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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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Noh H, Nam SW, Yoon JM, Ham DI. Choroidal venous overload in Vogt‒Koyanagi‒Harada disease. Eye (Lond) 2024:10.1038/s41433-024-03198-8. [PMID: 38951674 DOI: 10.1038/s41433-024-03198-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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Guo S, Hu R, Wang M, Xia L, Yang P. Dynamic Changes of Fundus and Predictors of Visual Prognosis in New-Onset Vogt-Koyanagi-Harada Disease. Ocul Immunol Inflamm 2024:1-9. [PMID: 38916535 DOI: 10.1080/09273948.2024.2369940] [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: 02/21/2024] [Accepted: 06/15/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE To characterize the dynamic changes of fundus in Vogt-Koyanagi-Harada (VKH) disease through enhanced spectral-domain optical coherence tomography (EDI-OCT) and explore the predictors of visual prognosis. METHODS In this retrospective cohort study, a total of 2152 VKH patients referred to our uveitis center from January 2013 to April 2022 were screened; 151 new-onset VKH patients (299 eyes) and 82 healthy controls (164 eyes) were included. The manifestations of fundus at baseline, 1 month, 3 months, and 12 months after treatment were analysed and their relevance to visual prognosis were evaluated. RESULTS After retinal detachment (RD) (97.3%) and optic disc swelling (100%) presented at baseline, retinal reattachment (81.6%) and the granular hyperreflective depositions at the retinal pigment epithelium (RPE) (61.5%) were observed at month 1. The RPE and ellipsoid zone rearrangement accompanying interdigitation zone attenuation (57.9%) was noted finally. Choroidal thickness of patients was higher than that in the controls at baseline and month 1 (both P < 0.001). Best-corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution [logMAR]) (P < 0.001; OR, 4.01), subretinal fibrinoid exudate (P < 0.001; OR, 3.9) and RPE folds (p = 0.001; OR, 2.39) at baseline, and the RD at month 1 (P < 0.001; OR, 3.42) were associated with visual prognosis. CONCLUSIONS New-onset VKH patients after treatment exhibited dynamic changes in the fundus especially the outer retina during a 12-month period. The BCVA, subretinal fibrinoid exudate, and RPE folds at baseline, and RD at month May 1, serve as predictors of visual prognosis.
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Affiliation(s)
- Suo Guo
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Rong Hu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Meiwen Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Lan Xia
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
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An G, Lei B, Wang Z, Yang K, Fan D, Li B, Fu K, Fang H, Zhang M, Li L, Zhao Y, Jin X, Du L. Multicenter and multimodal imaging study reveals rare fundus lesions in patients after SARS-CoV-2 infection. Sci Rep 2024; 14:14369. [PMID: 38909148 PMCID: PMC11193808 DOI: 10.1038/s41598-024-65216-9] [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: 03/02/2024] [Accepted: 06/18/2024] [Indexed: 06/24/2024] Open
Abstract
To define the characteristics of fundus manifestations in patients after SARS-CoV-2 infection with multimodal imaging techniques. This is a retrospective multicenter and multimodal imaging study including 90 patients. All patients with a visual complaint occurring immediately after SARS-CoV-2 infection were referred to six clinics between December 2022 and February 2023. Demographic information and the temporal relationship between SARS-CoV-2 infection and visual symptoms were documented. The characteristics of the fundus lesions were evaluated using multimodal imaging. Ninety patients from six hospitals were included in this study, including 24 males (26.67%) and 66 (73.33%) females. Seventy-eight patients (86.66%) (146 eyes) were diagnosed with Acute Macular Neuroretinopathy (AMN). The AMN patients were primarily young women (67.95%). Sixty-eight patients (87.18%) had AMN in both eyes. Thirty-eight eyes (24.36%) included Purtscher or Purtscher-like lesions. optical coherence tomography and infrared retinal photographs can show AMN lesions well. Eleven cases were diagnosed with simple Purtscher or Purtscher-like retinopathy (2 cases, 2.22%), Vogt‒Koyanagi‒Harada (VKH) syndrome or VKH-like uveitis (3 cases, 3.33%), multiple evanescent white-dot syndrome (MEWDS) (2 cases, 2.22%), and rhino-orbital-cerebral mucormycosis (ROCM) (5 cases, 5.56%). After SARS-CoV-2 infection, diversified fundus lesions were evident in patients with visual complaints. In this report, AMN was the dominant manifestation, followed by Purtscher or Purtscher-like retinopathy, MEWDS, VKH-like uveitis, and ROCM.
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Affiliation(s)
- Guangqi An
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Institute of Fundus Diseases, Zhengzhou University, Zhengzhou, Henan, China
| | - Bo Lei
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Eye institute, Henan Academy of Innovations in Medical Science, Zhengzhou, Henan, China
| | - Zhili Wang
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Kaizhuan Yang
- The Second People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Dongsheng Fan
- Department of Ophthalmology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan, China
| | - Bing Li
- Nanyang Municipal Eye Hospital, Nanyang, Henan, China
| | - Ke Fu
- Department of Ophthalmology, The First Affiliated Hospital of Nanyang Medical College, Nanyang, Henan, China
| | - Haixin Fang
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Min Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Institute of Fundus Diseases, Zhengzhou University, Zhengzhou, Henan, China
| | - Lin Li
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yu Zhao
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xuemin Jin
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
- Institute of Fundus Diseases, Zhengzhou University, Zhengzhou, Henan, China.
| | - Liping Du
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
- Institute of Fundus Diseases, Zhengzhou University, Zhengzhou, Henan, China.
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Feng H, Chen W, Yang J, Kong H, Li H, He Y, Wang H. Predictive factors and adalimumab efficacy in managing chronic recurrence Vogt-Koyanagi-Harada disease. BMC Ophthalmol 2024; 24:238. [PMID: 38849758 PMCID: PMC11157948 DOI: 10.1186/s12886-024-03511-9] [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: 01/21/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND This study explores prognostic factors influencing Vogt-Koyanagi-Harada (VKH) disease and observes the efficacy and safety of Adalimumab (ADA) in treating recurrence in Vogt-Koyanagi-Harada (VKH) patients. METHODS A retrospective study was conducted on all patients diagnosed with VKH disease at Beijing Tongren Hospital between 2020 and 2023. Clinical data included initial and final visual acuity, age, gender, ocular complications, treatment modalities, disease duration, and recurrence frequency. RESULTS A total of 62 VKH patients were included, comprising 34 in the acute-resolved group and 28 in the chronic-recurrent group. The mean age of patients in the acute-resolved group was 38.29 ± 15.46 years, while the mean age of chronic-recurrent group had a 49.00 ± 16.43 years. Initial best-corrected visual acuity (BCVA) examination at the first visit showed an average BCVA of 0.64 ± 0.29 logMAR in the acute-resolved group and 1.38 ± 0.54 logMAR in the chronic-recurrent group (p = 0.002). During follow-up, ocular complications were observed in 29.4% of the acute-resolved group patients and 41.7% of the chronic-recurrent group patients (P = 0.006). "Sunset glow fundus" was observed in 23.5% of the acute-resolved group and 64.3% of the chronic-recurrent group patients (P = 0.001). Poor initial BCVA (P = 0.046) and the occurrence of "sunset glow fundus" (P = 0.040) were significantly associated with progression to the chronic recurrent phase. Logistic regression analysis revealed that older age at onset (P = 0.042) and the occurrence of "sunset glow fundus" (P = 0.037) were significant predictors for progression to the chronic recurrent phase. ADA significantly reduced anterior chamber inflammatory cells (P = 0.000) and vitreous cavity inflammatory cells (P = 0.001) in the chronic-recurrent group, and markedly decreased the recurrence rate in VKH patients (P = 0.009). CONCLUSION In comparison to acute-resolved patients, chronic-recurrent patients exhibited poorer initial BCVA and a significantly increased incidence of "sunset glow fundus." Older age at onset and the occurrence of "sunset glow fundus" at diagnosis are crucial predictive factors for VKH patients progressing to the chronic recurrent phase. ADA effectively alleviates refractory VKH disease and is generally well-tolerated.
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Affiliation(s)
- Hui Feng
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Weixin Chen
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Jianzhu Yang
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Haorong Kong
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Hongyu Li
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Yuan He
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Hong Wang
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China.
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Jin K, Liang A, Song H, Xiao F, Gao F, Han X, Zhang M, Zhao C. A Novel Risk Stratification-Based Immunomodulatory Treatment Strategy for Vogt-Koyanagi-Harada Disease. Am J Ophthalmol 2024; 262:25-33. [PMID: 38369223 DOI: 10.1016/j.ajo.2024.01.035] [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: 12/09/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE To develop a more tailored immunomodulatory treatment (IMT) strategy based on a novel 2-arm risk stratification system in Vogt-Koyanagi-Harada (VKH) patients. DESIGN A retrospective clinical cohort study. METHODS Seventy-nine VKH patients in the acute stage were stratified into low- (n = 58) and high-risk (n = 21) groups based on their exposure to risk factors. They were treated with oral glucocorticoids (GCs) plus as-needed (PRN) or first-line IMT. Best corrected visual acuity (BCVA), sunset glow fundus (SGF) occurrence, relapse rate, and systemic adverse events were evaluated during follow-up. RESULTS Compared with the low-risk group, the high-risk group showed poorer BCVA at baseline (estimated difference 0.51, 95% CI 0.30-0.78; P < .001) and 6-month follow-up (estimated difference 0.08, 95% CI 0.00-0.08; P = .006), higher incidence of SGF at 12 months (52% vs 28%; RR 1.9, 95% CI 1.1-3.4; P = .040), and higher relapse rate at 6 months (24% vs 5%; RR 4.6, 95% CI 1.2-17.5; P = .028) and 12 months (52% vs 12%; RR 4.4, 95% CI 1.9-9.7; P < .001). In the low-risk cohort, no significant difference between the 2 IMT strategies was observed in primary outcomes. In the high-risk cohort, patients with the immediate IMT showed better BCVA (estimated difference -0.20, 95% CI -0.3 to -0.08; P = .007), lower incidence of SGF (27% vs 80%; RR 0.3, 95% CI 0.1-0.9; P = .030), and lower relapse rate (27% vs 80%; RR 0.3, 95% CI 0.1-0.9; P = .030) compared with the PRN regimen. Moreover, the immediate IMT regimen had a higher frequency of systemic adverse events than the PRN regimen (47% vs 7%; RR 7.1, 95% CI 2.5-20.4; P < .001). CONCLUSIONS High-risk stratification at baseline was associated with poor prognosis. The immediate IMT regimen was only beneficial for high-risk VKH patients regarding visual outcome, SGF, and relapse rate. This study suggests a potential need for a customized IMT strategy for VKH patients.
