Reversal of Peripheral Iris Depigmentation Associated with Vogt-Koyanagi-Harada Disease

OBJECTIVE

To describe the reversal of peripheral iris depigmentation associated with Vogt-Koyanagi-Harada (VKH) disease.

METHODS

A retrospective report of two cases.

RESULTS

Both patients were diagnosed with a chronic recurrent VKH disease and developed bilateral peripheral iris depigmentation (BPID). The first patient is an 8-year-old girl who was treated with systemic corticosteroids, methotrexate and adjuvant rituximab infusions that induced complete remission of uveitis and reversal of peripheral iris depigmentation at the last follow-up. The second was a 6-year-old who was treated with topical and systemic corticosteroids and oral methotrexate that induced complete remission of uveitis and reversal of peripheral iris depigmentation at the last follow-up.

CONCLUSIONS

Adequate control of uveitis associated with chronic recurrent VKH disease with appropriate immunomodulatory agents and perhaps adjuvant rituximab can reverse BPID and improve the outcomes.

Prognostic value of pretreatment indocyanine green angiography in the acute uveitic phase of Vogt-Koyanagi-Harada disease

PURPOSE

To investigate the prognostic value of pretreatment indocyanine green angiographic (ICGA) features in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada (VKH) disease.

METHODS

Retrospective analysis of 84 patients (168 eyes). Main outcome measures were final visual acuity, development of 'sunset glow fundus' (SGF) and progression to chronic recurrent evolution.

RESULTS

Thirty-eight patients (76 eyes) presented in the phase preceding anterior segment (AS) inflammation (early presentation) and 46 patients (92 eyes) had AS inflammation at presentation (late presentation). The mean number of hypofluorescent dark dots (HDDs) and frequency of disc hyperfluorescence were more in the late presentation group (p < 0.001 for both comparisons), whereas the early presentation group showed higher frequencies of peripapillary punctate choroidal hyperfluorescence (p < 0.001) and hypofluorescent patches involving macula corresponding to the areas of exudative retinal detachment (p = 0.012). The mean number of HDDs and the frequency of disc hyperfluorescence were higher among eyes that developed SGF (p < 0.001 for both comparisons) and eyes that progressed to chronic recurrent evolution (p < 0.001; p = 0.001, respectively). The frequencies of peripapillary punctate choroidal hyperfluorescence and hypofluorescent patches corresponding to the areas of exudative retinal detachment were less in the eyes that developed SGF (p = 0.019; p = 0.003, respectively). Punctate choroidal hyperfluorescence elsewhere was less frequent in the eyes that developed SGF (p < 0.001) and eyes that progressed to chronic recurrent evolution (p = 0.002).

CONCLUSIONS

Pretreatment ICGA has a prognostic value in initial-onset acute uveitis associated with VKH disease.

Therapeutic window of opportunity in the acute uveitic phase of Vogt-Koyanagi-Harada disease: Prevention of late autoimmune complications by early intervention

PURPOSE

To determine relationship between timing of treatment initiation and disease outcomes and whether a therapeutic window of opportunity exists in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada disease.

METHODS

Retrospective analysis of 112 patients (224 eyes). Main outcome measures were final visual acuity, progression to chronic recurrent evolution, development of complications, particularly 'sunset glow fundus', and drug-free remission cure of uveitis.

RESULTS

Forty-six patients (92 eyes) presented in the phase preceding anterior segment (AS) inflammation (early presentation) and 66 patients (132 eyes) had AS inflammation at presentation (late presentation). In significantly more eyes in the early presentation group (85.9%), final visual acuity of 20/20 was achieved compared with those in the late presentation group (66.7%) (p = 0.001). None of the eyes in the early presentation group progressed to chronic recurrent evolution and none developed 'sunset glow fundus', whereas in the late presentation group, 28.8% of the eyes progressed to chronic recurrent evolution (p < 0.001) and 56.1% developed 'sunset glow fundus' (p < 0.001). Patients in the early presentation group were able to discontinue treatment without relapse of inflammation at significantly shorter time intervals compared to patients in the delayed presentation group (p < 0.001). In the late presentation group, logistic regression analysis demonstrated that presenting clinical features predicting unfavourable outcomes were posterior synechiae (odds ratio = 4.03; 95% confidence interval [CI] = 1.29-12.23), bullous exudative retinal detachment extending to the periphery (odds ratio = 3.35; 95% CI = 1.53-7.32) and female gender (odds ratio = 2.05; CI = 1.08-3.90).

CONCLUSIONS

Our findings suggest that the window of opportunity lies in the phase preceding AS inflammation and initiation of effective treatment during this phase results in cure of uveitis and prevents blinding complications.

Effect of 2019 Coronavirus Pandemic on Ophthalmologists Practicing in Saudi Arabia: A Psychological Health Assessment

PURPOSE:

To assess the psychological impact and mental health outcomes including depression, anxiety, and insomnia during COVID-19 crisis among ophthalmologists.

METHODS:

This was a simple random study in which ophthalmologists practicing in Saudi Arabia were asked to fill in a self-administered online survey during the period from March 28, 2020, to April 04, 2020. Four validated psychiatric assessment tools were used to detect symptoms of depression, anxiety, insomnia, and stress perception.

RESULTS:

One hundred and seven participants successfully completed the survey with a response rate of 30.6%. Males constituted 56.1% (n = 60). Ophthalmology residents constituted the majority (n = 66, 61.7%). About half of the physicians exhibited symptoms of depression (n = 56, 50.5%), anxiety (n = 50, 46.7%), and insomnia (n = 48, 44.9%). Symptoms of stress ranged between low (28%), moderate (68.2%), and high (3.7%). According to the cutoff values for severe symptoms, 29% were identified as having depression, 38.3% had anxiety, and 15% had insomnia.Depression was found to be more common among female ophthalmologists (P = 0.06), those living with an elderly (P = 0.003), and fellows (P = 0.006). Female ophthalmologists suffering from anxiety were significantly more than male ophthalmologists (P = 0.046). There was a trend toward suffering from anxiety in frontline health-care providers (P = 0.139) and in ophthalmologists who are living with an elderly (P = 0.149). Female participants exhibited significantly more moderate-to-high symptoms of stress (P = 0.018).

CONCLUSIONS:

Ophthalmologists' psychological needs, females in particular, should be addressed appropriately during the COVID-19 pandemic. Establishing psychological support units, especially for high-risk individuals, should be considered to minimize psychological adverse effects.