Indocyanine green angiography in Vogt–Koyanagi–Harada disease: angiographic signs and utility in patient follow-up

Abstract

Choroidal inflammation shown by ICG angiography can be suppressed completely by initial high-dose inflammation suppressive therapy. However, recurrent subclinical choroidal inflammation is detected at the end of the tapering period in a high proportion of cases. This indicates that, in the absence of an ICGA follow-up, undetected smoldering subclinical disease may persist, thereby explaining the frequently reported evolution towards sunset glow fundus despite an apparently controlled disease. This is a clear indication that VKH disease should be followed by ICG angiography and, in the case of choroidal subclinical reactivation, a reversal of therapy tapering and an extension of therapy duration should be considered.

Optical coherence tomography imaging in uveitis

“…The authors also pointed to the possible presence of subclinical inflammation affecting the inner choroid in a large proportion of VKH patients despite high-dose immunosuppressive agents. This had previously been suggested by Herbort et al [110]. The mean choroidal thickness in the acute phase was measured as 424 lm as opposed to 287 lm in control subjects.…”

New insights into Vogt-Koyanagi-Harada disease

“…ICGA is a useful method of assessing choroidal status. Typical signs of choroiditis were described in eyes with VKH in acute stage (7,36) . Recently, ICGA of eyes in chronic stage with apparent isolated anterior recurrence disclosed early choroidal stromal vessel hyperfluorescence and leakage, suggesting subclinical choroiditis (37) .…”

“…Other less common findings may be present, such as fuzzy vascular pattern of large stromal vessels, optic disc hyperfluorescence, and choriocapillaris filling delay. There are evidences that ICGA is very useful to monitor the response to corticosteroid therapy by allowing semi-quantification of the degree of choroidal inflammation (7) . Interestingly, ICGA signs of active choroidal inflammation during chronic or convalescent stages show significant decrease after systemic corticosteroid therapy, confirming the inflammatory nature of the findings (37) .…”

“…On the other hand, clinical findings, such as progressive tissue depigmentation (including sunset glow fundus) and uveitis recurrence indicate that systemic and ocular inflammation may persist after the acute phase (5)(6) (Figure 2). Additionally, ICGA findings suggest the presence of choroidal inflammation in eyes without clinically detectable inflammation (7) . The aim of this paper is to review the latest research results on VKH pathogenesis and chronic/convalescent stages, which may help to better understand this potentially blinding disease and to improve its treatment.…”

Typical Smokestack Leak Sign in a Case of Vogt-Koyanagi-Harada Disease

“…The ICG shows multiple areas of choroidal vascular hyperpermeability in the mid-to-late phases of ICGA, which are indicative of CSCR, 5 whereas diffuse choroidal vascular hyperpermeability, hypofluorescent dark dots, and optic disc staining are typical features of VKH disease. 6 The treatment for CSCR and that of VKH is completely different, with steroids, being the mainstay of therapy in VKH but being contraindicated in CSCR. 1 We treated our case with systemic steroids and immunosuppressants.…”