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Affiliation(s)
- Kehan Jin
- From the Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing
| | - Anyi Liang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University (A.L.), Guangzhou, China
| | - Hang Song
- From the Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing
| | - Feiyue Xiao
- From the Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing
| | - Fei Gao
- From the Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing
| | - Xiaoxu Han
- From the Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing
| | - Meifen Zhang
- From the Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing.
| | - Chan Zhao
- From the Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing.
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Dai L, Zhong Z, Wu Q, Gao Y, Lu X, Zhang F, Tang C, Wang Y, Zhou C, Yang P. Cost-Effectiveness Analysis of Adalimumab Versus Cyclosporine for Vogt-Koyanagi-Harada Disease: A Randomized Controlled Study. Curr Eye Res 2024:1-9. [PMID: 38783638 DOI: 10.1080/02713683.2024.2355659] [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: 01/19/2023] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To compare the 26-week cost-effectiveness of adalimumab-corticosteroids (ADA-CS) and cyclosporine-corticosteroids (CSA-CS) for Vogt-Koyanagi-Harada (VKH). METHODS A preplanned cost-effectiveness analysis based on the per-protocol population of a randomized-controlled trial. VKH subjects were randomized to receive either cyclosporine (100-200 mg daily) combined with corticosteroids or adalimumab (40 mg twice monthly) combined with corticosteroids. The primary outcome of this cost-effectiveness study was the incremental cost-effectiveness ratio (ICER). Costs and quality-adjusted life-years (QALYs) data were calculated by the medical records and health utility, respectively. Subgroup (early and late-phase VKH) analysis and sensitivity analyses were performed. RESULTS The ICER at 26 weeks was $62,425/QALY for the total participants. Compared to the CSA-CS group, costs in the ADA-CS group were more expensive (mean difference [ΔA-C]: $2,497) with more gains in QALYs (mean difference [ΔA-C]: 0.04). The probability of ADA-CS being cost-effective was 0.17 and 0.41 at willingness to pay (WTP) thresholds of $12,000/QALY and $36,000/QALY, respectively. Subgroup analysis and sensitivity analyses showed consistent findings with the primary analysis. CONCLUSIONS Regardless of early or late-phase VKH, the CSA-CS strategy may be recommended as the preferred initial choice for the majority of VKH.
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Affiliation(s)
- Lingyu Dai
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Zhenyu Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Qiuying Wu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Yu Gao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Xiaorong Lu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Fuxiang Zhang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Chong Tang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Yao Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Chunjiang Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
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8
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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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9
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Tugal-Tutkun I, Smit DP, Abu El-Asrar AM, Herbort CP, Thorne JE. Vogt-Koyanagi-Harada Disease. Ocul Immunol Inflamm 2024; 32:363-366. [PMID: 38657222 DOI: 10.1080/09273948.2024.2331401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Ilknur Tugal-Tutkun
- Eye Protection Foundation Bayrampasa Eye Hospital, Istanbul, Turkey
- The Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Derrick P Smit
- The Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - 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
| | - Carl P Herbort
- Inflammatory and Retinal Eye Diseases, Centre for Ophthalmic Specialised Care, Lausanne, Switzerland
| | - Jennifer E Thorne
- The Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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10
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Khairallah M, Khochtali S, Abroug N, Ksiaa I. Letter to the Editor: Comment on Fauquier A. et al. "Impact of Initial Management on Disease Evolution in Vogt-Koyanagi-Harada Syndrome: A Retrospective Cohort of 50 Patients". Ocul Immunol Inflamm 2024; 32:440-441. [PMID: 37369106 DOI: 10.1080/09273948.2023.2227259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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11
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Driban M, Yan A, Selvam A, Ong J, Vupparaboina KK, Chhablani J. Artificial intelligence in chorioretinal pathology through fundoscopy: a comprehensive review. Int J Retina Vitreous 2024; 10:36. [PMID: 38654344 PMCID: PMC11036694 DOI: 10.1186/s40942-024-00554-4] [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: 03/04/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Applications for artificial intelligence (AI) in ophthalmology are continually evolving. Fundoscopy is one of the oldest ocular imaging techniques but remains a mainstay in posterior segment imaging due to its prevalence, ease of use, and ongoing technological advancement. AI has been leveraged for fundoscopy to accomplish core tasks including segmentation, classification, and prediction. MAIN BODY In this article we provide a review of AI in fundoscopy applied to representative chorioretinal pathologies, including diabetic retinopathy and age-related macular degeneration, among others. We conclude with a discussion of future directions and current limitations. SHORT CONCLUSION As AI evolves, it will become increasingly essential for the modern ophthalmologist to understand its applications and limitations to improve patient outcomes and continue to innovate.
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Affiliation(s)
- Matthew Driban
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Audrey Yan
- Department of Medicine, West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA
| | - Amrish Selvam
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, USA
| | | | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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12
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Yargi-Ozkocak B, Altan C, Kemer-Atik B, Basarir B, Taskapili M. Blood Whispers: Exploring Hematologic Indicators for Diagnosing and Predicting Severity of Vogt-Koyanagi-Harada Syndrome. Ocul Immunol Inflamm 2024:1-9. [PMID: 38592364 DOI: 10.1080/09273948.2024.2334793] [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: 12/08/2023] [Accepted: 03/21/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE To investigate the association of clinical findings and indocyanine green angiography (ICGA) score with inflammatory markers derived from complete blood count (CBC) parameters in patients with Vogt-Koyanagi-Harada (VKH) to determine the diagnostic and predictive role. METHODS Demographic characteristics, presenting complaints, ocular findings, optical coherence tomography findings, ICGA scores and best corrected visual acuity were recorded in treatment-naive VKH patients at presentation. Patients were divided into two groups as acute stage and chronic recurrent stage. CBC parameters were noted in patients at presentation and healthy controls (HC, n = 25). Neutrophil-lymphocyte-platelet-monocyte counts, neutrophil/lymphocyte (NLR), platelet/lymphocyte (PLR), monocyte/lymphocyte and systemic immune-inflammation index (SII) were recorded. The association between these markers and clinical severity were evaluated. RESULTS Thirty-two patients with VKH (23 females/9 males) with a mean age of 34.1 ± 14.6 years were included in the study. There was an increase in neutrophil count, NLR and SII in patients with VKH compared to HC (p < 0.001). The cut-off values for these three parameters were 4.37, 2.24 and 562.35, respectively. Twenty-six patients presented in the acute stage and six patients presented in the chronic recurrent stage. Choroidal thickness, early stromal hyperfluorescence and total ICGA scores were higher in patients presenting in the acute stage (p < 0.001, 0.001 and 0.025, respectively). Patients with higher disease severity at presentation were treated earlier. Early stromal vessel hyperfluorescence and choroidal vasculitis scores were correlated with decreased lymphocyte count, increased NLR, PLR and SII (p < 0.05). CONCLUSION CBC-derived inflammatory parameters indicate that VKH is a systemic inflammation. These parameters can be used in the diagnosis and determination of disease severity of VKH.
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Affiliation(s)
- Berru Yargi-Ozkocak
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Cigdem Altan
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Burcu Kemer-Atik
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Berna Basarir
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Muhittin Taskapili
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
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13
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Xu J, Agranat JS, Chen X. UNILATERAL ANNULAR CHOROIDAL EFFUSIONS AS A RARE PRESENTATION OF HARADA DISEASE. Retin Cases Brief Rep 2024; 18:263-268. [PMID: 36730813 DOI: 10.1097/icb.0000000000001366] [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: 02/03/2022] [Accepted: 10/25/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To report a rare case of Harada disease that initially presented as a unilateral ring of choroidal effusions. METHODS Retrospective chart review. RESULTS A 42-year-old Trinidadian woman presented with a serous retinal detachment overlying a unilateral ring of choroidal effusions in the absence of any systemic symptoms. Visual acuity was hand motion with a relative afferent pupillary defect. Biometry revealed an axial length of 21.12 mm and a thickened sclerochoroidal complex. Fluorescein angiography did not demonstrate pinpoint leakage or subretinal pooling classically seen in Harada disease. Oral steroids improved the visual acuity to 20/50, and laboratory testing and head imaging returned nonrevealing. After 2 months of incomplete steroidal treatment due to nonadherence, the patient represented with bilateral decreased visual acuity, anterior uveitis, serous detachments, and diffuse pinpoint leakage on fluorescein angiography consistent with the early stage of Harada disease. CONCLUSION This is a case of a unilateral presentation of Harada disease with an impressive ring of choroidal effusions before developing a classic bilateral appearance. Possible contributions to the initial presentation include choroidal venous congestion in the setting of a borderline short eye and thickened sclerochoroidal complex.
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Affiliation(s)
- Jia Xu
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts; and
| | - Joshua S Agranat
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts; and
| | - Xuejing Chen
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts; and
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
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14
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Fernández-Navarro J, García-García J, Gregorio García-García J, Segura T. Ultrasonographic study of the orbit as an early diagnostic tool in Vogt Koyanagi Harada disease (VKH): A case report. Heliyon 2024; 10:e26196. [PMID: 38379990 PMCID: PMC10877363 DOI: 10.1016/j.heliyon.2024.e26196] [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: 08/23/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
In recent years, ultrasound has demonstrated its usefulness in the approach to vascular structures and other tissues such as the orbit, facilitating the early diagnosis of various diseases without having to rely on other more invasive or less available tests. In Vogt Koyanagi Harada syndrome, characterised by bilateral acute uveitis, ocular ultrasound is a clear example of the usefulness of ultrasonography in early diagnosis, facilitating the initiation of specific treatment to change the ominous natural history of this disease. This case shows the usefulness of the echography to make the differential diagnosis with other diseases that clinical onset could be similar than VKH, but with a different diagnostic and therapeutic approach.
