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Case Preserntation
Dr Md Afzal Mahfuzullah
MBBS MCPS FCPS
Long term Fellow
Vitreo-Retina Department
Ispahani Islamia Eye Institute amp Hospital
bull Ms Shirin Akhter
bull Age13
bull Student
Chief Complaints
bull Diminished of vision of both eyes for 6 month
bull Headache for 8 months
bull Tinnitus amp vertigo for same duration
Past History
History of cataract surgery 2 month back
On first visit on 17th Sept 2014
RE LE
VA 636 612
IOP (GAT) 11 mm of Hg 13 mm of Hg
Out come Treated as Anterior uveitis amp improved
On 2nd visit on 14 Oct 2014
RE LE
VA 660 624
IOP (GAT) 13mm of Hg 12mm of Hg
B Scan With in normal limit
With in normal limit
Out come Treated as Anterior uveitis amp improved
On 3rd visit on 21 Dec 2014
RE LE
VA 660 624
IOP (GAT) 13mm of Hg 12mm of Hg
B Scan mild vitreous opacity
mild vitreous opacity
Lens Complicated cataract
Complicated cataract
Vitreous Cells+ Cells+
Outcome Treated as Anterior amp Intermediate uveitis amp improved
Advised for cataract extraction after 3 month
Surgery was performed on 25th February
bull IA with acrylic hydrophobic foldable PCIOL was
inserted
bull On Discharge
RE LE
VA 636 612
Pin Hole 618 69
On 4th visit on 7th April 2015
Retina departmentRight Eye Left Eye
Distance Vision 360 No improvement
with pinhole
160 No improvement
with pinhole
Near Vision N60 N60
Eyelids Normal Normal
Conjunctiva Congested Congested
Cornea Clear Clear
Anterior Chamber Cell +Flare+
Cell +Flare +
Iris Normal Normal
Pupil reaction 360 deg post synachae 360 deg post synachae
Lens Pseudophakia Complicated cataract
Cont ocular exam
RIGHT EYE LEFT EYE
IOP 14 mmHg 12 mmHg
Fundus Media ndashVitreous opacity
No fundal view
Media ndashVitreous opacityNo fundal view
General Examination
bull Patient is cooperative conscious oriented
Vital Parameters
bull Blood pressure 13080 mmHg
bull Pulse 84min
Neurological Examination
bull Other cranial nerves ndash Normal
bull Motor System - Normal
bull Sensory System ndash Normal
bull Cerebellar system ndash Normal
Respiratory System
bull Normal breath sounds heard
bull No added sounds
Cardiovascular System
bull S1 S2 heard
bull No murmur
bullHb 12 gm
bullESR 34 mm after 1 hr
bullPlatelet 485 lakhcumm
bullRBC 427 millioncumm
bullRBS 98 mgdl
bull PCV 29
bullMCV 68 fl
bullMCH 20 pg
bull MCHC 30
bullTC 12300 cellscumm
N 87 E 4 L 9
ANA negative
RA (85 Iuml )negative
CRP within normal
limits
Mantoux Test ndash Negative
Chest X Ray ndash Normal
HLA B27 Negative
VDRL Negative
Investigations
B scan of both eye
bull B scan
bull LE
bull B scan
bull RE
Differential Diagnosis
bull VKH
bull Uveitis due to JIA
bull Posterior Scleritis
Vogt-Koyanagi-Harada
Management from Retina department
Admission on 07-04-2015
bull Started on Inj IV Methyl Prednisolone 500
mg in 250 ml DA ndashfor 3 days
bull Oral Tab Prednisololne 30 mg
bull Oral Tab Azathioprine 50 mg
bull Review after 1 week
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr OpinOphthalmol 200011437 (review)
Condition at time of discharge
10042015
bull Right eye - VA 660
bull Left eye- VA 660
Discussion
Discussion
bull Vogt 1906 one case
bull Koyanagi 1923 six cases
bull Harada 1926 posterior uveitis and pleocytosis of CSF
Vogt-Koyanagi-Harada or VKH
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
bull Ms Shirin Akhter
bull Age13
bull Student
Chief Complaints
bull Diminished of vision of both eyes for 6 month
bull Headache for 8 months
bull Tinnitus amp vertigo for same duration
Past History
History of cataract surgery 2 month back
On first visit on 17th Sept 2014
RE LE
VA 636 612
IOP (GAT) 11 mm of Hg 13 mm of Hg
Out come Treated as Anterior uveitis amp improved
On 2nd visit on 14 Oct 2014
RE LE
VA 660 624
IOP (GAT) 13mm of Hg 12mm of Hg
B Scan With in normal limit
With in normal limit
Out come Treated as Anterior uveitis amp improved
On 3rd visit on 21 Dec 2014
RE LE
VA 660 624
IOP (GAT) 13mm of Hg 12mm of Hg
B Scan mild vitreous opacity
mild vitreous opacity
Lens Complicated cataract
Complicated cataract
Vitreous Cells+ Cells+
Outcome Treated as Anterior amp Intermediate uveitis amp improved
Advised for cataract extraction after 3 month
