Bacillary Layer Detachment in Acute Vogt-Koyanagi-Harada Disease

Abstract

Objectives: To evaluate the frequency and treatment response of eyes with bacillary layer detachment (BLD) in acute Vogt-Koyanagi-Harada (VKH) disease using spectral-domain optical coherence tomography (SD-OCT). Materials and Methods:We retrospectively reviewed the medical records of 58 eyes of acute VKH patients with at least 6 months of follow-up between January 2009 and March 2021. SD-OCT, color fundus photographs, and fluorescein angiography images were analyzed in all patients. Results: The study included 58 eyes of 29 patients. BLD was detected in 33 of the 58 eyes (56.9%) at baseline. Mean serous retinal detachment (SRD) height was 918.50±336.64 µm in the BLD group and 215.33±167.83 µm in the group without BLD (p<0.05). A positive correlation was found between SRD height and the presence of BLD (r=0.783, p<0.05). BLD was significantly more common in patients with a baseline SRD height greater than 500 µm (p<0.05). As subfoveal central choroidal thickness (CCT) could not be measured by enhanced depth imaging-OCT at baseline due to extreme choroidal thickness in all eyes, the earliest post-treatment CCT measurements were analyzed. At the completion of pulse steroid therapy, mean CCT was 425±82.87 µm in the BLD group and 385.58±82.87 µm in the group without BLD (p=0.04). The mean time to BLD resolution was 12.88±6.5 days (range: 2-26). Conclusion: BLD is a common tomographic finding in eyes with acute VKH disease and can be differentiated from the associated SRD through careful SD-OCT analysis. Though it is mostly observed in patients with more serious disease, the presence of BLD has no negative effect on long-term visual function.

Letter to the Editor Re: Bacillary Layer Detachment in Acute Vogt-Koyanagi-Harada Disease

“…In conclusion, our observations support those of Ataş et al 1 in demonstrating good visual outcome despite the presence of BLD. Further studies will be beneficial to examine other OCT features that are associated with poorer prognosis, increased complications (such as choroidal neovascular membrane), or recurrent disease.…”

“…We read with interest the recent paper by Ataş et al 1 on bacillary layer detachment (BLD) in acute Vogt-Koyanagi-Harada (VKH) disease. We would like to share our experience in the Department of Ophthalmology of Te Whatu Ora in Auckland, New Zealand.…”

Atypical Central Serous Chorioretinopathy Masquerading as Vogt-Koyanagi-Harada Disease: A Case Report

“…In a recent study describing OCT features of VKH, BALAD (referred to as membranous structures in that study) was found to have the highest positive predictive value (97.3%) for VKH of all the OCT features assessed [ 6 ]. Another group showed that it is a common tomographic finding in eyes with acute VKH disease and mostly observed in patients with more serious disease [ 7 ]. Importantly, the Standardization of Uveitis Nomenclature (SUN) working group, included BALAD (“septae” on OCT) as one of the criteria for diagnosis of acute VKH [ 2 ].…”

Estudo dos achados na tomografia de coerência óptica na doença de Vogt-Koyanagi-Harada e de suas associações como biomarcadores de prognóstico

“…A presença do descolamento bacilar na apresentação inicial destacou-se como marcador de prognóstico, aumentando o risco, de forma independente, para uma pior evolução nos desfechos fundoscópicos (fibrose e fundo em pôr do sol) no primeiro ano da doença. Até o momento, encontramos duas publicações que exploram o achado de descolamento bacilar na DVKH 28,149 , mas não com a abrangência de associações e análise multimodal que foram realizadas neste estudo.…”