title: Retinal pigment epithelium folds as a diagnostic finding of Vogt-Koyanagi-Harada disease.
abstract: OBJECTIVE
  To examine using the folds of the retinal pigment epithelium (RPE) to diagnose Vogt-Koyanagi-Harada (VKH) disease.
  
  
  METHODS
  Retrospective clinical review of 57 Japanese patients between July 2005 and April 2009. Optical coherence tomography (OCT), fundus photographs and fluorescein angiography (FA) were studied to investigate Kendall's coefficients of concordance in seven findings by four ophthalmologists. The sensitivity and specificity of each finding were examined to confirm its efficacy. Each result was defined as positive when more than three of the ophthalmologists judged that the finding existed.
  
  
  RESULTS
  The folds of the RPE on OCT were observed in 30/42 (71.4 %) eyes having VKH disease, but none in the other 72 eyes. Kendall's coefficient of concordance in the detection of the folds of the RPE was 0.90 and was the highest among all other findings. Sensitivity was higher in the detection of the RPE folds on OCT and in optic nerve staining on FA than other findings and the specificity was 100 % for the RPE folds and 26.7 % for the optic nerve staining.
  
  
  CONCLUSIONS
  The detection of the folds of the RPE on OCT is a simple and effective method to help diagnose VKH disease at its acute stage which does not require pupil dilation.
authors.affiliation: Department of Ophthalmology, Tsukazaki Hospital, 68-1 Waku, Aboshi-ku, Himeji, Hyogo 6711227, Japan. y.kato@tsukazaki-eye.net
authors.forename: Yoshitake
authors.initials: Y
authors.lastname: Kato
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tabuchi
authors.forename: Atsuki
authors.initials: A
authors.lastname: Fukushima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008875:Middle Aged; D012163:Retinal Detachment / Q000175:diagnosis* / Q000209:etiology; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014607:Uveomeningoencephalitic Syndrome / Q000150:complications / Q000175:diagnosis*