Objective To evaluate the value of fundus autofluorescence (FAF) imaging combined with spectral domain optical coherence tomography (SD-OCT) in diagnosis, prognostic assessment and follow-up observation of acute Vogt-Koyanagi-Harada (VKH) disease. Methods Clinical data were collected from 12 patients (23 eyes) with acute VKH disease treated in our hospital from May, 2018 to November, 2019, including detailed medical history, best corrected visual acuity (BCVA), and results of slit lamp biomicroscopy, fundus photography, SD-OCT, fundus fluorescein angiography (FFA) and FAF imaging. SD-OCT and FAF imaging were repeated after a course of treatment and in follow-up examination, and the results were compared with those at the time of admission. Results VKH disease involved both eyes in 11 patients (91.7% ). Fundus photography showed optic disc edema in 16 eyes (69.6%), and multiple retinal neuroepithelial detachment was detected by SD-OCT in all the involved eyes (100%). IN all the eyes, FFA revealed small and dense fluorescein leakage in the early stage and fluorescein accumulation in advanced stages of VHK disease to form multiple dye pooling in the areas of serous detachment. Hyperauto flfl uorescence was a common finding in FAF imaging (100% ), and the area involved was consistent with that of fluorescein accumulation shown by FAF imaging. Ten eyes (43.5% ) showed patches of relative hypoauto flfl uorescence in the hyperauto flfl uorescence areas, and granular hyperauto flfl uorescence was found in the lesions in 4 eyes (17.4% ). During the remission period of VKH disease, FAF imaging showed normal finding in 8 eyes (34.8%) and reduced areas (by 55.2%) and intensity (by 46.5% ) of hyperautoflfluorescence in 9 eyes (39.1% ). In 6 eyes (26.1% ), only a few hyperautoflfluorescent spots scattered in the macula were observed. SD-OCT demonstrated significantly reduced (by 69.5% on average) or even disappearance of subretinal fluid in the eyes. The fluorescence intensity in FAF imaging showed a significant positive correlation with the volume of subretinal fluid detected by SD-OCT (r=0.626, P<0.05). Conclusion The combination of fluorescein angiography, FAF imaging and SD-OCT can significantly improve the diagnostic accuracy of VKH disease. FAF imaging combined with SD-OCT provides an effective and noninvasive modality for evaluation of remission and monitoring the changes in VKH disease.

Vogt-Koyanagi-Harada disease, optical coherence tomography, fundus autofluorescence imaging