Bacillary Layer Detachment in Acute Vogt-Koyanagi-Harada Disease: An Early Predictor of Long-term Complications
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Purpose
To evaluate the presence of bacillary layer detachment (BALAD) at presentation in patients with Vogt-Koyanagi-Harada disease (VKHD) as a predictor of long-term structural and functional outcomes.
Methods
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. The main outcome measures were SD-OCT retinal alterations during study period; risk factors for SRF, SGF, and ANL at M12.
Results
At baseline, 96.4% of 56 eyes had serous retinal detachments (SRD) and 48.2% had BALAD; at M1, 42.4% had SRD and 6.1% had BALAD. 9.1%, 4.5%, and 3.0% of eyes had SRD at M3, M6, and M9, respectively. Bivariate analysis showed that early BALAD was related 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 factor 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 factor for SGF. Late ANL was not linked to BALAD at presentation.
Conclusion
BALAD at presentation in acute VKHD was an early predictor of SRF and SGF at 12-month follow-up.
Conflict of interest
No
1
Last name
GUSMÃO
Initials of first name(s)
CC
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
São Paulo
Country
Brazil
2
Last name
MISSAKA
Initials of first name(s)
RFBG
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
São Paulo
Country
Brazil
3
Last name
GOLDBAUM
Initials of first name(s)
M
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
São Paulo
Country
Brazil
4
Last name
MACHADO
Initials of first name(s)
CG
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
São Paulo
Country
Brazil
5
Last name
CUNNINGHAM JR
Initials of first name(s)
E
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
São Paulo
Country
Brazil
6
Last name
SOUTO
Initials of first name(s)
FM
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
São Paulo
Country
Brazil
7
Last name
NÓBREGA
Initials of first name(s)
PFC
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
São Paulo
Country
Brazil
8
Last name
LAVEZZO
Initials of first name(s)
MM
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
São Paulo
Country
Brazil
9
Last name
OYAMADA
Initials of first name(s)
MK
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
São Paulo
Country
Brazil
10
Last name
HIRATA
Initials of first name(s)
CE
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
São Paulo
Country
Brazil
11
Last name
YAMAMOTO
Initials of first name(s)
JH
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
São Paulo
Country
Brazil
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