Surgery was performed on 25th February
bull IA with acrylic hydrophobic foldable PCIOL was
inserted
bull On Discharge
RE LE
VA 636 612
Pin Hole 618 69
On 4th visit on 7th April 2015
Retina departmentRight Eye Left Eye
Distance Vision 360 No improvement
with pinhole
160 No improvement
with pinhole
Near Vision N60 N60
Eyelids Normal Normal
Conjunctiva Congested Congested
Cornea Clear Clear
Anterior Chamber Cell +Flare+
Cell +Flare +
Iris Normal Normal
Pupil reaction 360 deg post synachae 360 deg post synachae
Lens Pseudophakia Complicated cataract
Cont ocular exam
RIGHT EYE LEFT EYE
IOP 14 mmHg 12 mmHg
Fundus Media ndashVitreous opacity
No fundal view
Media ndashVitreous opacityNo fundal view
General Examination
bull Patient is cooperative conscious oriented
Vital Parameters
bull Blood pressure 13080 mmHg
bull Pulse 84min
Neurological Examination
bull Other cranial nerves ndash Normal
bull Motor System - Normal
bull Sensory System ndash Normal
bull Cerebellar system ndash Normal
Respiratory System
bull Normal breath sounds heard
bull No added sounds
Cardiovascular System
bull S1 S2 heard
bull No murmur
bullHb 12 gm
bullESR 34 mm after 1 hr
bullPlatelet 485 lakhcumm
bullRBC 427 millioncumm
bullRBS 98 mgdl
bull PCV 29
bullMCV 68 fl
bullMCH 20 pg
bull MCHC 30
bullTC 12300 cellscumm
N 87 E 4 L 9
ANA negative
RA (85 Iuml )negative
CRP within normal
limits
Mantoux Test ndash Negative
Chest X Ray ndash Normal
HLA B27 Negative
VDRL Negative
Investigations
B scan of both eye
bull B scan
bull LE
bull B scan
bull RE
Differential Diagnosis
bull VKH
bull Uveitis due to JIA
bull Posterior Scleritis
Vogt-Koyanagi-Harada
Management from Retina department
Admission on 07-04-2015
bull Started on Inj IV Methyl Prednisolone 500
mg in 250 ml DA ndashfor 3 days
bull Oral Tab Prednisololne 30 mg
bull Oral Tab Azathioprine 50 mg
bull Review after 1 week
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr OpinOphthalmol 200011437 (review)
Condition at time of discharge
10042015
bull Right eye - VA 660
bull Left eye- VA 660
Discussion
Discussion
bull Vogt 1906 one case
bull Koyanagi 1923 six cases
bull Harada 1926 posterior uveitis and pleocytosis of CSF
Vogt-Koyanagi-Harada or VKH
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
On first visit on 17th Sept 2014
RE LE
VA 636 612
IOP (GAT) 11 mm of Hg 13 mm of Hg
Out come Treated as Anterior uveitis amp improved
On 2nd visit on 14 Oct 2014
RE LE
VA 660 624
IOP (GAT) 13mm of Hg 12mm of Hg
B Scan With in normal limit
With in normal limit
Out come Treated as Anterior uveitis amp improved
On 3rd visit on 21 Dec 2014
RE LE
VA 660 624
IOP (GAT) 13mm of Hg 12mm of Hg
B Scan mild vitreous opacity
mild vitreous opacity
Lens Complicated cataract
Complicated cataract
Vitreous Cells+ Cells+
Outcome Treated as Anterior amp Intermediate uveitis amp improved
Advised for cataract extraction after 3 month
Surgery was performed on 25th February
bull IA with acrylic hydrophobic foldable PCIOL was
inserted
bull On Discharge
RE LE
VA 636 612
Pin Hole 618 69
On 4th visit on 7th April 2015
Retina departmentRight Eye Left Eye
Distance Vision 360 No improvement
with pinhole
160 No improvement
with pinhole
Near Vision N60 N60
Eyelids Normal Normal
Conjunctiva Congested Congested
Cornea Clear Clear
Anterior Chamber Cell +Flare+
Cell +Flare +
Iris Normal Normal
Pupil reaction 360 deg post synachae 360 deg post synachae
Lens Pseudophakia Complicated cataract
Cont ocular exam
RIGHT EYE LEFT EYE
IOP 14 mmHg 12 mmHg
Fundus Media ndashVitreous opacity
No fundal view
Media ndashVitreous opacityNo fundal view
General Examination
bull Patient is cooperative conscious oriented
Vital Parameters
bull Blood pressure 13080 mmHg
bull Pulse 84min
Neurological Examination
bull Other cranial nerves ndash Normal
bull Motor System - Normal
bull Sensory System ndash Normal
bull Cerebellar system ndash Normal
Respiratory System
bull Normal breath sounds heard
bull No added sounds
Cardiovascular System
bull S1 S2 heard
bull No murmur
bullHb 12 gm
bullESR 34 mm after 1 hr
bullPlatelet 485 lakhcumm
bullRBC 427 millioncumm
bullRBS 98 mgdl
bull PCV 29
bullMCV 68 fl
bullMCH 20 pg
bull MCHC 30
bullTC 12300 cellscumm
N 87 E 4 L 9
