Enhanced Depth Imaging Optical Coherence Tomography of the Choroid in Vogt–koyanagi–harada Disease

Nakayama, Makiko; Keino, Hiroshi; Okada, Annabelle A.; Watanabe, Takayo; Taki, Wakako; Inoue, Makoto; Hirakata, Akito

doi:10.1097/iae.0b013e318256205a

Cited by 189 publications

(113 citation statements)

References 15 publications

(18 reference statements)

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“…In patients with acute VKH disease, EDI-OCT images clearly showed bilateral diffusely thickened choroids that decreased over time with corticosteroid treatment [4][5][6]. In the current case, we clearly visualized the full-thickness choroid except in the untreated phase and the decreasing choroidal thickness during tapering of oral prednisolone.…”

Section: Discussionsupporting

confidence: 49%

“…Nakayama et al [5] defined rebound choroidal thickening as an increase exceeding 100 μm over the previous lowest measurement obtained during corticosteroid tapering; they reported that five eyes with rebound choroidal thickening had no recurrent inflammation by slit-lamp biomicroscopy or funduscopy during follow-up. However, Nakai et al [6] reported that a SRD developed again in four eyes with anterior inflammation and the choroidal thickness again increased markedly.…”

Section: Discussionmentioning

confidence: 99%

“…Enhanced-depth imaging optical coherence tomography (EDI-OCT) has provided new information about the overall choroidal thickness [3]. Increasing evidence shows that patients with acute VKH disease have marked choroidal thickening, possibly related to inflammatory infiltration and increased choroidal exudation [4][5][6]. In addition, the choroidal thickness decreases after high-dose corticosteroid treatment but increases again in recurrent VKH disease [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Recurrent Vogt–Koyanagi–Harada disease with sensorineural hearing loss and choroidal thickening

et al. 2013

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Purpose We report a case of Vogt-Koyanagi-Harada (VKH) disease that recurred with sensorineural hearing loss and choroidal thickening. MethodsWe measured the choroidal thickness using enhanced-depth imaging optical coherence tomography (EDI-OCT) in a patient with VKH during corticosteroid-tapering therapy.Results A 71-year-old man presented with fever, headache, and anorthopia associated with wavy choroidal folds and a serous retinal detachment (SRD). The EDI-OCT images showed choroidal thickening (> 600 μm at the subfovea), and he was diagnosed with VKH disease. After treatment with pulsed intravenous methylprednisolone, the choroidal folds and SRD resolved and the choroidal thickness decreased. About 6 months after subsequent treatment with an oral corticosteroid started, headache, tinnitus, and sensorineural hearing loss developed, and increased choroidal thickness was observed without other evidence of increased ocular inflammation. A high-dose corticosteroid was injected and tapered, and the sensorineural hearing loss improved immediately and the choroidal thickness decreased. Ishibazawa et al. 4Conclusions In the current case, sensorineural hearing loss occurred with recurrent VKH disease; however, there were no ocular inflammatory signs except for rebound choroidal thickening. Measuring the choroidal thickness using EDI-OCT can sensitively identify recurrent VKH disease.

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Recurrent Vogt–Koyanagi–Harada disease with sensorineural hearing loss and choroidal thickening

et al. 2013

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“…EDI-OCT studies into other uveitic conditions such as Vogt-Koyanagi-Harada disease 23 and Behçet's disease 45 have observed a thicker choroid in active compared with quiescent disease. A possible explanation for this observation is that in the presence of inflammation, the release of mediators such as prostaglandins causes blood vessels to dilate leading to increases in OCT-derived measurements of choroidal thickness.…”

Section: The Choroid In Granulomatous Uveitismentioning

confidence: 99%

“…For example, OCT has been used (1) to describe characteristic features of specific uveitis entities, including thinning of Haller's large vessel layer of the choroid in idiopathic panuveitis and extra-macular choroidal changes in birdshot chorioretinopathy; 18,19 (2) to identify distinct stages of a disease process as illustrated by punctate inner choroidopathy; 20,21 (3) objective measurement of vitreous inflammation; 22 and (4) to monitor response to therapy, exemplified by a reduction of subfoveal choroidal thickening with corticosteroid therapy in Vogt-KoyanagiHarada disease. 23 Additionally, the potential of OCT angiography in uveitic diseases has yet to be realised.…”

Section: Introductionmentioning

confidence: 99%

Structural changes of the choroid in sarcoid- and tuberculosis-related granulomatous uveitis

