RESUMO
PURPOSE: To correlate changes in subfoveal choroidal thickness (SCT) with the degree of anterior inflammatory activity in chronic Vogt-Koyanagi-Harada (VKH) disease. METHODS: Anterior segment inflammation was assessed using SUN anterior chamber cell grading criteria, and SCT was measured using EDI-OCT in patients with VKH at multiple visits. ANOVA was used to compare the mean SCT for each anterior chamber cell grade. Regression analysis was used to correlate the anterior segment cell grade and the SCT. RESULTS: 14 patients were included in the study. A total of 432 data points consisting of SCT and anterior segment cell values were analyzed. ANOVA demonstrated significant difference between the mean SCT for different anterior chamber cell grades (p < .0001). Regression analysis demonstrated significant correlation between SCT and grade of anterior chamber cells (R2 = 0.37, p < .001). CONCLUSIONS: Chronic VKH is characterized by a dynamic change in SCT that correlates with anterior segment inflammatory activity.
Assuntos
Síndrome Uveomeningoencefálica , Corioide , Humanos , Inflamação/diagnóstico , Tamanho do Órgão , Tomografia de Coerência Óptica , Síndrome Uveomeningoencefálica/complicações , Síndrome Uveomeningoencefálica/diagnósticoRESUMO
PURPOSE: To identify the risk factors for the development of subretinal fibrosis (SRF) among patients with Vogt-Koyanagi-Harada (VKH) syndrome. METHODS: In this case-control study, electronic clinical records from patients diagnosed with VKH syndrome who attended the Inflammatory Eye Disease Clinic at a tertiary care ophthalmology reference center were assessed to identify risk factors from demographic, clinical, and epidemiological variables. Cases were defined as SRF and VKH, whereas the controls were VKH patients without SRF. RESULTS: A total of 150 electronic charts were reviewed, 92 patients with a follow-up longer than 12 months were included; 39 cases and 53 controls. A multivariate analysis found bullous serous retinal detachment as a significant risk factor for SRF (adjusted OR 8.93, 95% CI 1.94-41.1). CONCLUSION: Patients with VKH syndrome who develop a bullous retinal detachment have an 8 times higher risk of developing SRF in the long term.
Assuntos
Descolamento Retiniano , Síndrome Uveomeningoencefálica , Estudos de Casos e Controles , Fibrose , Humanos , Descolamento Retiniano/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Síndrome Uveomeningoencefálica/complicações , Síndrome Uveomeningoencefálica/diagnósticoRESUMO
Purpose: To assess the effectiveness of intravitreal (IV) bevacizumab and the need for systemic immunosuppressive therapy (IMT) in choroidal neovascularization (CNV) in Vogt-Koyanagi-Harada disease (VKHD).Methods: CNV treatment consisted of three monthly IV bevacizumab injections as a loading dose; if intra/subretinal fluid (IRF) persisted, further injections were proceeded besides increment in systemic IMT. Outcome analyses at 3, 6, and 12 months were visual acuity, central foveal thickness, macular volume, IRF, and addition of IMT.Results: Seven eyes of six patients were included. Five patients (five eyes) completed a 12-month follow-up and received 12 IV bevacizumab injections. At the 12-month follow-up, visual acuity improved in four out of five eyes (p = .0568); all eyes had decreased macular volume (p = .0431) but they still had persistent IRF; and all cases needed IMT introduction/increment.Conclusion: Intravitreal bevacizumab in association with systemic IMT was effective for CNV in VKHD. Active CNV may indicate disease of inadequate clinical control.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Síndrome Uveomeningoencefálica/complicações , Adulto , Neovascularização de Coroide/etiologia , Neovascularização de Coroide/fisiopatologia , Feminino , Angiofluoresceinografia , Seguimentos , Humanos , Injeções Intravítreas , Pessoa de Meia-Idade , Estudos Prospectivos , Líquido Sub-Retiniano , Tomografia de Coerência Óptica , Resultado do Tratamento , Síndrome Uveomeningoencefálica/fisiopatologia , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologiaRESUMO
Aims: To evaluate associations between vision-related (VR-) and health-related (HR-) QoL metrics and inflammation and treatment in non-acute VKHD patients.Methods: Cross-sectional study in a tertiary center in Sao Paulo, Brazil with 22 patients with non-acute VKHD followed prospectively for ≥12 months since acute disease onset, with systematic evaluation and predefined treatment protocols. VR- and HR-QoL aspects were assessed by VFQ-25 and SF-36 questionnaires, respectively. Associations between the questionnaire's subscale item scores with inflammation and systemic medical therapies were assessed.Results: After generalized linear model analysis, worse VA, severe fundus changes, fluctuation of VA and fluctuation of anterior chamber cells impacted negatively on VR-QoL items. Higher cumulative total dose of corticosteroids and use of immunosuppressive therapy impacted negatively on both questionnaires.Conclusion: Worse VA, clinical inflammation and systemic treatment have a significant impact on VR- and HR-QoL questionnaires. Subclinical choroidal inflammation did not seem to impact QoL.
