Subject(s)
Retinal Detachment/diagnosis , Retinitis/diagnosis , Uveomeningoencephalitic Syndrome/diagnosis , Exudates and Transudates , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Infusions, Intravenous , Pulse Therapy, Drug , Recurrence , Retinal Detachment/drug therapy , Retinitis/drug therapy , Subretinal Fluid , Tomography, Optical Coherence , Uveomeningoencephalitic Syndrome/drug therapyABSTRACT
PURPOSE: To evaluate the duration of immunomodulatory therapy (corticosteroids, immunosuppressive drugs) with regard to the rate of relapses and clinical features (exudative retinal detachment or anterior uveitis) in inflammatory episodes of Vogt--Koyanagi--Harada disease. METHODS: Data of all 42 patients diagnosed with acute uveitis associated with VKH disease during the period of January 2005 to December 2008 at the Pitié-Salpêtrière Hospital or at the Lariboisière Hospital in Paris, France were extracted by chart review. RESULTS: There were 31 patients (73.8%) with episodes of recurrence and were included in the study. At the first recurrence, 81% (13 patients) of exudative retinal detachments (ERD) were associated with an initial immunomodulatory treatment conducted ≤6 months (3.76 months ± 2.67). Conversely, an initial treatment duration of >6 months was associated with anterior uveitis signs for 66% of patients (eight patients) with anterior first recurrence (p = 0.0061). On second episode of recurrence, 75% of patients (three patients) who developed exudative retinal detachment had been managed by immunomodulatory therapy for ≤6 months with the total duration of immunomodulatory treatment ≤6 months during previous inflammatory episodes. Conversely, all 16 patients who presented anterior uveitis with additional manifestations (optic disc oedema, macular oedema, vitritis and/or 'Sunset glow' fundus) have been treated for more than 6 months or treated during the initial occurrence lasting more than 9 months (p = 0.0035). CONCLUSIONS: The duration of systemic corticosteroids (and/or immunosuppressive drug therapy) for ≤6 months at first and second recurrence was associated with features of further exudative retinal detachment instead of anterior uveitis in VKH disease.
Subject(s)
Glucocorticoids/administration & dosage , Immunosuppressive Agents/administration & dosage , Retinal Detachment/diagnosis , Uveitis, Anterior/diagnosis , Uveomeningoencephalitic Syndrome/diagnosis , Uveomeningoencephalitic Syndrome/drug therapy , Administration, Oral , Adult , Drug Therapy, Combination , Female , Follow-Up Studies , Humans , Infusions, Intravenous , Male , Middle Aged , Prednisolone/administration & dosage , Recurrence , Retrospective Studies , Time Factors , Young AdultABSTRACT
PURPOSE: This study aimed to demonstrate that vitrectomy may prevent the occurrence of diabetic macular oedema (DMO). METHODS: Three patients with diabetes type 1 underwent vitrectomy in one eye to treat complications of proliferative diabetic retinopathy. RESULTS: During follow-up, all patients suffered unilateral macular oedema in the non-vitrectomized eye as a result of general metabolic changes. In two of these patients, the DMO resolved with management of the underlying medical condition. CONCLUSIONS: These case reports suggest the vitreous may play a role in the occurrence of DMO associated with general risk factors. Further studies are needed to increase understanding of the mechanisms involved in the development and progression of DMO.
Subject(s)
Diabetic Retinopathy/prevention & control , Macular Edema/prevention & control , Vitrectomy , Adult , Diabetes Mellitus, Type 1/complications , Female , Humans , Laser Coagulation , Male , Retinal Detachment/surgery , Visual Acuity/physiology , Vitreous Hemorrhage/surgery , Young AdultSubject(s)
Uveomeningoencephalitic Syndrome/diagnosis , Angiography , Diagnosis, Differential , Female , Humans , Middle AgedABSTRACT
This paper presents the novel domain of evidence-based research (EBR) in the treatment of patients with Alzheimer's disease (AD) from the perspective of traditional medicine and of complementary and alternative medicine. In earlier lectures we have described the process of evidence-based medicine as a methodological approach to clinical practice that is directed to aid clinical decision-making. Here, we present a practical example of this approach with respect to traditional pharmacological interventions and to complementary and alternative treatments for patients with AD.
