Association between baseline macular morphologic features on optical coherence tomography (OCT) and visual outcomes in patients with Vogt-Koyanagi-Harada disease

Abstract

Purpose : Vogt-Koyanagi-Harada (VKH) disease is a vision-threatening systemic illness characterized by panuveitis with choroidal thickening and serous retinal detachments. Spectral domain OCT (SD-OCT) images such posterior findings. We evaluated whether SD-OCT presenting features (bacillary detachments, retinal pigment epithelium (RPE) folds, internal limiting membrane (ILM) fluctuations, and RPE undulation index) were associated with visual outcome in VKH.

Methods : An exploratory subanalysis of data from the First-line Antimetabolites for Steroid-Sparing Treatment (FAST) Trial was performed. The FAST Trial was a randomized clinical trial that compared corticosteroid-sparing control of intermediate, posterior and panuveitis in patients randomized to a standardized corticosteroid taper plus either methotrexate or mycophenolate mofetil. SD-OCT images from VKH participants were analyzed for the presence or absence of bacillary detachments, RPE folds, and ILM fluctuations. A modified RPE undulation index (ratio of horizontal RPE line length to total horizontal scan length on a foveal-centered SD-OCT scan) was calculated to provide a quantifiable marker for choroidal folds. RPE line length measurements were obtained using ImageJ (NIH, Bethesda, MD, USA). Statistical analysis included associations with visual acuity (logMAR) using linear mixed models with fixed effects for visit (baseline vs final) and variables of interest.

Results : A total of 158 eyes were diagnosed as VKH and had evaluable SD-OCT images. Most participants were female (70.4%) and 54.3% of participants received methotrexate while 45.7% received mycophenolate mofetil. At baseline, bacillary detachments were noted in 23.5% of eyes, RPE folds in 22.8%, and ILM fluctuations in 35.2%. The mean modified RPE undulation index at baseline was 1.09±0.09. None of the SD-OCT features of interest were associated with best spectacle-corrected visual acuity (BSCVA) at 6-month primary endpoint. Mean final BSCVA was similar in those with and without SD-OCT features of interest at baseline and was between 0.1 and 0.2 logMAR (Snellen visual acuity 20/25 to 20/30).

Conclusions : In eyes with VKH featuring prominent retinal disruption and choroidal folds on presenting SD-OCT, final visual outcome can be excellent provided adequate control of inflammation.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.