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Evolution of spectral‐domain optical coherence tomography images in an acute stage of Vogt‐Koyanagi‐Harada disease
Author(s) -
Almenara Michelena C.,
Ascaso F.J.,
Núñez E.,
Martínez M.,
Pérez I.,
Esteban O.,
Idoate A.,
Sánchez J.I.,
Bartolomé I.,
Berniolles J.,
Cristóbal J.Á.
Publication year - 2016
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2016.0283
Subject(s) - medicine , blurred vision , vogt–koyanagi–harada disease , ophthalmology , visual acuity , intraocular pressure , metamorphopsia , optic nerve , uveitis
Purpose Vogt‐Koyanagi‐Harada (VKH) disease is a rare granulomatous inflammatory disorder that affects pigmented structures, such as eye, inner ear, meninges, skin and hear. It is mainly a Th1 lymphocyte mediated aggression to melanocytes after a viral trigger in the presence of HLA‐DRB1*0405 allele. The disease has an acute onset of bilateral blurred vision preceded by flu‐like symptoms. Prompt diagnosis followed by early, aggressive and long‐term treatment with high‐dose corticosteroids is critical for a good visual prognosis. Methods We present a case of a 55‐year‐old woman with a 12‐h history of bilateral central blurred vision accompanied with oppressive headache for the past 5 days. Best‐corrected visual acuity (BCVA) was counting fingers in both eyes. Slit‐lamp biomicroscopy evaluation and Goldmann applanation intraocular pressure (IOP) were normal. Results Funduscopic examination and spectral‐domain optical coherence tomography (SD‐OCT) revealed bilateral optic disc swealling and multiple focal areas of exudative retinal detachment, including macular detachment. Combined with cerebrospinal fluid pleocytosis, this patient was diagnosed with VKH disease and was treated with intravenous methylprednisolone followed by oral prednisolone which was then gradually tapered. SD‐OCT were performed upon initial presentation and at 5‐days and 1‐month follow‐up. Retinal signs resolved two months following treatment and BCVA was 20/25 in both eyes. Conclusions Focal areas of subretinal fluid are usually present at the beginning of VKH disease. SD‐OCT has a significantly importance in the early detection of these areas and follow‐up of the disease.