Peripheral Vascular Leakage In Vogt-Koyanagi-Harada Syndrome As Evaluated By Ultra Wide-field Fundus Fluorescein Angiography

Objective: To discuss peripheral vascular leakage in Vogt-Koyanagi-Harada syndrome(VKH)as evaluated by ultra wide-field fundus fluorescein angiography(UWFFA).To observe the angiographic features in peripheral fundus,To measure peripheral vascular leakage in UWFFA at 7-9m in,To analysis the correlations and dif ferences among peripheral vascular leakage,best correct visual acuity(BCV A),intraocular pressure(IOP),recurrence,active period,anterior reaction,posterior leakage,circle fovea distance,circle papilla distance,peripapillary atrophy(PP A),central retinal thickness(CRT),To guide clinical progression in VKHMethods :1 To collect VKH patients in The Second Hospital of Hebei Medical University during 2014.2 to 2016.2.13 patients(26 eyes).Dem ographic and clinical data were recorded,including age,sex,onset period,general check-up,BCVA,IOP,slit lamp microscope,anterior photography,fundus photography,UWFFA,optical coherence tomography(OCT).To analyse the data at first visit,3 months after treatment,6-8m onths after treatment,with 8 months' follow-up period in all patients.2 According to the peripheral vascular leakage in UWFFA at first visit,13 patients were classified into 2 groups :2.1 peripheral vascular leakage gr oup(group M:14 eyes): UWFFA shows fluorescein diffusion,vascular staining,patchy hyperfluorescence in peripheral fundus2.2 peripheral vascular leakage absence group(group N:12 eyes)All patients were given intravitreal triamcinolone acetonide(TA)(4mg/eye),those who recur were treated with systemic corticosteroids therapy,intravenous methylprednisolone 500mg/day for 3 days as the initial dose and gradually tapered to oral prednisone(1 mg/kg of body weight/day)based on effect,until drug withdrawal when 1 pill once every other day.The treatment period was maintained for at least 6 months.Results: Of the 13 patients enrolled,7 patients(53.85%)showed peripheral vascular leakage with a mean area of 10957.00±27199.75 pixels(pixel or pixels :a unit of measurement in Heidelberg Spectralis HRA).The initial-onset acute VKH eyes with peripheral vascular leakage in UWFF A tended to exhibit recurrence,longer activity period,longer than 30 days(if taking 30 days as the boundary),anterior reaction,peripheral vascular leakage(larger area than the first)and peripapillary atrophy at 6-8 month(all above P <0.005);CRT,area of posterior leakage,BCVA and IOP at 6-8 month were not significantly different between groups(all above P?0.05);area of posterior leakage was not correlated with peripheral vascular leakage area(all above P?0.05);CRT was positively correlated with area of posterior leakage(P ? 0.05);CRT was not correlated with peripheral vascular leakage area(P?0.05);circle papilla distance tended to bigger than circle fovea distance of the same time and the two were positively correlated(P?0.05);circle fovea distance was not significantly different between the first and the 6-8 month(P?0.05),activity period of longerth an 30 days tended to exhibit anterior reaction(P?0.05),anterior reaction was not significantly different between peripheral vascular leakage and peripheral vascular leakage absence of the same time(P?0.05).Conclusions:1 UWFFA has a wider field of fundus and is more likely to explore the peripheral fundus abnormalities,compared with traditional FFA.2 Peripheral vascular leakage at in itial-onset phase of VKH have an effect on recurrence,activity period,anterior reaction,chronic persistent peripheral vascular leakage,PPA and prognosis,no effect on CRT,area of posterior leakage,BCVA and IOP at 6-8 month.3 CRT at initial-onset phase of VKH was positively correlated with area of posterior leakage,nevertheless,peripheral vascular leakage area has no effect on CRT.4 Circle papilla distance is bigger than circle fovea distance of the same time and the two were positively correlated.5 Activity period of longer than 30 days tended to exhibit anterior reaction compared with that shorter.