Association of Retinal Pigment Epithelium Reflectivity on Optical Coherence Tomography with Recurrence of Vogt–Koyanagi–Harada Disease: A Retrospective Observational Study

Abstract

Purpose

Despite the necessity of optical coherence tomography (OCT) for diagnosis and longitudinal monitoring in patients with Vogt–Koyanagi–Harada (VKH) disease, no studies have identified useful OCT markers for predicting recurrence in these patients. Although the precise reason for this remains unclear, one possibility is that infiltration of inflammatory cells into the choroid attenuates the OCT signal, making it difficult to precisely assess the structure of the choroid. Therefore, this study aimed to investigate changes in retinal pigment epithelium (RPE) reflectivity immediately above the choroid in eyes with acute VKH disease, as well as the association between RPE reflectivity and VKH disease recurrence.

Patients and Methods

This single-centered retrospective observational study included 20 treatment-naïve patients with acute VKH disease presenting with serous retinal detachment (SRD) in the posterior pole at the initial visit between October 2015 and January 2020, as well as 15 healthy control eyes. All patients were followed up for at least 6 months and received treatment with intravenous methylprednisolone followed by oral administration of prednisolone. Swept-source OCT images through the fovea were used to measure central retinal thickness, central choroidal thickness, and RPE reflectivity.

Results

During an observation period of 37.2 ± 30.8 months, recurrence of inflammation was observed in 11 patients (55.0%). Initial visual acuity was worse in patients who developed recurrence than in those who did not (P=0.024). On initial OCT images, RPE reflectivity differed significantly between patients with and without recurrence (1.75 ± 0.42 vs 1.35 ± 0.20; P=0.018), while there were no significant differences in other chorioretinal parameters, such as central retinal thickness and choroidal thickness.

Conclusion

RPE reflectivity on OCT images may be useful for predicting the recurrence of inflammation in patients with VKH disease.

Keywords:

• Vogt-Koyanagi-Harada disease
• optical coherence tomography
• retinal pigment epithelium
• inflammation recurrence

Data Sharing Statement

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Ethics Approval and Consent to Participate

The current observational study was approved by the Institutional Review Board of Kyoto University Graduate School of Medicine (Kyoto, Japan) (approval number: 0352) and adhered to the tenets of the Declaration of Helsinki. Written informed consent was obtained from all patients.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

None of the authors has proprietary interest in any product described in the article. Y. Muraoka: personal fees from Bayer Yakuhin, Novartis Pharma, Canon, Santen Pharmaceutical, Alcon Japan, Senju Pharmaceutical, Japan Focus, Findex, Kowa Pharmaceutical, Pfizer, AMO Japan, Wakamoto Pharmaceutical, Alcon Pharma, Otsuka Pharmaceutical, Tomey Corporation, Taiho Pharma, Hoya, Chugai Pharmaceutical, Astellas, Eisai, Daiichi-Sankyo, Janssen Pharmaceutical, Kyoto Drug Discovery & Development, Allergan Japan, MSD, Ellex, Sanwa Kagaku Kenkyusho, Nitten Pharmaceutical, AbbVie GK, outside the submitted work. S. Kadomoto: Canon, Santen Pharmaceutical, Senju Pharmaceutical, Japan Focus. K. Ishihara: Bayer Yakuhin, Santen Pharmaceutical. A Uji: Bayer Yakuhin, Novartis Pharma, Canon, Santen Pharmaceutical, Senju Pharmaceutical. A. Tsujikawa: grants and/or personal fees from Canon, Findex, Santen Pharmaceutical, Sumitomo Pharma, Kowa Pharmaceutical, Pfizer, AMO Japan, Senju Pharmaceutical, Wakamoto Pharmaceutical, Alcon Japan, Alcon Pharma, Otsuka Pharmaceutical, Tomey Corporation, Taiho Pharma, Hoya, Bayer Yakuhin, Novartis Pharma, Kyowa Kirin, Nidek, Chugai Pharmaceutical, Rohto Nitten, Nippon Boehringer Ingelheim, Rohto Pharmaceutical, Johnson & Johnson, Nikon Solutions, Astellas, Eisai, Daiichi-Sankyo, Janssen Pharmaceutical, Kyoto Drug Discovery & Development, Allergan Japan, MSD, Ellex, Sanwa Kagaku Kenkyusho, Nitten Pharmaceutical, AbbVie GK. The authors report no other conflicts of interest in this work.

Additional information

Funding

This work was supported in part by a grant-in-aid for scientific research (no. 20K09771) from the Japan Society for the Promotion of Science (Tokyo, Japan) and by Canon INC. (Tokyo, Japan). The funders had no role in the study design, data collection/analysis, decision to publish, or preparation of the article.