Objective To observe multimodality imaging features of different properties in multifocal choroiditis (MFC). Methods Twenty-eight patients (51 eyes) with MFC were enrolled in this study. There were 10 males and 18 females. The patients aged from 31 to 49 years, with the mean age of (41.5±0.8) years. There were 23 bilateral patients and 5 unilateral patients. All patients underwent best corrected visual acuity (BCVA), slit-lamp biomicroscopy, indirect ophthalmoscopy, fundus colorized photography, infrared fundus photography, fundus autofluorescence (FAF), fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) examinations. The lesions were classified as active inflammatory lesion, inactive inflammatory lesion, active choroidal neovascularization (CNV) and inactive CNV. The multimodality imaging features of different properties in MFC was observed. Results In fundus colour photography, the boundaries of active inflammatory lesions were blurry, while inactive inflammatory lesions had relatively clear boundaries. Secondary active CNV showed mild uplift and surrounding retinal edema; Secondary active CNV lesions showed mild uplift, retinal edema around the lesion; Secondary non-active CNV had no retinal exudate edema lesions, but had lesions fibrosis and varying degrees of pigmentation. Infrared fundus examination revealed that both active and inactive inflammatory lesions showed a uniform punctate or sheet-like fluorescence. The fluorescence of CNV lesions was not uniform; there was a bright ring around the strong fluorescence. FAF found that active inflammatory lesions showed weak autofluorescence (AF), surrounded by a strong fluorescence ring; inactive inflammatory lesions showed AF loss. Secondary active CNV lesions showed strong AF with a bright ring along the edge, and obscured fluorescence for co-occurred hemorrhagic edema; secondary non-active CNV lesions were strong AF, surrounded by a weak AF ring. FFA revealed that active inflammatory lesions showed weak fluorescence in the early stage, and fluorescence gradually increased in the late stage with slight leakage. Inactive inflammatory lesions showed typical transmitted fluorescence. Fluorescein leakage secondary to active CNV was significant; lesions secondary to inactive CNV showed scar staining. In OCT, the active inflammatory lesions showed moderately weak reflex signals in the protruding lesions under the retinal pigment epithelium (RPE). The inactive inflammatory lesions showed penetrable RPE defects or choroidal scar, it also showed clear RPE uplift lesions with a strong reflection signal. Secondary active CNV showed subretinal fluid retention; secondary non-active CNV showed RPE defects and choroidal scarring. Conclusions Active inflammatory lesions in MFC have blurred boundary, retinal edema and fluorescein leakage in FFA; inactive inflammatory lesions have clear boundary and typical transmitted fluorescence in FFA, and no retinal edema. Secondary active CNV showed subretinal fluid in OCT; and secondary non-active CNV showed RPE defects and choroidal scarring.
Objective To investigate the imaging characteristics and clinical significance of bacillary layer detachment (BALAD) in patients with acute Vogt-Koyanagi-Harada (VKH) syndrome. MethodsA retrospective clinical study. A total of 125 patients (250 eyes) with acute VKH syndrome diagnosed by multimodal imaging in Department of Ophthalmology of Yunnan University Affiliated Hospital from January 2018 to December 2024 were included in this study. All affected eyes underwent fundus color photography, fluorescein fundus angiography (FFA), and optical coherence tomography (OCT) examinations. According to the OCT examination results, the affected eyes were divided into the BALAD combined group and the non-BALAD combined group. All patients received systemic oral prednisone acetate treatment. The multimodal imaging features of BALAD was observed and the clinical prognostic indicators of the two groups were compared at 6 months after treatment. The χ2 test was used for comparison between groups. ResultsAmong the 250 eyes, 168 eyes (67.2%) were in the combined BALAD group and 82 eyes (32.8%) were in the non-combined BALAD group. Fundus color photography examination showed BALAD as a circular or approximately circular at the posterior pole. FFA examination showed weak fluorescence in the early stage of the lesion area, and fluorescein leakage occured in the late stage, but its fluorescence intensity was slightly weaker than that of the surrounding leakage area. OCT examination showed that BALAD presents a typical cyst-like space within the retina, with a continuous epiretinal membrane covering the top and a thickened ellipsoidal zone (EZ) at the bottom. Moreover, the EZ in this area remains continuous with those outside the BALAD region. The retinal pigment epithelial layer showed wavy changes. According to the morphology and density of the exudate in the cyst cavity, it can be classified into mild and micro-exudate type (a small amount of punctate strong reflex, 42 eyes), dense exudate type (relatively dense punctate exudate, 114 eyes), and fibrous exudate type (flocculent or cord-like exudate, 12 eyes). Six months after treatment, the EZ defect rate and the recurrence rate of VKH syndrome in the BALAD combined group were significantly higher than those in the non-BALAD combined group (χ2 =0.547, 5.768; P ＜0.05). In terms of prognosis, 42 eyes with mild and micro exudation responded well to the treatment. Among the 114 eyes with dense exudation, 70 eyes responded well. The treatment response was poor in 12 eyes with fibrous exudation type, among which 6 eyes eventually formed fibrous scars. ConclusionsBALAD is a common OCT image in patients with acute VKH, with a more typical fundus manifestation. The occurrence of BALAD is correlated with damage to the EZ band and recurrence of VKH.