OSLI Retina

July 2020

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July 2020 · Vol. 51, No. 7 407 ■ C A S E R E P O R T ■ Widefield Swept-Source OCTA in Vogt-Koyanagi- Harada Disease Filippos Vingopoulos, MD; Ying Cui, MD, PhD; Raviv Katz, MSc; Rongrong Le, MD, PhD; Ying Zhu, MD; Jay C. Wang, MD; Yifan Lu, MD; Lucia Sobrin, MD, MPH; John B. Miller, MD ABSTRACT: Herein, the authors describe an initial case report of widefield swept-source optical co- herence tomography angiography (SS-OCTA) in Vogt-Koyanagi-Harada (VKH) disease. When com- pared to fluorescent angiography, indocyanine green angiography, and enhanced-depth OCT — upon which the revised criteria for VHK are based — widefield SS-OCTA enables detection of vitre- ous inflammation, noninvasive identification of characteristic areas of flow void at the level of cho- riocapillaris in the acute phase and may be a novel valuable tool not only for noninvasive diagnosis and monitoring of disease progression, persistence, resolution, and recurrence to guide therapy in VKH disease in the future. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:407-412.] INTRODUCTION Vogt-Koyanagi-Harada (VKH) disease is a systemic autoimmune inflammatory disorder characterized by bilateral panuveitis frequently associated with neuro- logic, auditory, and integumentary manifestations. 1 It accounts for 6% to 8% of all uveitis in Asia and 1% to 4% in North America. 2 Bilateral stromal choroiditis with multifocal exu- dative retinal detachments (RDs) is the most charac- teristic finding in the acute phase, whereas recurrent posterior and/or anterior uveitis, choroidal depig- mentation, and sunset glow fundus are hallmarks of the chronic/recurrent stages. 3 Fluorescein angiography (FA) reveals pinpoint staining and larger hypofluorescent lesions in the ear- ly phase, which leak and become hyperfluorescent in the late phase, with pooling of dye in the areas of ex- udative RDs. Indocyanine green angiography (ICGA) can detect subtle changes in choroidal microvascula- ture, appearing as hypofluorescent dark spots, which have been shown to correspond to the choroidal in- flammatory foci/granulomas. 4 On conventional spectral-domain optical coher- ence tomography angiography (SD-OCTA), multiple areas of hypoperfusion in the choriocapillaris (CC) that seem to correspond to hypofluorescent spots on ICGA have been reported. 5,6 Herein, we present the first report of widefield swept-source OCTA (SS-OCTA) in VKH and investi- gate its potential use in the acute stage as well as in the follow-up of VKH patients. CASE REPORT A 38-year-old Asian female with a history of upper respiratory infection 2 weeks prior presented complain- ing of 2 weeks of bilateral hearing loss, tinnitus, and blurry vision, worse in the last 5 days. Her best-correct- ed visual acuity (BCVA) was counting fingers at 6 feet in and 20/300 in her right and left eyes, respectively. On examination, she had 3+ anterior chamber cells with 2+ flare and 1+ vitreous cells in both eyes, corneas with bilateral inferior keratic precipitates, pigment on the anterior lens capsules and normal in- traocular pressures bilaterally. Funduscopy revealed slightly hyperemic discs and large multifocal serous retinal detachments in both eyes (Figure 1). Widefield SS-OCT high-definition (HD) 51-line (12 mm) (PLEX Elite 9000; Carl Zeiss Meditec, Dub- lin, CA) showed extensive subretinal fluid (SRF) and subfoveal fluid in both eyes with multifocal serous From the Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts (FV, YC, RK, RL, YZ, JCW, YL, LS, JBM); Retina Service, Mas- sachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts (FV, YC, RK, RL, YZ, JCW, YL, LS, JBM); Harvard Retinal Imaging Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts (FV, YC, RK, RL, YZ, JCW, YL, JBM); Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (YC); Wen- zhou Medical University Affiliated Eye Hospital, Wenzhou Medical Universi- ty, Wenzhou, Zhejiang, China (RL); and the Department of Ophthalmology, Xiangya Hospital, Central South University, Chang-sha, Hunan, China (YZ). Originally submitted February 15, 2020. Revision received February 15, 2020. Accepted for publication May 8, 2020. Dr. Sobrin is a consultant for Novartis. Dr. Miller is a consultant for Alcon, Allergan, Zeiss, Heidelberg, and Genentech. The remaining authors report no relevant financial disclosures. Drs. Sobrin and Miller contributed to this paper equally. Address correspondence to John B. Miller, MD, Retina Service, Massa- chusetts Eye and Ear, Deptartment of Ophthalmology, Harvard Medical School, Harvard Retinal Imaging Lab, 243 Charles Street, Boston, MA 02114; email: john_miller@meei.harvard.edu. doi: 10.3928/23258160-20200702-06

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