Objective To investigate the cilinical value of indocyanine green angiography(ICGA) in patients with Vogt-Koyanagi-Harada syndrome(VKH). Methods Fundus fluorescein angiography(FFA) and indocyanine green angiography(ICGA) were used for comparative analyses in 26 cases(52 eyes)of VKH. Results In the acute stage of VKH,FFA revealed the multifocal leakage in the pigment epithelium and the multifocal serous retinal detachment,and the typical FFA manifestations disappeard following treatment．In the acute stage of the disease the ICGA showed:(1)numerous patchy areas of hypofluorescence and decreased flurescence in large and middle choroidal vessels(66.7%);(2)dilatation of the choroidal vessels(70.8%)and(3)in latephase of ICGA,the patchy areas of hyperfluorescence(79.2%).During the recovery stage of the disease,the abnormal undings in ICGA were resolved slower than those found in FFA. Conclusions ICGA may assist in providing valuable informations on choroidal circulation of VKH and be useful in evaluating the curative effects． (Chin J Ocul Fundus Dis,20000,16:9-11)
Objective To compare the differences of optic disc parameters and the thickness of circumpapillary retinal nerve fiber layer (CP-RNFL) in acute uveitis Vogt-Koyanagi-Harada (VKH) syndrome with different degrees of optic disc edema. Methods This is a retrospective study including 40 eyes of 23 VKH patients. The eyes were divided into 2 groups according to the results of fluorescein fundus angiography (FFA). The discs with hyperfluorescence but no leakage were in mild optic disc edema group (group A, 13 patients and 25 eyes), and the discs with hyperfluorescence and leakage were in severe optic disc edema group (group B, 10 patients and 15 eyes). The patients were significantly older in group B than in group A (t=−2.17, P＜0.05). The differences of gender, diseased time (t=−1.67) and corrected visual acuity (t=−0.76) between 2 groups were not significant (P＞0.05). Eighty eyes of 46 normal healthy subjects, matching group A and group B with age and gender, were divided into group C (26 subjects and 50 eyes) and group D (20 subjects and 30 eyes) respectively. All subjects underwent three dimensional optical coherence tomography examinations. The parameters included average thickness of entire circumpapillary retinal nerve fiber layer (CP-RNFL), thickness of nasal, superior, temporal and inferior quadrant of CP-RNFL, disc area, disc cup area, rim area, cup/disc (C/D) area ratio, C/D horizontal diameter ratio and C/D vertical diameter ratio. Results The disc area, disc cup area and rim area were bigger, the thickness of mean CP-RNFL and the nasal and temporal quadrants of CP-RNFL were thicker in group A than those in group C (P＜0.05). The disc area and rim area were bigger, the thickness of mean CP-RNFL and the nasal, superior, temporal and inferior quadrant of CP-RNFL were thicker, C/D area ratio and C/D diameter ratio were smaller in group B than those in group D (P＜0.05). The disc area was bigger, disc cup area, C/D area ratio and C/D diameter ratio were smaller, the thickness of mean CP-RNFL and the nasal , superior and inferior quadrants of CP-RNFL were thicker in group B than those in group A (P＜0.05). Conclusions Acute VKH uveitis with mild optic disc edema has thicker CP-RNFL in the nasal and temporal quadrants; with severe optic disc edema has thicker CP-RNFL in all 4 quadrants. Acute VKH uveitis also has smaller C/D area ratio and C/D diameter ratio.
ObjectiveTo compare the differences of optic nerve head (ONH) parameters and the thickness of circumpapillary retinal nerve fiber layer (CP-RNFL) between acute Vogt-Koyanagi-Harada syndrome (VKH) and acute central serous chorioretinopathy (CSC) patients.MethodsRetrospective clinical case control analysis. This study included 38 eyes of 20 acute VKH patients (VKH group) and 37 eyes of 37 acute CSC patients (CSC group). Seventy five eyes of 57 normal healthy subjects, matching patients with age and gender, were collected as control group. The disc RPE angle, the thickness of average CP-RNFL, the nasal, superior, temporal and inferior quadrant CP-RNFL thickness, and ONH parameters including optic disc area, cup area, rim area, C/D area ratio, linear CD ratio (CDR), vertical CDR were measured by 3D-OCT. Analysis of variance was performed for comparison among three groups. Minimum significant difference t test was performed for comparison between two groups.ResultsThe differences of ONH parameters between VKH group and CSC group: 29 eyes of VKH group appeared retinal detachment next to disc, only 12 eyes appeared in CSC group. Twenty one eyes of VKH group appeared optic disc hyperemia while none in CSC group. The three groups’ disc RPE angles were (138.62±11.96)°, (154.09±5.85)° and (153.41±5.77)°. VKH group were significantly smaller than CSC group (t=－2.05, P=0.00) and control group (t=－1.68, P=0.00), while there was no significant difference between CSC group and control group (t=－1.88, P=0.72). The optic cup area and rim area were significantly bigger in VKH group than in CSC group (t=4.61, 2.71; P=0.00, 0.01), and the thickness of mean CP-RNFL, all quadrants of CP-RNFL were significantly thicker in VKH group than in CSC group (t=6.25, 4.40, 3.53, 5.48, 2.69; P=0.00, 0.00, 0.00, 0.00, 0.01).ConclusionCompared with the acute CSC, VKH patients are likely to appear retinal detachment next to disc, their disc RPE angles are smaller, their optic cup area and rim area are bigger, and their CP-RNFL thickness are thicker.
