Abstract
PURPOSE: To study the impact of early and late treatment on chorioretinal microvasculature in Vogt-Koyanagi-Harada (VKH) disease using optical coherence tomography angiography (OCTA). METHODS: A total of 103 patients with VKH disease were divided into early (group 1, starting treatment within 2 months after disease onset) and late (group 2, starting treatment 2 months after disease onset) treatment groups. Flow area (FA) and vessel density (VD) of the retinal superficial vascular complex (SVC) and deep vascular complex (DVC), FA of the choriocapillaris, three-dimensional choroidal vascular volume (CVV), and choroidal vascularity index (CVI) were analyzed and compared to 103 healthy individuals. The relationship between the final best-corrected visual acuity (BCVA) and the aforementioned parameters was also analyzed. RESULTS: FA of the SVC (all P < 0.05, except 0-1 mm P = 0.087), DVC (all P < 0.05), choriocapillaris (1-2.5 mm P = 0.033), and CVV (all P < 0.05) were lower in group 2 as compared to group 1. Compared to healthy controls, FA of the SVC (all P < 0.001, except 0-1 mm P = 0.104) and DVC (all P < 0.05), VD of the SVC (1-2.5 mm P = 0.001) and DVC (1-5 mm P = 0.003, 2.5-5 mm P < 0.001), FA of the choriocapillaris (all P < 0.05), and CVV (total area P = 0.049, 1-5 mm P = 0.045, 2.5-5 mm P = 0.041) were lower in group 2, while FA (all P < 0.05, except 0-1 mm P = 0.925) and VD (1-5 mm P = 0.003, 2.5-5 mm P = 0.004) of the DVC and FA of the choriocapillaris (total area P = 0.007, 0-1 mm P < 0.001, 1-2.5 mm P = 0.007) were lower in group 1. There was no significant difference concerning CVI among groups (all P > 0.05). FA of the SVC, DVC, and choriocapillaris and VD of DVC and CVI were negatively associated with the final logarithm of the minimum angle of resolution BCVA. CONCLUSIONS: Patients with VKH disease who are treated within 2 months of disease onset showed a better chorioretinal microvascular outcome as defined by OCTA compared to those treated late. TRANSLATIONAL RELEVANCE: Our study employs OCTA to design three-dimensional metrics for the retina and choroid, bridging the gap between traditional two-dimensional OCTA findings and enhanced clinical outcomes for patients with VKH disease.