Subretinal Fibrosis Research Articles

Sympathetic ophthalmia manifesting with conjunctival chemosis

A 13-year-old girl was referred to us with the complaints of severe headache and decreased visual acuity (VA) in the right eye, of 1 week duration. She had a history of penetrating ocular trauma in the left eye 1 month earlier. Her best-corrected VA was counting fingers in the right eye and no light perception in the left eye. External examination revealed a massive inferior conjunctival chemosis bilaterally (Fig. 1a). Slitlamp examination of the right eye showed 0.5? cells, no corneal precipitates, and mild vitritis. There were a cloud cornea and an iris distortion, and no posterior segment structures were visible in the traumatized eye. Fundus examination of the right eye revealed focal yellow–white lesions at the level of the retinal pigment epithelium (RPE), multifocal serous retinal detachment (SRD), and hyperemic optic disc (Fig. 1b). Fluorescein angiography showed multifocal leaks at the level of the RPE with pooling of dye in the area of SRD (Fig. 1c). Ultrasonography of the right eye showed marked, diffuse choroidal thickening (3 mm), and diffuse retroscleral edema with T-sign in the peripapillary region (Fig. 1d). In the traumatized eye, there was choroidal and ciliary body detachment. Optical coherence tomography of the right eye showed SRD with subretinal septa. A diagnosis of SO was made, and the patient was treated with intravenous methylprednisolone (1 g/day for 3 consecutive days) followed by oral administration of prednisone (1.5 mg/kg). Three days after presentation, intraocular inflammation had improved and conjunctival chemosis had completely resolved. One week later, the chemosis had recurred and the SRD became more extensive and bullous. Cyclosporin (5 mg/kg/day) and then infliximab (5 mg/kg/ 0–2–4–8 weeks) were added. After a follow-up of 3 months, conjunctival chemosis had disappeared (Fig. 2a) and VA was 20/200. SRD had resolved, and there were subretinal fibrosis with RPE proliferation (Fig. 2b). Ultrasonography showed resolution of choroidal thickening and retroscleral edema (Fig. 2c). S. Attia S. Jenzeri I. Chtioui B. Jelliti S. Zaouali S. B. Yahia M. Khairallah (&) Department of Ophthalmology, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia e-mail: moncef.khairallah@rns.tn

Immediate Vitrectomy With Silicone Oil Tamponade in Severe Ocular Injuries

Background: The trend in severe ocular injuries is to suture the lacerations and perform vitrectomy later. We describe immediate vitrectomy for severe ocular trauma in a prospective interventional case series. Methods: Immediate extensive vitreoretinal surgery (anterior segment rehabilitation, vitrectomy, drainage of choroidal hemorrhage, silicone endotamponade) was performed. The primary outcome was the functional outcome assessed as log Mar best-corrected visual acuity (BCVA). The secondary outcome was the anatomic success defined as permanent retinal attachment. Results: Seven eyes of 7 consecutive patients had severe posterior segment injuries: zone I (3 eyes), zone II (2 eyes), and zone III (2 eyes). Mean BCVA improved from a baseline value of 3.1 (hand motion [HM]) to a best postoperative value of 1.1 (6/80) (P = 0.016) to a final value of 1.5 (counting fingers [CF]4 m) (P = 0.016) with a mean follow-up of 24.9 months (range, 9-41 months; median, 25 months). Final anatomic success was achieved in 6 eyes. BCVA was severely affected by diffuse subretinal fibrosis (PVR) in 3 eyes (2 patients developed this form of PVR and BCVA deteriorated from CF at 3 m and 6/120 to CF at 30 cm and hand motion respectively; the third patient had an initial and final vision of hand motion. Conclusions: Immediate extensive vitreoretinal surgery in severe ocular trauma can achieve initial anatomic success and initial visual improvement in all cases with subsequent visual loss from proliferative vitreoretinopathy in some eyes.

