Título

EVOLUTION OF NEAR-INFRARED REFLECTANCE AND FUNDUS AUTOFLUORESCENCE IN A PATIENT WITH SEVERE VOGT-KOYANAGI-HARADA DISEASE

Objetivo

Vogt-Koyanagi-Harada Disease (VKHD) can have a dramatic course, especially when treatment is delayed. Near-Infrared Reflectance (nIR-R) is a non-invasive tool that highlights deep retinal layers. We report the case of a patient who had severe visual loss and extensive retinal pigment epithelium (RPE) damage due to VKHD, and we analyze sequential nIR-R and green light-fundus autofluorescence (GL-FAF) after treatment initiation.

Relato do Caso

A 45-year-old woman was referred to us with a 25-day history of severe visual loss OU. Visual acuity (VA) was hand motions (HM) OU and she had exuberant bullous serous retinal detachment (SRD), such that her retina could only be inspected through anterior segment biomicroscopy. VKHD was diagnosed, and she was started on pulse therapy + MMF. Repeat pulse therapy was needed one week later as the bullous SRD failed to subside. 3 weeks after treatment initiation, nIR-R of her right eye (RE) displayed a central plaque of normal reflectance with dots of low reflectance in a honeycomb pattern, while GL-FAF showed a similar island of preserved autofluorescence (AF) with fewer hypoAF dots. Her left eye (LE) revealed on nIR-R a reticulate streak of central remaining normal reflectance, symmetric to the area of residual normal AF OS. VA by then was HM. 3 weeks later nIR-R OD remained unchanged, while FAF showed a similar area of remaining normal AF but now with a honeycomb pattern as anticipated by nIR-R. VA was 20/200 OU. 8 weeks later, even though VA improved to 20/125 and 20/160, the area of remaining normal reflectivity OD showed attenuation, while FAF showed enlargement of the hypoAF dots. The residual streak of normal reflectivity on nIR-R OS was further attenuated, but FAF was unchanged.

Conclusão

Our case appears to point to a possible anticipation of RPE degeneration in VKHD by nIR-R compared to GL-FAF, which we believe could be explained by the ability of the former to map areas of melanin depletion, an event that antecedes RPE apoptotic loss of lipofuscin content in VKHD.