Lumbini Eye Institute and Research Centre, Bhairahawa, Nepal.
Nepal J Ophthalmol. 2020 Jan;12(23):146-152. doi: 10.3126/nepjoph.v12i1.26202.
Vogt-Koyanagi-Harada (VKH) disease is defined as an autoimmune disorder characterized by bilateral granulomatous panuveitis with systemic manifestations, such as tinnitus, vertigo, and meningism caused by melanocyte antigen-reactive T-cells. Majority of VKH patients present at the age between 20 and 50 years. VKH is uncommon in elderly and challenging to manage. VKH is one of the important differential diagnosis of bilateral pan uveitis Case: A 65 year/ female brought with chief complaint of sudden loss of vision in both eyes, headache and hearing problem for 1 month. She didn't give any history of other systemic illness, ocular surgery, ocular trauma, chronic use of medicament. Her visual acuity was hand movement with accurate projection of rays (HM) in both eyes The intraocular pressure (IOP) was 12mmHg in both eye. Slit-lamp bio microscopy revealed features of Pan uveitis in both eye. Systemic work up revealed no any other abnormalities. A diagnosis of early phase VKH was made and treated with intravenous pulse steroid therapy followed by tapering dose of oral steroid along with immunemodulator resulting in a very good visual recovery.
VKH can present in elderly. immunomodulator should be considered in elderly to prevent side effect of steroid along with recurrence of inflammation.
Vogt-Koyanagi-Harada（VKH）病被定义为一种自身免疫性疾病，其特征为双侧肉芽肿性全葡萄膜炎伴全身表现，如黑色素细胞抗原反应性 T 细胞引起的耳鸣、眩晕和脑膜刺激征。大多数 VKH 患者的发病年龄在 20 至 50 岁之间。老年人中 VKH 不常见，且难以治疗。VKH 是双侧全葡萄膜炎的重要鉴别诊断之一。
一名 65 岁女性，因双眼突发性视力丧失、头痛和听力问题 1 个月就诊。她没有其他全身疾病、眼部手术、眼部创伤或长期使用药物的病史。她的视力在双眼均为手动（HM）。双眼眼压（IOP）均为 12mmHg。裂隙灯生物显微镜显示双眼全葡萄膜炎的特征。系统检查未发现其他异常。诊断为早期 VKH，并给予静脉注射类固醇脉冲治疗，随后逐渐减少口服类固醇剂量，并联合免疫调节剂治疗，视力恢复良好。
VKH 可发生于老年人。在老年人中应考虑使用免疫调节剂，以预防类固醇的副作用和炎症的复发。
