A CASE OF BILATERAL EXUDATIVE RETINAL DETACHMENT

AUTHOR DR RUPALI TYAGICO-AUTHOR 1 DR SHUBHA NAGPALCO-AUTHOR 2 DR NEELAM PUTHRANCO-AUTHOR 3 DR VARSHA KULKARNIMS OPHTHALMOLOGYBHARATI HOSPITALBHARATI VIDYAPEETH UNIVERSITYPUNE

INTRODUCTION

COMMON CAUSES OF EXUDATIVE RETINAL

DETACHEMNET

COAT’S DISEASE(1/10,00,000)

CHOROIDAL MELANOMA

(1/10,00,000)

EXUDATIVE ARMD(1/1.75 MILLION)

VOGT KOYONAGI HARADA SYNDROME

(1/4,00,000)

CASE REPORT 15 years old female presented with history of sudden, painless and

progressive diminution of vision OU since 5days.

Preceded by fever and giddiness. No history of tinnitus, vertigo, headache, meningismus, alopecia, trauma or ocular surgery.

Visual acuity OU ,was reduced to PL + ,PR accurate.

Slit Lamp Examination(OU) -Fine keratic precipitates OU.

-Pupils normal size briskly reacting. Investigations revealed microcytic hypochromic anemia (Hb: 7.6 gm/dl and

serum ferritin 2.90 ng/ml).

OD OS

Exudative retinal detachment with multiple fluid pockets and

dilated tortuous vessels on Fundus Photo.

The B-scan showing exudative retinal detachment

There was no evidence of posterior scleritis

OCT revealed multiple cystic spaces in the sub retinal

space with an intact retinal pigment epithelium

INVESTIGATIONS

PRE

TREATMENT

TREATMENT PLAN

Patient was treated with Intravenous Methylprednisolone 1 gram per day for 5 days, followed by tablet Prednisolone in tapering doses over a period of 1 month.

Topically, OU eye drop Prednisolone QID, eye drop Nepafenac TDS, eye drop Homide BD.

ON 7TH DAY OF TREATMENTOD (VISUAL ACQUITY

6/12) OS (VISUAL ACUITY 6/18)

COMPLETELY ATTACHED RETINA

SUNSET GLOW

OCT REVEALING ATTACHED RETINA

DISCUSSION

DEFINITIONVKH is a multisystemic disorder characterized by granulomatous panuveitis with exudative retinal detachments that is often associated with neurological and cutaneous manifestations.(1)ETIOPATHOGENESIS It is considered to be a cell mediated autoimmune disease directed against melanocytes. Autoimmune reaction directed against an antigenic component shared by uveal, dermal and

meningeal melanocytes like (2,3,4,5)

Genetics

Tyrosinase or tyrosine related proteinsUnidentified 75kd protein

S-100 protein

HLA-DR4,HLA-DR53,HLA-DQ4,HLA-DQ7,HLA-DR1,HLA-DR4

DISCUSSION

COMPLETE

COMPLETEDIFFUSE CHOROIDITIS

SEROUS RETINAL DETACHMENT

ANTERIOR UVEITISNEUROLOGICAL

(MENINGISMUS, CSF PLEOCYTOSIS)

AUDITORY (TINNITUS)INTEGUMENTARY

(ALOPECIA, VITILIGO,POLIOSIS)

INCOMPLETENEUROLOGICAL AND AUDITORY

OR INTEGUMENTARY

PROBABLEONLY OCULAR

DISEASE

SIGNS OF VKH

. Read RW, Holland GN, Rao NA, Tabbara KF, Ohno S, Arellanes-Garcia L, et al. Revised diagnostic criteria for Vogt-Koyanagi-Harada disease: report of an international committee on nomenclature. Am J Ophthalmol. 2001 May. 131(5):647-52

DISCUSSION

FINDINGS COMPLETE VKH

INCOMPLETE VKH

PROBABLE VKH

OUR CASE

1.ANTERIOR UVEITIS2.DIFFUSE CHOROIDITIS3.RETINAL DETACHMENT4.NEUROLOGICAL

5.AUDITORY

6.INTEGUMENTARY OR

TYPES OF VOGT KOYANAGI HARADA SYNDROME

CONCLUSION

The diagnosis of Probable Vogt Koyanagi Harada Syndrome should be considered in a case of Bilateral Exudative Retinal Detachment with Anterior Uveitis

REFRENCES

1.Andreoli CM, Foster CS. Vogt-Koyanagi-Harada disease. Int Ophthalmol Clin. 2006 Spring. 46(2):111-22.2.Rajendram R, Evans M, Rao NA. Vogt-Koyanagi-Harada disease. Int Ophthalmol Clin. 2005 Spring. 45(2):115-34. 3.Yang P, Ren Y, Li B, Fang W, Meng Q, Kijlstra A. Clinical characteristics of Vogt-Koyanagi-Harada syndrome in Chinese patients. Ophthalmology. 2007 Mar. 114(3):606-144. Usui Y, Goto H, Sakai J, Takeuchi M, Usui M, Rao NA. Presumed Vogt-Koyanagi-Harada disease with unilateral ocular involvement: report of three cases. Graefes Arch Clin Exp Ophthalmol. 2009 Aug. 247(8):1127-32. [5. da Silva FT, Damico FM, Marin ML, Goldberg AC, Hirata CE, Takiuti PH, et al. Revised diagnostic criteria for vogt-koyanagi-harada disease: considerations on the different disease categories. Am J Ophthalmol. 2009 Feb. 147(2):339-345.e56. Read RW, Holland GN, Rao NA, Tabbara KF, Ohno S, Arellanes-Garcia L, et al. Revised diagnostic criteria for Vogt-Koyanagi-Harada disease: report of an international committee on nomenclature. Am J Ophthalmol. 2001 May. 131(5):647-52

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