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PubMed2005

Quantification and anatomic distribution of choroidal abnormalities in patients with type I neurofibromatosis.

BACKGROUND: Choroidal abnormality manifesting as a bright patchy lesion under infrared monochromatic light has previously been described in neurofibromatosis type I patients in whom the choroid appears normal under conventional ophthalmoscopic examination or on the fluorescein angiogram. We investigated the correlation between patient age and the number of choroidal abnormalities, as well as the anatomic distribution of choroidal abnormalities in the fundus. METHODS: We examined the fundus of 28 eyes in 14 patients with neurofibromatosis type I. Patients ranged in age from 2 to 38 years and were examined between April 2001 and April 2002 by confocal scanning laser ophthalmoscopy with infrared monochromatic light (780 nm wavelength). We divided the fundus into five regions (one within the retinal vascular arcade and those supero-temporal, infero-temporal, supero-nasal, and infero-nasal to it), and lesions on the border between regions were assigned to the region containing the greater part of the lesion. We studied the total number of choroidal abnormalities and the correlation between the total number and age. RESULTS: A positive correlation was found between the total number of choroidal abnormalities and age (Spearman rank correlation coefficient, r=0.6209, P=0.0178). There was a significantly greater number of choroidal abnormalities in the arcade region than in the other four regions (ANOVA, P<0.001). CONCLUSIONS: Choroidal abnormalities tend to increase with age and are most often observed within the vascular arcade.

Adolescent↗
PubMed2006

Circumscribed choroidal hemangioma: A case report and review of the literature.

BACKGROUND: Choroidal hemangioma is a rare, benign vascular ocular tumor that presents as either a circumscribed mass or as a diffuse variant. Circumscribed choroidal hemangiomas (CCH) resemble posterior segment lesions such as choroidal melanoma, choroidal metastases, central serous chorioretinopathy, or nonspecific retinal detachment. A circumscribed choroidal hemangioma often appears as a subtle red-orange mass or as a grayish lesion in the posterior choroid. In rare instances, CCH may be associated with subretinal fluid accumulation and retinal detachment. CASE REPORT: A 35-year-old Hispanic man presented for a routine eye examination and was observed to have a choroidal lesion in the posterior pole. The lesion is an elevated subretinal mass located superotemporal to the fovea in the right eye. A Humphery visual field 24-2 test found a scotoma corresponding to the location of the lesion. B-scan ultrasound confirmed a fairly dense and large lesion. A-scan showed low to medium internal reflectivity and an acoustically solid lesion. Because the patient was asymptomatic, management through observation was recommended. CONCLUSIONS: Circumscribed choroidal hemangiomas must be adequately differentiated from other vascular tumors. A selective battery of diagnostic tests will facilitate the correct diagnosis. Management of CCH may depend on the character of the lesion and risks of ocular morbidity and vision loss.

Adult↗
PubMed1984

Choroidal granuloma in sarcoidosis.

We examined two patients--a 33-year-old black man and a 62-year-old white woman--who had pale yellow choroidal tumefactions with subretinal fluid and reduced vision. One patient had a history of granulomatous iritis; both patients were initially thought to have metastatic choroidal carcinoma. Systemic investigation yielded positive tissue diagnosis for sarcoidosis, leading to the diagnosis of presumed sarcoid choroidal infiltration. There was striking absence of inflammation of the retina, retinal vessels, and vitreous cavities. Fluorescein angiography disclosed initial hypofluorescence and late hyperfluorescence and ultrasonography demonstrated medium internal reflectivity. Neither study could exclude metastatic choroidal carcinoma. One patient had an increased level of angiotensin-converting enzyme on serial determinations through 15 months of observation and during treatment with corticosteroids, indicating a good correlation with improved vision and flattening of the choroidal granuloma. In both cases there was only partial resolution of the choroidal granuloma with corticosteroids. We conclude that choroidal granuloma can be the sole ocular manifestation of sarcoidosis and in this context is likely to be confused with metastatic choroidal carcinoma. We also believe that biopsy confirmation is needed because noninvasive tests such as gallium scans and angiotensin-converting enzyme cannot be relied on for diagnosing sarcoidosis and excluding carcinoma.

