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Grayson Wilkes Armstrong, Meghan J Smith, George N Papaliodis, John B Miller; Optical Coherence Tomography Angiography of Acute-Onset Vogt-Koyanagi-Harada Disease in a Young Female. Invest. Ophthalmol. Vis. Sci. 2019;60(11):PB080.
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Optical coherence tomography angiography (OCTA) is capable of non-invasively assessing choroidal blood flow. To date, limited knowledge exists on OCTA findings in uveitic diseases preferentially affecting the choroid, such as Vogt-Koyanagi-Harada (VKH) disease. We present unique OCTA imaging findings in acute VKH disease and show that OCTA imaging may be beneficial in early diagnosis, assessing for response to treatment, and monitoring for relapse of disease in VKH.
A young female presenting to Massachusetts Eye & Ear (Boston, USA) diagnosed with acute VKH underwent complete ophthalmic exam with multimodal imaging. Optical coherence tomography angiography was performed using the Optovue Avanti, using AngioVue OCTA Software (Optovue, Inc., Fremont, CA, USA).
Clinical examination revealed a visual acuity of 20/40 OD and 20/25-1 OS, with normal pupils and intraocular pressures. Anterior segment revealed conjunctival injection, endothelial keratoprecipitates, and 2+ cell without hypopyon. Posterior examination demonstrated 1+ vitritis as well as serous macular detachments (Fig 1A). Fundus autofluorescence demonstrated hyperfluorescence in areas of serous retinal detachment (Fig 1B). Fluorescein angiography demonstrated delayed choroidal filling with optic disc leakage as well as macular and peripapillary focal staining resembling a ‘starry sky’ pattern in early and late frames (Fig 1C-D). Spectral-domain OCT showed bilateral serous retinal detachments with a subretinal fibrinous septae in the right eye (Fig 1E). OCTA demonstrated (1) diffuse areas of decreased choriocapillaris flow signal in areas of serious retinal detachments (Fig 2C-D, solid line), (2) numerous smaller focal areas of choriocapillaris flow void (Fig 2C-D, broken line), and (3) normal choriocapillaris flow signal beneath the right eye subretinal fibrinous septae. All clinical and imaging findings resolved at 2.5 months after treatment with systemic and topical corticosteroids (Fig 2E-F).
We present three unique OCTA imaging findings in the acute phase of VKH. All OCTA findings resolved in our patient after use of corticosteroids. These findings support the conclusion that OCTA imaging may be beneficial in early diagnosis, assessing for response to treatment, and monitoring for relapse of disease in VKH.
This abstract was presented at the 2019 ARVO Imaging in the Eye Conference, held in Vancouver, Canada, April 26-27, 2019.
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