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   Table of Contents      
PHOTO ESSAY
Year : 2015  |  Volume : 63  |  Issue : 2  |  Page : 162-163

Angiographic and spectral domain optical coherence tomography features in case of Vogt-Koyanagi-Harada disease


Department of Retina and Vitreous, Retina Foundation, Rajbhavan Road, Ahmedabad, Gujarat, India

Date of Submission12-Nov-2014
Date of Acceptance22-Feb-2015
Date of Web Publication1-Apr-2015

Correspondence Address:
Dr. Manish P Nagpal
Retina Foundation, Asopalav Eye Hospital, Rajbhavan Road, Underbridge, Shahibaug, Ahmedabad - 380 004, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.154403

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Keywords: SD - OCT, FA, ICG, VKH


How to cite this article:
Nagpal MP, Bhatt KJ, Mehrotra NS, Goswami SD. Angiographic and spectral domain optical coherence tomography features in case of Vogt-Koyanagi-Harada disease. Indian J Ophthalmol 2015;63:162-3

How to cite this URL:
Nagpal MP, Bhatt KJ, Mehrotra NS, Goswami SD. Angiographic and spectral domain optical coherence tomography features in case of Vogt-Koyanagi-Harada disease. Indian J Ophthalmol [serial online] 2015 [cited 2019 Nov 21];63:162-3. Available from: http://www.ijo.in/text.asp?2015/63/2/162/154403

A 13-year-old male patient came with diminution of vision in right eye for last 10 days. His best-corrected visual acuity (BCVA) was 20/120 OD and 20/30 OS. Anterior segment OU was normal. Dilated fundus OU showed multiple serous retinal detachments, elevation of the peripapillary retinochoroidal layer and hyperemia of optic nerve head [Figure 1]. Spectral domain optical coherence tomography (SD-OCT) and combined fluorescein-indocyanine green angiography (FA-ICGA) confirmed the diagnosis of Vogt-Koyanagi-Harada (VKH). SD-OCT showed multilobular serous retinal detachment, subretinal septas, and hyperreflective dot reflexes in subretinal fluid [Figure 2]. Early-phase FA showed multiple points of dye leakage at the level of the retinal pigment epithelium (RPE), and late-phase FA showed pooling of dye [Figure 3]. ICGA revealed multiple hypofluorescent dark spots during the early and late phase [Figure 3]. Following the course of intravenous pulse therapy and oral steroids, BCVA improved to 20/20 OU with resolution on OCT after 1-month [Figure 4].
Figure 1: Fundus photograph of OD (a) and OS (b) showing multiple serous retinal detachments, elevation of the peripapillary retinochoroidal layer, and hyperemia of optic nerve head

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Figure 2: Spectral domain optical coherence tomography of OD (a) and OS (b) showing multilobular serous retinal detachment in OU, subretinal septas (1) (c) and hyper-reflective dot reflexes (2) (d) seen in OD

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Figure 3: Fluorescein angiogram early phase of OD (a) and OS (c) showing multiple pinpoint leakage and late phase of OD (e) and OS (g) showing pooling of dye. Indocyanine green angiography OU (b, d, f, h) showing hypofluorescent dark spots in both early (b and d) and late phases (f and h)

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Figure 4: Spectral domain optical coherence tomography 1-month post steroid treatment of OD (a) and OS (b) showing resolution

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  Discussion Top


Vogt-Koyanagi-Harada disease is a bilateral granulomatous panuveitis associated with autoimmunity against the melanocytes accompanied by neurologic, auditory, and/or integumentary symptoms and signs. The acute uveitic stage of VKH is characterized by bilateral anterior and/or posterior segment involvement with exudative retinal detachment. [1]

In acute stage VKH, specific fundus fluorescein angiography findings include choriocapillaris filling delay, multiple pinpoint leakage at the level of RPE, choroidal folds, and pooling of dye in areas of serous detachment in the late phase. [2]

Indocyanine green angiography shows early choroidal stromal vessel hyperfluorescence and leakage, fuzzy choroidal stromal vessels in the intermediate phase, and the presence of hypofluorescent dark spots. [3]

Optical coherence tomography reveals multilobular serous retinal detachment and subretinal septas that divide the subretinal space into several compartments which contain numerous hyper-reflective dot reflexes. [4] These represent inflammatory products like fibrin. Undulations and bumps on the RPE surface have also been described. [5] There is complete resolution of the serous retinal detachments and subretinal septas after steroid pulse therapy.

 
  References Top

1.
Moorthy RS, Inomata H, Rao NA. Vogt-Koyanagi-Harada syndrome. Surv Ophthalmol 1995;39:265-92.  Back to cited text no. 1
    
2.
Fardeau C, Tran TH, Gharbi B, Cassoux N, Bodaghi B, LeHoang P. Retinal fluorescein and indocyanine green angiography and optical coherence tomography in successive stages of Vogt-Koyanagi-Harada disease. Int Ophthalmol 2007;27:163-72.  Back to cited text no. 2
    
3.
Herbort CP, Mantovani A, Bouchenaki N. Indocyanine green angiography in Vogt-Koyanagi-Harada disease: Angiographic signs and utility in patient follow-up. Int Ophthalmol 2007;27:173-82.  Back to cited text no. 3
    
4.
Yamaguchi Y, Otani T, Kishi S. Tomographic features of serous retinal detachment with multilobular dye pooling in acute Vogt-Koyanagi-Harada disease. Am J Ophthalmol 2007;144:260-5.  Back to cited text no. 4
    
5.
Gupta V, Gupta A, Gupta P, Sharma A. Spectral-domain cirrus optical coherence tomography of choroidal striations seen in the acute stage of Vogt-Koyanagi-Harada disease. Am J Ophthalmol 2009;147:148-53.e2.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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