Adult↗
PubMed2003

Choroidal osteoma: observations from a community setting.

PURPOSE: To determine the characteristics of choroidal osteoma arising from a previously unreported patient population and to document new observations in this condition. DESIGN: Retrospective, observational case series. PARTICIPANTS: Eleven consecutive patients seen from 1986 through 2002 with choroidal osteoma from one community-based retina practice. INTERVENTION: Laser ablation of subretinal neovascularization in two cases and focal laser treatment of retinal pigment epithelial leaks in one case. METHODS: Photographs, fluorescein and indocyanine green angiograms, and clinical records were analyzed. MAIN OUTCOME MEASURES: Demographic variables, visual acuity, complications of laser treatment, growth of lesions, and associated funduscopic changes. RESULTS: Choroidal osteoma from a community setting is more frequently asymptomatic (5/11 cases; 45%) than in previously reported university series, is usually initially misdiagnosed, and is not rare. Light-intensity focal laser photocoagulation for serous retinal detachment unaccompanied by subretinal neovascularization can resolve fluid (1/11 cases; 9%). Laser ablation of secondary subretinal neovascularization stimulates rapid choroidal osteoma vascular remodeling (2/11 cases; 18%) and can cause retina-osteoma venous and arterial anastomoses (1/11 cases; 9%). Spontaneous choroidal hemorrhage unaccompanied by subretinal neovascularization can occur with confinement to the osteoma borders (1/11 cases; 9%). Association of choroidal osteoma with retinitis pigmentosa is reported. CONCLUSIONS: These data on choroidal osteoma natural history and treatment help clinicians managing these lesions. In the community, a higher index of suspicion for choroidal osteoma is warranted.

Adolescent↗
PubMed2004

Polypoidal choroidal vasculopathy.

BACKGROUND: Polypoidal choroidal vasculopathy (PCV) is a unique form of occult choroidal neovascular membrane. The clinical presentation and angiographic findings distinguish idiopathic PCV from other known neovascular and choroidal degenerative disorders. The characteristic morphology of PCV includes the presence of a branching network of inner choroidal vessels with terminal aneurysmal dilations. Other key findings include subtle nodular protrusions, which may precede multiple serosanguineous retinal pigment epithelial detachments. If Bruch's membrane is compromised, there is an additional risk of exudative retinopathy or vitreal hemorrhage. CASE REPORTS: Three patients with polypoidal choroidal vasculopathy are described with visual impairment secondary to irregular choroidal vascular lesions producing recurrent subretinal hemorrhages and exudative retinopathy. CONCLUSIONS: The characteristic presentation and clinical course of polypoidal choroidal vasculopathy distinguish it from the typical presentation of age-related macular degeneration and other causes of hemorrhagic and exudative retinopathy. Imaging techniques such as fluorescein angiography, indocyanine green angiography, and optical coherence tomography may assist in the accurate diagnosis of PCV, so that appropriate treatment and management can be provided. In patients who manifest exudative, hemorrhagic retinopathy, with no signs of active inflammation or an anatomic predisposition to choroidal neovascularization, PCV should be considered.

Aged↗
PubMed1997

Choroidal abnormalities in birdshot chorioretinopathy: an indocyanine green angiography study.

Birdshot chorioretinopathy is a rare inflammatory disorder with an insidious onset that can slowly progress to severe visual loss. The pathogenesis is unknown. This study used indocyanine green (ICG) angiography to investigate the degree of choroidal vascular involvement with progression of disease and to determine the nature of the birdshot lesions. Seven patients with birdshot chorioretinopathy had ICG angiography performed with a scanning laser ophthalmoscope at various stages of clinical disease. Results were compared with fluorescein fundal angiography (FFA). All large choroidal vessels appeared normal. The birdshot lesions were demonstrated with ICG but not with FFA and were represented by dark areas on ICG angiography. Typically these areas were bordered by large or medium-sized choroidal vessels and their appearance suggested small choroidal vessel hypoperfusion. In disease of recent onset, some lesions masked fluorescence from large underlying choroidal vessels possibly due to inflammatory choroidal infiltrates. In long-standing disease, the choroidal angioarchitecture was relatively normal within the birdshot lesions. This study of birdshot chorioretinopathy demonstrates abnormalities in the small choroidal vessels within the birdshot lesions. ICG angiography detects the birdshot lesions more readily than FFA and may be of benefit in assessing disease activity.

