Tetsuya Muto

In this study, we aimed to identify factors for risk of chronic evolution in Vogt–Koyanagi–Harada (VKH) disease at 1 month following pulse steroid therapy. This was a retrospective clinical cohort, single center study. A total of 121 eyes from 61 treatment-naïve patients with acute VKH disease, who underwent pulse steroid therapy and had follow-up for over 12 months were evaluated. Patients were categorized into SGF and non-SGF groups according to fundus outcomes at 12 months after treatment. Anterior chamber morphology was assessed using Pentacam ^® , while axial length and lens thickness were measured with the IOLMaster 700. Multivariable analysis demonstrated that lower best-corrected visual acuity (BCVA) ( p < 0.001) and increased corneal thickness ( p = 0.016) at 1 month were significantly associated with the development of SGF. Receiver operating characteristic curve analysis determined optimal cut-off values for predicting SGF as a logarithmic BCVA greater than −0.040 and a corneal thickness exceeding 574.500 µm. The corresponding Youden index values were 0.291 for BCVA and 0.244 for corneal thickness. Elevated logarithmic BCVA values and increased corneal thickness at 1 month after treatment were identified as risk factors for the subsequent SGF development. Applying higher cut-off values for these factors may facilitate more targeted therapeutic strategies in patients with VKH disease.

This study reports two cases of Vogt–Koyanagi–Harada disease recurrence after laser treatment. Case 1 involved a woman in her late 70s with Vogt–Koyanagi–Harada disease that was controlled by adalimumab and steroid eye solution therapy. She presented with uveitis recurrence 4 weeks after undergoing neodymium:yttrium aluminum garnet laser posterior capsulotomy in both eyes. She was immediately treated with sub-Tenon triamcinolone acetonide injection in both eyes, which provided palliative relief. During the following year, she experienced further recurrences every 3–5 months. Case 2 involved a woman in her 40s with Vogt–Koyanagi–Harada disease and untreated type 2 diabetes. She had undergone pulse steroid therapy 3 months ago. She was prescribed insulin and oral diabetic medicine. The sudden glycemic control caused progression of her diabetic retinopathy, which was treated with retinal photocoagulation of the left eye. Three days later, there was recurrence of bilateral serous retinal detachment. She was immediately treated with sub-Tenon triamcinolone acetonide injection in both eyes, which improved serous detachment. Additional retinal photocoagulation was performed in both eyes 18 months later. These cases suggest that laser treatment triggers recurrence of Vogt–Koyanagi–Harada disease. Further investigation of this association is warranted.

Purpose: To determine the prevalence and clinical characteristics of retinal artery occlusion (RAO), including branch RAO (BRAO) and central RAO (CRAO), among new patients before and after the declaration of a state of emergency due to coronavirus disease 2019 (April 7, 2020) in Japan. Methods: New patients and patients with newly diagnosed RAO were categorized into “Before” and “After” groups based on the initial visit. The prevalence, sex ratio, and age of patients newly diagnosed with RAO were compared between the groups. The rates of patients newly diagnosed with rhegmatogenous retinal detachment (RRD) and pseudoexfoliation glaucoma (PEX) were also examined in the Before and After groups. Results: This study included 53 and 31 patients with BRAO and 55 and 40 patients with CRAO in the Before and After groups, respectively. There were no significant differences in prevalence of RAOs among newly diagnosed patients (BRAO: p = 0.449; CRAO: p = 0.060), patients with RRD (BRAO: p = 0.425; CRAO: p = 0.082), or patients with PEX (BRAO: p = 0.317; CRAO: p = 0.072), as well as in sex ratio and age. Although initial best‐corrected visual acuity (BRAO: p = 0.303; CRAO: p = 0.291) of RAOs showed no significant differences, the final best‐corrected visual acuity in BRAO significantly worsened in the After group ( p = 0.002). Conclusions: Although the coronavirus disease 2019 pandemic did not affect the prevalence of RAOs among new patients compared with that of RRD and PEX, it may have affected its pathophysiology.

