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Tanikawa A, Maruyama K, Liu S, Mao Z, Wang Z, Shiraki N, Hashida N, Kawasaki R, Chan K, Nishida K. Unveiling Key Pathological Indicators for Disease Progression in Vogt Koyanagi Harada Disease and Sympathetic Ophthalmia Through Advanced Choroidal Volume Analysis. Ocul Immunol Inflamm 2024:1-9. [PMID: 38709183 DOI: 10.1080/09273948.2024.2337836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/27/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To evaluate the association between quantitative parameters derived from volume analysis of optical coherence tomography (OCT) data and disease worsening in Vogt-Koyanagi-Harada disease (VKHD) and sympathetic ophthalmia (SO). METHODS This retrospective study, conducted at Osaka University Hospital, employed swept-source OCT scans from patients diagnosed with VKHD or SO between October 2012 and January 2021. The choroidal vessel structure was segmented and visualized in three dimensions, generating quantitative vessel volume maps. Region-specific choroidal vessel volume (CVV), choroidal volume (CV), and vessel index (VI) were scrutinized for their potential correlation with disease severity. RESULTS Thirty-five eyes of 18 VKHD and 2 SO patient (8 females, 10 males) were evaluated. OCT-derived CVV maps revealed regional CV alterations in VKHD and SO patients. Two parameters, i.e. CV at 3- and 6-month follow-ups (p = 0.044, p = 0.040, respectively, with area under the ROC curve of 0.70) and CVV at 6 months (p = 0.046, area under the ROC curve of 0.71), were significantly higher in recurrent VKHD and SO compared to effectively treated cases. CONCLUSIONS The volume analysis of OCT images facilitates a three-dimensional visualization of choroidal alterations, which may serve as a reflection of disease severity in VKHD and SO patients. Furthermore, noninvasive initial CVV or CV measurements may serve as potential biomarkers for predicting disease recurrence in VKHD and SO.
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Affiliation(s)
- Akira Tanikawa
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Kazuichi Maruyama
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
- Department of Vision Informatics, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Osaka, Japan
| | - Shiyi Liu
- Topcon Advanced Biomedical Imaging Laboratory, Oakland, New Jersey
| | - Zaixing Mao
- Topcon Advanced Biomedical Imaging Laboratory, Oakland, New Jersey
| | - Zhenguo Wang
- Topcon Advanced Biomedical Imaging Laboratory, Oakland, New Jersey
| | - Nobuhiko Shiraki
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Noriyasu Hashida
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Ryo Kawasaki
- Artificial Intelligence Center for Medical Research and Application, Osaka University Hospital, Suita, Osaka, Japan
- Graduate Scholl of Medicine/Division of Environmental Medicine and Population Science/Department of Social and Environmental Medicine, Osaka University, Suita, Osaka, Japan
| | - Kinpui Chan
- Topcon Advanced Biomedical Imaging Laboratory, Oakland, New Jersey
| | - Kohji Nishida
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Osaka, Japan
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Sugiyama R, Ohnishi T, Yamagami S, Nagaoka T. A case of acute syphilitic posterior placoid chorioretinitis showing improved choroidal blood flow after treatment. Am J Ophthalmol Case Rep 2023; 32:101880. [PMID: 37456147 PMCID: PMC10339182 DOI: 10.1016/j.ajoc.2023.101880] [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: 03/02/2023] [Revised: 05/29/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Acute syphilitic posterior placoid chorioretinitis (ASPPC) is a rare form of ocular syphilis. However, its pathophysiology is not fully understood. Laser speckle flowgraphy (LSFG) can facilitate the non-invasive evaluation of blood flow and allow investigations into the effects of treatments in various ocular diseases. We report a case of ASPPC that presented with symptoms only in the right eye but showed bilateral disease in LSFG. Observations A 54-year-old man presented with decreased vision and visual field defects in the right eye 2 days prior to the initial visit. Fundoscopy images showed a typical yellowish placoid lesion in the macular area, and optical coherence tomography showed disruption of the outer retinal layers and nodular appearance of the retinal pigment epithelium. Fluorescence angiography showed excessive leakage of the placoid lesion characterized by hypofluorescent dots in the inner area ("leopard spotting"). The patient was diagnosed with unilateral ASPPC based on multiple imaging and serological tests. Penicillin was administered for 2 weeks, and the patient showed improvement in symptoms and restoration of the retinal structure. The mean blur rate of the right/left eye was 2.1/5.9 arbitrary units (AU) before treatment and increased to 4.5/9.3 AU 6 months after treatment. Conclusions and importance Despite the absence of typical imaging signs and symptoms in the left eye, both eyes may have been affected with different degrees of severity. Thus, LSFG may facilitate the evaluation of treatment effects and the prediction of ocular inflammatory diseases in the early stages.