Adult↗
PubMed1993

[Bilateral choroid osteoma].

BACKGROUND: Choroidal Osteoma is a rare, typically monolateral benign ossifying tumor of the choroid found in healthy females aged 10 to 30 years. In contrast, multiple idiopathic sclerochoroidal calcifications occur in elderly otherwise healthy subjects. Local or generalized distortions of calcium phosphate metabolism may cause secondary choroidal calcifications. PATIENT: We report on a 56-year-old woman, who underwent removal of a histologically verified osteoma 2 years ago. Ophthalmoscopically, there were multiple prominent choroidal tumors in the inferior midperiphery of both eyes. Ultrasonography showed high reflectivity and marked shadowing posterior to the lesion. CT-scan demonstrated the presence of calcifications. The patient neither belonged to the age group, in which choroidal osteomas are typically found, nor were the lesions located in the typical manner as reported in literature. The location in the inferior choroid has not yet been described for idiopathic sclerochoroidal calcifications. The presence of secondary choroidal calcifications was very unlikely, as there was no history of ocular inflammation or systemic disease such as hyperparathyreoidism or chronic renal failure. CONCLUSION: Thus, despite the lack of histologic examination, one may assume the rare incidence of bilateral choroidal osteomas in atypical inferior localisation in our patient.

Choroid↗
PubMed2006

Aquaporin(s) expression in choroid plexus tumours.

OBJECTIVE: It was the aim of this study to investigate the pattern of aquaporin 1 (AQP1) expression in normal and neoplastic choroid plexus, with specific reference to the association with communicating hydrocephalus or liquoral cysts. Second, to infer a new view on the cerebrospinal fluid plexus production and on the etiology of the cysts and communicating hydrocephalus occasionally associated with choroid plexus papillomas. MATERIALS AND METHODS: Nineteen paraffin-embedded specimens, 10 of normal choroid plexus and 9 of choroid plexus tumours, were immunostained with a monoclonal antibody raised against the intracellular C-terminal AQP1 epitope. Results were analysed in terms of intensity and intracellular distribution of immunostaining and in terms of number of stained cells; they were considered in light of the clinical association with hydrocephalus or liquoral cysts. RESULTS: AQP1 was heavily expressed in the apical side of the choroid epithelium in normal plexus specimens. Choroid plexus papillomas showed a very heterogeneous pattern of AQP1 expression. Immunostaining was absent in the case of choroid plexus carcinoma. Very strong to strong and diffuse AQP1 expression in large to very large papillomas was associated with liquoral cysts or communicating hydrocephalus. CONCLUSIONS: AQP1 expression characterizes normal choroid plexus and plexus papillomas. Intensity and diffusion of AQP1 expression together with the size of the tumour mass are somewhat predictive of communicating hydrocephalus or liquoral cyst, lesions possibly caused by a disturbance of cerebrospinal fluid homeostasis.

Aquaporin 1↗
PubMed2005

Inhibitory effect of nifedipine on tumor necrosis factor alpha-induced neovascularization in cultured choroidal explants of streptozotocin-diabetic rat.

