Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Thesis (doctoral)--Uppsala University, 1982. / Includes bibliographical references (p. 35-39).

Ischaemic stroke is a major cause of death and disability worldwide. Cerebral autoregulation, which can be impaired during acute stroke, and collateral flow to brain tissue through the circle of Willis, both play a role in preventing tissue infarction. The configuration of the arterial circle varies between individuals. Thus, personalised modelling of the cerebral arterial network, to determine the potential for collateral flow, can be of significant value in the clinical context of stroke. The interaction between autoregulation and collateral flow remains poorly understood. In this study, steady-state physiological models of the cerebral arterial network, including several common variants of the circle of Willis, were coupled to a spatially variable mathematical representation of cerebral autoregulation. The resulting model was used to simulate various arterial occlusions, as well as bilateral and unilateral impairment of autoregulation, in each structural variant. The work identified few circle of Willis variants that present either particularly high-risk or particularly low-risk of cerebral ischaemia. Instead it was found that most variants are dependent upon the bilateral function of autoregulation to facilitate collateral flow and preserve cerebral blood flows. When autoregulation was impaired unilaterally, downstream of an occlusion, blood flows in the contralateral hemisphere were preserved at the expense of the ipsilateral tissue at risk. Arterial network models have in the past been personalised using structural, rather than functional, angiography measurements. This thesis presents a novel model-based method for absolute blood volume flow rate quantification in short arterial segments using dynamic magnetic resonance angiography data. The work also investigated the additional information that can be obtained from such functional angiography. The flow quantification technique was found to accurately estimate flows in shorter arterial segments than an existing technique. However, improvements to noise performance, and strategies for rejection of contaminating signals from overlapping vessels within the imaging plane, are required before the technique can be applied to personalised cerebral arterial network modelling.

Ioversol and Iomeprol are radiological contrast media commonly used interchangeably in many South African imaging facilities for coronary angiography. Despite differences in chemical composition, they are presumed to have similar renal safety profiles. However, no studies directly compare the renal safety of these two contrast media for coronary angiography in a predominantly healthy population. A systematic review was performed to establish which contrast medium is safer. Articles were sourced from Medline, CINAHL, Scopus, Science Direct, and PubMed Clinical Queries databases. Eligible studies were peer-reviewed articles of coronary angiography examinations carried out on a healthy adult population, where Ioversol or Iomeprol or both were administered, with contrast-induced nephropathy as an end-point. Six articles with a total population of 2431 patients were selected. The Cochrane Risk of Bias Tool was used in evaluating included articles. Pooling studies using the random effects model did not show a statistically significant reduction in contrast-induced nephropathy when Iomeprol was administered (Risk ratio 1.14, 95% confidence interval 0.797-1.643, p = 0.466). Moderate heterogeneity (I2=54.21%) across the studies was observed. Study limitations included potential bias during data extraction because this was performed by a single reviewer, and language restrictions to include only English titles. Iomeprol may be better for use in the clinical setting because of more a predictable renal safety profile. / Health Studies / M. P. H. (Health Studies)

