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Sato T, Nihei R, Sora D, Nishio Y, Takeuchi M. Case report: Bilateral panuveitis resembling Vogt-Koyanagi-Harada disease after second dose of BNT162b2 mRNA COVID-19 vaccine. Front Immunol 2022; 13:967972. [PMID: 36248859 PMCID: PMC9556971 DOI: 10.3389/fimmu.2022.967972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/08/2022] [Indexed: 12/27/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains a serious pandemic. COVID-19 vaccination is urgent needed for limiting SARS-CoV-2 outbreaks by herd immunity. Simultaneously, post-marketing surveillance to assess vaccine safety is important, and collection of vaccine-related adverse events has been in progress. Vision-threatening ophthalmic adverse events of COVID-19 vaccines are rare but are a matter of concern. We report a 45-year-old Japanese male with positive for HLA-DR4/HLA-DRB1*0405, who developed bilateral panuveitis resembling Vogt-Koyanagi-Harada (VKH) disease after the second dose of Pfizer-BioNTech COVID-19 mRNA (BNT162b2) vaccine. Glucocorticosteroid (GC) therapy combined with cyclosporine A (CsA) readily improved the panuveitis. The immune profile at the time of onset was analyzed using CyTOF technology, which revealed activations of innate immunity mainly consisting of natural killer cells, and acquired immunity predominantly composed of B cells and CD8+ T cells. On the other hand, the immune profile in the remission phase was altered by GC therapy with CsA to a profile composed primarily of CD4+ cells, which was considerably similar to that of the healthy control before the vaccination. Our results indicate that BNT162b2 vaccine may trigger an accidental immune cross-reactivity to melanocyte epitopes in the choroid, resulting in the onset of panuveitis resembling VKH disease.
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Papasavvas I, Tugal-Tutkun I, Herbort CP. Mechanisms, Pathophysiology and Current Immunomodulatory/Immunosuppressive Therapy of Non-Infectious and/or Immune-Mediated Choroiditis. Pharmaceuticals (Basel) 2022; 15:ph15040398. [PMID: 35455395 PMCID: PMC9031533 DOI: 10.3390/ph15040398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 12/19/2022] Open
Abstract
Non-infectious choroiditis comprises immune-mediated diseases resulting from diverse pathophysiological mechanisms. These conditions are sub-divided into two main groups, (1) diseases of the choriocapillaris and (2) diseases of the choroidal stroma. The purpose of this study is to expose the pathophysiology of the most common diseases of both these groups and recommend the optimal immunomodulatory/immunosuppressive therapy of each analyzed condition based on literature data and data from our own centers. Material and Methods: Narrative review. In the group of choriocapillaritis entities or primary inflammatory choriocapillaropathies (PICCPs) including multiple evanescent white dot syndrome (MEWDS), acute posterior multifocal placoid pigment epitheliopathy (APMPPE), idiopathic multifocal choroiditis (MFC) and serpiginous choroiditis (SC), as well as secondary choriocapillaritides including acute syphilitic posterior multifocal placoid chorioretinitis (ASPMPC) and tuberculosis-related SC (TB-SC), were analyzed. In the group of stromal choroidites, HLA-A29 birdshot retinochoroiditis (BRC) and Vogt-Koyanagi-Harada (VKH) disease were included. For each entity a literature search, in the PubMed database, on treatment was performed and analyzed and the therapeutic attitudes of our own centers were presented. Management of immune-mediated choroiditis implies vigorous immunosuppressive therapy given in a prompt and prolonged fashion in most of these entities.
