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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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Muto T, Sakamoto M, Kusuda S, Haruyama Y, Machida S, Imaizumi S, Sekiryu T. Effect of the COVID-19 pandemic on Vogt-Koyanagi-Harada disease. Sci Rep 2024; 14:13211. [PMID: 38851824 PMCID: PMC11162482 DOI: 10.1038/s41598-024-63957-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/04/2024] [Indexed: 06/10/2024] Open
Abstract
To determine the disease prevalence rate and clinical characteristics of Vogt-Koyanagi-Harada (VKH) disease among new patients before and after the declaration of a state of emergency (April 7, 2020) in Japan. New patients and patients with newly diagnosed VKH disease were categorized into "Before" and "After" groups based on the initial visit. The prevalence rate, sex ratio, and age of patients newly diagnosed with VKH were compared between the groups. Best-corrected visual acuity (BCVA) and recurrence rates were compared among 59 patients observed for > 12 months after receiving pulse steroid therapy. For reference, we also examined the prevalence rate of patients newly diagnosed with acute angle closure (AAC) in the Before and After groups. The prevalence rates of VKH disease among newly diagnosed patients (P < 0.05) or patients with AAC (P < 0.001) were significantly higher in the After group. No significant differences in sex ratio or age of VKH disease were observed in both groups. BCVA and recurrence rates showed no significant differences. The COVID-19 pandemic increased the prevalence of VKH disease among new patients compared with that of AAC. However, the clinical features of VKH disease were unlikely affected by the COVID-19 pandemic.
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Affiliation(s)
- Tetsuya Muto
- Department of Ophthalmology, Dokkyo Medical University Saitama Medical Center, Koshigaya, 343-8555, Japan.
- Department of Ophthalmology, Imaizumi Eye Hospital, 20-9 Domaecho, Koriyama, 963-8877, Japan.
- Department of Ophthalmology, Fukushima Medical University, Fukushima, 960-1295, Japan.
| | - Masaaki Sakamoto
- Department of Ophthalmology, Dokkyo Medical University Saitama Medical Center, Koshigaya, 343-8555, Japan
| | - Shoichiro Kusuda
- Department of Ophthalmology, Dokkyo Medical University Saitama Medical Center, Koshigaya, 343-8555, Japan
| | - Yasuo Haruyama
- Dokkyo Medical University Center for Research Cooperative and Support, Mibu, 321-0293, Japan
| | - Shigeki Machida
- Department of Ophthalmology, Dokkyo Medical University Saitama Medical Center, Koshigaya, 343-8555, Japan
| | - Shinichiro Imaizumi
- Department of Ophthalmology, Imaizumi Eye Hospital, 20-9 Domaecho, Koriyama, 963-8877, Japan
| | - Tetsuju Sekiryu
- Department of Ophthalmology, Fukushima Medical University, Fukushima, 960-1295, Japan
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Fonollosa A, Charcán I, Giralt L, Artaraz J, Soto A, Ruiz-Arruza I, Agarwal A. Hyper-Reflective Outer Nuclear Layer (HONL) in Vogt-Koyanagi-Harada Disease and Sympathetic Ophthalmia. Ocul Immunol Inflamm 2024; 32:419-423. [PMID: 36332138 DOI: 10.1080/09273948.2022.2134038] [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: 06/30/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To describe the optical coherence tomography (OCT) findings of hyper-reflective outer nuclear layer (HONL) in two cases of stromal choroiditis (Vogt-Koyanagi-Harada disease - VKH, and sympathetic ophthalmia - SO). METHODS Case report. RESULTS Clinical and imaging findings of two patients (37-year-old female with VKH and 34-year-old male with SO) have been described. Both patients showed typical features of the disease with subretinal fluid accumulation and choroidal thickening on OCT. However, OCT of both patients at the initial visit revealed HONL, which was unusual in these conditions. During follow-up, OCT scans revealed thinning and atrophy of the outer retinal layers, irregular thickening of the retinal pigment epithelium, and irregular autofluorescence pattern on autofluorescence imaging. CONCLUSIONS The presence of HONL may serve as a poor prognostic factor in VKH and SO, resulting in thinning and atrophy of the outer retinal layers.
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Affiliation(s)
- A Fonollosa
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
- Department of Retina, Instituto Oftalmológico Bilbao, Bilbao, Spain
| | - I Charcán
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - L Giralt
- Department of Retina, Institut Català de la Retina, Barcelona, Spain
| | - J Artaraz
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - A Soto
- Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - I Ruiz-Arruza
- Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (UAE)
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Kang H, Sun H, Yang Y, Tuong ZK, Shu M, Wei Y, Zhang Y, Yu D, Tao Y. Autoimmune uveitis in Behçet's disease and Vogt-Koyanagi-Harada disease differ in tissue immune infiltration and T cell clonality. Clin Transl Immunology 2023; 12:e1461. [PMID: 37720629 PMCID: PMC10503407 DOI: 10.1002/cti2.1461] [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: 01/06/2023] [Revised: 06/16/2023] [Accepted: 08/04/2023] [Indexed: 09/19/2023] Open
Abstract
Objectives Non-infectious uveitis is often secondary to systemic autoimmune diseases, with Behçet's disease (BD) and Vogt-Koyanagi-Harada disease (VKHD) as the two most common causes. Uveitis in BD and VKHD can show similar clinical manifestations, but the underlying immunopathogenesis remains unclear. Methods To understand immune landscapes in inflammatory eye tissues, we performed single-cell RNA paired with T cell receptor (TCR) sequencing of immune cell infiltrates in aqueous humour from six patients with BD (N = 3) and VKHD (N = 3) uveitis patients. Results Although T cells strongly infiltrated in both types of autoimmune uveitis, myeloid cells only significantly presented in BD uveitis but not in VKHD uveitis. Conversely, VKHD uveitis but not BD uveitis showed an overwhelming dominance by CD4+ T cells (> 80%) within the T cell population due to expansion of CD4+ T cell clusters with effector memory (Tem) phenotypes. Correspondingly, VKHD uveitis demonstrated a selective expansion of CD4+ T cell clones which were enriched in pro-inflammatory Granzyme H+ CD4+ Tem cluster and showed TCR and Th1 pathway activation. In contrast, BD uveitis showed a preferential expansion of CD8+ T cell clones in pro-inflammatory Granzyme H+ CD8+ Tem cluster, and pathway activation for cytoskeleton remodelling, cellular adhesion and cytotoxicity. Conclusion Single-cell analyses of ocular tissues reveal distinct landscapes of immune cell infiltration and T-cell clonal expansions between VKHD and BD uveitis. Preferential involvements of pro-inflammatory CD4+ Th1 cells in VKHD and cytotoxic CD8+ T cells in BD suggest a difference in disease immunopathogenesis and can guide precision disease management.
