Pathophysiology of the development of intraocular inflammation in VKH

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Choroiditis has recently been classified and subdivided into choriocapillaritis when the impact of inflammation is at the level of the choriocapillsris and into stromal choroiditis when the inflammation is situated in the choroidal stroma. The choroidal stroma can be the chance localization of an infectious or non-infectious systemic disease such as tuberculosis or sarcoidosis and is then termed secondary stromal choroiditis. The situation is different in Vogt-Koyanagi-Harada disease (VKH)(and birdshot retinochoroiditis) where the target of the inflammatory reaction is selectively situated in the choroidal stroma and should therefore be called primary stromal choroiditis. The choroidal inflammation develops first silently while it is still confined to the stroma. Probably this phase corresponds to the proromal stage. It is only when the inflammation spills over, usually in an explosive fashion, into neighbouring compartments such as the retina, optic disc and vitreous that the disease becomes clinically apparent.The fact that the choroidal stroma is the primum movens means that the follw-up of choroidaql inflammation by ICGA is crucial and that therapy has a good impact as long as sustained ICGA assisted therapy is applied

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