ANA negative
RA (85 Iuml )negative
CRP within normal
limits
Mantoux Test ndash Negative
Chest X Ray ndash Normal
HLA B27 Negative
VDRL Negative
Investigations
B scan of both eye
bull B scan
bull LE
bull B scan
bull RE
Differential Diagnosis
bull VKH
bull Uveitis due to JIA
bull Posterior Scleritis
Vogt-Koyanagi-Harada
Management from Retina department
Admission on 07-04-2015
bull Started on Inj IV Methyl Prednisolone 500
mg in 250 ml DA ndashfor 3 days
bull Oral Tab Prednisololne 30 mg
bull Oral Tab Azathioprine 50 mg
bull Review after 1 week
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr OpinOphthalmol 200011437 (review)
Condition at time of discharge
10042015
bull Right eye - VA 660
bull Left eye- VA 660
Discussion
Discussion
bull Vogt 1906 one case
bull Koyanagi 1923 six cases
bull Harada 1926 posterior uveitis and pleocytosis of CSF
Vogt-Koyanagi-Harada or VKH
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
On 2nd visit on 14 Oct 2014
RE LE
VA 660 624
IOP (GAT) 13mm of Hg 12mm of Hg
B Scan With in normal limit
With in normal limit
Out come Treated as Anterior uveitis amp improved
On 3rd visit on 21 Dec 2014
RE LE
VA 660 624
IOP (GAT) 13mm of Hg 12mm of Hg
B Scan mild vitreous opacity
mild vitreous opacity
Lens Complicated cataract
Complicated cataract
Vitreous Cells+ Cells+
Outcome Treated as Anterior amp Intermediate uveitis amp improved
Advised for cataract extraction after 3 month
Surgery was performed on 25th February
bull IA with acrylic hydrophobic foldable PCIOL was
inserted
bull On Discharge
RE LE
VA 636 612
Pin Hole 618 69
On 4th visit on 7th April 2015
Retina departmentRight Eye Left Eye
Distance Vision 360 No improvement
with pinhole
160 No improvement
with pinhole
Near Vision N60 N60
Eyelids Normal Normal
Conjunctiva Congested Congested
Cornea Clear Clear
Anterior Chamber Cell +Flare+
Cell +Flare +
Iris Normal Normal
Pupil reaction 360 deg post synachae 360 deg post synachae
Lens Pseudophakia Complicated cataract
Cont ocular exam
RIGHT EYE LEFT EYE
IOP 14 mmHg 12 mmHg
Fundus Media ndashVitreous opacity
No fundal view
Media ndashVitreous opacityNo fundal view
General Examination
bull Patient is cooperative conscious oriented
Vital Parameters
bull Blood pressure 13080 mmHg
bull Pulse 84min
Neurological Examination
bull Other cranial nerves ndash Normal
bull Motor System - Normal
bull Sensory System ndash Normal
bull Cerebellar system ndash Normal
Respiratory System
bull Normal breath sounds heard
bull No added sounds
Cardiovascular System
bull S1 S2 heard
bull No murmur
bullHb 12 gm
bullESR 34 mm after 1 hr
bullPlatelet 485 lakhcumm
bullRBC 427 millioncumm
bullRBS 98 mgdl
bull PCV 29
bullMCV 68 fl
bullMCH 20 pg
bull MCHC 30
bullTC 12300 cellscumm
N 87 E 4 L 9
ANA negative
RA (85 Iuml )negative
CRP within normal
limits
Mantoux Test ndash Negative
Chest X Ray ndash Normal
HLA B27 Negative
VDRL Negative
Investigations
B scan of both eye
bull B scan
bull LE
bull B scan
bull RE
Differential Diagnosis
bull VKH
bull Uveitis due to JIA
bull Posterior Scleritis
Vogt-Koyanagi-Harada
Management from Retina department
Admission on 07-04-2015
bull Started on Inj IV Methyl Prednisolone 500
mg in 250 ml DA ndashfor 3 days
bull Oral Tab Prednisololne 30 mg
bull Oral Tab Azathioprine 50 mg
bull Review after 1 week
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr OpinOphthalmol 200011437 (review)
Condition at time of discharge
10042015
bull Right eye - VA 660
bull Left eye- VA 660
Discussion
Discussion
bull Vogt 1906 one case
bull Koyanagi 1923 six cases
bull Harada 1926 posterior uveitis and pleocytosis of CSF
Vogt-Koyanagi-Harada or VKH
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
On 3rd visit on 21 Dec 2014
RE LE
VA 660 624
IOP (GAT) 13mm of Hg 12mm of Hg
B Scan mild vitreous opacity
mild vitreous opacity
Lens Complicated cataract
Complicated cataract
Vitreous Cells+ Cells+
Outcome Treated as Anterior amp Intermediate uveitis amp improved
Advised for cataract extraction after 3 month
Surgery was performed on 25th February
bull IA with acrylic hydrophobic foldable PCIOL was
inserted
bull On Discharge
RE LE
VA 636 612
Pin Hole 618 69
On 4th visit on 7th April 2015
