The Impact of Indocyanine Green Angiography in Late Phase Vogt-Koyanagi-Harada Disease Patients

Abstract

Purpose: : 1. To describe the prevalence of signs of subclinical posterior activity in late phase VKH patients found in indocyanine green angiography (ICGA), 2. Correlate these findings with anterior segment activity and fundus fluorescein angiography (FFA) findings.

Methods: : Prospective, observational and transversal study including 77 eyes of 33 patients in the late phase of VKH disease from HCFMUSP. 11 patients underwent examination more than once. Fundus pictures, FFA and ICGA were taken (TRC 50-X, and Imaginet, 50X, Imaginet Systems, TOPCON Inc, Tokyo, Japan) simultaneously, all according to pre-defined protocols. The ICGA results were interpreted by 5 different retina specialists and disagreements were settled by a consensus. Clinical evaluation was undertaken in a blinded manner and activity was defined according to the SUN consensus.

Results: : Clinical evaluation rendered 23 active and 54 inactive eyes, none of the patients had posterior segment activity. According to ICGA results, 43 eyes were considered active and 34 were inactive. Concordance on activity among clinical and ICGA appraisal was found in 43 eyes (16 with activity by either evaluation and 27 by neither). Discordance was found in 34 eyes (27 with activity on ICGA only and 7 with activity on clinical evaluation only). Findings in order of prevalence were hypofluorescent dots (78 eyes, 10 of which were considered inflammatory dots), leaking fuzzy vessels (58 eyes), focal hyperfluorescence (13 eyes, 4 of which were peripapillary) and late diffuse hyperfluorescence (51 eyes).

Conclusions: : ICGA detected posterior activity in 57% of late phase VKH patients.In half of these patients no clinical activity was detected. Prospective studies to understand the relevance of these signs in the course of VKH disease are needed.

Keywords: imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • uveitis-clinical/animal model