Introdução: A doença aterosclerótica intracraniana é uma das principais causas de acidente vascular cerebral isquêmico (AVCI) no mundo, porém sua prevalência parece estar subestimada na população brasileira pela carência de estudos na área. O objetivo principal deste estudo foi descrever a frequência e gravidade da estenose intracraniana nos pacientes com AVCI ou ataque isquêmico transitório (AIT), utilizando a ultrassonografia transcraniana colorida (UTC). O objetivo secundário foi correlacionar os achados deste exame com a angiotomografia de crânio (AngioTC). Métodos: estudo observacional e prospectivo, onde foram avaliados pacientes consecutivos com o diagnóstico de AVCI ou AIT admitidos no período de fevereiro de 2014 a dezembro de 2014. A avaliação inicial consistiu na coleta de dados demográficos, epidemiológicos e clínicos e em seguida os pacientes foram submetidos ao exame de UTC através das janelas transtemporais e suboccipital, com o intuito de avaliar a presença de estenose intracraniana. Estenose intracraniana foi graduada em moderada (50- 70%), grave (70-99%) e suboclusão/oclusão (>= 99%). Foram considerados sintomáticos os casos em que houve uma associação entre os novos sinais e sintomas e uma nova área de infarto ao exame de neuroimagem no território da artéria envolvida ou quando o quadro neurológico correspondeu ao território da artéria envolvida. Os pacientes que possuíam UTC e AngioTC em sua avaliação foram comparados de forma cega quanto ao grau de estenose intracraniana seguindo a mesma classificação. Resultados: Foram avaliados 271 pacientes com o diagnóstico de AVCI ou AIT agudos (149 homens, com média de idade de 65,8 ± 12,5), 263 (97%) foram submetidos a exame de circulação intracraniana, sendo a ultrassonografia transcraniana colorida realizada em 168 casos (61,9%). Apenas 25 indivíduos (14,9%) foram excluídos devido a janela transtemporal insuficiente. Dentre os 143 pacientes que puderam ser avaliados adequadamente pela ultrassonografia transcraniana, a prevalência de estenose arterial intracraniana foi de 38,5% (55 casos); sendo sintomática em 25,2% dos casos. A média de idade dos pacientes era de 64 ± 11 anos, 26,9 % eram brancos e 29,4% hipertensos. Os pacientes com estenose intracraniana apresentaram maior pontuação na escala do NIH: 10 (IQ 4 - 19) vs 6 (IQ 3 - 13), maiores níveis de pressão arterial sistólica na admissão: 160 (IQ 145-170) vs 140 (IQ 130 - 155) e menores taxas de HDL: 32 (IQ 27 - 39) vs 36 (IQ 30 - 45). Após análise multivariada, o fator de risco independentemente associado à estenose intracraniana foi a hipertesão arterial sistêmica na admissão (p=0,006). Nos 100 pacientes com ambos os exames, a sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo da UTC comparada a AngioTC para detecção de estenoses intracranianas moderadas-graves foi de 60%, 73%, 73% e 60%, respectivamente. Conclusões: Encontramos alta frequência de estenose arterial intracraniana entre os pacientes com AVCI agudo e AIT na nossa população, especialmente entre indivíduos portadores de hipertensão arterial sistêmica. A UTC é uma ferramenta não-invasiva que pode ser utilizada para investigação da doença moderada-grave com acurácia moderada quando comparada a AngioTC / Background: Intracranial atherosclerotic disease is a major cause of ischemic stroke in the world, but its prevalence seems to be underestimated in our population by the lack of studies in the area. The aim of this study was to describe the frequency and severity of intracranial stenosis in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA), using the transcranial color-coded sonography (TCCS). The secondary objective was to correlate the TCCS test results with the findings on CT angiography on the same patients. Methods: Prospective observational study that evaluated consecutive patients admitted with a diagnosis of ischemic stroke or TIA during the period February 2014 to December 2014. The initial evaluation consisted of collection of demographic, epidemiological and clinical data and then the patients underwent the examination TCCS through transtemporal and suboccipital windows, in order to assess the presence of intracranial stenosis. Intracranial stenosis was graded moderate (50-70%), severe (70-99%) and subocclusion/occlusion (>= 99%). The cases were considered symptomatic when there was an association between new symptoms and signs and a new infarct area on neuroimaging in the territory of the stenotic artery or when the neurological status corresponded to the territory of that artery. Patients who had TCCS and intracranial angiography in their