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Affiliation(s)
| | - Takako Ohnishi
- Corresponding author. Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
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3
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De novo Vogt-Koyanagi-Harada disease after vaccination for COVID-19, successfully treated with systemic steroid therapy and monitored with laser speckle flowgraphy. Am J Ophthalmol Case Rep 2022; 27:101616. [PMID: 35719316 PMCID: PMC9187874 DOI: 10.1016/j.ajoc.2022.101616] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Vogt-Koyanagi-Harada (VKH) disease after vaccination for coronavirus disease 2019 (COVID-19) is rare, and the prognosis for this condition and its effect on ocular blood flow remains unclear. The purpose of this paper is to present the first case of de novo VKH disease after the second vaccination for COVID-19 with an mRNA vaccine that was successfully treated with systemic steroid therapy and monitored with laser speckle flowgraphy (LSFG). Observations A 30s-year-old Japanese woman reported bilateral decreased visual function 2 weeks after receiving a second dose of the BNT162b2 mRNA vaccine. Best-corrected visual acuity was 20/50 OD and 20/70 OS. Optical coherence tomography revealed bilateral serous retinal detachment over the swollen choroidal layer. LFSG showed decreased blood flow in the peripapillary region of both eyes. This case was diagnosed as complete VKH syndrome, and the patient underwent systemic steroid therapy. After treatment, the retinal detachment disappeared, choroidal thickness decreased, and ocular blood flow increased. Three months later, visual acuity recovered to 20/20 in both eyes. Conclusions Caution should be exercised in cases with visual symptoms after COVID-19 vaccination, even after more than one dose and more than one week after vaccination. LSFG may be a useful way to measure the ocular blood flow response to treatment and determine the prognosis for VKH disease after COVID-19 vaccination.
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4
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Haneda M, Hashimoto Y, Mishima A, Saito D, Yoshitomi T. Changes in choroidal circulation hemodynamics during the menstrual cycle in young, healthy women. PLoS One 2022; 17:e0270501. [PMID: 35759478 PMCID: PMC9236247 DOI: 10.1371/journal.pone.0270501] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/10/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose The current study aimed to investigate the time course of changes in choroidal circulation hemodynamics and their relationship to systemic circulation dynamics during the normal menstrual cycle in young, healthy women using laser speckle flowgraphy (LSFG). Methods This prospective study included 26 eyes from 13 young, healthy women (21.3 ± 4.0 years) with a normal menstrual cycle and 24 eyes from 12 young, healthy men (21.8 ± 4.4 years) as a control group. The macular mean blur rate (MBR), a quantitative index of relative blood flow velocity in the choroid, was measured using LSFG. MBR, intraocular pressure (IOP), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and ocular perfusion pressure (OPP) were evaluated in the late follicular phase and mid-luteal phase in women and at baseline and 10 days after baseline in men, respectively. Results In the female group, IOP, SBP, DBP, MBP, and OPP values were significantly higher in the mid-luteal phase than those observed in the late follicular phase (P = 0.035, P < 0.001, P = 0.041, P = 0.001, P = 0.014, respectively). The average macular MBR values in the late follicular phase and mid-luteal phase were 12.7 ± 5.3 and 13.7 ± 6.6 (+7.7 ± 19.4%), representing a significant increase in the mid-luteal phase (P = 0.041). The rate of change in MBR exhibited a significant positive correlation with changes in DBP and MBP (R = 0.456, P = 0.019 and R = 0.474, P = 0.014). However, there were no significant changes in any of the factors in the male group during the study period. Conclusions Our results suggest that in young, healthy women with a normal menstrual cycle, choroidal blood flow velocity decreases during the late follicular phase and increases during the mid-luteal phase, depending on systemic circulatory dynamics.
