J Korean Ophthalmol Soc.  2015 Jul;56(7):1127-1133. 10.3341/jkos.2015.56.7.1127.

Spectral-Domain Optical Coherence Tomography Findings of Vogt-Koyanagi-Harada Disease

• Kim YS
• Lee SH
• Kim YK
• Park TK
• Lee SJ
• Ohn YH

• KMID: 2148816
• DOI: http://doi.org/10.3341/jkos.2015.56.7.1127

Abstract

PURPOSE
To report characteristics of Vogt-Koyanagi-Harada (VKH) disease as observed on spectral-domain optical coherence tomography (SD-OCT) images.
CASE SUMMARY
(Case 1) A 38-year-old female presented with visual impairment in both eyes. On fundus examination, multifocal serous retinal detachment in the posterior pole was observed in both eyes. On enhanced SD-OCT, serous retinal detachment and cystoid macular edema in the outer retina were observed and the intraretinal fluid space was divided by a membranous structure forming an intraretinal compartmentalized cystic space. Under the diagnosis of VKH disease, the patient was treated with intravenous administration of methylprednisolone. After treatment, enhanced SD-OCT images showed decreased serous retinal detachment. (Case 2) A 58-year-old male presented with visual impairment in both eyes. On fundus examination, multifocal serous retinal detachment in the posterior pole was observed in both eyes. On enhanced SD-OCT, choroidal folds were observed and the membranous structure showed continuity with ellipsoid zone, suggesting the membranous structure was part of the outer photoreceptor layer of the adjacent attached retina. The patient was treated with intravenous administration of methylprednisolone. After treatment, enhanced SD-OCT images showed cystic space was decreased.
CONCLUSIONS
SD-OCT images of VKH disease demonstrated multiple serous retinal detachments and intraretinal compartmentalized cystic space divided by a membranous structure. The membranous structure may be considered a part of the outer photoreceptor layer of the attached retina.

Keyword

Spectral domain optical coherence tomography; Vogt-Koyanagi-Harada disease

MeSH Terms

Administration, Intravenous
Adult
Choroid
Diagnosis
Female
Humans
Macular Edema
Male
Methylprednisolone
Middle Aged
Retina
Retinal Detachment
Tomography, Optical Coherence*
Uveomeningoencephalitic Syndrome*
Vision Disorders
Methylprednisolone

Figure

• 

  Figure 1. Case 1. Images from the right eye of acute Vogt-Koyanagi-Harada disease. (A) Color fundus photograph. Arrow indicates optical coherence tomography (OCT) scanning vertical line shown in (D). (B) Fluorescein angiograms (FA). Late-phase FA (15 mi-nutes) shows multilobular pools of dye. (C) Indocyanine green angiogram (ICGA). Hypofluorescent dark dots shown in late-phase. (D) Vertical enhanced spectral-domain OCT (SD-OCT) image. The membranous structure showed continuity with ellipsoid zone, suggesting that the membranous structure is a part of the outer photoreceptor layer. (E) Schematic illustration of OCT layers of acute Vogt-Koyanagi-Harada disease. SRD = serous retinal detachment; CS = cystoid space; MS = membranous structure; ELM = ex-ternal limiting membrane; IS/OS = inner segment/outer segment junction; RPE = retinal pigment epithelium.

• 

  Figure 2. Case 1. Images from the right eye at four days after treatment. (A) Color fundus photograph. Arrow indicates optical co-herence tomography (OCT) scanning vertical line shown in D. (B) Fluorescein angiograms (FA). Late-phase FA (15 minutes) shows decreased pooling of dye. (C) Indocyanine green angiogram (ICGA). Decreased hypofluorescent dark dots shown in late-phase. (D) Vertical enhanced spectral-domain OCT (SD-OCT) image. The membranous structure in the center of cystoid space was formed and a clearly distinguishable ELM was noted. (E) Schematic illustration of OCT layers at four days after treatment. SRD = serous reti-nal detachment; CS = cystoid space; MS = membranous structure; ELM = external limiting membrane; IS/OS = inner seg-ment/outer segment junction; RPE = retinal pigment epithelium.