assessment were blindly compared for the degree of intracranial stenosis following the same classification. Results: We evaluated 271 patients with diagnosis of acute ischemic stroke and TIA (149 men, mean age 65.8 ± 12.5), 263 (97%) underwent examination of intracranial circulation, with the TCCS held in 168 cases (61.9%). Only 25 individuals (14.9%) were excluded due to insufficient transtemporal window. Among the 143 patients who could be evaluated properly by transcranial ultrasound, the prevalence of intracranial arterial stenosis was 38.5% (55 cases); with 25,2% symptomatic cases. The average age of patients was 64 ± 11 years, 26.9% were white and 29.4% hypertensive. Patients with intracranial stenosis had higher scores on the NIHSS: 10 (IR 4-19) vs 6 (IR 3- 13), higher levels of systolic blood pressure at entry: 160 (IR 145-170) vs 140 (IR 130 - 155) and lower HDL rates: 32 (IR 27-39) vs 36 (IR 30-45). After multivariate analysis, the risk factor independently associated with intracranial stenosis was systemic arterial hypertension at admission (p = 0.006). In the 83 patients with both tests, the sensitivity, specificity, positive predictive value and negative predictive value of TCCS compared to CT angiography for detection of intracranial stenosis moderate-severe was 60%, 73%, 73% e 60%, respectively, Conclusions: We found a high frequency of intracranial artery stenosis in patients with acute ischemic stroke and TIA in our population, especially among individuals with hypertension. TCCS is a non-invasive tool that can be used to study moderate-severe disease with moderate accuracy compared to CT angiography

As fístulas arteriovenosas da região do seio cavernoso constituem as fístulas carotidocavernosas que podem ser diretas ou indiretas. As indiretas são raras, a sua sintomatologia é variada e o tratamento é controverso. Este estudo compreendeu a análise prospectiva de 44 pacientes portadores de fístulas carotidocavernosas indiretas (FCCI) no período de 01 de janeiro de 1994 e 31 de janeiro de 2004, 42 com etiologia espontânea e dois pacientes com etiologia traumática, sendo estes analisados separadamente. Doze (12) pacientes foram submetidos à conduta expectante e orientados a realizar manobras de compressão carótido-jugular. O tratamento endovascular foi realizado por via arterial, venosa ou combinação dos dois, num total de 30 pacientes. Considerando o grupo inteiro, ocorreu trombose espontânea em aproximadamente 24% dos pacientes. Os sintomas e o aspecto angiográfico após o tratamento evoluíram com melhora ou cura em 100% dos casos, com oclusão completa das FCCI em 63,3%, a grande maioria destes submetidos a apenas um procedimento. Além dos acessos venosos tradicionais aos seios cavernosos, vias de acesso alternativas através da veia oftálmica superior foram realizadas por punção percutânea de veia facial, veia supratroclear ou veia frontal. O material embolizante mais utilizado foi o adesivo tissular líquido, \"cola\", isoladamente ou em conjunto com outros materiais. Houve complicações transitórias em 13,3% dos pacientes tratados e nenhuma complicação permanente foi observada, o que demonstrou a baixa morbidade deste procedimento / The arteriovenous fistulas of the cavernous sinus (CS) region constitute the carotid-cavernous fistula, which can be direct or indirect. The indirect type is quite rare, its clinical features is very inespecific and its treatment modalities controversial. Forty-four patients with indirect carotid-cavernous fistulas (ICCF) were studied in a prospective manner between January 1994 to January 2004, 42 with spontaneous etiology and 2 with traumatic etiology, being these analyzed separately. Twelve (12) patients were submitted to a expectant management and instructed to perform carotid-jugular compression. Endovascular treatment was accomplished by arterial approach, vein approach or combination of both, in a total of 30 patients. Considering the entire group, spontaneous thrombosis was observed in approximately 24%. Symptoms and the angiographic features after endovascular treatment improved or disappeared in 100% of the cases, with total obliteration in 63.3%, most of them submitted to just one procedure. Despite the traditional venous routes to the CS, alternative accesses through the superior ophthalmic vein (SOV) were accomplished by percutaneous puncture of the facial, supratrochlear or frontal vein. Liquid adhesive (glue) was the most often embolic material used isolated or with other materials. No permanent complication was observed and only 13,3% of the patients treated cursed with transitory complications, what demonstrated the low morbidity of this procedure

