Clinical features and visual outcomes of 111 patients with new-onset acute Vogt-Koyanagi-Harada disease treated with pulse intravenous corticosteroids

2018 ◽  
Vol 103 (2) ◽  
pp. 274-278 ◽  
Author(s):  
Makiko Nakayama ◽  
Hiroshi Keino ◽  
Takayo Watanabe ◽  
Annabelle A Okada
Keyword(s):  
Clinical Features ◽  
Serous Retinal Detachment ◽  
Corticosteroid Treatment ◽  
Japanese Patients ◽  
Systemic Complications ◽  
Visual Outcomes ◽  
Number Of Patients ◽  
Clinical Records ◽  
Vkh Disease ◽  
New Onset

PurposeTo describe the clinical features, treatment and visual outcomes of Japanese patients with new-onset acute Vogt-Koyanagi-Harada (VKH) disease.MethodsClinical records of 111 patients who presented between 1999 and 2015 to the Ocular Inflammation Service of the Kyorin Eye Center, Tokyo, were reviewed.ResultsOf the 111 patients (68 women, 43 men), 16 had complete, 90 had incomplete and 5 had probable VKH disease. The median follow-up period was 36 months (4–175 months). The mean age at presentation was 41 years (19–74 years). Serous retinal detachment (202 eyes) and optic disc hyperaemia (89 eyes) were observed at presentation. Of the patients tested, 45/48 (93.8%) were human leucocyte antigen-DR4 positive and 63/77 (81.8%) had cerebrospinal fluid pleocytosis. Initial corticosteroid treatment consisted of pulse intravenous therapy in all patients. Sunset glow fundus was observed in 49.5% of eyes, and anterior and/or posterior segment recurrence of inflammation was observed in 25 patients (22.5%). Treatment was transitioned to cyclosporine in 17 patients (15.3%) for steroid sparing (6 patients) or recurrent inflammation (11 patients), with good subsequent control. Ocular complications were observed in 47 of 222 eyes (21.2%) (mostly cataract), and systemic complications were observed in 8.1% of patients (mostly hypertension and diabetes mellitus). Ninety-three percent of eyes (167 of 178 eyes) had a visual acuity of ≥1.0 at 1 year after presentation.ConclusionsAn aggressive corticosteroid treatment strategy in a large number of patients with new-onset acute VKH disease, with transitioning to cyclosporine in selected cases, resulted in excellent visual outcomes and low rates of recurrence.

Clinical features and visual outcomes of Japanese patients with scleritis

2010 ◽  
Vol 94 (11) ◽  
pp. 1459-1463 ◽  
Author(s):  
H. Keino ◽  
T. Watanabe ◽  
W. Taki ◽  
C. Nakashima ◽  
A. A. Okada
Keyword(s):  
Clinical Features ◽  
Japanese Patients ◽  
Visual Outcomes

scholarly journals Unilateral Vogt-Koyanagi-Harada Disease: A Clinical Case Report

2015 ◽  
Vol 6 (3) ◽  
pp. 361-365 ◽  
Author(s):  
Arminda Neves ◽  
Ana Cardoso ◽  
Mariana Almeida ◽  
Joana Campos ◽  
António Campos ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Case Report ◽  
Retinal Detachment ◽  
Serous Retinal Detachment ◽  
Subretinal Fluid ◽  
Posterior Pole ◽  
Exudative Retinal Detachment ◽  
The Right ◽  
Clinical Records ◽  
Vkh Disease

