Vogt-Koyanagi-Harada (VKH) disease is a diffuse granulomatous panuveitis associated with melanocyte-rich tissue inflammation. The PATHOGNOMONIC early finding on fluorescein angiography in the acute uveitic phase is:

• A Disc hyperfluorescence with peripapillary choroidal folds
• B Arteriolar occlusion pattern with ischemic retina
• C Multiple areas of early pinpoint hyperfluorescence at the level of RPE with late subretinal pooling ✓
• D Macular star formation with disc edema

Explanation

In acute VKH, FA shows the characteristic pattern of multiple early hyperfluorescent dots at the RPE level (corresponding to focal choroidal inflammation damaging RPE pump function) that coalesce into areas of subretinal fluid pooling late — giving a 'tomato ketchup fundus' appearance on ophthalmoscopy with exudative retinal detachments. This pattern reflects diffuse choroidal granulomatous inflammation with secondary serous detachment. Early diagnosis and high-dose IV corticosteroids are critical to prevent the 'sunset glow fundus' atrophic changes seen in the chronic phase.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.