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Enzo Castiglione, Rodrigo Anguita, Tomas Barrueto, Crescente Lopez, Felipe Rojas, Rodrigo Vidal; Choroidal thickness is a marker for successful tapering of therapy in VKH disease. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3316.
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© ARVO (1962-2015); The Authors (2016-present)
Vogt-Koyanagi-Harada (VKH) disease causes a chronic, bilateral, non-infectious uveitis with blinding potential. Sub clinical activity detected by indocyanine green angiography correlates with the long term appearance of sunset glow fundus. Optical coherence tomography with enhanced-depth imaging (EDI-OCT) can safely show choroidal thickening during VKH onset and activity. Choroidal thickening correlated with relapsing inflammation in Asian population.We propose EDI-OCT to be a helpful aid when tapering treatment by detecting recurrent inflammation.
Single-center, longitudinal study.Inclusion criteria: incomplete or probable VKH according to international revised diagnostic criteria, receiving systemic therapy. Minimum follow up of 6 months.Exclusion criteria: myopia larger than 6 diopters.Subjects were evaluated every one to three months for best corrected visual acuity, slit-lamp examination, fundoscopy and EDI-OCT with Heidelberg Spectralis. Choroidal thickness was obtained by a single experienced operator. Only images with a quality index above 25dB were accepted.We evaluated thickening greater than 32 and 48 microns for their sensitivity to detect clinical inflammation defined as the presence of ≧+0,5 anterior chamber cells or prescription of periocular steroid injection or increase in systemic therapy. We also evaluated thinning of more than 48 microns to predict absence on inflammation after therapy reduction.
Sixteen eyes from 8 patients were evaluated a total of 146 times.Choroidal thickening for both values assessed was associated to inflammation 50% of the times (7/14 for >32 and 5/10 for >48 microns).A reduction greater than 48 microns was observed in 16 cases. It coexisted with inflammation in only 3 cases, always unilateral. There was no inflammation in the same or in the next visit in the other 81% of cases. Thinning of more than 48 microns predicted successful reduction of therapy without recurring inflammation in all 7 eyes in which it was attempted.
EDI-OCT is a useful aid for clinical decision making in the management of VKH disease and is a good candidate for detecting sub clinical activity.A reduction in choroidal thickness of more than 48 microns in the absence of clinical inflammation is a good predictor for no recurrence whether therapy was maintained or mildly reduced.Cut values for significant choroidal thickening/thinning need yet to be refined.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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