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Affiliation(s)
- Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Rue Charles-Monnard 6, CH-1003 Lausanne, Switzerland;
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey;
| | - Carl P. Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Rue Charles-Monnard 6, CH-1003 Lausanne, Switzerland;
- Correspondence:
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Herbort CP, Tugal-Tutkun I, Abu-El-Asrar A, Gupta A, Takeuchi M, Fardeau C, Hedayatfar A, Urzua C, Papasavvas I. Precise, simplified diagnostic criteria and optimised management of initial-onset Vogt-Koyanagi-Harada disease: an updated review. Eye (Lond) 2022; 36:29-43. [PMID: 34145419 PMCID: PMC8727674 DOI: 10.1038/s41433-021-01573-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
Vogt-Koyanagi-Harada (VKH) disease is a primary autoimmune stromal choroiditis. This review aimed to provide a novel perspective of the disease. We took into account recent developments in the understanding of the disease and crucial progress in investigational modalities of the choroid, which has led to new, simpler diagnostic criteria. We analysed recent novel notions in the literature and new diagnostic tools for VKH. We identified the following updates for VKH disease: (1) A crucial differentiation between the acute initial-onset and the chronic forms of the disease; (2) the integration of new, precise imaging methods to assess choroidal inflammation; (3) the promotion of simplified, more reliable diagnostic criteria for acute initial-onset of the disease, based on the sine qua non presence of diffuse choroiditis, detected with indocyanine green angiography (ICGA) and/or Enhanced Depth Imaging OCT (EDI-OCT); and (4) treatment optimisation through early, vigorous, sustained corticosteroid and nonsteroidal immunosuppression, as the first line of treatment for initial-onset VKH disease, and monitoring subclinical choroidal inflammation during follow-ups. Several studies have shown that most patients could discontinue treatment without an inflammation relapse. ICGA and EDI-OCT represented the methods of choice for precisely monitoring disease evolution. Simplified, precise, new diagnostic criteria allow early diagnosis of VKH. In VKH disease, inflammation exclusively originates in the choroidal stroma. Therefore, in many cases, early, sustained treatment, with dual corticosteroid and nonsteroidal immunosuppressive therapy can result in full "healing", which obviates chronic, uncontrolled, subclinical choroidal inflammation.
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Affiliation(s)
- Carl P Herbort
- Inflammatory and Retinal Eye Diseases, , Centre for Ophthalmic Specialised care, Lausanne, Switzerland.
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmed Abu-El-Asrar
- Department of Ophthalmology, Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amod Gupta
- Professor Emeritus, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defence Medical College, Tokorozawa, Saitama, Japan
| | - Christine Fardeau
- Department of Ophthalmology, Reference center for rare diseases, La Pitié-Salpêtrière Hospital, Paris-Sorbonne University, Paris, France
| | - Alireza Hedayatfar
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Cristhian Urzua
- Laboratory of Ocular and Systemic Autoimmune Diseases, Department of Ophthalmology, Faculty of Medicine, University of Chile, Santiago, Chile
- Facultad de Medicina, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Ioannis Papasavvas
- Inflammatory and Retinal Eye Diseases, , Centre for Ophthalmic Specialised care, Lausanne, Switzerland
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Ramtohul P, Engelbert M, Malclès A, Gigon E, Miserocchi E, Modorati G, Cunha de Souza E, Besirli CG, Curcio CA, Freund KB. BACILLARY LAYER DETACHMENT: MULTIMODAL IMAGING AND HISTOLOGIC EVIDENCE OF A NOVEL OPTICAL COHERENCE TOMOGRAPHY TERMINOLOGY: Literature Review and Proposed Theory. Retina 2021; 41:2193-2207. [PMID: 34029276 DOI: 10.1097/iae.0000000000003217] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To clarify the histologic basis of bacillary layer detachment (BALAD) through a review of the current literature and an analysis of retinal imaging. METHODS The literature for previous reports of BALAD were reviewed. An analysis of retinal images was performed to support anatomical conclusions. RESULTS A total of 164 unique patients with BALAD on optical coherence tomography (OCT) were identified from the published literature. Twenty-two underlying etiologies, all associated with subretinal exudation, were identified. Forty-one different OCT terminologies were found. The defining OCT feature of BALAD was a split at the level of the photoreceptor inner segment myoid creating a distinctive intraretinal cavity. Resolution of BALAD was followed by a rapid restoration of the ellipsoid zone. Histology of age-related macular degeneration eyes suggests that individual photoreceptors can shed inner segments. Furthermore, detachment of the entire layer of inner segments is a common postmortem artifact. It is proposed that BALAD occurs when outwardly directed forces promoting attachment of photoreceptor outer segments to the retinal pigment epithelium exceed the tensile strength of the photoreceptor inner segment myoid. CONCLUSION This review serves to strengthen the OCT nomenclature "bacillary layer detachment," based on specific reflectance information obtained by OCT and previously published histologic observations.
