Optical Coherence Tomography Biomarkers in Acute Vogt-Koyanagi-Harada Disease: Clinical Significance of Hyperreflective Outer Nuclear Layer and Bacillary Layer Detachment.

PURPOSE

To assess the clinical importance of hyperreflective outer nuclear layer (HONL) and bacillary layer detachment (BALAD) on optical coherence tomography in acute Vogt-Koyanagi-Harada (VKH) disease.

METHODS

A retrospective analysis of 24 patients with acute VKH, involving at least 12 months of follow-up.

RESULTS

Among the 42 eyes with serous retinal detachment (SRD) at presentation, BALAD was identified in 21 eyes (50%) and HONL in 23 eyes (55%). Eyes with BALAD and HONL had poorer median best corrected visual acuity (BCVA) at baseline ( = 0.023,  = 0.002), but the final BCVA showed no difference between groups ( = 0.965,  = 0.287). The height of SRD at presentation was greater in eyes with BALAD and HONL than those without ( = 0.026,  < 0.001).HONL was strongly associated with SRD height ( < 0.001). The rates of loss of ellipsoid zone (EZ) and retinal pigment epithelium (RPE) integrity were higher in eyes with BALAD at 1 month ( < 0.05), although no significant difference was noted at 1 year ( = 0.520). In the HONL group, EZ and RPE integrity loss rates were higher at 1 month and 1 year ( < 0.05). Subfoveal choroidal thickness values did not vary based on the presence of HONL or BALAD at 1 month, 1 year, and during the last visit after treatment ( > 0.05). Ocular complication and recurrence rates were comparable across all groups ( > 0.05). HONL and BALAD were not considered significant risk factors for recurrence ( > 0.05).

CONCLUSION

In patients with acute VKH, HONL and BALAD were associated with more severe clinical features at presentation. However, HONL and BALAD did not affect long-term visual prognosis, recurrence, and development of ocular complications.