Assuntos
Glucocorticoides/uso terapêutico , Imunossupressores/uso terapêutico , Inflamação/etiologia , Qualidade de Vida , Autorrelato , Síndrome Uveomeningoencefálica/tratamento farmacológico , Acuidade Visual , Adulto , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Inflamação/diagnóstico , Inflamação/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Síndrome Uveomeningoencefálica/complicações , Síndrome Uveomeningoencefálica/epidemiologia , Adulto JovemRESUMO
The Vogt-Koyanagi-Harada syndrome (VKHS) is a rare, multisystemic and autoimmune disease. The syndrome mainly affects the eyes, followed by bilateral chronic panuveitis, however, the syndrome may also affect the melanocytes tissues, for example, the eyes, inner ear, meninges and skin. The syndrome origin mechanism is not yet completely known. Commonly, the specific ethnic groups that are affected by the VKHS are as follows: Hispanics, Asians, Indians, Native Americans and ethnic groups from the Middle East. The audiological characteristics of the syndrome and the possible audiologist interventions for a specific case will be reported. The patient was attended at the Clinic of Speech Therapy, Faculdade de Odontologia de Bauru (FOB). She is 53 years old and presented audiological complaints. She was diagnosed with VKHS by a specialist doctor. Throughout the audiologist assessment, she presented bilateral sensorineural hearing loss, absent otoacoustic evoked emissions, complaints about postural vertigo and acute tinnitus. The specific case reported presented sudden sensorineural hearing loss, vertigo, tinnitus and bilateral ocular disease. Even though drug treatment was performed, the hearing loss remained. Therefore, before the hearing aid (HA) fitting, the audiologist should perform the hearing management, investigate if the patient takes the drug treatment and the occurrence of suggestive symptoms of the syndrome. These are some points that help in the reference to the specialist doctor and the audiologist strongly participates in what concerns the hearing.
A síndrome de Vogt-Koyanagi-Harada (SVKH) é rara, multissistêmica e autoimune. Atinge principalmente os olhos, provocando uma panuveíte crônica bilateral, porém traz afecções em outras áreas e tecidos que são ricos em melanócitos, como olhos, orelha interna, meninges e a pele. Sua origem ainda não é totalmente conhecida. Geralmente, a SVKH atinge indivíduos de origem hispânica, do Oriente Médio, indianos, nativos americanos e asiáticos. Descrição dos aspectos audiológicos acometidos pela síndrome e as possíveis intervenções fonoaudiológicas para um caso específico. Paciente de 53 anos, sexo feminino, compareceu à Clínica de Fonoaudiologia, Faculdade de Odontologia de Bauru (FOB) com queixas audiológicas e diagnóstico médico da SVKH. A paciente apresentou perda auditiva sensório-neural bilateralmente, emissões otoacústicas evocadas ausentes e queixas vestibulares de vertigem postural e desequilíbrio ao andar, bem como queixa de zumbido agudo contínuo. O caso apresentado mostrou perda auditiva sensório-neural, vertigem, zumbido e acometimento ocular bilateral. Apesar do tratamento com corticoesteroide, a perda auditiva se manteve. Desta forma, precedente à indicação do AASI, o fonoaudiólogo deve atentar-se para o acompanhamento audiológico do caso, realização ou não de tratamento medicamentoso e ocorrência de sintomas sugestivos da síndrome, favorecendo o encaminhamento para o médico e participando ativamente do processo terapêutico envolvendo a audição.
