Clinical observation of bacillary layer detachment in acute Vogt-Koyanagi-Harada disease_Chinese Journal of Ocular Fundus Diseases

Authors：

Lu Jingfang ,  Li Juanjuan

Department of Ophthalmology, Yunnan University Affiliated Hospital, Key Laboratory of Eye Disease, Researchof Yunnan Province, Yunnan Eye Hospital, Kunming 650021, China;

Corresponding?author：

Li Juanjuan, Email: ljj800502@163.com

Keywords：

Bacillay layer detachment; Vogt-Koyanagi-Harada; Optical coherence tomography

DOI：

10.3760/cma.j.cn511434-20250210-00050

Video：

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Objective To investigate the imaging characteristics and clinical significance of rod-cone detachment (BALAD) in patients with acute VKH. Methods A 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. Results Among 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 irregular bulge 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. Conclusions BALAD 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.

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2.	Cicinelli MV, Giuffré C, Marchese A, et al. The bacillary detachment in posterior segment ocular diseases[J]. Ophthalmol Retina, 2020, 4: 454-456. DOI: 10.1016/j.oret.2019.12.003.
3.	Agarwal A, Freund KB, Kumar A, et al. Bacillary layer detachment in acute Vogt-Koyanagi-Harada disease: a novel swept-source optical coherence tomography analysis[J]. Retina, 2021, 41(4): 774-783. DOI: 10.1097/IAE.0000000000002914.
4.	中華醫學會眼科學分會眼免疫學組, 中國醫師協會眼科醫師分會葡萄膜炎與免疫學組. 中國福格特-小柳-原田綜合征臨床診療專家共識(2023年)[J]. 中華眼科雜志, 2023, 59(7): 518-525. DOI: 10.3760/cma.j.cn112142-20230313-00098.Ophthalmology Immunology Group of the Ophthalmology Branch of the Chinese Medical Association, Uveitis and Immunology Group of the Ophthalmology Branch of the Chinese Medical Doctor Association. Chinese expert consensus on the clinical diagnosis and treatment of Vogt-Koyanagi-Harada syndrome (2023)[J]. Chin J Ophthalmol, 2023, 59(7): 518-525. DOI: 10.3760/cma.j.cn112142-20230313-00098.
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7.	Spaide RF, Curcio CA. Anatomical correlates to the bandsseen in the outer retina by optical coherence tomography: literature review and model[J]. Retina, 2011, 31(8): 1609-1619. DOI: 10.1097/IAE.0b013e3182247535.
8.	Mehta N, Chong J, Tsui E, et al. Presumed foveal bacillary layer detachment in a patient with toxoplasmosis chorioretinitis and pachychoroid disease[J]. Retin Cases Brief Rep, 2021, 15(4): 391-398. DOI: 10.1097/ICB.0000000000000817.
9.	Hoang QV, Linsenmeier RA, Chung CK, et al. Photoreceptor inner segments in monkey and human retina: mitochondrial density, optics, and regional variation[J]. Vis Neurosci, 2002, 19(4): 395-407. DOI: 10.1017/s0952523802194028.
10.	Ramtohul P, Denis D, Gascon P. Bacillary layer detachment in acute posterior multifocal placoid pigment epitheliopathy: a multimodal imaging analysis[J/OL]. Retina, 2021, 41(2): e12-e14[2021-02-01]. https://pubmed.ncbi.nlm.nih.gov/33141789/. DOI: 10.1097/IAE.0000000000003014.
11.	Lujan BJ. Spectral domain optical coherence tomography imaging of punctate outer retinal toxoplasmosis[J]. Saudi J Ophthalmol, 2014, 28(2): 152-156. DOI: 10.1016/j.sjopt.2014.03.010.
12.	Socci da Costa D, Gomes E Silva A, Melichar A, et al. Bacillary layer detachment in serpiginous-like choroiditis of presumed intraocular tuberculosis: report of two cases[J/OL]. Am J Ophthalmol Case Rep, 2022, 27: 101653[2022-07-07]. https://pubmed.ncbi.nlm.nih.gov/35845750/. DOI: 10.1016/j.ajoc.2022.101653.
13.	Shenoy P, Kohli GM, Bhatia P, et al. Bacillary layer detachment in a case of sympathetic ophthalmia: presentation and pattern of resolution on swept source optical coherence tomography[J]. Indian J Ophthalmol, 2021, 4: 662-665. DOI: 10.4103/ijo.IJO_75_21.
14.	Cox JT, Wu F, Rossin EJ, et al. Bacillary layer detachment associated with endogenous fungal endophthalmitis[J]. J Vitreoretin Dis, 2022, 6(4): 316-319. DOI: 10.1177/24741264221101224.
15.	Fouad YA, Salman AG, Ashour DM, et al. Bacillary layer detachment with malignant choroidal tumors: a case series[J/OL]. BMC Ophthalmol, 2023, 23(1): 142[2023-04-06]. https://pubmed.ncbi.nlm.nih.gov/37024887/. DOI: 10.1186/s12886-023-02892-7.
16.	Ramtohul P, Malclès A, Gigon E, et al. Long-term outcomes of bacillary layer detachment in neovascular age-related macular degeneration[J]. Ophthalmol Retina, 2022, 6(3): 185-195. DOI: 10.1016/j.oret.2021.09.010.
17.	Tekin K, Teke MY. Bacillary layer detachment: a novel optical coherence tomography nding as part of blunt eye trauma[J]. Clin Exp Optom, 2019, 102(3): 343-344. DOI: 10.1111/cxo.12876.
18.	Lin D, Chen W, Zhang G, et al. Comparison of the optical coherence tomographic characters between acute Vogt-Koyanagi-Harada disease and acute central serous chorioretinopathy[J/OL]. BMC Ophthalmol, 2014, 14: 87[2014-06-28]. https://pubmed.ncbi.nlm.nih.gov/24974016/. DOI: 10.1186/1471-2415-14-87.

