RESUMEN
PURPOSE: To evaluate changes in scleral thickness in Vogt-Koyanagi-Harada (VKH) disease. METHODS: This study included 34 eyes of 17 treatment-naïve patients with acute-phase VKH disease. Scleral thickness and the presence of ciliochoroidal effusion were examined using anterior segment optical coherence tomography at baseline and 1 week, 2 weeks, and 12 weeks after the start of corticosteroid treatment. Scleral thickness was measured 6 mm posterior to the scleral spur in four directions. RESULTS: Twenty-eight eyes (82.4%) initially had ciliochoroidal effusion, but this rapidly decreased to nine eyes (26.5%) after 1 week. The sclera with ciliochoroidal effusion became thinner from baseline to 1 week at the superior (400.2 ± 46.9-353.5 ± 47.9 µm), temporal (428.4 ± 53.6-387.8 ± 56.1 µm), inferior (451.5 ± 71.0-400.5 ± 50.5 µm), and nasal (452.4 ± 78.0-407.6 ± 62.9 µm) points (P < 0.01 for all), and no further changes were observed. The sclera without ciliochoroidal effusion remained unchanged. CONCLUSION: In VKH disease, eyes with ciliochoroidal effusion exhibited the maximum scleral thickness during the acute phase. This thickening responded rapidly to treatment and became thinner within 1 week. Inflammation in VKH disease may affect not only the choroid but also the sclera.
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Glucocorticoides , Esclerótica , Tomografía de Coherencia Óptica , Síndrome Uveomeningoencefálico , Humanos , Síndrome Uveomeningoencefálico/tratamiento farmacológico , Síndrome Uveomeningoencefálico/diagnóstico , Síndrome Uveomeningoencefálico/fisiopatología , Tomografía de Coherencia Óptica/métodos , Esclerótica/patología , Esclerótica/diagnóstico por imagen , Femenino , Masculino , Adulto , Persona de Mediana Edad , Enfermedad Aguda , Glucocorticoides/uso terapéutico , Glucocorticoides/administración & dosificación , Agudeza Visual , Adulto Joven , Estudios Retrospectivos , Anciano , Coroides/patología , Coroides/diagnóstico por imagen , Efusiones Coroideas/diagnóstico , Efusiones Coroideas/tratamiento farmacológicoRESUMEN
BACKGROUND: This study explores prognostic factors influencing Vogt-Koyanagi-Harada (VKH) disease and observes the efficacy and safety of Adalimumab (ADA) in treating recurrence in Vogt-Koyanagi-Harada (VKH) patients. METHODS: A retrospective study was conducted on all patients diagnosed with VKH disease at Beijing Tongren Hospital between 2020 and 2023. Clinical data included initial and final visual acuity, age, gender, ocular complications, treatment modalities, disease duration, and recurrence frequency. RESULTS: A total of 62 VKH patients were included, comprising 34 in the acute-resolved group and 28 in the chronic-recurrent group. The mean age of patients in the acute-resolved group was 38.29 ± 15.46 years, while the mean age of chronic-recurrent group had a 49.00 ± 16.43 years. Initial best-corrected visual acuity (BCVA) examination at the first visit showed an average BCVA of 0.64 ± 0.29 logMAR in the acute-resolved group and 1.38 ± 0.54 logMAR in the chronic-recurrent group (p = 0.002). During follow-up, ocular complications were observed in 29.4% of the acute-resolved group patients and 41.7% of the chronic-recurrent group patients (P = 0.006). "Sunset glow fundus" was observed in 23.5% of the acute-resolved group and 64.3% of the chronic-recurrent group patients (P = 0.001). Poor initial BCVA (P = 0.046) and the occurrence of "sunset glow fundus" (P = 0.040) were significantly associated with progression to the chronic recurrent phase. Logistic regression analysis revealed that older age at onset (P = 0.042) and the occurrence of "sunset glow fundus" (P = 0.037) were significant predictors for progression to the chronic recurrent phase. ADA significantly reduced anterior chamber inflammatory cells (P = 0.000) and vitreous cavity inflammatory cells (P = 0.001) in the chronic-recurrent group, and markedly decreased the recurrence rate in VKH patients (P = 0.009). CONCLUSION: In comparison to acute-resolved patients, chronic-recurrent patients exhibited poorer initial BCVA and a significantly increased incidence of "sunset glow fundus." Older age at onset and the occurrence of "sunset glow fundus" at diagnosis are crucial predictive factors for VKH patients progressing to the chronic recurrent phase. ADA effectively alleviates refractory VKH disease and is generally well-tolerated.
