| Objective: Observed Vogt-Koyanagi-Harada disease clinical features ofanterior segment lesions and correlation between posterior segment lesionswith pulsecorti-costeroid therapy and the related factors of disease recurrence.Methods: Data of13patients with VKH, coming from The SecondHospital of Hebei Medical University.They were hospitalized and treated withpulse corticosteroid therapy between November2011to December2012.Check26eyes using ultrasound biomicroscopy (UBM) and optical coherencetomography (OCT) at day0, day3, day7, day14, day30,12weeks and32weeks. According to the slit lamp microscope with or without Anteriorvitreous opacity, patients were divided into two groups.And according theexamination results before treatment to assessment the recurrence factors ofdisease.Results:26eyes of VKH before treatment,the characteristics of FFAshowed cystic of hypofluorescein like several or single lake was observed inthe late phase,the characteristics of UBM showed the ciliary body edema,found the ciliary process position forward rotation, the shallow anteriorchamber, decreased angle opening.The mean of T value as measured ciliaryprocess height was1.55±0.13mm; the mean of A angle as the ciliary processparameters was72.05±7.80°; B angle was52.16±9.00°;the mean of ACD asanterior chamber depth was2.56±0.29mm;the mean of AA500as anteriorchamber open angle was21.84±7.35°.As the inflammation subsided duringtreatment, A angle, B angle, axial anterior chamber depth, angle openingdegree average was significantly increased compared with before treatment,but the T value decreased.In the impact of glucocorticoid treatment for14days,UBM examination showed26eyes of the mean T value was1.36±0.08mm, the mean of A angle was87.42±6.63°, the mean of B angle was66.37± 8.60°,the mean of ACD was2.78±0.11mm, the mean of AA500was32.04±6.12°.They compared with before treatment and3days after treatment werewith statistical difference;but compared with30days,12weeks,32weeks aftertreatment,there was no significant difference.Anterior segment tissue returnedto normal in14days after treatment,.Before treatment UBM showed20eyes with varying degrees of ciliarybody and anterior choroidal detachment, mean height of detachment was99.54±101.14μm, OCT examination showed that the retinal detachment,mean height of detachment was633.92±389.05μm. Neurosensory detachmentwas positively correlated with cyclodialysis and anterior choroidal detachment(P<0.05).30days after treatment OCT examination showed26eyes (100%) ofretinal reattachment, subretinal fluid was complete absorbed. The bestcorrected vision acuity compared with before treatment had significantdifferences (P<0.05).In addition,4eyes showed ciliary body cysts before treatment by UBM.The diameters of the cysts of the mean of927.52±246.71μm, the height was487.64±156.43μm.In the treatment of32weeks after, all of the cysts existencebut the volume had obviously reduction, mean diameters was515±97.64μm,mean height was254.36±78.52μm.8eyes showed with anterior vitreous opacity by slit lamp microscope, atthe same time showed punctate or strip uneven echo in vitreous base by UBM.8eyes of T value, A angle, B angle, the height of ciliary body and anteriorchoroidal detachment compared with the18eyes without punctate or stripuneven echo in vitreous base, there were significant differences (P<0.05)The factors associated with recurrence of primary VKH disease withacute anterior segment inflammation in the course of treatment effects includethe time from onset to treatment (P=0.000), Initial best corrected vision acuity(P=0.002), the range of ciliary body and anterior choroidal detachment(P=0.000), ciliary body and anterior choroidal detachment height (P=0.000),typical sunset fundus appeared in the course of treatment (P=0.003), com- plications (P=0.004). Age of onset (P=0.253), gender (P=0.217), prodromalsymptoms (P=0.276) had no correlation with the recurrence of the disease.Conclusion:1Primary VKH at the acute stage by UBM examination can discover theciliary body edema, found the ciliary process position forward rotation, theshallow anterior chamber, decreased angle opening, part of eyes ciliary bodyand anterior choroidal detachment, ciliary body cyst, punctate or strip unevenecho in vitreous base. The eyes with anterior vitreous opacity showed moreanterior segment tissues changed.2The tissues lesions between anterior segment and posterior segment wererelated. Recovery of anterior segment tissues earlier than posterior segmentvision and retinal recovery was the same time.3To provide reliable technical means for understanding VKH disease,used incombination with OCT and FFA can correctly, objective to show disease fromthe posterior segment to anterior segment lesions of eyes, part of the range,degree and order of occurrence4Most of VKH patients were acquired satisfactory effect, have a relationshipwith gave timely and adequate corticosteroid in the acute phase of VKH. Theexperimental study of anterior segment inflammation related factors ofrecurrence can provide objective basis for treatment and to develop treatmentsfor individuals and prevent persistent disease recurrence. |
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