We have previously reported that the Nepsilon (carboxymethyl)lysine (CML) adduct, a major structure of an advanced glycation end product, facilitates proliferation of CD34+ endothelial progenitor cells budded from cultured choroidal explants and produces immature vessel-like structures in fibrin gel. The CML adduct is accumulated and facilitates immature neovascularization in cultured choroidal explants of streptozotocin (STZ)-induced diabetic rat. The CML-enhanced neovascularization activity is associated with the actions of tumor necrosis factor (TNF) alpha, vascular endothelial growth factor and platelet-derived growth factor released from the choroidal explant (Kobayashi et al., Biol. Pharm. Bull., 27, 1382-1387 (2004); 27, 1565-1571 (2004)). The present study was investigated an inhibitory effect of a dihydropyridine calcium antagonist nifedipine on TNF alpha-induced choroidal neovascularization in the STZ-diabetic rat. TNF alpha (1-100 ng/ml) increased neovascularization of cultured choroidal explants in the age-matched normal rat but did not increase it in the diabetic rat. Anti-TNF alpha antibody (1 : 1000) decreased the neovascularization in the diabetic rat but not in the normal rat. Nifedipine (1 microM) inhibited TNF alpha-induced neovascularization of the normal choroidal explant in a non-competitive manner. Nifedipine (1 microM) also inhibited the diabetic state-induced neovascularization and its inhibitory action was reversed by TNF alpha (1-10 ng/ml). In conclusion, STZ-diabetic state facilitated choroidal neovascularization through the release of TNF alpha. Nifedipine inhibited the action of TNF alpha probably by blocking voltage-dependent Ca2+ channels in the endothelial progenitor cells of the diabetic choroid.

Animals↗
PubMed1998

Choroidal hemangioma: MR findings and differentiation from uveal melanoma.

BACKGROUND AND PURPOSE: The aim of this study was to establish the MR imaging characteristics of choroidal hemangioma and to compare them with those of uveal melanoma. METHODS: Among 41 patients examined at 1.5 T (4-cm surface coil, T1-weighted and fast spin-echo T2-weighted sequences), 25 had uveal melanoma and 16 had circumscribed choroidal hemangioma. After i.v. bolus injection of gadopentetate dimeglumine, dynamic and T1-weighted sequences were acquired. RESULTS: In patients with choroidal hemangioma, uniform signal characteristics were detected on fast T2-weighted images. In 15 of 16 patients with choroidal hemangioma, lesions were isointense with vitreous on fast spin-echo T2-weighted images, whereas lesions in 24 of 25 patients with uveal melanoma were hypointense. Signal characteristics of uveal melanoma and hemangioma did not differ significantly on plain T1-weighted images. Enhancement was earlier and much stronger for circumscribed choroidal hemangioma than for uveal melanoma. After i.v. bolus application of gadopentetate dimeglumine, the increase of signal intensity was higher for circumscribed choroidal hemangioma (signal intensity ratio, 5.8) than for uveal melanoma (signal intensity ratio, 2.2). CONCLUSION: Circumscribed choroidal hemangioma may be difficult to differentiate from melanoma by ophthalmologic examination. Differentiation may not be possible if direct viewing of uveal space-occupying lesions is hampered by opaque vitreous media. The characteristic findings on fast spin-echo T2-weighted MR images and early enhanced images aid in differentiating choroidal hemangioma from uveal melanoma.

Adolescent↗
PubMed2003

Observation of choroidal circulation using index of erythrocytic velocity.

OBJECTIVE: To describe a noninvasive method to visualize choroidal circulation by means of erythrocytic velocity. METHODS: Laser speckle flowgraphy (LSFG) and indocyanine green (ICG) angiography were performed on 9 volunteers. The LSFG measures the quantitative relative velocity index of erythrocytes (normalized blur [NB] value) in retinal and choroidal vessels. We averaged NB values from 3 pulsations and made composite 1.5-mm-square NB maps during 1 pulsation. By overlapping 5 adjacent maps, we created a panoramic 3.0-mm-square NB map of the posterior pole. The vascular patterns of the panoramic map and ICG angiography were compared. To determine the influence of retinal vessels, we induced branch retinal artery occlusion in 2 monkey eyes and compared the panoramic maps before and after occlusion. RESULTS: The NB map showed pulsatile blood flow in choroidal and retinal vessels. Vascular pattern contrast was improved in the NB map. Choroidal vessels in ICG angiography corresponded to those in the NB map. Vascular patterns in the map changed little before and after branch retinal artery occlusion. CONCLUSIONS: The LSFG noninvasively visualized the hemodynamics of choroidal circulation, and the vascular pattern, which is mainly choroidal in origin, was comparable with that of ICG angiography. CLINICAL RELEVANCE: The LSFG may be used to evaluate choroidal hemodynamics in various choroidal diseases.

