Multimodal Imaging in Diagnosis of Vogt Koyanagi Harada Disease with Reference to Choroid and Retinal Pigment Epithelium

Abstract

A 48 year dark skinned North Indian male presented first time to our outpatient with history of bilateral visual decline of 3 weeks duration with associated features of headache, myalgia and rhinitus of 4 weeks duration. A detailed examination confirmed bilateral active anterior granulomatous uveitis with bilateral disc oedema with serous retinal detachment. Multimodal imaging examination was carried out with nideks mirante. Diagnosis in favour of vogt koyanagi harada disease was confirmed. The posterior segment was assessed for various changes in acute and remission phase of vogt koyanagi harada disease with fundus fluorescein angiography, fundus autoflourescence, retroillumination and optical coherence tomography. Thickness and structural change related to central macula thickness, retinal pigment epithelium and choroid were assessed pre and post treatment with additional support of optical coherence tomography and retroillumination. Both these techniques were able to document a greater value change pre and post treatment in these structures. Hence we conclude the need to include these techniques in retinal pigment epithelium and choroidal assessment in vogt koyanagi harada disease.