Abematsu Noriko, Shimonagano Yuka, Nakao Kumiko, Sakamoto Taiji, Shimizu Kentaro, Hirashima Setsuo
Department of Ophthalmology Kagoshima University Graduate School of Medical and Dental Sciences, Japan.
Nippon Ganka Gakkai Zasshi. 2006 Aug;110(8):601-6.
Although optic disc swelling is one of the common findings of Vogt-Koyanagi-Harada (VKH) disease, severe visual field loss from optic disc involvement is not common. We report a case of severe visual field contraction from optic disc involvement in VKH disease.
A 51-year-old woman was diagnosed as having VKH disease and was treated with intravenous pulse methylprednisolone. Exudative retinal detachments disappeared and visual acuity improved, but optic disc swelling was persistent in both eyes. Ten weeks after VKH disease onset, she claimed acute visual field loss in the right eye. Marked optic disc swelling with peripapillary hemorrhages and severe visual field loss were observed in the right eye. Fluorescein angiography showed filling delay and late leakage of the optic disc in the right eye. One month later, right optic disc swelling disappeared, but visual field loss remained. In addition, 5.5 months later, the left optic disc swelled further, and the left visual field was markedly contracted. Hyperbaric oxygen therapy was added. The swelling in the left optic disc gradually decreased and disappeared in one month, but the visual field loss remained.
The optic disc involvement with irreversible visual field loss in this case is thought to be due to anterior ischemic optic neuropathy, which may be a possible complication of VKH disease.
尽管视盘肿胀是Vogt-小柳-原田（VKH）病的常见表现之一，但因视盘受累导致严重视野缺损并不常见。我们报告1例VKH病患者因视盘受累出现严重视野收缩的病例。
一名51岁女性被诊断为VKH病，并接受了静脉注射甲基强的松龙冲击治疗。渗出性视网膜脱离消失，视力改善，但双眼视盘肿胀持续存在。VKH病发病10周后，她称右眼急性视野缺损。右眼可见明显的视盘肿胀伴视盘周围出血及严重视野缺损。荧光素血管造影显示右眼视盘充盈延迟及晚期渗漏。1个月后，右眼视盘肿胀消失，但视野缺损仍存在。此外，5.5个月后，左眼视盘进一步肿胀，左眼视野明显收缩。遂加用高压氧治疗。左眼视盘肿胀在1个月内逐渐减轻并消失，但视野缺损仍存在。
本例中视盘受累伴不可逆视野缺损被认为是由于前部缺血性视神经病变所致，这可能是VKH病的一种并发症。
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