Assuntos
Perda Auditiva Neurossensorial , Perda Auditiva , Zumbido , Síndrome Uveomeningoencefálica , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/etiologia , Humanos , Pessoa de Meia-Idade , Síndrome Uveomeningoencefálica/complicações , Síndrome Uveomeningoencefálica/diagnóstico , VertigemRESUMO
RESUMO A síndrome de Vogt-Koyanagi-Harada (SVKH) é rara, multissistêmica e autoimune. Atinge principalmente os olhos, provocando uma panuveíte crônica bilateral, porém traz afecções em outras áreas e tecidos que são ricos em melanócitos, como olhos, orelha interna, meninges e a pele. Sua origem ainda não é totalmente conhecida. Geralmente, a SVKH atinge indivíduos de origem hispânica, do Oriente Médio, indianos, nativos americanos e asiáticos. Descrição dos aspectos audiológicos acometidos pela síndrome e as possíveis intervenções fonoaudiológicas para um caso específico. Paciente de 53 anos, sexo feminino, compareceu à Clínica de Fonoaudiologia, Faculdade de Odontologia de Bauru (FOB) com queixas audiológicas e diagnóstico médico da SVKH. A paciente apresentou perda auditiva sensório-neural bilateralmente, emissões otoacústicas evocadas ausentes e queixas vestibulares de vertigem postural e desequilíbrio ao andar, bem como queixa de zumbido agudo contínuo. O caso apresentado mostrou perda auditiva sensório-neural, vertigem, zumbido e acometimento ocular bilateral. Apesar do tratamento com corticoesteroide, a perda auditiva se manteve. Desta forma, precedente à indicação do AASI, o fonoaudiólogo deve atentar-se para o acompanhamento audiológico do caso, realização ou não de tratamento medicamentoso e ocorrência de sintomas sugestivos da síndrome, favorecendo o encaminhamento para o médico e participando ativamente do processo terapêutico envolvendo a audição.
ABSTRACT The Vogt-Koyanagi-Harada syndrome (VKHS) is a rare, multisystemic and autoimmune disease. The syndrome mainly affects the eyes, followed by bilateral chronic panuveitis, however, the syndrome may also affect the melanocytes tissues, for example, the eyes, inner ear, meninges and skin. The syndrome origin mechanism is not yet completely known. Commonly, the specific ethnic groups that are affected by the VKHS are as follows: Hispanics, Asians, Indians, Native Americans and ethnic groups from the Middle East. The audiological characteristics of the syndrome and the possible audiologist interventions for a specific case will be reported. The patient was attended at the Clinic of Speech Therapy, Faculdade de Odontologia de Bauru (FOB). She is 53 years old and presented audiological complaints. She was diagnosed with VKHS by a specialist doctor. Throughout the audiologist assessment, she presented bilateral sensorineural hearing loss, absent otoacoustic evoked emissions, complaints about postural vertigo and acute tinnitus. The specific case reported presented sudden sensorineural hearing loss, vertigo, tinnitus and bilateral ocular disease. Even though drug treatment was performed, the hearing loss remained. Therefore, before the hearing aid (HA) fitting, the audiologist should perform the hearing management, investigate if the patient takes the drug treatment and the occurrence of suggestive symptoms of the syndrome. These are some points that help in the reference to the specialist doctor and the audiologist strongly participates in what concerns the hearing.
Assuntos
Humanos , Feminino , Zumbido , Síndrome Uveomeningoencefálica/complicações , Síndrome Uveomeningoencefálica/diagnóstico , Perda Auditiva , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/etiologia , Vertigem , Pessoa de Meia-IdadeRESUMO
RESUMEN La patología autoinmune de oído interno se caracteriza por presentar hipoacusia sensorioneural bilateral, asimétrica y progresiva, que responde a terapia médica, presentándose aislada o como parte de una enfermedad sistémica como la enfermedad de Vogt-Koyanagi-Harada. Se presenta el caso de una paciente que consulta por cefalea, visión borrosa y sintomatología audiológica, con diagnóstico de enfermedad de Vogt-Koyanagi-Harada. Revisamos la literatura disponible respecto a la enfermedad y sus manifestaciones otológicas.
