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Jin K, Liang A, Song H, Xiao F, Gao F, Han X, Zhang M, Zhao C. A Novel Risk Stratification-Based Immunomodulatory Treatment Strategy for Vogt-Koyanagi-Harada Disease. Am J Ophthalmol 2024; 262:25-33. [PMID: 38369223 DOI: 10.1016/j.ajo.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/20/2024]
Abstract
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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Affiliation(s)
- Kehan Jin
- From the Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing
| | - Anyi Liang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University (A.L.), Guangzhou, China
| | - Hang Song
- From the Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing
| | - Feiyue Xiao
- From the Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing
| | - Fei Gao
- From the Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing
| | - Xiaoxu Han
- From the Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing
| | - Meifen Zhang
- From the Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing.
| | - Chan Zhao
- From the Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (K.J., H.S., F.X., F.G., X.H., M.Z., C.Z.), Beijing.
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Fauquier A, Barba T, Hot A, Sève P, Elbany S, Blanche P, Monnet D, Brézin A, Terrier B, Durel CA. Impact of Initial Management on Disease Evolution in Vogt-Koyanagi-Harada Syndrome: A Retrospective Cohort of 50 Patients. Ocul Immunol Inflamm 2024; 32:402-406. [PMID: 37141529 DOI: 10.1080/09273948.2023.2206485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE The study aims to determine the impact of initial management in Vogt-Koyanagi-Harada syndrome (VKHS). METHODS Patients diagnosed with a VKHS between January 2001 and December 2020 in two French tertiary centers were included in a retrospective study. RESULTS Fifty patients were included with a median duration of follow-up of 29.8 months. All patients received oral prednisone after methylprednisolone in all but four of them. Five patients received at least one associated immunosuppressive therapy (IST) within the first 6 months and 26 patients received IST during the entire follow-up period. Twenty-eight patients presented at least one relapse at a median of 5.4 months from diagnosis. Multivariate analyses demonstrated a significant association between relapse and delayed treatment (>26 days) (HR = 3.69, CI95% 1.30-10.47, p = .01), whereas no association was observed between relapse and the number of corticosteroid pulses at initial management. CONCLUSION An early corticosteroid treatment within the first 26 days of symptoms decreased the relapse rate.
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Affiliation(s)
- Alice Fauquier
- Department of Internal Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thomas Barba
- Department of Internal Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Hot
- Department of Internal Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pascal Sève
- Department of Internal Medicine, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Sandra Elbany
- Department of Ophthalmology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Philippe Blanche
- Department of Internal Medicine, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université de Paris Cité, Paris, France
| | - Dominique Monnet
- Department of Ophthalmology, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université de Paris Cité, Paris, France
| | - Antoine Brézin
- Department of Ophthalmology, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université de Paris Cité, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université de Paris Cité, Paris, France
| | - Cécile-Audrey Durel
- Department of Internal Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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Nakai S, Takeuchi M, Usui Y, Namba K, Suzuki K, Harada Y, Kusuhara S, Kaburaki T, Tanaka R, Takeuchi M, Mizuki N, Nakai K, Goto H, Herbort CP. Efficacy and Safety of Adalimumab for Exacerbation or Relapse of Ocular Inflammation in Patients with Vogt-Koyanagi-Harada Disease: A Multicenter Study. Ocul Immunol Inflamm 2024; 32:367-375. [PMID: 35748779 DOI: 10.1080/09273948.2022.2092007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 06/02/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE We investigated efficacy and safety of adalimumab (ADA) treatment for exacerbation or recurrence of Vogt-Koyanagi-Harada (VKH) patients. METHODS Medical records of 70 VKH patients who received ADA treatment for more than 6 months were retrospectively investigated. RESULTS The mean age of VKH patients was 54.8 ± 15.1 years, and male/female ratio was 34/36, and sunset glow fundus was observed in 71.4%. Subfoveal choroidal thickness, indocyanine green angiography scores, and corticosteroid and cyclosporine doses were significantly reduced by ADA treatment for 6 months compared to baseline, while LogMAR and flare counts were also improved without being statistically significant. Adverse events were observed in 17.1%, in which tuberculosis was at 7.14% and psoriasis was at 2.86%; however, ADA treatment was continued in 91.4%. CONCLUSIONS ADA was shown to be effective to achieve remission of VKH disease refractory to conventional treatments and was generally well tolerated with few serious adverse events.
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Affiliation(s)
- Shunsaku Nakai
- Department of Ophthalmology, National Defense Medical College, Saitama, Japan
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Saitama, Japan
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kayo Suzuki
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Higashihiroshima, Japan
| | - Sentaro Kusuhara
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Rie Tanaka
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kei Nakai
- Department of Ophthalmology, Yodogawa Christian Hospital, Osaka, Japan
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Carl P Herbort
- Centre for Ophthalmic Specialized Care, Lausanne, Switzerland
- Jichi Medical University Saitama Medical Center, Saitama, Japan
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Yargi-Ozkocak B, Altan C, Kemer-Atik B, Basarir B, Taskapili M. Blood Whispers: Exploring Hematologic Indicators for Diagnosing and Predicting Severity of Vogt-Koyanagi-Harada Syndrome. Ocul Immunol Inflamm 2024:1-9. [PMID: 38592364 DOI: 10.1080/09273948.2024.2334793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/21/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE To investigate the association of clinical findings and indocyanine green angiography (ICGA) score with inflammatory markers derived from complete blood count (CBC) parameters in patients with Vogt-Koyanagi-Harada (VKH) to determine the diagnostic and predictive role. METHODS Demographic characteristics, presenting complaints, ocular findings, optical coherence tomography findings, ICGA scores and best corrected visual acuity were recorded in treatment-naive VKH patients at presentation. Patients were divided into two groups as acute stage and chronic recurrent stage. CBC parameters were noted in patients at presentation and healthy controls (HC, n = 25). Neutrophil-lymphocyte-platelet-monocyte counts, neutrophil/lymphocyte (NLR), platelet/lymphocyte (PLR), monocyte/lymphocyte and systemic immune-inflammation index (SII) were recorded. The association between these markers and clinical severity were evaluated. RESULTS Thirty-two patients with VKH (23 females/9 males) with a mean age of 34.1 ± 14.6 years were included in the study. There was an increase in neutrophil count, NLR and SII in patients with VKH compared to HC (p < 0.001). The cut-off values for these three parameters were 4.37, 2.24 and 562.35, respectively. Twenty-six patients presented in the acute stage and six patients presented in the chronic recurrent stage. Choroidal thickness, early stromal hyperfluorescence and total ICGA scores were higher in patients presenting in the acute stage (p < 0.001, 0.001 and 0.025, respectively). Patients with higher disease severity at presentation were treated earlier. Early stromal vessel hyperfluorescence and choroidal vasculitis scores were correlated with decreased lymphocyte count, increased NLR, PLR and SII (p < 0.05). CONCLUSION CBC-derived inflammatory parameters indicate that VKH is a systemic inflammation. These parameters can be used in the diagnosis and determination of disease severity of VKH.
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Affiliation(s)
- Berru Yargi-Ozkocak
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Cigdem Altan
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Burcu Kemer-Atik
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Berna Basarir
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Muhittin Taskapili
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
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Tayal A, Daigavane S, Gupta N. Vogt-Koyanagi-Harada Disease: A Narrative Review. Cureus 2024; 16:e58867. [PMID: 38800227 PMCID: PMC11116741 DOI: 10.7759/cureus.58867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Vogt-Koyanagi-Harada (VKH) disease is an idiopathic immune-related sickness that affects multiple systems and melanocytes in organs such as the uvea, ear, and meninges. The primary cause of activity is cellular immunological responses. Vogt-Koyanagi disease is identified primarily by skin abnormalities and anterior uveitis. Harada's illness is distinguished by neurological symptoms and exudative retinal detachments, which are associated with the HLA-DR4 and HLA-DRw53 genes. Pigmented races, such as Hispanics and Native Americans, are more likely to have VKH disease. Clinical features are blurred vision, floaters, alopecia, vitiligo, diffuse choroidal inflammation with disc edema, and exudative retinal detachment. Differential diagnoses include posterior scleritis, uveal effusion syndrome, central serous chorioretinopathy, and sympathetic ophthalmitis. The investigations used are optical coherence tomography (OCT), fundus fluorescein angiography (FA), and B-scan ultrasonography (USG). Treatment is done by using systemic steroids, cycloplegics, and immunosuppressants.
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Affiliation(s)
- Ayushi Tayal
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sachin Daigavane
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nivesh Gupta
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Sato T, Taniguchi N, Nishio Y, Ito M, Takeuchi M. Classification of Peripheral Blood Leukocyte Phenotypes and Serum Cytokines in Vogt-Koyanagi-Harada Disease before and after Glucocorticoid Therapy. J Clin Med 2023; 12:7742. [PMID: 38137811 PMCID: PMC10743729 DOI: 10.3390/jcm12247742] [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: 11/25/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023] Open
Abstract
Vogt-Koyanagi-Harada disease (VKH) is an autoimmune disease, and glucocorticoid therapy (GC) is widely used for VKH. We provided a profile of leukocyte populations and serum cytokines in VKH patients under GC. A prospective observational study was conducted on three treatment-naïve VKH patients. Peripheral blood samples were collected from the patients before GC (VKH-acute) and after 6 months (VKH-remission), and healthy individuals were used as controls. Proportions of 37-type leukocytes and levels of 27-kind cytokines were measured by mass cytometry and multiplex bead analysis. Property similarity was analyzed using hierarchical cluster analysis. The leukocytes and cytokines were broadly classified into four and three clusters: (1) a cluster with high intensity in VKH-acute consisting of B cells, Th2-like, Th17-like, basophils, and IL-7 and IP-10; (2) a cluster with high intensity in VKH-remission composed of monocytes, neutrophils, IL-4, and TNFα; in leukocytes, (3) a cluster with low intensity in VKH-acute and -remission consisting of CD8+ T cells, Th1-like, and NKT cells; (4) a cluster with low intensity in VKH-remission composed of NK cells, Tregs, and DCs; and in cytokines, (5) a cluster with high intensities in VKH-acute and -remission comprising G-CSF, MCP-1, eotaxin, and IL-17A. These findings suggest that inflammatory composition in blood during the acute phase of VKH represents complex hyperimmune responses dominantly driven by Th and B cells.
