Subretinal fibrosis in a pregnant patient with Vogt-Kayanagi Harada disease

Author: Jeribi Mohamed (Tunisia)

Co-authors: Imen Zone Abid, Takwa Sammouda, Omar Ayedi, Salma Gargouri, Amira Trigui

Purpose

To describe a case of a pregnant patient diagnosed with Vogt-Kayanagi-Harada disease, treated with high dose systematic corticosteroids and aziathoprine. Clinical evolution was marked by the development of subretinal fibroses and poor final visual acuity. 

Setting/Venue

 Department of Ophtalmology Habib Bourguiba University Hospital, University of Sfax, Tunisia

Methods

A single case report documented with multimodal imaging. 

Results

A 38-year old women in the 22th week of pregnancy complaining of bilateral blurry vision. On examination, visual acuity was limited to counting fingers in both eyes. A mild anterior chamber inflammation(1+ cells) was observed . Funduscopy showed bilateral serous retinal detachment and optic nerve hyperhemia .Optical coherence tomography (OCT) scanning showed diffuse thickened choroid and multifocal exsudative retinal detachments in both eyes. The patient was diagnosed with incomplete form Vogt-Kayanagi Harada disease. She was treated with intravenous pulse of Methylprednisolone 1 g per day for 3 days followed by oral prednisone 1mg/Kg/day on tapering dose. At 10-day follow up, due to worsening of serous retinal detachment, bilateral sub-tenon triamcinolone acetonide injections were done and oral aziathoprine 150mg was added. Visual acuity in the both eyes initially improved to 20/200, then slowly deteriorated despite long term immunosuppressive therapy . On Examination at last follow-up, visual acuity was limited to counting fingers and fundus examination showed a peripapillary and extrafoveal subretinal fibrosis with widespread RPE alterations in both eyes.

Conlusions

Subretinal fibrosis (SRF) is a vision-threatening complication of Vogt-Koyanagi Harada disease . Inspite of early and aggressive immunosuppressant therapy that managed inflammation, SRF can occur and may contribute to permanent visual loss.

Financial Disclosure

non