Título

INTRARETINAL CYSTOID SPACES IN ACUTE VOGT–KOYANAGI–HARADA DISEASE

Objetivo

To present intraretinal cystoid spaces observed in spectral-domain optical coherence tomography (SD-OCT) images of eyes with acute Vogt-Koyanagi-Harada disease (VKHD).

Método

Retrospective and descriptive study with VKHD patients who presented intraretinal cystoid spaces in the acute phase. All patients were followed for a minimum of one year from disease onset with predefined treatment protocols and systematic evaluation. We reviewed conventional OCT images, enhanced depth SD-OCT images (HRA+OCT, Heidelberg), including serial sections through the macula obtained at the initial visit and during the follow-up until complete resolution of serous retinal detachment.

Resultado

Twenty-nine patients (58 eyes) were evaluated. Of these, 8 patients (7 women, 12 eyes [20%]; mean age 34.6±10.2 years) had intraretinal cystoid spaces (IRCS) at baseline (M0) and/or at first month of follow-up (M1). In this group, the mean time to start treatment was 29.2±13.5 days. All these patients were treated with high-dose corticosteroid; six patients (75%) received additional early azathioprine until the second month of follow-up. In the group with cystoid spaces, the mean visual acuity (VA) at M0 was 1.70±0.5logMAR and at M1 was 0.55±0.65logMAR. With 1 year of follow-up, VA was 0.07±0.2logMAR. We observed significant variation in the mean optical density among the IRCS and the serous retinal detachment (p=0.008) (Figures).

Conclusão

Even though cystoids spaces have been described in early SD-OCT literature in acute VKHD, detailed and better definition of SD-OCT findings relocated previous findings as serous retinal detachment or more recently as bacillary detachment. Intraretinal cystoid spaces, affecting inner and/or external nuclear layers, as described here, have not been reported till far. We hypothesize that our findings may be due to the action of inflammatory mediators, but studies are needed to understand its relevance since all patients had good VA during the follow-up.