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Affiliation(s)
- Mayumi Haneda
- Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Yuki Hashimoto
- Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka, Japan
- * E-mail:
| | - Airi Mishima
- Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Daichi Saito
- Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Takeshi Yoshitomi
- Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka, Japan
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5
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Agarwal A, Invernizzi A. The Role of Optical Coherence Tomography and Optical Coherence Tomography Angiography in the Differential Diagnosis of Posterior Uveitis. Ocul Immunol Inflamm 2022; 30:682-689. [PMID: 35593586 DOI: 10.1080/09273948.2022.2071743] [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
PURPOSE Modalities such as optical coherence tomography (OCT) and OCT angiography (OCTA) have improved the diagnostic utility of fundus imaging in management of uveitis. The purpose of this study is to review role of OCT and OCTA in differential diagnosis of certain posterior uveitic entities. METHODS Narrative review. RESULTS In this review, we have comprehensively summarized the utility of OCT and OCTA in helping the clinician diagnose common but challenging inflammatory conditions including ocular toxoplasmosis, viral retinitis, and vitreoretinal lymphoma, among others. OCT and OCTA can also be used to assess the choriocapillaris involvement in conditions such as multiple evanescent white dot syndrome, and choroidal granulomas in tubercular and sarcoid uveitis. CONCLUSIONS Fundus imaging with OCT and OCTA has assumed a significant role in establishing the diagnosis in uveitis apart from microbiological and other laboratory analysis. Advantages such as rapidity and non-invasiveness make these imaging modalities very useful and convenient.
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Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology, Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Alessandro Invernizzi
- Department of Biomedical and Clinical Science "Luigi Sacco," Eye Clinic, University of Milan, Milan, Italy.,The Discipline of Clinical Ophthalmology and Eye Health, Save Sight Institute, Sydney Eye Hospital, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
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6
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Liang A, Jia S, Gao F, Han X, Pei M, Qu Y, Xiao J, Zhao C, Zhang M. Decrease of choriocapillary vascular density measured by optical coherence tomography angiography in Vogt-Koyanagi-Harada disease. Graefes Arch Clin Exp Ophthalmol 2021; 259:3395-3404. [PMID: 34216256 PMCID: PMC8523392 DOI: 10.1007/s00417-021-05238-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/01/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Changes of choroidal circulation throughout the disease course of Vogt-Koyanagi-Harada (VKH) disease and the clinical significance remain unclear. Choriocapillary vascular density (CC VD) measured by optical coherence tomography angiography (OCTA) were compared in different disease stages of VKH and its correlation with other parameters was analyzed, aiming to explore their clinical relevance. METHODS This is a retrospective case series. One hundred and fourteen VKH patients and 47 normal controls (NCs) were included. Patients were grouped into the acute uveitic, convalescent, and chronic recurrent stages (only anterior recurrent cases included), and OCTA images were obtained from VKH patients in these stages. Best corrected visual acuity (BCVA), CC VD, and subfoveal choroidal thickness (SFCT) were recorded and compared. RESULTS CC VD in acute (58.26% ± 0.84%), convalescent (64.85% ± 0.33%), and chronic recurrent (62.78% ± 0.70%) stage of VKH patients were all significantly lower than that in NCs (66.37% ± 0.41%) (p < 0.001, p = 0.017, and p < 0.001, respectively). CC VD increased by 6.59% ± 0.91% with resolution of acute inflammation (p < 0.001) and decreased by 2.07% ± 0.74% during anterior uveitis relapse (p = 0.009). Patients with a positive history of anterior recurrence had lower CC VD (- 2.43% ± 0.75%, p = 0.003) in the convalescent stage than those without. CC VD was negatively correlated with logMAR BCVA in VKH (r = - 0.261, p < 0.001). CONCLUSION CC VD was decreased in every stage of VKH. CC VD has the potential to reflect the status of uveitis and might be promising in monitoring the disease activity. OCTA is a convenient and straightforward tool to evaluate choroidal vascularity, and CC VD provides supplemental quantitative information of the choriocapillaris. Further studies are needed to explore the values of OCTA quantitative parameters in monitoring VKH progression, predicting visual prognosis, and guiding clinical decisions.
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Affiliation(s)
- Anyi Liang
- Department of Ophthalmology, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Shanshan Jia
- Department of Ophthalmology, The Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Shenzhen, 518020, China
| | - Fei Gao
- Department of Ophthalmology, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Xiaoxu Han
- Department of Ophthalmology, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Minghang Pei
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yi Qu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, 100191, China
| | - Junyan Xiao
- Department of Ophthalmology, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Chan Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China. .,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China.
| | - Meifen Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China. .,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China.
