Department of Ophthalmology, Kasr Al-Ainy School of Medicine, Cairo University, Giza, Egypt; and.
Watany Eye Hospital, Cairo, Egypt.
Retina. 2022 Sep 1;42(9):1788-1795. doi: 10.1097/IAE.0000000000003525.
To assess changes in choroidal thickness and blood flow in active Vogt-Koyanagi-Harada syndrome and after remission using optical coherence tomography angiography.
This was a prospective study of patients with active early uveitis secondary to Vogt-Koyanagi-Harada syndrome. They underwent optical coherence tomography angiography imaging twice: at baseline and after remission on treatment. 3- × 3- and 6- × 6-mm choriocapillaris slabs were used to evaluate parafoveal adjusted flow index as a marker for choroidal blood flow. Mean choroidal thickness of 3 points (subfoveally and 2 points 300 µ m parafoveally) was also measured.
Thirty-nine eyes of 25 patients were initially recruited. After excluding eyes with media opacity, submacular fibrosis, and choroidal neovascularization, 23 eyes of 14 patients were included. The mean follow-up period was 8.7 ± 2.5 months. Mean choroidal thickness in activity and remission was 581.65 ± 108.29 µ m and 318.34 ± 72.85 µ m respectively ( P < 0.01). Mean adjusted flow index in the 3- × 3-mm slabs activity and remission were 0.495 ± 0.027 and 0.519 ± 0.0336 ( P = 0.011), and the 6- × 6-mm slabs were 0.487 ± 0.037 and 0.517 ± 0.052 respectively ( P = 0.025).
We demonstrate decreasing choroidal thickness with paradoxically increasing choroidal flow on optical coherence tomography angiography in remitting Vogt-Koyanagi-Harada syndrome. This may reflect inflammatory infiltrations or granulomas increasing choroidal thickness during activity and causing sluggish circulation of the choriocapillaris, and a reversal of this process with remission. These findings shed more light on the relationship between Vogt Koyanagi Harada syndrome and its underlying choroidal disturbances. Larger studies are needed to evaluate the efficacy of adjusted flow index in evaluating and predicting disease activity.
利用光相干断层扫描血管造影评估活动期 Vogt-小柳原田综合征的脉络膜厚度和血流变化，以及缓解期的变化。
这是一项前瞻性研究，纳入了继发于 Vogt-小柳原田综合征的早期活动性葡萄膜炎患者。他们在基线和治疗缓解后接受了两次光相干断层扫描血管造影成像：使用 3×3mm 和 6×6mm 脉络膜毛细血管层进行成像，以评估旁黄斑区调整后的血流指数作为脉络膜血流的标志物。还测量了 3 个点（黄斑下和 2 个点旁黄斑 300μm）的平均脉络膜厚度。
最初纳入了 25 名患者的 39 只眼。排除了有介质混浊、黄斑下纤维化和脉络膜新生血管形成的眼后，14 名患者的 23 只眼被纳入研究。平均随访时间为 8.7±2.5 个月。活动期和缓解期的平均脉络膜厚度分别为 581.65±108.29μm 和 318.34±72.85μm（P<0.01）。3×3mm 扫描层的活动期和缓解期平均调整后的血流指数分别为 0.495±0.027 和 0.519±0.0336（P=0.011），6×6mm 扫描层分别为 0.487±0.037 和 0.517±0.052（P=0.025）。
我们在缓解期 Vogt-小柳原田综合征中发现脉络膜厚度减少，同时脉络膜血流增加，这与光相干断层扫描血管造影的结果相反。这可能反映了炎症浸润或肉芽肿在活动期增加脉络膜厚度，导致脉络膜毛细血管循环缓慢，在缓解期则出现这种情况的逆转。这些发现为 Vogt-Koyanagi-Harada 综合征及其潜在的脉络膜紊乱之间的关系提供了更多的了解。需要更大规模的研究来评估调整后的血流指数在评估和预测疾病活动中的疗效。
