VKH disease in Brazilian patients evolved to chronic-recurrent disease in 79 % of cases; 38 % developed subretinal fibrosis, in spite of similar initial treatment regimens. Time to initiate treatment influenced outcomes.

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BackgroundTo investigate indocyanine green angiography (ICGA) findings in patients with long-standing Vogt-Koyanagi-Harada (VKH) disease and their correlation with disease activity on clinical examination as well as with systemic corticosteroid therapy.MethodsTwenty-eight patients (51 eyes) with long-standing (≥6 months from disease onset) VKH disease whose treatment was tapered based only in clinical features were prospectively included at a single center in Brazil. All patients underwent standardized clinical evaluation, which included fundus photography, fluorescein angiography and ICGA. Clinical disease activity was determined based in the Standardization in Uveitis Nomenclature Working Group. Fisher exact test and logistic regression models were used for statistical analysis.ResultsDisease-related choroidal inflammation on ICGA was observed in 72.5% (31 of 51 eyes). Angiographic findings suggestive of (choroidal and/or retinal) disease activity were not observed on FA. Clinically active disease based on clinical evaluation was observed in 41.2% (21 of 51 eyes). In these 21 eyes, disease-related choroidal inflammation on ICGA was observed in 76.2% (16 of 21 eyes); in the remaining eyes (without clinical active disease) disease-related choroidal inflammation on ICGA was observed in 70.0% (21 of 30 eyes). In respect to systemic corticosteroid therapy, 10 patients (18 of 51 eyes) were under treatment with prednisone. In these 10 (18 of 51 eyes) patients, disease-related choroidal inflammation on ICGA was observed in 83.3% (15 of 18 eyes); in the remaining patients (33 of 51 eyes) disease-related choroidal inflammation on ICGA was observed in 66.7% (22 of 33 eyes).ConclusionICGA findings suggestive of disease-related choroidal inflammation were observed in a considerable proportion of patients with long-standing VKH disease, independent of the inflammatory status of the disease on clinical examination or current use of systemic corticosteroid. Therefore, the current study reinforces the crucial role of ICGA to assist the management and treatment of patients with long-standing VKH disease.

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BackgroundDetection of choroidal inflammation in Vogt-Koyanagi-Harada (VKH) disease is still a challenge. Progression to sunset glow fundus has been observed despite apparent good clinical control of inflammation. Indocyanine green angiography (ICGA) permits choroid inflammation detection, though it is invasive, time consuming, and costly. The purpose of the present study is to report a sign indicative of probable inflammation on enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT): a localized increase in choroidal thickness with bulging of the outer retina (‘choroidal bulging’) in patients with VKH disease in the non-acute uveitic stage.FindingsThis is a retrospective observational study. The choroidal bulging was a particular finding observed in four eyes of three patients with VKH disease in the non-acute uveitic stage (median disease duration 55.3 ± 40.3 months, range 10 to 108). This study is part of an ongoing longitudinal study in patients with VKH disease carried out in the Uveitis Service, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. In all eyes, the choroidal bulging was identified in the presence of anterior chamber cells and/or on fundus angiographic (fluorescein and indocyanine green) findings, indicative of disease activity. Changes in the thickness of the choroidal bulging accompanied the variation in the clinical and angiographic signs of inflammation.ConclusionThe choroidal bulging is a particular finding detected on EDI-OCT that may indicate ongoing inflammation in the posterior segment of the eye. This EDI-OCT feature may assist in the treatment-monitoring of patients with Vogt-Koyanagi-Harada disease in the non-acute uveitic stage.

Introduction It is believed that the prevention of head trauma (TBI) can be achieved with campaigns to raise awareness about safety measures. Methods Longitudinal, observational and analytical cohort study. Standardized questionnaires were administered to students from 4th to 6th grade elementary school, before and immediately after the intervention. Items on habits//exposure to TCEs were analyzed categorically as theoretical knowledge were evaluated semi-continuously. A randomly selected subgroup was subjected to the same questionnaires past 9 months of educational lectures. Results A total of 117 students (55 girls) were interviewed initially (4th [n ¼ 14/117], 5th [n ¼ 54/117] and 6th [n ¼ 49/117] series, average age of 9.8, 10, 7 and 11.8 years). Of these, 22 students were submitted to the late posttest (7th grade, 12.7 years on average). Among the participants, 37% (43/116) students had already suffered/knew someone who suffered TBI, 58% (18/31) were involved in traffic accidents and 42% (13/31) were involved in accidents with bicycle, skates or skateboard. Among these subjects, 90.3% reported occasional use or never having used protection during play. A significant discrepancy was detected between safety habits and theoretical knowledge related to helmet use and the use of seat belts (effective use versus hits on knowledge of respectively 37% versus 61%, and 70% versus 92%). In the theoretical evaluation, improvement was observed only with regard to the importance of helmet usage (61% in the pretest, 72% in the immediate posttest and 95% in the late posttest). Conclusion The high rate of experience with TBI coupled with the significant discrepancy between habits and knowledge regarding trauma prevention stress the need for effective measures leading to their actual implementation. The intervention increased awareness about the importance of helmet usage, suggesting partial effectivity from a theoretical standpoint.