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Matsumoto M, Suzuma K, Akiyama F, Yamada K, Harada S, Tsuiki E, Kitaoka T. Retinal Microvascular Resistance Estimated from Waveform Analysis Is Significantly Higher With a Threshold Value in Central Retinal Vein Occlusion. Transl Vis Sci Technol 2020; 9:4. [PMID: 33288991 PMCID: PMC7571322 DOI: 10.1167/tvst.9.11.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose Evaluation of blood flow is useful for understanding the severity of central retinal vein occlusion (CRVO). Actual blood flow may be determined by the resistivity of the retinal vein in CRVO. We have previously evaluated mean blur rate (MBR) to reflect total retinal blood flow velocity in CRVO cases using laser speckle flowgraphy (LSFG). This study evaluated retinal total vascular resistance in CRVO cases using the new index of total capillary resistance (TCR) from LSFG. Methods We measured the TCR of 68 CRVO patients who visited Nagasaki University Hospital between 2009 and 2016 and 42 age-matched controls without systemic disease. We compared TCRs among control eyes, CRVO fellow eyes, and CRVO affected eyes. A CRVO threshold value was then obtained from the receiver operating characteristic curve. Results MBR was significantly lower for CRVO affected eyes (20.3 ± 8.2) than for control eyes (37.5 ± 8.4; P < 0.01) and CRVO fellow eyes (36.4 ± 10.0; P < 0.01, Dunn's test). TCR was significantly higher for CRVO affected eyes (1.20 ± 0.55) than for control eyes (0.68 ± 0.2; P < 0.01) and CRVO fellow eyes (0.81 ± 0.28; P < 0.01, Dunn's test). The threshold for the presence of CRVO was 0.93 and area under the curve was 0.84. Conclusions By measuring TCR in addition to MBR, more detailed information regarding CRVO pathology can be obtained. Translational Relevance Comparison of values before and after treatment may be useful for evaluating the effects of treatment.
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Affiliation(s)
- Makiko Matsumoto
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Kiyoshi Suzuma
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Kagawa University, Kagawa, Japan
| | - Fumito Akiyama
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Kanako Yamada
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Shiori Harada
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Eiko Tsuiki
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takashi Kitaoka
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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8
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Urzua CA, Herbort C, Valenzuela RA, Abu El-Asrar AM, Arellanes-Garcia L, Schlaen A, Yamamoto J, Pavesio C. Initial-onset acute and chronic recurrent stages are two distinctive courses of Vogt-Koyanagi-Harada disease. J Ophthalmic Inflamm Infect 2020; 10:23. [PMID: 32924094 PMCID: PMC7487280 DOI: 10.1186/s12348-020-00214-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 08/13/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To describe distinctive stages of Vogt-Koyanagi-Harada (VKH) disease: initial-onset acute versus chronic recurrent disease. METHODS A comprehensive literature review regarding stages and clinical presentations of VKH disease was conducted. RESULTS Despite a list of signs that has been described as characteristic features of early or late phases of VKH disease, the current classification -developed by an international committee and published in 2001- does not consider a distinction regarding the time from onset of disease symptoms, and specific findings observed at certain time point from the symptoms presentation and outcomes related to the stage of VKH disease. In that sense, chronic recurrent VKH disease is more refractory to treatment and is associated with a higher rate of complications. Accordingly, this subset of VKH patients has poorer functional and anatomical outcomes than patients with an initial-onset acute disease. CONCLUSIONS An early clear distinction of VKH phenotype [Initial-onset acute versus chronic recurrent disease] should be considered in each clinical scenario, evaluating the delay in diagnosis and the clinical presentation, since it may help clinicians to perform a correct disease prognosis categorization and thus to make treatment decisions in terms of potential refractoriness or expected clinical outcomes.