• 

  Figure 3. Case 2. Images from the right eye of acute Vogt-Koyanagi-Harada disease. (A) Color fundus photograph. Arrow indicates optical coherence tomography (OCT) scanning vertical line shown in (D). (B) Fluorescein angiograms (FA). Late-phase FA (15 mi-nutes) shows multilobular pools of dye. (C) Indocyanine green angiogram (ICGA). Hypofluorescent dark dots shown in late-phase. (D) Vertical enhanced spectral-domain OCT (SD-OCT) image. Choroidal folds were noted. (E) Schematic illustration of OCT lay-ers of acute Vogt-Koyanagi-Harada disease. SRD = serous retinal detachment; CS = cystoid space; ELM = external limiting mem-brane; IS/OS = inner segment/outer segment junction; RPE = retinal pigment epithelium.

• 

  Figure 4. Case 2. Images from the right eye at 12 days after treatment. (A) Color fundus photograph. Arrow indicates optical coher-ence tomography (OCT) scanning vertical line shown in (D). (B) Fluorescein angiograms (FA). Late-phase FA (15 minutes) shows decreased pooling of dye. (C) Indocyanine green angiogram (ICGA). Decreased hypofluorescent dark dots shown in late-phase. (D) Vertical enhanced spectral-domain OCT (SD-OCT) image. The choroidal folds disappeared and a clearly distinguishable ELM was noted. (E) Schematic illustration of OCT layers at 12 days after treatment. SRD = serous retinal detachment; CS = cystoid space; ELM = external limiting membrane; IS/OS = inner segment/outer segment junction; RPE = retinal pigment epithelium.

Reference

References

1. Moorthy RS, Inomata H, Rao NA. Vogt-Koyanagi-Harada syndrome. Surv Ophthalmol. 1995; 39:265–92.

2. Sugiura S. Vogt-Koyanagi-Harada disease. Jpn J Ophthalmol. 1978; 22:9–35.

3. Damico FM, Cunha-Neto E, Goldberg AC, et al. T-cell recognition and cytokine profile induced by melanocyte epitopes in patients with HLA-DRB1*0405-positive and -negative Vogt-Koyanagi- Harada uveitis. Invest Ophthalmol Vis Sci. 2005; 46:2465–71.

4. Gocho K, Kondo I, Yamaki K. Identification of autoreactive T cells in Vogt-Koyanagi-Harada disease. Invest Ophthalmol Vis Sci. 2001; 42:2004–9.

5. Sugita S, Takase H, Taguchi C, et al. Ocular infiltrating CD4+ T cells from patients with Vogt-Koyanagi-Harada disease recognize human melanocyte antigens. Invest Ophthalmol Vis Sci. 2006; 47:2547–54.

6. Sakamoto A, Hangai M, Yoshimura N. Spectral-domain optical co-herence tomography with multiple B-scan averaging for enhanced imaging of retinal diseases. Ophthalmology. 2008; 115:1071–8.e7.

7. Schmitt JM, Xiang SH, Yung KM. Speckle in optical coherence tomography. J Biomed Opt. 1999; 4:95–105.

8. Maruyama Y, Kishi S. Tomographic features of serous retinal de-tachment in Vogt-Koyanagi-Harada syndrome. Ophthalmic Surg Lasers Imaging. 2004; 35:239–42.

9. Yamaguchi Y, Otani T, Kishi S. Tomographic features of serous ret-inal detachment with multilobular dye pooling in acute Vogt- Koyanagi-Harada disease. Am J Ophthalmol. 2007; 144:260–5.

10. Ishihara K, Hangai M, Kita M, Yoshimura N. Acute Vogt- Koyanagi-Harada disease in enhanced spectral-domain optical co-herence tomography. Ophthalmology. 2009; 116:1799–807.

11. Leite MT, Rao HL, Zangwill LM, et al. Comparison of the diag nostic accuracies of the Spectralis, Cirrus, and RTVue optical coherence tomography devices in glaucoma. Ophthalmology. 2011; 118:1334–9.

12. Yamamoto M, Nishijima K, Nakamura M, Yoshimura N. Inner ret-inal changes in acute-phase Vogt-Koyanagi-Harada disease meas-ured by enhanced spectral domain optical coherence tomography. Jpn J Ophthalmol. 2011; 55:1–6.

13. Wu W, Wen F, Huang S, et al. Choroidal folds in Vogt-Koyanagi- Harada disease. Am J Ophthalmol. 2007; 143:900–1.

14. Lee WK, Boo HD, Kim HK. The Intracho roidal changes in Haradas disease. J Korean Ophthalmol Soc. 1999; 40:1242–52.

15. Nakayama M, Keino H, Okada AA, et al. Enhanced depth imaging optical coherence tomography of the choroid in Vogt-Koyanagi- Harada disease. Retina. 2012; 32:2061–9.