scholarly journals A Case of Vogt-Koyanagi-Harada Disease-Like Uveitis Induced by Nivolumab and Ipilimumab Combination Therapy

2021 ◽  
pp. 952-960
Author(s):  
Keisuke Minami ◽  
Mariko Egawa ◽  
Keisuke Kajita ◽  
Fumiko Murao ◽  
Yoshinori Mitamura
Keyword(s):  
Visual Acuity ◽  
Choroidal Thickness ◽  
Vision Loss ◽  
Checkpoint Inhibitors ◽  
Serous Retinal Detachment ◽  
Enhanced Depth Imaging ◽  
Steroid Pulse ◽  
Corrected Visual Acuity ◽  
Oral Steroids ◽  
Vkh Disease

Nivolumab and ipilimumab are widely used immune checkpoint inhibitors (ICPIs) for the treatment of metastatic melanoma. ICPIs cause an array of side effects called immune-related adverse events (IRAEs) due to activation of an immune response. ICPI-uveitis can cause irreversible vision loss if untreated. There are few reports of recurrent Vogt-Koyanagi-Harada (VKH) disease-like uveitis induced by nivolumab and ipilimumab. We report a case of VKH disease-like uveitis recurrence after resuming ICPIs. A 73-year-old man with advanced melanoma was referred to our clinic with visual loss 25 days after starting nivolumab/ipilimumab. His corrected visual acuity was 0.5 in the right eye and 0.02 in the left eye. Enhanced-depth imaging optical coherence tomography (EDI-OCT) showed marked choroid thickening. The patient was diagnosed with VKH disease-like uveitis due to IRAEs. Subtenon injection of triamcinolone acetonide was performed, and nivolumab/ipilimumab was suspended, but serous retinal detachment (SRD) markedly worsened and choroidal detachment appeared. With 2 courses of steroid pulse therapy and oral steroids, SRD disappeared, and corrected visual acuity recovered in both eyes. Five months after the first injection, exacerbation of melanoma was observed, and nivolumab and oral steroids were restarted. Six weeks later, an increase in choroidal thickness was observed with EDI-OCT and diagnosed as a recurrence of VKH disease-like uveitis. Monitoring for the recurrence of VKH disease-like uveitis during the administration of ICPIs, even after uveitis is treated, is essential. Assessment of choroidal thickness with EDI-OCT may be useful for detecting early signs of VKH disease-like uveitis.

scholarly journals Observational study of clinical characteristics of dome-shaped macula in Chinese Han with high myopia at Zhongshan Ophthalmic Centre

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e021887 ◽  
Author(s):  
Xiujuan Zhao ◽  
Xiaoyan Ding ◽  
Cancan Lyu ◽  
Shiyi Li ◽  
Yu Lian ◽  
...  
Keyword(s):  
Visual Acuity ◽  
High Myopia ◽  
Choroidal Thickness ◽  
Clinical Characteristics ◽  
Serous Retinal Detachment ◽  
Protective Mechanism ◽  
Chinese Han ◽  
Corrected Visual Acuity ◽  
Myopic Maculopathy ◽  
Best Corrected Visual Acuity

PurposeTo evaluate the prevalence of dome-shaped macula (DSM) in highly myopic eyes among Chinese Han and to detect the correlation with myopic maculopathy and macular complications.MethodsA total of 736 Chinese Han patients (1384 eyes) with high myopia (refractive error≤6.0 diopters or axial length ≥26.5 mm) are reviewed based on information entered into a high-myopia database at Zhongshan Ophthalmic Centre. Subfoveal choroidal thickness (SFCT) and parafoveal choroidal thickness (PFCT) are measured. The prevalence of DSM in patients with myopic maculopathy is categorised from C0 to C4. Clinical features, including macular complications, SFCT and PFCT, are compared between myopic eyes with and without DSM.ResultsAmong the 1384 eyes, 149 (10.77%) show DSM. In highly myopic eyes without macular complications, the best corrected visual acuity is significantly worse in patients with DSM (p=0.002), and the ratio between subfoveal and parafoveal choroidal thickness (S/PCT) is significantly elevated in patients with DSM (p=0.021). The proportion of foveal schisis (17.24% vs 62.86%) is much lower in eyes with DSM compared with those without DSM. However, the proportions of extrafoveal schisis (39.66% vs 5.37%), foveal serous retinal detachment (SRD) (5.17% vs 0) and epiretinal membrane (ERM) (24.14% vs 10.74%) are much higher in eyes with DSM. The proportion of DSM was lower in C0 and C1, but higher proportion of DSM was found in C3 and C4.ConclusionsDSM is found in 10.77% of highly myopic eyes among Chinese Han. DSM might be a protective mechanism for foveal schisis and a risk factor for extrafoveal schisis, SRD and ERM.

