Contribution of dual fluorescein and indocyanine green angiography to the appraisal of posterior involvement in birdshot retinochoroiditis and Vogt‐Koyanagi‐Harada disease

Abstract

PurposeTo assess the levels of retinal versus choroid involvement in two stromal choroiditis entities, birdshot retinochoroiditis (BRC) and Vogt‐Koyanagi‐Harada (VKH) disease in initial onset non treated disease.MethodsThis retrospective study included patients diagnosed with BRC and VKH, seen during initial onset disease at the Centre for Ophthalmic Specialized Care, Lausanne, Switzerland. Angiographic signs were quantified, using an established dual FA and ICGA scoring system for uveitis, and the FA/ICGA ratios were compared between diseases.ResultsAmong 1,739 patients with uveitis seen from 1995 to 2014, 7 newly diagnosed BRC patients and 4 patients with newly diagnosed VKH disease were included in the study. Patients with BRC and VKH had mean FA angiographic scores of 16.64 ± 3.75 and 4.25 ± 1.83; mean ICGA angiographic scores of 21.00 ± 3.48 and 25.25 ± 3.84; and mean FA/ICGA ratios of 0.79 ± 0.21 and 0.17 ± 0.09, respectively.ConclusionsThis study showed the differential involvements of the retina and choroid in BRC and VKH. Choroid was predominantly involved in both diseases, which clearly indicated that ICGA was the method of choice, and that it should be performed in conjunction with FA. Also, the FA/ICGA ratio highlighted the fundamental differences between BRC and VKH. VKH had a purely choroidal origin of inflammation, and BRC had both retinal and choroidal origins of inflammation.

Choroidal Inflammation and Choriocapillaris Ischemia in Focal Choroidal Excavation in Comparison to Pachychoroid Neovasculopathy

“…Dark dots or areas (excluding atrophy) that indicated choroidal stromal inflammatory foci or choriocapillaris nonperfusion in ICGA were rated with a well-established ICGA scoring system. [11][12][13] Originally, the scoring system consisted of four categories: Early stromal vessel hyperfluorescence, choroidal vasculitis, dark dots or areas (excluding atrophy), and optic disk hyperfluorescence. We measured the dark dots or areas (excluding atrophy) that indicated choroidal stromal inflammatory foci or choriocapillaris nonperfusion to evaluate choroidal inflammation or presence of ischemia.…”

Vogt-Koyanagi-Harada Disease and Birdshot Retinochoroidopathy, Similarities and Differences: A Glimpse into the Clinicopathology of Stromal Choroiditis, a Perspective and a Review

“…In our experience, cystoid macular edema (CMO) involving the foveola is less frequent than reported in the past and occurs in up to 40 % of cases at any time of the evolution of the disease. Even when there is massive exudation from retinal vessels, the foveola can remain free of edema [76,90] (▶ Fig. 7 f, left eye).…”

“…CMO is best investigated by FA at onset and can be followed by FA. In addition, OCT allows for a closer follow-up of CMO [78,90,93]. In our series of patients mostly under corticosteroid/Immunosuppressive treatment, the rate of patients presenting a CMO with foveolar involvement did not exceed 30-40 % [72] (▶ Fig.…”

HLA-A29 and Birdshot Uveitis: Further Down the Rabbit Hole

“…Because BU shows early inflammation of the choroidal stroma ( 12 ), Herbort and associates proposed to classify BU as a primary stromal choroiditis , together with Vogt-Koyanagi-Harada (VKH) disease. VKH is a condition characterized by chronic inflammation toward melanocytes that affect multiple parts of the body, including the choroidal stroma and the larger choroidal vessels ( 11 , 13 ). In VKH no retinal involvement at early stages of disease are noticeable.…”