Document Detail

Acute Vogt-Koyanagi-Harada disease in enhanced spectral-domain optical coherence tomography.
MedLine Citation:
PMID:  19643489     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To demonstrate unique membranous structures seen on enhanced spectral domain optical coherence tomography (SD-OCT) images of eyes with acute Vogt-Koyanagi-Harada (VKH) disease. DESIGN: Retrospective, observational case series. PARTICIPANTS: Twenty eyes of 10 consecutive patients diagnosed with acute VKH disease. METHODS: We reviewed fundus photographs, conventional OCT images, fluorescein angiograms (FA), and enhanced SD-OCT images, including serial sections through the macula, obtained at the initial visit and periodically after steroid treatment until complete resolution of serous retinal detachment. MAIN OUTCOME MEASURES: Findings on enhanced SD-OCT imaging and FA in eyes with VKH disease. RESULTS: All 20 eyes had multifocal serous retinal detachment in the posterior fundus that appeared as multilobular dye pooling on late-phase FA. In 17 of the 20 eyes (85%), some areas of dye pooling corresponded to cystoid spaces on enhanced SD-OCT images and in 14 of the 20 (70%) eyes, there were areas of dye pooling and cystoid spaces in the fovea. The floors of the cystoid spaces consisted of a membranous structure of uniform thickness (mean thickness in the fovea of 14 eyes, 62.5+/-3.3 microm). The membranous structure, on SD-OCT, seemed to include a highly reflective line, which was continuous with the line representing the junction of the photoreceptor inner and outer segments (IS/OS) in attached areas of the retina. Intraretinal split was seen to overlie the abnormal IS/OS line in the vicinity of cystoid spaces involving the fovea in 9 of the 20 eyes (45%). During the course of steroid therapy, the membranous structure changed to a granular structure. CONCLUSIONS: The membranous structure that can be seen in eyes with acute VKH disease seems to represent a portion of the outer segment layer that has become separated from the inner segment layer by cystoid spaces. We hypothesize that the membranous form of the outer segment is bound with the action of inflammatory products, such as fibrin, and this membranous structure changes to a granular structure as steroid therapy "dissolves" the fibrin holding the outer segments together. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Kenji Ishihara; Masanori Hangai; Mihori Kita; Nagahisa Yoshimura
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-07-30
Journal Detail:
Title:  Ophthalmology     Volume:  116     ISSN:  1549-4713     ISO Abbreviation:  Ophthalmology     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-09-04     Completed Date:  2009-09-24     Revised Date:  2010-03-10    
Medline Journal Info:
Nlm Unique ID:  7802443     Medline TA:  Ophthalmology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1799-807     Citation Subset:  IM    
Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin,Sakyo-ku, Kyoto, Japan.
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MeSH Terms
Acute Disease
Cysts / diagnosis*
Fluorescein Angiography
Glucocorticoids / therapeutic use
Methylprednisolone / therapeutic use
Middle Aged
Prednisolone / therapeutic use
Retinal Detachment / diagnosis*
Retinal Photoreceptor Cell Outer Segment / pathology*
Retrospective Studies
Tomography, Optical Coherence*
Uveomeningoencephalitic Syndrome / drug therapy,  pathology*
Reg. No./Substance:
0/Glucocorticoids; 50-24-8/Prednisolone; 83-43-2/Methylprednisolone
Comment In:
Ophthalmology. 2010 Mar;117(3):642, 642.e1; author reply 643, 643.e1   [PMID:  20189040 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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