The relationship between coronavirus disease 2019 (COVID‐19) infection or vaccination and retinal artery occlusions (RAOs) remains controversial. COVID‐19 infection or vaccination can sometimes cause thrombin formation. RAOs occur due to thrombin in the retinal artery. The average age of occurrence after COVID‐19 infection was 48.7 ± 17.2 years in central RAO (CRAO) and 41.3 ± 17.8 years in branch RAO (BRAO). After COVID‐19 vaccination, the average age was 54.7 ± 17.1 years in CRAO and 62.3 ± 21.2 years in BRAO. The mean time from COVID‐19 diagnosis to symptom onset was 10.5 ± 9.3 days in CRAO and 48.3 ± 39.6 days in BRAO. After vaccination, the mean time was 7.3 ± 6.8 days in CRAO and 21.0 ± 24.9 days in BRAO. Initial visual acuity (VA) after COVID‐19 infection was 2.53 ± 0.65 in CRAO and 0.09 ± 0.07 in BRAO. Final VA was 2.73 ± 0.12 in CRAO, but data for BRAO were unavailable. After vaccination, initial VA was 2.28 ± 0.97 in CRAO and −0.02 ± 0.16 in BRAO. Final VA was 2.12 ± 1.24 in CRAO and could not be calculated in BRAO. The relationship between COVID‐19 or its vaccination and RAOs was investigated through past case reports. Two types of reports existed regarding RAO incidence after the COVID‐19 pandemic—some indicated an increase, while others found no change. No reports suggested a decrease in RAO occurrence. The current evidence does not clarify the relationship between COVID‐19 or its vaccine and RAOs. However, this relationship cannot be ruled out. Further investigations are necessary, as future infectious disease pandemics may occur.

This study aimed to identify factors present at the initial visit for the development of sunset glow fundus (SGF) in Vogt–Koyanagi–Harada (VKH) disease. A total of 139 eyes from 70 naïve patients with acute VKH disease who underwent pulse steroid therapy were categorized into “SGF” and “non-SGF” groups based on fundus appearance at 12 months post-therapy. Multivariable analysis revealed that patients with meningismus (p = 0.004), incomplete type (p = 0.035), and probable type (p = 0.002) in older revised diagnostic criteria; ex-smoker (p = 0.016), and smoker (p = 0.010) status; high logarithmic best-corrected visual acuity (BCVA) (p < 0.001); high spherical equivalent (SE) (p = 0.005); shallow peripheral anterior chamber depth (ACD) (p < 0.001); narrow anterior chamber angle (ACA) (p = 0.015); increased pupil diameter (p < 0.001); and thicker cornea (p = 0.019) were associated with SGF. The optimal cut-off values for predicting SGF were identified as follows: logarithmic BCVA greater than 0.261, SE exceeding − 2.813 D, peripheral ACD less than 2.138 mm, ACA less than 40.55 °, pupil diameter exceeding 3.040 mm, and corneal thickness exceeding 579.500 μm. Patients with VKH disease who exhibit above risk factors require early and careful management.

Oral contraceptive use, vaccination for Coronavirus disease 2019 (COVID-19), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are risk factors for venous thromboembolism. Branch retinal vein occlusion (BRVO) generally develops mid-60s patients. Herein, we present a case of superotemporal BRVO caused by the above mentioned risk factors in a young woman. To the best of our knowledge, this is the first report about superotemporal BRVO associated with oral contraceptives, COVID-19 vaccination, and SARS-CoV-2. A 21-year-old woman presented with loss of visual acuity in her right eye for 10 days. She had been receiving oral contraceptives for 2 years for oligomenorrhea before noticing ophthalmological symptoms. Despite having received two doses of an mRNA COVID-19 vaccine, she contracted COVID-19 and developed fever, sore throat, cough, low back pain, and general malaise about 40 days before the initial visit. However, only cough persisted for more than a month. The right eye showed superotemporal BRVO with macular edema (ME). She did not smoke nor had diabetes or hypertension. Blood test results, including cardiolipin antibody IgG, were normal. She was treated with an intravitreal aflibercept injection. ME in the fundus showed rapid improvement and resolution. Although more than 20 months have passed since the first injection, there has been no relapse of ME. The combination of oral contraceptive use, COVID-19 vaccination, and subsequent SARS-CoV-2 infection could induce the development of venous thromboembolism, thereby leading to superotemporal BRVO. Given that cases of COVID-19 have increased globally, patients with retinal vein occlusion who use oral contraceptives are likely to be encountered more frequently.

