Abstract
Objectives
To investigate the association of optic nerve head (ONH) swelling in the acute uveitic phase of Vogt-Koyanagi-Harada (VKH) disease with blood flow velocity in the choroid and ONH and oxygen saturation and diameter of retinal vessels.
Methods
In this prospective study, 25 patients (50 eyes) were studied. Thirteen patients (26 eyes) had ONH swelling and 12 patients (24 eyes) had no ONH swelling. Laser speckle flowgraphy (LSFG) and retinal oximetry measurements were performed at presentation.
Results
In the ONH, mean blur rate (MBR)-vessel, representing blood flow velocity in retinal vessels, was significantly lower in the eyes affected by ONH swelling, while choroidal MBR was not significantly different. Eyes with ONH swelling had a significantly lower oxygen saturation in retinal venules, a significantly higher arteriovenous oxygen saturation difference and a significantly smaller calibre of retinal arterioles compared with eyes without ONH swelling. There were significant positive correlations between the MBR-vessel of the ONH and venular oxygen saturation and calibre of retinal arterioles. In addition, MBR-vessel of the ONH had a significant negative correlation with arteriovenous oxygen saturation difference.
Conclusions
The occurrence of ONH swelling in the acute uveitic phase of VKH disease is associated with lower retinal blood flow velocity and smaller calibre of retinal arterioles as well as lower oxygen saturation in retinal venules and higher arteriovenous difference in oxygen saturation.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
Data availability
Data are available from authors upon request.
References
Gocho K, Kondo I, Yamaki K. Identification of autoreactive T cells in Vogt-Koyanagi-Harada disease. Invest Ophthalmol Vis Sci. 2020;42:2004–9.
Yamaki K, Gocho K, Hayakawa K, Kondo I, Sakuragi S. Tyrosinase family proteins are antigens specific to Vogt-Koyanagi-Harada disease. J Immunol. 2000;165:7323–9.
Yamaki K, Kondo I, Nakamura H, Miyano M, Konno S, Sakuragi S. Ocular and extraocular inflammation induced by immunization of tyrosinase related protein 1 and 2 in Lewis rats. Exp Eye Res. 2000;71:361–9.
Nakao K, Abematsu N, Mizushima Y, Sakamoto T. Optic disc swelling in Vogt-Koyanagi-Harada disease. Invest Ophthalmol Vis Sci. 2012;53:1917–22.
Okunuki Y, Tsubota K, Kezuka T, Goto H. Differences in the clinical features of two types of Vogt-Koyanagi-Harada disease: serous retinal detachment and optic disc swelling. Jpn J Ophthalmol. 2015;59:103–8.
Abu El-Asrar AM, Alsarhani W, Alzubaidi A, Gikandi PW. Effect of immunosuppressive therapy on ocular blood flow in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada disease. Acta Ophthalmol. 2021;99:e1405–14.
Hirooka K, Saito W, Namba K, Takemoto Y, Mizuuchi K, Uno T, et al. Relationship between choroidal blood flow velocity and choroidal thickness during systemic corticosteroid therapy for Vogt-Koyanagi-Harada disease. Graefes Arch Clin Exp Ophthalmol. 2015;253:609–17.
Hirose S, Saito W, Yoshida K, Saito M, Dong Z, Namba K, et al. Elevated choroidal blood flow velocity during systemic corticosteroid therapy in Vogt-Koyanagi-Harada disease. Acta Ophthalmol. 2008;86:902–7.
Sugiyama T, Araie M, Riva CE, Schmetterer L, Orgul S. Use of laser speckle flowgraphy in ocular blood flow research. Acta Ophthalmol. 2010;88:723–9.
Takahashi H, Sugiyama T, Tokushige H, Maeno T, Nakazawa T, Ikeda T, et al. Comparison of CCD-equipped laser speckle flowgraphy with hydrogen gas clearance method in the measurement of optic nerve head microcirculation in rabbits. Exp Eye Res. 2013;108:10–5.
Wang L, Cull GA, Piper C, Burgoyne CF, Fortune B. Anterior and posterior optic nerve head blood flow in nonhuman primate experimental glaucoma model measured by laser speckle imaging technique and microsphere method. Investig Ophthalmol Vis Sci. 2012;53:8303–9.
Geirsdottir A, Palsson O, Hardarson SH, Olafsdottir OB, Kristjansdottir JV, Stefansson E. Retinal vessel oxygen saturation in healthy individuals. Investig Ophthalmol Vis Sci. 2012;53:5433–42.
Palsson O, Geirsdottir A, Hardarson SH, Olafsdottir OB, Kristjansdottir JV, Stefansson E. Retinal oximetry images must be standardized: a methodological analysis. Investig Ophthalmol Vis Sci. 2012;53:1729–33.
