Multimodal fundus features of Acute Vogt-Koyanagi-Harada Syndrome in Han Chinese population introduction

This study aimed to characterize the multimodal imaging features of acute Vogt-Koyanagi-Harada disease (AVKH) in Han Chinese patients, with the expectation of providing valuable references for the clinical diagnosis, disease monitoring, and research on the pathological mechanisms of AVKH.

We enrolled newly diagnosed Han Chinese AVKH patients meeting revised criteria. All patients underwent multicolor imaging fundus photography (MCIFP), fluorescein fundus angiography (FFA), and optical coherence tomography (OCT). We analyzed the incidence and coexistence patterns of typical fundus features.

Thirty-two patients (61 eyes) were included for MCIFP, 28 (55 eyes) for FFA, and 29 (58 eyes) for OCT. The detection rate of neurosensory retinal detachment (NSRD) differed significantly among modalities (< 0.05): OCT (91.4%) > MCIFP (81.9%) > FFA (74.5%). On MCIFP, retinal striae (RS) and optic disc edema (ODE) were present in 80.3% and 32.2% of eyes, respectively, with NSRD+RS as the most frequent pattern. On FFA, pinpoint hyperfluorescent spots (PHS) and optic disc staining (ODS) each occurred in 85.5%, and all eyes showed ≥2 coexisting features. On OCT, internal limiting membrane (ILM) fluctuation was highly common (89.7%), and NSRD combined with ILM fluctuation was observed in 81.0% of eyes.

Han Chinese AVKH patients mainly present with multiple coexisting fundus features, with no isolated finding on FFA. NSRD, RS, PHS, ODE, and ILM fluctuation are core hallmarks. We recommend a complementary multimodal pathway: MCIFP for initial screening, FFA for evaluating inflammatory activity, and OCT for assessing microstructural injury and follow-up.