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Affiliation(s)
- Prithvi Ramtohul
- Centre Hospitalier Universitaire de l'Hôpital Nord, Marseille, France
| | - Michael Engelbert
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, NYU Langone School of Medicine, New York, New York
| | - Ariane Malclès
- Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland
| | - Edward Gigon
- Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland
| | - Elisabetta Miserocchi
- Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | - Giulio Modorati
- Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | | | - Cagri G Besirli
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; and
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, NYU Langone School of Medicine, New York, New York
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Papasavvas I, Herbort CP. Reactivation of Vogt-Koyanagi-Harada disease under control for more than 6 years, following anti-SARS-CoV-2 vaccination. J Ophthalmic Inflamm Infect 2021; 11:21. [PMID: 34224024 PMCID: PMC8256412 DOI: 10.1186/s12348-021-00251-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/10/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND/PURPOSE Vogt-Koyanagi-Harada (VKH) disease is a primary stromal choroiditis with bilateral granulomatous panuveitis. If initial-onset VKH is treated early and relentlessly the disease can be controlled and even "cured" in a substantial number of cases. We are reporting on a patient treated early and in a sustained fashion who was inflammation free for seven years but who presented a reactivation 6 weeks after the second dose of anti-SARS-CoV-2 vaccination. CASE REPORT A 43-year-old woman presented with severe initial-onset VKH disease which was brought under control using steroidal and non-steroidal Immunosuppression (mycophenolic acid and cyclosporine) with additional infliximab infusions because of the persistence of subclinical choroiditis identified on ICGA. Under infliximab alone disease had been inflammation free with no subclinical disease and absence of sunset glow fundus for 6 years. However, following anti-SARS-CoV-2 vaccination, severe resurgence of the disease occurred with exudative retinal detachments. Disease was rapidly brought again under control with oral prednisone (1 mg/kg) therapy and a new loading scheme of infliximab therapy. CONCLUSION VKH disease results from an autoimmune process directed against melanocyte associated antigens which can be controlled when early and sustained immunosuppressive treatment is introduced. It seems that anti-SARS-CoV-2 vaccination can be at the origin of reactivation of long-time controlled disease.
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Affiliation(s)
- Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Teaching Centre Clinic Montchoisi, Lausanne, Switzerland
| | - Carl P Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Teaching Centre Clinic Montchoisi, Lausanne, Switzerland.
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Papasavvas I, Herbort CP. Vogt-Koyanagi-Harada disease is always bilateral: reports of unilateral cases failed to use choroidal investigations showing subclinical involvement of the fellow eye. J Ophthalmic Inflamm Infect 2021; 11:6. [PMID: 33559795 PMCID: PMC7873149 DOI: 10.1186/s12348-021-00237-3] [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: 12/07/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background/purpose Vogt-Koyanagi-Harada (VKH) disease is a primary stromal choroiditis and a bilateral granulomatous panuveitis which, if not treated early and properly, could have a deleterious evolution. The purpose of our case report is to demonstrate that “so called” unilateral VKH disease should be investigated further with an Indocyanine Green Angiography (ICGA), in order to detect subclinical choroidal involvement of the other eye. Case report We present a case of 42-year old woman who came to see us for second opinion. She had consulted elsewhere for a left uveitis and had been treated with a periocular corticosteroid injection. At presentation she mentioned persistent headaches. Visual acuity on the Snellen scale was 1.0 OD and 0.5 OS. Slit-lamp examination showed granulomatous (rare mutton-fat KPs) signs in her left eye. Laser flare photometry showed a subclinical flare of 17.8 ph/ms OD and a flare of 66.4 ph/ms OS (normal values 3–6 ph/ms). Fundus examination showed left discoloration due to choroidal infiltration with a normal fundus aspect OD. ICGA showed a diffuse choroiditis also in the apparently normal right eye. Lumbar puncture confirmed the diagnosis of VKH and appropriate treatment was introduced. Conclusion VKH disease results from a generalized autoimmune process against melanocyte associated antigens starting in the choroidal stroma. It can be asymmetrical but is always bilateral, as long as investigations such as ICGA, able to detect subclinical choroiditis, are performed.