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Affiliation(s)
- Hao Kang
- Department of Ophthalmology, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Hongjian Sun
- Frazer Institute, Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia
- Shandong Artificial Intelligence InstituteQilu University of Technology (Shandong Academy of Sciences)JinanChina
| | - Yang Yang
- Frazer Institute, Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia
- Shandong Artificial Intelligence InstituteQilu University of Technology (Shandong Academy of Sciences)JinanChina
| | - Zewen K Tuong
- Ian Frazer Centre for Children's Immunotherapy Research, Children's Health Research Centre, Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia
| | - Minglei Shu
- Shandong Artificial Intelligence InstituteQilu University of Technology (Shandong Academy of Sciences)JinanChina
| | - Yunbo Wei
- School of Pharmaceutical Sciences, Laboratory of Immunology for Environment and Health, Shandong Analysis and Test CenterQilu University of Technology (Shandong Academy of Sciences)JinanChina
| | - Yu Zhang
- School of Pharmaceutical Sciences, Laboratory of Immunology for Environment and Health, Shandong Analysis and Test CenterQilu University of Technology (Shandong Academy of Sciences)JinanChina
| | - Di Yu
- Frazer Institute, Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia
- Ian Frazer Centre for Children's Immunotherapy Research, Children's Health Research Centre, Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia
| | - Yong Tao
- Department of Ophthalmology, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
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Yang P, Liao W, Pu Y, Zhong Z, Wang H, Yu Q, Cai J, Wang W, Su G. Vogt-Koyanagi-Harada disease in pediatric, adult and elderly: clinical characteristics and visual outcomes. Graefes Arch Clin Exp Ophthalmol 2023; 261:2641-2650. [PMID: 37058172 DOI: 10.1007/s00417-023-06058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE To depict a whole spectrum of clinical feartures and visual prognosis among pediatric, adult, and elderly Vogt-Koyanagi-Harada disease (VKH) patients. METHODS Retrospective chart review was conducted in 2571 VKH patients diagnosed from April 2008 to January 2022. Based on age of disease onset, patients were divided into pediatric (age ≤ 16 years), adult (16 < age < 65 years), and elderly (age ≥ 65 years) VKH group. Ocular and extraocular manifestations were compared among these patients. Visual outcomes and complications were evaluated using logistic regression models and restricted cubic splines analysis. RESULTS The median follow-up time was 48 (IQR, 12-60) months. Pediatric, adult and elderly VKH were found in 106 (4.1%), 2355 (91.6%), and 110 (4.3%) patients, respectively. All of the patients showed similar ocular manifestations in the context of disease phasing. The proportion of neurological and auditory manifestations in pediatric (42.3% and 7.5%) VKH patients was significantly lower than that in adults (66.5% and 47.9%) and elderly (68.2% and 50%) (both p < 0.0001). An increased risk of macular abnormalities was seen in adults (OR, 3.43; 95% CI, 1.62-7.29) compared with elderly VKH. An inverted-U-shaped pattern was observed between disease onset age and a poor visual outcome (visual acuity 6/18 or worse) according to OR value in VKH patients. The highest risk of BCVA ≤ 6/18 was observed in 32 years at disease onset (OR, 1.51; 95% CI, 1.18-1.94). A higher risk of visual loss was observed in adult VKH patients (OR, 9.06; 95% CI, 2.18-37.6) compared with elderly VKH patients. And stratified by macular abnormalities, the interaction test was not significant (P = 0.634). CONCLUSION Our study identified, for the first time, a whole spectrum of clinical features of VKH based on a large cohort of Chinese patients. Adult VKH patients have an increased risk of poor visual outcomes, possibly due to increased frequency of macular abnormalities.
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Affiliation(s)
- 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, Youyi Road 1, Chongqing, 400016, People's Republic of China.
| | - Weiting Liao
- 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, Youyi Road 1, Chongqing, 400016, People's Republic of China
| | - Yanlin Pu
- 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, Youyi Road 1, Chongqing, 400016, People's Republic of 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, Youyi Road 1, Chongqing, 400016, People's Republic of China
| | - Hongmiao Wang
- 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, Youyi Road 1, Chongqing, 400016, People's Republic of China
| | - Qiuyue Yu
- 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, Youyi Road 1, Chongqing, 400016, People's Republic of China
| | - Jinyu Cai
- 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, Youyi Road 1, Chongqing, 400016, People's Republic of China
| | - Wujiao Wang
- 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, Youyi Road 1, Chongqing, 400016, People's Republic of 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, Youyi Road 1, Chongqing, 400016, People's Republic of China
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Zhang C, Wang Y, Chen Y, Zhou H, Hong Q, Yu X, Ng TK, Cen LP. Acute phase clinical manifestations of patients with Vogt-Koyanagi-Harada disease in Southern China. BMC Ophthalmol 2023; 23:199. [PMID: 37147563 PMCID: PMC10161656 DOI: 10.1186/s12886-023-02952-y] [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: 05/11/2022] [Accepted: 04/28/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUNDS To characterize the acute phase clinical manifestations and visual outcomes of the patients with Vogt-Koyanagi Harada (VKH) disease in southern China. METHODS In total, 186 patients with acute-onset VKH disease were recruited. The demographic data, clinical signs, ophthalmic examinations, and visual outcomes were analyzed. RESULTS Among the 186 VKH patients, 3 were diagnosed as complete VKH, 125 as incomplete VKH, and 58 as probable VKH. All patients visited the hospital within 3 months of onset and complained of decreased vision. For the extraocular manifestations, 121 patients (65%) referred neurological symptoms. Anterior chamber activity was negative in most eyes within an onset of 7 days, which increased slightly with onset beyond 1 week. Exudative retinal detachment (366 eyes, 98%) and optic disc hyperaemia (314 eyes, 84%) were commonly observed at presentation. A typical ancillary examination helped with the diagnosis of VKH. Systemic corticosteroid therapy was prescribed. The logMAR best-corrected visual acuity improved significantly from 0.74 ± 0.54 at baseline to 0.12 ± 0.24 at the 1-year follow-up visit. The recurrence rate was 18% in the follow-up visits. Erythrocyte sedimentation rate and C-reactive protein were significantly correlated to VKH recurrences. CONCLUSION Posterior uveitis, followed by mild anterior uveitis, is the typical initial manifestation in the acute phase of Chinese VKH patients. Visual outcome improvement is promising in most patients receiving systemic corticosteroid therapy in the acute phase. Detection of the clinical features at the initial onset of VKH could facilitate early treatment and better vision improvement.