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Affiliation(s)
- José Fernández-Navarro
- Department of Neurology, Puerta del Mar Universitary Hospital, av/Ana de Viya 21, 11009 Cádiz, Spain
| | - Jorge García-García
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, c/Hermanos Falco 37, 02006 Albacete, Spain
| | - José Gregorio García-García
- Department of Ophthalmology, Complejo Hospitalario Universitario de Albacete, c/Hermanos Falco 37, 02006 Albacete, Spain
| | - Tomás Segura
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, c/Hermanos Falco 37, 02006 Albacete, Spain
- Instituto de Investigación en Discapacidades Neurológicas (IDINE), Facultad de Medicina, Universidad de Castilla-La Mancha, 02008 Albacete, Spain
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15
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Duran M, Shieh D, Choi P, He YG, Ufret-Vincenty RL. Atypical Central Serous Chorioretinopathy Masquerading as Vogt-Koyanagi-Harada Disease: A Case Report. Case Rep Ophthalmol 2024; 15:448-457. [PMID: 39015236 PMCID: PMC11250661 DOI: 10.1159/000538736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/31/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction We aimed to describe a clinical presentation of central serous retinopathy that poses a diagnostic and management dilemma. Case Presentation A 30-year-old male patient presented with bilateral vision loss and multifocal serous retinal detachments involving the posterior pole of both eyes. Optical coherence tomography revealed prominent bilateral bacillary layer detachments. The patient complained of recent headaches and tinnitus. However, the clinical exam did not reveal overt inflammation and the patient admitted to being under significant stress. The clinical presentation raised concerns for both central serous retinopathy (CSR) and Vogt-Koyanagi-Harada (VKH). Additional findings, including white fundus spots and focal areas of retinal vascular leakage, were seen in our patient. We highlight these because, while they have been described in CSR, they are not commonly discussed and could add to the diagnostic dilemma. After a conservative approach that avoided steroids, our patient showed marked improvement over the following month, supporting a diagnosis of CSR. Conclusion CSR can mimic VKH disease. A high level of suspicion is needed to avoid instituting steroid therapy that could induce a severe iatrogenic exacerbation of the disease.
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Affiliation(s)
- Munevver Duran
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, USA
| | - David Shieh
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Preston Choi
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Yu-Guang He
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, USA
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16
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Lidder AK, Choi S, Modi YS, Brodie SE, Davis JL, Gregori NZ, Lam BL. Bilateral exudative retinal detachments after subretinal gene therapy with voretigene neparvovec-rzyl for RPE65 Leber Congenital Amaurosis. Am J Ophthalmol Case Rep 2023; 32:101879. [PMID: 37521805 PMCID: PMC10373644 DOI: 10.1016/j.ajoc.2023.101879] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To report panuveitis with exudative retinal detachments in a healthy 27-year-old woman with biallelic mutations in the RPE65 gene, who underwent bilateral sequential gene therapy with subretinal administration of voretigene neparvovec-rzyl. Observations Visual acuity improved for 30 days after surgery as oral corticosteroids were tapered. At postoperative week 6, vision declined due to sudden onset uveitis and exudative retinal detachments in both eyes. HLA Class II typing revealed the haplotype associated with sympathetic ophthalmia and Vogt-Koyanagi-Harada (VKH). The inflammation improved after corticosteroid, mycophenolate mofetil, and adalimumab therapy while vision remained poor. Conclusions and Importance Surgically-induced sympathetic ophthalmia is a plausible explanation for the clinical findings; surgery of both eyes within one week would conceal the inciting eye. VKH or inflammation related to the gene therapy are other possible etiologies but severe bilateral panuveitis has not been reported with voretigene neparvovec-rzyl. Informed consent for gene therapy surgery should include a discussion of the rare complication of sympathetic ophthalmia following vitrectomy surgery.
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Affiliation(s)
- Alcina K. Lidder
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Stephanie Choi
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY, United States
| | - Yasha S. Modi
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY, United States
| | - Scott E. Brodie
- Harkness Eye Institute, Columbia University, New York, NY, United States
| | - Janet L. Davis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ninel Z. Gregori
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Byron L. Lam
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
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Sada I, Harada Y, Hiyama T, Mizukami M, Kan T, Kawai M, Kiuchi Y. Uveitis associated with immune checkpoint inhibitors or BRAF/MEK inhibitors in patients with malignant melanoma. Melanoma Res 2023; 33:539-546. [PMID: 37788106 DOI: 10.1097/cmr.0000000000000933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
The objective of this study was to evaluate the frequency and characteristics of uveitis associated with immune checkpoint inhibitors (ICIs) or BRAF/MEK inhibitors (B/MIs) in patients with malignant melanoma. Patients diagnosed with malignant melanoma who underwent radical or local resection for malignant melanoma, regardless of clinical stage or postoperative adjuvant therapy, at Hiroshima University Hospital from January 2015 to June 2021 were enrolled in a retrospective cohort. The medical records of patients were collected to estimate the prevalence of ocular adverse events. The clinical characteristics of patients who developed uveitis were reviewed. Among 152 patients, 54 and 12 were treated with ICIs and B/MIs, respectively. Four patients developed uveitis; 1 in the ICI group and 3 in the B/MI group, while there were no uveitis cases among patients who did not receive ICIs or B/MIs. Three patients had Vogt-Koyanagi-Harada disease-like findings. Uveitis was improved by steroid therapy with or without oncological treatment interruption. Oncological treatment could be resumed. Patients with melanoma treated with ICIs or B/MIs had a higher risk of uveitis compared with those who did not receive them. Oncological treatment could be resumed in all patients who developed uveitis.
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Affiliation(s)
- Ikuyo Sada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University
| | - Tomona Hiyama
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University
| | - Mina Mizukami
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University
| | - Takanobu Kan
- Department of Dermatology, Graduate School of Biomedical Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Mikio Kawai
- Department of Dermatology, Graduate School of Biomedical Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University
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18
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Li L, Yuan L, Zhou X, Hua X, Yuan X. Bibliometric analysis of the Vogt‒Koyanagi‒Harada disease literature. Int Ophthalmol 2023; 43:4137-4150. [PMID: 37552428 PMCID: PMC10520158 DOI: 10.1007/s10792-023-02815-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/17/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE As an autoimmune disease, Vogt‒Koyanagi‒Harada disease (VKHD) is a main type of uveitis in many countries and regions, significantly impacting patient vision. At present, information regarding VKHD is still limited, and further research is needed. We conducted a bibliometric analysis to characterize the overall status, current trends, and current focus of VKHD research. METHOD Literature published from 1975 to 2022 was obtained from the Web of Science core collection and analysed with the R-language packages Bibliometrix, VOSviewer, and CiteSpace software. RESULTS A total of 1050 papers on VKHD were retrieved from 261 journals, and 16,084 references were obtained from the papers in the original search. The average annual number of published articles was approximately 21.9, and the number of publications rapidly increased after 2004. The journal Ocular Immunology and Inflammation published the most papers on VKHD, while the American Journal of Ophthalmology has the highest citation frequency. The leading countries were Japan, China (PRC), and the United States of America (USA). Yang PZ from Chongqing Medical University was the most prolific and cited author. The most frequently cited study discussed revision of VKHD diagnostic criteria. An analysis of the highest frequency keywords showed that most research focused on the treatment, diagnosis, and pathogenesis of VKHD and its relationship with other related diseases. At present, the most urgent research direction is in the relationship between COVID-19 or COVID-19 vaccines and VKHD and the corresponding mechanisms underlying it. CONCLUSION Utilizing dynamic and visualization tools, bibliometrics provides a clear depiction of the research history, development trends, and research hotspots in VKHD It serves as a valuable tool for identifying research gaps and areas that necessitate further exploration. Our study revealed potential directions for future VKHD research, including investigating specific molecular mechanisms underlying the disease, exploring the clinical utility of optical coherence tomography angiography and other diagnostic techniques, and conducting clinical research on novel therapeutic drugs.
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Affiliation(s)
- Liangpin Li
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, China
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, 300020, China
| | - Liyun Yuan
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, 300020, China
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Xueyan Zhou
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, 300020, China
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Xia Hua
- Tianjin Aier Eye Hospital, Tianjin University, Tianjin, 300190, China.
| | - Xiaoyong Yuan
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, China.
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, 300020, China.
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Lucchini S, Govetto A, Carini E, Casalino G, Donati S, Radice P. Presumed sympathetic ophthalmia following scleral buckling surgery: A case report and review of the literature. Eur J Ophthalmol 2023; 33:NP53-NP57. [PMID: 36517983 DOI: 10.1177/11206721221145212] [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: 10/22/2023]
Abstract
PURPOSE To report a case of presumed sympathetic ophthalmia (SO) following scleral buckling (SB) surgery and to discuss the possible pathogenesis of this condition by reviewing the current evidence on this subject. METHODS Case report and narrative review of the literature; our case was imaged with spectral-domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA), fundus autofluorescence (FAF), fluorescein angiography (FFA) and indocyanine green angiography (ICGA). RESULTS A 55-year-old man presented with a macula on rhegmatogenous retinal detachment which was treated with 360° SB surgery, subretinal fluid drain (SRFD), cryopexy and pneumoretinopexy. Due to failure of the primary surgery, a second procedure was performed the day after with the explant of the prior buckle and the implant of a wider circumferential element. At three months from surgery, the patient complained of severe bilateral vision loss. Multimodal imaging revealed bilateral, multi-focal exudative retinal detachments and choroidal swelling. A diagnosis of presumed SO was made and the patient was treated with a combination of steroid and immunosuppressive drugs. The clinical picture completely resolved at postoperative month 12. CONCLUSION SO may be a rare complication of SB surgery. In our case, early recognition and prompt immunosuppressive treatment achieved good long-term clinical results.