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Adalimumab , Recurrencia , Síndrome Uveomeningoencefálico , Agudeza Visual , Humanos , Síndrome Uveomeningoencefálico/tratamiento farmacológico , Síndrome Uveomeningoencefálico/diagnóstico , Síndrome Uveomeningoencefálico/fisiopatología , Adalimumab/uso terapéutico , Femenino , Masculino , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Agudeza Visual/fisiología , Enfermedad Crónica , Adulto Joven , Antiinflamatorios/uso terapéutico , Estudios de Seguimiento , Adolescente , Resultado del Tratamiento , Anciano , PronósticoRESUMEN
PURPOSE: To describe the choroidal retinal microvascular system in Vogt-Koyanagi-Harada (VKH) subjects and furnish additional proof for the early authentication and treatment of VKH suffers. METHODS: From the beginning to July 2023, a comprehensive search for issued articles on optical coherence tomography angiography (OCTA) among VKH sufferers was implemented in Embase, PubMed, and Web of Science databases. This meta-analysis included 9 eligible studies. Primary endpoints included four kinds of vascular densities, such as superficial capillaris plexus (SCP), deep capillaris plexus (DCP), and choriocapillary (CC). In addition to these, there were foveal avascular zone (FAZ), central retinal thickness (CT), best-corrected distance visual acuity (BCVA log MAR), and subfoveal choroidal thickness (SFCT). RESULTS: SCP and DCP vessel densities in maculas were both smaller in VKH sufferers in the active stage than those normal and remission examinees (SCP vessel density, p < 0.00001, DCP vessel density, p < 0.00001). Compared to remission, CC vascular density was lower during the active phase. (p < 0.00001). SFCT and CT in the active phase exceeded those in normal and remission examinees (all of them p < 0.00001). In terms of the patients with remission, their FAZ was bigger than that in normal subjects. (MD =0.04, p < 0.0001). CONCLUSIONS: Retinal and choroidal microvasculatures are characteristically changed in active VKH patients, which suggests that OCTA can be used as a tool for VKH follow-up.
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Coroides , Angiografía con Fluoresceína , Vasos Retinianos , Tomografía de Coherencia Óptica , Síndrome Uveomeningoencefálico , Agudeza Visual , Humanos , Tomografía de Coherencia Óptica/métodos , Síndrome Uveomeningoencefálico/diagnóstico por imagen , Síndrome Uveomeningoencefálico/fisiopatología , Síndrome Uveomeningoencefálico/diagnóstico , Angiografía con Fluoresceína/métodos , Coroides/irrigación sanguínea , Coroides/diagnóstico por imagen , Vasos Retinianos/diagnóstico por imagen , Vasos Retinianos/patología , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To investigate the association between pretreatment blood flow velocity in the choroid and optic nerve head (ONH) and retinal oxygen metabolism in the acute uveitic phase and the development of 'sunset glow fundus' in Vogt-Koyanagi-Harada (VKH) disease. METHODS: Retrospective analysis of 41 patients (82 eyes). Laser speckle flowgraphy and retinal oximetry measurements were performed at the presentation. The main outcome measure was the development of 'sunset glow fundus'. RESULTS: Twenty patients (40 eyes) presented in the phase preceding anterior segment inflammation (early presentation), and 21 patients (42 eyes) presented with anterior segment inflammation (late presentation). In ONH, mean blur rate (MBR)-vessel, representing blood flow velocity in retinal vessels, was significantly lower in the late presentation group, while choroidal MBR was not significantly different. The late presentation group had significantly lower oxygen saturation in retinal venules, a higher arteriovenous oxygen saturation difference and a smaller calibre of retinal arterioles compared with the early presentation group. Eyes that subsequently developed 'sunset glow fundus' had significantly lower ONH MBR-vessels, lower oxygen saturation in retinal venules, a higher arteriovenous oxygen saturation difference and a smaller calibre of retinal arterioles compared with eyes without 'sunset glow fundus'. ONH MBR-vessel had a significant negative correlation with arteriovenous oxygen saturation difference and a significant positive correlation with calibre of retinal arterioles. CONCLUSIONS: In the acute uveitic phase of VKH disease, the development of 'sunset glow fundus' is associated with pretreatment reduced retinal blood flow velocity, calibre of retinal arterioles and oxygen saturation in retinal venules, as well as an increased arteriovenous oxygen saturation difference.
