptoms. As vestibular dysfunction in patients with VKH disease cannot be detected through history taking alone, nystagmus testing, caloric testing, and VEMP testing should be performed to evaluate vestibular functions associated with VKH disease. It is considered that abnormal VEMP findings are associated with otolith organ dysfunction.
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Affiliation(s)
- Keishi Fujiwara
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Lodhi SA, Reddy JL, Peram V. Clinical spectrum and management options in Vogt-Koyanagi-Harada disease. Clin Ophthalmol 2017; 11:1399-1406. [PMID: 28848322 PMCID: PMC5557111 DOI: 10.2147/opth.s134977] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to describe the clinical features, treatment options, and visual outcome of Vogt–Koyanagi–Harada (VKH) disease patients over a 9-year period. Method A retrospective chart analysis of 32 patients with VKH, from January 2007 to December 2015, at a tertiary care government medical college eye hospital in South India. Results A total of 32 patients were diagnosed with VKH. The mean age at diagnosis was 32.03±8.8 years. There were 24 patients (42 eyes) with acute VKH and eight patients (16 eyes) with recurrent/chronic VKH. The mean baseline best-corrected visual acuity on presentation in the acute VKH group was 5/60 (1.114±0.565) and at last follow-up it was 6/9 (0.225±0.157). Intravenous methyl prednisolone (IVMP) was administered for 3 days to all patients with acute and recurrent VKH, followed by posterior subtenon triamcinolone (40 mg/mL) and oral azathioprine. Conclusion VKH-related uveitis is more common in the female gender in this South Indian population. Posterior uveitis is the most common initial manifestation. Initial aggressive treatment with IVMP, peribulbar long-acting corticosteroids, and immunosuppressives, avoiding side effects of systemic steroids, gives a good visual outcome without recurrences. Cases of unilateral VKH, seen in six patients, are the initial manifestations in the natural course of the disease, which if managed aggressively at the acute stage prevents recurrence in the other eye.
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Affiliation(s)
- Sikander Ak Lodhi
- Department of Ophthalmology, Osmania Medical College/Sarojini Devi Eye Hospital, Hyderabad, Telangana, India
| | - Jm Lokabhi Reddy
- Department of Ophthalmology, Osmania Medical College/Sarojini Devi Eye Hospital, Hyderabad, Telangana, India
| | - Venkataratnam Peram
- Department of Ophthalmology, Osmania Medical College/Sarojini Devi Eye Hospital, Hyderabad, Telangana, India
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Vogt-Koyanagi-Harada disease. Surv Ophthalmol 2017; 62:1-25. [DOI: 10.1016/j.survophthal.2016.05.002] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/16/2016] [Accepted: 05/16/2016] [Indexed: 12/17/2022]
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Silpa-archa S, Silpa-archa N, Preble JM, Foster CS. Vogt–Koyanagi–Harada syndrome: Perspectives for immunogenetics, multimodal imaging, and therapeutic options. Autoimmun Rev 2016; 15:809-19. [DOI: 10.1016/j.autrev.2016.04.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 03/24/2016] [Indexed: 11/24/2022]
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Du L, Kijlstra A, Yang P. Vogt-Koyanagi-Harada disease: Novel insights into pathophysiology, diagnosis and treatment. Prog Retin Eye Res 2016; 52:84-111. [PMID: 26875727 DOI: 10.1016/j.preteyeres.2016.02.002] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/07/2016] [Accepted: 02/08/2016] [Indexed: 02/07/2023]
Abstract
Vogt-Koyanagi-Harada (VKH) disease is one of the major vision-threatening diseases in certain populations, such as Asians, native Americans, Hispanics and Middle Easterners. It is characterized by bilateral uveitis that is frequently associated with neurological (meningeal), auditory, and integumentary manifestations. Although the etiology and pathogenesis of VKH disease need to be further elucidated, it is widely accepted that the clinical manifestations are caused by an autoimmune response directed against melanin associated antigens in the target organs, i.e. the eye, inner ear, meninges and skin. In the past decades, accumulating evidence has shown that genetic factors, including VKH disease specific risk factors (HLA-DR4) and general risk factors for immune mediated diseases (IL-23R), dysfunction of immune responses, including the innate and adaptive immune system and environmental triggering factors are all involved in the development of VKH disease. Clinically, the criteria of diagnosis for VKH disease have been further improved by the employment of novel imaging techniques for the eye. For the treatment, early and adequate corticosteroids are still the mainstream regime for the disease. However, immunosuppressive and biological agents have shown benefit for the treatment of VKH disease, especially for those patients not responding to corticosteroids. This review is focused on our current knowledge of VKH disease, especially for the diagnosis, pathogenesis (genetic factors and immune mechanisms), ancillary tests and treatment. A better understanding of the role of microbiome composition, genetic basis and ongoing immune processes along with the development of novel biomarkers and objective quantitative assays to monitor intraocular inflammation are needed to improve current management of VKH patients.
