Blue Light And Near-infrared Fundus Autofluorescence In Long-standing Vogt-Koyanagi-Harada Disease

Abstract

Purpose: : To investigate fundus autofluorescence (FAF) in patients with Vogt-Koyanagi-Harada (VKH) disease with more than 6 months’ duration and to correlate FAF findings with clinical disease activity and fundoscopic standardized grading.

Methods: : Fifty-one patients (97 eyes) were included in the study. A confocal scanning laser ophthalmoscope was utilized for FAF documentation. Two wavelengths were utilized for fundus imaging: blue light (b-FAF) and near-infrared light (ni-FAF). The FAF images were analyzed by three independent observers to detect hyperautofluorescent areas/spots. According to fundus aspect each eye was classified as mild (mild diffuse fundus depigmentation and no other focal findings), moderate (moderate diffuse fundus depigmentation accompanied by one of the following focal findings: 1) at least one nummular lesion at three or more quadrants, 2) pigment clumps at three or more quadrants, and 3) any subretinal fibrosis) or severe (severe diffuse fundus depigmentation with two or more focal findings). Clinical disease activity (according to the S.U.N. guidelines) and fundoscopic disease severity grading were compared with b-FAF and ni-FAF findings.

Results: : Hyperautofluorescence areas/spots were observed in 59.8% (58 out of 97 eyes) on b-FAF, and in 99.0% (96 out of 97 eyes) on ni-FAF. Overt clinical activity was detected in 12.4% (12 out of 97 eyes). Hyperautofluorescence in both b-FAF and ni-FAF did not show correlation with clinical activity (cells in the anterior chamber). Hyperautofluorescence on b-FAF was unevenly distributed between fundoscopic severity groups (mild= 33.3% [15 out of 45 eyes] vs. severe=75.6% [31 out of 36 eyes]) while being close to omnipresent on ni-FAF (mild=100% [45 out of 45 eyes] vs. severe=97.6% [40 out of 41 eyes]).

Conclusions: : Hyperautofluorescence on ni-FAF may be a hallmark of long-standing VKH disease whereas pigmentary derangement appears to influence the generation of hyperautofluorescent areas/spot on b-FAF. Neither FAF imaging modalities seem to correlate with the presence of clinical disease activity (cells in the anterior chamber).

Keywords: imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • inflammation • uvea