High-dose iodine-125 episcleral brachytherapy for circumscribed choroidal haemangioma

AimsTo evaluate episcleral plaque radiotherapy with high-dose 125I for the treatment of circumscribed choroidal haemangioma (CCH).MethodsA retrospective review was performed of patients treated for CCH between 1995 and 2007. Brachytherapy...

Subretinal Fibrosis and Uveitis Syndrome in a Patient with Ectodermal Dysplasia

Purpose: To report a case of subretinal fibrosis and uveitis syndrome in association with ectodermal dysplasia.Methods: Chart review of a patient with subretinal fibrosis and uveitis syndrome and ectodermal dysplasia.Results: The authors identified one case of a patient with the diagnoses of subretinal fibrosis and uveitis syndrome and ectodermal dysplasia.Conclusions: This represents an uncommon case of a patient with the diagnoses of both subretinal fibrosis and uveitis syndrome and ectodermal dysplasia.

Fundus-Based and Electroretinographic Strategies for Stratification of Late-Stage Vogt-Koyanagi-Harada Disease Patients

To propose an analytic framework for ocular fundus alterations in late-stage Vogt-Koyanagi-Harada (VKH) disease, to describe the characteristics of overall retinal function as measured with full-field electroretinography (ERG), and to correlate the intensity of the fundus changes with full-field ERG alterations and to stratify patients accordingly. Cross-sectional case series. Forty-seven eyes of 26 patients with late-stage VKH disease (> 6 months past disease onset) followed-up at the University of São Paulo School of Medicine underwent fundus photography within 2 months of a full-field ERG examination, both according to predefined protocols. Fundus pictures were evaluated by two observers regarding diffuse fundus depigmentation, nummular lesions, pigment clumps, and subretinal fibrosis, and an overall analysis classified the fundus changes as mild, moderate, or severe. Full-field ERG results were analyzed according to fundus-based stratification and also were stratified into 3 groups solely on the basis of decreasing amplitudes (ERG based or cluster stratification). The concordance between fundus-based and full-field ERG-based stratification strategies was estimated. Overall fundus grading showed substantial interobserver concordance (kappa = 0.78). Comparison of full-field ERG parameters of the three fundus-based stratified groups showed diffusely diminished amplitudes with preservation of implicit times (P < .05). Fundus-based and full-field ERG-based stratification strategies also showed substantial concordance (kappa = 0.68). The analytic framework for fundus findings proposed in this study seems reproducible and useful, because the severity categories do correlate with retinal function as measured by full-field ERG. This system may allow more precise exchange of information between practitioners as well as researchers with regard to identifying patients with greater retinal compromise rapidly as well as in comparison of outcomes of different treatment regimens.

Visual rehabilitation in pre phthisis bulbi's patient: case report

Uveitis is a group of intraocular inflammatory diseases that affects mainly patients of working age. Vogt-Koyanagi-Harada disease is a chronic, granulomatous, systemic and autoimmune disease with manifestations in the eye, skin, and hearing and nervous systems. Ocular complications include cataract, glaucoma, choroidal neovascular membrane formation, and subretinal fibrosis, which can lead to phthisis bulbi with profound low vision or even blindness. The purpose of this article is to present the visual rehabilitation of a young patient with pre phthisis bulbi as a complication of the uveitis. During the active stage of the disease the patient quit her studies in a crucial phase of her life. After clinical treatment and surgery, training program of optical device adaptation and residual visual optimization were performed. Due to the great patient's motivation, it was possible to reintegrate her to social life.