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Affiliation(s)
- Liping Du
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China
| | - Aize Kijlstra
- University Eye Clinic Maastricht, Maastricht, Limburg, The Netherlands; Wageningen UR Livestock Research, Wageningen, The Netherlands
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China.
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Arevalo JF, Lasave AF, Gupta V, Kozak I, Al Harbi MB, Al Rushood AA, Al Dhibi HA. Clinical Outcomes of Patients with Vogt-Koyanagi-Harada Disease Over 12 Years at a Tertiary Center. Ocul Immunol Inflamm 2015; 24:521-9. [PMID: 26399962 DOI: 10.3109/09273948.2015.1025984] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe the clinical characteristics and treatment outcomes of Vogt-Koyanagi-Harada (VKH) disease over a 12-year period. METHODS A retrospective chart review was used to identify VKH patients, from January 1999 to December 2011. RESULTS In total, 154 patients (308 eyes) were diagnosed with VKH. The mean age at diagnosis was 33.8 ± 13 years. Mean baseline best-corrected visual acuity (BCVA) was 20/125; (0.8 ± 0.6 logMAR). Recurrent episodes occurred in 107 (54%) patients. Oral prednisone was administered in all patients. At the last visit, the mean BCVA was 20/50 (0.4 ± 0.7 logMAR). The most common complications post-treatment were: glaucoma [104 (33.8%) eyes] and cataract [84 (27.2%) eyes]. CONCLUSIONS In Saudi Arabia, VKH-related uveitis is predominant in young females. Bilateral panuveitis is the most common ocular manifestation and near 50% of eyes present with exudative retinal detachment. Oral prednisone was the primary treatment and the majority of eyes maintained 20/50 or better vision.
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Affiliation(s)
- J Fernando Arevalo
- a Retina Division , Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA .,b Vitreoretinal and Uveitis Division , King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia , and
| | - Andres F Lasave
- c Retina and Vitreous Service, Clinica Privada de Ojos , Mar del Plata , Argentina
| | - Vishali Gupta
- b Vitreoretinal and Uveitis Division , King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia , and
| | - Igor Kozak
- b Vitreoretinal and Uveitis Division , King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia , and
| | - Mosa Barakat Al Harbi
- a Retina Division , Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Abdulaziz Adel Al Rushood
- b Vitreoretinal and Uveitis Division , King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia , and
| | - Hassan A Al Dhibi
- b Vitreoretinal and Uveitis Division , King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia , and
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Ng JY, Luk FO, Lai TY, Pang CP. Influence of molecular genetics in Vogt-Koyanagi-Harada disease. J Ophthalmic Inflamm Infect 2014; 4:20. [PMID: 25097674 PMCID: PMC4105881 DOI: 10.1186/s12348-014-0020-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 07/08/2014] [Indexed: 01/13/2023] Open
Abstract
Vogt-Koyanagi-Harada (VKH) disease is a systemic autoimmune disorder against melanocytes. Recent studies have identified multiple genetic factors that might be associated with the pathogenesis of VKH disease. We performed an electronic database search of PubMed, MEDLINE, and EMBASE, and all relevant papers published up to 13 June 2014 were reviewed. A total of 1,031 publications including articles relevant to the genetics of VKH disease and the references of these articles were reviewed. The review identified a number of genetic factors which might be involved in the pathogenesis of VKH disease, some of which may alter the clinical course of VKH disease. Genes which might be involved in the pathogenesis of VKH disease included genes expressing HLA, complement factor H, interleukins, cytotoxic T-lymphocyte antigen 4 (CTLA-4), killer cell immunoglobulin-like receptors (KIR), programmed cell death 1 (PDCD1), protein tyrosine phosphatase non-receptor 22 (PTPN22), osteopontin, tumor necrosis factor alpha-induced protein 3 (TNFAIP3), macrophage migration inhibitory factor (MIF), and other immune response genes. Further studies to explore the correlation among different genotypes and phenotypes of VKH disease will be useful to shed light on the pathogenesis of uveitis in VKH disease and may facilitate the development of new treatment modalities of uveitis in VKH disease.
