Vaccine-Associated Posterior Uveitis

Vogt-Koyanagi-Harada Disease and COVID

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.

PRIMARY MULTIPLE EVANESCENT WHITE DOT SYNDROME AND MULTIPLE EVANESCENT WHITE DOT SYNDROME SECONDARY TO MULTIFOCAL CHOROIDITIS/PUNCTATE INNER CHOROIDOPATHY: A Comparative Study

PURPOSE

To present and compare the clinical features and multimodal imaging (MMI) findings of the primary form of multiple evanescent white dot syndrome (MEWDS) and MEWDS secondary to multifocal choroiditis/punctate inner choroidopathy (MFC/PIC).

METHODS

A prospective case series. Thirty eyes of 30 MEWDS patients were included and divided into the primary MEWDS group and MEWDS secondary to MFC/PIC group. Demographic, epidemiologic, and clinical characteristics and MEWDS-related MMI findings of the two groups were compared.

RESULTS

Seventeen eyes from 17 patients with primary MEWDS and 13 eyes from 13 patients with MEWDS secondary to MFC/PIC were evaluated. Patients with MEWDS secondary to MFC/PIC tended to have a higher degree of myopia than those with primary MEWDS. No other significant differences in demographic, epidemiologic, and clinical characteristics and MMI findings were found between the two groups.

CONCLUSION

"MEWDS-like reaction" hypothesis seems to be correct for MEWDS secondary to MFC/PIC, and the authors highlight the importance of MMI examinations in MEWDS. Further research is needed to confirm whether the hypothesis is applicable to other forms of secondary MEWDS.

Acute Posterior Multifocal Placoid Pigment Epitheliopathy With Associated Papillitis

The purpose of this study was to report the rare presentation of bilateral acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and unilateral papillitis treated successfully with corticosteroid therapy. The methods used in this study include fundus photography and fluorescein angiography. A 40-year-old female presented to the emergency room with decreased vision, headache, and photophobia with fundus examination findings of bilateral creamy placoid lesions in the posterior pole and unilateral papillitis, macular edema, and disc hemorrhages. Fluorescein angiography demonstrated early hypofluorescence corresponding to the placoid lesions followed by late, irregular hyperfluorescent staining. Optical coherence tomography revealed peripapillary and macular edema of the left eye. The patient was treated with two retrobulbar corticosteroid injections and a course of oral prednisone with improvement in fundus findings and visual acuity at follow-up examination six weeks from the presentation. The presence of optic nerve and macular edema in APMPPE suggests severe chorioretinal inflammation for which systemic and local corticosteroids are a reasonable treatment option.

Vogt-Koyanagi-Harada disease following influenza vaccination

Purpose

To report a case of Vogt–Koyanagi–Harada (VKH) disease following influenza vaccination.

Observations

A 30-year-old Filipino male developed bilateral pain, redness, photophobia, floaters, headache and tinnitus 2 days after receiving the annual influenza vaccine. He presented to the emergency department 5 days after symptom onset. His past medical and ocular history was unremarkable. His best-corrected distance visual acuity (BCVA) was 20/100 in the right eye (OD) and 20/150 in the left eye (OS). Slit-lamp examination revealed fine keratic precipitates and 1+ anterior chamber cells in both eyes (OU). Dilated fundus examination revealed 1+ vitreous cells with trace haze and multiple serous retinal detachments OU. Magnetic resonance imaging (MRI) of the brain and chest X-ray were unremarkable. Serologic testing was negative for infectious, inflammatory and neoplastic causes. The patient tested positive for HLA-DR4. A diagnosis of acute Vogt-Koyanagi-Harada disease was made and high-dose oral prednisone, intravitreal triamcinolone acetonide and mycophenolate mofetil were needed to achieve quiescence. At 6 months follow-up, our patient remains in remission with no active intraocular inflammation or subretinal fluid. His BCVA has improved to 20/50 OD and 20/30 OS.

Conclusion and importance

The annual influenza vaccine may be a trigger for onset or recurrence of VKH in genetically susceptible individuals.