scholarly journals Real-world outcomes of two-year Conbercept therapy for diabetic macular edema

2021 ◽  
Vol 14 (3) ◽  
pp. 416-422
Author(s):  
Yong Cheng ◽  
◽  
Ming-Wei Zhao ◽  
Tong Qian ◽  
◽  
...  
Keyword(s):  
Visual Acuity ◽  
Adverse Events ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Vision Loss ◽  
Retinal Thickness ◽  
Corrected Visual Acuity ◽  
The Mean ◽  
Number Of Injections ◽  
Best Corrected Visual Acuity

AIM: To evaluate the two-year outcomes of patients treated for diabetic macular edema (DME) with intravitreal Conbercept (IVC). METHODS: The clinical data of 30 DME patients (36 eyes) were retrospectively reviewed. The patients were treated with IVC for 3mo. Additional IVC was given at subsequent monthly visits, if needed (3+PRN). The patients were followed up for 24mo. RESULTS: The best-corrected visual acuity (BCVA) at 24mo significantly increased (66.7±15.3 letters) in comparison with the baseline (54.4±15.4 letters, P<0.0001). The mean improvement in BCVA was 11.0±2.9 letters. At 24mo, 44.1% of the eyes surveyed gained ≥15 letters, 52.9% of the eyes gained ≥10 letters, and 70.6% of the eyes gained ≥5 letters. No vision loss was noted in 96.8% of the eyes, and 5.9% of the eyes lost ≥5 letters, but ≤10 letters. The central retinal thickness (CRT) at 24mo was significantly reduced (277.1±122.9 μm) in comparison with the baseline (510.9±186.1 μm, P<0.0001). At 24mo, 43.3% of the patients had a CRT ≤250 μm. The mean number of injections over 24mo was 10.6±2.0. No severe eye or systemic adverse events related to either the drug or injection were noted. CONCLUSION: IVC is safe and effective for the treatment of DME.

scholarly journals Transient choroidal detachment after ultrasonic circular cyclocoagulation

2019 ◽  
Vol 12 (10) ◽  
pp. e231677
Author(s):  
Tiago Morais Sarmento ◽  
Ricardo Figueiredo ◽  
João Garrido ◽  
Ana Luisa Rebelo
Keyword(s):  
Visual Acuity ◽  
Best Practice ◽  
Choroidal Detachment ◽  
Refractory Glaucoma ◽  
Corrected Visual Acuity ◽  
Retrobulbar Anaesthesia ◽  
Oral Steroids ◽  
Hypotensive Therapy ◽  
Best Corrected Visual Acuity

Two patients with refractory glaucoma followed in our ophthalmology department registered progression on left eyes (OS) despite best practice. Best corrected visual acuity (BCVA) was 9/10 and 8/10 and intraocular pressure (IOP) was above 20 mm Hg while under maximal hypotensive therapy. The procedure was performed under retrobulbar anaesthesia with second-generation EyeOp1probes. In follow-up, OS were hypotonic with registered IOP ≤5 mm Hg and revealed a 3/10 BCVA. The funduscopy showed one temporal and superior and another nasal and temporal choroidal detachments. The patients started oral steroids and interrupted all ocular hypotensive medication. After therapy, patients returned with normal rising OS IOPs and with totally reapplied choroids, accompanied by normalised BCVA. These two cases are proof of the possibility of transient choroidal detachment after a ultrasonic circular cyclocoagulation. While a very rare major vision-threatening complication, every ophthalmologist should remind it when sudden BCVA reductions occur after this procedure.

scholarly journals Evaluation of acute central serous chorioretinopathy using enhanced depth imaging OCT and multifocal electroretinography

2020 ◽  
Author(s):  
In Hwan Hong ◽  
In Boem Chang ◽  
Jae Ryong Han
Keyword(s):  
Central Serous Chorioretinopathy ◽  
Choroidal Thickness ◽  
Serous Retinal Detachment ◽  
Subretinal Fluid ◽  
Multifocal Electroretinography ◽  
Enhanced Depth Imaging ◽  
Implicit Time ◽  
Depth Imaging ◽  
Acute Central Serous Chorioretinopathy ◽  
Normal Controls