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Coroides , Flujometría por Láser-Doppler , Consumo de Oxígeno , Oxígeno , Flujo Sanguíneo Regional , Vasos Retinianos , Síndrome Uveomeningoencefálico , Humanos , Síndrome Uveomeningoencefálico/fisiopatología , Síndrome Uveomeningoencefálico/metabolismo , Síndrome Uveomeningoencefálico/diagnóstico , Masculino , Estudios Retrospectivos , Femenino , Adulto , Flujo Sanguíneo Regional/fisiología , Oxígeno/metabolismo , Persona de Mediana Edad , Enfermedad Aguda , Coroides/irrigación sanguínea , Coroides/metabolismo , Vasos Retinianos/fisiopatología , Vasos Retinianos/metabolismo , Velocidad del Flujo Sanguíneo/fisiología , Consumo de Oxígeno/fisiología , Oximetría/métodos , Disco Óptico/irrigación sanguínea , Disco Óptico/metabolismo , Angiografía con Fluoresceína/métodos , Saturación de Oxígeno/fisiología , Agudeza Visual , Adulto Joven , Estudios de Seguimiento , Fondo de OjoRESUMEN
PURPOSE: To develop a more tailored immunomodulatory treatment (IMT) strategy based on a novel 2-arm risk stratification system in Vogt-Koyanagi-Harada (VKH) patients. DESIGN: A retrospective clinical cohort study. METHODS: Seventy-nine VKH patients in the acute stage were stratified into low- (n = 58) and high-risk (n = 21) groups based on their exposure to risk factors. They were treated with oral glucocorticoids (GCs) plus as-needed (PRN) or first-line IMT. Best corrected visual acuity (BCVA), sunset glow fundus (SGF) occurrence, relapse rate, and systemic adverse events were evaluated during follow-up. RESULTS: Compared with the low-risk group, the high-risk group showed poorer BCVA at baseline (estimated difference 0.51, 95% CI 0.30-0.78; P < .001) and 6-month follow-up (estimated difference 0.08, 95% CI 0.00-0.08; P = .006), higher incidence of SGF at 12 months (52% vs 28%; RR 1.9, 95% CI 1.1-3.4; P = .040), and higher relapse rate at 6 months (24% vs 5%; RR 4.6, 95% CI 1.2-17.5; P = .028) and 12 months (52% vs 12%; RR 4.4, 95% CI 1.9-9.7; P < .001). In the low-risk cohort, no significant difference between the 2 IMT strategies was observed in primary outcomes. In the high-risk cohort, patients with the immediate IMT showed better BCVA (estimated difference -0.20, 95% CI -0.3 to -0.08; P = .007), lower incidence of SGF (27% vs 80%; RR 0.3, 95% CI 0.1-0.9; P = .030), and lower relapse rate (27% vs 80%; RR 0.3, 95% CI 0.1-0.9; P = .030) compared with the PRN regimen. Moreover, the immediate IMT regimen had a higher frequency of systemic adverse events than the PRN regimen (47% vs 7%; RR 7.1, 95% CI 2.5-20.4; P < .001). CONCLUSIONS: High-risk stratification at baseline was associated with poor prognosis. The immediate IMT regimen was only beneficial for high-risk VKH patients regarding visual outcome, SGF, and relapse rate. This study suggests a potential need for a customized IMT strategy for VKH patients.
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Glucocorticoides , Síndrome Uveomeningoencefálico , Agudeza Visual , Humanos , Síndrome Uveomeningoencefálico/tratamiento farmacológico , Síndrome Uveomeningoencefálico/diagnóstico , Síndrome Uveomeningoencefálico/fisiopatología , Estudios Retrospectivos , Masculino , Femenino , Agudeza Visual/fisiología , Adulto , Glucocorticoides/uso terapéutico , Glucocorticoides/administración & dosificación , Persona de Mediana Edad , Medición de Riesgo , Estudios de Seguimiento , Factores de Riesgo , Administración Oral , Recurrencia , Adulto Joven , Tomografía de Coherencia Óptica , Angiografía con Fluoresceína/métodos , Inmunosupresores/uso terapéuticoRESUMEN
OBJECTIVES: Acute central serous chorioretinopathy (CSC) and Vogt-Koyanagi-Harada (VKH) disease in the acute uveitic phase are characterized by serous retinal detachment caused by dysfunction of the choroid. The aim of this study is to compare blood flow velocity and pulse waveform parameters in the choroid between these two diseases. METHODS: In this study, 25 patients (50 eyes) with VKH disease, 21 patients (27 eyes) with CSC and 15 healthy controls (30 eyes) were studied. Laser speckle flowgraphy (LSFG) was performed at presentation. RESULTS: Choroidal mean blur rate (MBR), representing blood flow velocity in choroidal vessels, was significantly lower in the eyes affected by VKH disease compared with the healthy control and CSC eyes. CSC eyes had a significantly higher MBR compared with healthy controls. Among the analyzed pulse waveform parameters, blow-out time (BOT), falling rate (FR) and flow acceleration index (FAI) changed significantly. BOT value was significantly lower in CSC eyes than in healthy control and VKH eyes. FR and FAI values were significantly lower in VKH eyes than in healthy control and CSC eyes. There was a strong positive correlation between MBR and FAI. CONCLUSIONS: Our findings confirm different pathophysiology of these two diseases. Assessment of choroidal blood flow velocity and haemodynamics with LSFG provides useful information to differentiate acute CSC and initial-onset acute uveitis associated with VKH disease.