ABSTRACT Autoimmune inner ear disease presents a bilateral, asymmetric and progressive sensorineural hearing loss, that responds to medical therapy, presenting alone or associated to a systemic disease such as Vogt-Koyanagi-Harada disease. We present the case of a patient with headache, blur vision and audiologic symptoms, diagnosed with Vogt-Koyanagi-Harada disease. We review the literature about the disease and its otologic manifestations.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Síndrome Uveomeningoencefálica/complicações , Perda Auditiva Neurossensorial/etiologia , Audiometria , Uveíte , Síndrome Uveomeningoencefálica/tratamento farmacológico , Cefaleia , Perda Auditiva Neurossensorial/diagnósticoRESUMO
Vogt-Koyanagi-Harada (VKH) syndrome is a systemic inflammatory disease that causes chronic and bilateral granulomatous panuveitis, usually described in adults. Objectives: To describe manifestations and complications of VKH in pediatric patients. Methods: Retrospectivedescriptive study upon patients <14 years-old with VKH, attended from January 1985 to July 2010 in three different centers. Results: A total of 17 patients (34 eyes) were studied; 9 (53%) female. The mean age was 10.8 years-old. Among extraocular manifestations; neurological (71%), dermatological (29%) and auditive (24%) signs were observed. Ocular findings included optic-disc involvement (94%), anterior uveitis (79%), choroiditis (77%), serous retinal detachment (71%) and vitritis (71%). Initial visual acuity (VA) was ≤0.05 in 47% of cases and ≥0.6 in 12% of patients. 71% presented complications: glaucoma (20 eyes), sinechiae (10 eyes), maculopathy (6 eyes) cataract (5 eyes) and ptisis bulbi (1 eyes). 35% received only corticosteroids and 65% inmunosupressive drugs. After treatment, 6% had VA ≤0.05 and 59% ≥0.6. Ten patients (59%) recurred: 30% compromising posterior pole, and 50% recurred >3 times. Conclusions: VKH in children is infrequent. It presents with optic-disc involvement and complications of posterior pole. It requires a high degree of suspicion, quick evaluation and early treatment, which include inmunosupressive and extended corticosteroid therapy. Nevertheless, a high rate of recurrence is seen among this group of patients. (AU)
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Síndrome Uveomeningoencefálica/diagnóstico , Síndrome Uveomeningoencefálica/terapia , Síndrome Uveomeningoencefálica/complicações , Síndrome Uveomeningoencefálica/epidemiologiaRESUMO
Purpose: To correlate clinical findings of Vogt-Koyanagi-Harada disease with standardized echography findings in a cross-sectional, descriptive and observational study. Methods: Patients with Vogt-Koyanagi-Harada disease in the convalescent and recurrence phases were evaluated with standardized ocular echography. Eyes with opaque media were excluded. Clinical findings were correlated with echographic data. Results: Thirty-seven eyes of 25 patients were included. Best corrected visual acuity was in average 20/100 (0.70 logMAR). Clinical findings included: sunset glow fundus (92%), pigment migration (92%), nummular chorioretinal depigmented scars (68%) and subretinal fibrosis (64.8%). Standardized echography was able to recognize all the cases with subretinal fibrosis (n=24) described clinically. Standardized echography showed a 100% sensitivity and specificity of finding subretinal fibrosis. Subretinal fibrosis in patients with Vogt-Koyanagi-Harada represents a risk factor for low vision. In our patients’ eyes, presence of subretinal fibrosis had a 2.5 time relative risk of having a visual acuity equal or worst to 20/70. Conclusions: Standardized echography represents a useful tool in patients with VKH in the chronic (convalescence and recurrence) phase of the disease. Subretinal fibrosis, a sight threatening complication in the convalescence and recurrent phases of Vogt-Koyanagi-Harada, can be diagnosed with ocular echography, with characteristic images. Knowledge of these images can be useful in cases with opaque media and bilateral anterior segment granulomatous inflammatory disease. .
Objetivo: Correlacionar achados clínicos da síndrome de Vogt-Koyanagi-Harada com resultados ecográficos padronizado da doença em um estudo transversal, descritivo e observacional. Métodos: Pacientes com a doença de Vogt-Koyanagi-Harada, o convalescente e recorrência em fases padronizadas foram avaliados com ecografia ocular. Olhos com material opaco foram excluídos. Achados clínicos foram correlacionados com dados ecográficos. Resultados: Um total de 25 pacientes e trinta e sete olhos foram incluídos no estudo. A acuidade visual (AV) 20/100 foi em média 0.70 logMAR. Os achados clínicos incluídos: sunset glow fundus (92%), pigmento migração (92%), numular despigmentado cicatrizes coriorretinianas (68%) e fibrose sub-retiniana (64,8%). A ecografia padronizada foi capaz de reconhecer todos os casos de fibrose sub-retiniana (n= 24) descrito clinicamente. A ecografia revelou um padrão 100% de sensibilidade e especificidade do diagnóstico fibrose sub-retiniana. Sub-retiniana em pacientes com fibrose Vogt-Koyanagi-Harada representa um fator de risco para a baixa visão. Em nossos pacientes olhos, presença de fibrose subretiniana tinham um risco relativo 2,5 hora de ter uma acuidade visual igual ou pior para 20/70. Conclusão: Ecografia padronizadarepresenta uma ferramenta útil em pacientes portadores da doença na fase crônica (convalescença, e recidiva). Fibrose sub-retiniana, uma visão ameaçadora e complicação na convalescença e recorrentes nas fases da Síndrome de Vogt-Koyanagi- Harada, podem ser diagnosticados com ecografia ocular, com imagens características. O conhecimento dessas imagens pode ser útil em casos com material opaco e segmento anterior bilateral da doença inflamatória granulomatosa. .
