Acute visual disturbance in chronic Vogt-Koyanagi-Harada (VKH) disease
Purpose
To report a case of acute exacerbation of chronic VKH disease with no signs of inflammation.
Methods
A 30-year-old man with sunset glow fundus presented with sudden onset of blurred vision of the right eye. He had an episode of blurred vision of both eyes 8 years ago. Upon examination, the best corrected visual acuity of the right eye was counting fingers at 30 cm, the left eye was 20/20. Intraocular pressure of both eyes was within normal limits. Eyelids, conjunctiva, and cornea of both eyes appeared normal looking. The anterior chamber was deep and quiet. There was no cataract, and no vitritis. Fundus exam of both eyes revealed depigmented fundus appearance with bright orange-red color of the choroid, demonstrating the classic sunset glow fundus picture. Ocular coherence tomography (OCT) revealed no macular edema, no subretinal fluid and no obvious choroidal thickening. Fluorescein angiography (FAG) and indocyanine green angiography (ICG) revealed no vascular leakage or disc leakage, and no signs of choroidal inflammation.
Results
Due to the patient's persistent blurred vision of the right eye, we initiated high dose oral prednisolone treatment (60mg/day) in addition to immunosuppressant with cyclosporin. His right eye vision gradually improved, and a slow tapering of oral prednisolone ensued. 4 weeks after treatment, his right eye vision returned to 20/20. His oral prednisolone had slowly tapered off, however cyclosporin treatment was kept for preventing recurrence.
Conclusion
It is important to be aware of the possibility of acute exacerbation without signs of ocular inflammation in the eyes of a chronic VKH patient. Aggressive and timely anti-inflammatory treatment may be needed to prevent irreversible damage to vision.
Conflict of interest
No
Authors 1
Last name
HUANG
Initials of first name(s)
J
Department
Department of Ophthalmology, Keelung Chang Gung Memorial Hospital
City
Keelung City
Country
Taiwan
Authors 2
Last name
Yeung
Initials of first name(s)
L
Department
Department of Ophthalmology, Keelung Chang Gung Memorial Hospital
City
Keelung City
Country
Taiwan
This website uses cookies to ensure you get the best experience on our website.
Learn more