Update on the diagnosis and treatment of Vogt-Koyanagi-Harada syndrome  

作　　者：Ghazala A.Datoo O’Keefe 

机构地区：[1]Department of Ophthalmology,Emory University School of Medicine,Section of Vitreoretinal Surgery and Diseases,Section of Uveitis and Vasculitis,Atlanta,Georgia,USA

出　　处：《Annals of Eye Science》2020年第3期5-10,共6页眼科学年鉴（英文）

摘　　要：Vogt-Koyanagi-Harada syndrome(VKH)is a bilateral granulomatous panuveitis associated with serous retinal detachments and vitritis,and can be associated with extraocular manifestations of meningismus,poliosis,vitiligo,hearing loss,and headaches.It is mediated by CD4+T cells that target melanocytes in the eye,ear,meninges,and skin.It classically presents in 4 different phases:prodromal,uveitic,convalescent,and recurrent.There have been considerable advances in our understanding of the disease in recent years,and options for treatment have also expanded beyond systemic corticosteroids though these remain the mainstay of therapy in patients with VKH.This brief review will focus on updates in the diagnosis and treatment of VKH,specifically advances in imaging techniques including the use of optical coherence tomography angiography(OCTA)and enhanced depth imaging(EDI)optical coherence tomography(OCT).OCT parameters that are diagnostically predictive of acute VKH compared to other exudative maculopathies include the presence of subretinal membranous structures,a high retinal detachment,subretinal hyperreflective dots,and RPE folds.Evaluations of choroidal thickness using EDI-OCT demonstrate predominant involvement of the outer choroid in the acute inflammatory phase of VKH,consistent with histopathological analysis.OCTA may emerge as an alternative to fluorescein angiography(FA)and indocyanine angiography(ICGA)but is limited at this time due to its small field of view.While the mainstay of treatment of acute VKH continues to be systemic corticosteroids,biological response modifiers(BRMs)such as adalimumab and infliximab have been shown to be effective in the management of adult and pediatric VKH with one benefit being a faster onset of action compared to conventional immunosuppression.Literature Search:A literature search was done in PubMed using the words“Vogt Koyanagi Harada”“imaging”“diagnosis”“treatment”“therapy“posterior uveitis”.

关 键 词：Vogt-Koyanagi Harada posterior uveitis IMAGING immunomodulatory therapy optical coherence tomography 

分 类 号：R57[医药卫生—消化系统]