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Affiliation(s)
- Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Teaching Centre Clinic Montchoisi, Lausanne, Switzerland
| | - Carl P Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Teaching Centre Clinic Montchoisi, Lausanne, Switzerland.
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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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Qi J, Du L, Deng J, Qin Y, Su G, Hou S, Lv M, Zhang Q, Kijlstra A, Yang P. Replication of Genome-Wide Association Analysis Identifies New Susceptibility Loci at Long Noncoding RNA Regions for Vogt-Koyanagi-Harada Disease. ACTA ACUST UNITED AC 2019; 60:4820-4829. [PMID: 31747682 DOI: 10.1167/iovs.19-27708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Jian Qi
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, The People's Republic of China
| | - Liping Du
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, The People's Republic of China
| | - Jing Deng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, The People's Republic of China
| | - Yang Qin
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, The People's Republic of China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, The People's Republic of China
| | - Shengping Hou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, The People's Republic of China
| | - Meng Lv
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, The People's Republic of China
| | - Qi Zhang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, The People's Republic of 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, The People's Republic of China
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Incomplete Vogt–Koyanagi–Harada disease following treatment with encorafenib and binimetinib for metastatic melanoma. Melanoma Res 2018; 28:648-651. [DOI: 10.1097/cmr.0000000000000505] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Sato T, Takeuchi M. Pregnancy-induced hypertension-related chorioretinitis resembling uveal effusion syndrome: A case report. Medicine (Baltimore) 2018; 97:e11572. [PMID: 30045283 PMCID: PMC6078765 DOI: 10.1097/md.0000000000011572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Pregnancy-induced hypertension (PIH) is a major cause of maternal and fetal mortality. Hypertensive choroidopathy is a preliminary sign of vasogenic edema in the choroid, and is associated with PIH. Here, we report a post-natal case of PIH-related chorioretinitis with bilateral severe serous retinal detachment (SRD) resembling uveal effusion syndrome. PATIENT CONCERNS A 35-year-old woman was diagnosed with severe PIH at 37 weeks of pregnancy. She underwent an emergency cesarean delivery. Four days after delivery, she perceived a sudden decrease of vision. At presentation, fundus examination demonstrated bullous SRD and multiple white mottles in the posterior poles of both eyes. Optical coherence tomography (OCT) showed macula edema and retinal pigment epithelium (RPE) folds. Indocyanine green angiography (ICGA) demonstrated delayed filling of choroidal circulation in the early phase and multiple hyperfluorescent spots in the mid phase. DIAGNOSES PIH. INTERVENTIONS Antihypertension treatment alone resulted in gradual resolution of the SRD. OUTCOMES At 463 days after delivery, fundus photographs of both eyes showed leopard spots corresponding to hyperautofluorescent spots with dark rim observed on fundus autofluorescence images. LESSONS Ophthalmologists should be aware of PIH-related chorioretinitis with similar clinical manifestations as uveal effusion syndrome, and should treat with antihypertensive agents in cooperation with obstetricians.
