Spectral Domain Optical Coherence Tomography of Vogt-Koyanagi-Harada Disease: Novel Findings and New Insights into the Pathogenesis

Objective To provide novel spectral domain optical coherence tomography (SD OCT) findings of Vogt-Koyanagi-Harada (VKH) disease as well as new insights into the pathogenesis of this disease. Methods Detailed SD OCT and fluorescein angiography (FA) findings of 18 consecutive VKH patients (11 women and 7 men) from December 2007 to April 2009 who were in acute uveitic stage at presentation were reviewed. All the patients had been followed up for at least 6 months with reevaluation(s) of SD OCT performed in 10 patients. Results Intraretinal cysts were found to be located in various layers of the outer retina. In addition to the photoreceptor layer, they could also be found between the outer plexiform layer and the outer nuclear layer, or spanning the external limiting membrane. On FA, intraretinal cysts could be hypofluorescent, normofluorescent, or hyperfluorescent. Some intraretinal cysts had a characteristic FA pattern, in which a small round hypofluorescent area was surrounded by a ring of hyperfluorescence (donut-shaped dye pooling). Subretinal fibrinoid deposit appeared in acute uveitic stage in two severe VKH patients and seemed to develop from subretinal exudates and evolved into typical subretinal fibrosis. Gradual transfiguration/migration and progressive proliferation/pigmentation of the subretinal fibrinoid deposit/subretinal fibrosis was observed in one patient. Conclusions Intraretinal cysts could form in various layers of the outer retina and may result from extension of choroidal inflammation. Subretinal fibrosis may develop from subretinal exudates in VKH patients and may cause substantial visual impairment.

Bilateral Macular Lesions Following Electrical Injury

HIGH-VOLTAGE electrical injuries can result in a variety of ocular complications.Cataract and macular edema are the most common injuries.1Other injuries include punctate keratopathy,uveitis,macular hole,subretinal macular haemorrhage,and choroidal atrophy.1-4 We report a case that optical coherence tomography(OCT)and multifocal electroretinogram(mf ERG)clearly demonstrated the

Systemic Lupus Erythematosus and Antiphospholipid Syndrome Related Retinal Vasculitis Mimicking Ocular Cysticercosis: a Case Report

MAKING accurate and timely diagnosis is often challenging when patients with a systemic disease first present with ocular manifestations.The possibility that vasculitis associated with systemic lupus erythematosus(SLE)and antiphospholipid syndrome(APS)can be misdiagnosed as cysticercosis has not been discussed in the literatures.

Bilateral diffuse uveal melanocytic proliferation associated with endometrial carcinoma–multimodal imaging analysis

Dear Editor,We present a rare case of bilateral diffuse uveal melanocytic proliferation (BDUMP) associated with endometrial carcinoma.BDUMP is a rare paraneoplastic ocular syndrome with generally poor prognosis.Typical features include:1) multiple subtle,round,or oval red patches in the retinal pigment epithelium (RPE) of the posterior fundus;2)multifocal areas of early hyperfluorescence corresponding to these patches;3) development of multiple,slightly elevated pigmented and non-pigmented uveal melanocytic tumours with diffuse thickening of the uveal tracts;4) exudative retinal detachment;5) rapid progression of cataracts.These patches progressively increase in size and merge into the giraffe-like pattern characteristic of BDUMP.Additional signs may be present,including cysts in the ciliary body and iris,dilated episcleral vessels,and a shallow anterior chamber.