First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Clin Exp Ophthalmol. 2011 Sep-Oct;39(7):639-47. doi: 10.1111/j.1442-9071.2011.02523.x. Epub 2011 Apr 4.
To investigate the clinical features of Vogt-Koyanagi-Harada (VKH) disease presenting as acute angle closure glaucoma at onset.
Retrospective non-comparative case series.
Four hundred and eighty-six VKH patients seen from February 2001 to March 2010.
The history and clinical findings of all patients were reviewed. Auxiliary examinations, including ultrasound biomicroscopy, fundus fluorescein angiography and optical coherence tomography, were performed in certain cases. Corticosteroids with or without cyclosporine A were used to treat these patients.
Patients' demographics, clinical presentation and auxiliary examination findings.
Eight out of 486 VKH patients were misdiagnosed as acute angle closure glaucoma. The mean age of these eight patients was 55.6 years. Six patients were female. The mean intraocular pressure (IOP) at disease onset was 32.9 mmHg. All of these patients had a shallow anterior chamber and a narrow or closed angle at their first visit. The complaints of these patients were mostly headache and sudden decreased vision in both eyes. Alterations shown on ultrasound biomicroscopy included detachment of the ciliary body and peripheral choroid. The increased IOP did not respond to anti-glaucoma therapy, but resolved following treatment with corticosteroids. The eye of one patient was enucleated after failed trabeculectomies prior to referral to our uveitis centre.
VKH disease presenting with a bilateral increased IOP mostly occurs in older women. The strikingly decreased visual acuity associated with mild to moderate increased IOP is a clue to the diagnosis. The increased IOP responded well to corticosteroids but not to anti-glaucoma treatment.
探讨以急性闭角型青光眼起病的 Vogt-小柳原田（VKH）病的临床特征。
回顾性非对照病例系列研究。
2001 年 2 月至 2010 年 3 月期间就诊的 486 例 VKH 患者。
回顾性分析所有患者的病史和临床资料。对部分患者进行超声生物显微镜、眼底荧光血管造影和光学相干断层扫描等辅助检查。对这些患者采用皮质类固醇联合或不联合环孢素 A 进行治疗。
患者的人口统计学资料、临床表现和辅助检查结果。
486 例 VKH 患者中有 8 例误诊为急性闭角型青光眼。这 8 例患者的平均年龄为 55.6 岁，均为女性。初诊时平均眼压 32.9mmHg。所有患者均存在前房浅和房角窄或关闭。这些患者的主要症状为双眼突发头痛和视力下降。超声生物显微镜检查显示睫状体和周边脉络膜脱离。这些患者的眼压升高对降眼压治疗反应不佳，而应用皮质类固醇治疗后眼压恢复正常。1 例患者在转诊至葡萄膜炎中心之前因小梁切除术失败而眼球摘除。
以双侧眼压升高为表现的 VKH 病主要发生于老年女性，视力明显下降伴轻中度眼压升高是其诊断线索。皮质类固醇治疗对升高的眼压有效，但对降眼压治疗无效。
