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Open Access Research article

Indocyanine green angiography findings in patients with long-standing Vogt-Koyanagi-Harada disease: a cross-sectional study

Felipe T da Silva1, Carlos E Hirata1, Viviane M Sakata1, Edilberto Olivalves1, Rony Preti2, Sergio LG Pimentel2, Andre Gomes2, Walter Y Takahashi2, Rogerio A Costa3 and Joyce H Yamamoto14*

Author Affiliations

1 Uveitis Service, Department of Ophthalmology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil

2 Retina Section, Department of Ophthalmology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil

3 Division of Macula: Imaging & Treatment, Centro Brasileiro de Ciências Visuais, Belo Horizonte, MG, Brazil

4 Rua Diana, 863 apto 91 J, São Paulo, SP, 05019-000, Brazil

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BMC Ophthalmology 2012, 12:40  doi:10.1186/1471-2415-12-40

Published: 13 August 2012

Abstract

Background

To investigate indocyanine green angiography (ICGA) findings in patients with long-standing Vogt-Koyanagi-Harada (VKH) disease and their correlation with disease activity on clinical examination as well as with systemic corticosteroid therapy.

Methods

Twenty-eight patients (51 eyes) with long-standing (≥6 months from disease onset) VKH disease whose treatment was tapered based only in clinical features were prospectively included at a single center in Brazil. All patients underwent standardized clinical evaluation, which included fundus photography, fluorescein angiography and ICGA. Clinical disease activity was determined based in the Standardization in Uveitis Nomenclature Working Group. Fisher exact test and logistic regression models were used for statistical analysis.

Results

Disease-related choroidal inflammation on ICGA was observed in 72.5% (31 of 51 eyes). Angiographic findings suggestive of (choroidal and/or retinal) disease activity were not observed on FA. Clinically active disease based on clinical evaluation was observed in 41.2% (21 of 51 eyes). In these 21 eyes, disease-related choroidal inflammation on ICGA was observed in 76.2% (16 of 21 eyes); in the remaining eyes (without clinical active disease) disease-related choroidal inflammation on ICGA was observed in 70.0% (21 of 30 eyes). In respect to systemic corticosteroid therapy, 10 patients (18 of 51 eyes) were under treatment with prednisone. In these 10 (18 of 51 eyes) patients, disease-related choroidal inflammation on ICGA was observed in 83.3% (15 of 18 eyes); in the remaining patients (33 of 51 eyes) disease-related choroidal inflammation on ICGA was observed in 66.7% (22 of 33 eyes).

Conclusion

ICGA findings suggestive of disease-related choroidal inflammation were observed in a considerable proportion of patients with long-standing VKH disease, independent of the inflammatory status of the disease on clinical examination or current use of systemic corticosteroid. Therefore, the current study reinforces the crucial role of ICGA to assist the management and treatment of patients with long-standing VKH disease.

Keywords:
Angiography; Indocyanine green; Choroid; Diagnosis; Inflammation; Vogt-Koyanagi-Harada