RETINAL ANGIOMATOUS PROLIFERATION

To investigate the natural history and visual outcome in eyes with untreated retinal angiomatous proliferation, a neovascular form of age-related macular degeneration. Fourteen consecutive white patients (11 women, 78%; mean age, 74 years) with 16 eyes affected by retinal angiomatous proliferation were prospectively followed-up without treatment by means of complete ophthalmologic examinations at regular intervals, including best-corrected visual acuity and dynamic fluorescein and indocyanine green angiography using a scanning laser ophthalmoscope. The patients were observed for a mean of 20 months (range, 6-44 months). Mean visual acuity in the eyes with retinal angiomatous proliferation was 0.48 at the initial examination, decreased to 0.23 after 6 months, and was 0.19 at the final examination, with a mean decrease of 6 lines from baseline. In 13 eyes (81%), visual acuity deteriorated by 2 Early Treatment Diabetic Retinopathy Study lines or worse by the time of the 6-month examination, and 31% of the patients had experienced severe loss of vision; the remaining 3 eyes (19%) showed a relatively stable clinical course and visual acuity. By the time of the final examination, visual acuity had decreased to 0.1 or worse in 11 eyes (69%), and 5 of the 14 patients (36%) were legally blind. At the final examination, 10 eyes (62%) showed a subretinal fibrosis and 9 (56%) showed a retinal choroidal anastomosis. Retinal angiomatous proliferation is a distinct form of neovascular age-related macular degeneration with high vasogenic potential, having its own clinical course and visual prognosis. The poor visual outcome is because of the exudative nature of the retinal angiomatous proliferation, and progression to poor vision is common and rapid (within 3 months in faster cases, and within 1 year in slower cases). The treatment options for this type of neovascular lesion should be planned bearing in mind its unfavorable natural history.

RISK FACTORS FOR POSTERIOR CYSTOID RETINAL DEGENERATION IN CENTRAL SEROUS CHORIORETINOPATHY

To identify factors associated with the development of posterior cystoid retinal degeneration (PCRD) in central serous chorioretinopathy (CSC). The authors retrospectively studied 51 eyes of 51 patients with chronic CSC and subretinal or intraretinal exudation documented by optical coherence tomography (OCT), and evaluated the association of hypertension, systemic use of corticosteroids, duration of symptoms, subretinal fibrosis, and large laser scars with the development of PCRD. Twenty-four eyes (47%) had PCRD and 27 eyes (53%) had serous macular detachment without cystoid retinal changes. Multivariate analysis showed that a duration of symptoms exceeding 5 years (odds ratio [OR], 25.4; 95% confidence interval [CI], 2.8-233.2; P = 0.004) and subretinal fibrosis (OR, 19.1; 95% CI, 1.8-205.1; P = 0.015) were significantly associated with PCRD. Disease duration longer than 5 years and subretinal fibrosis are associated with the development of PCRD in CSC. Prospective evaluations could substantiate the associations found in this study and further clarify their significance.

Maculopathy associated with angioid streaks

Abstract Purpose To present choroidal neovascularization and macular atrophy without neovascularization associated with angioid streaks by means of two case reports. Methods Two middle aged man (42 an 46 years old) with angioid streaks were evaluated. The first pacient showed choroidal neovascularization and subretinal fibrosis, which was treated with intravitreal ranibizumab. The second case had macular atrophy in one eye in association with subretinal fibrosis in the contralateral eye. Results A single dose of intravitreal ranibizumab improved the structural features of exudative maculopathy. Functional improvement (visual acuity) was less important because of subretinal fibrosis. Atrophic maculopathy was not susceptible to treatment. Conclusion Angioid streaks diagnosis is usually late. It must be suspect in middle aged pacients with choroidal neovascularization and their visual prognosis depends on early treatment. Macular atrophy associated to angioid streaks is very uncommon.

