Nguyen Nam V, Khan Farid, Emig Mark, Yeh Steven
College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA.
J Vitreoretin Dis. 2023 Feb 17;7(3):249-253. doi: 10.1177/24741264231152675. eCollection 2023 May-Jun.
To report a case of multifocal central serous chorioretinopathy (CSCR) mimicking Vogt-Koyanagi-Harada (VKH) disease. A 42-year-old man was evaluated for an exudative retinal detachment (RD) with a presumptive diagnosis of VKH while being treated with corticosteroids. The examination showed subretinal fibrin deposition with a bullous, exudative, macula-involved RD in the left eye and a progressive decline in visual acuity (VA) to hand motions. Multimodal imaging showed multifocal hyperfluorescent leaks bilaterally by angiography, highly suggestive of CSCR exacerbated by corticosteroids. After the multifocal CSCR diagnosis, the systemic corticosteroids were tapered and eventually discontinued. The patient was then managed with focal laser photocoagulation, photodynamic therapy, and acetazolamide. The VA improved to 20/30 with complete resolution of the bullous RD at the 12-month follow-up. Extensive bullous RD with subretinal fibrin deposition is an infrequent manifestation of CSCR commonly associated with corticosteroid use that can mimic VKH. Thus, it is important to distinguish CSCR from VKH and the potential of combination therapy in managing chronic multifocal CSCR with a bullous RD.
报告一例伪装成Vogt-小柳原田（VKH）病的多灶性中心性浆液性脉络膜视网膜病变（CSCR）。一名42岁男性因渗出性视网膜脱离（RD）接受评估，在接受皮质类固醇治疗时初步诊断为VKH。检查发现左眼有视网膜下纤维蛋白沉积，伴有大泡性、渗出性、累及黄斑的RD，视力（VA）逐渐下降至手动视力。多模态成像显示血管造影双侧有多灶性高荧光渗漏，高度提示为皮质类固醇加重的CSCR。在诊断为多灶性CSCR后，逐渐减少全身皮质类固醇用量并最终停用。然后对患者进行局部激光光凝、光动力疗法和乙酰唑胺治疗。在12个月的随访中，视力提高到20/30，大泡性RD完全消退。伴有视网膜下纤维蛋白沉积的广泛大泡性RD是CSCR的一种罕见表现，通常与使用皮质类固醇有关，可伪装成VKH。因此，区分CSCR和VKH以及联合治疗在处理伴有大泡性RD的慢性多灶性CSCR中的潜力很重要。
