title: Concomitant choroidal inflammation during anterior segment recurrence in Vogt-Koyanagi-Harada disease.
abstract: OBJECTIVE
  To determine whether clinically isolated anterior segment recurrence is associated with concomitant subclinical choroidal inflammation in Vogt-Koyanagi-Harada (VKH) disease.
  
  
  METHODS
  Interventional, retrospective case series.
  
  
  METHODS
  Nine patients with recurrent VKH disease who satisfied the following criteria: 1) presence of anterior chamber (AC) inflammation of at least 1+ cells after a period of quiescence of three months or more, 2) no posterior segment involvement, and 3) indocyanine green angiography (ICGA) performed during the time of anterior segment recurrence at the Singapore National Eye Centre. ICGA was performed. Therapy was administered based on clinical features. The main outcome measures were the ICGA features.
  
  
  RESULTS
  Twelve eyes of nine patients were included in the study. All eyes had mild AC inflammation of 1 to 2+ cells, except for one eye that had 3+ cells. ICGA showed early large vessel hyperfluorescence, becoming fuzzy in character in the intermediate phase in 11 of 12 eyes with AC inflammation. In four eyes, few hypofluorescent dots were seen in the intermediate phase that remained hypofluorescent in the late phases. Late diffuse hyperfluorescence was observed in five eyes. All patients received high-dose oral prednisolone and topical prednisolone acetate. Four patients required additional steroid-sparing immunosuppressants. All patients attained clinical quiescence within two weeks to two months. Repeat ICGA showed absence of active leakage, significant decrease in choroidal vascular leakage, or no change in the number and density of hypofluorescent spots.
  
  
  CONCLUSIONS
  Isolated anterior segment recurrence in VKH disease may occur concomitantly with subclinical choroidal inflammation and requires systemic therapy.
authors.affiliation: Singapore National Eye Centre, Singapore, Republic of Singapore.
authors.forename: Kristine
authors.initials: K
authors.lastname: Bacsal
authors.forename: Daniel Su Hsien
authors.initials: DS
authors.lastname: Wen
authors.forename: Soon-Phaik
authors.initials: SP
authors.lastname: Chee
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000869:Anterior Eye Segment / Q000187:drug effects / Q000473:pathology*; D002833:Choroiditis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D012008:Recurrence; D014607:Uveomeningoencephalitic Syndrome / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D004396:Coloring Agents; D005938:Glucocorticoids; D011239:Prednisolone; D007208:Indocyanine Green