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Affiliation(s)
- Joanne Yw Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, 3/F Hong Kong Eye Hospital, 147K Argyle Street, Kowloon ᅟ, Hong Kong
| | - Fiona Oj Luk
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, 3/F Hong Kong Eye Hospital, 147K Argyle Street, Kowloon ᅟ, Hong Kong
| | - Timothy Yy Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, 3/F Hong Kong Eye Hospital, 147K Argyle Street, Kowloon ᅟ, Hong Kong
| | - Chi-Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, 3/F Hong Kong Eye Hospital, 147K Argyle Street, Kowloon ᅟ, Hong Kong
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A clinical grading system based on ultra-wide field retinal imaging for sunset glow fundus in Vogt-Koyanagi-Harada Disease. Graefes Arch Clin Exp Ophthalmol 2014; 253:359-68. [DOI: 10.1007/s00417-014-2710-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/22/2014] [Accepted: 06/23/2014] [Indexed: 11/26/2022] Open
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Morita S, Nakamaru Y, Obara N, Masuya M, Fukuda S. Characteristics and Prognosis of Hearing Loss Associated with Vogt-Koyanagi-Harada Disease. Audiol Neurootol 2013; 19:49-56. [DOI: 10.1159/000356386] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 10/10/2013] [Indexed: 11/19/2022] Open
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Gaudreau P, Moy J, Lindsay F. An unusual cause of vertigo, tinnitus, and hyperacusis: Vogt-Koyanagi-Harada syndrome. EAR, NOSE & THROAT JOURNAL 2013; 91:E7-9. [PMID: 23288830 DOI: 10.1177/014556131209101213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
We describe the case of a 36-year-old woman with a history of vitiligo who presented with an insidious onset of neurologic, vestibular, ocular, and auditory symptoms. She had recently noted the onset of vertigo, tinnitus, and hypersensitivity to sound. Findings on audiometry were within normal limits, although the patient reported some auditory discomfort during the testing. The patient had a history of bilateral uveitis and peripheral neurologic symptoms. She was diagnosed with Vogt-Koyanagi-Harada (VKH) syndrome and started on corticosteroid therapy. Her neurologic, vestibular, ocular, and auditory symptoms resolved. VKH syndrome is an uncommon cause of vertigo and hearing loss, but it should be considered in the differential diagnosis of patients with autoimmunity-related inner ear symptoms.
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Affiliation(s)
- Philip Gaudreau
- Department of Otolaryngology, Naval Medical Center, Portsmouth, VA 23708, USA.
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Khairallah AS. Headache as an initial manifestation of Vogt-Koyanagi-Harada disease. Saudi J Ophthalmol 2013; 28:239-42. [PMID: 25278805 DOI: 10.1016/j.sjopt.2013.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 03/19/2013] [Accepted: 10/03/2013] [Indexed: 10/26/2022] Open
Abstract
A 29 year-old healthy Saudi female presented with a 1 week history of headache followed by decreased vision in both eyes. Biomicroscopy revealed anterior uveitis without hypopyon, posterior synechia or keratic precipitate. Fundus examinations were remarkable for serous retinal detachment and hyperemic discs. Fundus fluorescein angiogram showed a hot disc with multiple pinpoint leakage in both eyes. CT scan and MRI were normal, all uveitis workups were negative. Five months later, the patient presented with complete criteria of Vogt-Koyanagi-Harada disease including a 2 weeks history of tinnitus, alopecia, poliosis and vitiligo. Headache alone followed by decreased vision before the onset of neurological and auditory symptoms can be an initial presentation of VKH disease. VKH should be considered in the differential diagnosis of atypical presentation of symptoms.
