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Recurrent Unilateral Vogt-Koyanagi-Harada Disease with Posterior Scleritis.

Moon SY, Yoon WT, Park SP - Korean J Ophthalmol (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

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Dear Editor, Vogt-Koyanagi-Harada (VKH) disease usually presents as bilateral panuveitis associated with poliosis, vitiligo, alopecia, and central nervous system and auditory signs... VKH is a non-necrotizing diffuse granulomatous inflammation involving the uvea... Although the exact cause of inflammation remains unclear, current evidence suggests that it involves an autoimmune process driven by T lymphocytes associated with melanocytes... VKH disease usually presents as bilateral panuveitis... Differentiation between VKH disease and posterior scleritis is achieved through observation of sun set glow fundus and neurologic or dermatologic signs not seen in posterior scleritis... Posterior scleritis is also usually unilateral, and T-sign is a unique characteristic of this disease... Recently, there have been some reports, especially in Japan, of posterior scleritis appearing concurrently with VKH disease in patients; Kouda et al. reported that posterior scleritis was an early manifestation of VKH... In our case, neurologic symptoms such as headache and tinnitus appeared as clinical features of VKH, while T-sign and lid swelling were signs of posterior scleritis... Anterior chamber reaction and serous retinal detachment were also observed in both VKH and posterior scleritis... Thus, we conclude that our case involved unilateral VKH disease with posterior scleritis.

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(A) Alopecia developed several months before ophthalmic symptoms. (B) Initial fundus photography of the left eye, diffuse serous retinal detachment was observed. (C) Initial optical coherence tomographs showed subretinal fluid with serous retinal detachment, involing macula. (D) Initial fluorescein angiography showed some leak points and pooling into the subretinal space. (E) Recurred state, there was upper lid erythema, swelling and ptosis. (F) Recurred state, the ultrasonographs showed the increased thickness of the posterior scleral wall and the typical T sign caused by the spread of inflammation along the Tenon's space into the optic nerve sheath. (G) Recurred state, the serous retnal detachment was relapsed in optical coherence tomographs. But it was less severe than initial state.
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Figure 1: (A) Alopecia developed several months before ophthalmic symptoms. (B) Initial fundus photography of the left eye, diffuse serous retinal detachment was observed. (C) Initial optical coherence tomographs showed subretinal fluid with serous retinal detachment, involing macula. (D) Initial fluorescein angiography showed some leak points and pooling into the subretinal space. (E) Recurred state, there was upper lid erythema, swelling and ptosis. (F) Recurred state, the ultrasonographs showed the increased thickness of the posterior scleral wall and the typical T sign caused by the spread of inflammation along the Tenon's space into the optic nerve sheath. (G) Recurred state, the serous retnal detachment was relapsed in optical coherence tomographs. But it was less severe than initial state.

Mentions: A 37-year-old woman visited our clinic with blurred vision in her left eye. She had suffered from severe headache with tinnitus for 1 week, left eye pain for 4 days and metamorphopsia for 1 day. She also complained of a several month history of alopecia (Fig. 1A). The initial best-corrected visual acuity (BCVA) was 1.0 in the right eye and 0.16 in the left eye. The initial intraocular pressure was 10 mmHg in both eyes. A mild anterior chamber reaction was observed without keratic precipitate. On fundus examination of the left eye, serous retinal detachment was observed, but no vitreous cells or haziness were detected (Fig. 1B-1D). The patient was diagnosed with unilateral VKH disease, and prescribed prednisolone 60 mg/day. She was also administered topical prednisolone and cyclopentolate eye drops. Four weeks later, all of her symptoms had resolved completely and the BCVA of the left eye had recovered to 1.0. Thus, we began to taper systemic steroid from 60 to 5 mg over 2 months.


Recurrent Unilateral Vogt-Koyanagi-Harada Disease with Posterior Scleritis.

Moon SY, Yoon WT, Park SP - Korean J Ophthalmol (2015)

(A) Alopecia developed several months before ophthalmic symptoms. (B) Initial fundus photography of the left eye, diffuse serous retinal detachment was observed. (C) Initial optical coherence tomographs showed subretinal fluid with serous retinal detachment, involing macula. (D) Initial fluorescein angiography showed some leak points and pooling into the subretinal space. (E) Recurred state, there was upper lid erythema, swelling and ptosis. (F) Recurred state, the ultrasonographs showed the increased thickness of the posterior scleral wall and the typical T sign caused by the spread of inflammation along the Tenon's space into the optic nerve sheath. (G) Recurred state, the serous retnal detachment was relapsed in optical coherence tomographs. But it was less severe than initial state.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4595263&req=5

Figure 1: (A) Alopecia developed several months before ophthalmic symptoms. (B) Initial fundus photography of the left eye, diffuse serous retinal detachment was observed. (C) Initial optical coherence tomographs showed subretinal fluid with serous retinal detachment, involing macula. (D) Initial fluorescein angiography showed some leak points and pooling into the subretinal space. (E) Recurred state, there was upper lid erythema, swelling and ptosis. (F) Recurred state, the ultrasonographs showed the increased thickness of the posterior scleral wall and the typical T sign caused by the spread of inflammation along the Tenon's space into the optic nerve sheath. (G) Recurred state, the serous retnal detachment was relapsed in optical coherence tomographs. But it was less severe than initial state.
Mentions: A 37-year-old woman visited our clinic with blurred vision in her left eye. She had suffered from severe headache with tinnitus for 1 week, left eye pain for 4 days and metamorphopsia for 1 day. She also complained of a several month history of alopecia (Fig. 1A). The initial best-corrected visual acuity (BCVA) was 1.0 in the right eye and 0.16 in the left eye. The initial intraocular pressure was 10 mmHg in both eyes. A mild anterior chamber reaction was observed without keratic precipitate. On fundus examination of the left eye, serous retinal detachment was observed, but no vitreous cells or haziness were detected (Fig. 1B-1D). The patient was diagnosed with unilateral VKH disease, and prescribed prednisolone 60 mg/day. She was also administered topical prednisolone and cyclopentolate eye drops. Four weeks later, all of her symptoms had resolved completely and the BCVA of the left eye had recovered to 1.0. Thus, we began to taper systemic steroid from 60 to 5 mg over 2 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Dear Editor, Vogt-Koyanagi-Harada (VKH) disease usually presents as bilateral panuveitis associated with poliosis, vitiligo, alopecia, and central nervous system and auditory signs... VKH is a non-necrotizing diffuse granulomatous inflammation involving the uvea... Although the exact cause of inflammation remains unclear, current evidence suggests that it involves an autoimmune process driven by T lymphocytes associated with melanocytes... VKH disease usually presents as bilateral panuveitis... Differentiation between VKH disease and posterior scleritis is achieved through observation of sun set glow fundus and neurologic or dermatologic signs not seen in posterior scleritis... Posterior scleritis is also usually unilateral, and T-sign is a unique characteristic of this disease... Recently, there have been some reports, especially in Japan, of posterior scleritis appearing concurrently with VKH disease in patients; Kouda et al. reported that posterior scleritis was an early manifestation of VKH... In our case, neurologic symptoms such as headache and tinnitus appeared as clinical features of VKH, while T-sign and lid swelling were signs of posterior scleritis... Anterior chamber reaction and serous retinal detachment were also observed in both VKH and posterior scleritis... Thus, we conclude that our case involved unilateral VKH disease with posterior scleritis.

No MeSH data available.


Related in: MedlinePlus