INTRODUÇÃO: Os tomógrafos multidetectores (TCMD) aumentaram a sensibilidade na detecção do tromboembolismo pulmonar (TEP). Observa-se, no entanto, um substancial aumento no número de imagens e, conseqüentemente, no tempo de análise pelo radiologista. Uma possível solução, para este problema, é a realização de reconstruções em projeção de intensidade máxima (MIP) que reduz o número de imagens para análise. Existe ainda uma nova modalidade de imagem utilizando reconstrução MIP em planos rotacionais sobre um eixo horizontal ao nível dos hilos pulmonares (reformatação em pás de roda moinho, PRM), que tem demonstrado melhor a continuidade dos ramos arteriais que irradiam dos hilos. No entanto, estudos são necessários para determinar se o uso de reformatações MIP pode reduzir o número de imagens a serem analisadas, sem perda significativa de informações, e se a adição de reformatação PRM pode melhorar o diagnóstico de TEP. OBJETIVOS: Testar a hipótese de que imagens utilizando reconstruções em projeção de intensidade máxima de 2,0 mm e 4,0 mm de espessura, multiplanares, têm o mesmo valor diagnóstico para detecção de TEP nas grandes e pequenas artérias pulmonares, quando comparadas a imagens multiplanares de 1 mm, realizadas em TCMD de 10 e 16 fileiras de detectores. Avaliar se há influência no valor diagnóstico de TEP o acréscimo de reformatações PRM, nas imagens reconstruídas em MIP de 2 mm. CASUÍSTICA E MÉTODOS: Cinqüenta pacientes com suspeita diagnóstica de TEP (30 com TEP positivo e 20 com TEP negativo, detectados no exame tomográfico), realizaram tomografia computadorizada do tórax para avaliação das artérias pulmonares em TCMD com 16 e 10 fileiras de detectores (120 kV, 200 mAs e 1 mm de colimação). Cada exame foi reconstruído em 4 tipos de séries de imagens multiplanares: imagens multiplanares (MPR) de 1 mm e 3 tipos de reconstrução MIP, com espessuras de 2 mm, 4 mm e 2 mm acrescidas de reformatação PRM. Dois observadores avaliaram, independentemente, em estação de trabalho, a presença ou ausência de êmbolos nas artérias principais, lobares, segmentares e subsegmentares dos 50 pacientes em cada uma das reconstruções MIP, as quais foram comparadas usando-se a reformatação MPR de 1 mm como padrão de referência. RESULTADOS: As reconstruções MIP de 2 mm tiveram melhor acurácia, estatisticamente significativa, em relação a MIP de 4 mm, com valores de sensibilidade 100,0 e 100.0 para as artérias principais e lobares; 92,6 e 85,5 para as segmentares e 94,3 e 86,8 para as subsegmentares. Utilizando as imagens multiplanares de 1 mm como referência padrão. Todos pacientes com TEP foram detectados com imagens em MIP de 2 mm. Dois pacientes com TEP não foram diagnosticados com imagens em MIP de 4 mm. Não houve diferença estatisticamente significativa entre a reformatação MIP de 2 mm e 2 mm + PRM na detecção de êmbolos. CONCLUSÃO: Com um número de imagens equivalente a metade da reconstrução MPR de 1 mm, a reconstrução em MIP de 2 mm conseguiu detectar todos os pacientes com TEP positivo que foram diagnosticados pelas imagens multiplanares de 1 mm, com sensibilidade de 100,0 e 100,0 nas artérias principais e lobares, de 92,6 e 85,5 para as artérias segmentares e 94,3 e 86,8 para as artérias subsegmentares. O acréscimo de reformatações PRM às imagens em MIP de 2 mm não aumentou a acurácia na detecção de êmbolos, mas melhorou a visualização da continuidade dos êmbolos, principalmente, nas artérias centrais. / INTRODUCTION: Multidetector computed tomography (MDCT) has been making possible the increase of the sensibility in the detection of the pulmonary embolism (PE). It is observed, however, that there is a substantial increase in the number of images and, consequently, in the time of analysis for the radiologist. A possible solution to this problem is accomplishing a maximum intensity projection reconstruction (MIP) that reduces the number of images for analysis. Still, there