Multiple and Recurrent Ocular Manifestations in a Patient of Vogt-Koyanagi-Harada Syndrome

Abstract

Purpose: To report a case of Vogt-Koyanagi-Harada (VKH) syndrome with multiple ocular manifestations and recurrences. Methods: Case report. Case Report: A 17-year-old female patient presented with bilateral blurred vision for one week. Fundus examinations showed bilateral macular serous detachment, and fluorescein angiography revealed multiple pinpoint leakages, compatible with VKH syndrome. Subsequently, the patient developed a total of 5 consecutive episodes of anterior uveitis, occurring mostly after steroid tapering or a URI episode. Each attack responded well to oral prednisolone, prednisolone eye drops and sub-Tenon's triamcinolone injection, with a good recovery of visual acuity to 20/20 bilaterally. The oculocutaneous sequelae were a sunset-glow fundus with residual disc edema and depigmented regressed Dalen-Fuchs' nodules and cutaneous changes of hair loss and whitish hair. Because of later development of atrophic scars at the fovea, the final visual acuity deteriorated to 20/600 in the right eye and 20/50 in the left eye. Conclusions: This patient developed multiple ocular and cutaneous manifestations of VKH syndrome with frequent recurrences. Steroid treatments can yield good results but must but be tapered gradually, and sub-Tenon's injection of triamcinolone cam be ised om severe pr omtractable cases. Particular precaution should be taken for young patients for their recurrences and poor visual outcome.