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Affiliation(s)
- Tomohito Sato
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan; (T.S.); (N.T.); (Y.N.)
| | - Nanae Taniguchi
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan; (T.S.); (N.T.); (Y.N.)
| | - Yoshiaki Nishio
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan; (T.S.); (N.T.); (Y.N.)
| | - Masataka Ito
- Department of Developmental Anatomy and Regenerative Biology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan;
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan; (T.S.); (N.T.); (Y.N.)
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Kaya P, İnanç Tekin M, Özdal PÇ. Predictive Factors for the Prognosis of Vogt-Koyanagi-Harada Disease. Ocul Immunol Inflamm 2023; 31:1687-1693. [PMID: 36628436 DOI: 10.1080/09273948.2022.2159841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE To identify the prognostic factors in Vogt-Koyanagi-Harada (VKH) disease. METHODS This study included 23 patients (46 eyes) with acute-phase VKHdivided into two subgroups: Group 1; acute-resolved (10 patients), group 2; chronic-recurrent (13 patients). RESULTS Mean age were 29.5 ± 10.2 years in group 1, 35.8 ± 12.2 years group 2 (p = .033). Best-corrected visual acuity with logMAR at admission was 0.91 ± 0.65 in group 1, 0.88 ± 0.62 in group 2 (p = .798), and improved to 0.08 ± 0.24, 0.18 ± 0.6, respectively (p = .557). Extraocular findings were detected in 30% in group 1, and 53.8% in group 2 at the time of admission (p = .108). All patients were treated with 1 g/day 3-5 days intravenous steroid, and 10 patients had immunomodulatory treatment. Initiation of immunomodulatory therapy did not affect the prognosis (p = .676). CONCLUSION Older patients and/or who developed extraocular findings at the presentation were more prone to show recurrences.
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Affiliation(s)
- Pınar Kaya
- Department of Opthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Merve İnanç Tekin
- Department of Opthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Pınar Çakar Özdal
- Department of Opthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
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Manni P, Saturno MC, Accorinti M. Vogt-Koyanagi-Harada Disease and COVID. J Clin Med 2023; 12:6242. [PMID: 37834885 PMCID: PMC10573236 DOI: 10.3390/jcm12196242] [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: 08/04/2023] [Revised: 08/26/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Vogt-Koyanagi-Harada (VKH) is a rare multisystem inflammatory disease affecting the eyes, ears, brain, skin, and hair. The Coronavirus Disease 2019 (COVID-19) is a new contagious infection that might trigger the onset of VKH disease, as previously proposed for other viruses. Moreover, after the mass vaccination against SARS-CoV-2 worldwide, cases of VKH disease associated with COVID-19 vaccination have been reported. We present an overview of VKH and a comprehensive literature revision of all the VKH cases described after COVID-19 infection and vaccination, adding our experience. No differences have been found considering epidemiology and clinical findings of the disease compared to those reported in the no-COVID era. All of the patients promptly responded to systemic and local corticosteroid therapy with a good final visual prognosis. Different possible pathogenetic mechanisms underlying the onset of VKH after COVID-19 vaccination are discussed, while the presence of the HLA DR4 antigen as a genetic predisposition for the onset of the disease after COVID-19 infection and vaccination is proposed. VKH disease is one of the most frequently reported uveitic entities after COVID-19 vaccination, but a good response to therapy should not discourage vaccination. Nevertheless, ophthalmologists should be alerted to the possibility of VKH occurrence or relapse after COVID-19 vaccination, especially in genetically predisposed subjects.
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Affiliation(s)
| | | | - Massimo Accorinti
- Ocular Immunovirology Service, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.M.); (M.C.S.)
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Wang K, Zheng C, Zhao G, Zhang M, Liu T, Li H, Tao Q, Cheng Z, Li X, Zhang X. HIGH LONG-TERM DRUG-FREE REMISSION RATE FOR ACUTE VOGT-KOYANAGI-HARADA DISEASE WITH AN APPROPRIATE IMMUNOSUPPRESSIVE REGIMEN. Retina 2023; 43:1496-1505. [PMID: 37224445 PMCID: PMC10442124 DOI: 10.1097/iae.0000000000003837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To report the clinical profile and outcomes of acute Vogt-Koyanagi-Harada disease with a strict immunosuppression regimen and investigate the risk factors for a prolonged disease course. METHODS A total of 101 patients with acute Vogt-Koyanagi-Harada (202 eyes) with more than 24 months of follow-up were recruited from January 2011 to June 2020. They were divided into two groups according to the interval between the onset of Vogt-Koyanagi-Harada and treatment. Oral prednisone was gradually tapered off by a diminished dose according to a relatively strict protocol. Patient responses to the treatment regimen were classified as long-term drug-free remission or chronic recurrent. RESULTS Ninety-six patients (95.0%) achieved long-term drug-free remission without recurrence, while 5 (5.0%) had chronic recurrence. Most patients achieved good best-corrected visual acuity (90.6% ≧20/25). A generalized estimation equation model demonstrated that time of visit, ocular complications, and cigarette smoking were independent risk factors for a longer disease course, and smokers required a higher drug dose and longer treatment course than nonsmokers. CONCLUSION An immunosuppressive regimen with an appropriate tapering speed can lead to long-term drug-free remission in patients with acute Vogt-Koyanagi-Harada. Cigarette smoking significantly affects ocular inflammation.
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Affiliation(s)
- Kaixuan Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and
| | - Chuanzhen Zheng
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and
| | | | - Mi Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and
| | - Tong Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and
| | - Huan Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and
| | - Qingqin Tao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and
| | - Zhaohui Cheng
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and
| | - Xiaomin Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and
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Yoshitomi S, Harada Y, Hiyama T, Yuasa Y, Hirooka K, Kiuchi Y. Incidence and pre/post-treatment risk factors of glaucoma in Vogt-Koyanagi-Harada disease. Int Ophthalmol 2023; 43:2857-2866. [PMID: 36929369 DOI: 10.1007/s10792-023-02688-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE To investigate the incidence and pre/post-treatment risk factors of glaucoma in patients with Vogt-Koyanagi-Harada (VKH) disease. METHODS Data regarding secondary glaucoma were collected from the medical records of patients with VKH disease who were followed up at the uveitis service at Hiroshima University for more than 6 months. We examined the incidence of glaucoma and pre/post-treatment risk factors for glaucoma in patients with VKH disease. RESULTS Forty-nine patients with VKH disease were included in this study (31 women and 18 men). The mean age at onset was 50.4 ± 15.4 years and the mean length of follow-up was 40.7 ± 25.5 months. The most common initial treatment was pulse intravenous corticosteroid therapy (89.8%). Fifteen patients developed secondary glaucoma during follow-up. The median time of glaucoma onset from VKH development was 4.5 months (range 0-44 months). Disc swelling type as a pre-treatment factor (p = 0.089, hazard ratio = 7.268), worse final best corrected visual acuity (p = 0.099, odds ratio = 1.545), and cataract progression (p = 0.076, odds ratio = 7.886) as post-treatment factors showed trends for glaucoma development. The patients who progressed to the chronic recurrent stage had more complications including glaucoma. CONCLUSION Secondary glaucoma occurred in more than 30% of patients with VKH disease. The factors that showed a trend toward glaucoma development may reflect an association with delayed treatment initiation and prolonged ocular inflammation.
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Affiliation(s)
- Suzu Yoshitomi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan.
| | - Tomona Hiyama
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Yuki Yuasa
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
- Department of Ophthalmology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Kazuyuki Hirooka
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
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11
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Outcomes of patients with acute Vogt-Koyanagi-Harada disease treated with intravenous corticosteroid pulse followed by the slow tapering of oral corticosteroid therapy. Int Ophthalmol 2023; 43:431-440. [PMID: 35869402 DOI: 10.1007/s10792-022-02440-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To elucidate the intravenous corticosteroid pulse treatment outcomes of patients with acute Vogt-Koyanagi-Harada (VKH) disease and assess the differences between patients with no inflammation worsening and those with persistent or worsening inflammation. Potential factors responsible for eyes with low visual outcomes were also investigated. METHODS We retrospectively reviewed the clinical records of patients with acute VKH disease who first visited us between 2009 and 2018 and were followed up for > 300 days. Clinical characteristics, treatments, and posttreatment conditions were assessed. Patients were classified into no inflammation worsening (acute-resolved [AR]) and inflammation worsening (chronic-recurrent [CR]) groups based on conditions after 6 months from disease onset. RESULTS This study included 60 eyes from 30 patients (mean age: 52.7 years). Patients were treated with methylprednisolone pulse followed by the slow tapering of oral prednisolone; 73% of patients developed AR and 27% CR, and the best-corrected visual acuity (BCVA) was ≥ 1.0 in 83% of eyes at 6 months following the introduction of treatment. Although the total prednisolone dose was higher in patients with CR disease, no significant difference was noted in the final BCVA. Among the patients, five eyes had a final BCVA of ≤ 0.5 due to anisometropic amblyopia, diabetic maculopathy, pre-existing macular hole, epiretinal membrane, and ellipsoid zone loss. CONCLUSIONS Patients with acute VKH disease treated with corticosteroid pulse appear to demonstrate good visual outcomes, including patients with CR; the majority of eyes with low visual outcomes have pre-existing conditions that explain the low vision.
