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Japanese Journal of Ophthalmology

, Volume 57, Issue 1, pp 90–94 | Cite as

Retinal pigment epithelium folds as a diagnostic finding of Vogt-Koyanagi-Harada disease

  • Yoshitake KatoEmail author
  • Yumiko Yamamoto
  • Hitoshi Tabuchi
  • Atsuki Fukushima
Clinical Investigation

Abstract

Objective

To examine using the folds of the retinal pigment epithelium (RPE) to diagnose Vogt-Koyanagi-Harada (VKH) disease.

Methods

Retrospective clinical review of 57 Japanese patients between July 2005 and April 2009. Optical coherence tomography (OCT), fundus photographs and fluorescein angiography (FA) were studied to investigate Kendall’s coefficients of concordance in seven findings by four ophthalmologists. The sensitivity and specificity of each finding were examined to confirm its efficacy. Each result was defined as positive when more than three of the ophthalmologists judged that the finding existed.

Results

The folds of the RPE on OCT were observed in 30/42 (71.4 %) eyes having VKH disease, but none in the other 72 eyes. Kendall’s coefficient of concordance in the detection of the folds of the RPE was 0.90 and was the highest among all other findings. Sensitivity was higher in the detection of the RPE folds on OCT and in optic nerve staining on FA than other findings and the specificity was 100 % for the RPE folds and 26.7 % for the optic nerve staining.

Conclusion

The detection of the folds of the RPE on OCT is a simple and effective method to help diagnose VKH disease at its acute stage which does not require pupil dilation.

Keywords

Retinal pigment epithelium folds Vogt-Koyanagi-Harada disease Optical coherence tomography 

References

  1. 1.
    Tagawa Y. Lymphocyte-mediated cytotoxicity against melanocyte antigens in Vogt-Koyanagi-Harada disease. Jpn J Ophthalmol. 1978;22:36–41.Google Scholar
  2. 2.
    Sugita S, Sagawa K, Mochizuki M, Shichijo S, Itoh K. Melanocyte lysis by cytotoxic T lymphocytes recognizing the MART-1 melanoma antigen in HLA-A2 patients with Vogt-Koyanagi-Harada disease. Int Immunol. 1996;8:799–803.PubMedCrossRefGoogle Scholar
  3. 3.
    Moorthy RS, Inomata H, Rao NA. Vogt-Koyanagi-Harada syndrome. Surv Ophthalmol. 1995;39:265–92.PubMedCrossRefGoogle Scholar
  4. 4.
    Yamamoto Y, Fukushima A, Nishino K, Koura Y, Komatsu T, Ueno H. Vogt-Koyanagi-Harada disease with onset in elderly patients aged 68 to 89 years. Jpn J ophthalmol. 2007;51:60–3.PubMedCrossRefGoogle Scholar
  5. 5.
    Read RW, Holand GN, Rao NA, Tabbara KF, Ohno S, Arellanes-Garcia L, et al. Revised diagnostic criteria for Vogt-Koyanagi-Harada disease: report of an international committee on nomenclature. Am J Ophthalmol. 2001;131:647–52.PubMedCrossRefGoogle Scholar
  6. 6.
    Komura R, Kasai M, Shoji K, Kanno C. Swollen ciliary processes as an initial symptom in Vogt-Koyanagi-Harada syndrome. Am J Ophthalmol. 1983;95:402–3.Google Scholar
  7. 7.
    Komura R, Sakai M, Okabe H. Transient shallow anterior chamber as initial symptom in Harada’s syndrome. Arch Ophthalmol. 1981;99:1604–6.CrossRefGoogle Scholar
  8. 8.
    Wada S, Kohno T, Yanagihara N, Hirabayashi M, Tabuchi H, Shiraki K, et al. Ultrasound biomicroscopic study of ciliary body changes in the post-treatment phase of Vogt-Koyanagi-Harada disease. Br J Ophthalmol. 2002;86:1374–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Wu W, Wen F, Huang S, Luo G, Wu D. Choroidal fold in Vogt-Koyanagi-Harada disease. Am J Ophthalmol. 2007;143:900–2.PubMedCrossRefGoogle Scholar
  10. 10.
    Gupta V, Gupta A, Gupta P, Sharma A. Spectral-domain cirrus optical coherence tomography of choroidal striations in the acute stage of Vogt-Koyanagi-Harada disease. Am J Ophthalmol. 2009;147:148–53.PubMedCrossRefGoogle Scholar
  11. 11.
    Gao W, Cense B, Zhang Y, Jonnal RS, Miller DT. Measuring retinal contributions to the optical Stiles–Crawford effect with optical coherence tomography. Opt Express. 2008;16:6486–501.PubMedCrossRefGoogle Scholar
  12. 12.
    Newell FW. Choroidal folds. The seventh Harry Searls Gradle Memorial lecture. Am J Ophthalmol. 1973;75:930–42.PubMedGoogle Scholar
  13. 13.
    Ishihara K, Hangai M, Kita M, Yoshimura N. Acute Vogt-Koyanagi-Harada disease in enhanced spectral-domain optical coherence tomography. Ophthalmology. 2009;116:1799–807.PubMedCrossRefGoogle Scholar
  14. 14.
    Shinoda K, Imamura Y, Matsumoto CS, Mizota A, Ando Y. Wavy and elevated retinal pigment epithelial line in optical coherence tomographic images of eyes with atypical Vogt-Koyanagi-Harada disease. Graefes Arch Clin Exp Ophthalmol. 2012;250:1399–402.PubMedCrossRefGoogle Scholar
  15. 15.
    Kokame GT, de Leon MD, Tanji T. Serous retinal detachment and cystoid macular edema in hypotony maculopathy. Am J Ophthalmol. 2001;131:384–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Yamaguchi Y, Otani T, Kishi S. Tomographic features of serous retinal detachment with multilobular dye pooling in acute Vogt-Koyanagi-Harada disease. Am J Ophthalmol. 2007;144:260–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Nakai K, Gomi F, Ikuno Y, Yasuno Y, Nouchi T, Ohguro N, et al. Choroidal observations in Vogt-Koyanagi-Harada disease using high-penetration optical coherence tomography. Graefes Arch Clin Exp Ophthalmol. 2012;250:1089–95.PubMedCrossRefGoogle Scholar
  18. 18.
    Otsuki T, Shimizu K, Igarashi A, Igarashi A, Kamiya K. Usefulness of anterior chamber depth measurement for efficacy assessment of steroid pulse therapy in patients with Vogt-Koyanagi-Harada Disease. Jpn J ophthalmol. 2010;54:396–400.PubMedCrossRefGoogle Scholar
  19. 19.
    Phelps CD. Angle-closure glaucoma secondary to ciliary body swelling. Arch Ophthalmol. 1974;92:287–90.PubMedCrossRefGoogle Scholar
  20. 20.
    Eibschiz-Tsimhoni M, Gelfand YA, Mezer E, Miller B. Bilateral angle closure glaucoma: an unusual presentation of Vogt-Koyanagi-Harada syndrome [letter]. Br J Ophthalmol. 1997;81:705–6.CrossRefGoogle Scholar

Copyright information

© Japanese Ophthalmological Society 2012

Authors and Affiliations

  • Yoshitake Kato
    • 1
    Email author
  • Yumiko Yamamoto
    • 2
  • Hitoshi Tabuchi
    • 1
  • Atsuki Fukushima
    • 2
  1. 1.Department of OphthalmologyTsukazaki HospitalHimejiJapan
  2. 2.Department of OphthalmologyKochi UniversityNankokuJapan

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