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Macular Hole Associated with Vogt-Koyanagi-Harada Disease at the Acute Uveitic Stage.

Mizuno M, Fujinami K, Watanabe K, Akiyama K - Case Rep Ophthalmol (2015)

Bottom Line: Six weeks after the initial administration of steroid, vitreomacular traction was found by optical coherence tomography in the LE, which progressed to stage 4 MH with the BCVA of 0.2 in the LE.The MH was closed successfully and the BCVA was 0.4 in the LE 5 weeks after the vitrectomy.To conclude, at the early stage of VKH, there is a possibility of MH formation due to the rapid progress of vitreous traction following the inflammation, and the surgical procedure could be effective to resolve this secondary disorder.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.

ABSTRACT
We describe a case with macular hole (MH) associated with Vogt-Koyanagi-Harada (VKH) disease. A 71-year-old Japanese woman presented with visual loss and headaches. The best-corrected visual acuity (BCVA) was 0.02 in the right eye (RE) and 0.1 in the left eye (LE). The patient was diagnosed with VKH based on circumferential choroidal detachments, multiple serous retinal detachments, and optic disc hyperemia. The multiple serous retinal detachments improved with high-dose corticosteroid therapy and gradual tapering. The BCVA was recovered to 1.2/0.7 in the RE/LE. Six weeks after the initial administration of steroid, vitreomacular traction was found by optical coherence tomography in the LE, which progressed to stage 4 MH with the BCVA of 0.2 in the LE. Twenty-three weeks after the initial treatment, vitrectomy was performed with the standard surgical procedures, including inner limiting membrane peeling around the fovea and air tamponade. The MH was closed successfully and the BCVA was 0.4 in the LE 5 weeks after the vitrectomy. This is the first report of a case with MH secondary to the acute uveitic stage of VKH. Successful closure of MH was achieved with the standard surgical intervention for an idiopathic MH. To conclude, at the early stage of VKH, there is a possibility of MH formation due to the rapid progress of vitreous traction following the inflammation, and the surgical procedure could be effective to resolve this secondary disorder.

No MeSH data available.


Related in: MedlinePlus

Serial OCT images of a case with MH secondary to VKH disease. a OCT demonstrated the choroidal folds and multiple subretinal fluids at presentation. b The choroidal folds and multiple subretinal fluids were resolved 4 weeks after the initial administration of steroid. VMT was first observed 6 weeks after treatment (c), and a MH was formed 2 weeks later (d). e Five weeks after vitrectomy (28 weeks after the initial treatment), successful closure of the MH was confirmed by OCT.
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Figure 2: Serial OCT images of a case with MH secondary to VKH disease. a OCT demonstrated the choroidal folds and multiple subretinal fluids at presentation. b The choroidal folds and multiple subretinal fluids were resolved 4 weeks after the initial administration of steroid. VMT was first observed 6 weeks after treatment (c), and a MH was formed 2 weeks later (d). e Five weeks after vitrectomy (28 weeks after the initial treatment), successful closure of the MH was confirmed by OCT.

Mentions: A 71-year-old Japanese woman presented with visual loss accompanied by headaches and tinnitus. No history of ocular disorders was reported except for cataract surgery in the right eye (RE). The best-corrected visual acuity (BCVA) at the initial examination was 0.02 in the RE and 0.1 in the left eye (LE). Slit-lamp ophthalmoscopy revealed inflammatory signs in the anterior chamber and vitreous cavity in both eyes. Comprehensive fundus examinations showed circumferential choroidal detachments, multiple serous retinal detachments, and optic disc hyperemia (fig. 1a–c, fig. 2a). An increased number of mononuclear cells were detected in the cerebrospinal fluid and homozygous HLA-DR4 alleles were identified.


Macular Hole Associated with Vogt-Koyanagi-Harada Disease at the Acute Uveitic Stage.

Mizuno M, Fujinami K, Watanabe K, Akiyama K - Case Rep Ophthalmol (2015)

Serial OCT images of a case with MH secondary to VKH disease. a OCT demonstrated the choroidal folds and multiple subretinal fluids at presentation. b The choroidal folds and multiple subretinal fluids were resolved 4 weeks after the initial administration of steroid. VMT was first observed 6 weeks after treatment (c), and a MH was formed 2 weeks later (d). e Five weeks after vitrectomy (28 weeks after the initial treatment), successful closure of the MH was confirmed by OCT.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608629&req=5

Figure 2: Serial OCT images of a case with MH secondary to VKH disease. a OCT demonstrated the choroidal folds and multiple subretinal fluids at presentation. b The choroidal folds and multiple subretinal fluids were resolved 4 weeks after the initial administration of steroid. VMT was first observed 6 weeks after treatment (c), and a MH was formed 2 weeks later (d). e Five weeks after vitrectomy (28 weeks after the initial treatment), successful closure of the MH was confirmed by OCT.
Mentions: A 71-year-old Japanese woman presented with visual loss accompanied by headaches and tinnitus. No history of ocular disorders was reported except for cataract surgery in the right eye (RE). The best-corrected visual acuity (BCVA) at the initial examination was 0.02 in the RE and 0.1 in the left eye (LE). Slit-lamp ophthalmoscopy revealed inflammatory signs in the anterior chamber and vitreous cavity in both eyes. Comprehensive fundus examinations showed circumferential choroidal detachments, multiple serous retinal detachments, and optic disc hyperemia (fig. 1a–c, fig. 2a). An increased number of mononuclear cells were detected in the cerebrospinal fluid and homozygous HLA-DR4 alleles were identified.

Bottom Line: Six weeks after the initial administration of steroid, vitreomacular traction was found by optical coherence tomography in the LE, which progressed to stage 4 MH with the BCVA of 0.2 in the LE.The MH was closed successfully and the BCVA was 0.4 in the LE 5 weeks after the vitrectomy.To conclude, at the early stage of VKH, there is a possibility of MH formation due to the rapid progress of vitreous traction following the inflammation, and the surgical procedure could be effective to resolve this secondary disorder.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.

ABSTRACT
We describe a case with macular hole (MH) associated with Vogt-Koyanagi-Harada (VKH) disease. A 71-year-old Japanese woman presented with visual loss and headaches. The best-corrected visual acuity (BCVA) was 0.02 in the right eye (RE) and 0.1 in the left eye (LE). The patient was diagnosed with VKH based on circumferential choroidal detachments, multiple serous retinal detachments, and optic disc hyperemia. The multiple serous retinal detachments improved with high-dose corticosteroid therapy and gradual tapering. The BCVA was recovered to 1.2/0.7 in the RE/LE. Six weeks after the initial administration of steroid, vitreomacular traction was found by optical coherence tomography in the LE, which progressed to stage 4 MH with the BCVA of 0.2 in the LE. Twenty-three weeks after the initial treatment, vitrectomy was performed with the standard surgical procedures, including inner limiting membrane peeling around the fovea and air tamponade. The MH was closed successfully and the BCVA was 0.4 in the LE 5 weeks after the vitrectomy. This is the first report of a case with MH secondary to the acute uveitic stage of VKH. Successful closure of MH was achieved with the standard surgical intervention for an idiopathic MH. To conclude, at the early stage of VKH, there is a possibility of MH formation due to the rapid progress of vitreous traction following the inflammation, and the surgical procedure could be effective to resolve this secondary disorder.

No MeSH data available.


Related in: MedlinePlus