Background/aims: To investigate the characteristics of fundus autofluorescence (FAF) in acute Vogt-Koyanagi-Harada (VKH) disease. Methods: FAF photography with blue light (BL-FAF) and near-infrared light (NIR-FAF) was performed on 10 eyes of five patients using a confocal scanning laser ophthalmoscope before and after treatment. The FAF images were followed for 6 months and retrospectively reviewed with comparisons of the other imaging modalities. Results: At presentation, four eyes of two patients who presented soon after the initial ocular symptoms showed mild and uniform hyperautofluorescence in the macula mixed with hypoautofluorescence in the areas of serous retinal detachment. After immediate treatment with an intravenous high-dose steroid, the abnormal FAF returned to normal at 6 months. The other six eyes of three patients, who presented weeks after the symptoms, initially demonstrated diffuse and mottled hyperautofluorescence over the posterior pole, mixed with hypoautofluorescence induced by serous retinal detachment in four eyes. After treatment with an intravenous high-dose steroid, all six eyes showed scattered and widespread hyperautofluorescence, which gradually became evident and concentrated in the macula, partially resulting in some hypoautofluorescent dots at 6 months. The BL-FAF and the NIR-FAF demonstrated similar FAF patterns, but more evidently in NIR-FAF. Conclusion: FAF photography non-invasively visualised sequential metabolic and functional changes in the retinal pigment epithelium (RPE) in acute VKH disease. The results suggest that early and sufficient treatment with a high-dose steroid might prevent persistent RPE damage. In addition, NIR-FAF can be an alternative method for the early detection of RPE abnormality.
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