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Affiliation(s)
- Chuhua Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, China
| | - Yun Wang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, China
| | - Yun Chen
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, China
| | - Hui Zhou
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, China
| | - Qiuxia Hong
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, China
| | - Xiuying Yu
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, China
| | - Tsz Kin Ng
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, China
- Shantou University Medical College, Shantou, 515041, Guangdong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ling-Ping Cen
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, China.
- Shantou University Medical College, Shantou, 515041, Guangdong, China.
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Zhao T, Cao Q, Zhou C, Wang Y, Du L, Yang P. Association Between HLA Polymorphisms and Sympathetic Ophthalmia in Han Chinese. Ocul Immunol Inflamm 2023:1-8. [PMID: 37145421 DOI: 10.1080/09273948.2023.2205930] [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: 05/06/2023]
Abstract
PURPOSE Sympathetic ophthalmia (SO) is considered as an autoimmune disease with unclear mechanisms. This study investigated the relationship between HLA polymorphisms and SO. METHODS HLA typing was performed using the LABType reverse SSO DNA typing method. The allele and haplotype frequencies were assessed using the PyPop software. Statistical significance of genotype distributions between 116 patients and 84 healthy individuals (control) was determined using Fisher's exact test or Pearson's chi-squared test. RESULTS The SO group had a higher frequency of HLA-DRB1 * 04:05, HLA-DQB1 * 04:01, DRB1 * 04:05-DQB1 * 04:01 haplotype as compared to the control group (Pc < 0.001 for all). CONCLUSION This study revealed that DRB1 * 04:05 and DQB1 * 04:01 alleles, as well as DRB1 * 04:05-DQB1 * 04:01 haplotye could be potential risk factors for SO.
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Affiliation(s)
- Tingting Zhao
- 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, People's Republic of 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, People's Republic of China
| | - Chunjiang Zhou
- 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, People's Republic of China
| | - Yao Wang
- 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, People's Republic of China
| | - Liping Du
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Henan Province Eye Hospital, Henan International Joint Research Laboratory for Ocular Immunology and Retinal Injury Repair, Zhengzhou, People's Republic of 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, People's Republic of China
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Zhuang X, Gao F, Sun Z, Ding X, Xu G. Case report: Sympathetic ophthalmia after vitrectomies in a patient with Von Hippel-Lindau syndrome. Front Med (Lausanne) 2023; 10:1118913. [PMID: 36860339 PMCID: PMC9968801 DOI: 10.3389/fmed.2023.1118913] [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: 12/08/2022] [Accepted: 01/16/2023] [Indexed: 02/17/2023] Open
Abstract
Background Sympathetic ophthalmia (SO) is a rare but sight-threatening uveitis, and most observations have been made after typical manifestations occur. This report focuses on the choroidal changes detected by multimodal imaging at the presymptomatic stage of SO, which is implicated in the early recognition of SO. Case presentation A 21-year-old woman suffered from decreased vision in the right eye and was diagnosed with retinal capillary hemangioblastomas associated with Von Hippel-Lindau syndrome. The patient underwent two 23-G pars plana vitrectomies (PPVs), soon after which typical signs of SO manifested. SO resolved quickly after the oral administration of prednisone and remained stable during the follow-up of more than 1 year. The retrospective analysis revealed preexisting bilaterally increased choroidal thickness, dots of flow void on the choroid, and choriocapillaris en-face slabs in optical coherence tomography angiography (OCTA) after the first PPV, which were all reversed by corticosteroid treatment. Conclusion The case report highlights the involvement of the choroid and choriocapillaris at the presymptomatic stage of SO after the first inciting event. Abnormally thickened choroid and flow void dots suggested that SO had started and an ensuing surgery would run the risk of exacerbating SO. OCTA scanning of both eyes should be ordered routinely for patients with a history of trauma or intraocular surgeries, especially before the next surgical intervention. The report also suggests that non-human leukocyte antigen gene variation may also regulate the progression of SO, which requires further laboratory investigations.
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Affiliation(s)
- Xiaonan Zhuang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Fengjuan Gao
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Zhongcui Sun
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Xinyi Ding
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China,*Correspondence: Gezhi Xu,
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Outcomes of patients with acute Vogt-Koyanagi-Harada disease treated with intravenous corticosteroid pulse followed by the slow tapering of oral corticosteroid therapy. Int Ophthalmol 2023; 43:431-440. [PMID: 35869402 DOI: 10.1007/s10792-022-02440-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To elucidate the intravenous corticosteroid pulse treatment outcomes of patients with acute Vogt-Koyanagi-Harada (VKH) disease and assess the differences between patients with no inflammation worsening and those with persistent or worsening inflammation. Potential factors responsible for eyes with low visual outcomes were also investigated. METHODS We retrospectively reviewed the clinical records of patients with acute VKH disease who first visited us between 2009 and 2018 and were followed up for > 300 days. Clinical characteristics, treatments, and posttreatment conditions were assessed. Patients were classified into no inflammation worsening (acute-resolved [AR]) and inflammation worsening (chronic-recurrent [CR]) groups based on conditions after 6 months from disease onset. RESULTS This study included 60 eyes from 30 patients (mean age: 52.7 years). Patients were treated with methylprednisolone pulse followed by the slow tapering of oral prednisolone; 73% of patients developed AR and 27% CR, and the best-corrected visual acuity (BCVA) was ≥ 1.0 in 83% of eyes at 6 months following the introduction of treatment. Although the total prednisolone dose was higher in patients with CR disease, no significant difference was noted in the final BCVA. Among the patients, five eyes had a final BCVA of ≤ 0.5 due to anisometropic amblyopia, diabetic maculopathy, pre-existing macular hole, epiretinal membrane, and ellipsoid zone loss. CONCLUSIONS Patients with acute VKH disease treated with corticosteroid pulse appear to demonstrate good visual outcomes, including patients with CR; the majority of eyes with low visual outcomes have pre-existing conditions that explain the low vision.
