Correlation between Retinal Changes and Visual Function in Late-Stage Vogt-Koyanagi-Harada Disease: An Optical Coherence Tomography Study

Abstract

Purpose. To characterize the optical coherence tomography (OCT) findings in late-stage Vogt-Koyanagi-Harada (VKH) disease and its correlation with visual function. Methods. The records of patients with late-stage VKH disease (defined as ≥12 months from disease onset) were retrospectively reviewed. The analysis focused on the OCT findings and microperimetry, in addition to the possible correlation between morphology and functional findings. Results. Twenty-nine patients (58 eyes) were included. Mean age at onset was 34.24 ± 10.67 years. The OCT revealed that the outer retina and retinal pigment epithelium (RPE) were mainly affected. These effects included RPE thickening and breakage or disappearance of the cone outer segment tip (COST) line and/or inner segment/outer segment (IS/OS) junction. The COST line and IS/OS results were related to macular function and the interval between symptom onset and initiation of high-dose corticosteroid treatment (all P < 0.01). Eyes with intact COST lines demonstrated intact IS/OS and normal RPE layers as well as better visual function and normal retinal sensitivity. Conclusions. The OCT findings are strongly correlated with macular function, as well as other clinical findings in late-stage VKH. With respect to the COST line and retinal sensitivity especially, the OCT and microperimetry findings may be useful for evaluating later-stage VKH.

Figure 1

Standards for OCT grading: (a) intact COST line (arrowheads) and junction between the photoreceptor inner and outer segments (IS/OS) line (arrows) with normal RPE layer; (b) discontinuous COST lines (arrowheads) and intact IS/OS line (arrows); (c) discontinuous COST line (arrowheads) and IS/OS line (arrows); and (d) thickened RPE layer (asterisk).

Figure 2

Fundus appearance, microperimetry, and OCT findings in different groups (12 months after disease onset). (a) (COST+/IS/OS+): a rather normal fundus; mean retinal sensitivity 19.50 dB; OCT image demonstrated intact COST and junction between the photoreceptor inner and outer segment (IS/OS) lines. (b) (COST−/IS/OS+): a “sunset glow” fundus; mean retinal sensitivity 18.00 dB; OCT shows fragmented COST line and intact IS/OS line. (c) (COST−/IS/OS−): severe sunset glow fundus with hyperpigmentation; mean retinal sensitivity 15.80 dB; OCT demonstrated absent COST line and fragmented IS/OS line with thickened RPE layer.