Adult↗
PubMed1979

Ultrasonographic features of choroidal malignant melanomas.

In a 12-month period 26 eyes were enucleated after an ultrasonographic diagnosis was made of malignant melanoma of the choroid. Histologic features of the tumors were reviewed. The ultrasonographic diagnosis was correct in 100% (26/26) of enucleated eyes. Spontaneous vascular movement (SVM) was identified by standardized A-scan echography in 69% (18/26) of the tumors. Contact B-scan ultrasonography demonstrated choroidal excavation in 65% (17/26) of the melanomas. During the 12-month study period, choroidal excavation was also demonstrated in cases of metastatic choroidal tumors, hemangiomas of the choroid, and long-standing choroidal nevi. The standardized A-scan finding of SVM is a compelling sign in the diagnosis of choroidal malignant melanoma. In contrast, the B-scan finding of choroidal excavation is a less useful sign since it may also be seen in various other ocular lesions.

Aged↗
PubMed2001

Involvement of the choroid plexus in central nervous system inflammation.

During inflammatory conditions in the central nervous system (CNS), immune cells immigrate into the CNS and can be detected in the CNS parenchyma and in the cerebrospinal fluid (CSF). The most comprehensively investigated model for CNS inflammation is experimental autoimmune encephalomyelitis (EAE), which is considered the prototype model for the human disease multiple sclerosis (MS). In EAE autoagressive CD4(+), T cells gain access to the CNS and initiate the molecular and cellular events leading to edema, inflammation, and demyelination in the CNS. The endothelial blood-brain barrier (BBB) has been considered the obvious place of entry for the circulating immune cells into the CNS. A role of the choroid plexus in the pathogenesis of EAE or MS, i.e., as an alternative entry site for circulating lymphocytes directly into the CSF, has not been seriously considered before. However, during EAE, we observed massive ultrastructural changes within the choroid plexus, which are different from changes observed during hypoxia. Using immunohistochemistry and in situ hybridization, we observed expression of VCAM-1 and ICAM-1 in the choroid plexus and demonstrated their upregulation and also de novo expression of MAdCAM-1 during EAE. Ultrastructural studies revealed polar localization of ICAM-1, VCAM-1, and MAdCAM-1 on the apical surface of choroid plexus epithelial cells and their complete absence on the fenestrated endothelial cells within the choroid plexus parenchyme. Furthermore, ICAM-1, VCAM-1, and MAdCAM-1 expressed in choroid plexus epithelium mediated binding of lymphocytes via their known ligands. In vitro, choroid plexus epithelial cells can be induced to express ICAM-1, VCAM-1, MAdCAM-1, and, additionally, MHC class I and II molecules on their surface. Taken together, our observations imply a previously unappreciated function of the choroid plexus in the immunosurveillance of the CNS.

Animals↗
PubMed2001

Choroid plexus: target for polypeptides and site of their synthesis.

Choroid plexus (CP) is an important target organ for polypeptides. The fenestrated phenotype of choroidal endothelium facilitates the penetration of blood-borne polypeptides across the capillary walls. Thus, both circulating and cerebrospinal fluid (CSF)-borne polypeptides can reach their receptors on choroidal epithelium. Several polypeptides have been demonstrated to regulate CSF formation by controlling blood flow to choroid plexus and/or the activity of ion transport in choroidal epithelium. However, many ligand-receptor interactions occurring in the CP are not involved in the regulation of fluid secretion. Increasing evidence suggests that the choroidal epithelium plays an important role in hormonal signaling via a receptor-mediated transport into the brain (e.g., leptin) and helps to clear certain CSF-borne polypeptides (e.g., soluble amyloid beta-protein). Thus, impaired choroidal transport or insufficient clearance of polypeptides may contribute to pathogenesis of systemic or central nervous system (CNS) disorders, such as obesity or Alzheimer's disease. CP epithelium is not only a target but is also a source of neuropeptides, growth factors, and cytokines in the CNS. These polypeptides following their release into the CSF may exert distal, endocrine-like effects on target cells in the brain due to bulk flow of this fluid. Distinct temporal patterns of choroidal expression of several polypeptides are observed during brain development and in various CNS disorders, including traumatic brain injury and ischemia. Therefore, it is proposed that the CP plays an integral role not only in normal brain functioning, but also in the recovery from the injury. This review attempts to critically analyze the available data to support the above hypothesis.

Angiotensin II↗
PubMed1998

Visual influences on diurnal rhythms in ocular length and choroidal thickness in chick eyes.

Recent investigations have raised the possibility that ocular diurnal rhythms might be involved in the regulation of eye growth. Specifically, the chick eye elongates with a daily rhythm, said to be absent in form-deprived eyes. The present study asks: (1) Which components of the eye have daily rhythms-only the overall eye size, or also choroidal thickness or anterior chamber depth? (2) Does the phase or amplitude of these rhythms differ in eyes growing either faster than normal (form-deprived eyes) or slower than normal (eyes recovering from form-deprivation myopia)? Using high-frequency A-scan ultrasonography that allowed fine (8-20 micron) resolution of anterior chamber depth, vitreous chamber depth, choroidal thickness and axial length, we measured normal eyes, form-deprived eyes and eyes recovering from form-deprivation myopia at 6 hour intervals for 5 days and 4 nights. All eyes showed daily rhythms in axial elongation and choroidal thickness. In both normal and form-deprived eyes, the axial length was greatest in the afternoon when the choroid was thinnest, and hence, these rhythms were approximately in anti-phase to one another; in addition, there is some evidence that the axial length rhythm in form-deprived eyes is phase-advanced relative to that of their fellow control eyes. The amplitude of the rhythm in choroidal thickness in form-deprived eyes was significantly larger than in normal eyes. In recovering eyes in which elongation is slowed, the rhythm in axial length was significantly phase-delayed relative to normal eyes (peak at 8 pm) and the rhythm in choroidal thickness was phase-advanced (peak at 8 pm); thus in these eyes, the two rhythms are in phase. In these eyes, the choroids were thickening by approximately 100 micron/day. In all three groups, the rhythm in anterior chamber depth appears to differ in phase from the rhythm in axial length (and hence from the rhythm at the posterior wall of the eye). We propose that the phase relationship between these choroidal and eye length rhythms influence the rate of growth of the eye, and conclude that diurnal ocular rhythms may be important in eye growth regulation.

Animals↗
PubMed1988

Transcytosis of protein through the mammalian cerebral epithelium and endothelium. I. Choroid plexus and the blood-cerebrospinal fluid barrier.

