The Effects Of Choroidal Folds Detection On Diagnosis And Treatment Of Vogt–Koyanagi–Harada Disease

Part I The effects of multimode imaging in diagnosing choroidal folds in Vogt–Koyanagi–Harada disease Purpose:To evaluate the effects of multimode imaging in detecting choroidal folds(CF)in Vogt–Koyanagi–Harada disease(VKH)and other posterior uveitis in differential diagnosis.Method:A retrospective case-control study.A total of 46 patients with 83 eyes with posterior uveitis from February 2013 to January 2020 in Subei Hospital were included.Among them,21 patients in VKH group were 42 eyes and 25 patients in non-VKH group were 41 eyes.All patients were subjected to detection of serological infection index and immune index,slit lamp,direct ophthalmoscope,fundus color photography,fundus fluorescence angiography(FFA)examination.At the same time,some patients underwent optical coherence tomography(OCT)examination,fundus infrared and autofluorescence.The proportion of choroidal folds,multiple needle-like high fluorescence around the optic disk,retinal pigment epithelium(RPE)folds and fluctuation of internal limiting membranes(ILM)changes in VKH group and non-VKH group were compared and analysed.Further analysis on the sensitivity and specificity of detecting choroidal folds with FFA,OCT,fundus infrared and autofluorescence.Results:(1)In the FFA,the number of eyes with choroidal folds(P=0.022),multiple acupuncture-like high fluorescence(P=0.014)and late multi-lake-like fluorescence accumulation(P=0.000)in VKH group was significantly higher than that in non-VKH group.The sensitivity of choroidal folds was 45% and the specificity was 80% for diagnosising VKH.The number of choroidal folds in the VKH group was 2-10,and the morphological distribution was typically radiated from the optic disc compared with the non-VKH group.The number of choroidal folds in the non-VKH group was 1-8,with concentric distributions of radial,transverse,oblique and ring macular.(2)In the OCT,the number of eyes with RPE folds(P=0.000),fluctuation of ILM changes(P=0.035),and subretinal fluid(P=0.000)in the VKH group were significantly higher than in the non-VKH group.Among them,the sensitivity of RPE folds was 85% and the specificity was 82% for diagnosising VKH.The sensitivity of fluctuation of ILM changes was 35%and the specificity was 94% for diagnosising VKH.(3)In the infrared ray examination,the number of eyes with choroidal folds in VKH group was significantly higher than that in non-VKH group(P=0.001),in which the sensitivity was 55% and the specificity was 100%.The choroidal folds in VKH group(strip strong infrared reflection)were significantly correlated with the choroidal folds in FFA images(striped weak fluorescence).In the fundus autofluorescence examination,three eyes in the VKH group had choroidal folds(banded weak fluorescence),whereas the non-VKH group did not have choroidal folds,and there was no statistical difference between the two groups(P=0.248).Among them,the sensitivity and specificity of diagnosis of VKH were 19% and 100% respectively.Conclusion:Detection of choroidal folds by multimode imaging is helpful for diagnosis and differential diagnosis of VKH disease.The sensitivity and specificity of detecting choroidal folds by OCT and fundus infrared were higher than that of FFA,but also simple and noninvasive and has more advantages.Part II Comparative study of clinical features and prognosis between VKH patients with choroid folds and VKH patients without choroid folds Purpose:To explore the clinical features and visual outcomes between VKH patients with choroid folds and VKH patients without choroid folds.Method:The VKH patients in Subei Hospital from February 2013 to December 2019 were included in the study.There were 20 patients with 40 eyes.Two experienced ophthalmologists divided all patients into CF group and non-CF group.The CF group patients were 9 people with18 eyes and non-CF group were 11 people with 22 eyes.All patients underwent slit lamp,direct ophthalmoscope,fundus color photography,FFA examination.The data of sex,age,course of disease,the best-corrected visual acuity(BCVA)at the first visit and the last BCVA after treatment were counted.At the same time,the differences of age,course of disease and prognosis were analyzed.Results:(1)The average age of patients with choroidal folds in the VKH group was older(P=0.001)and the first time interval was longer(P=0.027).There was no statistical difference between the sexes in two groups(P=0.642).(2)CF group and non-CF group had higher BCVA after treatment than their respective pre-treatment(P=0.000),with statistical differences.There was no significant difference in pre-treatment BCVA(P=0.086)and post-treatment BCVA(P=0.946)between the two groups.(3)The recurrence rate of CF group(66.7%)was higher than that of non-CF group(36.4%).Three patients with 2 people 4 eyes in CF group and 1 people 2 eyes in non-CF group were treated with immunosuppressant because of repeated recurrence.However,there was no statistical difference between the two groups on the use of immunosuppressants(P=0.057).Conclusion:The patients with choroidal folds in VKH group had a higher average age,longer history and a more prone to recurrence than those without.Whether it has choroidal fold or not,the visual acuity of VKH patients was improved after treatment,and there was no significant difference between the two groups in the treatment of pre-BCVA,the last BCVA after treatment and the need for immunosuppressant therapy.