1. Mehta N, Chong J, Tsui E, et al. Presumed foveal bacillary layer detachment in a patient with toxoplasmosis chorioretinitis and pachychoroid disease[J]. Retin Cases Brief Rep, 2021, 15(4): 391-398. DOI: 10.1097/ICB.0000000000000817.
2. Cicinelli MV, Giuffré C, Marchese A, et al. The bacillary detachment in posterior segment ocular diseases[J]. Ophthalmol Retina, 2020, 4: 454-456. DOI: 10.1016/j.oret.2019.12.003.
3. Agarwal A, Freund KB, Kumar A, et al. Bacillary layer detachment in acute Vogt-Koyanagi-Harada disease: a novel swept-source optical coherence tomography analysis[J]. Retina, 2021, 41(4): 774-783. DOI: 10.1097/IAE.0000000000002914.
4. 中華醫學會眼科學分會眼免疫學組, 中國醫師協會眼科醫師分會葡萄膜炎與免疫學組. 中國福格特-小柳-原田綜合征臨床診療專家共識(2023年)[J]. 中華眼科雜志, 2023, 59(7): 518-525. DOI: 10.3760/cma.j.cn112142-20230313-00098.Ophthalmology Immunology Group of the Ophthalmology Branch of the Chinese Medical Association, Uveitis and Immunology Group of the Ophthalmology Branch of the Chinese Medical Doctor Association. Chinese expert consensus on the clinical diagnosis and treatment of Vogt-Koyanagi-Harada syndrome (2023)[J]. Chin J Ophthalmol, 2023, 59(7): 518-525. DOI: 10.3760/cma.j.cn112142-20230313-00098.
5. Polyak SL. The retina: the anatomy and the histology of the retina in man, ape, and monkey, including the consideration of visual functions, the history of physiological optics, and the histological laboratory technique[M]. Chicago, IL: Universiity of Chicago Press, 1941.
6. Ramtohul P, Comet A, Denis D. Bacillary layer detachment in peripapillary pachychoroid syndrome[J/OL]. Ophthalmol Retina, 2020, 4(6): 587[2020-06-01]. https://pubmed.ncbi.nlm.nih.gov/32507275/. DOI: 10.1016/j.oret.2020.01.017.
7. Spaide RF, Curcio CA. Anatomical correlates to the bandsseen in the outer retina by optical coherence tomography: literature review and model[J]. Retina, 2011, 31(8): 1609-1619. DOI: 10.1097/IAE.0b013e3182247535.
8. Mehta N, Chong J, Tsui E, et al. Presumed foveal bacillary layer detachment in a patient with toxoplasmosis chorioretinitis and pachychoroid disease[J]. Retin Cases Brief Rep, 2021, 15(4): 391-398. DOI: 10.1097/ICB.0000000000000817.
9. Hoang QV, Linsenmeier RA, Chung CK, et al. Photoreceptor inner segments in monkey and human retina: mitochondrial density, optics, and regional variation[J]. Vis Neurosci, 2002, 19(4): 395-407. DOI: 10.1017/s0952523802194028.
