AIM:To investigate the characteristics of fundus autofluorescence (FAF) in acute Vogt-Koyanagi-Harada (VKH) disease. METHODS: A total of 9 patients 18 eyes with acute VKH were undertaken FAF by a confocal scanning laser ophthalmoscope (Heidelberg Retina Angiograph 2, HRA2). Characteristics of FAF images were compared with fundus fluorescein angiography (FFA) images. RESULTS:Early phase of FFA showed multiple areas of hyperfluorescence at the level of the retinal pigment epithelium (RPE)and late phase of FFA revealed multiple pooling of dye in the areas of serous detachment. In FAF imaging, the serous detached retinal areas were observed as hypoautofluorescence due to the blockage. In these hypoautofluorescence areas, hyperautofluorescent ring or semiring could still been seen. The site of these hyperautofluorescent ring corresponded with the leakage point in FFA. After resolution of serous detachment, the autofluorescence distribution returned to normal, while some hyperautofluorescent dots were observed scattered in macula.CONCLUSION:FAF imaging non-invasively visualised sequential metabolism and functional changes in RPE in acute VKH disease. The value of FAF in VKH needs further research.