Comparison of Lucentis monotherapy vs. combination therapy for neovascular AMD

Abstract Purpose To compare the efficacy of neovascular AMD(NAMD) treatment options by monthly Lucentis(L)(monotherapy), combination therapy utilizing RF‐PDT(P), and Lucentis combined with Kenalog(LK). Methods IRB‐approved retrospective chart review of therapies administered only as‐needed over 20 months. Inclusion criteria: active primary/recurrent subfoveal or juxtafoveal CNV (all types); Snellen BCVA ≥20/400. Exclusion criteria: f/u &lt;3 months or noncompliance; subfoveal atrophy/fibrosis. Kenalog offered with Lucentis when active PED or subretinal fibrosis threatening fovea. RF‐PDT combined with Avastin ± Kenalog(PA±K) or Kenalog alone(PK). Primary outcome measure: mean change in Snellen VA from baseline at last f/u. Secondary outcome measures: incidence of moderate/severe VA change; resolution of leakage; treatment‐free interval. Results 21 eyes received L; 16 eyes LK; 10 eyes RF‐PDT (5 PA±K; 5 PK). Mean f/u was 8.8 (range 3–18) months. At last f/u, mean Snellen VA for L improved ‐0.25; RF‐PDT remained stable +0.06 overall (although PA±K improved ‐0.135; PK worsened +0.27); LK worsened +0.13 logMAR units (p=0.02 for L vs. LK). VA loss &lt;15 letters was greater for L&gt;PA±K&gt;LK&gt;PK, occurring 91%, 80%, 75%, 60%, respectively. 14% L gained ≥30 letters. 20% PK lost ≥30 letters. Leakage resolved greater for L&gt;PA±K&gt;LK&gt;PK, occurring 86%, 80%, 69%, 40%, respectively. Conclusion At intermediate‐term f/u, Lucentis monotherapy administered only as‐needed had results similar to larger studies and was the most effective in maintaining or improving VA in NAMD. Lucentis monotherapy had the greatest leakage resolution and treatment‐free interval. RF‐PDT with Avastin was more effective than with Kenalog alone. Kenalog supplementation to Lucentis unlikely provided added benefit.

Hemangioma circunscrito de coroides tratado con terapia fotodinámica

A 45-year-old male referred with a scotoma in the left eye of 2 months' evolution. A peripapillary tumor was found, with a basal diameter of 7 mm and thickness 3.4 mm. It was diagnosed as a circumscribed choroidal hemangioma. It was decided to treat the patient using photodynamic therapy. After 4 sessions and 17 months follow-up, the patient remained asymptomatic and visual acuity was stable. There was evidence of subretinal fibrosis and no subretinal fluid was found. Photodynamic therapy is a good option for the treatment of circumscribed choroidal hemangioma given the minimal damage is causes to the adjacent retina.

Anti-sphingosine-1-phosphate monoclonal antibodies inhibit angiogenesis and sub-retinal fibrosis in a murine model of laser-induced choroidal neovascularization

The efficacy of novel monoclonal antibodies that neutralize the pro-angiogenic mediator, sphingosine-1-phosphate (S1P), were tested using in vitro and in vivo angiogenesis models, including choroidal neovascularization (CNV) induced by laser disruption of Bruch's membrane. S1P receptor levels in human brain choroid plexus endothelial cells (CPEC), human lung microvascular endothelial cells, human retinal vascular endothelial cells, and circulating endothelial progenitor cells were examined by semi-quantitative PCR. The ability of murine or humanized anti-S1P monoclonal antibodies (mAbs) to inhibit S1P-mediated microvessel tube formation by CPEC on Matrigel was evaluated and capillary density in subcutaneous growth factor-loaded Matrigel plugs was determined following anti-S1P treatment. S1P promoted in vitro capillary tube formation in CPEC consistent with the presence of cognate S1P1–5 receptor expression by these cells and the S1P antibody induced a dose-dependent reduction in microvessel tube formation. In a murine model of laser-induced rupture of Bruch's membrane, S1P was detected in posterior cups of mice receiving laser injury, but not in uninjured controls. Intravitreous injection of anti-S1P mAbs dramatically inhibited CNV formation and sub-retinal collagen deposition in all treatment groups (p<0.05 compared to controls), thereby identifying S1P as a previously unrecognized mediator of angiogenesis and subretinal fibrosis in this model. These findings suggest that neutralizing S1P with anti-S1P mAbs may be a novel method of treating patients with exudative age-related macular degeneration by reducing angiogenesis and sub-retinal fibrosis, which are responsible for visual acuity loss in this disease.

