Vogt-Koyanagi-Harada disease: Sunset-glow fundus is not a fatality any more

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Vogt-Koyanagi-Harada disease (VKH) is a primary stromal choroiditis, meaning that the inflammtion is exclusively originating in the uvea and particularly in the choroid. Therefore management of the disease should include indocyanine green angiography (ICGA), the only way to monitor choroidal sublinical disease after the acute disease has regressed and is no more clinically apparent. Because this subclinical disease is progressing in an occult smoldering fashion, it is not astonishing that in close to 100% of studies evolution towards sunset glow fundus (SGF) is the rule. Thanks to ICGA it is now possible to detect occultly evolving choroiditis in VKH and adapt therapy accordingly.When ICGA assisted therapy of VKH is used,evolution towards SGF can be prevented showing that this is not the normal evolution in VKH but the result of insufficiently treated VKH. The purpose of this work was to show that close monitoring of choroiditis in VKH using ICGA can modify the phenotype of VKH by preventing the development of sunset glow fundus.

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