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Affiliation(s)
- Cristhian A Urzua
- Department of Ophthalmology, Faculty of Medicine, University of Chile, Independencia, 1027, Santiago, Chile. .,Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile. .,Facultad de Medicina, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile.
| | - Carl Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.,Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
| | - Rodrigo A Valenzuela
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile.,Departamento de Ciencias Quimicas y Biologicas, Facultad de Salud, Universidad Bernardo O Higgins, Santiago, Chile
| | - Ahmed M Abu El-Asrar
- Department of Ophthalmology, Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lourdes Arellanes-Garcia
- Inflammatory Eye Diseases Clinic, "Dr. Luis Sanchez Bulnes" Hospital Asociación para Evitar la Ceguera en México (APEC), Mexico DF, Mexico
| | - Ariel Schlaen
- Hospital Universitario Austral, Hospital de Clinicas de Buenos Aires, Buenos Aires, Argentina
| | - Joyce Yamamoto
- Department of Ophthalmology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carlos Pavesio
- National Institute for Health Research, Biomedical Research Centre at Moorfields Eye Hospital, NHS Foundation Trust and UCL, Institute of Ophthalmology, London, UK
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Liang A, Zhao C, Jia S, Gao F, Han X, Pei M, Qu Y, Xiao J, Zhang M. Retinal Microcirculation Defects on OCTA Correlate with Active Inflammation and Vision in Vogt-Koyanagi-Harada Disease. Ocul Immunol Inflamm 2020; 29:1417-1423. [PMID: 32407159 DOI: 10.1080/09273948.2020.1751212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To analyze quantitative OCT-angiography (OCTA) measurements of Vogt-Koyanagi-Harada (VKH) disease at different disease stages.Methods: OCTA scans of 110 VKH patients in acute uveitic, convalescent and chronic recurrent stage were reviewed; posterior uveitis recurrent cases were excluded. Superficial and deep capillary plexus (SCP and DCP) vascular densities (VD) and subfoveal choroidal thickness (SFCT) were compared.Results: DCP VD was significantly lower and SFCT higher in VKH than normal controls (NC) in all 3 stages (all p < .001). Anterior uveitis recurrent patients had lower SCP and DCP VDs and thicker SFCT than convalescent patients (p = .001, p < .001, and p = .003, respectively). DCP VD was significantly correlated with visual acuity (p < .05). Patients with history of anterior recurrence had lower retinal VDs in the convalescent stage than those without (p < .001).Conclusion: Retinal microcirculation is impaired in VKH. DCP VD might be a sensitive indicator of inflammatory status and appeared to be well associated with visual outcome.
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Affiliation(s)
- Anyi Liang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chan Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shanshan Jia
- Department of Ophthalmology, The Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Shenzhen, China
| | - Fei Gao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxu Han
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Minghang Pei
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Qu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Junyan Xiao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Meifen Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Fukutsu K, Namba K, Iwata D, Mizuuchi K, Kase S, Suzuki K, Shimizu H, Shibata Y, Yamawaki F, Onozawa M, Ishida S. Pseudo-inflammatory manifestations of choroidal lymphoma resembling Vogt-Koyanagi-Harada disease: case report based on multimodal imaging. BMC Ophthalmol 2020; 20:94. [PMID: 32156266 PMCID: PMC7065374 DOI: 10.1186/s12886-020-01353-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 02/20/2020] [Indexed: 12/01/2022] Open
Abstract
Background Hematologic malignancies occasionally cause serous retinal detachment (SRD); however, its pathogenesis remains unclear. Here we present the imaging characteristics of metastatic choroidal lymphoma masquerading as Vogt-Koyanagi-Harada (VKH) disease. Case presentation A 45-year-old Japanese woman was referred to our clinic because of bilateral SRD with blurred vision. Fluorescein angiography revealed multiple pinpoint leakage followed by pooling OU. Enhanced depth imaging optical coherence tomography showed marked choroidal thickening OU. Laser speckle flowgraphy detected choroidal circulation impairment OU. Although these results totally agreed with the inflammatory manifestations of acute VKH disease, indocyanine green angiography demonstrated various sizes of sharply marginated hypofluorescent lesions that seemed atypical for the finding of VKH disease, i.e., vaguely marginated hypofluorescent small dots. Cerebrospinal fluid pleocytosis was not detected. Blood tests revealed leukocytosis together with elevation of lactate dehydrogenase and soluble interleukin-2 receptor levels. Corticosteroid pulse therapy did not improve any ocular findings. Bone marrow biopsy was then performed, leading to a definite diagnosis of diffuse large B-cell lymphoma. After starting systemic chemotherapy, both SRD and choroidal thickening resolved rapidly with visual recovery. However, choroidal hypoperfusion persisted, which contrasted distinctly with the inflammatory pattern of VKH disease, i.e., the restoration of choroidal blood flow in parallel with normalization of choroidal thickness. Conclusions Our detailed multimodal observations highlighted the differential imaging features of choroidal lymphoma despite close resemblance to VKH disease especially at the initial stage. Impaired circulation in the thickened choroid marked the pseudo-inflammatory pathogenesis of SRD due to choroidal involvement with neoplastic, but not inflammatory cells.
