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Evaluation of Melanin Changes in Acute Vogt–Koyanagi–Harada Disease Using Polarization-Sensitive Optical Coherence Tomography

Year: 2026

Type: article

Abstract: Purpose: To examine melanin changes in the RPE and choroid during the acute phase of Vogt-Koyanagi-Harada (VKH) disease using polarization-sensitive optical coherence tomography (PS-OCT). Methods: This study included 15 eyes of 8 patients with new-onset VKH disease and 5 eyes of 3 patients with posterior scleritis. PS-OCT captured a 12 × 12 mm area centered on the fovea, and en face images were created for the RPE and choroid. Polarimetric entropy within a 6-mm diameter circle centered on the fovea was calculated and compared between groups. Results: Choroidal polarimetric entropy was significantly lower in eyes with VKH disease than in those with posterior scleritis at baseline (0.296 ± 0.047 vs. 0.392 ± 0.050; P = 0.005; r = 0.64; 95% confidence interval, 0.42-0.74). One month after starting treatment, eyes with VKH disease showed a significant increase in choroidal polarimetric entropy (0.296 ± 0.047 to 0.350 ± 0.075; P = 0.001; r = 0.85; 95% confidence interval, 0.61-0.95), whereas no significant change was observed in eyes with posterior scleritis. RPE polarimetric entropy showed no significant changes between baseline and 1 month, with no differences between groups. Conclusions: PS-OCT revealed that choroidal melanin density decreased during the acute phase of VKH disease and significantly increased after treatment. PS-OCT provides a noninvasive method for observing melanin dynamics in VKH disease and aids in differentiating it from posterior scleritis. PS-OCT could offer valuable insights into the pathology of VKH disease and its potential implications for management.

Source: Investigative Ophthalmology & Visual Science

DOI: 10.1167/iovs.67.1.7