A prospective study on intravitreal bevacizumab (Avastin®) for neovascular age‐related macular degeneration of different durations

Choroidal neovascularization (CNV) accounts for 85-90% of severe visual impairment in age-related macular degeneration (AMD). Vascular endothelial growth factor (VEGF) is a major factor mediating angiogenesis, and VEGF inhibitors have become a new treatment modality. In this prospective study, we used bevacizumab (Avastin), a recombinant monoclonal antibody to VEGF, to treat neovascular AMD. The case material comprised 36 subjects (26 females, 10 males) aged 65-88 years with subfoveal neovascular AMD with all subtypes of CNV. There were two categories of patients: category I, long-standing CNV (12 months or more), preoperative visual acuity (VA) 0.16 (mean); category II, CNV (duration < 12 months), preoperative VA 0.25 (mean). Evaluation protocol included the Early Treatment Diabetic Retinopathy Study (ETDRS) VA, clinical ophthalmological examination, fluorescein angiography and optical coherence tomography (OCT). Intravitreal injections of bevacizumab (Avastin) (IVB), 1.25 mg (0.05 ml), were given under an operating microscope and aseptic conditions in a theatre for surgery with intervals of 4 or 6 weeks during the first 3 months and subsequently according to clinical assessment. The follow-up was 6 months in all cases. At 6 months, mean VA had improved by 4.6 ETDRS letters in the entire case material (P = 0.001), by 3.9 letters in category I (duration 12 months or more) and by 6.0 letters in category II (duration < 12 months). A total of 148 IVB (mean 4.1 injections/eye) were delivered during 6 months, the first 3 months comprising 3.1 IVB (mean) and the last 3 months 1.0 IVB (mean). No eyes suffered visual decline of 15 ETDRS letters. Fluorescein angiograms displayed stabilization or regression of CNV activity; OCT showed resorption of intraretinal oedema and subretinal fluid. No severe complications occurred but recurrence was common, and repeated IVBs were necessary in most cases during the 6-month period. When addressing the issue of frequency of IBV, we observed that 6-week intervals were sufficient because VA and CNV lesions generally stabilized at 4 weeks. The gain in VA was promising in eyes with < 12 months CNV duration. Even in eyes with a longer CNV duration, a slight visual improvement was observed when retinal oedema resorbed, although subretinal fibrosis and general cellular damage certainly limited recovery.

Posterior Cystoid Retinal Degeneration in Central Serous Chorioretinopathy

To study the pattern of cystoid retinal changes in the posterior fundi of eyes with chronic central serous chorioretinopathy (CSC) using optical coherence tomography (OCT). We retrospectively studied 34 eyes with chronic CSC and cystoid retinal changes at the posterior pole documented by OCT. We analyzed the distribution of cystoid retinal changes with respect to the fovea and chorioretinal lesions. Generally, cystoid retinal changes occurred in the papillomacular region (21 eyes); foveal involvement was observed in 20 eyes. Large cystoid changes in the central macula with concentric perifoveal lesion extension were detected in three eyes. Cystoid changes tended to occur where the retina adhered to subretinal fibrosis, large laser scars, or spontaneous atrophy of the retinal pigment epithelium and the choroid. Visual acuity ranged from 20/20 to 20/400. In nine eyes in which the cystoid changes spared the foveal center, visual acuity was 20/40 or better. Cystoid retinal degeneration in eyes with chronic CSC was distributed outside of the fovea and was not necessarily associated with severely reduced visual acuity. "Posterior cystoid retinal degeneration" defines this pathologic pattern appropriately. OCT findings suggest that intraretinal exudation and cystoid changes in chronic CSC develop through the formation of chorioretinal adherences.

