title: Choroidal circulation impairment during the anterior recurrence of Vogt-Koyanagi-Harada disease confirmed with indocyanine green angiography and laser speckle flowgraphy.
abstract: OBJECTIVE
  To assess choroidal inflammation-related circulatory changes associated with the anterior recurrence of Vogt-Koyanagi-Harada (VKH) disease, using indocyanine green angiography (ICGA) and laser speckle flowgraphy (LSFG).
  
  
  METHODS
  This retrospective case series included 17 eyes of 11 patients with VKH disease showing recurrent inflammatory findings in the anterior, but not posterior, segment (i.e. anterior recurrence). Indocyanine green angiography (ICGA) and LSFG were performed at the time of recurrence and one month after the initiation of corticosteroid therapy. The number and total area of hypofluorescent dark dots (HDDs) on ICGA were independently counted by three physicians and measured with ImageJ, respectively. Mean blur rate (MBR), a quantitative index of relative blood flow velocity, was calculated via the LSFG Analyzer software.
  
  
  RESULTS
  Hypofluorescent dark dots (HDDs) were identified on ICGA in 13 of 17 eyes (76%) with the anterior recurrence of VKH disease. The number and total area of HDDs significantly decreased from 203 ± 101 dots to 59 ± 51 dots and from 48 789 ± 24 251 pixels to 15 664 ± 13 254 pixels, respectively. The change ratio of MBR significantly increased by 17.9 ± 16.3% after the treatment. Importantly, there was no significant association between the change ratios of HDDs and MBR.
  
  
  CONCLUSIONS
  These findings on LSFG and ICGA clearly demonstrated subclinical involvement as well as post-treatment improvement of choroidal circulation impairment due to granulomatous inflammation in eyes with the anterior recurrence of VKH disease. The present data suggest the validity of using these two examinations, capable of detecting different circulatory changes, in the management of recurrent VKH disease.
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.|Department of Ophthalmology and Visual Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Takemoto
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.
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Mizuuchi
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Daiju
authors.initials: D
authors.lastname: Iwata
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Tomoe
authors.initials: T
authors.lastname: Uno
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Ohno
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Kiriko
authors.initials: K
authors.lastname: Hirooka
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hashimoto
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.|Department of Ocular Circulation and Metabolism, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Saito
authors.affiliation: Department of Ophthalmology and Visual Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Sugiyama
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.|Department of Ocular Circulation and Metabolism, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Ishida
mesh_terms: D000328:Adult; D000368:Aged; D000869:Anterior Eye Segment / Q000503:physiopathology*; D001783:Blood Flow Velocity; D002829:Choroid / Q000098:blood supply*; D004396:Coloring Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage*; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D012189:Retrospective Studies; D014607:Uveomeningoencephalitic Syndrome / Q000175:diagnosis / Q000503:physiopathology*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Vogt-Koyanagi-Harada disease; anterior recurrence; choroidal circulation; hypofluorescent dark dots; indocyanine green angiography; laser speckle flowgraphy; mean blur rate