Purpose: To report a case of a 20-year-old female with decreased visual acuity (VA) in the left eye (LE). Methods: This is a retrospective and descriptive case report based on data from clinical records, patient observation and analysis of diagnostic tests. Results: A 20-year-old female presented with decreased VA in the LE for 3 days. Best-corrected visual acuity (BCVA) was 20/20 in the right eye (RE) and 20/40 in the LE. Pupillary function, intraocular pressure, results of external segment examinations and slit-lamp biomicroscopy were normal, bilaterally. RE fundoscopy was normal, and in the LE it revealed papillitis and posterior pole exudative retinal detachment. Optical coherence tomography (OCT) confirmed the macular serous retinal detachment and showed thickening of the posterior choroid also revealed by orbital ultrasound and magnetic resonance imaging (MRI). Fluorescein angiography showed angiographic features typical of Vogt-Koyanagi-Harada (VKH) disease: disseminated spotted choroidal hyperfluorescence and choroidal multifocal hypofluorescence, multifocal profuse leakage in the retina with pooling, serous retinal detachment and optic disc hyperfluorescence. Serological testing for the diagnosis of infectious pathologies was negative, and the review of systems was normal. The patient received systemic steroids and cyclosporine. LE BCVA improved up to 20/20 at 18 months after the diagnosis, with complete reabsorption of subretinal fluid and normal retinal and choroidal thickness by OCT. Conclusion: Despite the unilateral involvement, the clinical and angiographic features were typical of VKH disease, and ophthalmologists should be aware to recognize this rare clinical variant of the disease.

scholarly journals Outcomes of Patients With Acute Vogt–koyanagi–harada Disease Treated With Intravenous Corticosteroid Pulse Followed by the Slow Tapering of Oral Corticosteroid Therapy

2022 ◽  
Author(s):  
Rui Fushitsu ◽  
Akihiro Ishibazawa ◽  
Masataka Murono ◽  
Reiko Kinouchi
Keyword(s):  
Low Vision ◽  
Oral Prednisolone ◽  
Systemic Steroid ◽  
Visual Outcomes ◽  
Prednisolone Dose ◽  
Significant Difference ◽  
Potential Factors ◽  
Clinical Records ◽  
Oral Corticosteroid Therapy ◽  
Vkh Disease

Abstract Purpose We investigated the treatment outcomes of patients with acute Vogt–Koyanagi–Harada (VKH) disease and assessed 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 assessed 62 eyes from 31 patients (mean age: 52.8 years). One patient was treated with topical treatment alone and showed poor visual outcomes. In total, 30 patients were treated with methylprednisolone pulse followed by the slow tapering of oral prednisolone; 73% of them developed AR and 27% CR. Although the total prednisolone dose was higher in patients with CR disease, no significant difference was noted in the final best-corrected visual acuity (BCVA). Among the patients receiving systemic steroid, 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 followed by the slow tapering of prednisolone appear to demonstrate good visual outcomes, including patients with CR; most eyes with low visual outcomes have pre-existing conditions that explain low vision.

scholarly journals Endophthalmitis following Intravitreal Injection, Cataract Surgery, and Vitrectomy: Clinical Features and Visual Outcomes

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ana Maria Cunha ◽  
Maria Manuel Iglésias ◽  
Amândio Rocha-Sousa ◽  
Fernando Falcão-Reis ◽  
Manuel Falcão
Keyword(s):  
Cataract Surgery ◽  
Clinical Features ◽  
Primary Outcome ◽  
Visual Outcome ◽  
Single Centre ◽  
Visual Outcomes ◽  
Poor Visual Outcome ◽  
Number Of Patients ◽  
Pars Plana ◽  
Better Than