is a new image modality using MIP reconstructions in rotational plans that pivot on a central horizontal axis between the lung hila (paddlewheel reformations, PDW). It provides a continuous display of branching arteries that radiate from both hila. However, studies are necessary to determine if the use of multiplan MIP reformation can reduce the number of images to be analyzed, without significant loss of information; and, if the addition of PDW reformation can improve the diagnosis of PE. OBJECTIVE: To test the hypothesis that images using maximum intensity projection reconstructions of 2,0 mm and 4,0 mm of thickness, multiplan, have the same diagnosis value for detection of pulmonary embolism in the big and small pulmonary arteries, when compared to multiplan images of 1 mm collimation, accomplished in 16 and 10 slice MDTC; and to evaluate if there is influence on the diagnosis value of PE the increment of PDW reformation, in the images rebuilt in MIP of 2 mm. CASUISTIC AND METHODS: Fifty patients suspected of having an acute PE (30 with positive PE and 20 with negative PE, detected during the tomography exam) accomplished computerized tomography of the thorax for evaluation of the pulmonary arteries by 16 and 10 slice MDTC (120 kV, 200 mAs and 1 mm collimation). Four kind of images series (1 mm thick multiplan images and 3 kinds of reconstructed images using the MIP tecnhnique with slab thicknesses of 2 mm, 4 mm and 2 mm added of PDW reformation) were obtained from each exam. Two observers independently evaluated, in work station, the presence or absence of emboli in the main and lobar, segmental and subsegmental arteries in the 50 patients in each one of the reconstructions in MIP, which they were compared using the reformation of 1 mm of thickness as reference pattern. RESULTS: The reconstructions in MIP of 2 mm had better accuracy than MIP of 4 mm, statistically significant with values of sensibility 100,0 and 100,0 for the main and lobar pulmonary arteries; 92,6 and 85,5 for the segmental and 94,3 and 86,8 for the subsegmental. The images in MPR of 1 mm were used as a reference pattern. All patients with PE were detected with images in MIP of 2 mm; two patients with PE were not diagnosed with images in MIP of 4 mm. There was not difference statisticament significant among reformation in MIP of 2 mm and 2 mm plus PDW in the detection of emboli. CONCLUSION: Reconstruction in MIP of 2 mm reduced the number of images for the half and it detected all patients with positive PE that were diagnosed by the multiplans images of 1 mm, with sensibility of 100,0 and 100,0 in the main and lobar arteries, of 92,6 and 85,5 and 79,2 for the segmental arteries and 94,3 and 86,8 for the subsegmental arteries. The increment of PDW reformation to the images in MIP of 2 mm didn\'t increase the accuracy in the detection of emboli, but it improved the visualization of the continuity of the emboli, mainly, in the central arteries.

Studium of the clinical impact of different forms of cardiac resynchronization therapy by patients with chronic heart failure MUDr. Lucie Burianová ABSTRACT: Introduction: Biventricular (BiV) pacing decreases mortality and improves quality of life of patients with severe heart failure. Haemodynamic and short time clinical studies suggest that isolated leftventricular pacing could have the same effect. Aims: Compare the effect of BiV and leftventricular pacing by subjects with dilated cardiomyopathy and severe heart failure with the attention to signs of dyssynchrony and remodelation of the left chamber. In methodical substudy compare the results of left chamber volumes and ejection fraction (EF LK) measured by CT angiography and 2-dimensional echocardiography with use of contrast agent (K-ECHO). Methods: Patients indicated for cardiac resynchronization therapy were randomized for either BiV or leftventricular pacing. After implantation of the device they were examinated clinically and by echocardiography every 3 months in the period of one year. Four years from the onset of the study the major adverse events in both groups were evaluated. The results of left chamber volumes and EF LK measured by K-ECHO and CT angiography were compared. Results: We enrolled 33 patients. We found clinical improvement in both...