Retina departmentRight Eye Left Eye
Distance Vision 360 No improvement
with pinhole
160 No improvement
with pinhole
Near Vision N60 N60
Eyelids Normal Normal
Conjunctiva Congested Congested
Cornea Clear Clear
Anterior Chamber Cell +Flare+
Cell +Flare +
Iris Normal Normal
Pupil reaction 360 deg post synachae 360 deg post synachae
Lens Pseudophakia Complicated cataract
Cont ocular exam
RIGHT EYE LEFT EYE
IOP 14 mmHg 12 mmHg
Fundus Media ndashVitreous opacity
No fundal view
Media ndashVitreous opacityNo fundal view
General Examination
bull Patient is cooperative conscious oriented
Vital Parameters
bull Blood pressure 13080 mmHg
bull Pulse 84min
Neurological Examination
bull Other cranial nerves ndash Normal
bull Motor System - Normal
bull Sensory System ndash Normal
bull Cerebellar system ndash Normal
Respiratory System
bull Normal breath sounds heard
bull No added sounds
Cardiovascular System
bull S1 S2 heard
bull No murmur
bullHb 12 gm
bullESR 34 mm after 1 hr
bullPlatelet 485 lakhcumm
bullRBC 427 millioncumm
bullRBS 98 mgdl
bull PCV 29
bullMCV 68 fl
bullMCH 20 pg
bull MCHC 30
bullTC 12300 cellscumm
N 87 E 4 L 9
ANA negative
RA (85 Iuml )negative
CRP within normal
limits
Mantoux Test ndash Negative
Chest X Ray ndash Normal
HLA B27 Negative
VDRL Negative
Investigations
B scan of both eye
bull B scan
bull LE
bull B scan
bull RE
Differential Diagnosis
bull VKH
bull Uveitis due to JIA
bull Posterior Scleritis
Vogt-Koyanagi-Harada
Management from Retina department
Admission on 07-04-2015
bull Started on Inj IV Methyl Prednisolone 500
mg in 250 ml DA ndashfor 3 days
bull Oral Tab Prednisololne 30 mg
bull Oral Tab Azathioprine 50 mg
bull Review after 1 week
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr OpinOphthalmol 200011437 (review)
Condition at time of discharge
10042015
bull Right eye - VA 660
bull Left eye- VA 660
Discussion
Discussion
bull Vogt 1906 one case
bull Koyanagi 1923 six cases
bull Harada 1926 posterior uveitis and pleocytosis of CSF
Vogt-Koyanagi-Harada or VKH
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Surgery was performed on 25th February
bull IA with acrylic hydrophobic foldable PCIOL was
inserted
bull On Discharge
RE LE
VA 636 612
Pin Hole 618 69
On 4th visit on 7th April 2015
Retina departmentRight Eye Left Eye
Distance Vision 360 No improvement
with pinhole
160 No improvement
with pinhole
Near Vision N60 N60
Eyelids Normal Normal
Conjunctiva Congested Congested
Cornea Clear Clear
Anterior Chamber Cell +Flare+
Cell +Flare +
Iris Normal Normal
Pupil reaction 360 deg post synachae 360 deg post synachae
Lens Pseudophakia Complicated cataract
Cont ocular exam
RIGHT EYE LEFT EYE
IOP 14 mmHg 12 mmHg
Fundus Media ndashVitreous opacity
No fundal view
Media ndashVitreous opacityNo fundal view
General Examination
bull Patient is cooperative conscious oriented
Vital Parameters
bull Blood pressure 13080 mmHg
bull Pulse 84min
Neurological Examination
bull Other cranial nerves ndash Normal
bull Motor System - Normal
bull Sensory System ndash Normal
bull Cerebellar system ndash Normal
Respiratory System
bull Normal breath sounds heard
bull No added sounds
Cardiovascular System
bull S1 S2 heard
bull No murmur
bullHb 12 gm
bullESR 34 mm after 1 hr
bullPlatelet 485 lakhcumm
bullRBC 427 millioncumm
bullRBS 98 mgdl
bull PCV 29
bullMCV 68 fl
bullMCH 20 pg
bull MCHC 30
bullTC 12300 cellscumm
N 87 E 4 L 9
ANA negative
RA (85 Iuml )negative
CRP within normal
limits
Mantoux Test ndash Negative
Chest X Ray ndash Normal
HLA B27 Negative
VDRL Negative
Investigations
B scan of both eye
bull B scan
bull LE
bull B scan
bull RE
Differential Diagnosis
bull VKH
bull Uveitis due to JIA
bull Posterior Scleritis
Vogt-Koyanagi-Harada
Management from Retina department
Admission on 07-04-2015
bull Started on Inj IV Methyl Prednisolone 500
mg in 250 ml DA ndashfor 3 days
bull Oral Tab Prednisololne 30 mg
bull Oral Tab Azathioprine 50 mg
bull Review after 1 week
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr OpinOphthalmol 200011437 (review)
Condition at time of discharge
10042015
bull Right eye - VA 660
bull Left eye- VA 660
Discussion
Discussion
bull Vogt 1906 one case
bull Koyanagi 1923 six cases
