RETINAL PIGMENT EPITHELIUM UNDULATIONS IN ACUTE STAGE OF VOGT-KOYANAGI-HARADA DISEASE: Biomarker for Functional Outcomes After High-Dose Steroid Therapy.
OBJECTIVE
To determine the clinical significance of retinal pigment epithelium (RPE) undulations in the acute stage of Vogt-Koyanagi-Harada disease.


METHODS
Retinal pigment epithelium undulations were detected and classified into 3 grades: Grade 1, slight; Grade 2, moderate; and Grade 3, severe undulations, in the enhanced depth imaging optical coherence tomographic images. The relationship between the clinical characteristics and the presence of RPE undulations was investigated.


RESULTS
Among the 61 eyes of 31 patients with Vogt-Koyanagi-Harada disease, 40 eyes had some degree of RPE undulations (Grade 1 = 12, Grade 2 = 15, and Grade 3 = 13). The patients with RPE undulations in both eyes were significantly older at the onset (P = 0.0002). The eyes with RPE undulations were more likely to develop posterior recurrences (P = 0.032) and have worse vision at 12 months (P = 0.043). Multiple regression analysis revealed that RPE undulations were an independent predictor of posterior recurrences (P = 0.009) and poor visual outcomes (P = 0.035).


CONCLUSIONS
Retinal pigment epithelium undulations detected by enhanced depth imaging optical coherence tomographic are relatively frequent occurrences at the acute stage of Vogt-Koyanagi-Harada, and their presence is a predictor of posterior recurrences and poor visual outcomes after high-dose steroid therapy.
*Department of Ophthalmology, Iwate Medical University School of Medicine, Morioka, Japan; †Department of Ophthalmology, Teikyo University School of Medicine, University Hospital Mizonokuchi, Kawasaki, Japan; and ‡Department of Ophthalmology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan.
Kouhei
K
Hashizume
Yutaka
Y
Imamura
Takamitsu
T
Fujiwara
Shigeki
S
Machida
Masahiro
M
Ishida
Daijiro
D
Kurosaka
D000208:Acute Disease; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001623:Betamethasone / Q000008:administration & dosage; D015415:Biomarkers; D004338:Drug Combinations; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D012163:Retinal Detachment / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D041623:Tomography, Optical Coherence; D014607:Uveomeningoencephalitic Syndrome / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy; D014792:Visual Acuity / Q000502:physiology
D015415:Biomarkers; D004338:Drug Combinations; D005938:Glucocorticoids; D001623:Betamethasone; D011239:Prednisolone; D008775:Methylprednisolone