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Síndrome Uveomeningoencefálica/complicações , Síndrome Uveomeningoencefálica/patologia , Síndrome Uveomeningoencefálica/diagnóstico por imagem , Ultrassonografia/normas , Técnicas de Diagnóstico Oftalmológico/normas , Retina/diagnóstico por imagem , Doenças Retinianas/etiologia , Doenças Retinianas/diagnóstico por imagem , Uveíte/etiologia , Uveíte/diagnóstico por imagem , Fibrose , Acuidade Visual , Doença Crônica , Estudos Transversais , Corioide/diagnóstico por imagem , Comprimento Axial do Olho , Estudo Observacional , Fundo de Olho , MéxicoRESUMO
We report a 37-year-old woman with uveitic phase of Vogt Koyanagi Harada disease and tonic pupil, the tonic pupil persisted after other clinical features of this syndrome had disappeared; neurological evaluation shows absent knee and arm tendon reflexes and positive cholinergic supersensitivity test with Pilocarpine 0.125% confirming the diagnosis of Holmes Adie Syndrome.
Assuntos
Síndrome de Adie/diagnóstico , Síndrome Uveomeningoencefálica/diagnóstico , Síndrome de Adie/complicações , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Síndrome Uveomeningoencefálica/complicações , Acuidade VisualRESUMO
El ojo, además de entregarnos el sentido de la visión, también nos permite conocer la salud general del organismo. Muchas enfermedades sistémicas se manifiestan en el órgano visual antes, durante o después del debut de ellas a nivel sistémico. Este compromiso visual es variado y depende de la enfermedad en cuestión, destacando la escleritis, uveítis y vasculitis retinales. Conocer el estado ocular permitirá al clínico realizar diagnósticos más asertivos y oportunos, realizar el tratamiento más adecuado y definir pronóstico en varias enfermedades, que tienen al globo ocular como un órgano blanco. El objetivo de esta revisión es atraer la atención del lector sobre el compromiso oftalmológico en varias enfermedades
The eye besides giving us sight, it let us know the general health of the whole body as well. Many systemic diseases become evident in the visual organ before, during or after its systemic onset. The visual involvement in these diseases is wide and depends on the underlying disease. It is worth to stand out the escleritis, uveitis and retinal vasculitis. The knowledge of the ocular health will let the physician to diagnose more accurately and in time, to start the most appropriate treatment and to define the prognosis of several diseases that have the eye as a target organ. The aim of this review is to draw the reader's attention to the ophthalmic involvement in several systemic diseases
Assuntos
Humanos , Uveíte/terapia , Vasculite Retiniana/etiologia , Sarcoidose/complicações , Uveíte/imunologia , Uveíte/terapia , Doenças Inflamatórias Intestinais/complicações , Antígeno HLA-B27 , Síndrome Uveomeningoencefálica/complicações , Síndrome de Behçet/complicações , Vasculite Sistêmica/complicações , Artropatias/complicações , Lúpus Eritematoso Sistêmico/complicaçõesRESUMO
Uveitis is a group of intraocular inflammatory diseases that affects mainly patients of working age. Vogt-Koyanagi-Harada disease is a chronic, granulomatous, systemic and autoimmune disease with manifestations in the eye, skin, and hearing and nervous systems. Ocular complications include cataract, glaucoma, choroidal neovascular membrane formation, and subretinal fibrosis, which can lead to phthisis bulbi with profound low vision or even blindness. The purpose of this article is to present the visual rehabilitation of a young patient with pre phthisis bulbi as a complication of the uveitis. During the active stage of the disease the patient quit her studies in a crucial phase of her life. After clinical treatment and surgery, training program of optical device adaptation and residual visual optimization were performed. Due to the great patient's motivation, it was possible to reintegrate her to social life.
Assuntos
Síndrome Uveomeningoencefálica/complicações , Baixa Visão/reabilitação , Acuidade Visual , Feminino , Humanos , Síndrome Uveomeningoencefálica/cirurgia , Adulto JovemRESUMO
Uveitis is a group of intraocular inflammatory diseases that affects mainly patients of working age. Vogt-Koyanagi-Harada disease is a chronic, granulomatous, systemic and autoimmune disease with manifestations in the eye, skin, and hearing and nervous systems. Ocular complications include cataract, glaucoma, choroidal neovascular membrane formation, and subretinal fibrosis, which can lead to phthisis bulbi with profound low vision or even blindness. The purpose of this article is to present the visual rehabilitation of a young patient with pre phthisis bulbi as a complication of the uveitis. During the active stage of the disease the patient quit her studies in a crucial phase of her life. After clinical treatment and surgery, training program of optical device adaptation and residual visual optimization were performed. Due to the great patient's motivation, it was possible to reintegrate her to social life.
Uveíte é o termo utilizado para descrever um grupo de doenças inflamatórias oculares que ocorrem predominantemente na idade produtiva. Vogt-Koyanagi-Harada é uma doença sistêmica, autoimune, granulomatosa, crônica com manifestações oculares, neurológicas, auditivas e cutâneas. As principais complicações incluem catarata, glaucoma, membrana neovascular e fibrose sub-retiniana, que podem evoluir para atrofia ocular, baixa visão profunda e cegueira. O propósito deste artigo é apresentar um caso de reabilitação visual em paciente jovem com pré phthisis bulbi consequente às complicações da uveíte. Após tratamento clínico e cirurgia, um programa de treinamento e adaptação de recursos ópticos foi realizado para otimizar o uso do resíduo visual, motivando a paciente para reintegrar-se socialmente e voltar aos estudos.
Assuntos
Feminino , Humanos , Adulto Jovem , Síndrome Uveomeningoencefálica/complicações , Acuidade Visual , Baixa Visão/reabilitação , Síndrome Uveomeningoencefálica/cirurgia , Adulto JovemRESUMO
BACKGROUND: Vogt-Koyanagi-Harada (VKH) syndrome is characterized by bilateral diffuse uveitis associated with auditory, neurological, and cutaneous signs and symptoms. VKH syndrome is a cell-mediated autoimmune disease against melanocytes. Choroidal neovascularization (CNV) occurs in 15% of VKH patients and is associated with poor visual prognosis. CASES: We report on two patients with VKH syndrome and CNV that were treated with intravitreal bevacizumab. OBSERVATIONS: One of the VKH patients also had an extrafoveal CNV membrane and underwent multiple intravitreal injections of bevacizumab in combination with laser photocoagulation, with subsequent improvement in visual acuity. The second had a subfoveal CNV that responded to a single intravitreal injection of bevacizumab. CONCLUSION: Intravitreal bevacizumab may be a useful drug to treat CNV in eyes with VKH syndrome.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Síndrome Uveomeningoencefálica/complicações , Idoso , Anticorpos Monoclonais Humanizados , Bevacizumab , Neovascularização de Coroide/etiologia , Feminino , Angiofluoresceinografia , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual , Corpo VítreoRESUMO
PURPOSE: To report the use of intravitreal injection of triamcinolone acetonide during the acute phase of Vogt-Koyanagi-Harada disease. DESIGN: Prospective interventional case series. METHODS: Three eyes from two patients at the acute phase of Vogt-Koyanagi-Harada disease with serous retinal detachments were treated with a 4-mg intravitreal injection of triamcinolone acetonide. The following variables were evaluated: visual acuity, intraocular pressure, and height of the serous retinal detachment using optical coherence tomography. RESULTS: The optical coherence tomography images showed a marked decrease in the retinal detachment in the first week after the injection with subsequent return to normal retinal thickness in all eyes. CONCLUSIONS: Intravitreal triamcinolone acetonide provides short-term improvement in visual acuity and serous retinal detachments associated with Vogt-Koyanagi-Harada disease. These findings should be followed by future studies to evaluate long-term effects.