The potential for transcytosis (endocytosis----intracellular transport----exocytosis) of protein and membrane events associated with fluid phase and adsorptive endocytic processes within epithelia of the choroid plexus [blood-cerebrospinal fluid (CSF) barrier] were investigated in mice injected intravenously or into the lateral cerebral ventricle with native horseradish peroxidase (HRP) or the lectin wheatgerm agglutinin (WGA) conjugated to HRP. WGA binds to specific cell surface oligosaccharides and enters cells by the process of adsorptive endocytosis; native HRP is taken into cells non-specifically by fluid phase endocytosis. The lysosomal system of organelles and the endoplasmic reticulum, identified by enzyme cytochemical markers applied to choroid epithelia, were analysed for possible participation in transcytosis and compared to epithelial organelles harbouring the exogenous tracer proteins. Blood-borne native HRP was endocytosed readily by choroid epithelia whereas WGA-HRP was not, perhaps because WGA-HRP does not escape fenestrated endothelia as easily as native HRP. The blood-borne proteins incorporated within endocytic vesicles by choroid epithelia were directed to endosomes (prelysosomes) and secondary lysosomes (e.g. tubules, multivesicular/dense bodies) for eventual degradation and did not reach the apical/microvillus surface. Both CSF-borne native HRP and WGA-HRP entered choroid epithelia within endocytic vesicles derived from the microvillus border. Native HRP, ultimately sequestered within endosomes and secondary lysosomes, failed to undergo transcytosis through the epithelia into the basolateral clefts. Conversely, CSF-borne WGA-HRP was transported through the epithelia and released into the basolateral clefts within 10 min post-injection. The lectin conjugate labelled epithelial vesicles, endosomes, secondary lysosomes and, at 30 min post-injection, the transmost saccule of the Golgi complex which exhibits acid hydrolase activity. Tubular profiles, related either to the endosome apparatus or to the lysosomal system, and the endoplasmic reticulum did not appear involved in the transcytotic pathway. The data suggest that CSF-borne protein entering the choroid epithelium by adsorptive endocytosis can undergo rapid transcytosis through the cell. The results provide insight to transcytotic pathways utilizing vesicles, the endosomal apparatus, and the Golgi complex within the choroid epithelium for circumventing the blood-CSF barrier. Hypothesized membrane events and morphological associations among constitutents of the endomembrane system within the choroid epithelium are summarized diagrammatically.

Animals↗
PubMed2004

Annular choroidal detachment in a patient with Vogt-Koyanagi-Harada disease.

BACKGROUND: Vogt-Koyanagi-Harada (VKH) disease is one of the diseases that show choroidal detachment. However, there are few reports about VKH disease associated with annular choroidal detachment. In this study, we describe an unusual case of VKH disease with an annular choroidal detachment and absence of a serous retinal detachment. METHODS: The study was an interventional case report. A 59-year-old Japanese woman presented with bilateral blurred vision with meningismus. Laboratory and clinical investigations were performed, including fluorescein angiography, B-scan echography, computed tomography scans, magnetic resonance imaging, cerebrospinal fluid examination, and blood examination including HLA typing. After a diagnosis of VKH disease was made, the patient was treated with systemic corticosteroids. RESULTS: The patient had iridocyclitis, optic disc swelling, choroidal thickening, and annular choroidal detachment in both eyes. Ophthalmoscopic examination did not reveal an obvious serous retinal detachment. Fluorescein angiography showed prominent leakage of dye from the optic disc and mild dye pooling in the subretinal space. The sclera was not thickened, and the axial lengths were relatively short. The findings were bilateral and symmetrical. Cerebrospinal fluid pleocytosis and HLA typing were consistent with VKH disease. After systemic corticosteroid treatment, the abnormal findings were resolved. Neither sunset glow fundus nor cutaneous lesions were observed, and no recurrences were observed during 4 years of follow-up. CONCLUSION: The annular choroidal detachment was probably caused by severe choroidal inflammation and resistance to scleral outflow because of the scleral abnormality due to inflammation and short axial length. We believe that intact and functioning retinal pigment epithelium prevented serous retinal detachment. This case reports annular choroidal detachment without retinal detachment associated with VKH diseases.

Betamethasone↗
PubMed2006

Choroidal dye filling velocity in patients with Vogt-Koyanagi-Harada disease.

PURPOSE: To evaluate quantitative choroidal dye filling velocity in patients with Vogt-Koyanagi-Harada disease (VKH) before and after corticosteroid treatment using indocyanine green (ICG) angiography. METHODS: ICG angiography was performed in seven VKH patients before and after systemic corticosteroid treatment. Choroidal dye curves were obtained by image analysis software and analyzed using an exponential model. The model's time constant (tau) was used to evaluate choroidal dye filling velocity. RESULTS: Compared with controls, acute phase choroidal tau values in VKH patients were significantly longer, suggesting choroidal circulation disturbance. During the recovery phase, choroidal tau values were significantly shortened, suggesting choroidal circulatory disturbance improvement. CONCLUSION: Choroidal dye filling velocity may be useful for VKH diagnosis and verification of corticosteroid treatment effectiveness.

Adult↗