bull Harada 1926 posterior uveitis and pleocytosis of CSF
Vogt-Koyanagi-Harada or VKH
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
On 4th visit on 7th April 2015
Retina departmentRight Eye Left Eye
Distance Vision 360 No improvement
with pinhole
160 No improvement
with pinhole
Near Vision N60 N60
Eyelids Normal Normal
Conjunctiva Congested Congested
Cornea Clear Clear
Anterior Chamber Cell +Flare+
Cell +Flare +
Iris Normal Normal
Pupil reaction 360 deg post synachae 360 deg post synachae
Lens Pseudophakia Complicated cataract
Cont ocular exam
RIGHT EYE LEFT EYE
IOP 14 mmHg 12 mmHg
Fundus Media ndashVitreous opacity
No fundal view
Media ndashVitreous opacityNo fundal view
General Examination
bull Patient is cooperative conscious oriented
Vital Parameters
bull Blood pressure 13080 mmHg
bull Pulse 84min
Neurological Examination
bull Other cranial nerves ndash Normal
bull Motor System - Normal
bull Sensory System ndash Normal
bull Cerebellar system ndash Normal
Respiratory System
bull Normal breath sounds heard
bull No added sounds
Cardiovascular System
bull S1 S2 heard
bull No murmur
bullHb 12 gm
bullESR 34 mm after 1 hr
bullPlatelet 485 lakhcumm
bullRBC 427 millioncumm
bullRBS 98 mgdl
bull PCV 29
bullMCV 68 fl
bullMCH 20 pg
bull MCHC 30
bullTC 12300 cellscumm
N 87 E 4 L 9
ANA negative
RA (85 Iuml )negative
CRP within normal
limits
Mantoux Test ndash Negative
Chest X Ray ndash Normal
HLA B27 Negative
VDRL Negative
Investigations
B scan of both eye
bull B scan
bull LE
bull B scan
bull RE
Differential Diagnosis
bull VKH
bull Uveitis due to JIA
bull Posterior Scleritis
Vogt-Koyanagi-Harada
Management from Retina department
Admission on 07-04-2015
bull Started on Inj IV Methyl Prednisolone 500
mg in 250 ml DA ndashfor 3 days
bull Oral Tab Prednisololne 30 mg
bull Oral Tab Azathioprine 50 mg
bull Review after 1 week
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr OpinOphthalmol 200011437 (review)
Condition at time of discharge
10042015
bull Right eye - VA 660
bull Left eye- VA 660
Discussion
Discussion
bull Vogt 1906 one case
bull Koyanagi 1923 six cases
bull Harada 1926 posterior uveitis and pleocytosis of CSF
Vogt-Koyanagi-Harada or VKH
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Cont ocular exam
RIGHT EYE LEFT EYE
IOP 14 mmHg 12 mmHg
Fundus Media ndashVitreous opacity
No fundal view
Media ndashVitreous opacityNo fundal view
General Examination
bull Patient is cooperative conscious oriented
Vital Parameters
bull Blood pressure 13080 mmHg
bull Pulse 84min
Neurological Examination
bull Other cranial nerves ndash Normal
bull Motor System - Normal
bull Sensory System ndash Normal
bull Cerebellar system ndash Normal
Respiratory System
bull Normal breath sounds heard
bull No added sounds
Cardiovascular System
bull S1 S2 heard
bull No murmur
bullHb 12 gm
bullESR 34 mm after 1 hr
bullPlatelet 485 lakhcumm
bullRBC 427 millioncumm
bullRBS 98 mgdl
bull PCV 29
bullMCV 68 fl
bullMCH 20 pg
bull MCHC 30
bullTC 12300 cellscumm
N 87 E 4 L 9
ANA negative
RA (85 Iuml )negative
CRP within normal
limits
Mantoux Test ndash Negative
Chest X Ray ndash Normal
HLA B27 Negative
VDRL Negative
Investigations
B scan of both eye
bull B scan
bull LE
bull B scan
bull RE
Differential Diagnosis
bull VKH
bull Uveitis due to JIA
bull Posterior Scleritis
Vogt-Koyanagi-Harada
Management from Retina department
Admission on 07-04-2015
bull Started on Inj IV Methyl Prednisolone 500
mg in 250 ml DA ndashfor 3 days
bull Oral Tab Prednisololne 30 mg
bull Oral Tab Azathioprine 50 mg
bull Review after 1 week
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr OpinOphthalmol 200011437 (review)
Condition at time of discharge
10042015
bull Right eye - VA 660
bull Left eye- VA 660
Discussion
Discussion
bull Vogt 1906 one case
bull Koyanagi 1923 six cases
bull Harada 1926 posterior uveitis and pleocytosis of CSF
Vogt-Koyanagi-Harada or VKH
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
General Examination
bull Patient is cooperative conscious oriented
Vital Parameters
bull Blood pressure 13080 mmHg
bull Pulse 84min
Neurological Examination
bull Other cranial nerves ndash Normal
bull Motor System - Normal
bull Sensory System ndash Normal
