Intraretinal cystoid spaces in acute Vogt–Koyanagi–Harada disease

Abstract

Purpose : To present intraretinal cystoid spaces observed in spectral-domain optical coherence tomography (SD-OCT) images of eyes with acute Vogt-Koyanagi-Harada disease (VKHD).

Methods : Retrospective and descriptive study with VKHD patients who presented intraretinal cystoid spaces in the acute phase. All patients were followed for a minimum of one year from disease onset with predefined treatment protocols and systematic evaluation. We reviewed conventional OCT images, enhanced depth SD-OCT images (HRA+OCT, Heidelberg), including serial sections through the macula obtained at the initial visit and during the follow-up until complete resolution of serous retinal detachment.

Results : Twenty-nine patients (58 eyes) were evaluated. Of these, 8 patients (7 women, 12 eyes [20%]; mean age 34.6±10.2 years) had intraretinal cystoid spaces (IRCS) at baseline (M0) and/or at first month of follow-up (M1) (Table 1). In this group, the mean time to start treatment was 29.2±13.5 days. All these patients were treated with high-dose corticosteroid; six patients (75%) received additional early azathioprine until the second month of follow-up. In the group with cystoid spaces, the mean visual acuity (VA) at M0 was 1.70±0.5logMAR and at M1 was 0.55±0.65logMAR. In 9 eyes, VA improvement was observed at M1, while in 3 eyes VA did not ameliorate. With 1 year of follow-up, VA was 0.07±0.2logMAR. At M0/M1, on SD-OCT, all eyes with cystoid spaces had concomitant serous retinal detachment (SRD), and in 3 eyes there was a split in the inner photoreceptor myoid zone (bacillary detachment). We observed a slight increase in the density of the IRCS compared to the subretinal fluid in the SRD (Figure 1), with a significant variation in the mean optical density ratio (ODR) among them (0.36±0.14 and 0.21±0.09, respectively; P = 0.008).

Conclusions : Even though cystoids spaces have been described in early SD-OCT literature in acute VKHD, detailed and better definition of SD-OCT findings relocated previous findings as serous retinal detachment or more recently as bacillary detachment. Intraretinal cystoid spaces, affecting inner and/or external nuclear layers, as described here, have not been reported till far. We hypothesize that our findings may be due to the action of inflammatory mediators, but studies are needed to understand its relevance since all patients had good VA during the follow-up.

This is a 2021 ARVO Annual Meeting abstract.