JOYCE HISAE YAMAMOTO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/33 - Laboratório de Oftalmologia, Hospital das Clínicas, Faculdade de Medicina
LIM/33 - Laboratório de Oftalmologia, Hospital das Clínicas, Faculdade de Medicina
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- Vogt-Koyanagi-Harada disease: review of a rare autoimmune disease targeting antigens of melanocytes(2016) LAVEZZO, Marcelo Mendes; SAKATA, Viviane Mayumi; MORITA, Celso; RODRIGUEZ, Ever Ernesto Caso; ABDALLAH, Smairah Frutuoso; SILVA, Felipe T. G. da; HIRATA, Carlos Eduardo; YAMAMOTO, Joyce HisaeVogt-Koyanagi-Harada disease (VKHD) is a rare granulomatous inflammatory disease that affects pigmented structures, such as eye, inner ear, meninges, skin and hair. This disease is mainly a Th1 lymphocyte mediated aggression to melanocytes after a viral trigger in the presence of HLA-DRB1*0405 allele. The absence of ocular trauma or previous intraocular surgery sets VKHD appart from sympathetic ophthalmia, its main differential diagnosis. The disease has an acute onset of bilateral blurred vision with hyperemia preceded by flu-like symptoms. The acute uveitic stage is characterized by a diffuse choroiditis with serous retinal detachment and optic disc hyperemia and edema. Fluorescein angiography in this phase demonstrates multiple early hyperfluorescent points. After the acute uveitic stage, ocular and integumentary system pigmentary changes may appear. Ocular findings may be accompanied by lymphocytic meningitis, hearing impairment and/or tinnitus in a variable proportion of patients. Prompt diagnosis followed by early, aggressive and long-term treatment with high-dose corticosteroids is most often ensued by good visual outcomes. However, some patients may experience chronic uveal inflammation with functional eye deterioration. The current review discusses the general features of VKHD, including epidemiology, classification into categories, differential diagnosis and current therapeutic approaches.
- Diagnosis and classification of Vogt-Koyanagi-Harada disease(2014) SAKATA, Viviane Mayumi; SILVA, Felipe Theodoro da; HIRATA, Carlos Eduardo; CARVALHO, Jozelio Freire de; YAMAMOTO, Joyce HisaeVogt-Koyanagi-Harada (VKH) disease is a systemic autoimmune disorder that affects pigmented tissues of the body, with its most dire manifestations affecting the eyes. This review focuses on the diagnostic criteria of VKH disease, including some information on history, epidemiology, appropriate clinical and classification criteria, etiopathogenesis, treatment and outcomes. Expert review of most relevant literature from the disease's first description to 2013 and correlation with the experience in the care of VKH disease patients at a tertiary Uveitis Service in Brazil gathered over the past 40 years. The clinical manifestations and ancillary assessment of VKH disease have been summarized in the Revised Diagnostic Criteria proposed in 2001 in a manner that allows systematic diagnosis of both acute and chronic patients. It includes the early acute uveitic manifestations (bilateral diffuse choroiditis with bullous serous retinal detachment and optic disk hyperemia), the late ocular manifestations (diffuse fundus depigmentation, nummular depigmented scars, retinal pigment epithelium clumping and/or migration, recurrent or chronic anterior uveitis), besides the extraocular manifestations (neurological/auditory and integumentary). There are two exclusion criteria, i.e. absence of previous ocular penetrating trauma or surgery and any other ocular disease that could be confounded with VKH disease. HLA-DRB1*0405 plays an important role in pathogenesis, rendering carriers more susceptible to disease. The primary ocular pathological feature is a diffuse thickening of the uveal tract in the acute phase. Later on, there may be a compromise of choriocapillaris, retinal pigment epithelium and outer retina, mostly due to an ""upstream"" effect, with clinical correlates as fundus derangements. Functional tests (electroretinogram and visual field testing) as well as imaging modalities (retinography, fluorescein/indocyanine green angiography, optical coherence tomography and ultrasound) play an important role in diagnosis, severity grading as well as disease monitorization. Though high-dose systemic corticosteroids remain gold-standard therapy, refractory cases may need other agents (cyclosporine A, anti-metabolites and biological agents). In spite of good visual outcomes in the majority of patients, knowledge about disease progression even after the acute phase and its impact on visual function warrant further investigation.