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Affiliation(s)
- Abdulrahman Samir Khairallah
- Department of Ophthalmology, King Fahad Hospital of the University, P.O. Box 40194, Alkhobar 31952, Saudi Arabia
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Clinical characteristics of Vogt–Koyanagi–Harada syndrome in a tertiary medical centre in western region of Kingdom of Saudi Arabia. J Taibah Univ Med Sci 2013. [DOI: 10.1016/j.jtumed.2013.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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23
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Evaluation of NLRP1 gene polymorphisms in Vogt-Koyanagi-Harada disease. Jpn J Ophthalmol 2011; 55:57-61. [PMID: 21331694 DOI: 10.1007/s10384-010-0887-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Accepted: 06/29/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Polymorphisms of the NACHT [neuronal apoptosis inhibitory protein (NAIP), CIITA, HET-E, TP1] and leucine-rich repeat protein 1 (NLRP1) gene are reported to be associated with susceptibility to vitiligo and several autoimmune diseases. Vogt-Koyanagi-Harada (VKH) disease is an autoimmune disorder affecting melanocytes in the skin, eyes, inner ear, and meninges. In this study, genetic associations between VKH disease and single-nucleotide polymorphisms (SNPs) surrounding the NLRP1 gene were investigated. METHODS Six SNPs (rs6502867, rs925597, rs3926687, rs2733359, rs878329, and rs4790796) near the NLRP1 gene, including noncoding regions, were sequenced by a direct method to genotype 167 Japanese patients with VKH disease and 187 healthy Japanese volunteers. RESULTS None of the six SNPs in the NLRP1 region were significantly associated with disease susceptibility or the ocular, neurological, and dermatological manifestations of VKH. CONCLUSIONS Although skin manifestations are clinically similar between vitiligo and VKH disease, the genetic and immunological mechanisms of these two diseases may be different.
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Rao NA, Gupta A, Dustin L, Chee SP, Okada AA, Khairallah M, Bodaghi B, Lehoang P, Accorinti M, Mochizuki M, Prabriputaloong T, Read RW. Frequency of distinguishing clinical features in Vogt-Koyanagi-Harada disease. Ophthalmology 2009; 117:591-9, 599.e1. [PMID: 20036008 DOI: 10.1016/j.ophtha.2009.08.030] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 08/17/2009] [Accepted: 08/21/2009] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine the frequency of occurrence of limited clinical features which distinguish patients with Vogt-Koyanagi-Harada (VKH) disease from those with non-VKH uveitis. DESIGN Comparative case series. PARTICIPANTS We included 1147 patients. METHODS All patients with bilateral ocular inflammatory disease presenting to any of 10 uveitis centers in the 3-month period between January 1 and March 31, 2006 (inclusive), were asked to participate. The clinical and historical features of disease were obtained from the participants via direct interview and chart review. Patients were stratified based on whether they were diagnosed with VKH disease or non-VKH uveitis for statistical analysis. MAIN OUTCOME MEASURES Presence or absence of various clinical features in the 2 populations. RESULTS Of 1147 patients, 180 were diagnosed with VKH disease and 967 with non-VKH uveitis. Hispanics and Asians were more likely to be diagnosed with VKH than non-VKH disease compared with other ethnicities. In acute disease, the finding of exudative retinal detachment was most likely to be found in VKH disease with a positive predictive value (PPV) of 100 and negative predictive value (NPV) of 88.4, whereas in chronic disease, sunset glow fundus was most likely to be found, with a PPV of 94.5 and NPV of 89.2. CONCLUSIONS Numerous clinical findings have been described in the past as important in the diagnosis of VKH. The current study reveals that of these, 2 are highly specific to this entity in an ethnically and geographically diverse group of patients with nontraumatic bilateral uveitis. These clinical findings are exudative retinal detachment during acute disease and sunset glow fundus during the chronic phase of the disease.
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Affiliation(s)
- Narsing A Rao
- Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine of University of Southern California, Los Angeles, California 90033, USA.