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12
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AlBloushi AF, AlEnezi SH, Al Owaifeer AM, Al-Hadlaq OS, Gikandi PW, Abu El-Asrar AM. Long-term Outcomes of Uveitis Associated with Vogt-Koyanagi-Harada Disease in the Pediatric Age Group. Ocul Immunol Inflamm 2022; 30:1669-1677. [PMID: 34184966 DOI: 10.1080/09273948.2021.1933074] [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: 12/16/2022]
Abstract
PURPOSE To investigate the outcomes of uveitis associated with Vogt-Koyanagi-Harada (VKH) disease in pediatric age group (aged 16 years and under). METHODS A retrospective review of patients with VKH disease. RESULTS Among the 244 patients identified, 38 (76 eyes) were children. Among them, five had insulin-dependent diabetes mellitus. 21 presented with initial-onset acute disease and 17 with chronic recurrent disease. The mean follow-up period was 59.1 months. At presentation, chronic recurrent disease was associated with more severe inflammation as indicated by the presence of mutton-fat keratic precipitates (p < .001), iris nodules (p = .005) and posterior synechiae (p < .001). During follow-up, the rate of complications was higher in children with chronic recurrent disease compared with initial-onset acute disease (p < .001). 92.4% of the eyes with initial-onset acute disease achieved a final visual acuity of ≥20/40 compared with 70.6% of the eyes with chronic recurrent disease (p = .013). CONCLUSIONS Chronic recurrent VKH disease in children is associated with worse outcomes.
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Affiliation(s)
- Abdulrahman F AlBloushi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saad H AlEnezi
- Ophthalmology Department, College of Medicine, Majmaah University, Al Majma'ah, Saudi Arabia
| | - Adi Mohammed Al Owaifeer
- Ophthalmology Unit, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia.,King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Omar S Al-Hadlaq
- 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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13
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Li Y, Su G, Huang F, Zhu Y, Luo X, Kijlstra A, Yang P. Identification of differently expressed mRNAs by peripheral blood mononuclear cells in Vogt-Koyanagi-Harada disease. Genes Dis 2022; 9:1378-1388. [PMID: 35873021 PMCID: PMC9293694 DOI: 10.1016/j.gendis.2021.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 11/29/2022] Open
Abstract
Vogt-Koyanagi-Harada disease (VKH) is a rare autoimmune disease characterized by diffuse and bilateral uveitis, alopecia, tinnitus, hearing loss, vitiligo and headache. The transcriptional expression pattern of peripheral blood mononuclear cells (PBMC) in VKH remains largely unknown. In this study, mRNA sequencing was conducted in PBMC from VKH patients with active uveitis before treatment (n = 7), the same patients after prednisone combined with cyclosporine treatment (n = 7) and healthy control subjects strictly matched with gender and age (n = 7). We found 118 differentially expressed genes (DEGs) between VKH patients and healthy control subjects, and 21 DEGs between VKH patients before and after treatment. TRIB1 was selected as a potential biomarker to monitor the development of VKH according to the mRNA sequencing. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were performed to predict the possible biological functions and signaling pathways of DEGs. Neutrophil degranulation, peptidase regulator activity, secretory granule membrane, cellular response to peptide, growth factor binding and cell projection membrane were enriched as GO annotations of DEGs. Arachidonic acid metabolism and mitogen-activated protein kinase (MAPK) signaling pathway were potential signaling pathways involved in pathogenesis and drug response of VKH. A protein–protein interaction (PPI) network was constructed by STRING, and colony stimulating factor 1 receptor (CSF1R) was identified as the hubgene of all DEGs by Cytoscape. The cell type presumed to contribute to the aberrant expression of DEGs was analyzed with the use of publicly available single-cell sequencing data of PBMC from a healthy donor and single-cell sequencing dataset of monocytes from VKH patients. Our findings may help to decipher the underlying cellular and molecular pathogenesis of VKH and may lead novel therapeutic applications.
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Affiliation(s)
- Yujing Li
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing 400016, PR China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing 400016, PR China
| | - Fanfan Huang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing 400016, PR China
| | - Ying Zhu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing 400016, PR China
| | - Xiang Luo
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing 400016, PR China
| | - Aize Kijlstra
- University Eye Clinic Maastricht, Maastricht 6211, the Netherlands
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing 400016, PR China
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14
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Fram B, Fernandez A, Syed H, Brar V. Recurrent Vogt-Koyanagi-Harada disease presenting with diffuse orbital inflammation. Am J Ophthalmol Case Rep 2022; 27:101625. [PMID: 35761879 PMCID: PMC9233211 DOI: 10.1016/j.ajoc.2022.101625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/31/2022] [Accepted: 06/14/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Brandon Fram
- Department of Ophthalmology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Andrew Fernandez
- Department of Ophthalmology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Huzaefah Syed
- Department of Rheumatology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Vikram Brar
- Department of Ophthalmology, Virginia Commonwealth University Health System, Richmond, VA, USA
- Corresponding author. 401 N 11th St Suite 439, Richmond, VA, 23298, USA.
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15
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Alvarez-Guzman C, Hartleben-Matkin C, Ruiz-Lozano RE, Rodriguez-Garcia A, Quiroga-Garza ME, Valdez-Garcia JE. Risk factors for secondary Glaucoma in patients with Vogt-Koyanagi-Harada disease. J Ophthalmic Inflamm Infect 2022; 12:22. [PMID: 35816207 PMCID: PMC9273804 DOI: 10.1186/s12348-022-00300-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND/PURPOSE Identify the prevalence and risk factors for secondary glaucoma among Mexican-mestizo patients with Vogt-Koyanagi-Harada Disease (VKH). METHODS Retrospective cohort study analyzing the demographic, clinical, and epidemiological variables. Risk estimates were calculated using a Cox proportional hazards regression model. RESULTS One hundred eyes of 50 patients, 44 (88%) women and 6 men (12%) with a median age of 35.5 years (IQR 29-46) and a median follow-up time of 72 months (IQR 13.7-126.7) were analyzed. The prevalence of glaucoma was 20%, with angle-closure accounting for 70% of all cases. Significant clinical risk factors for glaucoma development were a chronic recurrent stage at presentation (RR 2.88, 95% CI 1.11-12.63, p = 0.037), ≥ 2 episodes of recurrent anterior uveitis (RR 8.52, 95% CI 2.02-35.92, p < 0.001), angle-closure disease (ACD, RR 7.08, 95% CI 2.44-20.48, p < 0.001), iris bombé (RR 5.0, 95% CI 2.10-11.90, p < 0.001), and peripapillary atrophy (RR 3.56, 95% CI 1.43-8.85, p < 0.001). Exposure to > 24 months of oral (RR 9.33, 95% CI 2.21-39.28, p < 0.001) or > 12 months of topical corticosteroids (RR 3.88, 95% CI 1.31-11.46, p = 0.007) were associated with an increased likelihood for secondary glaucoma development. CONCLUSION Glaucoma is a frequent complication of VKH, often attributed to mixed pathogenic mechanisms. Chronic disease at presentation, recurrent inflammation, angle-closure mechanisms, iris bombé, and peripapillary atrophy represent clinically significant risk factors for developing secondary glaucoma. Prompt and aggressive steroid-spearing immunosuppressive therapy for adequate inflammation control may lower the risk of glaucoma in VKH.
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Affiliation(s)
- Carlos Alvarez-Guzman
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Instituto de Oftalmologia y Ciencias Visuales, Monterrey, Nuevo Leon, Mexico.,Fundación de Asistencia Privada Conde de Valenciana, IAP, Ciudad de México, México Chimalpopoca 14. Col. Obrera, CP 06800, Ciudad de México, Mexico
| | - Curt Hartleben-Matkin
- Fundación de Asistencia Privada Conde de Valenciana, IAP, Ciudad de México, México Chimalpopoca 14. Col. Obrera, CP 06800, Ciudad de México, Mexico
| | - Raul E Ruiz-Lozano
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Instituto de Oftalmologia y Ciencias Visuales, Monterrey, Nuevo Leon, Mexico
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Instituto de Oftalmologia y Ciencias Visuales, Monterrey, Nuevo Leon, Mexico. .,Instituto de Oftalmologia y Ciencias Visuales (1er Piso Ote.) Hospital Zambrano Hellion Tec Salud, Av. Batallon de San Patricio #112. Col. Real de San Agustin. San Pedro Garza Garcia, Nuevo Leon. CP, Mexico, 66278, Mexico.
| | - Manuel E Quiroga-Garza
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Instituto de Oftalmologia y Ciencias Visuales, Monterrey, Nuevo Leon, Mexico
| | - Jorge E Valdez-Garcia
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Instituto de Oftalmologia y Ciencias Visuales, Monterrey, Nuevo Leon, Mexico
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16
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High prevalence of angle-closure glaucoma in Vogt-Koyanagi-Harada disease. Int Ophthalmol 2022; 42:3913-3921. [PMID: 35789316 DOI: 10.1007/s10792-022-02412-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To determine the prevalence, clinical characteristics, and mechanisms of secondary glaucoma in Vogt-Koyanagi-Harada (VKH) disease. METHODS This retrospective, longitudinal observational study analyzed the demographic data, disease stage, glaucoma development, intraocular pressure, best-corrected visual acuity, lens status, optic nerve, gonioscopy, management, and visual outcomes of VKH disease. Clinical features were used to categorize the stage of VKH disease. VKH eyes were divided into two groups, with or without glaucoma, undergoing further analysis, including statistical analysis. RESULTS 305 eyes of 155 patients with VKH disease with a median follow-up of 22 months were included. Secondary glaucoma developed in 67 (22%) eyes, most of which (64.2%) had chronic recurrent VKH at presentation. Angle-closure was present in 55 (82.1%) of glaucoma eyes. Peripheral anterior and posterior synechiae were present in 58 (86.6%) and 51 (76.1%) eyes, respectively. Pupillary block and posterior synechiae resulted in iris bombé in 17 (25.4%) eyes with glaucoma. At the last visit, visual acuity was worse in eyes with glaucoma (p < 0.001). CONCLUSION We found that angle-closure disease is a significant cause of secondary glaucoma in VKH. Eyes with glaucoma were more likely to present in the chronic recurrent stage of the disease.
