No abstract available.
Adult ; Female ; Humans ; Recurrence ; Retina/*pathology ; Scleritis/*complications/diagnosis ; Tomography, Optical Coherence ; Uveomeningoencephalitic Syndrome/complications/*diagnosis

We describe a case of bilateral exudative retinal detachment associated with prodromal symptoms simulating the presentation of acute Vogt-Koyanagi-Harada disease that was eventually diagnosed as acute lymphoblastic leukemia. A 42-year-old man presented with sudden visual loss in both eyes for two weeks. He complained of intermittent headache, neck stiffness and tinnitus for a month. His best-corrected visual acuities were 20/200 in both eyes. Fluorescein angiography, optical coherence topography and indocyanine green angiography featured bilateral serous retinal detachments. A clinical diagnosis of incomplete type Vogt-Koyanagi-Harada disease was considered. However, complete blood cell count showed a marked increase in the number of white blood cells and bone marrow examination revealed precursor B cell lymphoblastic leukemia. The patient started on induction chemotherapy. A week later, his best-corrected visual acuities were 20/25 and the serous retinal detachments were nearly absorbed in both eyes. Bilateral exudative retinal detachment associated with neurologic and auditory abnormalities may be a presenting sign of acute lymphoblastic leukemia. Clinicians should be aware of the possibility of leukemia in such patients.
Adult ; Diagnosis, Differential ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Humans ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications/*diagnosis ; Retinal Detachment/diagnosis/*etiology ; Tomography, Optical Coherence ; Uveomeningoencephalitic Syndrome/*diagnosis ; Visual Acuity

PURPOSE: To evaluate the characteristics of fluid accumulation in the uveitic stage of Vogt-Koyanagi-Harada (VKH) disease using high resolution optical coherence tomography (OCT3). METHODS: Twenty-eight eyes in 14 patients with VKH disease were reviewed retrospectively. These 28 eyes were divided into 19 eyes with intraretinal fluid (C group) and 9 eyes without intraretinal fluid (N group). Changes in visual acuity and fluid accumulation observed using OCT were compared between the two groups. RESULTS: Visual acuity at the time of presentation was significantly worse in the C group than in the N group (p=0.005). The photoreceptor layer appeared to be double-layered due to a cystoid space in the C group. Layered structures and strands found in the cystoid space. Expanding sponge-form edema led to the development of a cystoid space in the photoreceptor layer. Intraretinal fluid resolved earlier than subretinal fluid. There were no observed differences in visual acuity between the two groups after four days of treatment. CONCLUSIONS: Accumulation of intraretinal fluid was related to poor initial visual acuity, but not to final visual acuity. High resolution OCT findings indicate that edema of the photoreceptor layer participates in the development of a cystoid space.
Adolescent ; Adult ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; *Image Enhancement ; Macular Edema/etiology/*pathology ; Male ; Middle Aged ; Photoreceptor Cells, Vertebrate/*pathology ; Retrospective Studies ; Tomography, Optical Coherence/*methods ; Uveomeningoencephalitic Syndrome/*complications/pathology ; Young Adult

A case of Vogt-Koyanagi-Harada disease (VKH) that developed in a 36-year-old woman with Graves' disease was described. The patient was treated with Lugol's solution and presented with bilateral serous retinal detachment. She had also suffered from methimazole-induced hypersensitivity and steroid-induced myopathy. Fluorescein angiography showed multiple leakage points and a lumbar puncture revealed pleocytosis, which was compatible with VKH. High dose steroid pulse therapy was successful. Altered immune regulation associated with drug-induced hypersensitivity may contribute to the development of VKH in patients with Graves' disease.
Adult ; Coloring Agents/administration & dosage ; Diagnosis, Differential ; Dose-Response Relationship, Drug ; Drug Therapy, Combination ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Glucocorticoids/administration & dosage ; Graves Disease/*complications/diagnosis/drug therapy ; Humans ; Immunosuppressive Agents/administration & dosage ; Injections, Intravenous ; Iodides/administration & dosage ; Ophthalmic Solutions/administration & dosage ; Uveomeningoencephalitic Syndrome/*complications/diagnosis/drug therapy