Raichandani Simran G, Kim Gowtham, Annamalai Radha, Rangarajan Sudha, Sankaralingam Rajeswari
Ophthalmology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND.
Ophthalmology, Aravind Eye Hospital, Chennai, IND.
Cureus. 2024 Jul 20;16(7):e64998. doi: 10.7759/cureus.64998. eCollection 2024 Jul.
Introduction Vogt-Koyanagi-Harada (VKH) syndrome is a granulomatous, autoimmune panuveitis, affecting the eyes, ears, skin, and meninges. It can cause choroiditis and can progress to the retina and optic disc causing visual loss. Imaging using fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and enhanced depth imaging-ocular coherence tomography (EDI-OCT) is required for clinical evaluation and management. Steroids and immunosuppression are the treatment modalities used. Aim The aim of this study is to report the correlation and severity of uveitis in relation to systemic manifestations. Method A retrospective study including 100 patients with VKH syndrome was carried out. They were classified based on clinical manifestations and investigations such as FFA, ICGA, B-scan ultrasonography (USG), and ocular coherence tomography (OCT). Patients were characterized as complete, incomplete, and probable VKH syndrome. Laboratory investigations were performed, and statistical analysis was done. Results Probable VKH syndrome was found to be the most common form of presentation in our study population. Defective vision was the most common complaint among the patients. Extraocular manifestations included tinnitus, vertigo, alopecia, headache, fatigue, and vitiligo and were seen in 33% of the patients. Disc edema and serous retinal detachment were seen in 85% of the patients. Improvement was noted in 25% of the patients with the use of corticosteroids. Conclusion Response to treatment with systemic corticosteroids and immunosuppression in the acute phase of uveitis is better compared to chronic uveitis. The ophthalmologist is usually first consulted in VKH syndrome due to presenting ocular complaints. A multidisciplinary approach is key to providing holistic management.
引言
伏格特-小柳-原田(VKH)综合征是一种肉芽肿性自身免疫性全葡萄膜炎,可累及眼睛、耳朵、皮肤和脑膜。它可引起脉络膜炎,并可进展至视网膜和视盘,导致视力丧失。临床评估和管理需要使用眼底荧光血管造影(FFA)、吲哚菁绿血管造影(ICGA)以及增强深度成像光学相干断层扫描(EDI-OCT)进行成像检查。治疗方式包括使用类固醇和免疫抑制药物。
目的
本研究的目的是报告葡萄膜炎与全身表现之间的相关性及严重程度。
方法
对100例VKH综合征患者进行了一项回顾性研究。根据临床表现以及FFA、ICGA、B超(USG)和光学相干断层扫描(OCT)等检查结果对患者进行分类。患者被分为完全型、不完全型和疑似VKH综合征。进行了实验室检查并开展了统计分析。
结果
在我们的研究人群中,疑似VKH综合征是最常见的表现形式。视力缺陷是患者中最常见的主诉。眼外表现包括耳鸣、眩晕、脱发、头痛、疲劳和白癜风,33%的患者出现这些症状。85%的患者出现视盘水肿和浆液性视网膜脱离。25%使用皮质类固醇的患者病情有改善。
结论
与慢性葡萄膜炎相比,葡萄膜炎急性期对全身皮质类固醇和免疫抑制治疗的反应更好。由于眼部症状,VKH综合征患者通常首先咨询眼科医生。多学科方法是提供全面管理的关键。