急性Vogt-小柳-原田病中的杆菌层脱离：巴西队列中长期并发症的早期预测指标
Bacillary layer detachment in acute Vogt-Koyanagi-Harada disease: an early predictor of long-term complications in a Brazilian cohort.
作者信息
Missaka Ruy Felippe Brito Gonçalves, Goldbaum Mauro, Machado Cleide Guimarães, T Cunningham Emmett, Souto Fernanda Maria Silveira, Lavezzo Marcelo Mendes, da Nóbrega Priscilla Figueiredo Campos, Gusmão Camillo Carneiro, Sakata Viviane Mayumi, Oyamada Maria Kiyoko, Hirata Carlos Eduardo, Yamamoto Joyce Hisae
机构信息
Department of Ophthalmology, LIM-33, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, 05402-000, SP, Brazil.
West Coast Medical Group, San Francisco, CA, USA.
出版信息
Int J Retina Vitreous. 2025 Apr 22;11(1):50. doi: 10.1186/s40942-025-00673-6.
BACKGROUND
Long-term complications occur in some patients with Vogt-Koyanagi-Harada disease (VKHD).This study aimed to evaluate the presence of bacillary layer detachment (BALAD) at presentation as an early predictor of long-term structural and functional outcomes in a Brazilian cohort of patients with VKHD.
METHODS
Retrospective, clinic-based cohort study in Sao Paulo, Brazil, including 33 patients (66 eyes) with acute VKHD systematically followed for 12 months, since presentation. Clinical and multimodal data collected on spectral domain optical coherence tomography (SD-OCT) were analyzed at baseline and months (M) 1, 3, 6, 9 and 12. Correlations between OCT-based structural findings and the occurrence of subretinal fibrosis (SRFib), sunset glow fundus (SGF), and nummular chorioretinal lesions (NCL) at month 12 were studied. Outcomes were presence of retinal changes on SD-OCT during the study period; risk factors for SRFib, SGF and NCL at month 12. Univariate, bivariate, and multivariate analyses were employed.
RESULTS
At baseline, serous retinal detachments (SRD) were observed in 96.4% and BALAD in 48.2% of 56 eyes; at M1, SRD were observed in 42.4% and BALAD in 6.1% of 66 eyes. Subretinal fluid (SRFld) was still present in 9.1% at M3, in 4.5% at M6 and in 3.0% of eyes at M9. Using bivariate analysis, the early presence of BALAD was associated with a larger SRD area (p = 0.036) at presentation, and with the presence of both SRFib (p < 0.001) and SGF (p = 0.008) at M12. Using multivariate regression analysis, both early BALAD (OR, 12.04; p = 0.011) and a longer interval to treatment start (32 vs. 17 days; OR, 1.17; p = 0.004) were each independently associated with the formation of SRFib at M12, whereas both early BALAD (OR, 14.78; p = 0.002) and anterior uveitis recurrences (OR, 30.94; p = 0.022) were each associated with the development of SGF. The late occurrence of NCL was not associated with the presence of BALAD at presentation.
CONCLUSIONS
In acute VKHD, the presence of BALAD at presentation was associated with a markedly increased long-term risk of developing both SRFib and SGF.
背景
一些小柳原田病（VKHD）患者会出现长期并发症。本研究旨在评估巴西VKHD患者队列中，就诊时出现的视网膜色素上皮脱离（BALAD）作为长期结构和功能预后早期预测指标的情况。
方法
在巴西圣保罗进行的一项基于临床的回顾性队列研究，纳入33例（66只眼）急性VKHD患者，自就诊起系统随访12个月。收集了基线以及第1、3、6、9和12个月时基于频域光学相干断层扫描（SD-OCT）的临床和多模态数据。研究了基于OCT的结构发现与第12个月时视网膜下纤维化（SRFib）、晚霞样眼底（SGF）和钱币状脉络膜视网膜病变（NCL）发生之间的相关性。观察指标为研究期间SD-OCT上视网膜变化的情况；第12个月时SRFib、SGF和NCL的危险因素。采用单因素、双因素和多因素分析。
结果
基线时，56只眼中96.4%出现浆液性视网膜脱离（SRD），48.2%出现BALAD；第1个月时，66只眼中42.4%出现SRD，6.1%出现BALAD。第3个月时9.1%的眼仍存在视网膜下液（SRFld），第6个月时为4.5%，第9个月时为3.0%。采用双因素分析，就诊时BALAD的早期出现与更大的SRD面积相关（p = 0.036），且与第12个月时SRFib（p < 0.001）和SGF（p = 0.008）的出现相关。采用多因素回归分析，早期BALAD（比值比[OR]，12.04；p = 0.011）和开始治疗的间隔时间较长（32天对17天；OR，1.17；p = 0.004）均与第12个月时SRFib的形成独立相关，而早期BALAD（OR，14.78；p = 0.002）和前葡萄膜炎复发（OR，30.94；p = 0.022）均与SGF的发生相关。NCL的晚期出现与就诊时BALAD的存在无关。
结论
在急性VKHD中，就诊时BALAD的存在与发生SRFib和SGF的长期风险显著增加相关。
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