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Coriorretinopatía Serosa Central , Coroides , Flujometría por Láser-Doppler , Flujo Sanguíneo Regional , Uveítis , Síndrome Uveomeningoencefálico , Humanos , Síndrome Uveomeningoencefálico/fisiopatología , Síndrome Uveomeningoencefálico/complicaciones , Síndrome Uveomeningoencefálico/diagnóstico , Coriorretinopatía Serosa Central/fisiopatología , Coriorretinopatía Serosa Central/diagnóstico , Masculino , Coroides/irrigación sanguínea , Femenino , Velocidad del Flujo Sanguíneo/fisiología , Enfermedad Aguda , Adulto , Persona de Mediana Edad , Uveítis/fisiopatología , Uveítis/diagnóstico , Flujo Sanguíneo Regional/fisiología , Tomografía de Coherencia Óptica/métodos , Angiografía con Fluoresceína/métodos , Agudeza Visual/fisiologíaRESUMEN
OBJECTIVE: To investigate the correlation between serum immunoglobulin E (IgE) levels and severity of Vogt-Koyanagi-Harada (VKH) disease. METHODS: The medical records of patients with VKH disease between 2015 and 2020 were reviewed. Serum immunoglobulins (IgA, IgE, IgG, and IgM), tumor necrosis factor α (TNFα) and C-reactive protein (CRP) were measured. Patients were divided into IgE-positive (IgE ≥ 100 IU/mL) and IgE-negative (IgE < 100 IU/mL) groups. The best-corrected visual acuity (BCVA) and macular morphologic characteristics including foveal thickness (FT), serous retinal detachment (SRD), sensory retinal thickness (SRT), central foveal thickness (CFT), cube volume (V), and cube average thickness (AT) were determined in patients in both groups. RESULTS: Of 128 patients included in the study, 35 (27.34%) patients were IgE-positive, BCVA (logMAR) was worse in the IgE-positive group. The mean CRP (P= .012) and TNFα (P≤ 0.001) levels were greater in the IgE-positive group than in the IgE-negative group. Regarding macular morphologic characteristics, FT (P= .010), SDR (P= .004), CFT (P= .008), V (P= .013), and AT (P= .006) were significantly greater in the IgE-positive group than in the IgE-negative group. CONCLUSIONS: Elevated serum IgE levels were associated with more severe macular changes in patients with VKH disease. These findings suggest that IgE may be involved in the progression of VKH disease.
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Angiografía con Fluoresceína/métodos , Inmunoglobulina E/sangre , Mácula Lútea/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Síndrome Uveomeningoencefálico/sangre , Agudeza Visual , Enfermedad Aguda , Adulto , Biomarcadores/sangre , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Fondo de Ojo , Humanos , Masculino , Gravedad del Paciente , Estudios Retrospectivos , Síndrome Uveomeningoencefálico/diagnóstico , Síndrome Uveomeningoencefálico/fisiopatologíaRESUMEN
Vogt-Koyanagi-Harada disease (VKH) is an autoimmune multisystemic syndrome that includes bilateral intraocular inflammation, associated with exudative retinal detachments, and systemic manifestations in the auditory, integumentary, and central nervous systems. The frequency of VKH disease in the world is variable, but in Santiago, Chile, it causes approximately 17% of non-infectious uveitis, an incidence 2 to 3-fold greater than in the USA or European countries. The evidence shows that the pathogenesis of VKH would be caused by cell-mediated autoimmunity directed against melanocytes present in the uveal tissue. CD4+ T lymphocytes (especially hyperactivity of Th17 and Th1 cells), B lymphocytes, cytokines (e.g., TGF-ß, IL-2, IL-6, IL-23 and INF-γ) and chemokines appear to play an important role in the development of VKH. Several lines of evidence support that the pathogenesis of uveitis observed in VKH involves an altered pattern of micro-ribonucleic acids (miRNA) expression, driving the loss of immunological tolerance. In this review, we discuss the evidence related to regulation and altered expression of miRNA associated with Vogt-Koyanagi-Harada and other autoimmune diseases. (AU)
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Síndrome Uveomeningoencefálico/fisiopatología , MicroARNs/genética , Enfermedades Autoinmunes/fisiopatología , Síndrome Uveomeningoencefálico/genética , Síndrome Uveomeningoencefálico/epidemiologíaRESUMEN
Purpose: To assess the effectiveness of intravitreal (IV) bevacizumab and the need for systemic immunosuppressive therapy (IMT) in choroidal neovascularization (CNV) in Vogt-Koyanagi-Harada disease (VKHD).Methods: CNV treatment consisted of three monthly IV bevacizumab injections as a loading dose; if intra/subretinal fluid (IRF) persisted, further injections were proceeded besides increment in systemic IMT. Outcome analyses at 3, 6, and 12 months were visual acuity, central foveal thickness, macular volume, IRF, and addition of IMT.Results: Seven eyes of six patients were included. Five patients (five eyes) completed a 12-month follow-up and received 12 IV bevacizumab injections. At the 12-month follow-up, visual acuity improved in four out of five eyes (p = .0568); all eyes had decreased macular volume (p = .0431) but they still had persistent IRF; and all cases needed IMT introduction/increment.Conclusion: Intravitreal bevacizumab in association with systemic IMT was effective for CNV in VKHD. Active CNV may indicate disease of inadequate clinical control.