10. Ramtohul P, Denis D, Gascon P. Bacillary layer detachment in acute posterior multifocal placoid pigment epitheliopathy: a multimodal imaging analysis[J/OL]. Retina, 2021, 41(2): e12-e14[2021-02-01]. https://pubmed.ncbi.nlm.nih.gov/33141789/. DOI: 10.1097/IAE.0000000000003014.
11. Lujan BJ. Spectral domain optical coherence tomography imaging of punctate outer retinal toxoplasmosis[J]. Saudi J Ophthalmol, 2014, 28(2): 152-156. DOI: 10.1016/j.sjopt.2014.03.010.
12. Socci da Costa D, Gomes E Silva A, Melichar A, et al. Bacillary layer detachment in serpiginous-like choroiditis of presumed intraocular tuberculosis: report of two cases[J/OL]. Am J Ophthalmol Case Rep, 2022, 27: 101653[2022-07-07]. https://pubmed.ncbi.nlm.nih.gov/35845750/. DOI: 10.1016/j.ajoc.2022.101653.
13. Shenoy P, Kohli GM, Bhatia P, et al. Bacillary layer detachment in a case of sympathetic ophthalmia: presentation and pattern of resolution on swept source optical coherence tomography[J]. Indian J Ophthalmol, 2021, 4: 662-665. DOI: 10.4103/ijo.IJO_75_21.
14. Cox JT, Wu F, Rossin EJ, et al. Bacillary layer detachment associated with endogenous fungal endophthalmitis[J]. J Vitreoretin Dis, 2022, 6(4): 316-319. DOI: 10.1177/24741264221101224.
15. Fouad YA, Salman AG, Ashour DM, et al. Bacillary layer detachment with malignant choroidal tumors: a case series[J/OL]. BMC Ophthalmol, 2023, 23(1): 142[2023-04-06]. https://pubmed.ncbi.nlm.nih.gov/37024887/. DOI: 10.1186/s12886-023-02892-7.
16. Ramtohul P, Malclès A, Gigon E, et al. Long-term outcomes of bacillary layer detachment in neovascular age-related macular degeneration[J]. Ophthalmol Retina, 2022, 6(3): 185-195. DOI: 10.1016/j.oret.2021.09.010.
17. Tekin K, Teke MY. Bacillary layer detachment: a novel optical coherence tomography nding as part of blunt eye trauma[J]. Clin Exp Optom, 2019, 102(3): 343-344. DOI: 10.1111/cxo.12876.
18. Lin D, Chen W, Zhang G, et al. Comparison of the optical coherence tomographic characters between acute Vogt-Koyanagi-Harada disease and acute central serous chorioretinopathy[J/OL]. BMC Ophthalmol, 2014, 14: 87[2014-06-28]. https://pubmed.ncbi.nlm.nih.gov/24974016/. DOI: 10.1186/1471-2415-14-87.

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Latest ArticlesClinical observation of bacillary layer detachment in acute Vogt-Koyanagi-Harada disease

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