Abstract Background To evaluate the functional and structural abnormalities in patients with acute central serous chorioretinopathy (CSC) by multifocal electroretinography (mfERG) and enhanced depth imaging optical coherence tomography (EDI-OCT) Methods This prospective observational study included 57 patients with unilateral CSC. Both eyes underwent mfERG and EDI-OCT. Peak amplitudes and implicit times of the first kernel responses were analyzed and compared with those in 25 age-matched normal controls. Correlational analyses were performed between the mfERG results and EDI-OCT parameters. The thicknesses of the central retina, subretinal fluid, and choroid was measured at baseline and 3 months later. Results Compared with the normal controls, the amplitude and implicit time on mfERG were significantly impaired in the area with serous retinal detachment (SRD). The P1 amplitude and implicit time of the areas beyond the SRD were also found to be significantly impaired in the affected eyes. Eyes with a greater reduction in SRD had a less impaired mfERG response in fellow eyes than those whose retinal detachments were not spontaneously decreased by more than 90% after 3 months. Correlational analysis did not reveal any significant correlations between mfERG values and OCT parameters except for central choroidal thickness. The subfoveal choroidal thickness was negatively correlated with the mfERG parameters. Conclusion The findings of this study indicate diffuse functional impairment in acute CSC which involves both eyes and areas beyond the SRD. The retinal response of the unaffected eye was associated with regression of SRD and functional retinal abnormality is correlated with pathological changes in the choroid.

scholarly journals Avaliação dos Resultados do Tratamento Antiangiogénico na Neovascularização Coroideia Associada à Miopia Patológica

2014 ◽  
Vol 27 (1) ◽  
pp. 49 ◽  
Author(s):  
Beatriz Carvalho ◽  
Paulo Freitas-Costa ◽  
João Pinheiro-Costa ◽  
Manuel Falcão ◽  
Ângela Carneiro ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Choroidal Neovascularization ◽  
Vision Loss ◽  
Long Term Results ◽  
Myopic Choroidal Neovascularization ◽  
Corrected Visual Acuity ◽  
Foveal Center ◽  
Best Corrected Visual Acuity

<strong>Introduction:</strong> Choroidal neovascularization secondary to pathological myopia is one of the leading causes of irreversible central vision loss in younger patients. The purposes of our study is to evaluate the long-term results of antiangiogenic treatment, with ranibizumab and/or bevacizumab, in myopic choroidal neovascularization and define the predictive factors for visual and anatomic outcomes.<br /><strong>Material and Methods:</strong> In this study were included 84 eyes from 81 patients with myopic choroidal neovascularization. Eighty-four (100%) eyes accomplish 12 months of follow-up, 67 (79.8%) 24 months, 54 (64.3%) 36 months, 29 (34.5%) 48 months, and 15 (16.7%) 60 months. We retrieved data related to best corrected visual acuity measured with ETDRS chart, foveal center thickness on optical coherence tomography and fluorescein angiographic findings, before and after treatment.<br />Results: The best corrected visual acuity and foveal center thickness improvements were statistically significant for all follow-up times (p &lt; 0.05). Mean baseline best corrected visual acuity was 43.7 ± 20.1 letters and mean baseline foveal center thickness was 304.8 ± 127.9μm. Mean best corrected visual acuity was 55.6 ± 18.5, 52.1 ± 22.3, 52.1 ± 22.6, 50.3 ± 23.8 and 47.8 ± 24.5 for 12, 24, 36, 48 and 60 months of treatment, respectively. Mean foveal center thickness was 209.7 ± 86.2, 190.6 ± 76.1, 174.7 ± 60.6, 189.8 ± 96.7 and 159.4 ± 73.3 for the same follow-up times. Baseline best corrected visual acuity was the only predictive factor for better visual outcome (p &lt; 0.001).<br /><strong>Discussion/Conclusion:</strong> Intravitreal anti-VEGF injections in patients with myopic choroidal neovascularization yielded a significant and sustained functional and anatomic improvement. Randomized long-term clinical trials are needed to determine the sustained efficacy of these drugs.

scholarly journals Pseudo-inflammatory manifestations of choroidal lymphoma resembling Vogt-Koyanagi-Harada disease: case report based on multimodal imaging