Purpose. To describe and compare the clinical features and visual outcomes of endophthalmitis following intravitreal injections (IVI), cataract surgery, and pars plana vitrectomy (PPV). Methods. This is a single-centre, retrospective study. All included patients had acute postoperative endophthalmitis secondary to one of these three procedures. Visual acuity (VA), comorbidities, time to presentation, and treatment were assessed. The primary outcome was visual outcome. A poor outcome was considered if final VA was worse than or equal to counting fingers (CF) and a good outcome was classified as VA better than CF. Results. Over 12 years, a total of 61 patients were included. Twenty-seven cases were post-cataract endophthalmitis; twenty-five were post-IVI and nine post-PPV. Endophthalmitis post-PPV had a worse visual outcome (88.9% of patients with VA worse than or equal to CF 95% CI 51.3 to 100.0%) than endophthalmitis following cataract surgery (25.9% of patients with VA worse than or equal to CF 95% CI 11.0 to 39.9%) and the IVI subgroup (44.0% of VA worse than or equal to CF 95% CI 24.0 to 67.0%) ( p = 0.001 and p = 0.047 ). There were no significant differences in the proportion of patients with a poor visual outcome between endophthalmitis following cataract surgery and IVI ( p = 0.171 ). Conclusions. The number of patients with poor visual outcomes following acute endophthalmitis was similar in endophthalmitis following IVI and cataract surgery, but better than endophthalmitis following vitrectomy.

Clinical Features, Treatment, and Visual Outcomes of Japanese Patients with Posterior Scleritis

2019 ◽  
Vol 28 (2) ◽  
pp. 209-216 ◽  
Author(s):  
Yoshimasa Ando ◽  
Hiroshi Keino ◽  
Makiko Nakayama ◽  
Takayo Watanabe ◽  
Annabelle A. Okada
Keyword(s):  
Clinical Features ◽  
Japanese Patients ◽  
Posterior Scleritis ◽  
Visual Outcomes

Vogt-Koyanagi-Harada Syndrome (Uveomeningoencephalitic Syndrome)

2017 ◽  
Vol 27 (1) ◽  
pp. 5-8 ◽  
Author(s):  
Katerina Manethova ◽  
Jan Ernest ◽  
Michal Hrevus
Keyword(s):  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Late Phase ◽  
Serous Retinal Detachment ◽  
Corticosteroid Treatment ◽  
Posterior Pole ◽  
Severe Headache ◽  
University Hospital ◽  
High Dose ◽  
Clinical Records

Purpose To report a case of a 29-year-old man who was examined at the Eye Clinic of Central Military University Hospital Prague for a severe headache and acute blurring of vision in both eyes diagnosed as incomplete Vogt-Koyanagi-Harada syndrome (VKH). Methods This is a retrospective and descriptive case report based on data from clinical records, patient observation and follow-ups and analysis of acquired diagnostic tests. Results A 29-year-old man presented with headache and decreased vision in his left eye (LE) for 2 days. Best-corrected visual acuity was 20/20 in both his eyes. Pupillary function, intraocular pressure, results of external segment examinations, and slit-lamp biomicroscopy were normal bilaterally. Right eye funduscopy was normal; in the LE, funduscopy revealed posterior pole exudative retinal detachments. Optical coherence tomography confirmed multiple serous (bullous) retinal detachments and showed thickening of the posterior choroid also revealed by orbital ultrasound. Fluorescein angiography showed angiographic features typical of VKH disease: disseminated spotted choroidal hyperfluorescence and choroidal multifocal hypofluorescence, multifocal profuse leakage in the retina with late phase pooling, serous retinal detachment, and optic disc hyperfluorescence. All serologic tests for the diagnosis of infectious pathologies were negative. Except for severe headache, the patient did not have any neurologic, integumentary, or auditory manifestations. Immediate high-dose systemic corticosteroid treatment was given. Conclusions Despite prompt diagnosis, prompt aggressive systemic therapy, and a rapid response in this case, progressive pigmentary changes of retinal pigment epithelium developed shortly thereafter.