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Affiliation(s)
- Sara Lucchini
- Ophthalmology Department, Circolo and Fondazione Macchi Hospital, ASST Sette Laghi, Varese, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Andrea Govetto
- Ophthalmology Department, Circolo and Fondazione Macchi Hospital, ASST Sette Laghi, Varese, Italy
| | - Elisa Carini
- Ophthalmology Department, Circolo and Fondazione Macchi Hospital, ASST Sette Laghi, Varese, Italy
| | - Giuseppe Casalino
- Eye Clinic, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Simone Donati
- Ophthalmology Department, Circolo and Fondazione Macchi Hospital, ASST Sette Laghi, Varese, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paolo Radice
- Ophthalmology Department, Circolo and Fondazione Macchi Hospital, ASST Sette Laghi, Varese, Italy
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20
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Ng SMS, Low R, Pak C, Lai S, Lee B, McCluskey P, Symes R, Invernizzi A, Tsui E, Sitaula RK, Kharel M, Khatri A, Utami AN, La Distia Nora R, Putera I, Sen A, Agarwal M, Mahendradas P, Biswas J, Pavesio C, Cimino L, Sobrin L, Kempen JH, Gupta V, Agrawal R. The role of a multicentre data repository in ocular inflammation: The Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS). Eye (Lond) 2023; 37:3084-3096. [PMID: 36918629 PMCID: PMC10564879 DOI: 10.1038/s41433-023-02472-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 01/19/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
In the current literature, clinical registry cohorts related to ocular inflammation are few and far between, and there are none involving multi-continental international data. Many existing registries comprise administrative databases, data related to specific uveitic diseases, or are designed to address a particular clinical problem. The existing data, although useful and serving their intended purposes, are segmented and may not be sufficiently robust to design prognostication tools or draw epidemiological conclusions in the field of uveitis and ocular inflammation. To solve this, we have developed the Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) Clinical Registry. OASIS collects prospective and retrospective data on patients with all types of ocular inflammatory conditions from centers all around the world. It is a primarily web-based platform with alternative offline modes of access. A comprehensive set of clinical data ranging from demographics, past medical history, clinical presentation, working diagnosis to visual outcomes are collected over a range of time points. Additionally, clinical images such as optical coherence tomography, fundus fluorescein angiography and indocyanine green angiography studies may be uploaded. Through the capturing of diverse, well-structured, and clinically meaningful data in a simplified and consistent fashion, OASIS will deliver a comprehensive and well organized data set ripe for data analysis. The applications of the registry are numerous, and include performing epidemiological analysis, monitoring drug side effects, and studying treatment safety efficacy. Furthermore, the data compiled in OASIS will be used to develop new classification and diagnostic systems, as well as treatment and prognostication guidelines for uveitis.
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Affiliation(s)
- Sean Ming Sheng Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Rebecca Low
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Clara Pak
- University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - SerSei Lai
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Bernett Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Peter McCluskey
- Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Richard Symes
- Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Alessandro Invernizzi
- Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Edmund Tsui
- Stein Eye Institute, David Geffen of Medicine at UCLA, Los Angeles, CA, USA
| | - Ranju Kharel Sitaula
- Department of Ophthalmology, B. P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Muna Kharel
- Nepal Army Institute of Health Sciences, Kathmandu, Nepal
| | | | | | | | | | - Alok Sen
- Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Manisha Agarwal
- Department of Ophthalmology, Dr Shroff's Charity Eye Hospital Daryaganj, New Delhi, India
| | | | | | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Luca Cimino
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, University of Modena and Reggio Emilia, Modena, Italy
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, 42121, Reggio Emilia, Italy
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, MA, USA
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, MA, USA
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia
- Department of Ophthalmology, Addis Ababa University Faculty of Medicine, Addis Ababa, Ethiopia
- Sight for Souls, Fort Myers, FL, USA
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK.
- Singapore Eye Research Institute, The Academia, Singapore, Singapore.
- Department of Ophthalmology and Visual Sciences, Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
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21
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Kaya P, İnanç Tekin M, Özdal PÇ. Predictive Factors for the Prognosis of Vogt-Koyanagi-Harada Disease. Ocul Immunol Inflamm 2023; 31:1687-1693. [PMID: 36628436 DOI: 10.1080/09273948.2022.2159841] [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: 08/20/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE To identify the prognostic factors in Vogt-Koyanagi-Harada (VKH) disease. METHODS This study included 23 patients (46 eyes) with acute-phase VKHdivided into two subgroups: Group 1; acute-resolved (10 patients), group 2; chronic-recurrent (13 patients). RESULTS Mean age were 29.5 ± 10.2 years in group 1, 35.8 ± 12.2 years group 2 (p = .033). Best-corrected visual acuity with logMAR at admission was 0.91 ± 0.65 in group 1, 0.88 ± 0.62 in group 2 (p = .798), and improved to 0.08 ± 0.24, 0.18 ± 0.6, respectively (p = .557). Extraocular findings were detected in 30% in group 1, and 53.8% in group 2 at the time of admission (p = .108). All patients were treated with 1 g/day 3-5 days intravenous steroid, and 10 patients had immunomodulatory treatment. Initiation of immunomodulatory therapy did not affect the prognosis (p = .676). CONCLUSION Older patients and/or who developed extraocular findings at the presentation were more prone to show recurrences.
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Affiliation(s)
- Pınar Kaya
- Department of Opthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Merve İnanç Tekin
- Department of Opthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Pınar Çakar Özdal
- Department of Opthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
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22
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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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23
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Jabs DA, Thorne JE, Wilkins CS, Habbu KA, Berkenstock MK, Burkholder BM, Chaon BC, Deobhakta A. TACROLIMUS FOR IMMUNOSUPPRESSION IN PATIENTS WITH NONINFECTIOUS INTERMEDIATE, POSTERIOR, OR PANUVEITIDES. Retina 2023; 43:1480-1486. [PMID: 37184495 DOI: 10.1097/iae.0000000000003836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE To evaluate the effectiveness of tacrolimus in patients with noninfectious intermediate, posterior, or panuveitis needing a two-immunosuppressive-agent regimen. METHODS Design: Retrospective cohort study. Setting: Two tertiary-care uveitis practices at academic medical centers. Patient population: Thirty-two patients with noninfectious intermediate, posterior, or panuveitides in whom single-agent immunosuppression was inadequate to effect successful corticosteroid sparing. Intervention: tacrolimus, added as the second immunosuppressive agent. Main outcome measure: successful corticosteroid sparing, defined as inactive uveitis at a dose of prednisone ≤7.5 mg/day. RESULTS Active uveitis was present in 65.6% of patients at initiation of tacrolimus, and the median time to inactive uveitis was 1.5 months (95% confidence interval 1.2, 4.08). The median time to successful corticosteroid sparing was 3.9 months (95% confidence interval 1.41, 6.67), and by 6 months of follow-up successful corticosteroid sparing was achieved in 75% of patients. Tacrolimus was discontinued for side effects in five patients, three for tremor, and two for hyperglycemia. All side effects were reversible with tacrolimus discontinuation. CONCLUSION Tacrolimus seems to have efficacy as a second immunosuppressive agent in two-immunosuppressive drug regimens, when a single agent does not permit successful corticosteroid sparing. Side effects were reversible with tacrolimus discontinuation.
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Affiliation(s)
- Douglas A Jabs
- Department of Epidemiology, the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Ophthalmology, the Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Jennifer E Thorne
- Department of Epidemiology, the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Ophthalmology, the Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Carl S Wilkins
- Department of Ophthalmology, the Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore, Maryland; and
- Department of Ophthalmology, the New York Eye and Ear Infirmary of Mount Sinai, the Icahn School of Medicine at Mount Sinai, New York, New York
| | - Karishma A Habbu
- Department of Ophthalmology, the Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Meghan K Berkenstock
- Department of Ophthalmology, the Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Bryn M Burkholder
- Department of Ophthalmology, the Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Benjamin C Chaon
- Department of Ophthalmology, the Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Avnish Deobhakta
- Department of Ophthalmology, the New York Eye and Ear Infirmary of Mount Sinai, the Icahn School of Medicine at Mount Sinai, New York, New York
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24
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Hosseini SM, Gharouni A, Motamed Shariati M. Vogt-Koyanagi-Harada disease with a unilateral presentation in a patient with marijuana overuse: Role of multimodal imaging in suspected patients. Clin Case Rep 2023; 11:e7879. [PMID: 37675413 PMCID: PMC10477722 DOI: 10.1002/ccr3.7879] [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: 06/22/2023] [Revised: 07/20/2023] [Accepted: 08/26/2023] [Indexed: 09/08/2023] Open
Abstract
Key Clinical Message Harada disease could uniquely present with only unilateral symptoms, as was seen in our patient. However, multimodal imaging including ICG angiography could show bilateral involvement. Considering the immunomodulatory effects of Cannabis, the absence of inflammatory findings and the unusual presentation of the disease, in our case, may have been caused by the use of marijuana. Abstract To report a patient addicted to marijuana with the diagnosis of Vogt-Koyanagi-Harada (VKH) disease with a unilateral presentation. A 24-year-old man presented to us with painless decreased vision in his right eye (RE) and photophobia 3 days ago. No history of significant family or past medical history was documented. Spectral-domain optical coherence tomography (SD-OCT) of the RE showed multiple areas of subretinal fluid in the macula. Indocyanine green angiography (ICGA) revealed round hypocyanescent dark dots (HDD) of similar size, evenly distributed in both eyes. With the diagnosis of VKH disease, anti-inflammatory treatment was started. To our knowledge, this is the first reported case of suspected VKH in a patient with marijuana overuse. Regarding the complex effects of tetrahydrocannabinol (THC), the active ingredient of marijuana, on the vascular and immune systems, reaching a definite conclusion is not possible. This report shows the value of multimodal imaging in patients with unusual presentations.
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Affiliation(s)
| | - Ahmad Gharouni
- Eye Research Center, Mashhad University of Medical SciencesMashhadIran
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25
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Yoshitomi S, Harada Y, Hiyama T, Yuasa Y, Hirooka K, Kiuchi Y. Incidence and pre/post-treatment risk factors of glaucoma in Vogt-Koyanagi-Harada disease. Int Ophthalmol 2023; 43:2857-2866. [PMID: 36929369 DOI: 10.1007/s10792-023-02688-0] [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: 07/05/2022] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE To investigate the incidence and pre/post-treatment risk factors of glaucoma in patients with Vogt-Koyanagi-Harada (VKH) disease. METHODS Data regarding secondary glaucoma were collected from the medical records of patients with VKH disease who were followed up at the uveitis service at Hiroshima University for more than 6 months. We examined the incidence of glaucoma and pre/post-treatment risk factors for glaucoma in patients with VKH disease. RESULTS Forty-nine patients with VKH disease were included in this study (31 women and 18 men). The mean age at onset was 50.4 ± 15.4 years and the mean length of follow-up was 40.7 ± 25.5 months. The most common initial treatment was pulse intravenous corticosteroid therapy (89.8%). Fifteen patients developed secondary glaucoma during follow-up. The median time of glaucoma onset from VKH development was 4.5 months (range 0-44 months). Disc swelling type as a pre-treatment factor (p = 0.089, hazard ratio = 7.268), worse final best corrected visual acuity (p = 0.099, odds ratio = 1.545), and cataract progression (p = 0.076, odds ratio = 7.886) as post-treatment factors showed trends for glaucoma development. The patients who progressed to the chronic recurrent stage had more complications including glaucoma. CONCLUSION Secondary glaucoma occurred in more than 30% of patients with VKH disease. The factors that showed a trend toward glaucoma development may reflect an association with delayed treatment initiation and prolonged ocular inflammation.