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17
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Shi W, Ye J, Shi Z, Pan C, Zhang Q, Lin Y, Luo Y, Su W, Zheng Y, Liu Y. Chromatin accessibility analysis reveals regulatory dynamics and therapeutic relevance of Vogt-Koyanagi-Harada disease. Commun Biol 2022; 5:506. [PMID: 35618758 PMCID: PMC9135711 DOI: 10.1038/s42003-022-03430-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/29/2022] [Indexed: 12/19/2022] Open
Abstract
The barrier to curing Vogt-Koyanagi-Harada disease (VKH) is thought to reside in a lack of understanding in the roles and regulations of peripheral inflammatory immune cells. Here we perform a single-cell multi-omic study of 166,149 cells in peripheral blood mononuclear cells from patients with VKH, profile the chromatin accessibility and gene expression in the same blood samples, and uncover prominent cellular heterogeneity. Immune cells in VKH blood are highly activated and pro-inflammatory. Notably, we describe an enrichment of transcription targets for nuclear factor kappa B in conventional dendritic cells (cDCs) that governed inflammation. Integrative analysis of transcriptomic and chromatin maps shows that the RELA in cDCs is related to disease complications and poor prognosis. Ligand-receptor interaction pairs also identify cDC as an important predictor that regulated multiple immune subsets. Our results reveal epigenetic and transcriptional dynamics in auto-inflammation, especially the cDC subtype that might lead to therapeutic strategies in VKH.
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Affiliation(s)
- Wen Shi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China.,Research Unit of Ocular Development and Regeneration, Chinese Academy of Medical Sciences, Beijing, 100085, China.,Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, 510005, China
| | - Jinguo Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Zhuoxing Shi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Caineng Pan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Qikai Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Yuheng Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Yuanting Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Wenru Su
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China. .,Research Unit of Ocular Development and Regeneration, Chinese Academy of Medical Sciences, Beijing, 100085, China. .,Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, 510005, China.
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China.,Research Unit of Ocular Development and Regeneration, Chinese Academy of Medical Sciences, Beijing, 100085, China.,Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, 510005, China
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18
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Almobarak FA, Alharbi AH, Aljadaan I, Aldhibi H. Phacoemulsification after trabeculectomy in uveitis associated with Vogt-Koyanagi-Harada disease: intermediate-term visual outcome, IOP control and trabeculectomy survival. BMC Ophthalmol 2022; 22:210. [PMID: 35534801 PMCID: PMC9087941 DOI: 10.1186/s12886-022-02438-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the visual outcome, intraocular pressure control and trabeculectomy survival after phacoemulsification in eyes with prior trabeculectomy in uveitis associated with Vogt-Koyanagi-Harada disease (VKH). DESIGN Retrospective comparative study. METHODS Eyes with uveitic glaucoma associated with VKH who underwent mitomycin C (MMC)-enhanced trabeculectomy were included. Eyes were divided into two groups: the first study group included eyes that later underwent cataract surgery in the form of phacoemulsification, and the second control group included eyes that did not have cataract surgery. The main outcome measures were changes in the visual acuity, intraocular pressure (IOP), the number of antiglaucoma medications, IOP control and trabeculectomy survival. RESULTS There were no significant differences in the final visual acuity (0.78 (±0.9) and 0.92 (±1.1), p = 0.80)) nor IOP (14.21 mmHg (±5.8) and 12.16 mmHg (±6.1), p = 0.29), but there was a difference in the antiglaucoma medications (1.58 (±1.5) and 0.53 (±1.0), p = 0.02) between the study and control group, respectively. There was no difference in the overall trabeculectomy survival (p = 0.381, Log Rank), but more eyes in the study group converted to qualified success after phacoemulsification and required more medications to control the IOP. CONCLUSION Phacoemulsification after trabeculectomy seems to be a safe procedure in eyes with combined vision threatening complications of VKH, although the visual improvement was limited. Nevertheless, more medications were required to control the IOP, resulting in less absolute and more qualified trabeculectomy success. Therefore, patient counseling before surgery is essential.
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Affiliation(s)
- Faisal A Almobarak
- Department of Ophthalmology, College of medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Saudi Arabia. .,Glaucoma Research Chair, King Saud University, Riyadh, Saudi Arabia. .,Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. .,Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
| | - Ali H Alharbi
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Ibrahim Aljadaan
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Hassan Aldhibi
- Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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19
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Yang S, Tao T, Huang Z, Liu X, Li H, Xie L, Wen F, Chi W, Su W. Adalimumab in Vogt-Koyanagi-Harada Disease Refractory to Conventional Therapy. Front Med (Lausanne) 2022; 8:799427. [PMID: 35096888 PMCID: PMC8789678 DOI: 10.3389/fmed.2021.799427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022] Open
Abstract
Background: No study explores the effectiveness of adalimumab in sight-threatening Vogt-Koyanagi-Harada (VKH) patients in China. Objective: To evaluate the short-term effectiveness and safety of adalimumab (ADA) in patients with sight-threatening Vogt-Koyanagi-Harada (VKH) disease refractory to conventional therapy. Methods: Medical records of VKH patients who had been treated with systemic glucocorticoids and immunosuppressants but whose condition was poorly controlled were collected and analyzed. Primary outcomes comprised of best-corrected visual acuity (BCVA), intraocular inflammation, relapses, and glucocorticoid-sparing effects. Other outcomes included central macular thickness (CMT), intraocular manifestations and adverse events (AEs). Results: Nine refractory VKH patients with a median age of 30 (16, 43) years old were enrolled in this study and received treatment for a median of 10 (7, 11) months. Mean BCVA improved from LogMar 0.63 ± 0.50 (20/72 or 0.36 ± 0.26 in Snellen chart) at baseline to LogMar 0.50 ± 0.37 (20/82 or 0.41 ± 0.28 in Snellen chart) at final visit (P = 0.090). The anterior chamber cell grade decreased from 2 (1.75, 3)+ at baseline to 0.5 (0, 1.25)+ cell at final visit (P < 0.001). The vitritis grade decreased from 1 (1, 1) + cell at baseline to 0 (0, 1)+ cell at final visit (P < 0.001). Patients suffered a median of 1 (0, 2) relapse during treatment. CMT remained stable from 238.50 ± 144.94 μm at baseline to 219.28 ± 77.20 μm at final visit (P = 0.553). The mean prednisone dosage decreased from 21.91 ± 18.39 mg/d to 2.73 ± 4.10 mg/d (P = 0.005). No severe AEs were found during treatment. Conclusions: The outcomes indicated that ADA was an effective and safe option for VKH patients refractory to conventional therapy by controlling inflammation, preserving visual function and reducing the daily glucocorticoid dose.
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Affiliation(s)
- Shizhao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Tianyu Tao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhaohao Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiuxing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - He Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lihui Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Feng Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wei Chi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wenru Su
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Mucosal-associated invariant T cells have therapeutic potential against ocular autoimmunity. Mucosal Immunol 2022; 15:351-361. [PMID: 34775490 DOI: 10.1038/s41385-021-00469-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/10/2021] [Accepted: 10/26/2021] [Indexed: 02/04/2023]
Abstract
Autoimmune uveitis is a sight-threatening disease induced by pathogenic T cells that recognize retinal antigens; it is observed in disorders including Vogt-Koyanagi-Harada disease (VKH). The roles of specific T cell subsets and their therapeutic potential against autoimmune uveitis are not fully understood. Here we conducted multi-parametric single-cell protein quantification which shows that the frequency of CD161highTRAV1-2+ mucosal-associated invariant T (MAIT) cells that recognize vitamin B2 metabolite-based antigens is decreased in relapsing VKH patients compared to individuals without active ocular inflammation. An experimental autoimmune uveitis (EAU) mouse model revealed that genetic depletion of MAIT cells reduced the expression of interleukin (Il) 22 and exacerbated retinal pathology. Reduced IL-22 levels were commonly observed in patients with relapsing VKH compared to individuals without active ocular inflammation. Both mouse and human MAIT cells produced IL-22 upon stimulation with their antigenic metabolite in vitro. An intravitreal administration of the antigenic metabolite into EAU mice induced retinal MAIT cell expansion and enhanced the expressions of Il22, as well as its downstream genes related to anti-inflammatory and neuroprotective effects, leading to an improvement in both retinal pathology and visual function. Taken together, we demonstrate that a metabolite-driven approach targeting MAIT cells has therapeutic potential against autoimmune uveitis.
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Lim J, Tan W, Nor N. Hints from the skin beneath: Vitiligo in Vogt–Koyanagi–Harada disease. DERMATOL SIN 2022. [DOI: 10.4103/ds.ds_23_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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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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23
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Arriola-Villalobos P, Moll-Udina A, Carrasco-López-Brea M, Sacristan C, Capella MJ, Peiteado D, Garrote-Llordén A, Albert Fort M, Jódar Márquez M, Jacobo Gonzalez Guijarro J, Demetrio-Pablo R, Luis Sánchez Sevilla J, Carreño E, González-López J, Miguel-Escuder L, Cuadros C, Díaz-Valle D, Adan A, Benítez Del Castillo JM, Fonollosa A, Cordero M, Martínez Costa L, Blanco-Alonso R. Vogt-Koyanagi-Harada disease in Spain. Eur J Ophthalmol 2021; 32:1547-1554. [PMID: 34269103 DOI: 10.1177/11206721211033477] [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: 11/17/2022]
Abstract
PURPOSE To describe the clinical and epidemiological characteristics of patients with Vogt-Koyanagi-Harada (VKH) disease in Spain. METHODS This was a retrospective multicenter analysis of data from VKH patients followed for at least 6 months. The data collected were related to demographics, clinical manifestations, treatments, and complications. RESULTS Participants were 112 patients (224 eyes), from 13 tertiary referral centers, of mean age 37.5 ± 14.7 years; 83.9% were women. Ethnicities were 61.6% Caucasian and 30.4% Hispanic. The disease was classified as complete in 16.1%, incomplete in 55.4%, and probable in 28.6%. When seen for the first time, the clinical course was acute in 69.6%, recurrent chronic in 15.2%, and chronic in 14.3%. The most frequent treatment was corticosteroids (acute stage 42.2%, maintenance stage 55.6%). The most common complications were cataract (41.1%) and ocular hypertension (16.1%). In most eyes, visual acuity was improved (96.7%) or remained stable at the end of follow up. CONCLUSION VKH in Spain mostly affects women and presents as incomplete acute stage disease. Visual prognosis is good. Cataract and glaucoma are the two most frequent complications.