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Abad S, Monnet D, Caillat-Zucman S, Mrejen S, Blanche P, Chalumeau M, Mouthon L, Dhote R, Brézin AP. Characteristics of Vogt-Koyanagi-Harada Disease in a French Cohort: Ethnicity, Systemic Manifestations, and HLA Genotype Data. Ocul Immunol Inflamm 2009; 16:3-8. [DOI: 10.1080/09273940801923895] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kitamei H, Kitaichi N, Namba K, Kotake S, Goda C, Kitamura M, Miyazaki A, Ohno S. Clinical features of intraocular inflammation in Hokkaido, Japan. Acta Ophthalmol 2009; 87:424-8. [PMID: 18652578 DOI: 10.1111/j.1755-3768.2008.01282.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE We aimed to investigate the clinical features of intraocular inflammation/uveitis in Hokkaido, Japan. METHODS We retrospectively reviewed the medical records of 1240 uveitis patients (511 men, 729 women) who visited Hokkaido University Hospital, Sapporo, Japan between 1994 and 2003. RESULTS Mean age at disease onset was 41.7 +/- 17.8 years in men and 45.7 +/- 18.3 years in women. Anterior, posterior and combined anterior and posterior segment intraocular inflammation accounted for 45.1%, 4.7% and 50.2% of cases, respectively. Sarcoidosis was the most frequent aetiology (14.9%), followed by Vogt-Koyanagi-Harada (VKH) disease (9.7%) and Behçet's disease (6.7%). Aetiologies in 49.8% patients were unknown. In sarcoidosis, women represented 72.4% of patients, and disease onset occurred at 35.1 +/- 19.0 years of age in men and 50.3 +/- 16.5 years in women. In VKH disease, 54.2% of patients were women, and disease onset took place at 45.9 +/- 15.8 years in men and 46.4 +/- 14.1 years in women. In Behçet's disease, men accounted for 56.6% of patients, and disease onset occurred at 35.5 +/- 8.5 years in men and 44.5 +/- 11.5 years in women. CONCLUSIONS Women were more prone to developing sarcoidosis compared with men. By contrast, men were more prone to developing Behçet's disease. The mean age at disease onset in both sarcoidosis and Behçet's disease was significantly lower in men than in women.
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Affiliation(s)
- Hirokuni Kitamei
- Department of Ophthalmology and Visual Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Damico FM, Marin ML, Goldberg AC, Hirata CE, Takiuti PH, Olivalves E, Yamamoto JH. Revised diagnostic criteria for vogt-koyanagi-harada disease: considerations on the different disease categories. Am J Ophthalmol 2009; 147:339-345.e5. [PMID: 18992868 DOI: 10.1016/j.ajo.2008.08.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 08/21/2008] [Accepted: 08/22/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To evalulate the applicability of the Revised Diagnostic Criteria for Vogt-Koyanagi-Harada (VKH) disease to Brazilian patients and to verify the association between different disease categories, clinical parameters, and the presence of HLA-DRB1*0405. DESIGN A retrospective observational case series. METHODS Medical charts of 67 patients (10 to 64 years in age; 12 men and 55 women), from the Uveitis Service, Hospital das Clínicas, University of São Paulo School of Medicine (HCFMUSP), São Paulo, Brazil were reviewed. Patients, previously diagnosed with VKH disease using criteria proposed by the American Uveitis Society, underwent retrospective classification based on the Revised Diagnostic Criteria. The degree of concordance was assessed. At presentation, 46 patients (69%) were in the early phase. In this group, the mean time from disease onset to treatment was 15 days (range, one to 30 days). Forty-eight patients (72%) were typed for HLA-DRB1*0405 by polymerase chain reaction-sequence specific primer and polymerase chain reaction-sequence-specific oligonucleotides primer. Disease categories, phase at initial presentation, and ocular complications were analyzed. RESULTS There was a 100% of concordance between the two criteria. Disease was classified as complete in 10 patients (15%), incomplete in 37 patients (55%), and probable in 20 patients (30%). In each group, respectively, 90%, 76%, and 45% were in the early phase at presentation (P = .017). There was no association between disease categories, the presence of HLA-DRB1*0405, and clinical parameters. CONCLUSION The Revised Diagnostic Criteria proved useful for diagnosis of VKH disease in Brazilian patients. The present retrospective study did not find any association between disease category and severity parameters. To better understand the relevance of disease categories, a minimum follow-up period to categorize patients should be included in future prospective studies.