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Affiliation(s)
- Suzu Yoshitomi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan.
| | - Tomona Hiyama
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Yuki Yuasa
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
- Department of Ophthalmology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Kazuyuki Hirooka
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
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Hirota Y, Muraoka Y, Kogo T, Ishikura M, Kadomoto S, Nishigori N, Ishihara K, Morooka S, Uji A, Tsujikawa A. Association of Retinal Pigment Epithelium Reflectivity on Optical Coherence Tomography with Recurrence of Vogt-Koyanagi-Harada Disease: A Retrospective Observational Study. Clin Ophthalmol 2023; 17:2071-2079. [PMID: 37496848 PMCID: PMC10368137 DOI: 10.2147/opth.s419546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/16/2023] [Indexed: 07/28/2023] Open
Abstract
Purpose Despite the necessity of optical coherence tomography (OCT) for diagnosis and longitudinal monitoring in patients with Vogt-Koyanagi-Harada (VKH) disease, no studies have identified useful OCT markers for predicting recurrence in these patients. Although the precise reason for this remains unclear, one possibility is that infiltration of inflammatory cells into the choroid attenuates the OCT signal, making it difficult to precisely assess the structure of the choroid. Therefore, this study aimed to investigate changes in retinal pigment epithelium (RPE) reflectivity immediately above the choroid in eyes with acute VKH disease, as well as the association between RPE reflectivity and VKH disease recurrence. Patients and Methods This single-centered retrospective observational study included 20 treatment-naïve patients with acute VKH disease presenting with serous retinal detachment (SRD) in the posterior pole at the initial visit between October 2015 and January 2020, as well as 15 healthy control eyes. All patients were followed up for at least 6 months and received treatment with intravenous methylprednisolone followed by oral administration of prednisolone. Swept-source OCT images through the fovea were used to measure central retinal thickness, central choroidal thickness, and RPE reflectivity. Results During an observation period of 37.2 ± 30.8 months, recurrence of inflammation was observed in 11 patients (55.0%). Initial visual acuity was worse in patients who developed recurrence than in those who did not (P=0.024). On initial OCT images, RPE reflectivity differed significantly between patients with and without recurrence (1.75 ± 0.42 vs 1.35 ± 0.20; P=0.018), while there were no significant differences in other chorioretinal parameters, such as central retinal thickness and choroidal thickness. Conclusion RPE reflectivity on OCT images may be useful for predicting the recurrence of inflammation in patients with VKH disease.
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Affiliation(s)
- Yoshimichi Hirota
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takahiro Kogo
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaharu Ishikura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shin Kadomoto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naomi Nishigori
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Ishihara
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoshi Morooka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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27
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Choo CH, Acharya NR, Shantha JG. Common practice patterns in the diagnosis and management of Vogt-Koyanagi-Harada syndrome: a survey study of uveitis specialists. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1217711. [PMID: 38983079 PMCID: PMC11182250 DOI: 10.3389/fopht.2023.1217711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/09/2023] [Indexed: 07/11/2024]
Abstract
Introduction Vogt-Koyanagi-Harada (VKH) syndrome is an inflammatory condition characterized by bilateral, granulomatous panuveitis with or without systemic manifestations, and accounts for up to 18% of referrals for panuveitis at tertiary centers in the United States of America. Despite ongoing research, there is limited evidence and no clear consensus on how to diagnose and treat patients with VKH, leading to variations in practice patterns among uveitis specialists. Methods An anonymous, online survey was distributed to uveitis specialists in the American Uveitis Society (AUS). The survey included 21 questions that asked for non-identifiable demographics and covered topics such as preferred imaging modalities, treatment for the first episode of VKH, and perceived efficacy of immunomodulatory therapy (IMT). Results A total of 104 surveys were included for analysis, representing a 38.4% response rate from the AUS listserv. A majority of respondents were uveitis fellowship trained and practiced in North America in an academic setting. Fluorescein angiography and enhanced depth imaging with optical coherence tomography were rated as the most consistently useful methods for the diagnosis of VKH. For treatment of acute initial-onset VKH, responses were divided between a preference for high-dose systemic corticosteroids with IMT (61.5%) and without IMT (37.5%). Methotrexate and mycophenolate mofetil were the most common IMTs to be used as first-line therapies, but adalimumab and infliximab were perceived to be the most effective for the treatment for VKH. Discussion While there are some common trends in the practice patterns for the diagnosis and treatment of patients with VKH, there was no clear consensus on the topic of IMT. There was a slight preference among uveitis specialists to use both IMT and systemic corticosteroids for the first episode of acute VKH.
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Affiliation(s)
| | | | - Jessica G. Shantha
- F.I. Proctor Foundation, University of California San Francisco (UCSF), San Francisco, CA, United States
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28
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Zhong Z, Dai L, Wu Q, Gao Y, Pu Y, Su G, Lu X, Zhang F, Tang C, Wang Y, Zhou C, Yang P. A randomized non-inferiority trial of therapeutic strategy with immunosuppressants versus biologics for Vogt-Koyanagi-Harada disease. Nat Commun 2023; 14:3768. [PMID: 37355662 PMCID: PMC10290648 DOI: 10.1038/s41467-023-39483-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/15/2023] [Indexed: 06/26/2023] Open
Abstract
Biologics are increasingly used to treat Vogt-Koyanagi-Harada disease, but head-to-head comparisons with conventional immunosuppressants are lacking. Here in this randomized trial (Chinese Clinical Trial Registry, ChiCTR2100043061), we assigned 110 patients (27 early-phase and 83 late-phase) to cyclosporine-based immunosuppressant strategy (N = 56) or adalimumab-based biologic strategy (N = 54), each combined with a modified corticosteroid regimen. The primary outcome is change from baseline in best-corrected visual acuity at week 26. The margin of non-inferiority for cyclosporine is -7 letters. The primary outcome is 11.2 letters (95% CI, 7.5 to 14.9) in the cyclosporine group and 6.3 letters (95% CI, 3.1 to 9.6) in the adalimumab group (difference, 4.9; 95% CI, 0.2 to 9.5; P < 0.001 for non-inferiority). The between-group difference is -0.8 letters (95% CI, -6.1 to 4.5) in early-phase disease and 5.7 letters (95% CI, 0.2 to 11.2) in late-phase. Serious adverse events are reported less frequently in the cyclosporine group than in the adalimumab group (0.70 vs. 1.21 events per patient-year). Here, we report that combined with a non-standard corticosteroid regimen, cyclosporine-based immunosuppressant strategy is non-inferior to adalimumab-based biologic strategy by 26 weeks for visual improvement in a cohort of patients with Vogt-Koyanagi-Harada disease, 75% of whom have a late-phase disease.
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Affiliation(s)
- Zhenyu Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Lingyu Dai
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Qiuying Wu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Yu Gao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Yanlin Pu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Xiaorong Lu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Fuxiang Zhang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Chong Tang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Yao Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Chunjiang Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, and Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China.
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Wu Q, Zhong Z, Zhou C, Cao Q, Su G, Yang P. Association of ZC3HAV1 single nucleotide polymorphisms with the susceptibility of Vogt-Koyanagi-Harada Disease. BMC Med Genomics 2023; 16:113. [PMID: 37221558 DOI: 10.1186/s12920-023-01546-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/14/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Polymorphisms of genes related to the immune response have been reported to confer susceptibility to Vogt-Koyanagi-Harada (VKH) disease. This study was carried out to determine whether zinc finger CCCH-type containing antiviral 1 (ZC3HAV1) and tripartite motif-containing protein 25 (TRIM25) genetic polymorphisms are associated with this disease. METHODS A total of 766 VKH patients and 909 healthy individuals were enrolled in this two-stage case-control study. Thirty-one tag single nucleotide polymorphisms (SNPs) of ZC3HAV1 and TRIM25 were genotyped by MassARRAY System and iPLEX Gold Genotyping Assay. Allele and genotype frequencies were analyzed by the χ2 test or Fisher's exact test. Cochran-Mantel-Haenszel test was used to assess the pooled odds ratio (OR) in the combined study. A stratified analysis was performed in terms of the major clinical features of VKH disease. RESULTS We found a statistically significant increased frequency of the minor A allele of ZC3HAV1 rs7779972 (P = 1.50 × 10- 4, pooled OR = 1.332, 95%CI = 1.149-1.545) in VKH disease as compared with controls by using the Cochran-Mantel-Haenszel test. The GG genotype of rs7779972 showed a protective association with VKH disease (P = 1.88 × 10- 3, OR = 0.733, 95%CI = 0.602-0.892). There was no difference regarding the frequency of the remaining SNPs between VKH cases and controls (all P > 2.08 × 10- 3). The stratified analysis showed no significant association of rs7779972 with the major clinical characteristics of VKH disease. CONCLUSION Our study indicated that the ZC3HAV1 variant rs7779972 might confer susceptibility to VKH disease in Han Chinese.
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Affiliation(s)
- Qiuying Wu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Zhenyu Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Chunya Zhou
- Department of Ophthalmology & Optometry, The School of Medical Technology and Engineering, Fujian Medical University, Fuzhou, P. R. China
| | - Qingfeng Cao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China.