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Affiliation(s)
- Pedro Arriola-Villalobos
- Servicio de Oftalmología, Hospital Clínico San Carlos, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.,Red Temática de Investigación Cooperativa en Salud, Oftared, Instituto de Salud Carlos III, Madrid, Spain.,Hospital QuironSalud Madrid, Madrid, Spain
| | - Aina Moll-Udina
- Clinic Hospital of Barcelona, Clinic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Mario Carrasco-López-Brea
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Cristina Sacristan
- Begiker-Ophthalmology Research Group, Ophthalmology Department, BioCruces Health Research Institute, Cruces Hospital, University of the Basque Country, Leioa, Spain
| | - Maria Jose Capella
- Centro de Oftalmología Barraquer, Barcelona, Spain.,Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Diana Peiteado
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, Spain
| | - Ana Garrote-Llordén
- Servicio de Oftalmología, Complejo Asistencial Universitario de León, Leon, Spain
| | - Mara Albert Fort
- Servicio de Oftalmología, Hospital Universitari Doctor Peset, Valencia, Spain
| | - Margarita Jódar Márquez
- Servicio de Oftalmología, Hospital Regional Universitario de Málaga, Malaga, Andalusia, Spain
| | | | | | | | - Ester Carreño
- Servicio de Oftalmología, Hospital Universitario Fundación Jimenez Díaz, Madrid, Spain.,Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - Julio González-López
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Lucia Miguel-Escuder
- Hospital Clinic of Barcelona, Clinic Institute of Ophthalmology, University of Barcelona, Barcelona, Catalonia, Spain
| | - Carlos Cuadros
- Begiker-Ophthalmology Research Group, Ophthalmology Department, BioCruces Health Research Institute, Cruces Hospital, University of the Basque Country, Leioa, Spain
| | - David Díaz-Valle
- Servicio de Oftalmología, Hospital Clínico San Carlos, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.,Red Temática de Investigación Cooperativa en Salud, Oftared, Instituto de Salud Carlos III, Madrid, Spain
| | - Alfredo Adan
- Clinic Hospital of Barcelona, Clinic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | | | - José M Benítez Del Castillo
- Servicio de Oftalmología, Hospital Clínico San Carlos, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.,Red Temática de Investigación Cooperativa en Salud, Oftared, Instituto de Salud Carlos III, Madrid, Spain
| | - Alejandro Fonollosa
- Begiker-Ophthalmology Research Group, Ophthalmology Department, BioCruces Health Research Institute, Cruces Hospital, University of the Basque Country, Leioa, Spain
| | - Miguel Cordero
- Servicio de Oftalmología, Complejo Asistencial Universitario de León, Leon, Spain
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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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25
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Maleki A, Anesi SD, Look-Why S, Asgari S, Manhapra A, Foster CS. Clinical course and poor prognostic factors of Vogt-Koyanagi-Harada disease in a tertiary uveitis clinic. Can J Ophthalmol 2021; 57:142-144. [PMID: 33984288 DOI: 10.1016/j.jcjo.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Arash Maleki
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass
| | - Stephen D Anesi
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass
| | - Sydney Look-Why
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass
| | - Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Ambika Manhapra
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Mass.; Ocular Immunology and Uveitis Foundation, Waltham, Mass.; Harvard Medical School, Department of Ophthalmology, Boston, Mass..
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26
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Jiang H, Li Z, Yu L, Zhang Y, Zhou L, Wu J, Yuan J, Han M, Xu T, He J, Wang S, Yu C, Pan S, Wu M, Liu H, Zeng H, Song Z, Wang Q, Qu S, Zhang J, Huang Y, Han J. Immune Phenotyping of Patients With Acute Vogt-Koyanagi-Harada Syndrome Before and After Glucocorticoids Therapy. Front Immunol 2021; 12:659150. [PMID: 33995378 PMCID: PMC8113950 DOI: 10.3389/fimmu.2021.659150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
Previous studies have established that disturbed lymphocytes are involved in the pathogenesis of Vogt-Koyanagi-Harada (VKH) syndrome. Accordingly, glucocorticoids (GCs), with their well-recognized immune-suppressive function, have been widely used for treatment of VKH patients with acute relapses. However, the systemic response of diverse immune cells to GC therapy in VKH is poorly characterized. To address this issue, we analyzed immune cell subpopulations and their phenotype, as well as cytokine profiles in peripheral blood from VKH patients (n=25) and health controls (HCs, n=21) by flow cytometry and luminex technique, respectively. For 16 patients underwent GC therapy (methylprednisolone, MP), the aforementioned measurements as well as the transcriptome data from patients before and after one-week’s GC therapy were also compared to interrogate the systemic immune response to GC therapy. Lymphocyte composition in the blood was different in VKH patients and HCs. VKH patients had significantly higher numbers of T cells with more activated, polarized and differentiated phenotype, more unswitched memory B cells and monocytes, as compared to HCs. MP treatment resulted in decreased frequencies of T cells and NK cells, inhibited NK cell activation and T cell differentiation, and more profoundly, a marked shift in the distribution of monocyte subsets. Collectively, our findings suggest that advanced activation and differentiation, as well as dysregulated numbers of peripheral lymphocytes are the major immunological features of VKH, and GC therapy with MP not only inhibits T cell activation directly, but also affects monocyte subsets, which might combinatorically result in the inhibition of the pathogenic immune response.
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Affiliation(s)
- Han Jiang
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhaohui Li
- Retinal and Vitreous Diseases Department of Wuhan Aier Eye Hospital, Wuhan University, Wuhan, China
| | - Long Yu
- Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Zhang
- Ophthalmic Imaging Department of Wuhan Aier Eye Hospital, Wuhan University, Wuhan, China
| | - Li Zhou
- Cataract Department of Wuhan Aier Eye Hospital, Wuhan University, Wuhan, China
| | - Jianhua Wu
- Retinal and Vitreous Diseases Department of Wuhan Aier Eye Hospital, Wuhan University, Wuhan, China
| | - Jing Yuan
- Retinal and Vitreous Diseases Department of Wuhan Aier Eye Hospital, Wuhan University, Wuhan, China
| | - Mengyao Han
- Retinal and Vitreous Diseases Department of Wuhan Aier Eye Hospital, Wuhan University, Wuhan, China
| | - Tao Xu
- Retinal and Vitreous Diseases Department of Wuhan Aier Eye Hospital, Wuhan University, Wuhan, China
| | - Junwen He
- Retinal and Vitreous Diseases Department of Wuhan Aier Eye Hospital, Wuhan University, Wuhan, China
| | - Shan Wang
- Ophthalmic Imaging Department of Wuhan Aier Eye Hospital, Wuhan University, Wuhan, China
| | - Chengfeng Yu
- Retinal and Vitreous Diseases Department of Wuhan Aier Eye Hospital, Wuhan University, Wuhan, China
| | - Sha Pan
- Retinal and Vitreous Diseases Department of Wuhan Aier Eye Hospital, Wuhan University, Wuhan, China
| | - Min Wu
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hangyu Liu
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haihong Zeng
- Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhu Song
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiangqiang Wang
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shen Qu
- Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junwei Zhang
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yafei Huang
- Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junyan Han
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Niederer R, Bar A, Al-Ani H, Sharief L, Sar S, Segal A, Lightman S, Tomkins-Netzer O. Management of inflammatory choroidal neovascular membranes. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2021.1842196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rachael Niederer
- University of Auckland, Auckland District Health Board, Auckland, New Zealand
| | - Asaf Bar
- Department of Ophthalmology, Wolfson Medical Centre, Tel Aviv-Yafo, Israel
| | - Haya Al-Ani
- University of Auckland, Auckland District Health Board, Auckland, New Zealand
| | - Lazha Sharief
- UCL/Institute of Ophthalmology and Moorfileds Eye Hospital, London, UK
| | - Shaul Sar
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Adi Segal
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Sue Lightman
- UCL/Institute of Ophthalmology and Moorfileds Eye Hospital, London, UK
| | - Oren Tomkins-Netzer
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
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28
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Komuku Y, Ishikawa H, Ide A, Matsuoka T, Fukuyama H, Okadome T, Gomi F. Predictive Biomarker for Progression Into the Sunset Glow Fundus of Vogt-Koyanagi-Harada Disease, Using Adaptive Binarization of Fundus Photographs. Transl Vis Sci Technol 2020; 9:10. [PMID: 33133773 PMCID: PMC7552939 DOI: 10.1167/tvst.9.11.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/05/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose The sunset glow fundus (SGF) appearance in Vogt-Koyanagi-Harada (VKH) disease was evaluated by means of adaptive binarization of patients’ fundus photographs. Methods Twenty-nine Japanese patients with acute VKH were enrolled in this study. We evaluated one eye of each patient, and thereby divided the patients into two groups; SGF+ and SGF− at 6 months after treatment. We compared patient age, gender, and spherical equivalent refractive error (SERE) and choroidal thickness measured using optical coherence tomography. We also compared the choroidal vascular appearance index (CVAI), derived by adaptive binarization image processing of fundus photographs, between the two groups. Measurements of choroidal thickness and CVAI were taken at the onset of disease, and 1, 3, and 6 months after treatment. The sunset glow index (SGI), as previously reported, was calculated using color fundus photographs, and compared to the CVAI. Results Eight patients (27.6%) were categorized into the SGF+ group. At all time points, the mean CVAI in the SGF+ group was significantly greater than that in the SGF− group. No significant difference was observed in choroidal thicknesses at any time point. The SGI was significantly greater in the SGF+ group at 6 months. Conclusions CVAI could be a new predictive biomarker for the development of SGF in patients with VKH disease. Translational Relevance Detecting SGF is important for management of patients with VKH, and CVAI may indicate the possibility of developing into SGF, although the color fundus photographs do not yet show SGF at that time.