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10
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Singh RB, Perepelkina T, Testi I, Young BK, Mirza T, Invernizzi A, Biswas J, Agarwal A. Imaging-based Assessment of Choriocapillaris: A Comprehensive Review. Semin Ophthalmol 2022:1-22. [PMID: 35982638 DOI: 10.1080/08820538.2022.2109939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
PURPOSE Over the past two decades, advancements in imaging modalities have significantly evolved the diagnosis and management of retinal diseases. Through these novel platforms, we have developed a deeper understanding of the anatomy of the choroidal vasculature and the choriocapillaris. The recently developed tools such as optical coherence tomography (OCT) and OCT angiography (OCTA) have helped elucidate the pathological mechanisms of several posterior segment diseases. In this review, we have explained the anatomy of the choriocapillaris and its close relationship to the outer retina and retinal pigment epithelium. METHODS A comprehensive search of medical literature was performed through the Medline/PubMed database using search terms: choriocapillaris, choroid, quantification, biomarkers, diabetic retinopathy, age-related macular degeneration, choroidal blood flow, mean blur rate, flow deficit, optical coherence tomography, optical coherence tomography angiography, fluorescein angiography, indocyanine green angiography, OCTA, Doppler imaging, uveitis, choroiditis, white dot syndrome, tubercular serpiginous-like choroiditis, choroidal granuloma, pachychoroid, toxoplasmosis, central serous chorioretinopathy, multifocal choroiditis, choroidal neovascularization, choroidal thickness, choroidal vascularity index, choroidal vascular density, and choroidal blood supply. The search terms were used either independently or combined with choriocapillaris/choroid. RESULTS The imaging techniques which are used to qualitatively and quantitatively analyze choriocapillaris are described. The pathological alterations in the choriocapillaris in an array of conditions such as diabetes mellitus, age-related macular degeneration, pachychoroid spectrum of diseases, and inflammatory disorders have been comprehensively reviewed. The future directions in the study of choriocapillaris have also been discussed. CONCLUSION The development of imaging tools such as OCT and OCTA has dramatically improved the assessment of choriocapillaris in health and disease. The choriocapillaris can be delineated from the stromal choroid using the OCT and quantified by manual or automated methods. However, these techniques have inherent limitations due to the lack of an anatomical distinction between the choriocapillaris and the stromal choroid, which can be overcome with the use of predefined segmentation slabs on OCT and OCTA. These segmentation slabs help in standardizing the choriocapillaris imaging and obtain repeatable measurements in various conditions such as diabetic retinopathy, age-related macular degeneration, pachychoroid spectrum, and ocular inflammations. Additionally, Doppler imaging has also been effectively used to evaluate the choroidal blood flow and quantifying the choriocapillaris and establishing its role in the pathogenesis of various retinochoroidal diseases. As tremendous technological advancements such as wide-field and ultra-wide field imaging take place, there will be a significant improvement in the ease and accuracy of quantifying the choriocapillaris.
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Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.,Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Tatiana Perepelkina
- Department of Ophthalmology, Louisiana State University Health Sciences, Shreveport, LA, USA
| | - Ilaria Testi
- Department of Ophthalmology, Moorfields Eye Hospital, London, UK
| | - Benjamin K Young
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Tuba Mirza
- Department of Ophthalmology, Ascension Macomb Oakland Eye Institute, Warren, MI, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Nethralaya, Chennai, India
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.,Department of Ophthalmology, Maastricht University Medical Center, Maastricht, The Netherlands
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11
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Agarwal M, Radosavljevic A, Tyagi M, Pichi F, Al Dhanhani AA, Agarwal A, Cunningham ET. Sympathetic Ophthalmia - An Overview. Ocul Immunol Inflamm 2022; 31:793-809. [PMID: 35579612 DOI: 10.1080/09273948.2022.2058554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Sympathetic ophthalmia (SO) is rare, bilateral granulomatous panuveitis that typically occurs following penetrating or perforating ocular trauma or surgery. This review aims to provide an update on the etiopathogenesis, clinical presentations, diagnosis and treatment of SO. METHODS Reports cited in MEDLINE database, that analyzed SO in at least 5 patients, published prior to December 1st, 2021 were included. RESULTS Initially, SO was associated with penetrating ocular trauma, however, various studies reported an increased incidence of SO after surgical procedures including vitreoretinal surgeries. Multimodal imaging including fluorescein and indocyanine green angiography, optical coherence tomography (OCT) and OCT angiography have added further insights into the understanding of SO. While pulse dose corticosteroids & immunosuppressive drugs are still the treatment of choice, TNF-α blockers & other biologic drugs represent new promising agents. CONCLUSION There is a growing pool of evidence in understanding the pathogenesis of SO. Novel treatment options have provided better prognosis for this potentially blinding condition.
