Bouchenaki Nadia, Herbort Carl P
Inflammatory and Retinal Eye Diseases, Center for Ophthalmic Specialized Care, Lausanne, Switzerland.
J Ophthalmic Vis Res. 2011 Oct;6(4):241-8.
To report the management of Vogt-Koyanagi-Harada (VKH) disease based on indocyanine green angiography (ICGA).
VKH patients with acute episodes of inflammation (inaugural or recurrent) who had received standard ICGA-guided care were studied retrospectively. Standard of care included high dose systemic corticosteroids at presentation and close ICGA follow-up with addition of immunosuppressive agents and/or intensification of ongoing therapy when recurrent choroidal lesions were detected by ICGA. Visual acuity, number of subclinical recurrences, type and duration of therapy, proportion of quiescent patients after therapy, and ICGA findings were recorded.
Nine patients including 8 female and one male subject were studied. Five patients had inaugural disease and 4 presented with recurrent acute episodes. Visual acuity increased from 0.86±0.36 to 1.14±0.34 in the right eyes, and from 0.77±0.34 to 1.05±0.33 in the left eyes. The number of ICGA-detected occult choroidal recurrences amounted to 13. Mean duration of treatment was 30.1±34.6 months leading to recurrence-free status after discontinuation of therapy in 6 cases with mean duration of 29.5 months.
Continuous monitoring and aggressive therapy guided by ICGA in VKH disease prolongs treatment as compared to textbook guidelines but offers the prospect of reaching inflammation-free status after discontinuation of therapy. Zero tolerance to subclinical choroidal inflammation avoids irremediable evolution towards sunset glow fundus in patients treated early after the initial acute inflammatory attack.
报告基于吲哚菁绿血管造影（ICGA）的Vogt-小柳-原田（VKH）病的治疗情况。
对接受标准ICGA引导治疗的急性炎症发作（初发或复发）的VKH患者进行回顾性研究。治疗标准包括初诊时使用高剂量全身皮质类固醇，并通过ICGA密切随访，当ICGA检测到脉络膜病变复发时，加用免疫抑制剂和/或强化正在进行的治疗。记录视力、亚临床复发次数、治疗类型和持续时间、治疗后静止患者的比例以及ICGA检查结果。
研究了9例患者，其中8例女性，1例男性。5例为初发病例，4例为复发性急性发作。右眼视力从0.86±0.36提高到1.14±0.34，左眼视力从0.77±0.34提高到1.05±0.33。ICGA检测到的隐匿性脉络膜复发次数为13次。平均治疗时间为30.1±34.6个月，6例患者在停药后达到无复发状态，平均持续时间为29.5个月。
与教科书指南相比，ICGA引导下的持续监测和积极治疗可延长VKH病的治疗时间，但停药后有望达到无炎症状态。对亚临床脉络膜炎症零容忍可避免初发急性炎症发作后早期治疗的患者不可挽回地发展为晚霞样眼底。
