Indocyanine green angiography findings in patients with long-standing Vogt-Koyanagi-Harada disease: a cross-sectional study

BMC Ophthalmology, Aug 2012

Background To investigate indocyanine green angiography (ICGA) findings in patients with long-standing Vogt-Koyanagi-Harada (VKH) disease and their correlation with disease activity on clinical examination as well as with systemic corticosteroid therapy. Methods Twenty-eight patients (51 eyes) with long-standing (≥6 months from disease onset) VKH disease whose treatment was tapered based only in clinical features were prospectively included at a single center in Brazil. All patients underwent standardized clinical evaluation, which included fundus photography, fluorescein angiography and ICGA. Clinical disease activity was determined based in the Standardization in Uveitis Nomenclature Working Group. Fisher exact test and logistic regression models were used for statistical analysis. Results Disease-related choroidal inflammation on ICGA was observed in 72.5% (31 of 51 eyes). Angiographic findings suggestive of (choroidal and/or retinal) disease activity were not observed on FA. Clinically active disease based on clinical evaluation was observed in 41.2% (21 of 51 eyes). In these 21 eyes, disease-related choroidal inflammation on ICGA was observed in 76.2% (16 of 21 eyes); in the remaining eyes (without clinical active disease) disease-related choroidal inflammation on ICGA was observed in 70.0% (21 of 30 eyes). In respect to systemic corticosteroid therapy, 10 patients (18 of 51 eyes) were under treatment with prednisone. In these 10 (18 of 51 eyes) patients, disease-related choroidal inflammation on ICGA was observed in 83.3% (15 of 18 eyes); in the remaining patients (33 of 51 eyes) disease-related choroidal inflammation on ICGA was observed in 66.7% (22 of 33 eyes). Conclusion ICGA findings suggestive of disease-related choroidal inflammation were observed in a considerable proportion of patients with long-standing VKH disease, independent of the inflammatory status of the disease on clinical examination or current use of systemic corticosteroid. Therefore, the current study reinforces the crucial role of ICGA to assist the management and treatment of patients with long-standing VKH disease.

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Indocyanine green angiography findings in patients with long-standing Vogt-Koyanagi-Harada disease: a cross-sectional study

BMC Ophthalmology Indocyanine green angiography findings in patients with long-standing Vogt-Koyanagi- Harada disease: a cross-sectional study Felipe T da Silva 0 3 Carlos E Hirata 0 3 Viviane M Sakata 0 3 Edilberto Olivalves 0 3 Rony Preti 2 Sergio LG Pimentel 2 Andre Gomes 2 Walter Y Takahashi 2 Rogerio A Costa 1 Joyce H Yamamoto 0 3 0 Uveitis Service, Department of Ophthalmology, Hospital das Clinicas, Universidade de Sao Paulo , Sao Paulo, SP , Brazil 1 Division of Macula: Imaging & Treatment, Centro Brasileiro de Ciencias Visuais , Belo Horizonte, MG , Brazil 2 Retina Section, Department of Ophthalmology, Hospital das Clinicas, Universidade de Sao Paulo , Sao Paulo, SP , Brazil 3 Uveitis Service, Department of Ophthalmology, Hospital das Clinicas, Universidade de Sao Paulo , Sao Paulo, SP , Brazil 4 Rua Diana , 863 apto 91 J, Sao Paulo, SP 05019-000 , Brazil Background: To investigate indocyanine green angiography (ICGA) findings in patients with long-standing Vogt-Koyanagi-Harada (VKH) disease and their correlation with disease activity on clinical examination as well as with systemic corticosteroid therapy. Methods: Twenty-eight patients (51 eyes) with long-standing (6 months from disease onset) VKH disease whose treatment was tapered based only in clinical features were prospectively included at a single center in Brazil. All patients underwent standardized clinical evaluation, which included fundus photography, fluorescein angiography and ICGA. Clinical disease activity was determined based in the Standardization in Uveitis Nomenclature Working Group. Fisher exact test and logistic regression models were used for statistical analysis. Results: Disease-related choroidal inflammation on ICGA was observed in 72.5% (31 of 51 eyes). Angiographic findings suggestive of (choroidal and/or retinal) disease activity were not observed on FA. Clinically active disease based on clinical evaluation was observed in 41.2% (21 of 51 eyes). In these 21 eyes, disease-related choroidal inflammation on ICGA was observed in 76.2% (16 of 21 eyes); in the remaining eyes (without clinical active disease) disease-related choroidal inflammation on ICGA was observed in 70.0% (21 of 30 eyes). In respect to systemic corticosteroid therapy, 10 patients (18 of 51 eyes) were under treatment with prednisone. In these 10 (18 of 51 eyes) patients, disease-related choroidal inflammation on ICGA was observed in 83.3% (15 of 18 eyes); in the remaining patients (33 of 51 eyes) disease-related choroidal inflammation on ICGA was observed in 66.7% (22 of 33 eyes). Conclusion: ICGA findings suggestive of disease-related choroidal inflammation were observed in a considerable proportion of patients with long-standing VKH disease, independent of the inflammatory status of the disease on clinical examination or current use of systemic corticosteroid. Therefore, the current study reinforces the crucial role of ICGA to assist the management and treatment of patients with long-standing VKH disease. Angiography; Indocyanine green; Choroid; Diagnosis; Inflammation; Vogt-Koyanagi-Harada - Background Vogt-Koyanagi-Harada (VKH) disease is a T-cell altered immune process that is directed at the melanocytes [1]. The diagnosis is essentially based on the observation of bilateral diffuse choroiditis of acute onset following flulike prodromic symptoms, and prompt treatment with systemic corticosteroid and/or immunosuppressant has been recommended. In spite of aggressive treatment during the acute phase of the disease, slowly progressive fundus depigmentation has been observed over time [2], even in the absence of detectable clinical signs of disease activity. There is increasing evidence that this slowly progressive fundus depigmentation is related to some disease activity undetected on regular clinical examination and is due to insufficient therapy; it does most probably not occur as part of the natural history of VKH disease [3]. In this sense, indocyanine green angiography (ICGA) may be an interesting ancillary tool. As the dye fluoresces in the near infrared wavelength, indocyanine green is particularly useful for imaging of the choroidal vascular compartment. In fact, the role of ICGA in detecting choroidal inflammation in patients with VKH disease has been investigated [4-7], mainly in European and Asian countries. Its relevance has been pointed out to either confirm elements already revealed by clinical examination or to determine the inflammatory status of the fundus and monitor VKH disease activity during follow-up, thus assisting the treatment process [4-7]. The use of ICGA for monitoring VKH disease activity, however, is not universally accepted [8,9]. Moreover, some of the ICGA findings suggestive of choroidal inflammation related to the disease may share angiographic features with those findings observed in patients under systemic corticosteroid treatment [10-13]. In the current report, we studied the ICGA findings in patients with long (...truncated)


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Felipe T da Silva, Carlos E Hirata, Viviane M Sakata, Edilberto Olivalves, Rony Preti, Sergio LG Pimentel, Andre Gomes, Walter Y Takahashi, Rogerio A Costa, Joyce H Yamamoto. Indocyanine green angiography findings in patients with long-standing Vogt-Koyanagi-Harada disease: a cross-sectional study, BMC Ophthalmology, 2012, pp. 40, 12, DOI: 10.1186/1471-2415-12-40