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Inhibidores de la Angiogénesis/uso terapéutico , Bevacizumab/uso terapéutico , Neovascularización Coroidal/tratamiento farmacológico , Síndrome Uveomeningoencefálico/complicaciones , Adulto , Neovascularización Coroidal/etiología , Neovascularización Coroidal/fisiopatología , Femenino , Angiografía con Fluoresceína , Estudios de Seguimiento , Humanos , Inyecciones Intravítreas , Persona de Mediana Edad , Estudios Prospectivos , Líquido Subretiniano , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Síndrome Uveomeningoencefálico/fisiopatología , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Agudeza Visual/fisiologíaRESUMEN
Purpose: To evaluate retinal and choroidal microvascular features of VKH patients in acute and convalescent phases after treatment using OCTA.Methods: A prospective, observational study was conducted in patients with initial VKH at the acute stage (n = 15) and healthy participants (n = 15) served as controls. After 3-month systemic corticosteroid treatment, patients' vascular parameters were recorded by OCTA before and after treatment and compared with results observed in healthy participants.Results: Our findings first uncovered that there are two types of abnormalities in the choriocapillary layer of patients with VKH in the acute stage: one is characterized as multiple dark spots of choriocapillary flow void and the other involves highly reflective areas surrounded by light spots with an increased flow area. During the convalescent stage, all eyes showed multifocal dark spots in the choriocapillary layer, leading to a reduced choroidal flow area.Conclusions: OCTA provides a better display of the microvascular appearance of the choroid to noninvasively evaluate choriocapillaris abnormalities in VKH disease.
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Coroides/irrigación sanguínea , Arterias Ciliares/fisiopatología , Vasos Retinianos/fisiopatología , Síndrome Uveomeningoencefálico/fisiopatología , Enfermedad Aguda , Adolescente , Adulto , Coroides/diagnóstico por imagen , Arterias Ciliares/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Convalecencia , Femenino , Angiografía con Fluoresceína , Humanos , Masculino , Microvasos , Persona de Mediana Edad , Estudios Prospectivos , Vasos Retinianos/diagnóstico por imagen , Tomografía de Coherencia Óptica , Síndrome Uveomeningoencefálico/diagnóstico por imagen , Adulto JovenRESUMEN
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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Angiografía por Tomografía Computarizada , Enfermedades de la Retina/fisiopatología , Vasos Retinianos/fisiopatología , Tomografía de Coherencia Óptica , Uveítis Anterior/fisiopatología , Síndrome Uveomeningoencefálico/fisiopatología , Trastornos de la Visión/fisiopatología , Adolescente , Adulto , Anciano , Niño , Coroides/irrigación sanguínea , Femenino , Humanos , Masculino , Microcirculación/fisiología , Persona de Mediana Edad , Enfermedades de la Retina/diagnóstico por imagen , Vasos Retinianos/diagnóstico por imagen , Estudios Retrospectivos , Uveítis Anterior/diagnóstico por imagen , Síndrome Uveomeningoencefálico/diagnóstico por imagen , Trastornos de la Visión/diagnóstico por imagen , Agudeza Visual/fisiologíaRESUMEN
Purpose: To report a rare case of Vogt-Koyanagi-Harada (VKH) patient with bilateral annular choroidal detachment and describe ultra-widefield angiographic findings.Method: Case report.Results: A 61-year-old male was diagnosed as VKH based on ocular signs and neurologic findings. Annular choroidal detachment anterior to the equator was noted in both eyes. Ultra-wide field (UWF) fluorescein angiography revealed multiple leakages at posterior pole and disc with dye pooling at the margin of choroidal detachment. Late-phase UWF indocyanine green angiography (ICGA) revealed hyperpermeability with dilated veins and many vortex ampullae obscured by detached choroid. Choroidal detachment and other manifestations improved after a high-dose systemic steroid treatment. UWF ICGA after the treatment revealed decreased choroidal vessel caliber with visible vortex ampullae.Conclusion: Vortex obstruction and choroidal vein dilatation were observed in a VKH patient with choroidal detachment, which might be related to its pathophysiology.
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Enfermedades de la Coroides/diagnóstico por imagen , Síndrome Uveomeningoencefálico/complicaciones , Coroides/irrigación sanguínea , Enfermedades de la Coroides/etiología , Enfermedades de la Coroides/fisiopatología , Colorantes/administración & dosificación , Dilatación Patológica , Angiografía con Fluoresceína , Humanos , Verde de Indocianina/administración & dosificación , Masculino , Persona de Mediana Edad , Imagen Multimodal , Tomografía de Coherencia Óptica , Síndrome Uveomeningoencefálico/diagnóstico , Síndrome Uveomeningoencefálico/fisiopatología , Venas/fisiopatologíaRESUMEN
PURPOSE: To clarify the chronological changes in the anterior chamber structure and identify the spherical equivalent and axial length to assess the effects of steroid pulse treatment in patients with Vogt-Koyanagi-Harada disease with active uveitis. METHODS: The anterior chamber condition, including anterior chamber volume, central anterior chamber depth, peripheral anterior chamber depth, anterior chamber angle, and pupil diameter, was measured using Pentacam, and axial length was measured using IOLMaster in patients with Vogt-Koyanagi-Harada disease between June 2015 and February 2018. Furthermore, the best-corrected visual acuity, spherical equivalent, and retinal foveola thickness were also analyzed. All patients were treated with steroid pulse. All these factors were compared before and at 1 and 6 months of treatment. RESULTS: Significant changes were observed in the anterior chamber volume, central anterior chamber depth, peripheral anterior chamber depth, anterior chamber angle, axial length, best-corrected visual acuity, spherical equivalent, and retinal foveal thickness before and at 1 and 6 months of steroid pulse treatment (P < 0.001, P < 0.001, P < 0.001, P = 0.0015, P = 0.027, P < 0.001, P = 0.0043, and P < 0.001, respectively). No significant difference was observed in the pupil diameter before and at 1 month and 6 months of steroid pulse treatment (P = 0.11). CONCLUSION: The anterior chamber structure, axial length, best-corrected visual acuity, spherical equivalent, and retinal foveal thickness were dramatically changed by steroid pulse treatment in patients with Vogt-Koyanagi-Harada disease who develop active uveitis. These changes were completed within 1 month.