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Yalcinbayir O, Baytan B, Gelisken O, Can B, Sezgin Evim M, Yildiz M, Meral Gunes A. Spectral domain optical coherence tomography findings of patients under treatment for pediatric acute lymphoblastic leukemia. J AAPOS 2017; 21:131-135.e1. [PMID: 28315402 DOI: 10.1016/j.jaapos.2016.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 11/23/2016] [Accepted: 12/16/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the use of spectral domain optical coherence tomography (SD-OCT) findings in pediatric acute lymphoblastic leukemia (ALL) patients. METHODS Children that were diagnosed with precursor B-cell ALL and classified as belonging to the medium-risk group for relapse were selected for this study. Individuals who were in continuous remission and on maintenance therapy were included in the study group. Cases that had central nervous system involvement were excluded. Age-matched, otherwise healthy children were selected for the control group. Each study participant underwent a comprehensive eye examination and SD-OCT evaluation. Thickness measurements were made within the retinal nerve fiber layer (RNFL), central macula, posterior polar, and peripapillary choroid. RESULTS A total of 112 eyes of 56 children were included: 54 eyes in the study group and 58 in the control group. Compared to the control group, subfoveal and temporal choroidal thicknesses of the posterior pole were significantly thinner in the study group (P < 0.005). Similarly, peripapillary choroidal thicknesses were significantly thinner in most sectors of the study group (P < 0.005). There were no major differences between groups in terms of central macular thicknesses and overall RNFL thicknesses. CONCLUSIONS Evidence of choroidal attenuation was found in this subgroup of pediatric ALL patients. Further studies are warranted to clarify the utility of SD-OCT in detecting subclinical ocular involvement and monitoring treatment response and risk of relapse in patients with pediatric leukemia.
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Affiliation(s)
- Ozgur Yalcinbayir
- Department of Ophthalmology. Uludag University School of Medicine, Bursa, Turkey.
| | - Birol Baytan
- Department of Pediatric Hematology, Uludag University School of Medicine, Bursa, Turkey
| | | | - Basak Can
- Department of Ophthalmology. Uludag University School of Medicine, Bursa, Turkey
| | - Melike Sezgin Evim
- Department of Pediatric Hematology, Uludag University School of Medicine, Bursa, Turkey
| | - Meral Yildiz
- Department of Ophthalmology. Uludag University School of Medicine, Bursa, Turkey
| | - Adalet Meral Gunes
- Department of Pediatric Hematology, Uludag University School of Medicine, Bursa, Turkey
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Elaraoud I, Andreatta W, Jiang L, Damer K, Al-Ibrahim J. A Mystery of Bilateral Annular Choroidal and Exudative Retinal Detachment with No Systemic Involvement: Is It Part of Vogt-Koyanagi-Harada Disease Spectrum or a New Entity? Case Rep Ophthalmol 2017; 8:1-6. [PMID: 28203189 PMCID: PMC5301087 DOI: 10.1159/000453543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/15/2016] [Indexed: 11/19/2022] Open
Abstract
A 65-year-old Caucasian male presented to the eye emergency department with bilateral significant visual loss. He was otherwise healthy with no significant past medical history. Ophthalmic history was significant for chronic open-angle glaucoma, for which the patient was using latanoprost once daily to both eyes. There was no preceding history of trauma or ocular surgery and the patient was emmetropic. Two weeks prior to his presentation, he reported a headache, which settled spontaneously. Slit-lamp examination demonstrated bilateral keratic precipitates, bilateral significantly shallow anterior chamber, and bilaterally normal intraocular pressures of 16 mm Hg. Fundal examination was significant for bilateral 360-degree choroidal detachments with exudative retinal detachment involving the maculae. These findings were confirmed using wide-field fundus photography, B-scan ultrasonography, and optical coherence tomography. Fundus fluorescein angiography did not reveal any evidence of retinal vasculitis. Indocyanine green chorioangiography of the posterior pole showed multiple areas of focal choroidal hypoperfusion. Extensive systemic investigation demonstrated no infectious, neoplastic, or inflammatory cause, and the patient did not complain of any systemic symptoms. Treatment with high-dose intravenous methylprednisolone was administered and this brought about complete resolution of both choroidal and retinal detachments, with partial visual recovery.
