Is there any choroidal inflammation in the non-acute stage of Vogt-Koyanagi-Harada disease (VKHD)?

Abstract

Purpose : To evaluate disease activity in the non-acute stage of VKHD.

Methods : Patients (P) within a minimum 12-mo period from disease onset (defined as non-acute) were prospectively evaluated over at least 1y. Follow-up protocol included every 3-mo clinical and imaging exams [indocyanince green and fluorescein angiographies (FA) and enhanced depth optical coherence tomography]. Full-field (ffERG) and multifocal electroretinograms (mfERG) were carried out at inclusion and at 12-mo follow-up. Imaging exams were read by 3 masked retina specialists. Disease activity signs were defined as clinical signs [anterior chamber cells (ACC), macular edema (ME) and choroidal neovascularization (CNV)] and as subclinical signs [perivascular or optic disc leakage on FA, dark dots and increase in choroidal thickness (CT≥30%)]. Treatment was tailored based on the presence of clinical signs. Patients with no clinical or subclinical signs were designed as pattern A; those with only subclinical signs, as pattern B, and those with both signs, as pattern C.

Results : 20P (17F/3M) with median disease duration of 55mo (12-144mo) were included. While CT increase, ME and CNV had a substantial to optimal reading concordance (kappa>0.8), other angiographic signs had poor concordance (kappa<0.2). During follow-up, cells were observed in 11 evaluations; subclinical posterior segment inflammation (PSI) was simultaneously observed in 64% of eyes. At inclusion, inflammation status was: none in 1P (5%); only subclinical signs in 10P (50%); and both clinical and subclinical in 9P (45%). The follow-up of pattern B patients showed that 2P converted to pattern C (ACC+); ERG parameters became stable in 4P and worsened in 3P (3P not done). Pattern C patients had ERG parameters stable in 2P and worsened in 4p. Treatment was incremented in 13P (65%) during follow-up.

Conclusions : 1. Among PSI signs, those observed on OCT were the most reliable ones; 2. ACC was indicative of subclinical PSI in 2/3 of the patients; 3. 18 out of 25 eyes (72%) included as with no clinical sign of inflammation, had subclinical PSI; during follow-up, only 2 eyes remained with no clinical or subclinical signs of inflammation; 4. Half of the eyes showed retina function deterioration during follow-up, despite remaining with good visual acuity.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Table 1 -Disease activity and electroretinogram parameters of patients with non-acute VKHD at inclusion and at 12-month follow-up.