INTRODUÇÃO: A implantação de stent auto-expansível de nitinol para o tratamento das lesões oclusivas femoro-poplíteas tem sido associado com maus resultados a longo prazo. O everolimus administrado via oral para inibir reestenoses do stent foi investigado recentemente em animais com bons resultados, porém sua segurança e eficácia não têm sido estudada em seres humanos. O propósito deste estudo piloto foi avaliar o impacto da terapia antiproliferativa com everolimus administrado via oral por 28 dias na diminuição de reestenose após implante de stent auto-expansível de nitinol para tratamento de lesões oclusivas da artéria femoral superficial. MÉTODOS E RESULTADOS: Trinta e quatro pacientes foram recrutados para este estudo randomizado, prospectivo. O grupo que recebeu everolimus via oral foi constituído por 15 pacientes e o grupo que não recebeu medicação composto por 19 pacientes. As características basais e do procedimento foram similares entre os dois grupos. Todos os pacientes tinham isquemia crônica do membro inferior e oclusão da artéria femoral superficial (média da lesão de 83,14 mm no grupo sem medicação e 105 mm no grupo everolimus). O objetivo primário do estudo foi a redução da porcentagem média do diâmetro da reestenose intra-stent após seis meses da angioplastia avaliada por angiografia quantitativa. A porcentagem média do diâmetro das reestenoses foi 46,9% no grupo tratado com everolimus e 44,5% no grupo que não recebeu a medicação (p=0,81). Não foram observados efeitos colaterais graves nos grupos. No acompanhamento clínico aos 24 meses não houve diferenças significativas entre os grupos em relação a eventos clínicos. A patência primária, primária assistida e secundária em 24 meses, foi 42%, 74% e 79% no grupo sem medicação e 27%, 73% e 73% no grupo tratado com everolimus. CONCLUSÃO: O everolimus via oral por 28 dias em doses altas é seguro e bem tolerado, com baixo índice de efeitos colaterais, porém não é eficaz na redução da porcentagem média do diâmetro da reestenose intra-stent em pacientes com implante de stents auto-expansíveis de nitinol nas lesões oclusivas complexas da artéria femoral superficial. / INTRODUCTION: The implantation of a self-expanding of nitinol stent in the treatment of femoropopliteal occlusive lesions has been associated with a poor outcome in a long term setting. Everolimus administered orally to inhibit restenosis of the stent was investigated recently in animals with good results, but its safety and efficacy has not been studied in humans. The purpose of this pilot study was to evaluate the impact of antiproliferative therapy with everolimus administered orally for 28 days in the reduction of restenosis after implantation of self-expandable nitinol stent for treatment of occlusive lesions of the superficial femoral artery. METHODS AND RESULTS: Thirty-four patients were recruited for this randomized, prospective study. The group that received oral Everolimus was consisted of 15 patients and the group that received no medication was 19 patients. The baseline characteristics and procedure were similar in both groups. All the patients had chronic lower limb ischemia and occlusion of the superficial femoral artery (mean of the lesion of 83.14 mm in the group without medication and 105 mm in the everolimus group). The primary objective of the study was to evaluate the reduction of the average percentage of the diameter of in-stent restenosis six months after angioplasty assessed by quantitative angiography. The in-stent mean percent diameter stenosis was 46.9% in the group treated with everolimus and 44.5% in the group that received no medication (p = 0.81). There were no serious side effects seen in either group in the clinical follow up at 24 months. There was no significant difference between groups in relation to clinical events. The primary patency, assisted primary and secondary in 24 months was 42%, 74% and 79% in the group without medication and 27%, 73% and 73% in the group treated with Everolimus. CONCLUSION: Everolimus administered orally for 28 consecutive days to stent implantation in high doses proves to be safe and well tolerated, with low rate of side effects, but it is not effective in reducing the average percentage of diameter of in-stent restenosis in patients with implantation of self-expandable nitinol stent in complex occlusive lesions of the superficial femoral artery.

