Bilateral acute angle closure glaucoma as an initial presentation of Vogt-Koyanagi-Harada syndrome: A clinical case report

Abstract

Purpose: Vogt-Koyanagi-Harada (VKH) is an autoimmune disease with bilateral granulomatous uveitis and various systemic manifestations. Bilateral acute angle closure glaucoma (AACG) can be a rare initial manifestation of VKH that may be misdiagnosed as primary angle closure glaucoma (PACG). Case report: A 62-year-old woman with bilateral painless loss of vision referred to Qingdao Municipal Hospital. She had been diagnosed as PACG before admission and prescribed with anti-glaucoma treatment which did not improve her symptom. She had severe bilateral uveitis, optic disk swelling, and serous retinal detachment in both eyes. Intraocular pressure (IOP) was 20 mmHg in the right eye and 23 mmHg in the left eye, and her best corrected visual acuities (BCVAs) were 0.02 in both eyes. She was treated with oral corticosteroid therapy on a tapering schedule. One month after the therapy, the IOP remained well-controlled with deepened anterior chamber. Her visual acuity and symptom were improved. Conclusions: We experienced a case of VKH disease with an unusual presentation of bilateral secondary AACG. It is important for ophthalmologists to know about this rare cause of painless loss of vision so that it could be treated properly.

Neovascular Glaucoma: A Rare Presenting Feature of Vogt-Koyanagi-Harada Syndrome

“…12% of all glaucomas in a series by Pandey et al had acute angle closure crisis at presentation [ 11 ]. A case report by Yuan et al describes bilateral acute angle closure glaucoma as the initial presentation in a patient with VKH [ 2 ].…”

“…Hence, manifestations are race-dependant [ 1 ]. In Japan and Singapore, VKH constitutes between 6.8-9.2% of all uveitis, 1.2% in the Middle East, 15.9% in China, 2.2% in India, and between 1-4% in the USA [ 2 ]. Non-necrotizing granulomas with late involvement of choriocapillaries and the formation of Dalen-Fuchs' nodules are pathognomonic on histopathology.…”

“…The typical VKH presentation is posterior segment uveitis (diffuse choroiditis with serous retinal detachment and disc edema) that may be followed by anterior segment involvement or panuveitis without proper treatment. Acute angle closure glaucoma or crisis may occasionally be found at presentation [ 2 ].…”

Bilateral posterior scleritis presenting as acute primary angle closure: A case report

“…VKH syndrome must be part of the differential diagnosis strategy and ruled out in order to make an accurate diagnosis of bilateral posterior scleritis. When the presence of bilateral shallow anterior chambers is accompanied by higher IOP, especially, fundi manifestations can include serous retinal detachment, optic disk swelling, and abnormal findings on fluorescein fundus angiography[ 7 ]. Ultrasonography is an essential tool for the diagnosis of posterior scleritis.…”