Mehta

Sim

Keane

et al. 2015

Eye

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Aim The aim of this study is to characterise the choroidal features of patients diagnosed with sarcoid-and tuberculosis (TB)-associated granulomatous uveitis using spectral domain optical coherence tomography (OCT). Methods Twenty-seven patients (27 eyes) diagnosed with sarcoid-(13 eyes) and TB (14 eyes)-related uveitis were included in this retrospective, cross-sectional study. Over a sixmonth period, patients diagnosed with sarcoid and TB granulomatous uveitis were scanned using enhanced depth imaging OCT. Clinical and demographical characteristics were recorded, including the method of diagnosis, disease activity, site of inflammation (anterior or posterior), treatments, and visual acuity (VA). Manual segmentation of the choroidal layers was performed using custom image analysis software. Results The main outcome measure was OCT-derived thickness measurements of the choroid and choroidal sublayers (Haller's large vessel and Sattler's medium vessel layers) at the macula region. The ratio of Haller's large vessel to Sattler's medium vessel layer was significantly different at the total macula circle in eyes diagnosed with TB uveitis (1.47 ( = 140.71/95.72 μm)) compared with sarcoid uveitis (1.07 ( = 137.70/128.69 μm)) (P = 0.001). A thinner choroid was observed in eyes with a VA ≥ 0.3 LogMAR (Snellen 6/12; 198.1 μm (interquartile range (IQR) = 147.0-253.4 μm) compared with those with VA o0.3 LogMAR (292.4 μm (IQR = 240.1-347.6 μm)) at the total macula circle (P = 0.004). At the foveal central subfield, the median choroidal thickness was 336.8 μm (IQR = 272.3-375.4 μm) in active compared with 239.3 μm (IQR = 195.3-330.9 μm) in quiescent disease (P = 0.04). Conclusion A disproportionately enlarged Sattler's layer may indicate a diagnosis of sarcoid-related uveitis, and choroidal thickening may be a feature of active granulomatous uveitis.

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Characterization of the Choroid-Scleral Junction and Suprachoroidal Layer in Healthy Individuals on Enhanced-Depth Imaging Optical Coherence Tomography

et al. 2014

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IMPORTANCE Accurate measurements of choroidal thickness (CT) using enhanced-depth imaging optical coherence tomography (EDI-OCT) require a well-defined choroid-scleral junction (CSJ), which may appear in some eyes as a hyporeflective band corresponding to the suprachoroidal layer (SCL). OBJECTIVE To identify factors associated with the presence and thickness of the SCL in healthy participants and determine how different CSJ boundary definitions impact CT measurements. DESIGN, SETTING, AND PARTICIPANTS Secondary analysis of EDI-OCT images obtained prospectively from 74 eyes of 74 controls (mean age, 68.6 years) from the Age-Related Eye Disease Study 2 Ancillary SDOCT Study. MAIN OUTCOMES AND MEASURES The CSJ appearances were categorized as either having no visible SCL or a hyporeflective band corresponding to the SCL. Ocular parameters associated with the presence and thickness of the SCL were identified. Subfoveal CT was measured using 3 different posterior boundaries: (1) the posterior vessel border (vascular CT [VCT]), (2) inner border of the SCL (stromal CT [StCT]), and (3) inner border of the sclera (total CT [TCT]). Manual segmentation using custom software was used to compare VCT, StCT, and TCT across the macula. RESULTS The SCL was visible in 33 eyes (44.6%). Factors associated with SCL presence and thickness included hyperopic refractive error (R 2 = 0.123; P = .045) and increased TCT (R 2 = 0.215; P = .004), but not age, visual acuity, intraocular pressure, retinal foveal thickness, VCT, or StCT. In eyes where the SCL was not visible, mean [SD] subfoveal VCT was 222.3 [101.5] μm and StCT and TCT were 240.0 [99.0] μm, with a difference of 17.7 [16.0] μm (P < .001). In eyes where the SCL was visible, mean [SD] subfoveal VCT, StCT, and TCT were 221.9 [83.1] μm, 257.7 [97.3] μm, and 294.1 [104.8] μm, respectively, with the greatest difference of 72.2 [30.4] μm between VCT and TCT (P < .001). All 3 CT measurements were significantly different along all points up to 3.0 mm nasal and temporal to the fovea. CONCLUSIONS AND RELEVANCE A hyporeflective SCL is visible at the CSJ on EDI-OCT in nearly half of healthy individuals, and its presence correlates with hyperopia. Different posterior boundary definitions may result in significant differences in CT measurements and should be explicitly identified in future choroidal studies and segmentation algorithms.

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Enhanced Depth Imaging Optical Coherence Tomography of the Choroid in Vogt–koyanagi–harada Disease

Abstract: Enhanced depth imaging-optical coherence tomography revealed decreasing choroidal thickness with high-dose corticosteroid treatment in our patients. Choroidal thickness as measured by EDI-OCT may serve as a marker for degree of choroidal inflammation in acute VKH disease.

Cited by 189 publications

References 15 publications

Recurrent Vogt–Koyanagi–Harada disease with sensorineural hearing loss and choroidal thickening

Recurrent Vogt–Koyanagi–Harada disease with sensorineural hearing loss and choroidal thickening

Structural changes of the choroid in sarcoid- and tuberculosis-related granulomatous uveitis

Characterization of the Choroid-Scleral Junction and Suprachoroidal Layer in Healthy Individuals on Enhanced-Depth Imaging Optical Coherence Tomography

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