Meifen Zhang

Choroidal folds in acute Vogt-Koyanagi-Harada disease.

Purpose: To shed light on the clinical significance of choroidal folds (CFs) in acute Vogt-Koyanagi-Harada disease (VKH). Methods: Twenty-three acute uveitic VKH patients diagnosed between October 2001 and January 2008 were reviewed retrospectively. Results: Twelve (52%) patients had CFs; for patients with CFs, more had poor initial visual acuity (≤ 0.1 in either eye, p <.05), and more received immunomodulatory therapy (IMT) than those without CFs (p <.05). Patients without CFs had better best-corrected visual acuity (BCV) at final visit (p <.01). Conclusions: CFs are probably a sign of severe choroidal inflammation and associated with corticosteroid resistance and/or dependence, which indicates IMT.

Spectral Domain Optical Coherence Tomography of Vogt-Koyanagi-Harada Disease: Novel Findings and New Insights into the Pathogenesis

OBJECTIVE To provide novel spectral domain optical coherence tomography (SD OCT) findings of Vogt-Koyanagi-Harada (VKH) disease as well as new insights into the pathogenesis of this disease. METHODS Detailed SD OCT and fluorescein angiography (FA) findings of 18 consecutive VKH patients (11 women and 7 men) from December 2007 to April 2009 who were in acute uveitic stage at presentation were reviewed. All the patients had been followed up for at least 6 months with reevaluation(s) of SD OCT performed in 10 patients. RESULTS Intraretinal cysts were found to be located in various layers of the outer retina. In addition to the photoreceptor layer, they could also be found between the outer plexiform layer and the outer nuclear layer, or spanning the external limiting membrane. On FA, intraretinal cysts could be hypofluorescent, normofluorescent, or hyperfluorescent. Some intraretinal cysts had a characteristic FA pattern, in which a small round hypofluorescent area was surrounded by a ring of hyperfluorescence (donut-shaped dye pooling). Subretinal fibrinoid deposit appeared in acute uveitic stage in two severe VKH patients and seemed to develop from subretinal exudates and evolved into typical subretinal fibrosis. Gradual transfiguration/migration and progressive proliferation/pigmentation of the subretinal fibrinoid deposit/subretinal fibrosis was observed in one patient. CONCLUSIONS Intraretinal cysts could form in various layers of the outer retina and may result from extension of choroidal inflammation. Subretinal fibrosis may develop from subretinal exudates in VKH patients and may cause substantial visual impairment.

Clinical Patterns of Uveitis in a Tertiary Center in North China.

ABSTRACT Purpose: To analyze the spectrum of uveitis at a tertiary hospital in northern China. Methods: This study is a retrospective study from June 2014 to February 2015. A total of 606 consecutive patients with uveitis were screened for etiologies and classified according to the anatomic sites of inflammation. Results: The mean age at presentation was 33.8 ± 15.5 years old. Males and females were almost equally affected. Panuveitis was the most common anatomic diagnosis, followed by anterior, posterior, and intermediate uveitis. VKH syndrome, Behçet disease and idiopathic anterior uveitis were the most common uveitis entities. Ocular complications were detected in 441 patients. Conclusions: More than half of the patients with uveitis from northern China had an identifiable cause or was diagnosed as a specific disease entity with VKH and BD among the major etiologies. Cataract, steroid-induced ocular hypertension and macular edema were the leading complications.

Visual Prognosis and Associated Factors of Phacoemulsification and Intraocular Lens Implantation in Different Uveitis Entities in Han Chinese

ABSTRACT Purpose: To address the visual prognosis and associated predictors of phacoemulsification and intraocular lens implantation in different uveitis entities in Han Chinese. Methods: A retrospective review of the uveitis patients who underwent phacoemulsification and intraocular lens implantation in our center between 2004 and 2014. Results: The 158 patients (226 eyes) included anterior uveitis (45 eyes), posterior/pan-uveitis (61 eyes), Vogt–Koyanagi–Harada disease (79 eyes) and Behçet disease (41 eyes). At 6 months after surgery, best-corrected visual acuity (BCVA) significantly improved (p < 0.001) in all uveitis groups with 134 (59.3%) eyes achieving 20/40 or better. The anterior uveitis and Behçet disease groups had significantly better and worse visual outcomes than other groups, respectively. Poor preoperative BCVA, macular lesions, and secondary glaucoma were independent variables that predicted a poor visual outcome. Conclusions: Our current study revealed a generally favorable outcome and associated predictors of phacoemulsification and intraocular lens implantation in uveitic cataracts in Han Chinese.