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30
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Corbitt K, Nowatzky J. Inflammatory eye disease for rheumatologists. Curr Opin Rheumatol 2023; 35:201-212. [PMID: 36943695 PMCID: PMC10461883 DOI: 10.1097/bor.0000000000000933] [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] [Indexed: 03/23/2023]
Abstract
PURPOSE OF REVIEW This review provides a framework for understanding inflammatory eye disease diagnosis, differential diagnosis, and management for rheumatologists. Uveitis, scleritis, episcleritis, peripheral ulcerative keratitis, and orbital inflammation are all discussed. The goal is to facilitate the development of approaches to inflammatory eye diseases that will help rheumatologists co-manage these patients with eye care providers specializing in ocular inflammation. RECENT FINDINGS In recent years, studies have aimed to advance biologic treatments and define standard-of-care therapy. Inflammatory eye diseases are highly heterogeneous and often rare, which poses significant challenges to their research and the interpretation of existing data. To date, glucocorticoids, mycophenolate, methotrexate, and TNF inhibitors remain the mainstay of treatment options for many of these diseases. SUMMARY Patients with inflammatory eye diseases require multidisciplinary care for best outcomes, frequently including rheumatologists. Understanding the differentials, diagnostics, and treatment are essential to preserving vision in these patients. The diverse nature of the disease processes within this field requires focusing on specific disease phenotypes and endotypes in research and clinical practice.
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Affiliation(s)
- Kelly Corbitt
- New York University Grossman School of Medicine, Department of Medicine, Division of Rheumatology
| | - Johannes Nowatzky
- New York University Grossman School of Medicine, Department of Medicine, Division of Rheumatology
- New York University Grossman School of Medicine, Department of Medicine, Division of Rheumatology, NYU Langone Behçet’s Disease Program, NYU Ocular Rheumatology Program
- New York University Grossman School of Medicine, Department of Pathology
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Prétot D, Engesser KM, Schlote T, Volpe MD. When Your Patient Needs New Glasses Every Day. Klin Monbl Augenheilkd 2023; 240:566-568. [PMID: 37164438 DOI: 10.1055/a-2004-5504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
| | | | - Torsten Schlote
- Ophthalmology, Heuberger Eye Clinic AG, Olten, Switzerland
- Ophthalmology, Ambimed Eye Clinic, Basel, Switzerland
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Maccora I, Marrani E, Pagnini I, Mastrolia MV, de Libero C, Caputo R, Simonini G. Challenges and management of childhood non-infectious chronic uveitis. Expert Rev Clin Immunol 2023; 19:599-611. [PMID: 36996498 DOI: 10.1080/1744666x.2023.2198210] [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: 04/01/2023]
Abstract
INTRODUCTION Childhood uveitis is a sight-threatening condition, because if not properly recognized and treated can lead to several ocular complications and blindness. It represents a real challenge not only from an etiologic/diagnostic point of view, but also for management and therapy. AREAS COVERED In this review we will discuss the main etiologies, the diagnostic approach, risk factors associated to childhood non-infectious uveitis (cNIU), and the difficulties in eye examination in childhood. Moreover, we will discuss the treatment of cNIU in term of therapeutic choice, timing of initiation and withdrawal. EXPERT OPINION Identification of specific diagnosis is mandatory to prevent severe complications, thus a thorough differential diagnosis is essential. Pediatric eye examination may be extremely challenging due to the scarce collaboration, but novel techniques and biomarkers will help in identify low grade of inflammation, eventually modify long-term outcomes. Once identified the appropriate diagnosis, recognition of children who may benefit of a systemic treatment is crucial. What, When and how long are the key questions to address in this field. Current evidence and future results of ongoing clinical trials will help in driving treatment. A proper ocular screening, not only in the context of systemic disease, should be discussed by experts.
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Affiliation(s)
- Ilaria Maccora
- Pediatric Rheumatology Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- NeuroFARBA department, University of Florence, Florence, Italy
| | - Edoardo Marrani
- Pediatric Rheumatology Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Ilaria Pagnini
- Pediatric Rheumatology Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | | | | | - Roberto Caputo
- Ophthalmology Unit, Meyer Children's Hospital, Florence, Italy
| | - Gabriele Simonini
- Pediatric Rheumatology Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- NeuroFARBA department, University of Florence, Florence, Italy
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Artificial intelligence in uveitis: A comprehensive review. Surv Ophthalmol 2023:S0039-6257(23)00044-9. [PMID: 36878360 DOI: 10.1016/j.survophthal.2023.02.007] [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: 09/20/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
Uveitis is a disease complex characterized by intraocular inflammation of the uvea that is an important cause of blindness and social morbidity. With the dawn of artificial intelligence (AI) and machine learning integration in healthcare, their application in uveitis creates an avenue to improve screening and diagnosis. Our review identified the use of artificial intelligence in studies of uveitis and classified them as diagnosis support, finding detection, screening, and standardization of uveitis nomenclature. The overall performance of models is poor, with limited datasets and a lack of validation studies and publicly available data and codes. We conclude that AI holds great promise to assist with the diagnosis and detection of ocular findings of uveitis, but further studies and large representative datasets are needed to guarantee generalizability and fairness.
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Xiao P, Ma K, Ye X, Wang G, Duan Z, Huang Y, Luo Z, Hu X, Chi W, Yuan J. Classification of Vogt-Koyanagi-Harada disease using feature selection and classification based on wide-field swept-source optical coherence tomography angiography. Front Bioeng Biotechnol 2023; 11:1086347. [PMID: 37200845 PMCID: PMC10185775 DOI: 10.3389/fbioe.2023.1086347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/20/2023] [Indexed: 05/20/2023] Open
Abstract
Background: Vogt-Koyanagi-Harada (VKH) disease is a common and easily blinded uveitis entity, with choroid being the main involved site. Classification of VKH disease and its different stages is crucial because they differ in clinical manifestations and therapeutic interventions. Wide-field swept-source optical coherence tomography angiography (WSS-OCTA) provides the advantages of non-invasiveness, large-field-of-view, high resolution, and ease of measuring and calculating choroid, offering the potential feasibility of simplified VKH classification assessment based on WSS-OCTA. Methods: 15 healthy controls (HC), 13 acute-phase and 17 convalescent-phase VKH patients were included, undertaken WSS-OCTA examination with a scanning field of 15 × 9 mm2. 20 WSS-OCTA parameters were then extracted from WSS-OCTA images. To classify HC and VKH patients in acute and convalescent phases, two 2-class VKH datasets (HC and VKH) and two 3-class VKH datasets (HC, acute-phase VKH, and convalescent-phase VKH) were established by the WSS-OCTA parameters alone or in combination with best-corrected visual acuity (logMAR BCVA) and intraocular pressure (IOP), respectively. A new feature selection and classification method that combines an equilibrium optimizer and a support vector machine (called SVM-EO) was adopted to select classification-sensitive parameters among the massive datasets and to achieve outstanding classification performance. The interpretability of the VKH classification models was demonstrated based on SHapley Additive exPlanations (SHAP). Results: Based on pure WSS-OCTA parameters, we achieved classification accuracies of 91.61% ± 12.17% and 86.69% ± 8.30% for 2- and 3-class VKH classification tasks. By combining the WSS-OCTA parameters and logMAR BCVA, we achieved better classification performance of 98.82% ± 2.63% and 96.16% ± 5.88%, respectively. Through SHAP analysis, we found that logMAR BCVA and vascular perfusion density (VPD) calculated from the whole field of view region in the choriocapillaris (whole FOV CC-VPD) were the most important features for VKH classification in our models. Conclusion: We achieved excellent VKH classification performance based on a non-invasive WSS-OCTA examination, which provides the possibility for future clinical VKH classification with high sensitivity and specificity.
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Affiliation(s)
- Peng Xiao
- *Correspondence: Peng Xiao, ; Jin Yuan,
| | | | | | | | | | | | | | | | | | - Jin Yuan
- *Correspondence: Peng Xiao, ; Jin Yuan,
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Jabs DA, Berkenstock MK, Altaweel MM, Holbrook JT, Sugar EA. The Conundrum of Clinical Trials for the Uveitides: Appropriate Outcome Measures for One Treatment Used in Several Diseases. Epidemiol Rev 2022; 44:2-16. [PMID: 35442407 PMCID: PMC10362938 DOI: 10.1093/epirev/mxac001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 02/01/2022] [Accepted: 03/03/2022] [Indexed: 12/29/2022] Open
Abstract
The uveitides consist of >30 diseases characterized by intraocular inflammation. Noninfectious intermediate, posterior, and panuveitides typically are treated with oral corticosteroids and immunosuppression, with a similar treatment approach for most diseases. Because these uveitides collectively are considered a rare disease, single-disease trials are difficult to impractical to recruit for, and most trials have included several different diseases for a given protocol treatment. However, measures of uveitis activity are disease specific, resulting in challenges for trial outcome measures. Several trials of investigational immunosuppressive drugs or biologic drugs have not demonstrated efficacy, but design problems with the outcome measures have limited the ability to interpret the results. Successful trials have included diseases for which a single uveitis activity measure suffices or a composite measure of uveitis activity is used. One potential solution to this problem is the use of a single, clinically relevant outcome, successful corticosteroid sparing, defined as inactive uveitis with a prednisone dose ≤7.5 mg/day coupled with disease-specific guidelines for determining inactive disease. The clinical relevance of this outcome is that active uveitis is associated with increased risks of visual impairment and blindness, and that prednisone doses ≤7.5 mg/day have a minimal risk of corticosteroid side effects. The consequence of this approach is that trial visits require a core set of measures for all participants and a disease-specific set of measures, both clinical and imaging, to assess uveitis activity. This approach is being used in the Adalimumab Versus Conventional Immunosuppression (ADVISE) Trial.
