Objective To investigate the imaging characteristics and clinical significance of rod-cone detachment (BALAD) in patients with acute VKH. 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 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. 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.
