AUTHOR DR RUPALI TYAGI, CO-AUTHOR 1 DR SHUBHA NAGPAL, CO-AUTHOR 2 DR NEELAM PUTHRAN, CO-AUTHOR 3 DR VARSHA KULKARNI MS OPHTHALMOLOGY BHARATI HOSPITAL BHARATI VIDYAPEETH UNIVERSITY PUNE

1. A CASE OF
BILATERAL EXUDATIVE
RETINAL DETACHMENT
AUTHOR DR RUPALI TYAGI
CO-AUTHOR 1 DR SHUBHA NAGPAL
CO-AUTHOR 2 DR NEELAM PUTHRAN
CO-AUTHOR 3 DR VARSHA KULKARNI
MS OPHTHALMOLOGY
BHARATI HOSPITAL
BHARATI VIDYAPEETH UNIVERSITY
PUNE

2. 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)

3. 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).

4. 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

5. 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.

6. ON 7TH DAY OF TREATMENT
OD (VISUAL ACQUITY 6/12) OS (VISUAL ACUITY 6/18)
COMPLETELY ATTACHED
RETINA
SUNSET GLOW
OCT REVEALING
ATTACHED RETINA

7. DISCUSSION
DEFINITION
VKH 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 proteins
Unidentified 75kd protein
S-100 protein
HLA-DR4,HLA-DR53,HLA-DQ4,HLA-DQ7,HLA-DR1,HLA-
DR4

8. DISCUSSION
COMPLETE
DIFFUSE CHOROIDITIS
SEROUS RETINAL
DETACHMENT
ANTERIOR UVEITIS
NEUROLOGICAL
(MENINGISMUS, CSF
PLEOCYTOSIS)
AUDITORY (TINNITUS)
INTEGUMENTARY (ALOPECIA,
VITILIGO,POLIOSIS)
INCOMPLETE
NEUROLOGICAL AND
AUDITORY
OR
INTEGUMENTARY
PROBABLE
ONLY OCULAR
DISEASE
SIGNS OF VKH

9. DISCUSSION
FINDINGS COMPLETE VKH INCOMPLETE VKH PROBABLE VKH OUR CASE
1.ANTERIOR UVEITIS
2.DIFFUSE
CHOROIDITIS
3.RETINAL
DETACHMENT
4.NEUROLOGICAL
5.AUDITORY
6.INTEGUMENTARY OR
TYPES OF VOGT KOYANAGI HARADA SYNDROME

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

11. 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):606-14
4. 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.e5
6. 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

12. THANK
YOU