PMID- 23277207
OWN - NLM
STAT- MEDLINE
DCOM- 20140319
LR  - 20211021
IS  - 1573-2630 (Electronic)
IS  - 0165-5701 (Linking)
VI  - 33
IP  - 5
DP  - 2013 Oct
TI  - Indocyanine green angiography-guided management of Vogt-Koyanagi-Harada disease: 
      differentiation between choroidal scars and active lesions.
PG  - 571-7
LID - 10.1007/s10792-012-9692-4 [doi]
AB  - When following Vogt-Koyanagi-Harada disease (VKH), indocyanine green angiography 
      (ICGA) is crucial in the subacute and convalescent stages of the disease in order 
      to detect subclinical choroiditis and prevent the development of 'sunset glow' 
      fundus. Hypofluorescent dark dots (HDDs) indicate persisting granulomas in the 
      choroid. However, probably as a result of the healing process of choroidal 
      granulomas, stromal choroidal fibrosis can also be shown by HDDs. We present two 
      cases where intravenous corticosteroid administration because of persistent HDDs 
      led to resolution of lesions in one case while they persisted in the other case. 
      We reviewed the medical history of two VKH patients. Complete routine work-up for 
      patients with posterior uveitis was performed. The charts were screened for the 
      presence of HDDs by ICGA in the subacute and convalescent stages of the disease 
      before and after administration of body weight-adapted pulse intravenous 
      methylprednisolone (PIM). The evolution of HDDs was studied and compared in both 
      patients. A female patient presented with a persistent bilateral granulomatous 
      panuveitis compatible with VKH. Cerebrospinal fluid analysis had shown 
      lymphocytic pleocytosis. At presentation, therapy consisted of oral prednisone 80 
      mg/day. Prednisone was tapered down to 22 mg/day over 3 months, when a recurrence 
      occurred with the presence of disseminated HDDs. PIM was administered, followed 
      by oral corticosteroids. After 8 days of therapy, ICGA showed an almost complete 
      disappearance of HDDs. A girl presented with bilateral panuveitis and widespread 
      depigmented areas of her fundus. Cerebrospinal fluid analysis showed monocytic 
      pleocytosis. Because of relative resistance to oral inflammation suppressive 
      therapy (IST), PIM was administered for 3 days. Nevertheless, ICGA showed 
      persistence of HDDs. Therapy was continued, and 3 months later, a follow-up ICGA 
      still depicted numerous HDDs. Another PIM course was given, which had no effect 
      on ICGA signs. HDDs in this case were interpreted as stromal choroidal scars. 
      ICGA-guided therapy (mainly HDD evolution monitoring) helps to eradicate occult 
      stromal disease in VKH and avoids 'sunset glow' fundus, by allowing precise 
      adjustment of therapy. In some cases, HDDs do not represent active lesions but 
      presumed intrastromal scars which need to be identified. A limited course of 
      maximal IST including PIM can unmask such cases and avoid overtreatment of these 
      patients.
FAU - Knecht, Pascal B
AU  - Knecht PB
AD  - Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care 
      (COS), Clinic Montchoisi, Rue de la Grotte 6, 1003, Lausanne, Switzerland, 
      pascalknecht@gmx.ch.
FAU - Mantovani, Alessandro
AU  - Mantovani A
FAU - Herbort, Carl P
AU  - Herbort CP
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20130101
PL  - Netherlands
TA  - Int Ophthalmol
JT  - International ophthalmology
JID - 7904294
RN  - 0 (Coloring Agents)
RN  - 0 (Glucocorticoids)
RN  - IX6J1063HV (Indocyanine Green)
SB  - IM
MH  - Adolescent
MH  - Choroiditis/*diagnosis
MH  - Coloring Agents
MH  - Female
MH  - Fluorescein Angiography/*methods
MH  - Glucocorticoids/therapeutic use
MH  - Humans
MH  - Indocyanine Green
MH  - Treatment Outcome
MH  - Uveomeningoencephalitic Syndrome/*diagnosis/drug therapy
MH  - Young Adult
EDAT- 2013/01/02 06:00
MHDA- 2014/03/22 06:00
CRDT- 2013/01/02 06:00
PHST- 2012/11/12 00:00 [received]
PHST- 2012/12/08 00:00 [accepted]
PHST- 2013/01/02 06:00 [entrez]
PHST- 2013/01/02 06:00 [pubmed]
PHST- 2014/03/22 06:00 [medline]
AID - 10.1007/s10792-012-9692-4 [doi]
PST - ppublish
SO  - Int Ophthalmol. 2013 Oct;33(5):571-7. doi: 10.1007/s10792-012-9692-4. Epub 2013 
      Jan 1.