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kanae Fukutsu ◽  
Kenichi Namba ◽  
Daiju Iwata ◽  
Kazuomi Mizuuchi ◽  
Satoru Kase ◽  
...  
Keyword(s):  
Serous Retinal Detachment ◽  
Interleukin 2 ◽  
B Cell Lymphoma ◽  
Laser Speckle ◽  
Enhanced Depth Imaging ◽  
Laser Speckle Flowgraphy ◽  
Imaging Features ◽  
Choroidal Thickening ◽  
Disease Case ◽  
Vkh Disease

Abstract Background Hematologic malignancies occasionally cause serous retinal detachment (SRD); however, its pathogenesis remains unclear. Here we present the imaging characteristics of metastatic choroidal lymphoma masquerading as Vogt-Koyanagi-Harada (VKH) disease. Case presentation A 45-year-old Japanese woman was referred to our clinic because of bilateral SRD with blurred vision. Fluorescein angiography revealed multiple pinpoint leakage followed by pooling OU. Enhanced depth imaging optical coherence tomography showed marked choroidal thickening OU. Laser speckle flowgraphy detected choroidal circulation impairment OU. Although these results totally agreed with the inflammatory manifestations of acute VKH disease, indocyanine green angiography demonstrated various sizes of sharply marginated hypofluorescent lesions that seemed atypical for the finding of VKH disease, i.e., vaguely marginated hypofluorescent small dots. Cerebrospinal fluid pleocytosis was not detected. Blood tests revealed leukocytosis together with elevation of lactate dehydrogenase and soluble interleukin-2 receptor levels. Corticosteroid pulse therapy did not improve any ocular findings. Bone marrow biopsy was then performed, leading to a definite diagnosis of diffuse large B-cell lymphoma. After starting systemic chemotherapy, both SRD and choroidal thickening resolved rapidly with visual recovery. However, choroidal hypoperfusion persisted, which contrasted distinctly with the inflammatory pattern of VKH disease, i.e., the restoration of choroidal blood flow in parallel with normalization of choroidal thickness. Conclusions Our detailed multimodal observations highlighted the differential imaging features of choroidal lymphoma despite close resemblance to VKH disease especially at the initial stage. Impaired circulation in the thickened choroid marked the pseudo-inflammatory pathogenesis of SRD due to choroidal involvement with neoplastic, but not inflammatory cells.

Dynamics choroidal thickness in anterior uveitis without visible retinal changes

2021 ◽  
pp. 204-207
Author(s):  
E.V. Udovichenko ◽  
◽  
E.L. Sorokin ◽  
L.P. Danilova ◽  
◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Intraocular Pressure ◽  
Anterior Uveitis ◽  
Choroidal Thickness ◽  
Main Group ◽  
Hla B27 ◽  
Acute Anterior Uveitis ◽  
Corrected Visual Acuity ◽  
Best Corrected Visual Acuity

Purpose. To assess the state of the choroid in patients with HLA-B27-associated anterior uveitis without detectable lesions of the macular zone by ophthalmoscopy. Material and methods. 22 patients with HLA-B27-associated acute anterior uveitis without detectable changes in the macular zone by ophthalmoscopy – the main group. Age: 39.02±13.76 years, men – 16 and women – 8. Best corrected visual acuity varied from 0.1 to 0.5 (average 0.3). The level of intraocular pressure according to Maklakov in all eyes varied from 15 to 22 mm Hg. The parameters of paired intact eyes of patients served as a control. The subfoveal choroid thickness (CT) was determined using optical coherence tomography in comparison with paired intact eyes before treatment and 2 weeks after its initiation. Results. The initial values of the CT indexes in the main group varied from 337 to 371 μm, averaging 354±8 μm. This is statistically significantly higher than in intact paired eyes 255±7 μm (from 246 to 268 μm), p <0.001. 2 weeks after the start of treatment CT indexes in the main group were 268±10 μm, which was statistically significantly lower than the initial indexes in this group, p<0.001. In paired eyes, they were 254±6 μm. Conclusion. A statistically significant increase in CT was revealed in the eyes of patients with acute anterior uveitis, which statistically significantly exceeded the values of the paired intact eye on average on 100 μm. 2 weeks after the start of treatment, the CT indexes statistically significantly decreased to 268±10 μm, which did not differ statistically significantly from the CT indexes of the intact eye. Key words: anterior uveitis, HLA-B27, choroidal thickness.

