Abstract
Purpose :
Vogt-Koyanagi-Harada (VKH) disease is bilateral and granulomatous uveitis. At the acute phase, the VKH-patients often suffer from decrease in the visual acuity (VA), and metamorphopsia because of serous retinal detachment (SRD), undulations of the retinal pigment epithelium (RPE), or choroidal fold at the fovea. Systemic steroid therapy for the inflammation is often effective, however, it is problematic that the inflammation can be recurrent generally when the dose of the steroid agent is reduced. Optical coherence tomography (OCT) is clinically useful for diagnosing and quantitatively evaluating the chorioretinal pathologies, however, there have been no valid OCT markers for predicting the recurrence. In this study, we focused to examine the OCT-reflectivity of the RPE at the acute phase, and the association with the future recurrence of the VKH-disease.
Methods :
We included 40 eyes (both eyes of 9 men and 11 women) with treatment naïve acute VKH-disease whom we can observe for more than 12 months. We excluded patients with uveitis other than VKH disease, and patients who had received steroid therapy for other pathologies. Using OCT B scans at the fovea, we measured the RPE-reflectivity by calculating the ratio of the difference in the reflectivities between the RPE and the vitreous body to that in the reflectivities between the retinal nerve fibers and the vitreous body. We defined the recurrence as the reappearance of inflammations in the anterior segment, or those in the posterior segment including SRD, undulation of the RPE, and thickening of the choroid on OCT during the observational period.
Results :
During the mean observational period of 37.2 months, 22 eyes of the 11 patients (55 %) had the recurrence. Logistic analysis using factors of age, retinal and thicknesses at the fovea, and RPE-reflectivity showed that the only RPE reflectivity was significantly associated with the recurrence (adjusted odds ratio: 40.560, 95% confidence interval: 1.20-1372.40, p = 0.039). Compared to eyes without the recurrence, the logMAR VA was poorer (0.08 ± 0.17 vs. 0.63 ± 0.70, p = 0.002), and the RPE reflectivity was greater at the initial visit in eyes with the recurrence (1.25 ± 0.19 vs. 1.54 ± 0.43, p = 0.010).
Conclusions :
In addition to the initial poor VA, the greater RPE-reflectivity on OCT may be a prognostic marker for the future recurrence of the VKH-disease.
This is a 2021 ARVO Annual Meeting abstract.