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Kitaichi N, Horie Y, Ohno S. Prompt therapy reduces the duration of systemic corticosteroids in Vogt-Koyanagi-Harada disease. Graefes Arch Clin Exp Ophthalmol 2008; 246:1641-2. [DOI: 10.1007/s00417-008-0869-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 05/03/2008] [Accepted: 05/11/2008] [Indexed: 10/21/2022] Open
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Arellanes García L, Carroll MO, Garza León MA. Vogt-Koyanagi-Harada syndrome in childhood. Int Ophthalmol Clin 2008; 48:107-117. [PMID: 18645404 DOI: 10.1097/iio.0b013e31817d9b70] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Lourdes Arellanes García
- Asociacion para Evitar la Ceguera en Mexico, Dr Luis Sanchez Bulnes, Vicente Garcia Torres 46, Col. San Lucas Coyoacan, CP 04030 Mexico DF, Mexico
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Cho JH, Ahn JY, Byeon SH, Huh JS. Thunderclap headache as initial manifestation of Vogt-Koyanagi-Harada disease. Headache 2007; 48:153-5. [PMID: 17868357 DOI: 10.1111/j.1526-4610.2007.00913.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 59-year-old Asian woman suffered from a TCH followed by sudden, binocular blurred vision, mimicking pituitary apoplexy. The diagnostic workup (including fluorescein angiography, MRI of the brain, and CSF analysis) showed severe optic disc swelling and dye leakage of multiple faint hyperfluorescent spots at retinal pigment epithelium level, diffuse pachymeningeal hypertrophy, and monocytic pleocytosis, respectively. VKH disease should be considered in the differential diagnosis of patients presenting with a TCH followed by sudden, bilateral decreased visual acuity.
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Affiliation(s)
- Jun Hyung Cho
- Brain Research Institute, Yonsei University College of Medicine--Department of Neurosurgery, Seoul, Korea
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Rao NA, Sukavatcharin S, Tsai JH. Vogt–Koyanagi–Harada disease diagnostic criteria. Int Ophthalmol 2007; 27:195-9. [PMID: 17384920 DOI: 10.1007/s10792-006-9021-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Accepted: 12/19/2006] [Indexed: 11/25/2022]
Abstract
Several different sets of criteria have been proposed to establish the diagnosis of Vogt-Koyanagi-Harada disease (VKH). Various investigators have used the criteria proposed by Sugiura, those proposed by by the American Uveitis Society as well as the revised diagnostic criteria proposed by the First VKH International Workshop group. These three sets of criteria share several clinical features that are considered to be essential for establishing the diagnosis of VKH, including bilateral uveitis, meningismus, and other extraocular changes. The detection of cerebrospinal fluid pleocytosis is considered to be an absolute in the criteria proposed by Sugiura but is not required for the diagnosis of VKH by the revised diagnostic criteria. We applied the latter diagnostic criteria to 28 well-documented patients with early phase VKH and to 88 patients examined during the late phase of VKH. All of these early and late phase patients fulfilled the criteria of the revised diagnostic criteria proposed by the workshop group, indicating 100% concurrence. However, none of the above proposed criteria were prospectively validated to show the positive and negative predictive value of the proposed criteria. Such a prospective study should be undertaken to address the validity of any one or all of the above sets of VKH diagnostic criteria.
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Affiliation(s)
- Narsing A Rao
- The USC Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, 1355 San Pablo Street, DVRC 211, Los Angeles, CA 90033, USA.
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Tsai JH, Sukavatcharin S, Rao NA. Utility of lumbar puncture in diagnosis of Vogt-Koyanagi-Harada disease. Int Ophthalmol 2007; 27:189-94. [PMID: 17340216 DOI: 10.1007/s10792-007-9044-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Accepted: 01/13/2007] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the significance of lumbar puncture in diagnosis of Vogt-Koyanagi-Harada disease (VKH). METHOD A retrospective analysis was conducted on 116 consecutive patients diagnosed with VKH. Two additional patients who presented with acute VKH were included in the analysis. Demographic characteristics, including gender, age, and ethnicity, were extracted from the medical record. The stage of disease at presentation was documented. Pertinent laboratory results and diagnostic procedures such as lumbar puncture, fluorescein angiography, and echography that contributed to the diagnosis of VKH were collected. RESULTS Lumbar puncture results for 10 patients were available. Eight of these patients presented with pleocytosis consistent with a diagnosis of VKH. Clinical features and fluorescein angiography confirmed the diagnosis in these patients. Both of the patients who did not exhibit cerebrospinal fluid (CSF) pleocytosis presented with headache, vision loss, and bilateral uveitis. Fluorescein angiography disclosed multiple foci of leakage at the retinal pigment epithelium level with accumulation of dye under the retina and disc leakage, confirming diagnosis of VKH. CONCLUSION The utility of lumbar puncture as a diagnostic criterion for VKH should be re-evaluated given that clinical features and fluorescein angiography alone often support the diagnosis. The inherent risks and complications associated with the procedure must prompt the clinician to reserve this evaluation for atypical presentations.
