Bilateral Retinal Detachments Presenting With Acute Angle Closure

Abstract

A Korean American woman in her early 60s was referred for evaluation of bilateral acuteangle closure and retinal detachments. She had emmetropia, and her ocular and medical history were unremarkable. Over the preceding few days, she noticed worsening blurry vision with redness in both eyes associated with headaches, nausea, and severe tinnitus. On presentation, her best-corrected visual acuity was 20/200 OD and 20/400 OS. Intraocular pressure was 45 mm Hg OU. Pupils were 4 mm and minimally reactive. There was 1+ conjunctival injection, diffuse corneal edema with Descemet folds, and the anterior chamber was shallow in both eyes. After the administration of multiple rounds of topical and oral medications, her intraocular pressure improved to 18 mm Hg OD and 19 mm Hg OS. A dilated fundus examination revealed tilted discs, serous retinal detachments, and multiple yellow, depigmented chorioretinal spots throughout the posterior pole in both eyes. B-scan ultrasonography showed shallow retinal detachments, choroidal thickening, and extensive, shallow choroidal detachments extending anteriorly in both eyes (Figure 1A). A-scan ultrasonography showed normal axial length of 22 mm OU. Optical coherence tomography indicated subretinal fluid and enhanced depth imaging demonstrated significant choroidal thickening in both eyes (Figure 1B). Fluorescein angiography revealed pinpoint hyperfluorescence with leakage. Indocyanine green angiography showed diffuse leakage throughout the posterior pole in both eyes. Diagnosis Vogt-Koyanagi-Harada disease What to Do Next C. Request a workup for infectious causes and start prednisone therapy Discussion

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

“…13 So far, about 47 VKH cases have been described to present with a shallow anterior chamber and/or an elevated IOP as an initial manifestation. 5,[13][14][15] In general, females appear to be more prone to present with this kind of clinical picture. The mean age at onset is 52.6 years in Chinese population, 13,14 which is similar to that in Japanese patients and older than that of Indian patients.…”

Prevalence of Angle Closure Glaucoma in Vogt-Koyanagi-Harada Disease

“…However, there is growing evidence that secondary angle-closure disease, characterized by the development of peripheral anterior and posterior synechiae with secondary iris bombé, plays a major role in the development of glaucoma [6]. Few authors have addressed angle-closure disease as a signi cant contributor to glaucoma development in VKH eyes [4,[6][7][8][9]. This study aims to determine the prevalence, clinical characteristics, and mechanisms of secondary glaucoma in a Mexican-mestizo population of VKH patients.…”