Assuntos
Glucocorticoides/uso terapêutico , Descolamento Retiniano/tratamento farmacológico , Triancinolona Acetonida/uso terapêutico , Síndrome Uveomeningoencefálica/tratamento farmacológico , Doença Aguda , Feminino , Humanos , Injeções , Pressão Intraocular , Pessoa de Meia-Idade , Estudos Prospectivos , Descolamento Retiniano/etiologia , Descolamento Retiniano/patologia , Tomografia de Coerência Óptica , Síndrome Uveomeningoencefálica/complicações , Síndrome Uveomeningoencefálica/patologia , Acuidade Visual , Corpo VítreoRESUMO
PURPOSE: To assess the role of photodynamic therapy using verteporfin in the treatment of subfoveal choroidal neovascularization in Vogt-Koyanagi-Harada syndrome. DESIGN: Interventional case report. METHODS: A 9-year-old patient with subfoveal choroidal neovascularization received a single photodynamic therapy with verteporfin session (one eye) and was prospectively followed with fluorescein angiography. RESULTS: A complete regression of the lesion was achieved within 1 week after treatment. Visual acuity improved from 20/800 to 20/320 by 6 months of follow-up. Fluorescein angiography disclosed unexpected retinal pigment epithelium alteration within the treatment area. CONCLUSION: Although regression of the choroidal neovascularization occurred, unpredicted findings involving normal retina in the vicinity of the lesion suggest that further studies are required to assess the clinical value of this treatment for subfoveal choroidal neovascularization in Vogt-Koyanagi-Harada syndrome.
Assuntos
Neovascularização de Coroide/tratamento farmacológico , Fotoquimioterapia , Fármacos Fotossensibilizantes/uso terapêutico , Porfirinas/uso terapêutico , Síndrome Uveomeningoencefálica/complicações , Criança , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/etiologia , Feminino , Angiofluoresceinografia , Fóvea Central , Humanos , Estudos Prospectivos , Verteporfina , Acuidade VisualRESUMO
We report the case of a 40-year-old woman with diffuse uveitis, sensorineural hearing loss and cerebrospinal fluid pleocytosis as features of Vogt-Koyanagi-Harada syndrome who developed symmetric polyarthritis and stiffness of small and large joints, in addition to rheumatoid arthritis. Although their target tissues are distinct, both diseases have a possible autoimmune origin strongly associated with HLA-DRB4.
Assuntos
Artrite Reumatoide/complicações , Síndrome Uveomeningoencefálica/complicações , Adulto , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/imunologia , Feminino , Dedos/diagnóstico por imagem , Antígenos HLA-DR , Humanos , Radiografia , Síndrome Uveomeningoencefálica/diagnóstico por imagem , Síndrome Uveomeningoencefálica/imunologia , Punho/diagnóstico por imagemRESUMO
El síndrome de Vogt Koyanagi Harada es una uveitis difusa, bilateral, aguda, granulomatosa, asociada a manifestaciones dermatológicas, auditivas y del sistema nervioso central. Es la panuveitis bilateral más frecuentemente encontrada en la población mestiza e indígena mexicana. Una respuesta autoinmune, regulada por factores genéticos y aparentemente dirigada contra los melanocitos parece ser la causa del proceso inflamatorio. El diagnóstico básicamente es clínico, aunque la florangiografía de retina y el estudio ecográfico pueden ayudar a sustentar el diagnóstico básicamente es clínico, aunque la florangiografía de retina y el estudio ecográfico pueden ayudar a sustentar el diagnóstico en algunos casos. En el presente artículo revisamos los conocimientos que en relación a fisiopatogenia, diagnóstico, pronóstico, tratamiento médico y quirúrgico se tienen actualmente
Assuntos
Humanos , Manifestações Oculares , Síndrome Uveomeningoencefálica/complicações , Síndrome Uveomeningoencefálica/epidemiologia , Síndrome Uveomeningoencefálica/fisiopatologia , Síndrome Uveomeningoencefálica/tratamento farmacológicoRESUMO
O artigo apresenta um caso com manifestaçöes oculares e extra-oculares clássicas de síndrome de Vogt Koyanagi Harada. Com o passar do tempo, um melanoma maligno de coróide, já com extensäo extra bulbar, foi diagnosticado, sugerindo a possibilidade de uma oftalmia simpática com manifestaçöes sistêmicas simulando a síndrome de Vogt Koyanagi Harada. O emprego de droga citotóxica, assim como a gravidez, contribuiram para um desfecho dramático