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Affiliation(s)
- Julie H Tsai
- Doheny Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, 1355 San Pablo Street DVRC211, Los Angeles, CA, USA
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Yamamoto Y, Fukushima A, Nishino K, Koura Y, Komatsu T, Ueno H. Vogt-Koyanagi-Harada Disease with Onset in Elderly Patients Aged 68 to 89 Years. Jpn J Ophthalmol 2007; 51:60-3. [PMID: 17295144 DOI: 10.1007/s10384-006-0379-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Accepted: 07/06/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND We present the clinical case reports of elderly Vogt-Koyanagi-Harada (VKH) disease patients, including the oldest patient at onset to date. CASES Four patients with VKH disease, whose ages at onset were 68 to 89 years, were treated at Kochi Medical School Hospital between December 2002 and September 2004. OBSERVATIONS Four elderly patients were diagnosed with VKH disease according to the International Revised Diagnostic Criteria for VKH disease. Two were treated with corticosteroid pulse therapy, but the other two could not tolerate high-dose steroid therapy and were treated with only topical corticosteroids. All had recurrences, which were treated effectively. None of these patients experienced recurrence after sunset glow fundus was observed in the follow-up period. CONCLUSIONS VKH disease is thought to be more common in younger people, but it is not as uncommon in elderly people as is generally believed. Among elderly VKH disease patients, some cannot tolerate high-dose corticosteroid therapy, so we need to treat these patients with only topical corticosteroids.
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Affiliation(s)
- Yumiko Yamamoto
- Department of Ophthalmology, Kochi Medical School, Kohasu, Nankoku, Japan.
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Kitaichi N, Matoba H, Ohno S. The positive role of lumbar puncture in the diagnosis of Vogt–Koyanagi–Harada disease: lymphocyte subsets in the aqueous humor and cerebrospinal fluid. Int Ophthalmol 2007; 27:97-103. [PMID: 17211585 DOI: 10.1007/s10792-006-9016-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 11/29/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE AND METHODS Activated T cells are believed to be important at the inflammatory sites in the pathogenesis of Vogt-Koyanagi-Harada disease. Patients are often affected by meningitis and uveitis. In this work, to examine the positive role of lumbar puncture in the diagnosis of VKH disease, we analyzed and compared the surface markers of aqueous humor cells, cerebrospinal fluid cells, and peripheral blood lymphocytes by use of flow cytometry. RESULTS Most lymphocytes were T cells. In aqueous humor and cerebrospinal fluid, numbers of CD3(+), CD4(+), and CD4(+)CD45RO(+) cells were significantly greater than in peripheral blood lymphocytes (P < 0.01). The CD4(+)/CD8(+) ratio for aqueous humor and cerebrospinal fluid was significantly higher than that for peripheral blood cells (P < 0.01). Four weeks after starting systemic corticosteroid treatment, numbers of CD4(+) and CD4(+)CD45RO(+) cells in cerebrospinal fluid were significantly lower than before treatment. CONCLUSIONS Profiles of surface markers were similar for cerebrospinal fluid and aqueous humor, but apparently different from that for peripheral blood cells. This suggests that cerebrospinal fluid may reflect the active local immunological reaction at sites affected by the disease, i.e. the uvea and the meninges.
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Affiliation(s)
- Nobuyoshi Kitaichi
- Department of Ophthalmology and Visual Sciences, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo 060-8638, Japan.