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 Two-Thirds Dose Photodynamic Therapy for Pachychoroid Neovasculopathy

2021 ◽  
Vol 10 (10) ◽  
pp. 2168
Author(s):  
Koji Tanaka ◽  
Ryusaburo Mori ◽  
Yu Wakatsuki ◽  
Hajime Onoe ◽  
Akiyuki Kawamura ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Photodynamic Therapy ◽  
Choroidal Thickness ◽  
Retinal Thickness ◽  
Serous Retinal Detachment ◽  
Additional Treatment ◽  
Conventional Dose ◽  
Anti Vegf ◽  
Pachychoroid Neovasculopathy ◽  
One Year

Pachychoroid neovasculopathy (PNV) is treated with antivascular endothelial growth factor (VEGF) injection and photodynamic therapy (PDT), but no curative treatment has yet been established. We aimed to clarify the treatment results of a reduced dose of PDT for PNV. The subjects were 27 eyes of 27 patients (male:female = 20:7, mean age 58.9 years). PDT, at 2/3 of the conventional dose (2/3PDT), was administered once. The patients were then observed for one year. Eyes with polypoidal choroidal vasculopathy (PCV) were excluded. We investigated the associations among the central retinal thickness, choroidal thickness, and visual acuity changes before treatment and one, three, six and 12 months after PDT. When serous retinal detachment was increased or unchanged or new hemorrhages were observed, as compared with pretreatment findings, intravitreal injection of an anti-VEGF agent was performed. Visual acuity was significantly improved, as compared to before treatment, at three, six, and 12 months after 2/3PDT. Foveal retinal thickness was significantly decreased after versus before treatment in the 2/3PDT group (p < 0.001). Foveal choroidal thickness was also significantly reduced in the 2/3PDT group (p = 0.001). Additional intravitreal anti-VEGF agent injections were administered to three patients (11%), while 24 (89%) required no additional treatment during the one-year follow-up period. For PNV without polyps, 2/3PDT appears to be effective.

scholarly journals Fundus Autofluorescence after Half-Dose Photodynamic Therapy for Chronic Central Serous Chorioretinopathy

2020 ◽  
pp. 1-5
Author(s):  
Kyoko Fujita ◽  
Yutaka Imamura ◽  
Kei Shinoda ◽  
Soiti Matsumoto ◽  
Mitsuko Yuzawa
Keyword(s):  
Photodynamic Therapy ◽  
Central Serous Chorioretinopathy ◽  
Choroidal Thickness ◽  
Fundus Autofluorescence ◽  
Serous Retinal Detachment ◽  
Enhanced Depth Imaging ◽  
Chronic Central Serous Chorioretinopathy ◽  
Long Term Effect ◽  
Half Dose

<b><i>Introduction:</i></b> To evaluate the fundus autofluorescence (FAF) images 1 year after half-dose photodynamic therapy (hdPDT) for chronic central serous chorioretinopathy (CSC). <b><i>Methods:</i></b> Forty-six eyes of 46 consecutive patients with chronic CSC underwent hdPDT. Short wavelength-elicited FAF images and enhanced depth imaging optical coherence tomographic (EDI-OCT) images were recorded before and at 1, 3, 6, 9, and 12 months after the hdPDT. The FAF images at 1 month were compared to those at 12 months after the hdPDT. <b><i>Results:</i></b> The serous retinal detachment (SRD) was resolved in all eyes. The best-corrected visual acuity (BCVA) improved significantly from 0.13 ± 0.28 logarithm of minimum angle of resolution (logMAR) units before to 0.01 ± 0.17 logMAR units at 12 months after the hdPDT (<i>p</i> = 0.001; paired <i>t</i> test). The mean choroidal thickness decreased significantly from 365.4 ± 103.0 µm to 284.3 ± 92.5 µm at 12 months (<i>p</i> &#x3c; 0.001). Abnormal FAF images were present within the irradiated area in all the eyes before the hdPDT. In 5 of 46 eyes, identifiable changes of the FAF images were observed 12 months after hdPDT. None of the eyes had the confluent hypo-FAF type during the follow-up period. Univariate analyses showed that the choroidal thickness before hdPDT correlated significantly with hypo-FAF enlargement (<i>p</i> = 0.005). However, multivariate analyses showed that the association was not significant (<i>p</i> = 0.06). <b><i>Conclusions:</i></b> The progression of the RPE damages occurred in approximately one-tenth of the eyes that underwent hdPDT for chronic CSC. The long-term effect of progression of hypo-FAF on visual functions remains to be determined.

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