OBJETIVO: Caracterizar morfologicamente e funcionalmente as alterações observadas no fundo de olho de pacientes com a doença de Vogt-Koyanagi- Harada (VKH) no estágio tardio. MÉTODOS: Estudo prospectivo, transversal, com inclusão de 36 pacientes com diagnóstico de doença de VKH no estágio tardio (definido como 6 meses ou mais após o início da doença) após obtenção do termo de consentimento livre e esclarecido. Fundo de olho (retinografia, RG) foi estratificado baseado em alterações difusas e focais assim como a função global da retina (eletroretinograma campo total, ERGct) segundo o método matemático de aglomeração (cluster). A concordância entre os dois métodos de estratificação foi estimada pelo teste kappa. Atividade clínica foi correlacionada com alterações indicativas de atividade de coróide pela angiografia com indocianina verde (AICV) (teste exato de Fisher). Alterações na integridade dos segmentos interno e externo de fotorreceptores (IS/OS) avaliada pela tomografia de coerência óptica espectral (OCT espectral) foram correlacionadas com a função macular (eletroretinograma multifocal, ERGmf) e acuidade visual (AV) (teste de Mann-Whitney). RESULTADOS: Houve concordância substancial entre os observadores em relação ao sistema analítico para estratificação fundoscópica proposto (kappa=0,78; intervalo de confiança 95%(IC95%)=0,63-0,93). Este sistema analítico também se correlacionou de maneira substancial com os achados do ERGct (kappa=0,68; IC 95% 0,52-1,07). Na avaliação com AICV, a proporção dos olhos com resultados compatíveis com atividade subclínica de coróide foi maior em pacientes com doença fundoscópica leve (12/13 olhos) se comparados exclusivamente com aqueles portadores de doença fundoscópica grave (11/19 olhos) (p=0,049). Os pacientes estratificados de acordo com as características fundoscópicas não diferiram de maneira substancial quanto aos aspectos clínicos. Atividade subclínica de coróide detectada pela AICV foi observada em 36 dos 51 olhos (72%). Atividade clínica (células na câmara anterior) foi observada em 21 dos 51 olhos (41%). Destes 76% (16/21) demonstravam sinais de atividade de coróide, ao passo que 5 de 21 olhos (24%) não os apresentavam. Dos pacientes com atividade clínica de doença e com AICV negativa, a maioria tinha doença grave (4/5 olhos) e nenhum tinha doença leve pela classificação fundoscópica. Quanto à função macular, as amplitudes e latências das ondas N1 e P1 diferiram dos controles (p<0,01). A junção IS/OS macular estava alterada em 17 de 42 olhos (40%) dos olhos. A AV foi diferente entre grupos estratificados de acordo com os resultados do ERGmf ( leve= 0,0 [20/20] e grave = 0,2 [20/32]; p<0,05) assim como entre os grupos estratificados pelo OCT espectral (IS/OS+ = 0,0 [20/20] e IS/OS-= 0,7 [20/100]; p<0,05). O grau de concordância entre estas estratégias foi baixo (K=0,17). CONCLUSÕES: O sistema analítico para achados fundoscópicos proposto teve alta reprodutibilidade e correlacionou-se com medidas objetivas de função retiniana (ERGct). A gravidade de doença estimada segundo a estratégia fundoscópica influencia a interpretação da AICV, sendo que pacientes com achados leves tendem a ter maior prevalência de atividade subclínica detectada pela AICV assim como pacientes graves apresentaram exame angiográfico negativo mesmo na vigência de atividade de segmento anterior. Os grupos estabelecidos com as estratégias funcional (ERGmf) e morfológica (OCT espectral) de análise macular diferiram significativamente em termos de acuidade visual, sendo que o ERGmf discerniu grupos com acuidades semelhantes. A concordância entre as duas técnicas de análise macular foi baixa devido à maior sensibilidade do ERGmf em