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Ondrey FG, Moldestad E, Mastroianni MA, Pikus A, Sklare D, Vernon E, Nusenblatt R, Smith J. Sensorineural Hearing Loss in Vogt-Koyanagi-Harada Syndrome. Laryngoscope 2006; 116:1873-6. [PMID: 17003710 DOI: 10.1097/01.mlg.0000234946.31603.fe] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vogt-Koyanagi-Harada (VKH) syndrome is a systemic condition characterized by ocular inflammatory disease as well as skin, ear, and meningeal manifestations. Patients with VKH often report tinnitus and hearing loss, but these symptoms tend to be given secondary consideration because most undergo treatment with steroids to prevent blindness resulting from granulomatous uveitis, exudative retinal detachment, and optic nerve inflammation. METHODS/STUDY DESIGN In the current retrospective review, 24 patients with this syndrome were screened for auditory system abnormalities. All patients denied history of noise exposure or ototoxic agent exposure. The age range of the patients was 13 to 42 years. RESULTS Three patients reported tinnitus and two patients reported sudden hearing loss. One patient experienced vertigo and aural fullness. Eight of 24 patients had pure-tone thresholds greater than 25 dB hearing loss at two or more frequencies. Five of 24 of these patients experienced hearing loss outside of the 95% confidence interval for published age-matched control populations. There was sloping sensorineural hearing loss at 4 kHz and above in five of 24 patients. All eight patients with hearing loss experienced some degree of hearing loss at 4 kHz or above. Three patients had mild to moderate low-frequency sensorineural hearing loss. There were no tympanometric abnormalities suggestive of conductive involvement. Abnormal acoustic reflex decay was observed in one patient. CONCLUSIONS We conclude that a significant number of patients with VKH experience sensorineural hearing loss and that every patient with VKH should undergo a review of systems for auditory abnormalities and referral for audiologic testing if symptomatic. It is possible that untreated patients may experience worse symptoms.
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Affiliation(s)
- Frank G Ondrey
- Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA.
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Tugal-Tutkun I, Ozyazgan Y, Akova YA, Sullu Y, Akyol N, Soylu M, Kazokoglu H. The spectrum of Vogt-Koyanagi-Harada disease in Turkey. Int Ophthalmol 2006; 27:117-23. [PMID: 16957877 DOI: 10.1007/s10792-006-9001-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Accepted: 06/08/2006] [Indexed: 10/24/2022]
Abstract
AIM The aim of this report was to provide a detailed description of the clinical features of Vogt-Koyanagi-Harada (VKH) disease in Turkish patients. METHODS We retrospectively analyzed 45 patients diagnosed with VKH disease at seven referral centers in Turkey. A standard data acquisition form was used for the analysis of demographic and clinical features. RESULTS The study cohort consisted of 45 patients (32 female, 13 male) who had a mean age at presentation of 31 years. Seven patients (15%) were aged 16 years or younger. Nineteen (42%) patients presented in the acute or subacute stage and 26 (58%) in the chronic stage. According to the revised diagnostic criteria, nine (20%) patients had the complete form of the disease, 23 (51%) had the incomplete form, and 13 (29%) had probable VKH disease. All patients had bilateral ocular involvement. Sunset-glow fundus was observed in 89% of the patients, pigment clumping in 73%, nummular depigmented scars in 71%, cataract in 53%, optic atrophy in 31%, glaucoma in 29%, subretinal fibrosis in 22%, choroidal neovascular membranes in 7%, and phthisis in 4%. All patients who presented at the acute uveitic stage received systemic corticosteroid therapy. Immunosuppressive treatment was employed in 30 (66%) patients, which was initiated at the acute uveitic stage in ten (22%) patients. Final visual acuity was better than 0.5 in 59% of the patients' eyes, between 0.1 and 0.5 in 21%, and less than 0.1 in 20%. CONCLUSIONS VKH disease is rare in Turkey. We conclude that the majority of patients with VKH in Turkey do not have the complete form of the disease. Based on our results, most patients with VKH seem to be late referrals. Ocular complications were common among these patients.
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Affiliation(s)
- Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Tsai JH, Evans M, Rao NA. Comparative study of two sets of criteria for the diagnosis of Vogt-Koyanagi-Harada disease. Am J Ophthalmol 2006; 141:778-9; author reply 779. [PMID: 16564834 DOI: 10.1016/j.ajo.2005.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Accepted: 12/01/2005] [Indexed: 11/25/2022]
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