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Published on: August 11, 2023
The prognostic value of angiography in Vogt-Koyanagi-Harada disease
Soon-Phaik Chee1, Aliza Jap, Chui Ming Gemmy Cheung
1Singapore National Eye Centre, Singapore. chee.soon.phaik@snec.com.sg
Insights
Early pinpoint peripapillary hyperfluorescence on fluorescein angiography (FA) is a useful prognostic sign for Vogt-Koyanagi-Harada disease (VKH). Indocyanine green angiography (ICGA) showed limited prognostic value in this study.
Area of Science:
- Ophthalmology
- Medical Imaging
- Immunology
Background:
- Vogt-Koyanagi-Harada (VKH) disease is a systemic inflammatory condition affecting ocular tissues.
- Accurate prognostication is crucial for managing VKH and preventing visual impairment.
- Diagnostic imaging modalities like FA and ICGA are employed to assess VKH activity.
Purpose of the Study:
- To evaluate the prognostic significance of fluorescein angiography (FA) and indocyanine green angiography (ICGA) in patients with Vogt-Koyanagi-Harada disease (VKH).
Main Methods:
- Retrospective review of medical charts, FA, and ICGA from VKH patients at the Singapore National Eye Centre.
- Analysis of patient demographics, treatment timing, and angiographic features.
- Correlation of imaging findings with disease outcomes (acute resolved vs. chronic recurrent).
Main Results:
- Early pinpoint peripapillary hyperfluorescence on FA was a significant prognostic factor for VKH.
- Common FA features included posterior pole and disc hyperfluorescence.
- ICGA revealed large choroidal vessels, delayed perfusion, and dark dots, but these lacked prognostic significance.
Conclusions:
- Pretreatment FA findings, specifically early pinpoint peripapillary hyperfluorescence, are valuable for predicting VKH disease course.
- Pretreatment ICGA offers limited prognostic utility in VKH patients.
Purpose:
To determine the prognostic value of fluorescein angiography (FA) and indocyanine green angiography (ICGA) in Vogt-Koyanagi-Harada disease (VKH).
Design:
Retrospective noninterventional study.
Methods:
Chart, FA, and ICGA review of VKH patients of Singapore National Eye Centre for age at onset, gender, race, timing of treatment, and angiographic features during the different phases of FA and ICGA. Outcome measure was disease outcome (acute resolved or chronic recurrent).
Results:
Twenty-one of the 28 patients with pretreatment FA also had ICGA. Median follow-up duration was 3.6 years (range 0.94-13.42 years). Median age was 42.2 years (range 15.7-77.2 years). The majority (18, 64.3%) were Chinese. The most frequently observed FA features included early pinpoint hyperfluorescence in the posterior pole and disc hyperfluorescence. Large choroidal vessel hyperfluorescence (early and intermediate phase), areas of delayed choroidal perfusion (early phase), and persistent dark dots were the 3 most common ICGA features. Pinpoint peripapillary hyperfluorescence was found to be a significant prognostic FA factor on both univariate and multivariate analysis. None of the ICGA features were found to be significant prognostic factors.
Conclusion:
Early pinpoint peripapillary hyperfluorescence on pretreatment FA is a useful prognostic sign in VKH patients, whereas pretreatment ICGA has limited prognostic value.
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