Hyper-Reflective Outer Nuclear Layer (HONL) in Vogt–Koyanagi–Harada Disease and Sympathetic Ophthalmia

ABSTRACT

Purpose

To describe the optical coherence tomography (OCT) findings of hyper-reflective outer nuclear layer (HONL) in two cases of stromal choroiditis (Vogt–Koyanagi–Harada disease – VKH, and sympathetic ophthalmia – SO).

Methods

Case report

Results

Clinical and imaging findings of two patients (37-year-old female with VKH and 34-year-old male with SO) have been described. Both patients showed typical features of the disease with subretinal fluid accumulation and choroidal thickening on OCT. However, OCT of both patients at the initial visit revealed HONL, which was unusual in these conditions. During follow-up, OCT scans revealed thinning and atrophy of the outer retinal layers, irregular thickening of the retinal pigment epithelium, and irregular autofluorescence pattern on autofluorescence imaging.

Conclusions

The presence of HONL may serve as a poor prognostic factor in VKH and SO, resulting in thinning and atrophy of the outer retinal layers.

KEYWORDS:

• Hyper-reflective outer nuclear layer
• optical coherence tomography
• posterior uveitis
• sympathetic ophtalmia
• Vogt–Koyanagi–Harada

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.