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Affiliation(s)
- Kanae Fukutsu
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Daiju Iwata
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Kazuomi Mizuuchi
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Kayo Suzuki
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroshi Shimizu
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Yukiko Shibata
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Fumihiko Yamawaki
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masahiro Onozawa
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
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11
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AlBloushi AF, Alfawaz AM, AlZaid A, Alsalamah AK, Gikandi PW, Abu El-Asrar AM. Incidence, Risk Factors and Surgical Outcomes of Cataract among Patients with Vogt-Koyanagi-Harada Disease. Ocul Immunol Inflamm 2019; 29:128-136. [PMID: 31638886 DOI: 10.1080/09273948.2019.1668430] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: To investigate risk factors and surgical outcomes of cataract in Vogt-Koyanagi-Harada (VKH) disease.Methods: Review of 187 patients (374 eyes).Results: At presentation, cataract was diagnosed in 56 (14.9%) eyes all had chronic recurrent VKH. During follow-up, cataract developed in additional 51 (13.6%) eyes. Fifteen (13.6%) of these had initial-onset acute VKH with anterior segment (AS) inflammation and 36 (19.4%) had chronic recurrent VKH. No patient with initial-onset acute VKH without AS inflammation developed cataract. Risk factors for cataract development during follow-up included female gender, keratic precipitates, anterior chamber reaction ≥2+, chronic recurrent VKH, posterior synechiae, iris nodules, glaucoma, glaucoma surgery, choroidal neovascular membrane, "sunset glow fundus" and chorioretinal atrophy. Thirty-two eyes underwent cataract extraction. Fourteen (43.8%) eyes achieved ≥20/40. Posterior segment complications of chronic recurrent VKH accounted for <20/40 outcome.Conclusions: Poor outcome after surgery is secondary to posterior segment complications of chronic recurrent VKH.
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Affiliation(s)
| | - Abdullah M Alfawaz
- Department of Ophthalmology College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman AlZaid
- Department of Ophthalmology College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abrar K Alsalamah
- Department of Ophthalmology College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Priscilla W Gikandi
- Department of Ophthalmology College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - 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
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12
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Hashimoto Y, Saito W, Namba K, Mizuuchi K, Iwata D, Noda K, Kanda A, Ishida S. Comparison of clinical characteristics in patients with Vogt-Koyanagi-Harada disease with and without anti-retinal antibodies. Graefes Arch Clin Exp Ophthalmol 2019; 257:1751-1758. [DOI: 10.1007/s00417-019-04330-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/07/2019] [Accepted: 04/16/2019] [Indexed: 12/19/2022] Open
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13
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Huang G, Peng J, Ye Z, Kijlstra A, Zhang D, Yang P. Multispectral image analysis in Vogt-Koyanagi-Harada disease. Acta Ophthalmol 2018; 96:411-419. [PMID: 29220112 DOI: 10.1111/aos.13606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate fundus abnormalities in Vogt-Koyanagi-Harada (VKH) disease by a noninvasive tool, multispectral imaging (MSI). METHODS A total of 77 patients with VKH and 163 healthy controls were enrolled between January and April 2015. The MSI findings were evaluated in combination with fundus fluorescein angiography (FFA), optical coherent tomography (OCT) and fundus photography (FP). Additionally, we compared extent of exposure of choroidal blood vessels between patients with VKH and healthy controls to evaluate retinal transmission function. RESULTS A number of features could be recognized by MSI which included (i) general depigmentation, (ii) clumping of pigment and (iii) macular depigmentation and/or hyperpigmentation. The percentages of these three abnormalities discovered by MSI in 52 inactive VKH patients with a duration of more than 2 months in VKH were 67.3%, 75% and 84.6% respectively, which were all significantly higher than those detected by FFA, OCT or FP (p = 0.0398, p < 0.0001). Our study showed that MSI detected a higher percentages of these four abnormalities in patients with sunset glow fundus than in patients without this phenomenon (p = 0.0492, p < 0.0001). Additionally, at the same wavelength (590 nm), exposure of choroidal blood vessels in inactive patients was stronger than in healthy controls and active patients (p < 0.01, p < 0.001). CONCLUSION Our results show that MSI is a sensitive noninvasive method to investigate the retinal pigment epithelium (RPE) in VKH disease. It is more likely to detect RPE abnormalities with MSI than when using FFA, OCT or FP. Retinal transmission function in inactive patients is stronger than that observed in active patients or healthy controls.