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Cámara Anterior/patología , Longitud Axial del Ojo/patología , Refracción Ocular/fisiología , Síndrome Uveomeningoencefálico/fisiopatología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Visión , Agudeza Visual/fisiología , Adulto JovenRESUMEN
Purpose: To demonstrate changes in three-dimensional choroidal volume with enhanced depth imaging optical coherence tomography (EDI-OCT) in patients with recurrent stage of Vogt-Koyanagi-Harada disease (VKH).Materials and Methods: This prospective comparative case series included 9 patients with recurrent VKH, 10 patients with quiet VKH, and 15 healthy controls after sample size was calculated. All VKH cases with recurrences underwent raster scanning with EDI-OCT at active and inactive stages of the disease.Results: All choroidal parameters in the active stage significantly reduced when the inflammation subsided: total choroidal volume (P = .02), central choroidal volume (P = .01), central choroidal thickness (P = .03). The changes in central choroidal volume over the resolution phase were more pronounced than the changes in central choroidal thickness in 56% of cases. Two cases presenting with only subclinical posterior segment recurrence had their choroidal parameters recovered after prompt treatment.Conclusions: In the recurrent stage of VKH, alteration in choroidal volume was evident by EDI-OCT even in an absence of anterior segment inflammation. Central choroidal volume may serve as a biomarker for detecting choroidal morphological change.
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Coroides/patología , Síndrome Uveomeningoencefálico/diagnóstico por imagen , Adulto , Anciano , Azatioprina/uso terapéutico , Coroides/diagnóstico por imagen , Ciclosporina/uso terapéutico , Femenino , Angiografía con Fluoresceína , Humanos , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Ácido Micofenólico/uso terapéutico , Estudios Prospectivos , Tomografía de Coherencia Óptica , Síndrome Uveomeningoencefálico/tratamiento farmacológico , Síndrome Uveomeningoencefálico/fisiopatología , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To evaluate associations between functional and structural measurements in patients with non-acute VKHD. METHODS: In this cross-sectional study, 16 non-acute VKHD patients (32 eyes; 14 female) were evaluated with multifocal electroretinogram (mfERG), standardized automated perimetry (SAP) and optical coherence tomography (OCT)examinations. All included patients had a minimum 12 months of follow-up from acute onset and were participants of an ongoing prospective study since acute phase with systematic clinical imaging evaluations and electroretinogram examinations within a predefined treatment. Age- and gender-matched controls were included. Main outcomes were functional and structural abnormalities and their correlation; secondary outcome was correlation of these findings with clinical characteristics, including fundus abnormalities. RESULTS: SAP and mfERG parameters were significantly worse in patients than in controls. Fourteen eyes (43.7%) had disrupted ellipsoid zone (EZ); visual acuity (VA) was similar between eyes with intact or disrupted EZ. Eyes with intact and disrupted EZ differed significantly concerning N1 and P1 amplitudes and N1 peak time values on mfERG and mean sensitivity (MS), central sensitivity (CS), foveal threshold, visual field index, mean deviation (MD) and pattern standard deviation values on SAP. The area under the curve on receiver operating curves for P1 amplitude was 0.81 (cut-off value = 34.7 nV/deg2 ) and for MD value was 0.84 (cut-off value = -5.2 dB). Central retinal thickness (CRT) significantly correlated with N1 and P1 amplitudes and P1 peak time values on mfERG (r = 0.354, r = 0.442 and r = -0.405, respectively) and MD, MS, CS and fovea threshold (log values) on SAP (r = 0.372, r = 0.406, r = 0.431 and r = 0.414, respectively). Statistically significant associations were found with the presence of peripapillary atrophy and recurrent anterior uveitis with a worse MD value (p = 0.004 and p < 0.001, respectively). CONCLUSION: In non-acute VKHD, disrupted EZ and reduced CRT were correlated with impaired mfERG and SAP parameters, even in patients with good VA.