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Affiliation(s)
- Yuki Komuku
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan
| | - Hiroto Ishikawa
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan
| | | | - Taiki Matsuoka
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan
| | - Hisashi Fukuyama
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan
| | | | - Fumi Gomi
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan
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29
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Agarwal M, Radosavljevic A, Patnaik G, Rishi E, Pichi F. Diagnostic Value of Optical Coherence Tomography in the Early Diagnosis of Macular Complications in Chronic Vogt-Koyanagi-Harada Disease. Ocul Immunol Inflamm 2020; 30:801-808. [PMID: 33136534 DOI: 10.1080/09273948.2020.1833225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe the role of optical coherence tomography (OCT) in detecting subclinical choroidal inflammation and early diagnosis of macular complications in chronic Vogt-Koyanagi-Harada (VKH) disease with sunset glow fundus. METHODS Retrospective observational study. Clinical features, OCT images, treatment, and visual outcome were analyzed. RESULTS Fourteen patients (9 females and 5 males) were included in the study. Mean age was 39 years (range 7-67 years). Mean duration of disease was 5.25 years (range 1-15 years). Anterior uveitis was seen in 14 eyes (52%). Fundus examination showed sunset glow fundus in all patients with no obvious macular pathology. OCT showed macular edema in 16 eyes (59%), choroidal neovascular membrane in 8 eyes (30%), and macular hole in 3 eyes (11%). CONCLUSION OCT should be regularly used to detect subclinical inflammation and early macular complications in chronic VKH disease where sunset glow fundus may delay the clinical diagnosis thus causing permanent damage.
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Affiliation(s)
- Mamta Agarwal
- Uveitis & Cornea Services, Sankara Nethralaya, Chennai, India
| | | | - Gazal Patnaik
- Uveitis Services, Sankara Nethralaya, Chennai, India
| | - Ekta Rishi
- Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Francesco Pichi
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Diallo K, Revuz S, Clavel-Refregiers G, Sené T, Titah C, Gerfaud-Valentin M, Seve P, Jaussaud R. Vogt-Koyanagi-Harada disease: a retrospective and multicentric study of 41 patients. BMC Ophthalmol 2020; 20:395. [PMID: 33028239 PMCID: PMC7539440 DOI: 10.1186/s12886-020-01656-x] [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: 09/11/2019] [Accepted: 09/23/2020] [Indexed: 11/18/2022] Open
Abstract
Background East and South East Asian subjects as well as Amerindians and Hispanic subjects are predominantly affected by Vogt-Koyanagi-Harada disease. In Europe, only few studies have described the clinical features and treatment of this disease, especially in France. Methods This retrospective case series was based on data collected from patients with a VKH disease diagnosed from January 2000 to March 2017, provided by three French Tertiary Centers. Results Forty-one patients (16 men and 25 women) were diagnosed: average age at diagnosis was 38.7 years. Patients were mainly from Maghreb (58%), but ethnic origins were multiple. Pleiocytosis was observed in 19 cases (63%) and 17 out of 41 patients showed audio vestibular signs (41%), and 11 showed skin signs (27%). Thirty-four were treated with corticosteroids (83%), 11 with an immunosuppressant treatment (27%) and 5 with biological therapy drugs (13%). Relapse was observed in 41% patients, even though final average visual acuity had improved. We did not find any significant clinical difference in the population from Maghreb compared to other populations, but for age and sex trends, since there was a majority of younger women. Conclusion We report here the second largest French cohort reported to date to our knowledge. The multiethnicity in our study suggests that VKH disease should be evoked whatever patients’ ethnicity.
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Affiliation(s)
- K Diallo
- Department of Internal Medicine, Nancy University Hospital, Nancy, France.
| | - S Revuz
- Department of Internal Medicine, Metz Private Hospital, Metz, France
| | - G Clavel-Refregiers
- Department of Internal Medicine, Rothschild Hospital Foundation, Paris, France
| | - T Sené
- Department of Internal Medicine, Rothschild Hospital Foundation, Paris, France
| | - C Titah
- Department of Ophthalmology, Rothschild Hospital Foundation, Paris, France
| | | | - P Seve
- Department of Internal Medicine, Lyon University Hospital, Lyon, France
| | - R Jaussaud
- Department of Internal Medicine, Nancy University Hospital, Nancy, France
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Golzarri MF, Cheja-Kalb R, Concha-Del-Río LE, Gonzalez-Salinas R, Arellanes-García L. Risk factors for subretinal fibrosis in patients with Vogt Koyanagi Harada syndrome. Ocul Immunol Inflamm 2020; 30:265-269. [PMID: 33021860 DOI: 10.1080/09273948.2020.1825750] [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: 10/23/2022]
Abstract
Purpose: To identify the risk factors for the development of subretinal fibrosis (SRF) among patients with Vogt-Koyanagi-Harada (VKH) syndrome.Methods: In this case-control study, electronic clinical records from patients diagnosed with VKH syndrome who attended the Inflammatory Eye Disease Clinic at a tertiary care ophthalmology reference center were assessed to identify risk factors from demographic, clinical, and epidemiological variables. Cases were defined as SRF and VKH, whereas the controls were VKH patients without SRF.Results: A total of 150 electronic charts were reviewed, 92 patients with a follow-up longer than 12 months were included; 39 cases and 53 controls. A multivariate analysis found bullous serous retinal detachment as a significant risk factor for SRF (adjusted OR 8.93, 95% CI 1.94-41.1).Conclusion: Patients with VKH syndrome who develop a bullous retinal detachment have an 8 times higher risk of developing SRF in the long term.
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Affiliation(s)
- Maria F Golzarri
- Ocular Inflammatory Diseases Clinic, Hospital Dr. Luis Sánchez Bulnes, Asociación Para Evitar La Ceguera En México, Mexico City, Mexico
| | - Rashel Cheja-Kalb
- Ocular Inflammatory Diseases Clinic, Hospital Dr. Luis Sánchez Bulnes, Asociación Para Evitar La Ceguera En México, Mexico City, Mexico
| | - Luz Elena Concha-Del-Río
- Ocular Inflammatory Diseases Clinic, Hospital Dr. Luis Sánchez Bulnes, Asociación Para Evitar La Ceguera En México, Mexico City, Mexico
| | | | - Lourdes Arellanes-García
- Ocular Inflammatory Diseases Clinic, Hospital Dr. Luis Sánchez Bulnes, Asociación Para Evitar La Ceguera En México, Mexico City, Mexico
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Yang P, Wang C, Su G, Pan S, Qin Y, Zhang J, Cao Q, Zhong Z, Zhou C, Wang Y, Kijlstra A. Prevalence, risk factors and management of ocular hypertension or glaucoma in patients with Vogt-Koyanagi-Harada disease. Br J Ophthalmol 2020; 105:1678-1682. [PMID: 33011689 DOI: 10.1136/bjophthalmol-2020-316323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/19/2020] [Accepted: 09/19/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS This study was performed to examine the prevalence, risk factors and treatment outcome of OHT/glaucoma in Chinese patients with Vogt-Koyanagi-Harada (VKH). METHODS Retrospective non-interventional case series were conducted on a total of 2281 patients with VKH referred from April 2008 to April 2019. Of these cases, 1457 had a minimum follow-up period of 3 months and were included for this study. Medical records were reviewed for demographic, ocular and treatment data. RESULTS Among 2914 eyes of 1457 patients with VKH, 695 (23.9%) eyes of 425 patients (29.2%) developed OHT/glaucoma. The risk factors of OHT/glaucoma included initial BCVA of 20/200 or worse (OR=4.826), final best-corrected visual acuity (BCVA) of 20/50-20/100 (OR=5.341) and final BCVA of 20/200 or worse (OR=4.235), the interval between uveitis attack and referral time interval being 2 months or more (OR=3.318), more than three recurrent episodes (OR=4.177) and posterior synechiae (OR=1.785). The main possible mechanisms of OHT/glaucoma were inflammatory factor-induced open-angle OHT/glaucoma in 277 eyes (39.9%) and pupillary block arising from complete posterior synechiae in 201 eyes (28.9%). In these 695 eyes with OHT/glaucoma, normalised intraocular pressure (IOP) was achieved in 389 eyes (56.0%) following medical treatment. In the remaining 306 eyes, various surgical interventions were performed and a normalised IOP could be achieved in 249 eyes (81.4%). CONCLUSION OHT/glaucoma is a common complication in Chinese patients with VKH. Risk factors of OHT/glaucoma included worse acuity at first and final visits, the longer interval between uveitis attack and referral, more recurrent episodes and posterior synechiae.