bull Cerebellar system ndash Normal
Respiratory System
bull Normal breath sounds heard
bull No added sounds
Cardiovascular System
bull S1 S2 heard
bull No murmur
bullHb 12 gm
bullESR 34 mm after 1 hr
bullPlatelet 485 lakhcumm
bullRBC 427 millioncumm
bullRBS 98 mgdl
bull PCV 29
bullMCV 68 fl
bullMCH 20 pg
bull MCHC 30
bullTC 12300 cellscumm
N 87 E 4 L 9
ANA negative
RA (85 Iuml )negative
CRP within normal
limits
Mantoux Test ndash Negative
Chest X Ray ndash Normal
HLA B27 Negative
VDRL Negative
Investigations
B scan of both eye
bull B scan
bull LE
bull B scan
bull RE
Differential Diagnosis
bull VKH
bull Uveitis due to JIA
bull Posterior Scleritis
Vogt-Koyanagi-Harada
Management from Retina department
Admission on 07-04-2015
bull Started on Inj IV Methyl Prednisolone 500
mg in 250 ml DA ndashfor 3 days
bull Oral Tab Prednisololne 30 mg
bull Oral Tab Azathioprine 50 mg
bull Review after 1 week
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr OpinOphthalmol 200011437 (review)
Condition at time of discharge
10042015
bull Right eye - VA 660
bull Left eye- VA 660
Discussion
Discussion
bull Vogt 1906 one case
bull Koyanagi 1923 six cases
bull Harada 1926 posterior uveitis and pleocytosis of CSF
Vogt-Koyanagi-Harada or VKH
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Neurological Examination
bull Other cranial nerves ndash Normal
bull Motor System - Normal
bull Sensory System ndash Normal
bull Cerebellar system ndash Normal
Respiratory System
bull Normal breath sounds heard
bull No added sounds
Cardiovascular System
bull S1 S2 heard
bull No murmur
bullHb 12 gm
bullESR 34 mm after 1 hr
bullPlatelet 485 lakhcumm
bullRBC 427 millioncumm
bullRBS 98 mgdl
bull PCV 29
bullMCV 68 fl
bullMCH 20 pg
bull MCHC 30
bullTC 12300 cellscumm
N 87 E 4 L 9
ANA negative
RA (85 Iuml )negative
CRP within normal
limits
Mantoux Test ndash Negative
Chest X Ray ndash Normal
HLA B27 Negative
VDRL Negative
Investigations
B scan of both eye
bull B scan
bull LE
bull B scan
bull RE
Differential Diagnosis
bull VKH
bull Uveitis due to JIA
bull Posterior Scleritis
Vogt-Koyanagi-Harada
Management from Retina department
Admission on 07-04-2015
bull Started on Inj IV Methyl Prednisolone 500
mg in 250 ml DA ndashfor 3 days
bull Oral Tab Prednisololne 30 mg
bull Oral Tab Azathioprine 50 mg
bull Review after 1 week
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr OpinOphthalmol 200011437 (review)
Condition at time of discharge
10042015
bull Right eye - VA 660
bull Left eye- VA 660
Discussion
Discussion
bull Vogt 1906 one case
bull Koyanagi 1923 six cases
bull Harada 1926 posterior uveitis and pleocytosis of CSF
Vogt-Koyanagi-Harada or VKH
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
bullHb 12 gm
bullESR 34 mm after 1 hr
bullPlatelet 485 lakhcumm
bullRBC 427 millioncumm
bullRBS 98 mgdl
bull PCV 29
bullMCV 68 fl
bullMCH 20 pg
bull MCHC 30
bullTC 12300 cellscumm
N 87 E 4 L 9
ANA negative
RA (85 Iuml )negative
CRP within normal
limits
Mantoux Test ndash Negative
Chest X Ray ndash Normal
HLA B27 Negative
VDRL Negative
Investigations
B scan of both eye
bull B scan
bull LE
bull B scan
bull RE
Differential Diagnosis
bull VKH
bull Uveitis due to JIA
bull Posterior Scleritis
Vogt-Koyanagi-Harada
Management from Retina department
Admission on 07-04-2015
bull Started on Inj IV Methyl Prednisolone 500
mg in 250 ml DA ndashfor 3 days
bull Oral Tab Prednisololne 30 mg
bull Oral Tab Azathioprine 50 mg
bull Review after 1 week
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr OpinOphthalmol 200011437 (review)
Condition at time of discharge
10042015
bull Right eye - VA 660
bull Left eye- VA 660
Discussion
Discussion
bull Vogt 1906 one case
bull Koyanagi 1923 six cases
bull Harada 1926 posterior uveitis and pleocytosis of CSF
Vogt-Koyanagi-Harada or VKH
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
B scan of both eye
bull B scan
bull LE
bull B scan
bull RE
Differential Diagnosis
bull VKH
bull Uveitis due to JIA
bull Posterior Scleritis
Vogt-Koyanagi-Harada
Management from Retina department
Admission on 07-04-2015
bull Started on Inj IV Methyl Prednisolone 500
mg in 250 ml DA ndashfor 3 days
bull Oral Tab Prednisololne 30 mg