detectar alterações. Estes dados sugerem que o dano funcional pode preceder e/ou ocorrer na ausência de alterações maculares detectáveis com o OCT espectral em pacientes no estágio tardio da doença de VKH / OBJECTIVES: To characterize the structural and functional derangements observed in eyes of patients with late-stage Vogt-Koyanagi-Harada (VKH) disease. METHODS: Cross sectional, prospective study including 36 patients diagnosed with late-stage VKH disease (defined as more than 6 months from disease`s onset) after obtainment of informed consent. Fundoscopy (retinography, RG) was stratified based on diffuse and focal findings as well as according to global retinal function (full-field electroretinogram, ffERG) applying cluster method of aggregation. The concordance between the two methods of stratification was estimated with the kappa test. Clinical disease activity was correlated with findings suggestive of subclinical choroidal activity on indocyanine green angiography (ICGA) (Fisher`s exact test). Disruption of photoreceptors inner and outer segments\' junction (IS/OS) evaluated using spectral optical coherence tomography (spectral OCT) was correlated with macular function (multifocal electroretinogram, mfERG) and best corrected visual acuity (BCVA)(Mann- Whitney test). RESULTS: Substantial interobserver concordance was detected with regard to the analytic system for fundus findings proposed (kappa=0.78; confidence interval 95%(CI95%); 0.63-0.93). This system also showed substantial correlation with ffERG findings (kappa=0.68; CI 95%; 0.52-1.07). Upon ICGA investigation, the proportion of eyes presenting signs of disease activity on ICGA was significantly greater among mild fundus cases (12/13) when compared exclusively with those presenting severe fundus disease (11/19) (p=0.049). The different severity categories based on fundoscopic evaluation did not differ in terms of clinical characteristics. Subclinical choroidal activity was observed in 36 of 51 eyes analyzed (72%). Clinical disease activity (cells in the anterior chamber) was observed in 21 of 51 eyes (41%). Most patients with clinical activity and negative ICGA examination (4/5) had severe disease and none had mild disease according to fundoscopic stratification. On macular evaluation, patients\' amplitudes and latencies of N1 and P1 waves differed from controls (p<0.01). Macular IS/OS junction was altered in 17 out of 42 eyes (40%). BCVA differed significantly between groups stratified according to both, mfERG (mild = 0.0 [20/20] and severe = 0.2 [20/32]; p<0.05) as well as spectral OCT (IS/OS+ = 0.0 [20/20] and IS/OS-= 0.7 [20/100]; p<0.05) assessment techniques. Concordance between these strategies of macular assessment was weak (K=0.17). CONCLUSIONS: The analytic system for fundus findings proposed herein demonstrated high reproducibility and substantial interobserver concordance with objective measures of retinal compromise (ffERG). The severity grading proposed influenced the interpretation of ICGA, as patients with mild disease had a greater proportion of positive findings while patients with severe disease presented negative ICGA in spite of anterior segment activity. Groups established according to both functional (mfERG) and morphological (spectral OCT) macular analysis strategies differed in terms of BCVA, although the mfERG distinguished groups with similar BCVA. The low concordance between the two strategies detected is attributable to the greater sensibility of the mfERG to detect alterations. These findings suggest that functional derangements may precede and/or occur in absence of alterations detectable with the spectral OCT in patients with late-stage VKH disease.