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Affiliation(s)
- Mamta Agarwal
- Medical Research Foundation, Sankara Nethralaya, Uveitis & Cornea Services, Chennai, India
| | | | | | - Francesco Pichi
- Eye Institute, Cleveland Clinic, Abu Dhabi, UAE.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University Cleveland, Cleveland, Ohio, USA
| | | | - Aditi Agarwal
- Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Emmett T Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA.,West Coast Retina Medical Group, San Francisco, California, USA.,The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.,Proctor Foundation, UCSF School of MedicineThe Francis I., San Francisco, California, USA
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12
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Zhuang H, Zhang R, Zhang T, Chang Q, Xu G. Clinical classification, visual outcomes, and optical coherence tomographic features of 48 patients with posterior sympathetic ophthalmia. Orphanet J Rare Dis 2022; 17:103. [PMID: 35246199 PMCID: PMC8895912 DOI: 10.1186/s13023-022-02258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 02/20/2022] [Indexed: 12/04/2022] Open
Abstract
Background To investigate the clinical manifestations, visual outcomes and optical coherence tomographic (OCT) features of patients with posterior sympathetic ophthalmia (PSO). Methods We performed a retrospective review of 48 patients diagnosed with PSO between January 2013 and December 2019. We compared the clinical and OCT features among different clinical types of PSO. Results PSO could be classified into two types according to whether the fundus exhibited serous retinal detachment (SRD) or multifocal choroiditis (MFC). There were 41 patients (85.4%) with SRD and 7 patients (14.6%) with MFC. The latent period of patients with MFC was significantly longer than that of patients with SRD (P = 0.002). The final visual acuity of patients with MFC was significantly worse than that of patients with SRD (P = 0.0001). In patients with acute SRD, OCT revealed that the mean height of retinal detachment in the fovea was 528.8 ± 437.5 μm. After treatment, the retina reattached in all patients and the band structures of the outer retina were restored in most patients (92.7%). In patients with acute MFC, the OCT images revealed inflammatory lesions on the retinal pigment epithelium layer. After treatment, the OCT images showed hyperreflective fibrosis of the lesions and loss of the outer retinal band structures in all patients. Conclusions We found that PSO could be classified according to the presence of SRD or MFC. The visual prognosis differed significantly between these types of PSO. OCT imaging is useful for clinical classification and monitoring of retinal changes after treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02258-0.
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Affiliation(s)
- Hong Zhuang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, and NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China
| | - Rui Zhang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Ting Zhang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, and NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China
| | - Qing Chang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, and NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China. .,Shanghai Key Laboratory of Visual Impairment and Restoration, and NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China.
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13
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Li M, Yang L, Cao J, Liu T, Liu X. Enriched and Decreased Intestinal Microbes in Active VKH Patients. Invest Ophthalmol Vis Sci 2022; 63:21. [PMID: 35142786 PMCID: PMC8842635 DOI: 10.1167/iovs.63.2.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose To determine the possible microbiome related to Vogt–Koyanagi–Harada (VKH) disease in comparison to patients with noninfectious anterior scleritis and healthy people. Methods Fecal samples were extracted from 42 individuals, including 11 patients with active VKH, 11 healthy people, and 20 patients with noninfectious anterior scleritis. We amplified the V3 to V4 16S ribosomal DNA (rDNA) region to obtain the target sequence. Then, the target sequence was amplified by polymerase chain reaction. The obtained target sequences were sequenced by high-throughput 16S rDNA analysis. Results At the genus level, there were three enriched (Stomatobaculum, Pseudomonas, Lachnoanaerobaculum) and two depleted (Gordonibacter, Slackia) microbes that were detected only in patients with VKH. There were 10 enriched and 12 depleted microbes that were observed in both patients with VKH disease and noninfectious anterior scleritis (P < 0.05). The interactions of these microbes were graphed. Tyzzerella and Eggerthella were the nodes of interaction between these microorganisms, which were regulated by both positive and negative aspects, but the expression level in patients with active VKH was upregulated. Conclusions Special or nonspecial enrichment and decreased intestinal microbes were observed in patients with active VKH. The action mechanism of these microbes needs further study.
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Affiliation(s)
- Mengyao Li
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China.,Clinical College, Jilin University, Changchun, P.R. China
| | - Li Yang
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
| | - Jinfeng Cao
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
| | - Tao Liu
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
| | - Xiaoli Liu
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
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14
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Zou Y, Li JJ, Xue W, Kong X, Duan H, Li Y, Wei L. Epigenetic Modifications and Therapy in Uveitis. Front Cell Dev Biol 2021; 9:758240. [PMID: 34869347 PMCID: PMC8636745 DOI: 10.3389/fcell.2021.758240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/28/2021] [Indexed: 12/12/2022] Open
Abstract
Uveitis is a sight-threatening intraocular inflammation, and the exact pathogenesis of uveitis is not yet clear. Recent studies, including multiple genome-wide association studies (GWASs), have identified genetic variations associated with the onset and progression of different types of uveitis, such as Vogt–Koyanagi–Harada (VKH) disease and Behcet’s disease (BD). However, epigenetic regulation has been shown to play key roles in the immunoregulation of uveitis, and epigenetic therapies are promising treatments for intraocular inflammation. In this review, we summarize recent advances in identifying epigenetic programs that cooperate with the physiology of intraocular immune responses and the pathology of intraocular inflammation. These attempts to understand the epigenetic mechanisms of uveitis may provide hope for the future development of epigenetic therapies for these devastating intraocular inflammatory conditions.
