J Korean Ophthalmol Soc.  2010 Jul;51(7):1023-1027. 10.3341/jkos.2010.51.7.1023.

Surgical Management of Atypical Vogt-Koyanagi-Harada Disease

• Lim YJ
• Han YS
• Chung IY
• Park JM

• KMID: 2213796
• DOI: http://doi.org/10.3341/jkos.2010.51.7.1023

Abstract

PURPOSE
To report a case of surgical treatment of bilateral bullous exudative retinal detachment associated with Vogt-Koyanagi-Harada disease.
CASE SUMMARY
A 64-year-old woman presented with decreased visual acuity, headache, and hearing loss for 2 months. Visual acuity was hand motion in the right eye and light perception in the left eye. Intraocular pressure was 16 mmHg in the right eye and 24 mmHg in the left eye. Slit lamp examimation disclosed corneal edema, conjunctival ciliary injection with chemosis, rubeosis iridis, and posterior synechia in both eyes. Fundus examination demonstrated bilateral bullous exudative retinal detachment. Lumbar puncture revealed pleocytosis and auditory function test showed neurosensory hearing loss. She was diagnosed as having bilateral bullous exudative retinal detachment associated Vogt-Koyanagi-Harada disease. On hospital day 3, intravitreal triamcinolone injection with external subretinal fluid drainage was performed in the right eye and on hospital day 6, intravitreal triamcinolone injection with external subretinal fluid drainage was performed in the left eye. Two months later, best corrected visual acuity was 0.2 in the right eye and 0.04 in the left eye.
CONCLUSIONS
Intravitreal trimacinolone acetonide injection with external subretinal fluid drainage is one of the good treatment for bullous exudative retinal detachment associated with Vogt-Koyanagi-Harada disease.

Keyword

Vogt-Koyanagi-Harada disease; VKH; Retinal detachment; Intravitreal trimacinolone acetonide injection

MeSH Terms

Corneal Edema
Drainage
Eye
Female
Hand
Headache
Hearing Loss
Humans
Intraocular Pressure
Leukocytosis
Light
Middle Aged
Retinal Detachment
Spinal Puncture
Subretinal Fluid
Triamcinolone
Uveomeningoencephalitic Syndrome
Visual Acuity
Triamcinolone

Figure

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  Figure 1. Anterior segment examination at admission day. (A,B) There are epithelial edema, Descemet's membrane folding at both cornea. Ciliary injection with chemosis was observed in both eyes. Rubeosis and 360 degree posterior synechia was observed in both anterior chambers. (C,D) Cataract, kissing type bullous retinal detachment and de-tached retina which was touched with posterior lens capsule were observed in both eyes.

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  Figure 2. B-scan finding at admission day. Retinal detachment was found in both eyes.

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  Figure 3. Fundus exams at the time of discharge. There are multiple subretinal fibrosis, RPE degeneration and decreased retinal detachment in both eyes.

Reference

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