Título

BACILLARY LAYER DETACHMENT IN ACUTE VOGT-KOYANAGI-HARADA DISEASE: AN EARLY PREDICTOR OF LONG-TERM COMPLICATIONS

Objetivo

To evaluate the presence of bacillary layer detachment (BALAD) at presentation in patients with VKHD as a predictor of long-term structural and functional outcomes.

Método

Retrospective cohort study. Thirty-three VKHD patients (66 eyes) were followed over 12 months under clinical and predefined therapeutic protocols. Clinical and multimodal data were collected at baseline and at months (M) 1, 3, 6, 9, and 12. Spectral-domain optical coherence tomography (SD-OCT)-based structural findings were correlated with subretinal fibrosis (SRF), sunset glow fundus (SGF), and atrophic nummular lesions (ANL) at M12. Univariate, bivariate, and multivariate analyses were used. Main outcome measures: SD-OCT retinal abnormalities during study period; risk factors for SRF, SGF, and ANL at M12.

Resultado

At baseline, 96.4% of 56 eyes had serous retinal detachment (SRD) and 48.2% had BALAD; at M1, 42.4% had SRD and 6.1% had BALAD. SRD was present in 9.1%, 4.5%, and 3.0% of eyes at M3, M6, and M9, respectively. Bivariate analysis showed that early BALAD was correlated with a large SRD area (p=0.036) at presentation and with both SRF (p<0.001) and SGF (p=0.008) at M12. Multivariate regression analysis showed that early BALAD (OR, 12.04; p=0.011) and a longer interval to treatment start (32 vs 17 days; OR, 1.17; p=0.004) were independent risk factors for SRF at M12, while early BALAD (OR, 14.78; p=0.002) and anterior uveitis recurrences (OR, 30.94; p=0.022) were independent risk factors for SGF. Late ANL was not linked to BALAD at presentation.

Conclusão

BALAD at presentation in acute VKHD was an early predictor of SRF and SGF at 12-month follow-up.