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Affiliation(s)
- Yanli Zou
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, China.,State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Jing Jing Li
- State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Wei Xue
- State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Xiangbin Kong
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, China
| | - Hucheng Duan
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, China
| | - Yiqun Li
- Department of Orthopaedics, Affiliated Foshan Hospital, Southern Medical University, Foshan, China
| | - Lai Wei
- State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
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15
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Paulbuddhe V, Addya S, Gurnani B, Singh D, Tripathy K, Chawla R. Sympathetic Ophthalmia: Where Do We Currently Stand on Treatment Strategies? Clin Ophthalmol 2021; 15:4201-4218. [PMID: 34707340 PMCID: PMC8542579 DOI: 10.2147/opth.s289688] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/30/2021] [Indexed: 01/05/2023] Open
Abstract
Sympathetic ophthalmia is a rare bilateral diffuse granulomatous panuveitis that usually results from surgical or penetrating trauma to one eye. The symptoms range from impaired near vision to pain, photophobia, and loss of visual acuity. Anterior segment manifestations include bilateral acute uveitis with mutton-fat keratic precipitates and posterior segment findings include vitritis, multifocal neurosensory retinal detachment, choroiditis, optic nerve edema, and Dalen-Fuchs nodules. The diagnosis is clinical. Ancillary investigations include fundus fluorescein angiography, indocyanine green angiography, optical coherence tomography (OCT), ultrasound B scan, and autofluorescence imaging. The management options include corticosteroids (topical and systemic) as the first line along with immunomodulatory therapy started at the presentation of the disease. Recent advances include imaging with OCT-angiography, enhanced depth imaging-OCT (EDI-OCT, choroidal vascular index/CVI), targeting IL-23/IL-17 pathway, and use of biologics for the management of this rare entity. Recent advances in early diagnosis and prompt treatment has led to improved final visual outcomes in both the sympathizing and exciting eye. This review is aimed at giving a comprehensive overview of sympathetic ophthalmia along with a special emphasis on current treatment strategies and recent advances.
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Affiliation(s)
- Vivek Paulbuddhe
- Department of Vitreoretina, ASG Eye Hospital, Guwahati, 781006, Assam, India
| | - Sujit Addya
- Department of Vitreoretina, ASG Eye Hospital, Guwahati, 781006, Assam, India
| | - Bharat Gurnani
- Department of Cornea, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, 605007, Puducherry, India
| | - Dheerendra Singh
- Department of Retina, ASG Eye Hospital, Bhopal, 462016, Madhya Pradesh, India
| | - Koushik Tripathy
- Department of Vitreoretina, ASG Eye Hospital, Kolkata, 700058, West Bengal, India
| | - Rohan Chawla
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, 110029, India
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16
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Hashimoto Y, Matsui H, Michihata N, Ishimaru M, Yasunaga H, Aihara M, Kaburaki T. Incidence of Sympathetic Ophthalmia after Inciting Events: A National Database Study in Japan. Ophthalmology 2021; 129:344-352. [PMID: 34560127 DOI: 10.1016/j.ophtha.2021.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/31/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To analyze the incidence of sympathetic ophthalmia (SO) after inciting events (eye trauma or intraocular surgery). DESIGN Retrospective cohort study. PARTICIPANTS Patients experiencing inciting events between 2012 and 2019. Onset of SO was defined as the first date of SO diagnosis. METHODS Using a nationwide administrative claims database in Japan, we calculated the cumulative incidence of SO after inciting events stratified by sex, 10-year age groups, and a categorical variable of primary or repeated, reflecting the history of inciting events in the past year (no inciting events, inciting events without trauma, or inciting events with trauma) using the Kaplan-Meier approach. We also estimated the adjusted hazard ratio (aHR) by Cox regression. We then restricted the population to those with only 1 inciting event during the observation period to investigate the pure effect of each inciting event. MAIN OUTCOME MEASURES Cumulative incidence of SO over 60 months. RESULTS A total of 888 041 inciting events (704 717 patients) were eligible. The total number of SO cases was 263, and the cumulative incidence of SO was 0.044% over 60 months. Female sex was not associated with onset of SO (aHR, 1.01; 95% confidence interval [CI], 0.79-1.29; P = 0.95). The group 40 to 49 years of age showed the highest incidence of 0.104% among the age groups (aHR vs. ≥80 years of age group [0.041%], 2.44 [95% CI, 1.56-3.80]; P < 0.001). Repeated inciting events with and without trauma showed higher incidences of SO (0.469% and 0.072%, respectively) than primary inciting events (0.036%) (aHR 11.68 [7.74-17.64] and 2.21 [95% CI, 1.59-3.07], respectively); P < 0.001 and P < 0.001, respectively). The incidence of SO after vitrectomy was much lower than after trauma (0.016% vs. 0.073%), and the incidence after scleral buckling was even lower. CONCLUSIONS The cumulative incidence of SO over 60 months was estimated to be 0.044% at minimum. Repeated inciting events, especially those with trauma, increased the risk of SO developing. Trauma was 4 to 5 times as likely to induce SO than vitrectomy. The present findings will be valuable for counseling patients about the risks of SO after trauma and before performing intraocular surgeries.
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Affiliation(s)
- Yohei Hashimoto
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miho Ishimaru
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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17
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Shen J, Zhang Z, Ye D, Wen Z, Shu X, Chen Z. Sympathetic ophthalmia after vitreoretinal surgery: a report of two cases. J Int Med Res 2021; 49:3000605211032782. [PMID: 34382463 PMCID: PMC8366150 DOI: 10.1177/03000605211032782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sympathetic ophthalmia (SO) is a panuveitis that usually occurs after trauma to one eye. We describe two cases of SO occurring after 23-gauge vitrectomy. Case 1 involved a 66-year-old woman who underwent pars plana vitrectomy (PPV) for a rhegmatogenous retinal detachment. Two months later, she presented with decreased visual acuity (VA) and bilateral uveitis. Case 2 involved a 43-year-old woman who underwent a second PPV for recurrent retinal detachment. Two months later, she presented with bilateral panuveitis. Both patients were diagnosed with SO and were treated with methylprednisolone and cyclosporine. The first patient was further treated with a dexamethasone intravitreal implant (Ozurdex®) owing to the side effects of methylprednisolone. The VA and symptoms improved significantly after treatment in both patients. Bilateral granulomatous panuveitis following PPV should alert surgeons to consider SO. Appropriate interventions for SO can produce positive outcomes.