Asunto(s)
Electrorretinografía/métodos , Retina/fisiopatología , Tomografía de Coherencia Óptica/métodos , Síndrome Uveomeningoencefálico/diagnóstico , Agudeza Visual , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Estudios Prospectivos , Retina/diagnóstico por imagen , Síndrome Uveomeningoencefálico/fisiopatologíaRESUMEN
PURPOSE: To assess macular capillary perfusion in patients with inactive Vogt-Koyanagi-Harada (VKH) disease by using optical coherence tomography angiography (OCTA). METHODS: A total of 51 eyes of 51 patients with inactive VKH (group 1, n = 23) and healthy volunteers (group 2, n = 28) underwent detailed eye examination including OCTA (RTVue-XR Avanti) scanning. OCTA images (6 × 6 mm) were assessed for central retinal thickness (CRT), subfoveal choroidal thickness (SFCT), vessel densities (VD) in superficial capillary plexus (SCP) and deep capillary plexus (DCP), choriocapillaris (CC) flow area and vessel flow density (VFD), foveal avascular zone (FAZ) area and acircularity index (AI). RESULTS: The mean ages of group 1 (13 female, 10 male) and group 2 (15 female, 13 male) were 39.9 ± 11.8 (range, 24-58) and 38.9 ± 8.5 (range, 29-51) years, respectively (p = 0.773). CRT and SFCT were 218.2 ± 39.4 µm and 195.6 ± 28.6 µm in group 1, while 243.5 ± 9.7 µm and 316.7 ± 20.1 µm in group 2, respectively (p < 0.05). VD in SCP and DCP were significantly lower in group 1 (50.6 ± 4.7% vs. 54.3 ± 3.4% and 53.9 ± 3.6% vs. 61.1 ± 2.7% respectively; p < 0.05). FAZ areas were 0.32 ± 0.11 mm2 in group 1 and 0.25 ± 0.06 mm2 in group 2 (p = 0.046). There was no statistically significant difference between groups regarding AI, CC flow area, and VFD (p > 0.05). There was weak negative correlation between BCVA (logMAR) and parafoveal and perifoveal VD in SCP and DCP of group 1 (p < 0.05). CONCLUSION: Macular capillary perfusion was significantly reduced both in SCP and DCP in patients with inactive VKH disease.
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Mácula Lútea/irrigación sanguínea , Vasos Retinianos/fisiopatología , Síndrome Uveomeningoencefálico/fisiopatología , Adulto , Capilares/fisiopatología , Coroides/patología , Estudios Transversales , Femenino , Angiografía con Fluoresceína , Voluntarios Sanos , Humanos , Mácula Lútea/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Vasos Retinianos/diagnóstico por imagen , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Síndrome Uveomeningoencefálico/diagnóstico por imagen , Agudeza Visual/fisiología , Adulto JovenRESUMEN
BACKGROUND: The common presence of human leukocyte antigen (HLA)-DRB1*04 in Vogt-Koyanagi-Harada (VKH) disease is well known. The aim of this study was to investigate the relationship between visual prognosis and HLA-DRB1*04 alleles during systemic corticosteroid therapy in patients with VKH disease. METHODS: This retrospective case series included 57 eyes from 29 consecutive patients with treatment-naïve VKH disease who received systemic corticosteroid therapy. Visual acuity, sex, refractive error, central retinal thickness (CRT), central choroidal thickness (CCT), and duration from onset to treatment were measured at initial and final visits. Mean values of parameters were compared with each visit. Genotyping was performed by polymerase chain reaction amplification with sequence-specific primer. RESULTS: Linear regression showed significant differences in logMAR best-corrected visual acuity between the three groups of homozygotes, heterozygotes, and normal subjects at baseline (p < 0.01), at 3 months after treatment (p < 0.01). There was no significant differences at 6 months after treatment (p = 0.257). No significant differences were detected between the three groups in age, sex, refractive error, CRT, CCT, or duration from onset to treatment. CONCLUSION: Alleles of HLA-DRB1*04 might affect visual prognosis and be related to early response after initiation of treatment in VKH disease.
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Antígenos HLA-DR/genética , Síndrome Uveomeningoencefálico , Agudeza Visual/fisiología , Corticoesteroides/uso terapéutico , Adulto , Coroides/patología , Femenino , Cadenas HLA-DRB1 , Prueba de Histocompatibilidad , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Retina/patología , Estudios Retrospectivos , Síndrome Uveomeningoencefálico/tratamiento farmacológico , Síndrome Uveomeningoencefálico/genética , Síndrome Uveomeningoencefálico/fisiopatologíaRESUMEN
BACKGROUND AND OBJECTIVE: To evaluate the flow characteristics and textural properties of choriocapillaris (CC) on optical coherence tomography angiography in eyes with resolved inflammatory choriocapillaropathies and Vogt-Koyanagi-Harada (VKH) disease. PATIENTS AND METHODS: A cohort of eyes with healed acute posterior multifocal placoid pigment epitheliopathy (APMPPE), serpiginous choroiditis (SC), and VKH disease were included. A 3 mm × 3 mm OCT angiogram of CC was acquired and graded for flow characteristics and textural properties. RESULTS: This study included 16 patients. Texture was heterogeneous in all eyes in the SC and VKH groups, and in four eyes (40%) in the APMPPE group. Most of the eyes with VKH disease had severe low flow, whereas most of the SC and APMPPE eyes demonstrated mild low flow. Heal duration had a strong negative correlation with severity of CC low flow and a weak, statistically nonsignificant correlation with texture heterogeneity. CONCLUSION: Despite the resolution of active inflammation, partial CC hypoperfusion and texture disruptions persist for longer durations and may resolve in a time dependent manner. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:566-572.].
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Coroides/fisiopatología , Coroiditis Multifocal/fisiopatología , Síndrome Uveomeningoencefálico/fisiopatología , Síndromes de Puntos Blancos/fisiopatología , Adulto , Angiografía , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Coroiditis Multifocal/diagnóstico por imagen , Flujo Sanguíneo Regional , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Síndrome Uveomeningoencefálico/diagnóstico por imagen , Síndromes de Puntos Blancos/diagnóstico por imagenRESUMEN
PURPOSE: To prospectively evaluate the dynamic changes of the full-field electroretinogram (ff-ERG) and its association with inflammatory signs in patients with Vogt-Koyanagi-Harada disease (VKHD) followed up after acute onset. METHODS: Twelve acute VKHD patients, who were followed up for at least 24 months, were enrolled at a tertiary center from June 2011 to January 2017. Treatment consisted of intravenous methylprednisolone followed by 1 mg/kg/day of oral prednisone with a slow tapering associated with late non-steroidal immunosuppressive therapy in previously defined cases. Inflammation was systematically evaluated with clinical and posterior segment imaging (PSI) exams (fluorescein angiography, FA, indocyanine green angiography, ICGA, enhanced depth imaging optical coherence tomography, EDI-OCT). A ff-ERG was performed upon enrollment as well as at predefined intervals. Scotopic ff-ERG parameters changes between the 12th and 24th months defined the ERG-stable or ERG-worsening groups. "Flare" was defined as an appearance or worsening of inflammatory signs (after the initial 6 months following disease onset) under the predefined treatment protocol. RESULTS: ff-ERG parameters initially improved in all eyes; in the evaluation between the 12th and 24th months, ff-ERG results were stable in 17 eyes (71 %) and worsened in 7 eyes (29 %). Subnormal ff-ERG results were observed in 15 eyes (62 %) at the 24th month. On the other hand, the flare was observed in 8 eyes (33 %) as cells in the anterior chamber and in 24 eyes (100 %) as any PSI inflammatory sign. The ERG-worsening group presented thicker subfoveal choroid at the first month (p = 0.001) and fluctuations in choroidal thickness more often during follow-up when compared to the ERG-stable group (p = 0.02). CONCLUSIONS: Scotopic ff-ERG parameters worsened between the 12th and 24th months in a quarter of the patients. Subclinical inflammation detected as an increase in CT seems to be related to worsening in visual function measured with ffERG.
Asunto(s)
Electrorretinografía/métodos , Retina/fisiopatología , Síndrome Uveomeningoencefálico/diagnóstico , Enfermedad Aguda , Adolescente , Adulto , Anciano , Coroides/patología , Progresión de la Enfermedad , Femenino , Angiografía con Fluoresceína/métodos , Estudios de Seguimiento , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Retina/diagnóstico por imagen , Factores de Tiempo , Tomografía de Coherencia Óptica/métodos , Síndrome Uveomeningoencefálico/fisiopatología , Adulto JovenRESUMEN
BACKGROUND: Vogt-Koyanagi-Harada (VKH) disease is a T-cell-mediated autoimmune disorder characterized by bilateral granulomatous panuveitis with various systemic manifestations. Although VKH disease rarely occurs in the pediatric population, the clinical course tends to be aggressive, and the visual prognosis is worse than that in adult patients due to severe ocular complications secondary to recurrent inflammation. CASE PRESENTATION: A 3-year-old girl with probable VKH was referred to Kobe University Hospital. She had severe bilateral panuveitis with posterior synechiae of the iris, marked optic disk swelling, and serous retinal detachment in both eyes, and her best corrected visual acuities (BCVAs) were 20/200 OD and 20/125 OS. A third course of therapy was administered because serous retinal detachment remained after two courses of therapy. She was treated with three courses of high-dose intravenous corticosteroid therapy, followed by slow tapering of oral corticosteroids. Her BCVAs recovered to 20/16 OU, and relapse of ocular inflammation and side effect of treatment were not observed during the 1.5-year follow-up period. CONCLUSIONS: We experienced a pediatric patient with probable VKH disease who was treated with three courses of high-dose intravenous corticosteroid therapy. With the favorable clinical course in our patient, initial treatment with repeated high-dose intravenous corticosteroid therapy might be beneficial in pediatric VKH disease.