Predictive factors at initial visit for sunset glow fundus in Vogt-Koyanagi-Harada disease

Abstract

This study aimed to identify factors present at the initial visit for the development of sunset glow fundus (SGF) in Vogt-Koyanagi-Harada (VKH) disease. A total of 139 eyes from 70 naïve patients with acute VKH disease who underwent pulse steroid therapy were categorized into "SGF" and "non-SGF" groups based on fundus appearance at 12 months post-therapy. Multivariable analysis revealed that patients with meningismus (p = 0.004), incomplete type (p = 0.035), and probable type (p = 0.002) in older revised diagnostic criteria; ex-smoker (p = 0.016), and smoker (p = 0.010) status; high logarithmic best-corrected visual acuity (BCVA) (p < 0.001); high spherical equivalent (SE) (p = 0.005); shallow peripheral anterior chamber depth (ACD) (p < 0.001); narrow anterior chamber angle (ACA) (p = 0.015); increased pupil diameter (p < 0.001); and thicker cornea (p = 0.019) were associated with SGF. The optimal cut-off values for predicting SGF were identified as follows: logarithmic BCVA greater than 0.261, SE exceeding - 2.813 D, peripheral ACD less than 2.138 mm, ACA less than 40.55 °, pupil diameter exceeding 3.040 mm, and corneal thickness exceeding 579.500 μm. Patients with VKH disease who exhibit above risk factors require early and careful management.

Keywords: Corneal thickness; Pupil diameter; Sunset glow fundus; Visual acuity; Vogt–Koyanagi–Harada disease.

Fig. 1

a Representative Pentacam images at the initial visit and color photos at 12 months for the SGF group after therapy. b Representative images for the non-SGF group. Increased pupil diameter, shallow peripheral ACD, and thick cornea were observed in the SGF group. ACD, anterior chamber depth; SGF, sunset glow fundus.

Fig. 2

a Comparison of pupil diameter between SGF and non-SGF groups at the initial visit in both eyes. The cut-off value for BCVA was 0.261. b Comparison of SE between the groups. The cut-off value was −2.813 D. c Comparison of peripheral ACD between the groups. The cut-off value was 2.138 mm. d Comparison of peripheral ACA between the groups. The cut-off value was 40.550 °. e Comparison of pupil diameter between the groups. The cut-off value was 3.040 mm. f Comparison of corneal thickness between the groups. The cut-off value was 579.500 μm. ACA, anterior chamber angle; ACD, anterior chamber depth; BCVA, best-corrected visual acuity; SE, spherical equivalent; SGF, sunset glow fundus.

Fig. 3

a Comparison of pupil diameter between SGF and non-SGF groups at the initial visit in the right eyes. The cut-off value for BCVA was 0.188. b Comparison of peripheral ACD between the groups. The cut-off value was 2.051 mm. c Comparison of pupil diameter between the groups. The cut-off value was 3.095 mm. ACD, anterior chamber depth; BCVA, best-corrected visual acuity; SGF, sunset glow fundus.