title: Indocyanine green angiography guided management of vogt-koyanagi-harada disease.
abstract: OBJECTIVE
  To report the management of Vogt-Koyanagi-Harada (VKH) disease based on indocyanine green angiography (ICGA).
  
  
  METHODS
  VKH patients with acute episodes of inflammation (inaugural or recurrent) who had received standard ICGA-guided care were studied retrospectively. Standard of care included high dose systemic corticosteroids at presentation and close ICGA follow-up with addition of immunosuppressive agents and/or intensification of ongoing therapy when recurrent choroidal lesions were detected by ICGA. Visual acuity, number of subclinical recurrences, type and duration of therapy, proportion of quiescent patients after therapy, and ICGA findings were recorded.
  
  
  RESULTS
  Nine patients including 8 female and one male subject were studied. Five patients had inaugural disease and 4 presented with recurrent acute episodes. Visual acuity increased from 0.86±0.36 to 1.14±0.34 in the right eyes, and from 0.77±0.34 to 1.05±0.33 in the left eyes. The number of ICGA-detected occult choroidal recurrences amounted to 13. Mean duration of treatment was 30.1±34.6 months leading to recurrence-free status after discontinuation of therapy in 6 cases with mean duration of 29.5 months.
  
  
  CONCLUSIONS
  Continuous monitoring and aggressive therapy guided by ICGA in VKH disease prolongs treatment as compared to textbook guidelines but offers the prospect of reaching inflammation-free status after discontinuation of therapy. Zero tolerance to subclinical choroidal inflammation avoids irremediable evolution towards sunset glow fundus in patients treated early after the initial acute inflammatory attack.
authors.affiliation: Inflammatory and Retinal Eye Diseases, Center for Ophthalmic Specialized Care, Lausanne, Switzerland.
authors.forename: Nadia
authors.initials: N
authors.lastname: Bouchenaki
authors.forename: Carl P
authors.initials: CP
authors.lastname: Herbort