Indocyanine green angiography findings in patients with long-standing Vogt-Koyanagi-Harada disease: a cross-sectional study

Felipe T da Silva, Carlos E Hirata, Viviane M Sakata, Edilberto Olivalves, Rony Preti, Sergio L G Pimentel, Andre Gomes, Walter Y Takahashi, Rogerio A Costa, Joyce H Yamamoto, Felipe T da Silva, Carlos E Hirata, Viviane M Sakata, Edilberto Olivalves, Rony Preti, Sergio L G Pimentel, Andre Gomes, Walter Y Takahashi, Rogerio A Costa, Joyce H Yamamoto

Abstract

Background: To investigate indocyanine green angiography (ICGA) findings in patients with long-standing Vogt-Koyanagi-Harada (VKH) disease and their correlation with disease activity on clinical examination as well as with systemic corticosteroid therapy.

Methods: Twenty-eight patients (51 eyes) with long-standing (≥6 months from disease onset) VKH disease whose treatment was tapered based only in clinical features were prospectively included at a single center in Brazil. All patients underwent standardized clinical evaluation, which included fundus photography, fluorescein angiography and ICGA. Clinical disease activity was determined based in the Standardization in Uveitis Nomenclature Working Group. Fisher exact test and logistic regression models were used for statistical analysis.

Results: Disease-related choroidal inflammation on ICGA was observed in 72.5% (31 of 51 eyes). Angiographic findings suggestive of (choroidal and/or retinal) disease activity were not observed on FA. Clinically active disease based on clinical evaluation was observed in 41.2% (21 of 51 eyes). In these 21 eyes, disease-related choroidal inflammation on ICGA was observed in 76.2% (16 of 21 eyes); in the remaining eyes (without clinical active disease) disease-related choroidal inflammation on ICGA was observed in 70.0% (21 of 30 eyes). In respect to systemic corticosteroid therapy, 10 patients (18 of 51 eyes) were under treatment with prednisone. In these 10 (18 of 51 eyes) patients, disease-related choroidal inflammation on ICGA was observed in 83.3% (15 of 18 eyes); in the remaining patients (33 of 51 eyes) disease-related choroidal inflammation on ICGA was observed in 66.7% (22 of 33 eyes).

Conclusion: ICGA findings suggestive of disease-related choroidal inflammation were observed in a considerable proportion of patients with long-standing VKH disease, independent of the inflammatory status of the disease on clinical examination or current use of systemic corticosteroid. Therefore, the current study reinforces the crucial role of ICGA to assist the management and treatment of patients with long-standing VKH disease.

Figures

Figure 1
Figure 1
Color fundus photography (A) as well as early, mid and late phase indocyanine green angiography (B,C,D, respectively) from a representative patient with Vogt-Koyanagi-Harada and long-standing disease. Note “fuzzy vessels” (arrows) on early and mid phases ICGA, and “late diffuse hyperfluorescence” (curved arrows) on late phase of the exam.
Figure 2
Figure 2
Color fundus photography (photomontage) from patients with Vogt-Koyanagi-Harada and long-standing disease. Mild (A) and severe disease (B) according to fundus-based disease severity grading (as per standardized analytic framework for ocular fundus alterations [22,23]).

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Source: PubMed

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