SUBRETINAL HEMORRHAGE AFTER LENS-SPARING VITRECTOMY IN INFANTS BORN AT OR UNDER 24 WEEKS GESTATION

To describe short term outcomes in a case series of infants with rapidly progressive retinopathy of prematurity (ROP) requiring laser and lens-sparing vitrectomies (LSV) at early postmenstrual ages (PMAs). Retrospective chart review of infants born at or under 24 0/7 weeks consecutively referred for management of severe ROP between August 2006 and January 2007. Five female infants (mean gestational age 23 4/7 weeks, mean birthweight 514.4 g) required laser treatment bilaterally for zone 1 or posterior zone II ROP at 35-37 weeks PMA. LSV was performed for progressive stage 4 ROP in eight eyes at 37-39 weeks PMA (mean 38.2 weeks). Subretinal hemorrhage occurred after LSV in five eyes, with three developing subretinal fibrosis preventing complete retinal reattachment. Premature infants in this series had rapidly progressive ROP requiring laser and LSV at early PMAs. Subretinal hemorrhage occurred and may be related to the amount of laser necessary to treat large zones of avascular retina, and the early timing of vitrectomy when postoperative contracting preretinal vitreous no longer has the natural tamponading force of formed gel against it. Improved therapies for premature infants of very young gestational ages and large avascular zones are needed.

Expression of VLDLR in the Retina and Evolution of Subretinal Neovascularization in the Knockout Mouse Model’s Retinal Angiomatous Proliferation

Very-low-density lipoprotein receptor (VLDLR) in knockout mice (vldlr(-/-)) has been reported to induce subretinal neovascularization. Therefore, VLDLR expression in the wild-type mouse retina was investigated and the retinal angiogenic process in vldlr(-/-) mice was characterized. VLDLR expression in the retina and in purified retinal vascular endothelial cells (RECs) and retinal pigment epithelial (RPE) cells was determined by reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry. Angiogenic evolution in vldlr(-/-) mice was examined by fundus fluorescein angiography, histology, double-staining of FITC-dextran perfusion and elastin immunohistochemistry, isolectin staining, and confocal fluorescence microscopy. VLDLR mRNA was detected in the wild-type mouse retina and in purified RECs and RPE cells. The VLDLR protein was localized in the RPE layer, vessels in the ganglion cell layer, and around the outer limiting membrane of the retina. The retinal pathogenic process in vldlr(-/-) mice recapitulates key features of retinal angiomatous proliferation (RAP) in humans, a subtype of neovascular age-related macular degeneration (AMD). These include neovascular growth originating from retinal vessels and progressing to the subretinal space with intraretinal, subretinal, and choroidal angiogenic stages, RPE disruption and Bruch membrane exposure, retinal-choroidal anastomosis, subsequent photoreceptor degeneration, RPE hyperplasia, and subretinal fibrosis at the end stage. VLDLR is expressed in the wild-type mouse retina, especially in RECs and RPE cells. The vldlr(-/-) mouse exhibits histologic and angiographic characteristics of RAP and is a reproducible animal model facilitating studies of the molecular mechanisms of RAP.

Vasoproliferative tumor of the retina in association with spontaneously reattached rhegmatogenous retinal detachment.

To report a case of spontaneously reattached rhegmatogenous retinal detachment seen in association with a vascularized tumor fitting the clinical features of a vasoproliferative tumor. Case report. A 38-year-old man presented with retinal findings compatible with those seen in patients with spontaneously reattached rhegmatogenous retinal detachments (presence of pigment in the vitreous, multiple high-water marks, chorioretinal and retinal pigment epithelial changes, and subretinal fibrosis) and a vascularized tumor fitting the clinical features of a vasoproliferative tumor. A vasoproliferative tumor of the retina can arise after spontaneous resolution of a rhegmatogenous retinal detachment.

