Título

BACILLARY LAYER DETACHMENT IN VOGT-KOYANAGI-HARADA DISEASE: A BIOMARKER WITH PROGNOSTIC VALUE

Objetivo

To report the frequency of bacillary layer detachment (BLD) and associations with other findings on optical coherence tomography (OCT), visual and clinical outcomes of patients with Vogt-Koyanagi-Harada disease (VKHD).

Método

Retrospective analysis of a consecutive series of patients with VKHD followed since acute phase for at least 1-year. All patients had spectral domain OCT, fluorescein angiography (FA), indocyanine green angiography (ICGA), systematic clinical and visual function evaluation at baseline, 1st, 3rd, 6th, 9th and 12th months (M). Generalized estimating equations of binomial distribution and logit link function with interchangeable correlation between eyes and moments were carried out.

Resultado

Thirty-three patients (66 eyes) were included, with a median age of 33 years (15 to 67 years), 29 female (88%). The median duration of disease was 67 months (27 to 121 months). The median initial visual acuity (VA) was 1.8 logMAR (0 to 2.3 logMAR) and 0.2 logMAR (0 to 2 logMAR) at M1. Sunset glow fundus (SGF) was seen in 42 eyes (63%) and subnormal full-field electroretinogram (ffERG) was seen in 76% of eyes (47/62) in M12. BLD was present in 87.5% (49/56) of eyes at M0 and in 34.8% (23/66) at M1. BLD resolution time was longer compared to serous retinal detachment (SRD) with medians of 1 month (0 to 12 months) and 0 month (0 to 9 months), respectively (Figure). Significant associations were observed between BLD in M1 with: worse VA in M0 (median 1.8 vs 1 logMAR; p=0.016); worse VA (median 0.25 vs 0.05 logMAR; p=0.014), worse FA scores (9 vs 5; p=0.002) and ICGA scores (15 vs 10.5p= 0.007) in M1; severe fundus (p=0.008), SGF (p=0.006), fibrosis (p=0.005), chorioretinal atrophy (p=0.008), and subnormal ffERG (p=0.045) in M12, as well as longer EZ resolution time (median 12 vs 3 months; p=0.006 ) (Table).

Conclusão

The presence of BLD in M1 stood out as a biomarker of a worse prognosis, as evidenced by changes in fundus and visual function at 12 months.