Vogt-小柳-原田病多模态影像：基于证据与共识的指南
国际葡萄膜炎与视网膜专家组成的MUV工作组通过系统文献回顾和名义群体技术形成共识，提出VKH病多模态影像应用指南。活动期VKH的诊断依据包括CFP上双侧多灶性浆液性视网膜脱离和视盘充血、OCT上多房性视网膜下液和脉络膜增厚、ICGA上圆形至椭圆形低荧光点。将CFP、OCT和ICGA纳入VKH评估可提高诊断准确性、改善活动性评估并早期发现威胁视力的并发症。
要点
- 活动期VKH典型影像：CFP双侧多灶性浆液性视网膜脱离、OCT多房性视网膜下液及脉络膜增厚、ICGA圆形至椭圆形低荧光点。
- OCT和ICGA对检测疾病活动性及亚临床/隐匿性复发敏感，FFA有助于检测多发针尖样高荧光病灶和视盘染色。
- OCT和OCTA是检测视网膜下纤维化和CNV等并发症的重要工具，FAF对诊断价值有限。
核心结论
- 将CFP、OCT和ICGA等多模态影像纳入VKH评估与分类，可提高诊断准确性、改善活动性评估并早期发现威胁视力的并发症。
研究设计与样本
- 由国际葡萄膜炎与视网膜专家组成的MUV工作组，采用系统文献回顾和名义群体技术进行共识制定。
- 专家小组独立回顾已发表文献及活动期、缓解期和晚期VKH的代表性病例，使用CFP、OCT、FAF、FFA、ICGA和OCTA等多模态影像。
- 通过结构化名义群体技术会议定义活动期和缓解期VKH的共识影像描述，以及VKH并发症（包括RPE破坏、CNV、视网膜下纤维化等）的影像特征。
关键影像表现/征象
- 活动期VKH在CFP上表现为双侧多灶性浆液性视网膜脱离和视盘充血。
- OCT上可见多房性视网膜下液和脉络膜增厚。
- ICGA上可见圆形至椭圆形低荧光点。
- FFA有助于检测多发针尖样高荧光病灶和视盘染色。
临床应用与阅片要点
- 多模态影像应作为VKH临床、神经和皮肤表现诊断系统的重要辅助手段。
- OCT和ICGA可用于检测疾病活动性及亚临床/隐匿性疾病复发。
- OCT和OCTA用于检测视网膜下纤维化和CNV等并发症。
- FAF对VKH诊断价值有限。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
PURPOSE: To develop imaging and consensus-based guidelines for the application of multimodal imaging in the diagnosis, assessment of disease activity, and detection of complications in Vogt-Koyanagi-Harada (VKH) disease.
DESIGN: Consensus agreement guided by systematic literature review and expert committee deliberation using a nominal group technique (NGT).
PARTICIPANTS: International uveitis and retina specialists participating in the Multimodal Imaging in Uveitis (MUV) taskforce.
METHODS: A panel of experts independently reviewed published literature and representative cases of active, resolved, and late-stage VKH disease, using multimodal imaging modalities: color fundus photography (CFP), OCT, fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and OCT angiography (OCTA). Structured NGT sessions were conducted to define consensus-based imaging descriptors of active and resolved VKH disease, plus VKH complications including retinal pigment epithelium disruption, choroidal neovascularization (CNV), subretinal fibrosis, and other sequelae.
MAIN OUTCOME MEASURES: Identification of reproducible multimodal imaging features of VKH and imaging criteria for determining disease activity and complications.
RESULTS: The experts agreed that active VKH diagnosis is supported by characteristic imaging findings in the early stages, including bilateral multifocal serous retinal detachments and optic disc hyperemia on CFP, multiloculated subretinal fluid and choroidal thickening on OCT, and round-to-oval hypofluorescent dots on ICGA. Multimodal imaging was considered a critical adjunct to the clinical, neurologic, and integumentary findings incorporated in existing diagnostic systems for VKH. Beyond diagnosis, these modalities are essential for assessing disease activity. Both OCT and ICGA were considered sensitive in detecting disease activity, and subclinical/occult disease reactivation. Fundus fluorescein angiography is useful for detecting multiple pinpoint hyperfluorescent lesions and optic nerve head staining. In contrast, FAF was considered of limited utility for diagnosis. OCT and OCTA were also regarded as important tools for detecting complications such as subretinal fibrosis and CNV.
CONCLUSIONS: Incorporating multimodal imaging findings, particularly CFP, OCT, and ICGA, into the evaluation and classification of VKH enhances diagnostic accuracy, improves assessment of disease activity, and enables earlier detection of vision-threatening complications. These consensus-based recommendations provide a structured framework for optimal multimodal imaging use in VKH and may inform future refinements of diagnostic criteria.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
引用
- Yang P, Xia L, Agarwal A, et al. Evidence and Consensus-Based Guidelines in Vogt-Koyanagi-Harada Disease: Multimodal Imaging in Uveitis (MUV) Taskforce Report 16. Ophthalmol Retina. 2026. PMID: 42176805. doi:10.1016/j.oret.2026.05.011
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。