Department of Ophthalmology, Queen Mary Hospital, Pokfulam, Hong Kong, China.
Retina. 2011 Mar;31(3):502-9. doi: 10.1097/IAE.0b013e3182083beb.
Current imaging modalities used in the evaluation of Vogt-Koyanagi-Harada (VKH) disease include ultrasound, fluorescein angiogram, indocyanine green angiography, and optical coherence tomography (OCT). However, they all fail to give detailed information on the ultrastructural changes of the choroid. A recent technique using OCT termed "enhanced depth imaging" produces high-resolution cross-sectional images of the whole thickness of the choroid. The purpose of the study was to describe a novel imaging finding in the choroid in cases of VKH uveitis and to assess for interobserver agreement of this new physical sign.
This is an age-matched, sex-matched, and spherical equivalent-matched, case-control, cross-sectional study. Six VKH patients in acute and convalescent stages underwent choroidal imaging using enhanced depth imaging spectral-domain OCT imaging. A horizontal enhanced depth imaging spectral-domain OCT scan across the fovea was selected for each eye and was compared with a scan from an age-matched, sex-matched, and spherical equivalent-matched control subject. A loss of focal hyperreflectivity, represented by a decrease in the number of hyperreflective dots in the inner choroid, was observed. This finding was assessed for interobserver agreement using five masked observers. Mean observed agreement and multirater kappa statistics (κ) were calculated. The average choroidal thickness was also calculated and compared among acute-phase VKH patients, convalescent-phase VKH patients, and control subjects.
There was a significant loss of focal hyperreflectivity in the inner choroid of VKH patients compared with control subjects in both acute and convalescent stages. Analysis revealed substantial interobserver agreement on this finding. The mean observed agreement was 95%, and the overall kappa coefficient (κ) was 0.80 (P < 0.01). The choroid of acute-phase VKH patients was thicker than that of convalescent-phase patients by 151 μm (P = 0.043) and control subjects by 137 μm (P = 0.001). There was no statistically significant difference in thickness between convalescent eyes and controls.
Enhanced depth imaging spectral-domain OCT highlights a loss of focal hyperreflectivity in the inner choroid of eyes with VKH, a feature that is consistently observed by independent masked observers. The presence of this feature in both acute and convalescent phases could represent permanent structural change to small choroidal vessels caused by VKH uveitis.
目前用于评估 Vogt-小柳-原田（VKH）病的影像学方法包括超声、荧光素血管造影、吲哚青绿血管造影和光学相干断层扫描（OCT）。然而，它们都无法提供脉络膜超微结构变化的详细信息。最近一种使用 OCT 的技术称为“增强深度成像”，可产生整个脉络膜厚度的高分辨率横截面图像。本研究的目的是描述 VKH 葡萄膜炎病例中脉络膜的一种新成像发现，并评估这种新物理征象的观察者间一致性。
这是一项年龄匹配、性别匹配和等效球镜匹配的病例对照、横断面研究。6 例 VKH 患者处于急性期和恢复期，使用增强深度成像光谱域 OCT 成像进行脉络膜成像。选择每个眼的黄斑中心凹水平增强深度成像光谱域 OCT 扫描，并与年龄匹配、性别匹配和等效球镜匹配的对照者的扫描进行比较。观察到内层脉络膜焦点高反射性的丧失，表现为内层脉络膜高反射点数量的减少。使用 5 名掩蔽观察者评估这种发现的观察者间一致性。计算平均观察一致性和多评价者kappa 统计量（κ）。还比较了急性期 VKH 患者、恢复期 VKH 患者和对照组的平均脉络膜厚度。
与对照组相比，急性期和恢复期 VKH 患者的内层脉络膜焦点高反射性显著丧失。分析显示，对这一发现有显著的观察者间一致性。平均观察一致性为 95%，总体kappa 系数（κ）为 0.80（P<0.01）。急性期 VKH 患者的脉络膜比恢复期患者厚 151μm（P=0.043），比对照组厚 137μm（P=0.001）。恢复期患者与对照组之间的厚度无统计学差异。
增强深度成像光谱域 OCT 突出显示 VKH 患者的内层脉络膜焦点高反射性丧失，这一特征被独立的掩蔽观察者一致观察到。该特征在急性期和恢复期的存在可能代表 VKH 葡萄膜炎引起的小脉络膜血管的永久性结构改变。