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Affiliation(s)
- Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Chaokui Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Su Pan
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Yang Qin
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Jun Zhang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Qingfeng Cao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Zhenyu Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Chunjiang Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Yao Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Aize Kijlstra
- University Eye Clinic Maastricht, Maastricht, The Netherlands
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Radic B, Vukojevic N, Petelin Gadze Z, Dapic Ivancic B, Barun B. Vogt-Koyanagi-Harada syndrome: importance of early treatment. Acta Neurol Belg 2020; 120:1217-1219. [PMID: 31927745 DOI: 10.1007/s13760-020-01273-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/03/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Borislav Radic
- Department of Neurology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Referral Centre of the Ministry of Health of the Republic of Croatia for Epilepsy, Affiliated to EpiCARE ERN, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Nenad Vukojevic
- Department of Ophthalmology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Zeljka Petelin Gadze
- Department of Neurology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Referral Centre of the Ministry of Health of the Republic of Croatia for Epilepsy, Affiliated to EpiCARE ERN, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Biljana Dapic Ivancic
- Department of Neurology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Referral Centre of the Ministry of Health of the Republic of Croatia for Epilepsy, Affiliated to EpiCARE ERN, Kispaticeva 12, 10000, Zagreb, Croatia.
| | - Barbara Barun
- Department of Neurology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Referral Centre of the Ministry of Health of the Republic of Croatia for Epilepsy, Affiliated to EpiCARE ERN, Kispaticeva 12, 10000, Zagreb, Croatia
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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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35
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Yuan F, Zhang Y, Yan X. Bilateral acute angle closure glaucoma as an initial presentation of Vogt-Koyanagi-Harada syndrome: A clinical case report. Eur J Ophthalmol 2020; 32:NP230-NP234. [PMID: 32811185 DOI: 10.1177/1120672120951442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Vogt-Koyanagi-Harada (VKH) is an autoimmune disease with bilateral granulomatous uveitis and various systemic manifestations. Bilateral acute angle closure glaucoma (AACG) can be a rare initial manifestation of VKH that may be misdiagnosed as primary angle closure glaucoma (PACG). CASE REPORT A 62-year-old woman with bilateral painless loss of vision referred to Qingdao Municipal Hospital. She had been diagnosed as PACG before admission and prescribed with anti-glaucoma treatment which did not improve her symptom. She had severe bilateral uveitis, optic disk swelling, and serous retinal detachment in both eyes. Intraocular pressure (IOP) was 20 mmHg in the right eye and 23 mmHg in the left eye, and her best corrected visual acuities (BCVAs) were 0.02 in both eyes. She was treated with oral corticosteroid therapy on a tapering schedule. One month after the therapy, the IOP remained well-controlled with deepened anterior chamber. Her visual acuity and symptom were improved. CONCLUSIONS We experienced a case of VKH disease with an unusual presentation of bilateral secondary AACG. It is important for ophthalmologists to know about this rare cause of painless loss of vision so that it could be treated properly.
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Affiliation(s)
- Fuxiang Yuan
- Ophthalmologic Center, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao 266071, Shandong Province, P.R. China
| | - Yu Zhang
- Ophthalmologic Center, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao 266071, Shandong Province, P.R. China
| | - Xiaoran Yan
- Ophthalmologic Center, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao 266071, Shandong Province, P.R. China
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36
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Jung HH, Kook KY, Ji YS. Comparison of Clinical Characteristics in Vogt-Koyanagi-Harada Disease between Patients with and without Prodromal Manifestations. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.6.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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37
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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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Kobayashi T, Fukumoto M, Takai N, Maruyama K, Tada R, Shouda H, Kida T, Ikeda T. A Case of Pneumatic Displacement with Gas Tamponade Performed for Macular Subretinal Hemorrhage Complicating Vogt-Koyanagi-Harada Disease. Case Rep Ophthalmol 2020; 11:143-150. [PMID: 32308616 PMCID: PMC7154246 DOI: 10.1159/000506436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/11/2020] [Indexed: 11/19/2022] Open
Abstract
We experienced a case of subretinal hemorrhage (SRH) from choroidal neovascularization (CNV) complicating Vogt-Koyanagi-Harada disease (VKH) that underwent pneumatic displacement of hematoma by intravitreal gas injection. A 76-year-old male revealed VKH relapses and optical coherence tomography showed irregular retinal pigment epithelium in his right eye and serous retinal detachment and retinal pigment epithelial detachment in his left eye. Fluorescein angiography of the left eye showed hyperfluorescence possibly attributable to CNV. One month later, SRH occurred in the left eye, yet it was spontaneously absorbed. However, approximately 1 year later, the SRH recurred in the left eye affecting a wide area, including the macular region, and his visual acuity (VA) decreased to 0.06. When pneumatic displacement of the hematoma by intravitreal gas injection was performed, the SRH was inferiorly displaced, and his VA improved to 0.4. Pneumatic displacement with gas tamponade was effective for treating a case of SRH caused by persistent CNV complicating VKH.
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Affiliation(s)
| | - Masanori Fukumoto
- Department of Ophthalmology, Osaka Medical College, Takatsuki-City, Japan
| | | | | | - Rei Tada
- Tada Eye Clinic, Ikeda-City, Japan
| | - Hiromi Shouda
- Department of Ophthalmology, Osaka Medical College, Takatsuki-City, Japan
| | - Teruyo Kida
- Department of Ophthalmology, Osaka Medical College, Takatsuki-City, Japan
| | - Tsunehiko Ikeda
- Department of Ophthalmology, Osaka Medical College, Takatsuki-City, Japan
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Tranos P, Karasavvidou EM, Gkorou O, Pavesio C. Optical coherence tomography angiography in uveitis. J Ophthalmic Inflamm Infect 2019; 9:21. [PMID: 31873858 PMCID: PMC6928173 DOI: 10.1186/s12348-019-0190-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 11/18/2019] [Indexed: 01/31/2023] Open
Abstract
Before the introduction of optical coherence tomography angiography (OCTA) in the early 2000s, dye-based angiography was considered the “gold standard” for the diagnosis and monitoring of ocular inflammation. OCTA is a novel technique, which demonstrates capillary networks based on the amount of light returned from moving blood cells, providing further information on pathophysiological changes in uveitis. The aim of this review is to describe the basic principles of OCTA and its application to ocular inflammatory disorders. It particularly emphasizes on its contribution not only in the diagnosis and management of the disease but also in the identification of possible complications, comparing it with fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA). Although the advent of OCTA has remarkably enhanced the assessment of uveitic entities, we highlight the need for further investigation in order to better understand its application to these conditions.
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Affiliation(s)
- Paris Tranos
- Vitreoretinal & Uveitis Department, Ophthalmica Clinic, Vas.Olgas 196 and Ploutonos, 546 55, Thessaloniki, Greece
| | - Evdoxia-Maria Karasavvidou
- Vitreoretinal & Uveitis Department, Ophthalmica Clinic, Vas.Olgas 196 and Ploutonos, 546 55, Thessaloniki, Greece. .,Department of Ophthalmology, Hippokrateio General Hospital of Thessaloniki, 49 Konstantinoupoleos Street, 546 42, Thessaloniki, Greece.
| | - Olga Gkorou
- Vitreoretinal & Uveitis Department, Ophthalmica Clinic, Vas.Olgas 196 and Ploutonos, 546 55, Thessaloniki, Greece
| | - Carlos Pavesio
- Uveitis Department, Moorfields Eye Hospital, 162 City Rd, London, EC1V 2PD, UK
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40
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Martins F, Sofiya L, Sykiotis GP, Lamine F, Maillard M, Fraga M, Shabafrouz K, Ribi C, Cairoli A, Guex-Crosier Y, Kuntzer T, Michielin O, Peters S, Coukos G, Spertini F, Thompson JA, Obeid M. Adverse effects of immune-checkpoint inhibitors: epidemiology, management and surveillance. Nat Rev Clin Oncol 2019; 16:563-580. [PMID: 31092901 DOI: 10.1038/s41571-019-0218-0] [Citation(s) in RCA: 1098] [Impact Index Per Article: 219.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Immune-checkpoint inhibitors (ICIs), including anti-cytotoxic T lymphocyte antigen 4 (CTLA-4), anti-programmed cell death 1 (PD-1) and anti-programmed cell death 1 ligand 1 (PD-L1) antibodies, are arguably the most important development in cancer therapy over the past decade. The indications for these agents continue to expand across malignancies and disease settings, thus reshaping many of the previous standard-of-care approaches and bringing new hope to patients. One of the costs of these advances is the emergence of a new spectrum of immune-related adverse events (irAEs), which are often distinctly different from the classical chemotherapy-related toxicities. Owing to the growing use of ICIs in oncology, clinicians will increasingly be confronted with common but also rare irAEs; hence, awareness needs to be raised regarding the clinical presentation, diagnosis and management of these toxicities. In this Review, we provide an overview of the various types of irAEs that have emerged to date. We discuss the epidemiology of these events and their kinetics, risk factors, subtypes and pathophysiology, as well as new insights regarding screening and surveillance strategies. We also highlight the most important aspects of the management of irAEs.
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Affiliation(s)
- Filipe Martins
- Service et Laboratoire Central d'Hématologie, Département d'Oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.,School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | | | - Gerasimos P Sykiotis
- Service d'Endocrinologie, Diabétologie et Métabolisme, CHUV, Lausanne, Switzerland
| | - Faiza Lamine
- Service d'Endocrinologie, Diabétologie et Métabolisme, CHUV, Lausanne, Switzerland
| | - Michel Maillard
- Service de Gastro-entérologie et Hépatologie, CHUV, Lausanne, Switzerland.,Crohn's and Colitis Center Lausanne, Lausanne, Switzerland
| | - Montserrat Fraga
- Service de Gastro-entérologie et Hépatologie, CHUV, Lausanne, Switzerland
| | | | - Camillo Ribi
- Service Immunologie et Allergie, CHUV, Lausanne, Switzerland
| | - Anne Cairoli
- Service et Laboratoire Central d'Hématologie, Département d'Oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Yan Guex-Crosier
- Hôpital Ophtalmique Jules Gonin - Fondation Asile des Aveugles, CHUV, Lausanne, Switzerland
| | | | | | | | - Georges Coukos
- Département d'Oncologie, CHUV, Lausanne, Switzerland.,Ludwig Institute for Cancer Research, Epalinges, Switzerland
| | | | - John A Thompson
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,National Cancer Institute, NIH, Bethesda, MD, USA
| | - Michel Obeid
- Service Immunologie et Allergie, CHUV, Lausanne, Switzerland. .,Faculté de Médecine Pitié-Salpêtrière, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France. .,Centre d'Immunothérapie et de Vaccinologie, CHUV, Lausanne, Switzerland.
