J Korean Ophthalmol Soc.  2012 Aug;53(8):1194-1199. 10.3341/jkos.2012.53.8.1194.

Bilateral Acute Myopia and Angle-Closure Due to Ciliochoroidal Effusion in Vogt-Koyanagi-Harada Syndrome

• Kim JH
• Lim JS
• Lee JW
• Lee JE
• Oum BS

• KMID: 2215968
• DOI: http://doi.org/10.3341/jkos.2012.53.8.1194

Abstract

PURPOSE
To report a case of bilateral acute myopia and angle-closure with ciliochoroidal detachment in Vogt-Koyanagi-Harada (VKH) syndrome.
CASE SUMMARY
A 43-year-old Korean woman diagnosed with VKH syndrome underwent intravenous methylprednisolone steroid pulse treatment. After oral medication was given for 2 days, the anterior chambers became shallow in both eyes. Intraocular pressure (IOP) increased to 25 mm Hg in the right eye and 23 mm Hg in the left eye. Subretinal fluid increased and visual acuity decreased with myopic shift in both eyes. IOP did not decrease despite maximum tolerated medical therapy. Ultrasound biomicroscopy (UBM) revealed that ciliochoroidal effusion caused forward displacement of the lens-iris diaphragm, which resulted in anterior chamber shallowing and angle closure in both eyes. The patient was treated with cycloplegic eyedrops and intravenous steroid pulse therapy. After intravenous steroid pulse treatment was given for 2 days, the anterior chambers became deep in both eyes. IOP reduced to 13 mm Hg and 14 mm Hg in the right and left eye respectively. Visual acuity increased with normalization of myopic shift. UBM revealed that the ciliochoroidal effusion had resolved in both eyes.

Keyword

Acute angle-closure; Acute myopia; Ciliochoroidal effusion; Vogt-Koyanagi-Harada (VKH) syndrome

MeSH Terms

Adult
Anterior Chamber
Diaphragm
Displacement (Psychology)
Eye
Female
Humans
Intraocular Pressure
Methylprednisolone
Microscopy, Acoustic
Myopia
Ophthalmic Solutions
Subretinal Fluid
Uveomeningoencephalitic Syndrome
Visual Acuity
Methylprednisolone
Ophthalmic Solutions

Figure

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  Figure 1 Fundus photographs showing bilateral multiple serous retinal detachment (A). Late phase of fluorescein angiography showing multiple cobble stone like hyperfluorescent spots and dye pooling (B). Optical coherence tomography demonstrates serous retinal detachment in the both eyes (C).

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  Figure 2 Ultrasound biomicroscopic images of the anterior segment before second steroid pulse therapy in the right eye (A) and the left eye (B). The anterior chamber angle is narrow, and a layer of fluid has accumulated external to the ciliary body and choroid (ciliochoroidal detatchment-asterisk) with forward displacement of the ciliary body in the both eyes. Ultrasound biomicroscopic images of the anterior segment on day 2 of the second steroid pulse therapy. The anterior chamber has deepened to normal depth and ciliochoroidal detachment has disappeared in the right eye (C) and the left eye (D).

• 

  Figure 3 Fundus photographs show bilateral multiple depigmentation and sunset glow appearance around the fovea in both eyes at 2 months after the second steroid pulse therapy (A). Optical coherence tomography shows that serous retinal detachment has resolved 2 months after the second steroid pulse therapy in the both eyes (B).

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