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Affiliation(s)
- Junhui Shen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zheng Zhang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Dian Ye
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zuohui Wen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xupeng Shu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zhiqing Chen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
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18
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Kaza H, Tyagi M, Agarwal K, Behera S, Pappuru RR, Mohan S, Saldanha M, Videkar C, Basu S, Pathengay A, Murthy S. Vogt Koyanagi Harada Disease In Paediatric Age Group: Clinical Characteristics, Remission, Recurrences and Complications in Asian Indian Population. Semin Ophthalmol 2021; 37:187-192. [PMID: 34224303 DOI: 10.1080/08820538.2021.1948067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe disease characteristics and outcomes of Vogt-Koyanagi-Harada (VKH) syndrome in paediatric patients. STUDY DESIGN Retrospective chart analysis. METHODS: A RETROSPECTIVE Analysis of all patients ≤16 years with VKH syndrome was done. Clinical presentations, complications, recurrences and outcomes in cases of paediatric VKH were reviewed. RESULTS 72 eyes of 36 patients with a mean age at presentation of 13.7 ± 2.34 years were assessed. Mean duration of symptoms and follow up were 9.88 ± 17.3 weeks and 55 months respectively. Clinical signs at presentation included anterior chamber cells >2+(34/72eyes, 47.2%), granulomatous keratic precipitates (6 eyes, 8.3%), posterior synechiae (35 eyes,48.6%), disc edema (46 eyes, 63.8%), neurosensory retinal detachments (44 eyes, 61.1%) and 'sunset-glow' fundus (9 eyes, 12.5%). Best corrected visual acuity (BCVA) at the time of presentation was 1.3logMAR or a Snellens equivalent of 20/400 which improved to 0.51logMAR (Snellens equivalent of 20/63) at last follow up. Remission was achieved in 61.1% cases. More than half of our patients developed one or more complications. CONCLUSION VKH in paediatric patients poses a challenge due to a delayed presentation and paediatric VKH patients have a worse visual acuity at the time of presentation as compared to adult age groups. Rates of remission may be low along with high risk of complications and hence there is a need for prolonged immunosuppression.
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Affiliation(s)
- Hrishikesh Kaza
- Uveitis and Ocular Immunology Services, LV Prasad Eye Institute, Hyderabad, India
| | - Mudit Tyagi
- Uveitis and Ocular Immunology Services, LV Prasad Eye Institute, Hyderabad, India.,Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L.V. Prasad Eye Institute, Hyderabad, India
| | - Komal Agarwal
- Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L.V. Prasad Eye Institute, Hyderabad, India
| | - Shashwat Behera
- Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L.V. Prasad Eye Institute, Hyderabad, India
| | - Rajeev R Pappuru
- Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L.V. Prasad Eye Institute, Hyderabad, India
| | - Sashwanthi Mohan
- Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L.V. Prasad Eye Institute, Hyderabad, India
| | - Merlin Saldanha
- Uveitis and Retina Services, GMRV Campus, L.V. Prasad Eye Institute, Visakhapatnam, India
| | - Chetan Videkar
- Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L.V. Prasad Eye Institute, Hyderabad, India
| | - Soumyava Basu
- Uveitis and Ocular Immunology Services, LV Prasad Eye Institute, Hyderabad, India
| | - Avinash Pathengay
- Uveitis and Retina Services, GMRV Campus, L.V. Prasad Eye Institute, Visakhapatnam, India
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19
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Hosseini SM, Shoeibi N, Azimi Zadeh M, Ghasemi M, Abrishami M. Persumed sympathetic Ophthalmia after scleral buckling surgery: case report. J Ophthalmic Inflamm Infect 2021; 11:4. [PMID: 33615391 PMCID: PMC7897590 DOI: 10.1186/s12348-020-00233-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Scleral buckling (SB) is usually considered an extraocular operation premeditated to have a low risk of sympathetic ophthalmia (SO). Here we report a rare case of presumed SO in a young female patient following SB. Case presentation A nineteen-year-old female patient was referred for visual loss in her left eye due to macula off inferior long-standing rhegmatogenous retinal detachment (RRD). The best corrected visual acuity (BCVA) was 20/400 in the left eye. SB with 360 degrees encircling band, an inferior segmental tire with one spot cryoretinopexy at the break site, and subretinal fluid drainage was performed. BCVA was improved to 20/80 and the retina was totally attached 1 week after the operation. The patient referred to the hospital 6 weeks later with severe visual loss in both eyes as counting finger 1 m. Patient examination indicated bilateral multifocal serous retinal detachment (SRD) and vitreous cells. The patient, diagnosed with SO, received intravenous corticosteroid pulse therapy and mycophenolate mofetil for treatment. The inflammation was controlled and SRD resolved after a 5-day intravenous treatment without being relapsed after 6 months. Consequently, BCVA became 20/20 and 20/50 in the right and left eye, respectively, after 6 months. The findings of systemic workup were negative for any extraocular disease or systemic involvement. Conclusion Since SB is a procedure without manipulating intraocular tissues, it is considered to impose a low risk for SO. This report presented SO occurrence after successful SB. Some factors may induce SO, including inciting the choroid and retinal pigment epithelium with cryoretinopexy or perforating for drainage.
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Affiliation(s)
- Seyedeh Maryam Hosseini
- Eye Research Center, Khatam-al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Qarani Boulevard, Mashhad, 9195965919, Iran
| | - Nasser Shoeibi
- Eye Research Center, Khatam-al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Qarani Boulevard, Mashhad, 9195965919, Iran
| | - Mahdieh Azimi Zadeh
- Eye Research Center, Khatam-al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Qarani Boulevard, Mashhad, 9195965919, Iran
| | - Mahdi Ghasemi
- Eye Research Center, Khatam-al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Qarani Boulevard, Mashhad, 9195965919, Iran
| | - Mojtaba Abrishami
- Eye Research Center, Khatam-al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Qarani Boulevard, Mashhad, 9195965919, Iran.
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20
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Agarwal M, Radosavljevic A, Patnaik G, Rishi E, Pichi F. Diagnostic Value of Optical Coherence Tomography in the Early Diagnosis of Macular Complications in Chronic Vogt-Koyanagi-Harada Disease. Ocul Immunol Inflamm 2020; 30:801-808. [PMID: 33136534 DOI: 10.1080/09273948.2020.1833225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe the role of optical coherence tomography (OCT) in detecting subclinical choroidal inflammation and early diagnosis of macular complications in chronic Vogt-Koyanagi-Harada (VKH) disease with sunset glow fundus. METHODS Retrospective observational study. Clinical features, OCT images, treatment, and visual outcome were analyzed. RESULTS Fourteen patients (9 females and 5 males) were included in the study. Mean age was 39 years (range 7-67 years). Mean duration of disease was 5.25 years (range 1-15 years). Anterior uveitis was seen in 14 eyes (52%). Fundus examination showed sunset glow fundus in all patients with no obvious macular pathology. OCT showed macular edema in 16 eyes (59%), choroidal neovascular membrane in 8 eyes (30%), and macular hole in 3 eyes (11%). CONCLUSION OCT should be regularly used to detect subclinical inflammation and early macular complications in chronic VKH disease where sunset glow fundus may delay the clinical diagnosis thus causing permanent damage.