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Jabs DA, Okada AA, McCLUSKEY P. Reply to Comment on: SUN Classification Criteria for Vogt-Koyanagi-Harada Disease. Am J Ophthalmol 2022; 244:230-231. [PMID: 35940244 DOI: 10.1016/j.ajo.2022.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 01/30/2023]
Affiliation(s)
- Douglas A Jabs
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Annabelle A Okada
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Peter McCLUSKEY
- Save Sight Institute, Discipline of Ophthalmology, University of Sydney Faculty of Medicine and Health, Sydney, Australia
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Carreño E, Pichi F, Agarwal A, Munk MR. Comment on "SUN Classification Criteria for Vogt-Koyanagi-Harada Disease". Am J Ophthalmol 2022; 244:228-229. [PMID: 35940245 DOI: 10.1016/j.ajo.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/04/2022] [Indexed: 01/30/2023]
Affiliation(s)
- Ester Carreño
- Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Marion R Munk
- Department of Ophthalmology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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EFFICACY OF COMBINED SYSTEMIC CORTICOSTEROID AND EARLY IMMUNOMODULATORY THERAPY WITHIN THREE MONTHS OF ONSET IN VOGT–KOYANAGI–HARADA DISEASE. Retina 2022; 42:2361-2367. [DOI: 10.1097/iae.0000000000003617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Jabs DA, McCluskey P, Palestine AG, Thorne JE. The standardisation of uveitis nomenclature (SUN) project. Clin Exp Ophthalmol 2022; 50:10.1111/ceo.14175. [PMID: 36164924 PMCID: PMC10040472 DOI: 10.1111/ceo.14175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 11/29/2022]
Abstract
The uveitides are a collection of over 30 diseases characterised by intraocular inflammation. Previous work demonstrated that the agreement among uveitis experts on diagnosis was modest at best with some pairs of experts having chance alone agreement on selected diseases. The Standardisation of Uveitis Nomenclature (SUN) is a17-year collaboration among experts in uveitis, ocular image grading, informatics, and machine learning to improve clinical and translational uveitis research. The SUN "Developing Classification Criteria for the Uveitides" project used a rigorous, multi-phase approach to develop classification criteria for 25 of the most common uveitic diseases. The project's phases were: (1) informatics; (2) case collection; (3) case selection; (4) machine learning; and (5) consensus review and publication. The results were classification criteria with a high degree of accuracy (93.3%-99.3% depending on anatomic class of the uveitis), the goal of which is to form the basis for future uveitis research.
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Affiliation(s)
- Douglas A Jabs
- The Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter McCluskey
- Save Sight Institute, Discipline of Ophthalmology, University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Alan G Palestine
- Department of Ophthalmology, The University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jennifer E Thorne
- The Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Fram B, Fernandez A, Syed H, Brar V. Recurrent Vogt-Koyanagi-Harada disease presenting with diffuse orbital inflammation. Am J Ophthalmol Case Rep 2022; 27:101625. [PMID: 35761879 PMCID: PMC9233211 DOI: 10.1016/j.ajoc.2022.101625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/31/2022] [Accepted: 06/14/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Brandon Fram
- Department of Ophthalmology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Andrew Fernandez
- Department of Ophthalmology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Huzaefah Syed
- Department of Rheumatology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Vikram Brar
- Department of Ophthalmology, Virginia Commonwealth University Health System, Richmond, VA, USA
- Corresponding author. 401 N 11th St Suite 439, Richmond, VA, 23298, USA.
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Urzua CA, Herbort CP, Takeuchi M, Schlaen A, Concha-Del-Rio LE, Usui Y, Cuitino L, Papasavvas I. Vogt-Koyanagi-Harada disease: the step-by-step approach to a better understanding of clinicopathology, immunopathology, diagnosis, and management: a brief review. J Ophthalmic Inflamm Infect 2022; 12:17. [PMID: 35553272 PMCID: PMC9098759 DOI: 10.1186/s12348-022-00293-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/07/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Appraisals of Vogt-Koyanagi-Harada disease (VKH) have become progressively more complete, since its first description in 1906. The availability of new investigational methods has improved our knowledge of the immunopathology, clinicopathology, diagnosis, and management of VKH disease. This review aimed to describe some of the steps that led to better characterization of VKH as a clinical entity. METHODS We searched on PubMed for articles that described the history of VKH disease and analyzed the progress in disease appraisal with new investigational and imaging methods. In particular, we searched for articles that investigated the clinicopathology, diagnosis, and management of VKH. FINDINGS The following developments were considered essential for improving the appraisal and understanding of VKH: (1) the history of the disease, (2) immunopathological mechanisms, (3) clinicopathology, (4) the importance of distinguishing initial-onset from chronic disease, (5) relevant imaging modalities, among which indocyanine green angiography is crucial, (6) diagnostic criteria that facilitate early diagnosis, and (7) the need for early, prolonged, aggressive treatment that combines steroidal and non-steroidal immunosuppression. CONCLUSION Based on these findings, the definition of VKH has improved. VKH disease starts in the choroidal stroma and later involves other structures when it is not diagnosed and treated early. Indocyanine green angiography and enhanced depth imaging optical coherence tomography facilitate early diagnosis and precise monitoring of choroidal inflammation. ICGA is clearly the gold standard for appraisals and follow-ups in VKH disease, however EDI-OCT should be especially considered in those areas where ICGA is not fully available. These modalities have contributed substantially to a "cure" for VKH, when treatment is introduced within the therapeutic window of opportunity.
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Affiliation(s)
- Cristhian A Urzua
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile. .,Department of Ophthalmology, University of Chile, Santiago, Chile. .,Facultad de Medicina, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile.
| | - Carl P Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialised Care (COS), Lausanne, Switzerland
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Ariel Schlaen
- Hospital Universitario Austral, Hospital de Clinicas de Buenos Aires, Buenos Aires, Argentina
| | - Luz E Concha-Del-Rio
- Inflammatory Eye Disease Clinic, Dr. Luis Sanchez Bulnes Hospital, Asociación para Evitar la Ceguera en México (APEC), Mexico City, CDMX, Mexico
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Loreto Cuitino
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile.,Servicio de Oftalmología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialised Care (COS), Lausanne, Switzerland
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Optical coherence tomography angiography reveals paradoxically decreasing choroidal thickness & increasing blood flow in remitting Vogt Koyanagi Harada syndrome. Retina 2022; 42:1788-1795. [PMID: 35552322 DOI: 10.1097/iae.0000000000003525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess changes in choroidal thickness & blood flow in active Vogt Koyanagi Harada (VKH) syndrome and after remission using optical coherence tomography angiography (OCTA). METHODS This was a prospective study of patients with active early uveitis secondary to VKH. They underwent OCTA imaging twice: at baseline and after remission on treatment. 3x3 & 6x6 mm choriocapillaris slabs were used to evaluate parafoveal adjusted flow index (AFI) as a marker for choroidal blood flow. Mean choroidal thickness (CT) of 3 points (subfoveally and 2 points 300um parafoveally) were also measured. RESULTS 39 eyes of 25 patients were initially recruited. After excluding eyes with media opacity, submacular fibrosis & choroidal neovascularization, 23 eyes of 14 patients were included. The mean follow-up period was 8.7 ± 2.5 months. Mean CT in activity and remission were 581.65 ± 108.29 µm and 318.34 ±72.85 µm respectively (p<0.01). Mean AFI in the 3x3 mm slabs activity & remission were 0.495 ± 0.027 & 0.519 ± 0.0336 (p=0.011), and the 6x6 mm slabs were 0.487 ± 0.037 & 0.517 ± 0.052 respectively (p=0.025). CONCLUSIONS We demonstrate decreasing CT with paradoxically increasing choroidal flow on OCTA in remitting VKH. This may reflect inflammatory infiltrations or granulomas increasing CT during activity & causing sluggish circulation of the choriocapillaris, and a reversal of this process with remission. These findings shed more light on the relationship between VKH & its underlying choroidal disturbances. Larger studies are needed to evaluate the efficacy of AFI in evaluating and predicting disease activity.
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Mudie LI, Reddy AK, Patnaik JL, Pecen P, Kim E, Cole K, Palestine AG. Evaluation of the SUN Classification Criteria for Uveitides in an Academic Uveitis Practice. Am J Ophthalmol 2022; 241:57-63. [PMID: 35469789 DOI: 10.1016/j.ajo.2022.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the new Standardization of Uveitis Nomenclature (SUN) classification criteria for uveitides by applying them to patients in an academic uveitis practice. DESIGN Evaluation of classification criteria. METHODS The charts of all patients attending the uveitis service at the University of Colorado Hospital between January 1, 2013, and December 31, 2020, were reviewed. Patients with scleritis, ocular cicatricial pemphigoid, and peripheral ulcerative keratitis were excluded. We attempted to classify each patient's uveitis using the SUN classification criteria. Classification attempts were made within the relevant anatomical or infectious categories for their pathology but did not necessarily have to match their clinical diagnosis by a uveitis specialist. We recorded whether classification was possible as well as their clinical diagnosis by a uveitis specialist. RESULTS All patients attending the uveitis clinic at our academic institution between January 1, 2013, and December 31, 2020, were reviewed. Of the 1143 patients with uveitis, 572 (50.0%) had a disease that was not listed in the SUN classification system, and so no attempt to classify these patients was possible. Of the remaining 571 patients, 522 (91.4%) were able to be classified by SUN and in 492 (94.3%) of the 522 cases, their SUN classification matched their clinical diagnosis by a uveitis specialist. CONCLUSIONS Half of the patients at an academic uveitis practice had a disease for which no SUN classification criteria existed. In cases where classification by SUN could be attempted, the system performed well and generally agreed with their clinical diagnosis.
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Affiliation(s)
- Lucy I Mudie
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA
| | - Amit K Reddy
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA
| | - Jennifer L Patnaik
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA
| | - Paula Pecen
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA; Carolina Eye Associates (P.P.), Greensboro, North Carolina, USA
| | - Emmeline Kim
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA
| | - Kaylee Cole
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA
| | - Alan G Palestine
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA.
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Marchese A, Cicinelli MV, Amato A, Bandello F, Gupta V, Miserocchi E, Agarwal A. The Next Steps in Ocular Imaging in Uveitis. Ocul Immunol Inflamm 2022; 31:785-792. [PMID: 35412936 DOI: 10.1080/09273948.2022.2055579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To describe the future steps and advances in the field of ocular imaging in uveitis. METHODS Narrative review. RESULTS There have been numerous advances in the field of imaging in uveitis in the past decade. Advanced techniques of imaging of the vitreous, vitreo-retinal interface, retinochoroid, and the sclera can provide significant information that helps in understanding the disease pathogenesis and manifestations. Imaging also helps in establishing a diagnosis in challenging cases, along with the laboratory and other assays. Notable developments in ocular imaging include wide-field and ultra-wide field imaging (including angiographies), automated quantification of the retinochoroidal vasculature using optical coherence tomography (OCT) and OCT angiography, quantification of vitreous cells, and intraoperative use of imaging in uveitis, among others. CONCLUSIONS We have summarized several technological achievements in ocular imaging in the field of uveitis and provided insights into the potential future developments.