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Affiliation(s)
| | | | - Li Jiang
- Birmingham Midlands Eye Centre, Birmingham, UK
| | - Kenan Damer
- Birmingham Midlands Eye Centre, Birmingham, UK
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Valenzuela RM, Keung B, Pula JH, Kattah JC. A Rare Case of Unilateral Progressive Vision Loss and Pachymeningitis. Neuroophthalmology 2016; 40:237-242. [PMID: 27928413 DOI: 10.1080/01658107.2016.1212079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 07/06/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022] Open
Abstract
We describe a 32-year-old man with presumed Vogt-Koyanagi Harada (VKH) syndrome, whose presenting symptoms were headache and progressive loss of vision in the right eye. Neuro-ophthalmic examination showed anterior and posterior uveitis, and retinal detachment in the right eye. Ocular coherence tomography (OCT) showed extensive submacular fluid in the right eye, while the fundus fluorescein angiogram (FFA) confirmed perifoveal retinal pigment epithelium (RPE) disruption and multifocal fluorescein leakage in the right eye. The brain MRI showed a small crescent of dependent fluid layering in the right posterior globe adjacent to the right optic nerve head, and pachymeningeal enhancement of the skull base dura along the clivus.This case demonstrates the utility of brain MRI and OCT findings in the early diagnosis of VKH syndrome, in the absence of prominent clinical signs of meningitis. Aggressive treatment is critical to preserve vision and prevent development of other systemic complications of the disease.
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Affiliation(s)
- Reuben Mari Valenzuela
- Department of Neurology, University of Illinois College of Medicine, Peoria, Peoria, Illinois, USA; Illinois Neurologic Institute, Peoria, Illinois, USA
| | - Bonnie Keung
- Illinois Neurologic Institute , Peoria, Illinois, USA
| | - John H Pula
- Department of Neurology, University of Illinois College of Medicine, Peoria, Peoria, Illinois, USA; North Shore University Health System, Glenview, Illinois, USA
| | - Jorge C Kattah
- Department of Neurology, University of Illinois College of Medicine, Peoria, Peoria, Illinois, USA; Illinois Neurologic Institute, Peoria, Illinois, USA
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Dansingani KK, Suzuki M, Naysan J, Samson CM, Spaide RF, Fisher YL. Panuveitis With Exudative Retinal Detachments After Vaccination Against Human Papilloma Virus. Ophthalmic Surg Lasers Imaging Retina 2015; 46:967-70. [DOI: 10.3928/23258160-20151008-11] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 08/10/2015] [Indexed: 11/20/2022]
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Khochtali S, Abroug N, Hani MS, Khairallah-Ksiaa I, Jelliti B, Khairallah M. Concurrent acute Vogt-Koyanagi-Harada disease in one eye and chronic disease in the fellow eye. J Ophthalmic Inflamm Infect 2015; 5:57. [PMID: 26335662 PMCID: PMC4558990 DOI: 10.1186/s12348-015-0057-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/14/2015] [Indexed: 11/18/2022] Open
Abstract
Background Vogt-Koyanagi-Harada (VKH) disease is a granulomatous panuveitis, usually involving both eyes at the same time or within a few days or weeks. Acute and chronic diseases are characterized by distinct clinical features, treatment modalities, and visual outcomes. We report an atypical case of probable VKH disease, with features of acute disease in one eye and chronic disease in the fellow eye. Findings A 53-year-old female presented with exudative retinal detachment associated with mild vitritis in the right eye and anterior uveitis, vitritis, and sunset-glow fundus in the left eye. Based on clinical findings and results of multimodal imaging including fundus photography, spectral-domain optical coherence tomography, fluorescein angiography, indocyanine green angiography, and B-scan ultrasonography, a diagnosis of acute VKH disease in the right eye and chronic VKH disease in the left eye was made. The patient received systemic corticosteroids and mycophenolate mofetil. After a 15-month follow-up, the right fundus eye was normal, and there was a sunset-glow fundus in the left eye. Conclusions VKH disease may begin with asymptomatic unilateral ocular involvement. The patient may present only when the fellow eye is affected. A significant delay before involvement of the second eye leads to atypical features of acute disease in one eye and chronic disease in the other eye.
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Affiliation(s)
- Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia,
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Clinical and multimodal imaging characteristics of acute Vogt–Koyanagi–Harada disease unassociated with clinically evident exudative retinal detachment. Int Ophthalmol 2015; 36:37-44. [DOI: 10.1007/s10792-015-0073-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
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