ObjectiveTo compare the clinical features of patients with acute Vogt-Koyanagi-Harada syndrome (VKH syndrome) of optic disc swelling (ODS) and serous retinal detachment (RD).MethodsA retrospective clinical study. From January 2013 to November 2019, 212 patients with acute VKH syndrome diagnosed in the Department of Ophthalmology of Shanghai Xuhui District Central Hospital were included in the study. Among them, there were 105 males (210 eyes) and 107 females (214 eyes). The average age was 40.84±13.90 years. All affected eyes were examined by BCVA, FFA, and OCT. The standard logarithmic visual acuity chart was used for BCVA examination, which was converted into logMAR visual acuity in statistics. According to the changes in the fundus, the patients were divided into the ODS group and the RD group, 36 patients with 72 eyes (16.98%) and 176 patients with 352 eyes (83.02%), respectively. The independent sample t test was performed to compare the age of onset, visit time and BCVA of the two groups of patients, the χ2 test was performed to compare the count data.ResultsAmong the 72 eyes of 36 patients in the ODS group, there were 16 males with 32 eyes (44.44%), 20 females with 40 eyes (55.56%). The average age was 40.56±16.57 years, the average visit time was 22.47±19.98 days, the average logMAR BCVA was 0.68±0.53. Among the 352 eyes of 176 patients in the RD group, there were 89 male patients with 178 eyes (50.56%), and 87 female patients with 174 eyes (49.43%). The average age was 40.90±13.34 years, the average visit time was 17.25±24.40 days, the average logMAR BCVA was 0.80±0.56. The average age (t=－0.116), gender composition ratio (χ2=0.448), average visit time (t=1.204), average logMAR BCVA (t=－1.661) comparisons between the two groups showed no statistically significant differences (P＞0.05). There was no statistically significant difference in the average logMAR BCVA between the RD group and the ODS group of different eyes (t=0.227, 0.810; P＞0.05). There were 50 (69.44%, 50/72) and 272 (77.27%, 272/352) eyes in the ODS group and RD group with inflammation of the anterior segment. There were anterior segment reactions between the two groups. There was no statistically significant difference in the number of eyes (χ2=1.003, P＞0.05). There were 34 (19.32%, 34/176) and 2 (5.56%, 2/36) patients with headache and hearing loss, respectively. The comparison of the number of patients with headache and hearing loss between the two groups showed statistically significant differences (χ2=4.015, P＜0.05).ConclusionCompared the patients with ODS acute VKH syndrome, the patients with serous RD acute VKH syndrome are more likely to have extraocular symptoms such as headache and hearing loss.
ObjectiveTo observe the changes of varicella zoster virus (VZV)-DNA load in aqueous humour samples in VZV-induced acute retinal necrosis (ARN) in the early stages of antiviral treatment. MethodsA retrospective observational clinical study. From April 2016 to April 2018, 24 patients with 24 eyes of VZV-induced ARN who were diagnosed by Department of Ophthalmology, Eye and ENT Hospital of Fudan University and received complete aqueous humor sampling were included in the study. Among them, there were 13 males with 13 eyes, 11 females with 11 eyes; 12 left eyes and 12 right eyes; the age was 52.0±9.5 years old (39-71 years old). The time from the onset of ocular symptoms to the diagnosis of ARN was 16.6±6.1 days (7-30 days). Best-corrected visual acuity (BCVA) and ultra-wide-field fundus imaging were performed in all affected eyes. The BCVA examination was carried out using the Snellen visual acuity chart, which was converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity. All patients were given intravitreal injection of 40 mg/ml ganciclovir 0.1 ml (including 4 mg of ganciclovir), 2 times a week, until the active necrotizing retinal lesions subsided, at most after the diagnosis 4 weeks, with a maximum of 9 injections. The follow-up period was 12.8±5.6 months. The aqueous humor samples were collected at presentation and 4, 7, 14, 21, 28 days after the initiation of antiviral therapy, and the VZV-DNA load was detected by real-time quantitative polymerase chain reaction. A plateau phase and a logarithmic reduction phase of the DNA load changes were observed after antiviral treatment began. Wilcoxon rank sum test was used to compare and analyze the differences in BCVA between the eyes at baseline and last follow-up. ResultsThe mean viral load at presentation was 8.6×107±1.3×108 copies/ml. The initial plateau phase last for an average of 7.4±2.4 days. In the following logarithmic reduction phase, the mean slope of the decline in viral load was －0.13±0.04 log/day, and the expected time for half reduction of the initial viral load was 2.5±0.7 days. After 28 days antiviral treatment, the viral load decreased to 1.7×105±1.8×105 copies/ml. In the course of the disease, rhegmatogenous retinal detachment occurred in 16 eyes. Before treatment and at the last follow-up, the logMAR BCVA of the affected eye was 1.1±0.6 and 0.8±0.7, respectively. The results of correlation analysis showed that the logMAR BCVA at the last follow-up was correlated with the initial VZV-DNA load (r=0.467, P=0.033). ConclusionThe VZV-DNA load in the aqueous humor of eyes with VZV-induced ARN is significantly decreased after antiviral treatment, which is closely related to the clinical process of ARN.