Vogt-Koyanagi-Harada Syndrome (VKH Syndrome)
A 62-year-old female presented with complaints of gradual blurring OU for 2 weeks. She had suffered a recent upper respiratory infection and treated it with unidentified herbal drugs. Her best-corrected vision was 6/30 in the right eye and 6/15 in the left eye. Intraocular pressure was normal. There was mild nuclear sclerosis in both lenses. The pupillary light reflex was mildly sluggish for both eyes. Fundoscopic examination showed swollen discs and serous detachments over the macula in both eyes (Fig. 14.1). A visual field test showed severe obscuration in the right eye and constriction in the left eye (Fig. 14.2). Multiple pinpoint leakages over the macular region were noted on fluorescein angiography (Fig. 14.3). A brain CT was negative for space-occupying lesions and did not indicate any signs of increased intracranial pressure. MR imaging showed thickened retino-choroidal layers in both eyes (Fig. 14.4). A lumbar puncture showed normal intracranial pressure and increased lymphocytes in the cerebrospinal fluid. The patient received methylprednisolone pulse therapy for 3 days and was then discharged with oral steroid medications. Her vision recovered to 6/7.5 in the right eye and 6/6.7 in the left eye. Her fundus had multiple patches of depigmentation 5 years later (Fig. 14.5).
- 8.Gass JDM. Harada’s disease. Stereoscopic atlas of macular diseases. Diagnosis and treatment. St. Louis: C. V. Mosby Co.; 1987. p. 150–3.Google Scholar