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Xiu-Ling Tan, Stephen Teoh, Su Ling Ho; Microperimetric Assessment of Macular Changes in Vogt-Koyanagi-Harada Disease. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2943.
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To describe microperimetry macular findings in Vogt-Koyanagi-Harada (VKH) disease and correlate the microperimetric findings with visual outcomes.
This was a retrospective observational study. Twelve patients were included: 7 patients with acute VKH, 2 patients at recurrence of VKH, and 3 patients in the convalescent stage. Macular sensitivities were measured with the Microperimeter-1 (MP1, Nidek, Japan). The association between best corrected visual acuities (BCVA) and mean central 10 degrees retinal sensitivities was evaluated with Spearman correlation analysis. A subgroup analysis of patients with acute VKH was performed, evaluating BCVA and microperimetric retinal sensitivities at baseline and at 1 week, 1 month and 6 months after treatment.
The mean age was 43.5 years (SD±13.5). 58.3% were female and 83.3% were Chinese. In acute VKH, 86.6% of the patients (n=5) presented with serous exudative retinal detachments, 57.1% (n=4) had optic disc swelling and 28.6% (n=2) had choroidal folds. In the convalescent phases, all patients had sunset glow fundus with concentric peripapillary atrophy. The mean LogMAR BCVA was 0.80 ± 0.822 in acute VKH, 0.47 ± 0.077 in convalescent phase, and 0.17 ± 0.945 in recurrent disease. Patients with convalescent VKH had better LogMAR BCVA compared to the active group (p=0.082). The mean retinal sensitivities within the central 10 degrees in acute, convalescent, recurrent stages of VKH were 7.19 ± 7.470 decibels (dB), 18.13 ± 0.818 dB, and 12.80 ± 3.747 dB respectively. The mean retinal sensitivities were lower in eyes with acute VKH than those with convalescent VKH (p=0.004). The mean retinal sensitivity correlated significantly with visual acuity (r=-0.713, p<0.001). In the subgroup analysis of patients with acute VKH, there was a statistically significant upward trend for mean retinal sensitivities (Spearman's rho = 1.000) and downward trend for LogMAR BCVA (Spearman's rho = -0.900, p = 0.037) over the course of treatment. However interestingly, there was a significant correlation between mean retinal sensitivity and BCVA only at baseline (p =0.001), but not at Week 1, Month 1 or Month 6.
Microperimetry provides a noninvasive indicator of disease severity and dynamic changes in macular pathology, reflecting the effect of treatment in association with improvement in visual acuity. This may help to guide tapering of systemic corticosteroid treatment.
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