Objective To observe the proportion changes of CD4+CD25+FOXP3+ T cells in peripheral blood of patients with VogtKoyanagiHarada disease (VKH) before and after one month of treatment. Methods he peripheral blood samples from 15 patients with VKH disease before and after one month of treatment by glucocorticoid, and from 15 healthy volunteers were collected，and lymphocytes were separated from them. CD4+CD25+ regulatory T cells were labeled by antibodies of cell surface marker CD4、CD25 and transcription factor FOXP3. The proportion of CD4+CD25+FOXP3+ T cells were detected by flow cytometry. Results Before the treatment, the percentage of CD4+CD25+FOXP3+ T cells in periphery blood was（0.30plusmn;0.19）% of CD4+ cell in VKH patients, and（1.41plusmn;0.52）% in control group, the difference was statistically significant（t=7.665,Plt;0.01）; after one month of treatment, the VKH patients group was（1.28plusmn;0.54）% which close to the control group. However there were two patients whose CD4+CD25+ T cells increased extraordinarily after one month of treatment. Conclusions The proportion of CD4+CD25+ FOCP3+ T cells in periphery blood in VKH patients were lower than control group obviously before treatment, but were close to control group after treatment. Those results indicated that VKH diseases may be associated with the decreased proportion of CD4+CD25+ regulatory T cells.
Objective To study choroidal vascular abnormal characterisitics in Harada is disease using indocyanine green angiography (ICGA)． Methods Twenty-six cases(52 eyes)of Harada is disease were examined with fundus fluorescein angiography(FFA) and ICGA． Results ICGA findings in Harada is disease were as follows:(1)choroidal hypofluorescence with edema in the early phase;(2)choroidal filling defects;(3)dilatation of choroidal vessels and vortex veins;(4)choroidal hyperpermeability in late period;(5)multifocal lower fluorescence in the midperiphery and posterior pole of the fundus in the late phase. Conclusions ICGA can find lesions of the choroidal vessels i．e． hypofluorescence with edema,disturbances of choroidal circulation，dilatation of choroidal vessels and vortex veins and the lower fluorescence maculation in the early phase and choroidal hyperpermeability in the late phase． (Chin J Ocul Fundus Dis,20000,16:12-13)
Objective To observe the clinical features of choroidal folds in Vogt-Koyanagi-Harada disease. Methods The clinical data of 112 patients with choroidal folds in Vogt-Koyanagi-Harada disease were retrospectively analyzed. All patients were examined by fundus color photography and fundus fluorescein angiography (FFA). 8 patients underwent indocyanine green angiography (ICGA) and 7 patients received optical coherence tomography (OCT) meanwhile. Results Of the 112 patients, 16 patients (14.3%) had choroidal folds. on FFA, there are 10 to 15 hypofluorescenct bands radiating from the optic disk which were similar to the large retinal vessels in shape and number(choroidal fine folds). On ICGA the choroidal folds showed obvious hyperfluorescence at the late stage. On OCT the reflective bands of Bruch membrane and retinal pigment epithelium (RPE) showed the wavy folds. Conclusions Choroidal folds in Vogt-Koyanagi-Harada disease are characterized by fine folds radiating from the optic disk which is not uncommon in Vogt-Koyanagi-Harada disease.
Objective To observe the spectral domain optical coherence tomography (SD-OCT) features of acute Vogt-Koyanagi-Harada (VKH) eyes before and after treatment.Methods Twenty-eight patients (56 eyes) with acute VKH diagnosed by slitlamp microscopy, B mode ultrasound and fundus fluorescein angiography (FFA) were enrolled in this study. All the patients were treated with steroid after diagnosis. SD-OCT was performed in all the patients before and after treatment. The follow-up was ranged from 12 to 32 weeks with a mean of (21.30plusmn;8.53) weeks. The foveal retinal detachment height, inner and outer segments (IS/OS) of photoreceptors, and the changes in retinal structure within the vascular arcades before and after treatment were comparatively analyzed. Results OCT examination results showed that before treatment, all eyes had retinal neural epithelial detachment. The average neural epithelial detachment height in the fovea was (635.44plusmn;340.04) mu;m. Forty-three eyes (76.8%) had different types of subretinal exudates; 41 eyes (73.2%) had b granular reflection in the subretinal space. Twenty-two eyes (39.3%) had paraforveal outer nuclear layer (ONL) thickening with finger-like protrusions attached with membrane-like structure. Thirty-three eyes (58.9%) had wavy lines of the retinal pigment epithelium (RPE). After the treatment, these exudates dissolved within one week and RPE line became straight. The retina reattached after (2.33plusmn;0.82) weeks. In most patients external limiting membrane and IS/OS became intact after (5.01plusmn;6.71) weeks and (11.40plusmn;7.89) weeks respectively. However, at the end of follow-up, 46 eyes (82.1%) still had focal areas of IS/OS defect and 11 eyes (19.6%) had focal ONL thinning. Conclusions Before the treatment, the OCT features of acute VKH are serous retinal detachment at fovea, different types of subretinal exudates and wavy RPE. After the treatment, the OCT features of acute VKH are exudates dissolving, straight RPE line and early recovery of external limiting membrane.