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

Young Shin Kim; Si Hyung Lee; Yoon Kyung Kim; Tae Kwann Park; Sung Jin Lee; Ohn Young-Hoon

doi:10.3341/jkos.2015.56.7.1127

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Kim, Lee, Kim, Park, Lee, and Young-Hoon: Spectral-Domain Optical Coherence Tomography Findings of Vogt-Koyanagi-Harada Disease

Original Article

J Korean Ophthalmol Soc 2015;56(7):1127-1133.

Published online: 27 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.7.1127

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

Young Shin Kim, M.D¹, Si Hyung Lee, M.D², Yoon Kyung Kim, M.D², Tae Kwann Park, M.D, PhD², Sung Jin Lee, M.D, PhD¹, Ohn Young-Hoon, M.D, PhD^2,

Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea

Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea

Address reprint requests to Young-Hoon Ohn, MD, PhD Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, #170 Jomaru-ro, Wonmi-gu, Bucheon 420-767, Korea Tel: 82-32-621-5425, Fax: 82-32-621-5435 E-mail: yhohn@schmc.ac.kr

∗ This study was presented as a poster at the 7th Joint Meeting of Korea-China-Japan Ophthalmologists 2014.

Received 21 November 201416 March 2015 Accepted 4 June 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

To report characteristics of Vogt-Koyanagi-Harada (VKH) disease as observed on spectral-domain optical coherence omography (SD-OCT) images.

Case summary:

(Case 1) A 38-year-old female presented with visual impairment in both eyes. On fundus examination, multi-focal serous retinal detachment in the posterior pole was observed in both eyes. On enhanced SD-OCT, serous retinal detach-ment 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, multi-focal serous retinal detachment in the posterior pole was observed in both eyes. On enhanced SD-OCT, choroidal folds were ob-served 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 compartmen-talized cystic space divided by a membranous structure. The membranous structure may be considered a part of the outer pho-toreceptor layer of the attached retina.

Keywords: Spectral domain optical coherence tomography, Vogt-Koyanagi-Harada disease

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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.

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