Vogt-Koyanagi-Harada Disease: Current Diagnosis and Management

Vogt-Koyanagi-Harada (VKH) disease is a rare granulomatous inflammatory disease that affects pigmented structures, such as eye, inner ear, meninges, skin, and hair. This disease is mainly a T1 lymphocyte-mediated aggression to melanocytes. The availability of new investigational methods has improved our knowledge of the pathogenesis, clinical approach, diagnosis, and management of VKH disease. The disease has an acute onset of bilateral blurred vision with hyperemia in the absence of prior ocular trauma or any previous intraocular surgery. The chronic phase comprises of ocular and integumentary system pigmentary changes. Ocular findings may be accompanied by meningismus, hearing impairment, and skin lesions in a variable proportion of patients. Prompt diagnosis with early, aggressive, and long-term treatment of high-dose corticosteroids ensures good visual outcomes. The aim of this chapter is to present the clinicopathology, classification, recent imaging, investigations, and management of VKH disease

Acute acquired comitant esotropia in children: A benign entity or an ominous sign?

Purpose: The purpose is to study the clinical features of acute acquired comitant esotropia (AACE) in children and analyze the course and outcome. Materials and Methods: A retrospective, clinical study of all patients under the age of 18 years with acute onset, nonaccommodative comitant esotropia in a tertiary eye care center from September 2013 to December 2016. Parameters studied were age, sex, visual acuity, eye involved, age of onset, precipitating event, amount of deviation, presence or absence of amblyopia, cycloplegic refraction, systemic involvement, surgical or nonsurgical intervention, course, and outcome. All patients underwent magnetic resonance imaging of brain and orbits, and systemic evaluation was done in suspicious cases. Minimum follow-up period was 6 months. Results: Out of 12 patients, 8 were male. Average age of the patients was 7.9 years. The mean esodeviation was 33.75 PD, and mean age of onset was 6.14 years (range: 2–15 years). There was left eye preponderance. Three patients (25%) had a history of a precipitating event. Cycloplegic refraction ranged from +0.50 DS to −6.75 DS, with majority having <+2.00 DS. Amblyopia was noted in 8 (66.6%) patients. Systemic involvement was seen in three patients in the form of ocular myasthenia, central nervous system glioma, and viral fever, respectively. Esotropia disappeared in one patient with overcorrected, high myopia following atropinization, and change of glass. Eight patients (66.6%) underwent strabismus surgery with good postoperative alignment, and the rest were managed conservatively. Conclusion: AACE is an unusual ocular alignment disorder characterized by a nonaccommodative esodeviation which can occur in older children, adults, and even the elderly. Although most children with this form of esotropia are otherwise healthy, systemic diseases must be considered and ruled out before planning surgery. Prompt amblyopia therapy and timely surgery can result in a satisfactory outcome in those without systemic involvement