Vogt-Koyanagi-Harada (VKH) disease in the acute uveitic stage classically shows which finding on FFA?
- A Multiple pinpoint hyperfluorescent leakage points at RPE level with pooling in subretinal space ✓
- B Early hypofluorescence with late staining of subretinal membranes
- C Window defect hyperfluorescence at areas of RPE atrophy
- D Blocked fluorescence from overlying haemorrhage
Correct answer: A. Multiple pinpoint hyperfluorescent leakage points at RPE level with pooling in subretinal space
Explanation
In acute VKH, FFA shows multiple focal hyperfluorescent spots at the RPE level (due to disruption of the RPE–Bruch membrane–choriocapillaris complex), which then pool in the subretinal spaces producing a 'starry sky' or 'polka dot' pattern. Subretinal fluid accumulation creates exudative retinal detachments that pool dye in the late frames. This pattern, together with choroidal folds and disc oedema, is characteristic. Window defects occur in the convalescent/chronic stages when RPE atrophy develops.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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