Depigmented atrophic lesions in sunset glow fundi of Vogt-Koyanagi-Harada disease

PURPOSE: Although the depigmented, small, round to oval lesions seen in the sunset glow fundi of Vogt-Koyanagi-Harada disease are considered to represent Dalen-Fuchs nodules, there is no histopathologic evidence to support such a consideration. An attempt is made herein to clarify the nature of the atrophic lesions and distinguish them from Dalen-Fuchs nodules seen in eyes with Vogt-Koyanagi-Harada disease. METHODS: Eyes from bye individuals with clinical diagnoses of Vogt Koyanagi-Harada disease were subjected to histopathologic examination. The retinal pigment epithelial changes from early active to convalescent and late chronic recurrent stages were evaluated, Particular attention was paid to Dalen Fuchs nodules, depigmented lesions in the sunset glow fundi, and hyperpigmentation of the chronic recurrent stage. RESULTS: Eyes of two individuals, one in the active stage of Vogt-Koyanagi-Harada disease and the other in the convalescent stage, showed the presence of Dalen-Fuchs nodules, The depigmented small retinal pigment epithelial lesions were seen in two individuals, both of whom exhibited the sunset glow fundus of the convalescent stage, The retinal pigment epithelial lesions repre- sented damage or disappearance of retinal pigment epithelial cells, and the sunset glow fundus appearance was from the loss of choroidal melanocytes. The heavy pigmentation seen in fundi with the chronic recurrent stage was the result of the proliferation of retinal pigment epithelial cells. CONCLUSION: The Dalen-Fuchs nodule is a specific histologic change observed at the level of retinal pigment epithelium in patients with Vogt Koyanagi-Harada disease. There is no histologic confirmation that the depigmented small atrophic lesions seen in the sunset glow fundi of Vogt-Koyanagi-Harada disease are Dalen-Fuchs nodules. The depigmented lesions represent localized damage or disappearance of retinal pigment epithelial cells. (C) 2001 by Elsevier Science Inc. All rights reserved.).