Recurrent Exudative Retinal Detachment in a Case of Vogt-Koyanagi-Harada

Purpose: To report recurrent exudative retinal detachment in a patient treated for Vogt-Koyanagi-Harada (VKH) disease. Case: An 18 year old woman presented with unilateral exudative retinal detachment. Despite initiation of systemic steroid treatment with a diagnosis or unilateral posterior scleritis, she developed exudative retinal detachment in the other eye as well. A diagnosis of incomplete VKH disease was made based on indocyanine green angiography findings of diffuse choroiditis and mild lymphocytic pleocytosis on cerebrospinal fluid analysis. After 9 days of pulse methylprednisolone 750 mg/day, bilateral exudative detachment subsided. At three weeks, cyclosporine 250 mg/day was added to treatment. When steroid dose was tapered to 4mg/day after 3 months, she developed recurrent bilateral exudative retinal detachment. Pulse methylprednisolone 1000mg/day was administered and azathioprin 100 mg/day was added to ongoing treatment. The subretinal fluid resolved immediately and she remained in remission without any further complications. Her visual acuity was 1.0 in both eyes at 16 months of follow-up. Conclusions: In VKH patients with severe ocular involvement, response to high-dose systemic corticosteroids is delayed. Early tapering of corticosteroid therapy may cause recurrent exudative retinal detachment. Recurrences may be seen despite early immunosuppressive therapy. Indocyanine green angiography reveals subclinical choroidal inflammation and will be useful in the diagnosis and in monitoring response to therapy in VKH patients.