Abu El-Asrar AM, AlBloushi AF, Gikandi PW, Hardarson SH, Stefansson E. Retinal vessel oxygen saturation is affected in uveitis associated with Vogt-Koyanagi-Harada disease. Br J Ophthalmol. 2019;103:1695–9.
Abu El-Asrar AM, Alotaibi MD, Gikandi PW, Stefansson E. Effect of immunosuppressive therapy on oxygen saturation and diameter of retinal vessels in initial onset acute uveitis associated with Vogt-Koyanagi-Harada disease. Acta Ophthalmol. 2021;99:75–82.
Aizawa N, Nitta F, Kunikata H, Sugiyama T, Ikeda T, Araie M, et al. Laser speckle and hydrogen gas clearance measurements of optic nerve circulation in albino and pigmented rabbits with or without optic disc atrophy. Investig Ophthalmol Vis Sci. 2014;55:7991–6.
Iwase T, Kobayashi M, Yamamoto K, Yanagida K, Ra E, Terasaki H. Changes in blood flow on optic nerve head after vitrectomy for rhegmatogenous retinal detachment. Investig Ophthalmol Vis Sci. 2016;57:6223–33.
Mendivil A, Cuartero V. Color Doppler image of central retinal artery of eyes with an intraconal mass. Curr Eye Res. 1999;18:104–9.
Mittra RA, Sergott RC, Flaharty PM, Lieb WE, Savino PJ, Bosley TM, et al. Optic nerve decompression improves hemodynamic parameters in papilledema. Ophthalmology. 1993;100:987–97.
Garhofer G, Zawinka C, Resch H, Huemer KH, Dorner GT, Schmetterer L. Diffuse luminance flicker increases blood flow in major retinal arteries and veins. Vis Res. 2004;44:833–8.
Hammer M, Vilser W, Riemer T, Liemt F, Jentsch S, Dawczynski J, et al. Retinal venous oxygen saturation increases by flicker light stimulation. Investig Ophthalmol Vis Sci. 2011;52:274–7.
Fondi K, Wozniak PA, Howorka K, Bata AM, Aschinger GC, Popa-Cherecheanu A, et al. Retinal oxygen extraction in individuals with type 1 diabetes with no or mild diabetic retinopathy. Diabetologia. 2017;60:1534–40.
Hardarson SH, Stefansson E. Retinal oxygen saturation is altered in diabetic retinopathy. Br J Ophthalmol. 2012;96:560–3.
Stefansson E, Olafsdottir OB, Einarsdottir AB, Eliasdottir TS, Eysteinsson T, Vehmeijer W, et al. Retinal Oximetry discovers novel biomarkers in retinal and brain diseases. Invest Ophthalmol Vis Sci. 2017;58:BIO227–33.
Eliasdottir TS, Bragason D, Hardarson SH, Kristjansdottir G, Stefansson E. Venous oxygen saturation is reduced and variable in central retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol. 2015;253:1653–61.
Hardarson SH, Stefansson E. Oxygen saturation in central retinal vein occlusion. Am J Ophthalmol. 2010;150:871–5.
Gilmore ED, Hudson C, Preiss D, Fisher J. Retinal arteriolar diameter, blood velocity, and blood flow response to an isocapnic hyperoxic provocation. Am J Physiol Heart Circ Physiol. 2005;288:H2912–7.
Maekubo T, Chuman H, Nao IN. Laser speckle flowgraphy for differentiating between nonarteritic ischemic optic neuropathy and anterior optic neuritis. Jpn J Ophthalmol. 2013;57:385–90.
Acknowledgements
The authors thank Ms. Crisalis Longanilla-Bautista for secretarial assistance.
Funding
This work was supported by King Saud University through Vice Deanship of Research Chair, Dr. Nasser Al Rashid Research Chair in Ophthalmology (AMA).
Author information
Authors and Affiliations
Contributions
AMA was responsible for conceptualisation, designing of methodology, validation of outputs, investigation, providing resources, data curation, writing, review and editing, supervision, project administration and funding. ES was responsible for conceptualisation, designing of methodology, review and editing. AFB was responsible for conceptualisation, designing of methodology, investigation, and data curation. PWG was responsible for designing of methodology, statistical analysis, investigation, data curation and review and editing. AA was responsible for designing of methodology, investigation and review and editing.
Corresponding author
Ethics declarations
Competing interests
AMA, None; AFA, None; PWG, None; AA, None; ES, Oxymap ehf. (I, S). has financial interests in the retinal oximeter used in the study.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Abu El-Asrar, A.M., AlBloushi, A.F., Gikandi, P.W. et al. Acute uveitic phase of Vogt-Koyanagi-Harada disease: optic nerve head swelling, ocular blood flow and retinal oxygen metabolism. Eye 37, 1432–1438 (2023). https://doi.org/10.1038/s41433-022-02141-z
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41433-022-02141-z
