Bacillary layer detachment in acute Vogt-Koyanagi-Harada disease: an early predictor of long-term complications in a Brazilian cohort.

Background: Long-term complications occur in some patients with Vogt-Koyanagi-Harada disease (VKHD).This study aimed to evaluate the presence of bacillary layer detachment (BALAD) at presentation as an early predictor of long-term structural and functional outcomes in a Brazilian cohort of patients with VKHD.

Methods: Retrospective, clinic-based cohort study in Sao Paulo, Brazil, including 33 patients (66 eyes) with acute VKHD systematically followed for 12 months, since presentation. Clinical and multimodal data collected on spectral domain optical coherence tomography (SD-OCT) were analyzed at baseline and months (M) 1, 3, 6, 9 and 12. Correlations between OCT-based structural findings and the occurrence of subretinal fibrosis (SRFib), sunset glow fundus (SGF), and nummular chorioretinal lesions (NCL) at month 12 were studied. Outcomes were presence of retinal changes on SD-OCT during the study period; risk factors for SRFib, SGF and NCL at month 12. Univariate, bivariate, and multivariate analyses were employed.

Results: At baseline, serous retinal detachments (SRD) were observed in 96.4% and BALAD in 48.2% of 56 eyes; at M1, SRD were observed in 42.4% and BALAD in 6.1% of 66 eyes. Subretinal fluid (SRFld) was still present in 9.1% at M3, in 4.5% at M6 and in 3.0% of eyes at M9. Using bivariate analysis, the early presence of BALAD was associated with a larger SRD area (p = 0.036) at presentation, and with the presence of both SRFib (p < 0.001) and SGF (p = 0.008) at M12. Using multivariate regression analysis, both early BALAD (OR, 12.04; p = 0.011) and a longer interval to treatment start (32 vs. 17 days; OR, 1.17; p = 0.004) were each independently associated with the formation of SRFib at M12, whereas both early BALAD (OR, 14.78; p = 0.002) and anterior uveitis recurrences (OR, 30.94; p = 0.022) were each associated with the development of SGF. The late occurrence of NCL was not associated with the presence of BALAD at presentation.

Conclusions: In acute VKHD, the presence of BALAD at presentation was associated with a markedly increased long-term risk of developing both SRFib and SGF.