Long-term efficacy of dexamethasone intravitreal implant in the treatment of Vogt-Koyanagi-Harada disease relapsing posterior uveitis

Purpose: To investigate the efficacy and safety of dexamethasone intravitreal implant in the treatment of relapsing posterior uveitis in patients with chronic recurrent Vogt–Koyanagi–Harada (VKH) disease. Methods: This was a prospective study of 29 eyes of 16 patients with posterior uveitis in chronic recurrent VKH disease. All patients received previous systemic steroid and immunosuppressive regimens. All patients underwent a comprehensive ophthalmic examination, including best?corrected visual acuity (BCVA), Indocyanine green angiography (ICGA), fundus fluorescein angiography (FFA), and spectral?domain optical coherence tomography (SD?OCT). All patients underwent intravitreal injection with sustained?release dexamethasone 0.7 mg implant (Ozurdex®). Primary outcome measures included mean change in BCVA and central foveal thickness (CFT) at 24 months of follow?up compared to the baseline. Results: At 24 month of follow?up, the mean BCVA improved from 0.82 ± 0.13 to 0.38 ± 0.06 logMAR (P < 0.0001). The mean CFT reduced from 505 ± 29 to 244 ± 23 um (P < 0.0001). The mean intraocular pressure (IOP) changed from 15.1 ± 2.2 to 16.9 ± 3.1 mmHg with no significant value (P?value = 0.0955). Twenty?one eyes (72.4%) received one injection, whereas eight eyes (27.6%) required two injections. The mean number of injections was 1.2 ± 0.60. The mean follow?up time was 24.75 ± 0.9 months. No serious ocular or systemic adverse events were noted during the follow?up period. Ocular hypertension was recorded in three (10.3%) eyes and controlled by IOP lowering medications. Cataract progression occurred in 11 (37.9%) eyes. Conclusion: Our cohort highlights the beneficial effects of the dexamethasone implant of 0.7 mg in the treatment of VKH disease relapsing posterior uveitis improving visual acuity, reducing macular edema, and minimizing the burden of systemic steroids in this sample study

Role of Swept source optical coherence tomography in management of acute Vogt-Koyanagi-Harada’s disease

Purpose: To evaluate the role of swept?source optical coherence tomography (SS?OCT) in the management of acute Vogt–Koyanagi–Harada’s (VKH) disease. Methods: Retrospective analysis of SS?OCT images of acute VKH patients between January 2015 and February 2020 in a tertiary eye care hospital. Results: We studied 34 eyes of 17 patients with acute probable VKH disease. The mean age was 31.6 ± 10.4 years. Twelve patients were women. The mean follow?up was 17.1 ± 9.3 months. The mean visual acuity was 0.86 logMAR (Snellen equivalent: 6/45) at presentation and 0.18 logMAR (Snellen equivalent: 6/9) at the last follow?up. The mean subfoveal choroidal thickness (SFCT) was 784.97 microns at presentation, 431.40 microns at the first month of therapy, 453.94 microns at six months of therapy, and 405.83 microns at the last follow?up. Qualitative features noted on SS?OCT on presentation was subretinal fluid (SRF) in 29 (85%) eyes, subretinal hyperreflective dots in 34 (100%) eyes, subretinal septa in 33 (97%) eyes, RPE undulations in 21 (61.7%) eyes, posterior vitreous cells in 34 (100%) eyes, SRF around disc in 9 (26%) eyes, and disc swelling in 34 (100%) eyes. At the end of 1 year of follow?up, RPE undulations were absent in 30 eyes (88%) and disc swelling was notably absent in all 34 eyes (100%), though SRF around disc was noted in 4 eyes (11.7%) of 2 patients who had recurrences. Conclusion: SFCT, SRF around disc, RPE undulation, and disc swelling may be important indicators on SS?OCT to guide therapy and prognosticate recurrences in acute VKH.

Vogt Koyanagi Harada disease following a recent COVID-19 infection

A 23?year?old female presented with a 3?day history of bilateral (OU) diminution of vision 3 weeks after COVID?19 infection. Best corrected visual acuity (BCVA) was 20/30 in right eye and 20/40 in left eye. Anterior segment showed OU 1+ cells in anterior chamber and anterior vitreous face. Fundus OU showed disc hyperemia and multiple pockets of subretinal fluid (SRF), confirmed on optical coherence tomography. Fundus fluorescein angiography showed multiple pin point leaks suggestive of Vogt Koyanagi Harada disease. Oral corticosteroids 1 mg/kg/day were started. At 2?months’ follow?up, her BCVA improved to 20/25 OU with complete resolution of SRF.

Sympathetic Ophthalmia as a Major Sight-threatening Disorder.

SO Iris and eyeball inflammatory condition affecting both eyes that occurs after a penetrating injury as a delayed autoimmune reaction to eye injury. Patients present with pain, photophobia, paresis of accommodation, metamorphopsia and mild to significant visual loss. The granulomatous anterior uveitis is accompanied by posterior segment findings including moderate to severe vitritis, choroiditis, papillitis, perivasculitis, and yellow-white lesions of the retinal pigment epithelium (Dalen-Fuchs nodules). The inflammation can lead to serious retinal detachment and macular edema. Extraocular symptoms include headache, meningitis or cerebrospinal fluid pleocytosis, hearing loss, poliosis and vitiligo. The inflammation is caused by a cell-mediated immune mechanism and autoimmune inflammatory response directed against ocular self-antigens released after the initial injury. SO may occur after ocular trauma (47 to 65% of patients) or contusions. Wounds involving the ciliary body are associated with the highest risk. Surgical interventions may also trigger SO, with posterior segment surgery carrying a higher risk than anterior segment surgery. Diagnosis of SO is mainly based on patient history and clinical presentation. Imaging studies (fluorescein or indocyanine green angiography, B-scan ultrasonography and optical coherence tomography) may be useful to confirm the diagnosis.

