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.
Objective To investigate the genetic interaction of HLA-DQB1 promoter and coding alleles in the pathogenesis of Vogt-Koyanagi-Harada syndrome (VKH). Methods Eighty-eight Chinese Han patients with VKH and eighty-eight non-VKH normal controls were enrolled in this study. DNA was extracted from white blood cells of the subjects by phenolchloroform method. Thirteen alleles were genotyped by polymerase chain reaction-sequence-specific primers (PCR-SSP), polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) and clone-sequencing was applied to determine the polymorphisms of the promoter and coding regions of HLA-DQB1 gene. Chromas and Bioedit software were used to analyze the sequences of the promoter of HLA-DQB1. Chi-square test and Fisher exact test were the statistical methods. Relationships among single nucleotide polymorphism (SNP) in the promoter and coding region were analyzed. Results Twelve of thirteen already known HLA-DQB1 alleles were genotyped by PCR-SSP in VKH patients. The most frequent allele in VKH patients was HLA-DQB10401 (0.318, 56∶176) which was significantly higher in patients than that in normal controls (0.045, 8∶176) (chi;2＝44.00, P＝0.000, OR＝9.8). So was for HLA-DQB10303 (0.068 vs. 0.006, chi;2＝9.67, P＝0.002, OR＝12.81). In contrast, the frequency of HLA-DQB10601 (0.017 vs.0.096, chi;2＝10.39, P＝0.001, OR＝0.16) and HLA-DQB10302 (0.062 vs. 0.193,chi;2＝13.48, P＝0.000, OR＝0.28) in VKH patients were significantly lower than normal controls. Twelve SNP were found in all subjects. The frequency of C allele at position -189C/A in VKH patients was significantly higher than that in controls (0.324 vs. 0.074, chi;2＝45.92, P＝0.000). However, the frequency of G allele at position -227G/A in VKH patients was significantly lower than that in the normal controls (0.011 vs. 0.108, chi;2＝15.63,P＝0.000). The frequency of combination of susceptible alleles in promoter and coding area （-189C and HLA-DQB10401） in VKH patients was statistically higher than that in controls, the frequency of combination of resistant alleles in control (-227G and HLA-DQB10601) was higher than that in VKH patients. Conclusions The specific interactions of SNP in the promoter and coding alleles of HLA-DQB1 are associated with the pathogenesis of VKH.
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 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 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 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)
ObjectiveTo measure and analyze the oxygen saturation and retinal blood vessel diameter in the eyes of patients with convalescence Vogt-Koyanagi-Harada (VKH) syndrome. MethodsIn this cross-sectional study, 28 eyes of 14 patients with convalescence VKH syndrome (VKH group) and 20 eyes of 10 healthy subjects (control group) were enrolled. The oxygen saturation and retinal blood vessel diameter were detected by spectrophotometric oximetry unit. Retinal images were collected using filters with wavelengths of 570 nm and 600 nm in the darkroom by the same technologist and then the fused image was obtained. The oxygen saturation of retinal vessels was marked in different colors. The measurement was repeated 2-3 times for each patient, then take an average. A top-quality image in each eye was selected to detect the oxygen saturation and diameter of retinal vessel which located in 1.5-3.0 disc diameter from the optic disc. Image analysis and data acquisition were completed by another technologist. ResultsRetinal venous oxygen saturation was (54.34±8.05)% in the VKH group and (60.07±7.91)% in the control group. The former was lower than the latter, the difference was significant (t=2.443, P=0.017). The mean diameter of retinal arteries was (102.8±18.1) μm in the VKH group and (112.9±19.8) μm in the control group. The former was smaller than the latter, the difference was significant (t=2.406, P=0.018). There was no significant difference of the mean diameter of retinal veins, oxygen saturation of retinal arteries and the arterial-venous difference between two groups (t=-0.330, 0.804, -0.631; P=0.743, 0.403, 0.536). ConclusionsRetinal venous oxygen saturation and the mean diameter of retinal arteries are significantly decreased in patients with VKH syndrome. There is no significant difference of diameter of retinal veins, oxygen saturation of retinal arteries and the arterial-venous difference between VKH syndrome patients and healthy subjects.
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.