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Affiliation(s)
- Alessandro Marchese
- Department of Ophthalmology, School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessia Amato
- Department of Ophthalmology, School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vishali Gupta
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Aniruddha Agarwal
- Department of Ophthalmology, The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (UAE)
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Abellanas M, Elena MJ, Keane PA, Balaskas K, Grewal DS, Carreño E. Artificial Intelligence and Imaging Processing in Optical Coherence Tomography and Digital Images in Uveitis. Ocul Immunol Inflamm 2022; 30:675-681. [PMID: 35412935 DOI: 10.1080/09273948.2022.2054433] [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: 10/18/2022]
Abstract
INTRODUCTION Computer vision, understood as the area of science that trains computers to interpret digital images through both artificial intelligence (AI) and classical algorithms, has significantly advanced the analysis and interpretation of optical coherence tomography (OCT) in retina research. The aim of this review is to summarise the recent advances of computer vision in imaging processing in uveitis, with a particular focus in optical coherence tomography images. MATERIAL AND METHODS Literature review. RESULTS The development of computer vision to assist uveitis diagnosis and prognosis is still undergoing, but important efforts have been made in the field. CONCLUSION The automatising of image processing in uveitis could be fundamental to establish objective and standardised outcomes for future clinical trials. In addition, it could help to better understand the disease and its progression.
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Affiliation(s)
- María Abellanas
- Department of Ophthalmology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - María José Elena
- Department of Ophthalmology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - Pearse A Keane
- Moorfields Eye Hospital NHS Foundation Trust, UK and University College London (UCL) Institute of Ophthalmology, UK
| | - Konstantinos Balaskas
- Moorfields Eye Hospital NHS Foundation Trust, UK and University College London (UCL) Institute of Ophthalmology, UK
| | - Dilraj S Grewal
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, USA
| | - Ester Carreño
- Department of Ophthalmology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
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Objective evaluation of choroidal melanin loss in patients with Vogt-Koyanagi-Harada disease using polarization-sensitive optical coherence tomography. Sci Rep 2022; 12:3526. [PMID: 35241784 PMCID: PMC8894486 DOI: 10.1038/s41598-022-07591-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 02/21/2022] [Indexed: 11/16/2022] Open
Abstract
In this study, sunset glow fundus was evaluated in patients with Vogt–Koyanagi–Harada (VKH) disease using polarization-sensitive optical coherence tomography (PS-OCT). We evaluated 40 VKH eyes (20 patients) and 59 healthy eyes (59 age-matched controls). VKH eyes were divided into three groups according to color fundus images: sunset (17 eyes), potential sunset (13 eyes), and non-sunset (10 eyes). Choroidal melanin thickness (ChMeT) and the choroidal melanin thickness ratio (ChMeTratio) were calculated based on the degree of polarization uniformity from PS-OCT. ChMeT was significantly lower in sunset eyes than in non-sunset or control eyes (P = 0.003). The ChMeTratios of sunset or potential sunset eyes were significantly lower than those of non-sunset or control eyes (P = 0.04). Regional evaluation of ChMeT and the ChMeTratio showed that choroidal depigmentation predominantly occurred in the macula’s outer ring area (P = 0.002). The areas under receiver operating characteristic curves discriminating combined sunset (sunset and potential sunset) from non-sunset eyes were 0.983 and 0.997 for ChMeT and the ChMeTratio, respectively. Time course evaluation of 12 eyes from disease onset showed that ChMeT and the ChMeTratio significantly decreased over time. PS-OCT may be useful for objectively evaluating choroidal depigmentation in patients with VKH disease.
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Hiyama T, Harada Y, Kiuchi Y. Clinical Characteristics and Efficacy of Adalimumab and Low-Dose Methotrexate Combination Therapy in Patients With Vogt-Koyanagi-Harada Disease. Front Med (Lausanne) 2022; 8:730215. [PMID: 35071253 PMCID: PMC8770852 DOI: 10.3389/fmed.2021.730215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
This retrospective study investigated the clinical characteristics and efficacy of adalimumab and low-dose methotrexate combination therapy in patients with Vogt-Koyanagi-Harada disease who were treated at Hiroshima University from February 2012 to May 2021. The patients' demographics, clinical features at administration of immunosuppressive therapy, steroid-sparing immunosuppressive therapy, side effects, and relapses were recorded. The efficacies of steroid-sparing immunosuppressive therapy (methotrexate, cyclosporine A, adalimumab, and adalimumab and methotrexate combination therapy) were analyzed. Among 62 patients, the median age at diagnosis was 47 years and the median duration of uveitis was 51 months. Systemic corticosteroid therapy was administered to 93.5% of patients (n = 58). Thirty-four patients (54.8%) were treated with steroid-sparing immunosuppressive therapy. Methotrexate and cyclosporine A were administered to 12 and 22 patients, respectively; relapse occurred in 50.0% and 22.7% of the patients, respectively. Discontinuation of cyclosporine A was required in 63.6% of patients because of side effects. Adalimumab was administered to 14 patients. Recurrence occurred in 11 patients, requiring methotrexate concomitantly. The mean dose of methotrexate at inflammatory quiescence after side effect-related dose decrease was 8.0 mg/week (0.13 mg/kg). The median duration of combination therapy without recurrence was 20 months. There were no serious adverse events during adalimumab therapy. A high relapse rate was observed in patients receiving methotrexate; a high rate of side effects requiring discontinuation was observed in patients receiving Cyclosporine A. Patients with late-stage Vogt-Koyanagi-Harada disease may achieve better control with adalimumab and methotrexate combination therapy.
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Affiliation(s)
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Abstract
PURPOSE OF REVIEW Here, we provide an overview of Vogt-Koyanagi-Harada disease (VKH), including recent updates in our understanding of disease pathophysiology, classification and therapeutics. RECENT FINDINGS Advancements in bioinformatics, metabolomics and genomics investigations continue to illuminate VKH pathogenesis, and may provide insight into future therapeutic options. Multimodal imaging is indispensable in the initial evaluation of VKH, and is becoming increasingly important in understanding disease pathogenesis, as well as monitoring therapeutic response. Enhanced VKH classification criteria, released in 2021, provide standardized guidelines and terminology for clinical and research purposes. SUMMARY Modern research and imaging techniques continue to improve our understanding of VKH; more work is needed to further elucidate pathogenic mechanisms and establish optimal therapeutic recommendations.
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Affiliation(s)
- Ashlin Joye
- Casey Eye Institute, Oregon Health and Science University
| | - Eric Suhler
- Department of Ophthalmology - Casey Eye Institute, Oregon Health and Science University, VA Portland Healthcare System, Portland, Oregon, USA
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Koong LR, Chee WK, Toh ZH, Ng XL, Agrawal R, Ho SL. Vogt-Koyanagi-Harada Disease Associated with COVID-19 mRNA Vaccine. Ocul Immunol Inflamm 2021; 29:1212-1215. [PMID: 34505819 DOI: 10.1080/09273948.2021.1974492] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A 54-year-old Chinese male with no previous ocular history presented to the ophthalmology department for the bilateral acute painless blurring of vision after receiving the 1st dose of COVID-19 mRNA vaccine (PFIZER-BioNTech/COMIRNATY). Clinical examination and imaging tests were consistent with Vogt-Koyanagi-Hara disease. The patient responded well with a high dose of intravenous methylprednisolone followed by a tapering dose of oral prednisolone.
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Affiliation(s)
- Lin Ru Koong
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Wai Kitt Chee
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Zhi Hong Toh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Xin Le Ng
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Ocular Infections and AntiMicrobials, Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Sciences, Academic and Clinical Programme, Duke NUS Medical School, Singapore
| | - Su Ling Ho
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
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Heiligenhaus A, Rothaus K, Pleyer U. [Development of classification criteria for uveitis by the standardization of uveitis nomenclature (SUN) working group]. Ophthalmologe 2021; 118:913-918. [PMID: 34459962 PMCID: PMC8413183 DOI: 10.1007/s00347-021-01486-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/19/2022]
Abstract
Hintergrund Die Standardization of Uveitis Nomenclature (SUN) Working Group ist eine internationale Expertenkommission, die das Ziel verfolgt, eine standardisierte und international anerkannte Terminologie für das Gebiet der Uveitis zu erarbeiten. Dies erscheint angesichts der Forderung nach evidenzbasierter Medizin gerade bei relativ seltenen Erkrankungen wie der Uveitis wichtig. Methoden Unter Verwendung formaler Konsensustechniken wurde eine Datenbank von > 4000 Uveitispatienten erstellt, bei denen zuvor eine Mehrheitsübereinstimmung in der Diagnose erzielt wurde. Die Patientendaten wurden innerhalb der Uveitissubklasse analysiert und in einen Trainingssatz und einen Validierungssatz aufgeteilt. Mit maschinellem Lernen (ML) wurden multinomiale logistische Regressionen mit Lasso-Regularisierung auf dem Trainingssatz durchgeführt. Die Genauigkeit der Regeln, die entwickelt wurden, um die Kriterien des maschinellen Lernens auszudrücken, wurde von einem maskierten Beobachter in einer 10 %igen Zufallsstichprobe bewertet. Ergebnisse Die Schätzungen der Gesamtgenauigkeit nach Uveitisklassen im Validierungsset waren für alle Uveitisformen hoch: anteriore Uveitiden 96,7 % (95 %-Konfidenzintervall [CI] 92,4–98,6); intermediäre Uveitiden 99,3 % (95 %-CI 96,1–99,9); posteriore Uveitiden 98,0 % (95 %-CI 94,3–99,3); Panuveitiden 94,0 % (95 %-CI 89,0–96,8) und infektiöse posteriore Uveitiden/Panuveitiden 93,3 % (95 %-CI 89,1–96,3). Schlussfolgerungen Es werden Klassifikationskriterien präsentiert, die einen hohen Grad an Genauigkeit (geringe Fehlklassifikationsraten) aufweisen und sich daher gut für die künftige klinische und translationale Forschung eignen.
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Affiliation(s)
- Arnd Heiligenhaus
- Augenzentrum, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland. .,Universität Duisburg-Essen, Essen, Deutschland.
| | - Kai Rothaus
- Augenzentrum, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | - Uwe Pleyer
- Berliner Institut für Gesundheitsforschung in der Charité (BIH), Campus Virchow Klinikum, Augenklinik, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
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