title: Significant role of the choroidal outer layer during recovery from choroidal thickening in Vogt-Koyanagi-Harada disease patients treated with systemic corticosteroids.
abstract: BACKGROUND
  Which of the choroidal layers suffers the most extensive morphological changes during the course of Vogt-Koyanagi-Harada (VKH) disease is still unknown. The aim of this study was to investigate the relationship between total thickness and the thickness of inner or outer layers in the choroid during systemic corticosteroid therapy in patients with VKH disease.
  
  
  METHODS
  This retrospective case series included 15 eyes of 10 patients with treatment-naïve VKH disease (4 men and 6 women; mean age, 41.4 ± 14.7 years) received systemic corticosteroid therapy. Whole, inner, and outer choroidal thickness was measured manually at 1 week and at 1 and 3 months after initiation of systemic corticosteroid therapy using enhanced depth imaging optical coherence tomography. The mean thickness values of the layers were compared at each stage.
  
  
  RESULTS
  Compared with the 1-week baseline, the mean whole and outer choroidal layer thicknesses were significantly lower at 1 (P = 0.008 and 0.03, respectively) and 3 months (P = 0.008 and 0.02, respectively), whereas the inner layer did not significantly thin. Importantly, there was a significant positive correlation between the rates of change of whole and outer layer thickness from 1 week to 3 months (R = 0.9312, P < 0.0001), but not between the rates of whole and inner layer thickness changes.
  
  
  CONCLUSIONS
  The thinning of total choroidal thickness observed after treatment with corticosteroids strongly correlated with outer layer thinning, suggesting that the choroidal outer layer is the primary target in acute-stage VKH disease.
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. hirooka0516k@yahoo.co.jp.
authors.forename: Kiriko
authors.initials: K
authors.lastname: Hirooka
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. wsaito@med.hokudai.ac.jp.|Department of Ocular Circulation and Metabolism, Hokkaido University Graduate School of Medicine, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan. wsaito@med.hokudai.ac.jp.
authors.forename: Wataru
authors.initials: W
authors.lastname: Saito
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. knamba@med.hokudai.ac.jp.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Namba
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. mizuuchi@peach.plala.or.jp.
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Mizuuchi
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. d.iwata@med.hokudai.ac.jp.
authors.forename: Daiju
authors.initials: D
authors.lastname: Iwata
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. mamepopposeat@yahoo.co.jp.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hashimoto
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. ishidasdu@med.hokudai.ac.jp.|Department of Ocular Circulation and Metabolism, Hokkaido University Graduate School of Medicine, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan. ishidasdu@med.hokudai.ac.jp.
authors.forename: Susumu
authors.initials: S
authors.lastname: Ishida
mesh_terms: D000293:Adolescent; D000328:Adult; D002829:Choroid / Q000473:pathology*; D015862:Choroid Diseases / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014607:Uveomeningoencephalitic Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone; D008775:Methylprednisolone