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Sakata VM, Morita C, Lavezzo MM, Rodriguez EEC, Abdallah SF, Pimentel SLG, Hirata CE, Yamamoto JH. Outcomes of Intravitreal Bevacizumab in Choroidal Neovascularization in Vogt-Koyanagi-Harada Disease- A Prospective Study. Ocul Immunol Inflamm 2019; 29:572-578. [PMID: 31746659 DOI: 10.1080/09273948.2019.1687731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
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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Affiliation(s)
- Viviane M Sakata
- Department of Ophthalmology, Faculdade de Medicina FMUSP, LIM 33, Universidade de Sao Paulo, Sao Paulo, Brazil.,Department of Ophthalmology, Hospital das Clinicas, Universidade Federal do Parana, Curitiba, Brazil
| | - Celso Morita
- Department of Ophthalmology, Faculdade de Medicina FMUSP, LIM 33, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcelo M Lavezzo
- Department of Ophthalmology, Faculdade de Medicina FMUSP, LIM 33, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ever E C Rodriguez
- Department of Ophthalmology, Faculdade de Medicina FMUSP, LIM 33, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Smairah F Abdallah
- Department of Ophthalmology, Faculdade de Medicina FMUSP, LIM 33, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sergio L G Pimentel
- Department of Ophthalmology, Faculdade de Medicina FMUSP, LIM 33, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carlos E Hirata
- Department of Ophthalmology, Faculdade de Medicina FMUSP, LIM 33, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Joyce H Yamamoto
- Department of Ophthalmology, Faculdade de Medicina FMUSP, LIM 33, Universidade de Sao Paulo, Sao Paulo, Brazil
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Park UC, Yu HG. Ocular Inflammation and Choroidal Thickness after Pars Plana Vitrectomy in Chronic Recurrent Stage of Vogt-Koyanagi-Harada Disease. Ocul Immunol Inflamm 2019; 29:388-395. [PMID: 31671005 DOI: 10.1080/09273948.2019.1677918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose: To evaluate subfoveal choroidal thickness (SCT) changes and ocular inflammation after pars plana vitrectomy (PPV) in Vogt-Koyanagi-Harada (VKH) disease.Methods: We analyzed best-corrected visual acuity (BCVA), ocular inflammation, complications, and SCT in 17 eyes of 14 patients with VKH disease who underwent PPV and had ≥12-month follow-up. Main surgical indications included vitreous opacity, epiretinal membrane, and macular hole.Results: Mean BCVA showed significant improvement at all time-points after PPV. Mean SCT significantly increased up until 3 months after PPV (P = .001), but returned to baseline at 12 months and was lower than baseline at the final visit (P = .025). Mean acute uveitis relapse rate decreased after PPV (P = .008). SCT increase was greater in the nine eyes with postoperative uveitis recurrence than in those without (P = .043).Conclusion: Vision improved after PPV in patients with VKH disease. SCT increase in the early postoperative period was associated with uveitis recurrence during follow-up, suggesting that vitrectomy may induce choroiditis after PPV in VKH.
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Affiliation(s)
- Un Chul Park
- Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea.,Retinal Degeneration Research Laboratory, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
| | - Hyeong Gon Yu
- Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea.,Retinal Degeneration Research Laboratory, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
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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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Identification of Underlying Inflammation in Vogt-Koyanagi-Harada Disease with Sunset Glow Fundus by Multiple Analyses. J Ophthalmol 2019; 2019:3853794. [PMID: 31687197 PMCID: PMC6794978 DOI: 10.1155/2019/3853794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/26/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate underlying subclinical ocular inflammation in Vogt-Koyanagi-Harada (VKH) disease with sunset glow fundus (SGF) by multiple analyses. Study Design Retrospective observational study. Methods Clinical records of 34 eyes of 17 VKH patients with SGF in whom laser flare photometry (LFP), enhanced depth imaging optical coherence tomography (EDI-OCT), and indocyanine green angiography (ICGA) were performed on the same day were reviewed. The mean age was 57.3 ± 16.3 years, and the mean duration from the initial onset of uveitis was 47.1 ± 22.1 months. Flare counts, ICGA scores, and subfoveal choroidal thickness (SFCT) were compared between eyes. Results Although clinical ocular inflammation was observed only in 4 eyes (11.8%), inflammatory signs were observed in 23 out of 34 eyes by LFP (67.6%), in 27 eyes by ICGA (79.4%), and in 10 eyes by SFCT (29.4%). Active inflammatory signs detected by ICGA were observed in 77.8% by LFP and in 25.9% by SFCT. The strength of agreement (Cohen's kappa coefficient) between positive ICGA score and positive flare score was 0.406 (95% CI: 0.076-0.7359, P < 0.01), but there was no association between positive ICGA score and increased SFCT. In addition, positive flare count was the significant prognostic factor of positive ICGA score with odds ratio 11.7. Conclusions Subclinical ocular inflammation signs were detected in most VKH patients with SGF by ICGA and a substantial proportion of which were also detected by LFP, whereas SFCT was less sensitive to detect subclinical inflammation.
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Yang P, Ye Z, Xu J, Du L, Zhou Q, Qi J, Liang L, Wang C, Zhou C, Cao Q, Wu L, Kijlstra A. Macular Abnormalities in Vogt-Koyanagi-Harada Disease. Ocul Immunol Inflamm 2019; 27:1195-1202. [PMID: 31415220 DOI: 10.1080/09273948.2019.1624781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To investigate the prevalence of macular abnormalities in Chinese Vogt-Koyanagi-Harada (VKH) patients.Methods: Clinical characteristics, therapeutic effectiveness and visual outcome were reviewed and analyzed.Results: The most common macular abnormality was macular edema (ME), followed by macular choroidal neovascularization (CNV). Macular abnormalities were associated with recurrent episodes, disease course and visual acuity ≤20/50 at first visit. The prevalence of macular abnormalities in patients who were not treated according to our regular treatment regimen with corticosteroids combined with immunosuppressive agents and who were followed-up for at least one year (13.1%) was significantly higher than in patients receiving the regular treatment (5.7%). Visual improvement was found in 66.7% of eyes with macular abnormalities after regular treatment.Conclusion: Macular abnormalities were associated with recurrent uveitis, course of disease and lower visual acuity at first visit. Regular treatment could prevent the development of macular abnormalities and improved visual outcome in most patients.
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Affiliation(s)
- Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, P. R. China
| | - Zi Ye
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, P. R. China
| | - Jing Xu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, P. R. China
| | - Liping Du
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, P. R. China
| | - Qingyun Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, P. R. China
| | - Jian Qi
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, P. R. China
| | - Liang Liang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, P. R. China
| | - Chaokui Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, P. R. China
| | - Chunjiang Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, P. R. China
| | - Qingfeng Cao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, P. R. China
| | - Lili Wu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, P. R. China
| | - Aize Kijlstra
- University Eye Clinic Maastricht, Maastricht, The Netherlands
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Triplett JD, Buzzard KA, Lubomski M, Riminton DS, Barnett MH, Welgampola MS, Halmagyi GM, Nguyen M, Landau K, Lee AG, Plant GT, Fraser CL, Reddel SW, Hardy TA. Immune-mediated conditions affecting the brain, eye and ear (BEE syndromes). J Neurol Neurosurg Psychiatry 2019; 90:882-894. [PMID: 30852493 DOI: 10.1136/jnnp-2018-319002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 12/19/2022]
Abstract
The triad of central nervous system symptoms, visual disturbance and hearing impairment is an oft-encountered clinical scenario. A number of immune-mediated diseases should be considered among the differential diagnoses including: Susac syndrome, Cogan syndrome or Vogt-Koyanagi-Harada disease; demyelinating conditions such as multiple sclerosis or neuromyelitis optica spectrum disorder; systemic diseases such as systemic lupus erythematosus, Sjögren syndrome or Behcet disease and granulomatous diseases such as sarcoidosis. In this article, we coin the term 'BEE syndromes' to draw attention to the various immune-mediated diseases that affect the brain, eye and ear. We present common disease manifestations and identify key clinical and investigation features.
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Affiliation(s)
- James D Triplett
- Neuroimmunology Clinic, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Katherine A Buzzard
- Department of Neurosciences, Eastern Health, Monash University, Clayton, Victoria, Australia
| | - Michal Lubomski
- Neuroimmunology Clinic, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - D Sean Riminton
- Neuroimmunology Clinic, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Michael H Barnett
- Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Miriam S Welgampola
- Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - G Michael Halmagyi
- Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - MaiAnh Nguyen
- Neuroimmunology Clinic, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Klara Landau
- Department of Ophthalmology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital in Houston, Houston, Texas, USA.,Weill Cornell Medical College, Cornell University, New York City, New York, USA.,University of Texas Medical Branch (UTMB), Baylor College of Medicine, The UT MD Anderson Cancer Center, Texas A and M College of Medicine (AGL), Houston, Texas, USA
| | - Gordon T Plant
- National Hospital for Neurology and Neurosurgery and Moorfield's Eye Hospital, University College London, London, UK
| | - Clare L Fraser
- Brain and Mind Centre, University of Sydney, Syndey, New South Wales, Australia
| | - Stephen W Reddel
- Neuroimmunology Clinic, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Todd A Hardy
- Neuroimmunology Clinic, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
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47
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Lueck CJ. Vogt-Koyanagi-Harada syndrome: what neurologists need to know. Pract Neurol 2019; 19:278-281. [PMID: 30890585 DOI: 10.1136/practneurol-2018-002165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 02/08/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Christian J Lueck
- Neurology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
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48
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Raman M, Vasumathi K, Anuradha A, Sheela S, Nisha C. A rare pediatric case of probable Vogt–Koyanagi–Harada syndrome. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2019. [DOI: 10.4103/tjosr.tjosr_37_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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49
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Kim JS, Kim DY, Kim KT, Chae JB. Clinical Features of Recurred Vogt-Koyanagi-Harada Syndrome during Oral Steroids Tapering Therapy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.4.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ji Soo Kim
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Dong Yoon Kim
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kyung Tae Kim
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ju Byung Chae
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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50
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The Role of Optical Coherence Tomography Angiography in the Management of Uveitis. Int Ophthalmol Clin 2018; 56:1-24. [PMID: 27575755 DOI: 10.1097/iio.0000000000000130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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