J Korean Ophthalmol Soc.  2009 Jan;50(1):160-166. 10.3341/jkos.2009.50.1.160.

Three Cases of Atypical Harada's Disease

• Yang JW
• Oh TH
• Park YH

• KMID: 2211912
• DOI: http://doi.org/10.3341/jkos.2009.50.1.160

Abstract

PURPOSE
We present three cases of atypical Harada's disease that exhibited different clinical courses.
CASE SUMMARY
(Case 1) A 56-year-old male initially presented with typical findings of Harada's disease accompanied by exudative retinal detachment of the left eye. However, he did not show any signs and symptoms of Harada's disease in his right eye for 4 years. (Case 2) A 73-year-old male came to our clinic complaining of decreased visual acuity in both eyes with headache and tinnitus. Fundoscopic findings showed bilateral annular choroidal detachment but no evidence of exudative retinal detachment. The same result was obtained on remission. (Case 3) A 53-year-old female presented with decreased visual acuity in both eyes with headache and tinnitus. Fundoscopic findings showed severe choroidal folds instead of exudative retinal detachment, which was observed in 2 other remissive cases.
CONCLUSIONS
We report 3 cases of atypical Harada's disease that did not present with bilateral exudative retinal detachment. Ophthalmologists should know that Harada's disease can exhibit diverse clinical courses.

Keyword

Atypical Harada's disease; Choroidal detachment; Chorioretinal fold; Unilateral

MeSH Terms

Aged
Choroid
Eye
Female
Headache
Humans
Male
Middle Aged
Porphyrins
Retinal Detachment
Tinnitus
Visual Acuity
Porphyrins

Figure

• 

  Figure 1. (Case 1) (A), (C) Fundus photograph and fluorescein angiograph of the right eye show normal findings. (B) Fundus photograph of the left eye shows multifocal sensory retinal detachment and disc congestion. (D) Fluorescein angiograph of the left eye shows multiple hyperfluorescent spots and dye pooling. Disc staining was also shown.

• 

  Figure 2. (Case 2) (A) Fundus photograph and B-scan show smooth-elevated choroidal detachment. (B) Fluorescein angiographs show multiple pinpoint hyperfluorescent spots at early stage, and diffuse subretinal dye pooling and disc staining at late stage in both eyes.

• 

  Figure 3. (Case 3) (A) Fundus photographs show chorioretinal folds and disc swelling in both eyes. (B) Fluorescein angiographs show multiple pinpoint hyperfluorescent spots and disc staining. Hypofluorescent lines in the macula were also shown.

Reference

References

1. Read RW, Rechodouni A, Butani N. . Complications and prognostic factors in Vogt-Koyanagi-Harada disease. Am J Ophthalmol. 2001; 131:599–606.

2. Mondkar SV, Biswas J, Ganesh SK. Analysis of 87 cases with Vogt-Koyanagi-Harada disease. Jpn J Ophthalmol. 2000; 44:296–301.

3. Read RW, Holland GN, Rao NA. . Revised diagnostic criteria for Vogt-Koyanagi-Harada disease: report of an international committee on nomenclature. Am J Ophthalmol. 2001; 131:647–52.

4. Rao PK, Rao NA. Vogt-Koyanagi-Harada disease. Ryan SJ, Retina , editors. 4th. St, Louis: Mosby;2006. v. 2. chap. 107.

5. Oh J, Oh IK, Huh K. Atypical Vogt-Koyanagi-Harada syndrome in a 7-year-old boy. J Korean Ophthalmol Soc. 2003; 44:2184–90.

6. Kouda N, Sasaki H, Harada S. . Early manifestation of Vogt-Koyanagi-Harada disease as unilateral posterior scleritis. Jpn J Ophthalmol. 2002; 46:590–3.

7. Forster DJ, Green RL, Rao NA. Unilateral manifestation of the Vogt-Koyanagi-Harada syndrome in a 7-year-old child. Am J Ophthalmol. 1991; 111:380–2.

8. Oshima Y, Harino S, Hara Y, Tano Y. Indocyanin green angiographic findings in Vogt-Koyanagi-Harada disease. Am J Ophthalmol. 1996; 122:58–66.

9. Lee WK, Boo HD, Kim HK. The intrachoroidal changes in Harada’s disease. J Korean Ophthalmol Soc. 1999; 40:1242–52.

10. Maruyama Y, Kimura Y, Kishi S, Shimizu K. Serous detachment of the ciliary body in Harada disease. Am J Ophthalmol. 1998; 125:666–72.

11. Kishi A, Naoi N, Sawada A. Ultrasound biomicroscopic findings of acute angle-closure glaucoma in Vogt-Koyanagi- Harada syndrome. Am J Ophthalmol. 1996; 122:735–7.

12. Yoshioka K, Onoe S. A case of Harada’s disease with choroidal detachment. Jpn Rev Clin Ophthalmol. 1995; 89:1400–3.

13. Ishihara A, Totsuka S. A case of Harada’s disease with shallow anterior chamber and choroidal detachment. Folia Ophthalmol Jpn. 1985; 36:1281–5.

14. Yamamoto N, Naito K. Annular choroidal detachment in a patient with Vogt-Koyanagi-Harada disease. Graefes Arch Clin Exp Ophthalmol. 2004; 242:355–8.

15. Wu W, Wen F, Huang S. . Choroidal folds in Vogt- Koyanagi-Harada disease. Am J Ophthalmol. 2007; 143:900–1.

16. Vitale AT, Maza MS. Scleral inflammatory disease. Ryan SJ, Retina , editors. 4th. St, Louis: Mosby;2006; v. 2. chap. 98.