bull Oral Tab Azathioprine 50 mg
bull Review after 1 week
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr OpinOphthalmol 200011437 (review)
Condition at time of discharge
10042015
bull Right eye - VA 660
bull Left eye- VA 660
Discussion
Discussion
bull Vogt 1906 one case
bull Koyanagi 1923 six cases
bull Harada 1926 posterior uveitis and pleocytosis of CSF
Vogt-Koyanagi-Harada or VKH
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Differential Diagnosis
bull VKH
bull Uveitis due to JIA
bull Posterior Scleritis
Vogt-Koyanagi-Harada
Management from Retina department
Admission on 07-04-2015
bull Started on Inj IV Methyl Prednisolone 500
mg in 250 ml DA ndashfor 3 days
bull Oral Tab Prednisololne 30 mg
bull Oral Tab Azathioprine 50 mg
bull Review after 1 week
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr OpinOphthalmol 200011437 (review)
Condition at time of discharge
10042015
bull Right eye - VA 660
bull Left eye- VA 660
Discussion
Discussion
bull Vogt 1906 one case
bull Koyanagi 1923 six cases
bull Harada 1926 posterior uveitis and pleocytosis of CSF
Vogt-Koyanagi-Harada or VKH
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Vogt-Koyanagi-Harada
Management from Retina department
Admission on 07-04-2015
bull Started on Inj IV Methyl Prednisolone 500
mg in 250 ml DA ndashfor 3 days
bull Oral Tab Prednisololne 30 mg
bull Oral Tab Azathioprine 50 mg
bull Review after 1 week
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr OpinOphthalmol 200011437 (review)
Condition at time of discharge
10042015
bull Right eye - VA 660
bull Left eye- VA 660
Discussion
Discussion
bull Vogt 1906 one case
bull Koyanagi 1923 six cases
bull Harada 1926 posterior uveitis and pleocytosis of CSF
Vogt-Koyanagi-Harada or VKH
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Management from Retina department
Admission on 07-04-2015
bull Started on Inj IV Methyl Prednisolone 500
mg in 250 ml DA ndashfor 3 days
bull Oral Tab Prednisololne 30 mg
bull Oral Tab Azathioprine 50 mg
bull Review after 1 week
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr OpinOphthalmol 200011437 (review)
Condition at time of discharge
10042015
bull Right eye - VA 660
bull Left eye- VA 660
Discussion
Discussion
bull Vogt 1906 one case
bull Koyanagi 1923 six cases
bull Harada 1926 posterior uveitis and pleocytosis of CSF
Vogt-Koyanagi-Harada or VKH
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Condition at time of discharge
10042015
bull Right eye - VA 660
bull Left eye- VA 660
Discussion
Discussion
bull Vogt 1906 one case
bull Koyanagi 1923 six cases
bull Harada 1926 posterior uveitis and pleocytosis of CSF
Vogt-Koyanagi-Harada or VKH
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Discussion
Discussion
bull Vogt 1906 one case
bull Koyanagi 1923 six cases
bull Harada 1926 posterior uveitis and pleocytosis of CSF
Vogt-Koyanagi-Harada or VKH
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Discussion
bull Vogt 1906 one case
bull Koyanagi 1923 six cases
bull Harada 1926 posterior uveitis and pleocytosis of CSF
Vogt-Koyanagi-Harada or VKH
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Discussion Cont
Epidemiology
bull More prevalent in darker skinned ethnic groups
common
in Japan
in people from Mediterranean origin
in American IndiansAfricans
in Indians
bull 2nd to 4th decade
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
bull Multisystem disease
bull Chronic bilateral granulomatous panuveitis
bull Associated with central nervous system auditory and
integumentary manifestations
bull Systemic disorder
Eyesears
Meninges
Skin
Ref Moorthy et al Surv Ophthalmol 1995 39265 (review)Read et al Am J Ophthalmol 2001131647
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Clinical course
Four phases
bull Prodromal
bull Acute uveitic
bull Convalescent or chronic
bull Chronic recurrent
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Prodromal Acute Uveitic Stage Convalsecent stage Chronic Recurrent stage
Mimics viral Infection
Bilateral blurring of vision
Ocular pain secondary to Ciliaryspasm
VitiligoAlopeciaPoliosis
43 in 1st three months52 in 1st six months