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Affiliation(s)
- Guo Huang
- The First Affiliated Hospital of Chongqing Medical University; Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute; Chongqing China
| | - Junchao Peng
- The First Affiliated Hospital of Chongqing Medical University; Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute; Chongqing China
| | - Zi Ye
- 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
| | - Donglei Zhang
- The First Affiliated Hospital of Chongqing Medical University; Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute; Chongqing China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University; Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute; Chongqing China
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14
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Liu S, Du L, Zhou Q, Zhang Q, Hu K, Qi J, Liang L, Zhou C, Kijlstra A, Yang P. The Choroidal Vascularity Index Decreases and Choroidal Thickness Increases in Vogt-Koyanagi-Harada Disease Patients During a Recurrent Anterior Uveitis Attack. Ocul Immunol Inflamm 2017; 26:1237-1243. [PMID: 28914578 DOI: 10.1080/09273948.2017.1343357] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To measure changes in the choroidal vascularity index (CVI) in chronic Vogt-Koyanagi-Harada (VKH) disease during a recurrent anterior uveitis attack. METHODS Forty VKH patients and 40 normal controls were included in this study. Choroidal images were recorded before and during a recurrent anterior uveitis attack, as well as after appropriate treatment. CVI was measured by the binarization technique using ImageJ software (Bethesda, MD). RESULTS The CVI was 0.75 ± 0.09 in quiescent VKH patients, which was significantly higher compared to healthy controls (0.70 ± 0.05, p < 0.0001). The CVI significantly decreased to 0.72 ± 0.09 when granulomatous anterior uveitis appeared in these patients. However, it returned to 0.75 ± 0.08 after uveitis resolved. CONCLUSIONS A significant decrease of the CVI occurred during recurrent anterior uveitis in chronic VKH. CVI may provide a novel parameter to guide the treatment of VKH disease.
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Affiliation(s)
- Shulin Liu
- a The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute , Chongqing , P.R. China
| | - Liping Du
- a The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute , Chongqing , P.R. China
| | - Qingyun Zhou
- a The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute , Chongqing , P.R. China
| | - Qi Zhang
- a The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute , Chongqing , P.R. China
| | - Ke Hu
- a The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute , Chongqing , P.R. China
| | - Jian Qi
- a The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute , Chongqing , P.R. China
| | - Liang Liang
- a The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute , Chongqing , P.R. China
| | - Chunjiang Zhou
- a The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute , Chongqing , P.R. China
| | - Aize Kijlstra
- b University Eye Clinic Maastricht , Ophthalmology Department, Maastricht , The Netherlands
| | - Peizeng Yang
- a The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute , Chongqing , P.R. China
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15
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Hirooka K, Saito W, Namba K, Mizuuchi K, Iwata D, Hashimoto Y, Ishida S. Early post-treatment choroidal thickness to alert sunset glow fundus in patients with Vogt-Koyanagi-Harada disease treated with systemic corticosteroids. PLoS One 2017; 12:e0172612. [PMID: 28241069 PMCID: PMC5328280 DOI: 10.1371/journal.pone.0172612] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 02/06/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose To determine if early post-treatment central choroidal thickness (CCT) changes can predict sunset glow fundus (SGF) development in patients with Vogt-Koyanagi-Harada (VKH) disease treated using systemic corticosteroids. Methods This retrospective case series included 39 eyes of 21 treatment-naïve patients with acute VKH disease who could be followed up for more than 12 months after systemic corticosteroid therapy. The eyes were divided into two groups according to whether SGF was present or absent at 12 months (9 eyes of 5 patients versus 30 eyes of 16 patients, respectively). Using enhanced depth imaging optical coherence tomography, CCT values were measured before treatment, then at 1 week and 1 and 3 months after treatment in both groups and compared between the two groups. Results Development of SGF was found 4–11 months after treatment. Mean post-treatment CCT decreased significantly at all examinations compared with baseline in both groups, along with resolution of serous retinal detachment. One week after treatment, mean CCT was significantly higher in eyes with SGF than in those without (P = 0.024). SGF was present at 12 months in 9 of 22 eyes with CCT values > 410 μm at 1 week after starting treatment, in contrast with none of 17 eyes with CCT ≤ 410 μm at this time (P = 0.003). Conclusions The current study suggested the potential validity of early post-treatment CCT as a feasible index to alert future progression to SGF in patients with VKH disease treated using systemic corticosteroids.
