Korean J Ophthalmol.  2015 Dec;29(6):389-395. 10.3341/kjo.2015.29.6.389.

Comparison of the Clinical Manifestations between Acute Vogt-Koyanagi-Harada Disease and Acute Bilateral Central Serous Chorioretinopathy

• Shin WB
• Kim MK
• Lee CS
• Lee SC
• Kim H

• KMID: 2363846
• DOI: http://doi.org/10.3341/kjo.2015.29.6.389

Abstract

PURPOSE
To compare clinical, angiographic, and optical coherence tomographic characteristics between eyes with acute Vogt-Koyanagi-Harada (VKH) disease and eyes with acute bilateral central serous chorioretinopathy (CSC), and to demonstrate distinguishing features between the two diseases in confusing cases.
METHODS
The medical records of 35 patients with VKH disease and 25 patients with bilateral CSC were retrospectively reviewed. Characteristics according to slit-lamp biomicroscopy, ophthalmoscopy, fundus photography, fluorescein angiography, indocyanine green angiography, and spectral-domain optical coherence tomography were compared between the two diseases.
RESULTS
Five of 35 patients (10 of 70 eyes, 14.3%) with VKH disease were initially misdiagnosed as CSC patients, and six of 25 patients (12 of 50 eyes, 24%) with bilateral CSC were initially misdiagnosed as patients with VKH disease. Pigment epithelial detachment in CSC and optic disc hyperemia in VKH disease show the highest positive predictive values of 100% for each disease.
CONCLUSIONS
Optic disc hyperemia in VKH disease and pigment epithelial detachment in bilateral CSC are the most specific clinical manifestations of each disease at initial patient presentation.

Keyword

Central serous chorioretinopathy; Fluorescein angiography; Indocyanine green angiography; Optical coherence tomography; Vogt-Koyanagi-Harada disease

MeSH Terms

Acute Disease
Adult
Aged
Aged, 80 and over
Central Serous Chorioretinopathy/*diagnostic imaging
Female
Fluorescein Angiography
Humans
Hyperemia/diagnosis
Indocyanine Green/administration & dosage
Male
Middle Aged
Multimodal Imaging
Ophthalmoscopy
Optic Disk/blood supply
Photography
Retinal Detachment/diagnosis
Retinal Pigment Epithelium/pathology
Retrospective Studies
Slit Lamp Microscopy
Tomography, Optical Coherence
Uveomeningoencephalitic Syndrome/*diagnostic imaging
Young Adult
Indocyanine Green

Figure

• 

  Fig. 1 Representative case of acute Vogt-Koyanagi-Harada disease. (A,B) On fundus examination, bilateral serous submacular fluids and hyperemic discs are observed. (C,D) Late-phase fluorescence angiography shows multiple hyperfluorescent spots around the discs, and disc hyperfluorescence in both eyes. (E,F) Indocyanine green angiography shows hyperfluorescent dark dots throughout posterior poles in both eyes. (G,H) Optical coherence tomography reveals subretinal fluid with thickened choroids.

• 

  Fig. 2 Representative case of acute bilateral central serous chorioretinopathy. (A,B) On fundus examination, bilateral serous submacular fluids are observed. (C,D) Late-phase fluorescence angiography shows multifocal hyperfluorescent dots throughout posterior poles in both eyes. (E,F) Late-phase indocyanine green angiography shows multifocal hyperf luorescence, suggesting choroidal vascular hyperpermeability. (G,H) Optical coherence tomography (OCT) reveals subretinal fluid and thickened choroids. Additionally, OCT scans reveal pigment epithelial detachments (yellow arrows), corresponding to black lines in (A) and (B).

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