- Initial-onset acute and chronic recurrent stages are two distinctive courses of Vogt-Koyanagi-Harada disease(2020) URZUA, Cristhian A.; HERBORT JR., Carl; VALENZUELA, Rodrigo A.; EL-ASRAR, Ahmed M. Abu; ARELLANES-GARCIA, Lourdes; SCHLAEN, Ariel; YAMAMOTO, Joyce; PAVESIO, CarlosPurpose To describe distinctive stages of Vogt-Koyanagi-Harada (VKH) disease: initial-onset acute versus chronic recurrent disease. Methods A comprehensive literature review regarding stages and clinical presentations of VKH disease was conducted. Results Despite a list of signs that has been described as characteristic features of early or late phases of VKH disease, the current classification -developed by an international committee and published in 2001- does not consider a distinction regarding the time from onset of disease symptoms, and specific findings observed at certain time point from the symptoms presentation and outcomes related to the stage of VKH disease. In that sense, chronic recurrent VKH disease is more refractory to treatment and is associated with a higher rate of complications. Accordingly, this subset of VKH patients has poorer functional and anatomical outcomes than patients with an initial-onset acute disease. Conclusions An early clear distinction of VKH phenotype [Initial-onset acute versus chronic recurrent disease] should be considered in each clinical scenario, evaluating the delay in diagnosis and the clinical presentation, since it may help clinicians to perform a correct disease prognosis categorization and thus to make treatment decisions in terms of potential refractoriness or expected clinical outcomes.
- Reappraisal of the management of Vogt-Koyanagi-Harada disease: sunset glow fundus is no more a fatality(2017) HERBORT JR., Carl P.; ASRAR, Ahmed M. Abu El; YAMAMOTO, Joyce H.; PAVESIO, Carlos E.; GUPTA, Vishali; KHAIRALLAH, Moncef; TUGAL-TUTKUN, Ilknur; SOHEILIAN, Masoud; TAKEUCHI, Masuru; PAPADIA, MarinaVogt-Koyanagi-Harada (VKH) disease is a primary autoimmune stromal choroiditis. Aim of the study was to gather a body of evidence from the literature and from experts that systemic corticosteroid combined with non-steroidal immunosuppressive therapy should become the standard of care in initial-onset VKH disease. Literature was reviewed and leading experts in VKH were consulted in different parts of the world in order to put forward a consensus attitude in the management of initial-onset VKH disease. There was a substantial body of evidence in the literature that early aggressive and sustained corticosteroid and non-steroidal immunosuppressive therapy in initial-onset VKH disease allows to achieve full control of choroidal inflammation, eliminating any subclinical choroidal inflammation, and substantially reduces recurrences with improvement of anatomical and functional outcomes. This was in agreement with experts' opinion and practice. ICGA was the method of choice to monitor disease evolution. Since the choroidal space is easily accessible to systemic therapy and because inflammation in VKH disease is exclusively originating from the choroidal stroma, early and sustained treatment right at the onset of the disease process with dual corticosteroid and non-steroidal immunosuppressive therapy can result in full ""healing"" in many cases preventing sunset glow fundus which results from depigmentation from chronic uncontrolled inflammation.
- Enhanced depth imaging optical coherence tomography in long-standing Vogt-Koyanagi-Harada disease(2013) SILVA, Felipe Theodoro da; SAKATA, Viviane Mayumi; NAKASHIMA, Aloisio; HIRATA, Carlos Eduardo; OLIVALVES, Edilberto; TAKAHASHI, Walter Yukihiko; COSTA, Rogerio Alves; YAMAMOTO, Joyce HisaeAim To evaluate the choroidal thickness (CT) in patients with long-standing Vogt-Koyanagi-Harada (VKH) disease using enhanced depth imaging optical coherence tomography (EDI-OCT). Methods A prospective case-control study developed at a tertiary centre at Sao Paulo, Brazil. EDI-OCT images were obtained in 16 patients (30 eyes) with VKH disease who had had the disease for more than 6 months since disease onset, and in 17 normal individuals controlled by age (32 eyes). Comprehensive ophthalmic examination and EDI-OCT evaluation were performed. CT was measured at the fovea and at 1000 mu m intervals from the foveal centre in both temporal and nasal directions. CT was correlated with disease duration, clinical disease activity and fundus-based disease severity. Results Mean subfoveal CT was 333 mu m (+/- 85.8) in controls and 250.7 mu m (+/- 93.3) in VKH patients (p=0.002). The choroid was significantly thinner in patients when compared to controls in all but one nasal point. In patients, the CT measurements at the foveal centre presented a negative correlation with disease duration (p<0.001). No significant difference in CT measurements was observed between eyes with and without clinical inflammation (p=0.42). There was a trend towards more severe fundus changes being associated with a thinner choroid (p=0.28). Conclusions Patients with VKH and long-standing disease had thinner choroids when compared to controls. Progressive choroidal thinning related to disease duration was observed at the macula of these patients. Whether this finding is part of the natural history of the disease or the result of a clinically undetected choroidal inflammation remains to be determined.