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Affiliation(s)
- Kiriko Hirooka
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Wataru Saito
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- Kaimeido Eye and Dental Clinic, Sapporo, Japan
- * E-mail:
| | - Kenichi Namba
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuomi Mizuuchi
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Daiju Iwata
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yuki Hashimoto
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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16
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Abu El-Asrar AM, Dosari M, Hemachandran S, Gikandi PW, Al-Muammar A. Mycophenolate mofetil combined with systemic corticosteroids prevents progression to chronic recurrent inflammation and development of 'sunset glow fundus' in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada disease. Acta Ophthalmol 2017; 95:85-90. [PMID: 27535102 DOI: 10.1111/aos.13189] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 06/13/2016] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the effectiveness and safety of mycophenolate mofetil (MMF) as first-line therapy combined with systemic corticosteroids in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada (VKH) disease. METHODS This prospective study included 38 patients (76 eyes). The main outcome measures were final visual acuity, corticosteroid-sparing effect, progression to chronic recurrent granulomatous uveitis and development of complications, particularly 'sunset glow fundus'. RESULTS The mean follow-up period was 37.0 ± 29.3 (range 9-120 months). Visual acuity of 20/20 was achieved by 93.4% of the eyes. Corticosteroid-sparing effect was achieved in all patients. The mean interval between starting treatment and tapering to 10 mg or less daily was 3.8 ± 1.3 months (range 3-7 months). Twenty-two patients (57.9%) discontinued treatment without relapse of inflammation. The mean time observed off of treatment was 28.1 ± 19.6 months (range 1-60 months). None of the eyes progressed to chronic recurrent granulomatous uveitis. The ocular complications encountered were glaucoma in two eyes (2.6%) and cataract in five eyes (6.6%). None of the eyes developed 'sunset glow fundus', and none of the patients developed any systemic adverse events associated with the treatment. CONCLUSIONS Use of MMF as first-line therapy combined with systemic corticosteroids in patients with initial-onset acute VKH disease prevents progression to chronic recurrent granulomatous inflammation and development of 'sunset glow fundus'.
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Affiliation(s)
- Ahmed M. Abu El-Asrar
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
- Dr. Nasser Al-Rashid Research Chair in Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
| | - Mona Dosari
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
| | - Suhail Hemachandran
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
| | - Priscilla W. Gikandi
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
| | - Abdulrahman Al-Muammar
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
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Baltmr A, Lightman S, Tomkins-Netzer O. Vogt-Koyanagi-Harada syndrome - current perspectives. Clin Ophthalmol 2016; 10:2345-2361. [PMID: 27932857 PMCID: PMC5135404 DOI: 10.2147/opth.s94866] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Vogt–Koyanagi–Harada syndrome is a cause of noninfectious panuveitis, leading to significant vision loss in many patients. It is an autoimmune disease occurring in genetically susceptible individuals and clinically presents as bilateral panuveitis with serous retinal detachments and hyperemic, swollen optic discs, which are associated with neurological and auditory manifestations. Early diagnosis and prompt and adequate treatment with immunosuppressive agents (corticosteroids and other immunosuppressive drugs) may halt disease progression and prevent recurrences and vision loss. This review summarizes the current knowledge on the variable clinical aspects of this disease, highlighting diagnostic and treatment strategies.
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Affiliation(s)
- Abeir Baltmr
- Uveitis Service, Moorfields Eye Hospital, London, UK
| | - Sue Lightman
- Uveitis Service, Moorfields Eye Hospital, London, UK; Department of Clinical Ophthalmology, UCL Institute of Ophthalmology, London, UK
| | - Oren Tomkins-Netzer
- Uveitis Service, Moorfields Eye Hospital, London, UK; Department of Clinical Ophthalmology, UCL Institute of Ophthalmology, London, UK; Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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