Clinical features, management and visual outcomes on patients with traumatic hyphema in a reference ophthalmological clinic in Colombia

2020 ◽  
Vol 64 (1) ◽  
pp. 28-34
Author(s):  
Virgilio Galvis ◽  
Angelica Pedraza-Concha ◽  
Alejandro Tello ◽  
M. Lina Plata ◽  
C. Luis Escaf ◽  
...  
Keyword(s):  
Clinical Features ◽  
Visual Outcomes

scholarly journals Polypharmacy-associated potential contraindications of drug prescriptions in patients with primary angle closure disease in a real-world setting

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Fumiaki Tanaka ◽  
Naoki Shibatani ◽  
Kazumi Fujita ◽  
Hiroaki Ikesue ◽  
Satoru Yoshimizu ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Anterior Chamber Depth ◽  
Japanese Patients ◽  
Median Number ◽  
Angle Closure ◽  
Primary Angle Closure ◽  
Primary Angle Closure Glaucoma ◽  
Number Of Patients ◽  
Multiple Drugs

Abstract Background Primary angle closure disease (PACD) is a type of glaucoma in which the intraocular pressure (IOP) is increased because of the blockage of the anterior chamber angle. Medications contraindicated for patients with PACD, such as anticholinergics, cause mydriasis, and can elevate IOP. However, anticholinergics are currently contraindicated only for primary angle closure glaucoma (PACG) in Japanese package inserts. In this study, we investigated the prescription status of medications contraindicated for PACD, such as anticholinergics, in patients with PACD scheduled for eye surgeries. Methods Forty-three Japanese patients diagnosed with PACD at Kobe City Eye Hospital, Japan, and scheduled hospitalization for eye surgeries between December 2017 and July 2018, were included. Data, including sex, age, diagnosis, IOP, anterior chamber depth, and patients’ regular medications prior to hospitalization, were collected for each patient from the electronic medical records. Results The number of patients with chronic primary angle closure (CPAC) and acute primary angle closure (APAC) was 35 (81.4%) and 8 (18.6%), respectively. Among all the 43 patients with PACD, 8 (18.6%) received 15 medications that are potentially contraindicated for PACD by non-ophthalmologist. According to medication categories, benzodiazepine hypnotics were the most commonly prescribed. Among the 8 patients with APAC, 2 (25.0%) had routinely received medications contraindicated for PACD. The median number of all kinds of prescriptions on the day of hospitalization was significantly higher for patients who received medications contraindicated for PACD than for those who did not receive them (p = 0.010). Conclusions About 20% of patients with PACD received medications potentially contraindicated for PACD, such as anticholinergics. Attention should be paid to patients prescribed multiple drugs for adverse events, such as increase in intraocular pressure.

scholarly journals Excision of Greater Superficial Petrosal Nerve Schwannoma Via a Pure Endoscopic Endonasal Approach

2021 ◽  
pp. 014556132110263
Author(s):  
Zhenlin Wang ◽  
Siyuan Zhang ◽  
Yan Qi ◽  
Lianjie Cao ◽  
Pu Li ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Clinical Features ◽  
Middle Cranial Fossa ◽  
Nerve Sheath Tumor ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Greater Superficial Petrosal Nerve ◽  
Clinical Records

Greater superficial petrosal nerve (GSPN) schwannomas are an exceedingly rare nerve sheath tumor. The current literature search was conducted using Medline and Embase database by key search terms. Only 31 cases have been reported in the literature so far. Facial palsy, hearing loss, and xerophthalmia accounted for 48.4% (15), 41.9% (13), and 29% (9) of all cases, respectively. The middle cranial fossa approach was used in all previous reports. A retrospective review of 2 GSPN schwannomas patients treated by endoscopic endonasal approach (EEA) in our center was collected. Clinical records, including clinical features, pre- and postoperative images, surgery, and follow-up information, were reviewed. In all cases, clinical features including facial numbness and headache were found, with tinnitus in case 1, hearing loss, xerophthalmia in case 2. Imaging studies showed a solid mass that originated in the anterior of the petrous bone. Two patients were treated by EEA. Furthermore, no recurrence was found during the follow-up period (15-29 months) in both of the 2 cases after the operation. Complete resection of GSPN schwannomas can be achieved via the pure EEA. Endoscopic endonasal approach for radical removal of tumors is safe and feasible.

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