title: A clinical grading system based on ultra-wide field retinal imaging for sunset glow fundus in Vogt-Koyanagi-Harada disease.
abstract: BACKGROUND
  To develop a grading system for sunset glow fundus (SGF) based on the results of ultra-wide field retinal imaging and to investigate the factors related to the severity of SGF in patients with Vogt-Koyanagi-Harada (VKH) disease.
  
  
  METHODS
  Records of 55 eyes with VKH disease were retrospectively reviewed. All patients had undergone serial fundus photography, ultra-wide field retinal imaging and spectral-domain optical coherence tomography. The morphologic characteristics of SGF and associated features related to the severity of the condition were evaluated.
  
  
  RESULTS
  Sunset glow fundi were classified into 3 groups based on the extent and severity of depigmentary changes: early (n = 7), intermediate (n = 10) and advanced (n = 20). Grade 0 indicates the absence of sunset glow appearance. Eyes with a higher SGF grade were more likely to exhibit chronic recurrence (P < 0.001) and an anterior chamber reaction ≥ 2+ (P < 0.001), and were less likely to exhibit exudative retinal detachment (P < 0.001) at the initial presentation. Higher grades were more likely to exhibit cataracts (P < 0.001), glaucoma (P = 0.010), patchy chorioretinal atrophic lesions (P = 0.012), depigmented atrophic lesions (P < 0.001), an increased peripapillary atrophy/disc area ratio (P < 0.001), a decreased subfoveal choroidal thickness (P < 0.001), more frequent uveitis recurrences (P = 0.012) and a longer disease duration (P < 0.001). SGF progression was faster in eyes with a longer active inflammatory period.
  
  
  CONCLUSIONS
  We present a simple and logical grading system for SGF as determined by using ultra-wide field retinal imaging. This grading system offers a means of assessing the degree of inflammation and facilitates speculation about the duration of VKH disease.
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, #101, Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Eun Kyoung
authors.initials: EK
authors.lastname: Lee
authors.forename: Sang-Yoon
authors.initials: SY
authors.lastname: Lee
authors.forename: Hyeong Gon
authors.initials: HG
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005654:Fundus Oculi; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010781:Photography; D020551:Pulse Therapy, Drug; D012164:Retinal Diseases / Q000145:classification* / Q000175:diagnosis* / Q000188:drug therapy; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014607:Uveomeningoencephalitic Syndrome / Q000145:classification* / Q000175:diagnosis* / Q000188:drug therapy; D014792:Visual Acuity / Q000502:physiology
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents