Browsing by Author "Herbort, Carl"
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Publication Precise, simplified diagnostic criteria and optimised management of initial-onset Vogt–Koyanagi–Harada disease: an updated review(2022) Herbort, Carl; Tugal, Ilknur; Abu, Ahmed; Gupta, Amod; Takeuchi, Masaru; Fardeau, Christine; Hedayatfar, Alireza; Urzúa, Cristhian; Papasavvas, IoannisVogt-Koyanagi-Harada (VKH) disease is a primary autoimmune stromal choroiditis. This review aimed to provide a novel perspective of the disease. We took into account recent developments in the understanding of the disease and crucial progress in investigational modalities of the choroid, which has led to new, simpler diagnostic criteria. We analysed recent novel notions in the literature and new diagnostic tools for VKH. We identified the following updates for VKH disease: (1) A crucial differentiation between the acute initial-onset and the chronic forms of the disease; (2) the integration of new, precise imaging methods to assess choroidal inflammation; (3) the promotion of simplified, more reliable diagnostic criteria for acute initial-onset of the disease, based on the sine qua non presence of diffuse choroiditis, detected with indocyanine green angiography (ICGA) and/or Enhanced Depth Imaging OCT (EDI-OCT); and (4) treatment optimisation through early, vigorous, sustained corticosteroid and nonsteroidal immunosuppression, as the first line of treatment for initial-onset VKH disease, and monitoring subclinical choroidal inflammation during follow-ups. Several studies have shown that most patients could discontinue treatment without an inflammation relapse. ICGA and EDI-OCT represented the methods of choice for precisely monitoring disease evolution. Simplified, precise, new diagnostic criteria allow early diagnosis of VKH. In VKH disease, inflammation exclusively originates in the choroidal stroma. Therefore, in many cases, early, sustained treatment, with dual corticosteroid and nonsteroidal immunosuppressive therapy can result in full "healing", which obviates chronic, uncontrolled, subclinical choroidal inflammation.Publication Vogt-Koyanagi-Harada disease: the stepby-step approach to a better understanding of clinicopathology, immunopathology, diagnosis, and management: a brief review(2022) Urzúa, Cristhian; Herbort, Carl; Takeuchi, Masaru; Schlaen, Ariel; Concha, Luz; Usui, Yoshihiko; Cuitino, Loreto; Papasavvas, IoannisBackground: Appraisals of Vogt-Koyanagi-Harada disease (VKH) have become progressively more complete, since its first description in 1906. The availability of new investigational methods has improved our knowledge of the immunopathology, clinicopathology, diagnosis, and management of VKH disease. This review aimed to describe some of the steps that led to better characterization of VKH as a clinical entity. Methods: We searched on PubMed for articles that described the history of VKH disease and analyzed the progress in disease appraisal with new investigational and imaging methods. In particular, we searched for articles that investigated the clinicopathology, diagnosis, and management of VKH. Findings: The following developments were considered essential for improving the appraisal and understanding of VKH: (1) the history of the disease, (2) immunopathological mechanisms, (3) clinicopathology, (4) the importance of distinguishing initial-onset from chronic disease, (5) relevant imaging modalities, among which indocyanine green angiography is crucial, (6) diagnostic criteria that facilitate early diagnosis, and (7) the need for early, prolonged, aggressive treatment that combines steroidal and non-steroidal immunosuppression. Conclusion: Based on these findings, the definition of VKH has improved. VKH disease starts in the choroidal stroma and later involves other structures when it is not diagnosed and treated early. Indocyanine green angiography and enhanced depth imaging optical coherence tomography facilitate early diagnosis and precise monitoring of choroidal inflammation. ICGA is clearly the gold standard for appraisals and follow-ups in VKH disease, however EDI-OCT should be especially considered in those areas where ICGA is not fully available. These modalities have contributed substantially to a "cure" for VKH, when treatment is introduced within the therapeutic window of opportunity.Publication "White dot syndromes", an inappropriate and outdated misnomer(2022) Neri, Piergiorgio; Herbort, Carl; Hedayatfar, Alireza; Tugal, Ilknur; Cimino, Luca; Urzúa, Cristhian; Papasavvas, Ioannis; Takeuchi, Masuru; Lages, VaniaAlong the years, examples of drifts in medical thought were not so rare. Approximative and imprecise views or inconsiderate notions are voiced by opinion leaders in high-impact journals, which can negatively affect the appraisal of a disease or a group of diseases for years or decades.