The relationship between coronavirus disease 2019 (COVID‐19) infection or vaccination and retinal vein occlusions (RVOs) remains controversial. RVOs include central and branch RVOs. Previous studies have indicated a link between RVOs and COVID‐19. RVOs develop when the retinal blood vessels are clogged by thrombin or lipid deposition. The retina, an important component of the visual apparatus, relays the visual information to the brain after light stimulation. When retinal veins are clogged, the damage can range from slightly reduced vision to complete blindness. SARS‐CoV‐2, the causative agent for COVID‐19, leads to endothelial dysfunction and increased von Willebrand factor (VWF) antigen levels in the blood, which activate the coagulation process and platelet aggregation. Activation of tissue factors initiates the coagulation cascade, leading to fibrin formation through thrombin. Because arteries and veins sometimes cross in the retina, the vein, with its thin vessel wall, may be compressed. As a result, blood flow slows due to venous constriction, and clotting is more likely to occur at the crossing point. RVO ultimately develops through these processes. Patients with COVID‐19 have significantly elevated levels of VWF antigen and activity, which likely contribute to the increased risk of thrombosis observed in COVID‐19‐associated coagulopathy. As RVOs align with conventional approaches, ophthalmologists should consider COVID‐19 as a potential etiological factor when evaluating patients presenting with acute vision loss. Enhanced awareness of this association may facilitate timely diagnosis and tailored patient care in affected populations.

Introduction: This study aimed to identify when ocular biomarker changes occur within 1 month and which ocular biomarkers correlate with best-corrected visual acuity (BCVA) at months 1 and 6. Methods: We evaluated 33 patients with Vogt-Koyanagi-Harada disease who received pulse steroid therapy. The central anterior-chamber depth (ACD) and peripheral ACD were evaluated. We also analyzed axial length (AL), BCVA, spherical equivalent (SE), choroidal foveal thickness (CFT), and retinal foveal thickness (RFT). Patients were divided into two groups based on BCVA at months 1 and 6, and correlations with ocular biomarkers were investigated. Results: RFT and CFT were significantly reduced as early as day 1 (p < 0.001). AL gradually increased, with a significant increase observed at month 1 (p < 0.05). BCVA improved significantly along with SE reduction, with significant changes observed at week 1 (p < 0.05 and p < 0.01, respectively). Anterior-chamber biomarkers gradually increased, with significant increases at week 2 for central ACD (p < 0.05) and at month 1 for peripheral ACD (p < 0.05). The better BCVA group at month 1 significantly correlated with thicker RFT (p < 0.01), better BCVA (p < 0.05), shallower central ACD (p < 0.05), and shallower peripheral ACD (p < 0.05) at the initial visit. No correlation was observed between the better BCVA group at month 6 and ocular biomarkers at the initial visit. Conclusion: Although RFT and CFT changes are the earliest indicators, changes in the anterior-chamber structure appeared to be slow and delayed. Thicker RFT, better BCVA, shallower central ACD, and shallower peripheral ACD at the initial visit correlated with better BCVA at 1 month.

This systematic examines research into patients diagnosed with retinal vascular occlusive diseases (RVODs) secondary to coronavirus disease 2019 (COVID-19) infection or vaccination. RVODs include central retinal vein occlusion, branch retinal vein occlusion, central retinal artery occlusion, and branch retinal artery occlusion. Previous studies have posited a possible link between RVODs and COVID-19. RVODs are of two types: retinal vein occlusion and retinal artery occlusion. These disorders develop when retinal blood vessels become clogged by thrombi or fat deposition. The retina is an important component of the visual apparatus. Its photoreceptors are stimulated by the light hitting the eye and record its pattern. The retina then relays this visual information to the brain. When retinal blood vessels become clogged, the damage can range from slightly reduced vision to complete blindness. COVID-19 causes endothelial dysfunction and increased levels of von Willebrand factor antigens in the blood. Elevation of von Willebrand factor activates the coagulation process and platelet aggregation. The treatment methods and visual prognosis in COVID-19-related RVODs do not differ from conventional RVODs. However, ophthalmologists need to be aware of the possible relationship and should consider RVODs when they encounter patients with vision loss following COVID-19 infection or vaccination.

To determine the disease prevalence rate and clinical characteristics of Vogt–Koyanagi–Harada (VKH) disease among new patients before and after the declaration of a state of emergency (April 7, 2020) in Japan. New patients and patients with newly diagnosed VKH disease were categorized into “Before” and “After” groups based on the initial visit. The prevalence rate, sex ratio, and age of patients newly diagnosed with VKH were compared between the groups. Best-corrected visual acuity (BCVA) and recurrence rates were compared among 59 patients observed for > 12 months after receiving pulse steroid therapy. For reference, we also examined the prevalence rate of patients newly diagnosed with acute angle closure (AAC) in the Before and After groups. The prevalence rates of VKH disease among newly diagnosed patients (P < 0.05) or patients with AAC (P < 0.001) were significantly higher in the After group. No significant differences in sex ratio or age of VKH disease were observed in both groups. BCVA and recurrence rates showed no significant differences. The COVID-19 pandemic increased the prevalence of VKH disease among new patients compared with that of AAC. However, the clinical features of VKH disease were unlikely affected by the COVID-19 pandemic.