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Affiliation(s)
- Mamta Agarwal
- Uveitis & Cornea Services, Sankara Nethralaya, Chennai, India
| | | | - Gazal Patnaik
- Uveitis Services, Sankara Nethralaya, Chennai, India
| | - Ekta Rishi
- Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Francesco Pichi
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
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21
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Rua D, Pohlmann D, Pleyer U. Sympathetic Ophthalmia - a Contribution to Immunology, Clinic and Current Imaging. Klin Monbl Augenheilkd 2020; 237:1060-1069. [PMID: 32967030 DOI: 10.1055/a-1245-4373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Sympathetic ophthalmia (SO) is a rare inflammation of an operated or injured eye that spreads to the fellow eye. It is typically a bilateral granulomatous panuveitis. The traumatized eye is referred to as inciting eye and the fellow eye as sympathizing eye. The pathophysiology of the disease is not entirely understood, but there is strong evidence of an autoimmune genesis. PATIENTS/MATERIAL AND METHODS A selective literature search on epidemiology, immunology, clinical features and risk factors of SO was carried out. In addition, our own experience using multimodal imaging for this clinical entity was introduced. RESULTS In the literature, the incidence after traumatic eye injuries is 0.1 - 3% and approximately 0.01% after intraocular surgery. Among the iatrogenic causes, vitreoretinal surgery has the highest rate of SO, presumably due to disruption of the blood-retinal barrier and involvement of retinal and choroidal tissue, which are susceptible to anterior traction, phthisis and chronic inflammation. In 90% of patients, the disease develops within a year following the eliciting event and is associated with a potentially bilateral risk of blindness. Typical symptoms include bilateral visual impairment with photophobia, dull pain and photopsia. The spectrum of clinical manifestations ranges from granulomatous anterior uveitis and vitritis, to choroiditis, serous retinal detachment and Dalen-Fuchs nodules in the context of posterior involvement. The diagnosis of SO is generally based on clinical presentation and is supported by imaging methods. These primarily comprise fluorescein and indocyanine green angiography, which are increasingly being supplemented by non-invasive methods such as optical coherence tomography. They can provide important information for assessment of severity, differential diagnosis as well as for disease monitoring. The differential diagnosis includes i. a. Vogt-Koyanagi-Harada syndrome, ocular sarcoidosis and the rare phacoanaphylactic endophthalmitis. Immediate systemic high-dose steroid therapy is used as initial treatment. The course of the disease is often relapsing to chronic progressive. Immunomodulators such as ciclosporine A, azathioprine, cyclophosphamide, mycophenolate mofetil, and biologics are increasingly being used and contribute to the significantly better prognosis of the disease. Generally, SO can be triggered by any kind of intraocular intervention. CONCLUSION SO remains a threatening clinical diagnosis that poses diagnostic and therapeutic challenges. It can be triggered post-traumatic, but also any intraocular surgery. This should be taken into account when assessing the indication for intraocular eye surgery, especially in eyes with reduced visual outcome.
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Affiliation(s)
- David Rua
- Universitäts-Augenklinik, Charité Campus Virchow-Klinik, Berlin
| | | | - Uwe Pleyer
- Universitäts-Augenklinik, Charité Campus Virchow-Klinik, Berlin
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22
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Dexamethasone pharmacokinetics characteristics via sub-tenon microfluidic system in uveitis rabbits. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Zhong Z, Su G, Kijlstra A, Yang P. Activation of the interleukin-23/interleukin-17 signalling pathway in autoinflammatory and autoimmune uveitis. Prog Retin Eye Res 2020; 80:100866. [PMID: 32422390 DOI: 10.1016/j.preteyeres.2020.100866] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 02/07/2023]
Abstract
Uveitis is a group of diseases characterized by intraocular inflammation, of which some are driven by autoinflammatory or autoimmune responses, such as Vogt-Koyanagi-Harada disease, Behçet's disease, uveitis associated with spondyloarthritis, ocular sarcoidosis, sympathetic ophthalmia and birdshot chorioretinopathy. These entities have various clinical forms, but genetic and biomarker data suggest that they share a common molecular basis, activation of the Interleukin (IL)-23/IL-17 pathway. Multiple factors including genetic predisposition, various cytokine imbalances, infectious agents and gut alterations are found to trigger an aberrant response of this pathway. The enhanced activity of the IL-23/IL-17 pathway is committed to the expansion and pathogenicity of Th17 cells. Evidence from animal models demonstrates that the development of pathogenic Th17 cells is responsible for the induction of experimental autoimmune uveitis. Further findings indicate that retinal pigment epithelium (RPE) cells may be a target of IL-17. IL-17 triggers downstream inflammatory cascades and causes dysfunction of RPE cells, which may affect retinal barrier function and thereby promote intraocular inflammation. Currently, several emerging drugs blocking the IL-23/IL-17 pathway have been assessed for the treatment of uveitis in pilot studies. The purpose of this is to summarize updated biological knowledge and preliminary clinical data, providing the rationale for further development and evaluation of novel drugs targeting the IL-23/IL-17 pathway in autoinflammatory and autoimmune uveitis. Future studies may focus on translational medicine targeting the IL-23/IL-17 pathway for the improvement of diagnosis and treatment of uveitis. In conclusion, activation of the IL-23/IL-17 pathway is a critical biological event and can be an important target for the treatment of autoinflammatory and autoimmune uveitis.
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Affiliation(s)
- Zhenyu Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China
| | - Aize Kijlstra
- University Eye Clinic Maastricht, Maastricht, the Netherlands
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China.
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