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Indian J Ophthalmol
2026 Jan 07; doi: 10.4103/IJO.IJO_1812_25.
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Optical coherence tomography angiography features of inflammatory choroidal neovascularizaton in Vogt-Koyanagi-Harada disease.
Rao V, Biswas J, Rao C, Hashim M, Boro M.
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PURPOSE: To describe optical coherence tomography angiography (OCTA) features of inflammatory choroidal neovascular membrane (iCNV) in Vogt-Koyanagi-Harada (VKH) disease.
METHODS: This is a retrospective review of the medical records of patients with iCNV in VKH disease, documented on OCTA, seen by a single uveitis specialist from a tertiary care eye hospital. Each patient had a detailed medical record of the clinical features and underwent swept-source OCTA (SS-OCTA) analyzed by a retina specialist and a uveitis specialist.
RESULTS: Analysis of the 11 eyes of 8 patients who had iCNV and SS-OCTA documentation showed that peripapillary iCNV was the most common. Distinct iCNV patterns noted were filamentous, sea fan, medusa head, and pruned along with flow voids of choroidal granulomas in the active inflammatory stage of the disease. Reduction of the flow signals in iCNV, on OCTA, indicated a response to treatment.
CONCLUSION: OCTA is a valuable tool in visualization and classification of choroidal neovascularizations and their response to treatment in inflammatory conditions like VKH disease.
Figure 1. Fundus photograph of the right eye with active inflammation in VKH and peripapillary, CNV (a); sunset glow fundus with peripheral retinal pigment epithelial defects in the right eye with peripapillary iCNV extending to become sub foveal (b); OCTA 6 × 6, en face of the filamentous iCNV (c); flow void areas suggestive of granulomas (white star) in the outer retina-choriocapillaris slab, in the active inflammatory stage and hypo reflective zone around the iCNV marked with white arrows with flow signal in the iCNV (d); OCTA, en face, showing resolving iCNV with clearer hyper reflective vessels (e); decreased hypo reflective zone around the iCNV (white arrow) and decreased flow voids of the granuloma (white star) and corresponding cross-section of the iCNV with compact SHRM and reduced flow signal after intravitreal anti-VEGF (f)
Figure 2. SS-OCT cross-sectional picture of iCNV showing pitchfork sign marked in white arrow
Figure 3. OCTA en face 6 × 6 picture showing the sea fan pattern of iCNV (a), which becomes a pruned tree pattern (b) with reduction of the intraretinal fluid after treatment
Figure 4. OCT cross-sectional picture of the choroidal thickness under the iCNV before intravitreal anti-VEGF injection was 473 microns (a) and 3 years later (b) and after multiple intravitreal anti-VEGF injection and systemic immunosuppression, the sub CNV choroidal thickness was 273 microns – ‘sponge sign’ (white double arrow), the intraretinal fluid has decreased, and the SHRM is compact, although the size of the CNV has increased over this period
