Pham Aarin Thuan, Onghanseng Neil, Halim Muhammad Sohail, Ormaechea Maria Soledad, Hassan Muhammad, Akhavanrezayat Amir, Uludag Gunay, Tran Anh Nt, Razeen Moataz M, Sredar Nripun, Dubra Alfredo, Nguyen Quan Dong
Byers Eye Institute, Stanford University, Palo Alto, CA, USA.
Hospital Universitario Austral, Pilar, Buenos Aires, Argentina.
Am J Ophthalmol Case Rep. 2022 Jul 13;27:101660. doi: 10.1016/j.ajoc.2022.101660. eCollection 2022 Sep.
To describe the reflectance adaptive optics scanning laser ophthalmoscopy (AOSLO) findings in different stages of Vogt-Koyanagi-Harada (VKH) disease and correlate them to visual gain post treatment. Confocal (cAOSLO) and non-confocal split-detector AOSLO (sdAOSLO) were used to assess longitudinally the status of the photoreceptors in a patient with VKH managed on corticosteroid and immunomodulatory therapy.
A 32-year-old Japanese American female presented with a 2-week history of blurred vision in both eyes (OU) and worsening headache previously diagnosed as a case of VKH and treated with high dose oral prednisone. At the time of presentation, though vision was improving, and frank serous retinal detachments were absent, spectral domain optical coherence tomography (SD-OCT) showed presence of residual subretinal fluid with disruption of the photoreceptor inner segments and outer segments (IS/OS) involving OU. The photoreceptor mosaic at the foveal center appeared very sparse with large areas devoid of visible photoreceptors on cAOSLO, in agreement with the SD-OCT data. sdAOSLO imaging over the same location shows a higher number of contiguous photoreceptors. After imaging, the patient was started on mycophenolate mofetil as steroid-sparing long-term therapy. Three months later, visual acuity improved to 20/20 OU, and SD-OCT showed almost complete resolution of subretinal fluid with significant improvement of the IS/OS SD-OCT signal, OU. cAOSLO imaging revealed a contiguous photoreceptor mosaic without gaps and of normal appearance.
VKH patients may demonstrate transient photoreceptor abnormalities on SD-OCT and cAOSLO imaging. sdAOSLO imaging revealed intact photoreceptor segments in areas that appeared as voids on cAOSLO, which later showed structural recovery on SD-OCT and cAOSLO. Therefore, sdAOSLO may predict potential for improvement in patients wherein there appears to be photoreceptor loss in cAOSLO and/or SD-OCT.
描述伏格特-小柳-原田（VKH）病不同阶段的反射率自适应光学扫描激光检眼镜（AOSLO）检查结果，并将其与治疗后的视力改善情况相关联。使用共焦（cAOSLO）和非共焦分裂探测器AOSLO（sdAOSLO）对一名接受皮质类固醇和免疫调节治疗的VKH患者的光感受器状态进行纵向评估。
一名32岁的日裔美国女性，双眼视力模糊2周，头痛加重，此前被诊断为VKH病例，接受高剂量口服泼尼松治疗。就诊时，尽管视力正在改善，且无明显的浆液性视网膜脱离，但光谱域光学相干断层扫描（SD-OCT）显示双眼存在残留的视网膜下液，伴有光感受器内节和外节（IS/OS）中断。与SD-OCT数据一致，中央凹中心的光感受器镶嵌显得非常稀疏，在cAOSLO上有大片区域没有可见的光感受器。同一位置的sdAOSLO成像显示有更多连续的光感受器。成像后，患者开始使用霉酚酸酯作为长期的类固醇替代疗法。三个月后，双眼视力提高到20/20，SD-OCT显示视网膜下液几乎完全消退，IS/OS的SD-OCT信号明显改善。cAOSLO成像显示连续的光感受器镶嵌，没有间隙，外观正常。
VKH患者在SD-OCT和cAOSLO成像上可能表现出短暂的光感受器异常。sdAOSLO成像显示在cAOSLO上看似空白的区域光感受器节段完整，这些区域后来在SD-OCT和cAOSLO上显示出结构恢复。因此，sdAOSLO可能预测cAOSLO和/或SD-OCT中出现光感受器丢失的患者的改善潜力。