Surgical Treatment of Subretinal Fibrosis Caused Macular Detachment in Vogt-Koyanagi-Harada Disease: A Pioneer Study

ABSTRACT Purpose: To describe surgical outcomes of macular detachment caused by subretinal fibrosis (SRF) in Vogt-Koyanagi-Harada disease (VKH). Methods: Retrospective review of VKH patients who underwent SRF removal surgery. Results: Seven eyes of six VKH patients with preoperative BCVA ranging from light perception to 20/250 were included. Six eyes underwent uncomplicated SRF removal with C3F8 or silicone oil (SO) tamponade and the following optional primary or subsequent procedures: intravitreal injection of triamcinolone acetonide, SO removal, lensectomy, or phacoemulsification with intraocular lens (IOL) implantation. All six eyes had attached macula and improved BCVA at the last visit (ranging from 20/2000 to 20/67) compared to baseline; the other eye, however, showed no light perception after surgery due to optic nerve injury. Conclusions: In VKH patients, macular detachment caused by SRF can be treated with surgery with generally favorable outcomes. Extreme caution should be taken to avoid optic nerve injury.

Subretinal Hypopyon in Sympathetic Ophthalmia

Purpose: To describe a rare case of sympathetic ophthalmia with subretinal hypopyon. Methods: Observational case report. Results: A 41-year-old man was diagnosed with sympathetic ophthalmia in his left eye. Oral prednisone was started. Three days later, he developed an inferior exudative retinal detachment with an underlying hypopyon. The exudative retinal detachment and hypopyon resolved completely within 48 hours. Conclusions: A subretinal hypopyon in sympathetic ophthalmia is a rare clinical finding. It is probably the result of acute inflammation in the subretinal space.

Chemokine and Adhesion Molecule Profiles in Aqueous Humor of Clinically Quiescent Uveitic Cataracts

ABSTRACT Purpose: To investigate the chemokine and adhesion molecule profiles in aqueous humor (AH) of eyes with inactive uveitis and their correlations with inflammation relapse after cataract surgery. Methods: Patients with inactive uveitis who underwent cataract surgery between July 2014 and January 2016 at our center were included. Undiluted AH samples (100–120 µl) were obtained through lateral corneal incisions during surgery, and concentrations of monocyte chemoattractant protein 1 (MCP-1/CCL2), macrophage inflammatory protein 1 (MIP-1), interleukin 8 (IL-8), regulated on activation, normal T cell expressed and secreted (RANTES/CCL5), soluble vascular cell adhesion molecule (sVCAM) and soluble intercellular adhesion molecule (sICAM) were measured by cytometric bead array (BD Bioscience, San Jose, CA). AH levels of these inflammatory factors were compared between different uveitis entities and non-inflammatory control. Risk factors for postoperative inflammation relapse were also analysed in uveitic eyes. Results: As compared with the control group, the panuveitis group had significantly higher aqueous concentrations of MCP-1, IL-8, sVCAM, sICAM; the anterior uveitis group had significantly higher concentrations of MCP-1, MIP-1, sVCAM. Uveitic cataracts with postoperative inflammation relapse had significantly higher levels of MCP-1 and IL-8 in AH than those without. And multivariate cox regression analysis revealed that high AH levels of MCP-1 was an independent predictor for postoperative inflammation relapse. Conclusions: Clinically quiescent uveitic eyes have elevated levels of chemokines and soluble adhesion molecules in AH, of which MCP-1 is associate with inflammation relapses after cataract surgery.

Intraocular Detection of Herpesviruses by xTAG Liquid Chip Technology in Patients with Acute Retinal Necrosis

ABSTRACT Purpose: To evaluate the performance of the xTAG liquid chip technology (xTAG-LCT) for etiological diagnosis of acute retinal necrosis (ARN). Methods: Fifteen vitreous and 3 aqueous samples from 18 ARN patients were analyzed by xTAG-LCT and multiplex PCR (mPCR)/quantitative PCR (qPCR). Results: xTAG-LCT revealed positive results in 17 of the 18 samples: 10 for Varicella Zoster Virus (VZV) alone; 5 for VZV and Epstein-Barr virus (EBV); 1 for herpes simplex viruses type 1 (HSV-1) and EBV; 1 for VZV, HSV-1 and EBV. While mPCR revealed the same results as xTAG-LCT for VZV and HSV-1 in all samples, only 2 of the 7 samples positive for EBV on xTAG-LCT were confirmed by qPCR. None of the 28 control vitreous samples from 8 non-ARN patients and 10 pair of cadaveric eyes was positive for any of the tested viruses. Conclusions: xTAG-LCT could be a useful alternative for etiological diagnosis of ARN.