Spectral domain optical coherence tomography of Vogt-Koyanagi-Harada disease: novel findings and new insights into the pathogenesis.
OBJECTIVE
To provide novel spectral domain optical coherence tomography (SD OCT) findings of Vogt-Koyanagi-Harada (VKH) disease as well as new insights into the pathogenesis of this disease.


METHODS
Detailed SD OCT and fluorescein angiography (FA) findings of 18 consecutive VKH patients (11 women and 7 men) from December 2007 to April 2009 who were in acute uveitic stage at presentation were reviewed. All the patients had been followed up for at least 6 months with reevaluation(s) of SD OCT performed in 10 patients.


RESULTS
Intraretinal cysts were found to be located in various layers of the outer retina. In addition to the photoreceptor layer, they could also be found between the outer plexiform layer and the outer nuclear layer, or spanning the external limiting membrane. On FA, intraretinal cysts could be hypofluorescent, normofluorescent, or hyperfluorescent. Some intraretinal cysts had a characteristic FA pattern, in which a small round hypofluorescent area was surrounded by a ring of hyperfluorescence (donut-shaped dye pooling). Subretinal fibrinoid deposit appeared in acute uveitic stage in two severe VKH patients and seemed to develop from subretinal exudates and evolved into typical subretinal fibrosis. Gradual transfiguration/migration and progressive proliferation/pigmentation of the subretinal fibrinoid deposit/subretinal fibrosis was observed in one patient.


CONCLUSIONS
Intraretinal cysts could form in various layers of the outer retina and may result from extension of choroidal inflammation. Subretinal fibrosis may develop from subretinal exudates in VKH patients and may cause substantial visual impairment.
Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Chan
C
Zhao
Mei-Fen
MF
Zhang
Fang-Tian
FT
Dong
Xu-Qian
XQ
Wang
Xin
X
Wen
Rong-Ping
RP
Dai
Wei-Hong
WH
Yu
Zhi-Qiao
ZQ
Zhang
Zhi-Kun
ZK
Yang
Fei
F
Gao
D000293:Adolescent; D000328:Adult; D003560:Cysts / Q000473:pathology; D005260:Female; D005355:Fibrosis; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D012160:Retina / Q000473:pathology; D041623:Tomography, Optical Coherence / Q000379:methods*; D014607:Uveomeningoencephalitic Syndrome / Q000209:etiology* / Q000473:pathology