Vitrectomy for Epimacular Membrane Secondary to Adult-Onset Coats’ Disease

The authors describe the management of an epimacular membrane secondary to adult-onset Coats' disease. A 26-year-old man presented with decreased vision (20/120) in the right eye for 4 months. Fundus examination revealed features suggestive of Coats' disease, with a thick epimacular membrane. Optical coherence tomography revealed underlying macular thickening. The patient underwent vitrectomy with removal of the epimacular membrane and internal limiting membrane; peripheral telangiectasia were simultaneously photocoagulated. Postoperatively, his visual acuity improved to 20/20, which remained stable for 12 months. Vitrectomy yields an excellent anatomical and functional outcome in epimacular membrane due to adult-onset Coats' disease, if performed before macular exudation leads to subretinal fibrosis.

Anatomy and Function of the Macula After Surgery for Retinal Detachment Complicated by Proliferative Vitreoretinopathy

To investigate the macular changes following silicone oil removal after surgery for complicated retinal detachment (RD) with proliferative vitreoretinopathy (PVR). Retrospective interventional case series. setting: Vienna, Austria. study population: Thirty-nine patients with attached retina after silicone oil removal following previous vitrectomy and silicone oil tamponade for complicated RD and PVR grade C3 and worse. observation procedures: Examination of macular anatomy with biomicroscopy, optical coherence tomography (OCT), and fluorescein angiography (FA). Macular function was tested by assessing logMAR distance visual acuity (VA) using Early Treatment Diabetic Retinopathy Study (ETDRS) charts and reading acuity and reading speed using a standardized test (Radner charts). main outcome measures: Macular anatomy, VA, reading acuity, and reading speed. The macula was clinically normal in five patients (12.8%). Retinal pigment epithelium (RPE) irregularities were found in nine patients (23.1%). Eight patients (20.5%) had macular pucker, seven (18.0%) had cystoid macular edema (CME), and 10 (25.6%) had subretinal fibrosis. The mean VA of all patients was logMAR 0.67 +/- 0.68 (range, -0.1 to 3.0). Six eyes did not achieve reading acuity. The distance VA of the remaining 33 eyes was logMAR 0.44 +/- 0.29 and their mean reading acuity was logRAD 0.62 +/- 0.35, with a reading speed ranging from 55 to 240 words per minute. We found macular changes in 87% of the patients, one-third thereof being eligible for further treatment (macular pucker or CME). Thus, the majority of these patients do not seem to be eligible for a further improvement of anatomic or functional outcome.

Vogt-Koyanagi-Harada disease in children

To identify prognostic factors for outcome in children with Vogt-Koyanagi-Harada (VKH) disease. All children 16 years and younger with acute uveitis associated with VKH disease treated between 1999 and 2006 were reviewed. Twenty-three children (46 eyes) were identified; 20 (87%) girls and three (13%) boys with a mean age at presentation of 12.5+/-2.4 years. Mean follow-up period was 48.6+/-30.8 months. Visual acuity of 20/40 or better was achieved in 38 (82.6%) eyes. Eleven eyes developed at least one complication, including cataract in eight eyes, glaucoma in eight eyes, subretinal neovascular membranes in two eyes, and subretinal fibrosis in one eye. Disease recurred during follow-up in 18 eyes. Development of complications was negatively associated with final visual acuity of 20/20 (P=0.0317). Shorter interval between symptoms and treatment was a predictor of final visual acuity of 20/20 (odds ratio=10.4; 95% confidence interval=1.61-67.3). Recurrence of inflammation was significantly associated with development of complications (P=0.003), worse visual acuity (P=0.022) and presence of posterior synechiae of the iris at presentation (P=0.0083), longer interval between symptoms and treatment (P=0.013), initial treatment with intravenous corticosteroids (P=0.0012), and rapid tapering of corticosteroids (P=0.0063). Visual prognosis of VKH in children is generally favourable. Clinical findings at presentation, development of complications, interval between symptoms and treatment, recurrence of inflammation, use of intravenous corticosteroids, and method of tapering of systemic corticosteroids were significant prognostic factors.