Fever Multifocal Choroidtis UvealdepigmentationSunset glow
GlaucomaCataract
Neurological Symptoms
Multifocal detachment of the sensory retina Exudative retinal detachment
Foci of hyperpigmentationof RPE
Subretinal Fibrosis
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Ocular Findings
bull Bilateral disease
bull Granulomatous panuveitis
bull Anterior Segment involvement
Iris nodules and mutton fat KPrsquos in chronic or recurrent disease
bull Shallowing of the AC + IOP uarr
Inflammatory swelling of ciliary body
Pupillary block
Formation of AS chronic glaucoma
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
International Nomenclature Committee Revised Diagnostic
Criteria
bull Complete VKH disease
bull Incomplete VKH disease
bull Probable VKH disease
Ref New insights into Vogt-Koyanagi-Harada disease Arq Bras Oftalmol 200972(3)413-20
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Treatment
bull Systemic corticosteroids
ndash Intravenous pulse therapy
ndash Oral treatment (1mgkgday)
bull Duration -inflammatory activity
bull Slow taper over 1 year period
bull Topical treatment for anterior uveitis
Ref Fang and Wang Curr Eye Res 200833517 (review) Read et al Curr Opin Ophthalmol 200011437 (review)
Yamaki et al Int Ophthalmol Clin 20024213 (review)
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Treatment Cont
bull Slow taper over 1 year period or ~ inflammatory activity
bull Consider adding Immune suppressive to reduce side effects of high dose steroids
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Prognosis
bull Visual prognosis is generally favorable
bull 875 achieved VA of ge612
bull High-dose systemic corticosteroids for gt9 months with slow tapering significantly improves the prognosis and decreases risk of recurrence
bull Age older than 18 years is significantly associated with the development of complications
bull visual prognosis is generally favorable in children
bull Ref Al-Kharashi Abu El-Asrar Int Ophthalmol 200727201
bull Abu El-Asrar et al Eye 2008221124
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Related Article
bull The Vogt-Koyanagi-Harada syndrome a rare differential diagnosis of uveitis in childhood A case report taking into account the revised diagnostic criteria]
bull Article in German] Klin Monbl Augenheilkd 2005 Nov222(11)919-22
bull Rieger R1 Keitzer R Pleyer U
bull Summery The existing diagnostic criteria of VKH syndrome may prove to be inadequate in diagnosing VKH syndrome particularly at the onset of the disease Considering that early diagnosis and treatment is crucial in improving the outcome of the disease current diagnostic criteria have been revised Recent retrospective data suggest a higher sensitivity for the revised diagnostic criteria
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Related Article
bull Vogt-Koyanagi-Harada Syndrome in a 10 Years Old Childbull Aalia R Sufi Sumera Zargar Tejit Singh
bull Department of Ophthalmology Government Medical College Srinagar Jammu amp Kashmir India
bull Online J Health Allied Scs201110(2)24
bull Summery Diagnosis of the Vogt-Koyanagi-Harada (VKH) syndrome specially in children is difficult due to the rarity of its occurrence in this age group the variable onset of clinical signs and symptoms in the course of the disease and absence of diagnostic serological parameters
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
bull Choroidal Thickness In Eyes With Recurrent Vogt-Koyanagi-Harada DiseaseYutaka Imamura1 Kouhei Hashizume2 Takamitsu Fujiwara2 Shigeki Machida2 Masahiro Ishida1 and Daijiro Kurosaka21Ophthalmology Teikyo University School of Medicine Kawasaki Japan2Ophthalmology Iwate Medical University School of Medicine Morioka Japan
bull Purpose To investigate the change of choroidal thickness in eyes showing recurrent inflammation during the follow-up of Vogt-Koyanagi-Harada disease (VKH) after high-dose steroid therapy
bull Conclusions Choroid becomes thick in eyes with relapsing VKH Thickening of choroid may be a hallmark of recurrence of inflammation during the follow-up of VKH after high-dose steroid therapy
Take Home massage
Take Home massage
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