Dentate pattern of the outer plexiform layer (OPL)/Henle fiber layer (HFL) interface in Vogt-Koyanagi-Harada disease (VKHD): a longitudinal analysis of 66 eyes

Abstract

Purpose : To report the frequency of dentate pattern and associations with other optical coherence tomography (OCT) findings and with clinical outcomes in patients with VKHD.

Methods : Thirty-three patients with VKHD were retrospectively included. They were followed from acute onset for at least 1 year and had systematic clinical and visual function evaluations at baseline (M0), months 1 (M1), 3 (M3), 6 (M6), 9 (M9) and 12 (M12). Spectral domain (SD-) OCT and enhanced depth imaging-OCT (Spectralis^® HRA + OCT), horizontal line through the fovea, were analyzed to determine the presence of dentate pattern and other findings. En face OCT (Spectralis^® OCT II) was used to assess the presence of fingerprint sign. Generalized estimating equations of binomial distribution and logit link function with interchangeable correlation between eyes and moments were carried out. The study was approved by Institutional Ethics Committee.

Results : Median age of patients (29F/4M) was 33 years (15 to 67). Median visual acuity (VA) was 1.8 logMAR (0 to 2.3) at M0, 0.2 logMAR (0 to 2) at M1 and 0 logMAR (0 to 0.7) at M12. Median choroidal thickness (CT) was 459μm (218 to 784) at M1 and 341μm (122 to 762) at M12 (Table). In the first year, dentate pattern was present in 81.8% of eyes (Figure), with average detection time of 5.2 months (1 to 12). Significant associations occurred between the presence of dentate pattern and better VA at M1 (median 0.175 vs 0.35 logMAR; p=0.006) and M12 (median 0 vs 0.14 logMAR; p=0.004) and greater CT at M1 (473.5 vs 352.5; p=0.031). Eyes with dentate pattern had worse initial indocyanine angiographic scores and evolved with more fibrosis and sunset glow fundus, without statistical significance.

Conclusions : Our study showed that these lesions are common during the first year of VKHD and were associated with better long-term visual acuity. Hyperreflective tooth-like lesions at the OPL/HFL junction have been described in OCT of different macular diseases. Recently, the term “HFL hyperreflectivity angular signal” (Ramtohul 2022) was proposed to unify these findings. However, it is still unclear whether they all have a common pathogenesis and prognostic value. The longitudinal aspect and correlations shown in our study can help the understanding of these findings.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.