Bilateral Acute Myopia and Angle-Closure Due to Ciliochoroidal Effusion in Vogt-Koyanagi-Harada Syndrome

PURPOSE: To report a case of bilateral acute myopia and angle-closure with ciliochoroidal detachment in Vogt-Koyanagi-Harada (VKH) syndrome. CASE SUMMARY: A 43-year-old Korean woman diagnosed with VKH syndrome underwent intravenous methylprednisolone steroid pulse treatment. After oral medication was given for 2 days, the anterior chambers became shallow in both eyes. Intraocular pressure (IOP) increased to 25 mm Hg in the right eye and 23 mm Hg in the left eye. Subretinal fluid increased and visual acuity decreased with myopic shift in both eyes. IOP did not decrease despite maximum tolerated medical therapy. Ultrasound biomicroscopy (UBM) revealed that ciliochoroidal effusion caused forward displacement of the lens-iris diaphragm, which resulted in anterior chamber shallowing and angle closure in both eyes. The patient was treated with cycloplegic eyedrops and intravenous steroid pulse therapy. After intravenous steroid pulse treatment was given for 2 days, the anterior chambers became deep in both eyes. IOP reduced to 13 mm Hg and 14 mm Hg in the right and left eye respectively. Visual acuity increased with normalization of myopic shift. UBM revealed that the ciliochoroidal effusion had resolved in both eyes.

Surgical Management of Atypical Vogt-Koyanagi-Harada Disease

PURPOSE: To report a case of surgical treatment of bilateral bullous exudative retinal detachment associated with Vogt-Koyanagi-Harada disease. CASE SUMMARY: A 64-year-old woman presented with decreased visual acuity, headache, and hearing loss for 2 months. Visual acuity was hand motion in the right eye and light perception in the left eye. Intraocular pressure was 16 mmHg in the right eye and 24 mmHg in the left eye. Slit lamp examimation disclosed corneal edema, conjunctival ciliary injection with chemosis, rubeosis iridis, and posterior synechia in both eyes. Fundus examination demonstrated bilateral bullous exudative retinal detachment. Lumbar puncture revealed pleocytosis and auditory function test showed neurosensory hearing loss. She was diagnosed as having bilateral bullous exudative retinal detachment associated Vogt-Koyanagi-Harada disease. On hospital day 3, intravitreal triamcinolone injection with external subretinal fluid drainage was performed in the right eye and on hospital day 6, intravitreal triamcinolone injection with external subretinal fluid drainage was performed in the left eye. Two months later, best corrected visual acuity was 0.2 in the right eye and 0.04 in the left eye. CONCLUSIONS: Intravitreal trimacinolone acetonide injection with external subretinal fluid drainage is one of the good treatment for bullous exudative retinal detachment associated with Vogt-Koyanagi-Harada disease.

A Case of Vogt-Koyanagi-Harada(VKH)Syndrome Combined with Choroidal Detachment in Diatetic Nephropathy Patient

VKH syndrome is a symptom complex having prodromal systemic manifestations, bilateral uveites and exudative retinal detachment. It has not been known clearly whether it is relelated to DM or not. We experienced a 43-year old man complaining of acutely decreased visual acuity in both eyes with bilateral choroidal detachment. He has been diabetic for 5 years in uncontrolled state. He was diagnosed to have VKH syndrome and was treated with local steroid injection with visual improvement. So we present this case with review of literatures.

Analysis of Typing in Patients with Uveitis in Korean Population

In order to evaluate association of particular HLA typing with certain uveitis in Korean population, HLA antigens were analyzed in 114 uneitis patients(acute anterior uveitis: 32 cases, Behcet`s disease: 25 cases, intermediate uveitis: 19 cases, Vogt-Koyanagi-Harada (V-K-H) syndrome: 10 cases, retinal vasculitis: 12 cases, Eale`s disease: 3 cases, posterior uveitis: 9 cases, pan.uveitis: 4 cases). The stronger association between acute anterior uveitis and HLA-B27 was statistically significant, and this result was similar to reports in other ethnic groups. Also, the association between V-K-H syndrome and HLA-DR4 showed same results. But the high frequency of HLA-DR7 in the patients with V-K-H syndrome was unque in patients of Korean popjlation and statistically significant. The association between HLA-A2 and posterior uveitis was high in patients of Korean population and statistically significant. Behcet`s disease was stronger association with HLA-B51 but not statistically significant and much weaker association than reports in Japanese group. Although many similarities of associations between particular uveitis and HLA typing were detected as compared with other ethnic groups, distinctive HLA associations were demonstrated in Korean population. Additional cases and long-term follow-up are required to confirm the association with HLA typing and the relationship with prognosis including clinical and laboratory variabilities.