Annular choroidal detachment in a patient with Vogt-Koyanagi-Harada disease.

Abstract

Vogt-Koyanagi-Harada (VKH) disease is one of the diseases that show choroidal detachment. However, there are few reports about VKH disease associated with annular choroidal detachment. In this study, we describe an unusual case of VKH disease with an annular choroidal detachment and absence of a serous retinal detachment. The study was an interventional case report. A 59-year-old Japanese woman presented with bilateral blurred vision with meningismus. Laboratory and clinical investigations were performed, including fluorescein angiography, B-scan echography, computed tomography scans, magnetic resonance imaging, cerebrospinal fluid examination, and blood examination including HLA typing. After a diagnosis of VKH disease was made, the patient was treated with systemic corticosteroids. The patient had iridocyclitis, optic disc swelling, choroidal thickening, and annular choroidal detachment in both eyes. Ophthalmoscopic examination did not reveal an obvious serous retinal detachment. Fluorescein angiography showed prominent leakage of dye from the optic disc and mild dye pooling in the subretinal space. The sclera was not thickened, and the axial lengths were relatively short. The findings were bilateral and symmetrical. Cerebrospinal fluid pleocytosis and HLA typing were consistent with VKH disease. After systemic corticosteroid treatment, the abnormal findings were resolved. Neither sunset glow fundus nor cutaneous lesions were observed, and no recurrences were observed during 4 years of follow-up. The annular choroidal detachment was probably caused by severe choroidal inflammation and resistance to scleral outflow because of the scleral abnormality due to inflammation and short axial length. We believe that intact and functioning retinal pigment epithelium prevented serous retinal detachment. This case reports annular choroidal detachment without retinal detachment associated with VKH diseases.