Maehira Marina, Oshiro Ayano, Imanaga Naoya, Yamauchi Yukihide, Koizumi Hideki
Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
Am J Ophthalmol Case Rep. 2023 Sep 21;32:101929. doi: 10.1016/j.ajoc.2023.101929. eCollection 2023 Dec.
To report Vogt-Koyanagi-Harada (VKH) disease in a patient with extreme anisometropia.
A 56-year-old woman was referred to our hospital. Her past medical history was significant for amblyopia in the right eye. At the initial visit, decimal best-corrected visual acuity (BCVA) was 0.03 (Snellen equivalent 5/160) in the right eye and 0.03 (Snellen equivalent 5/160) in the left eye, and axial length was 28.44 mm and 22.36 mm, respectively. Anterior chamber inflammation was seen predominantly in the right eye with fibrin exudates. Swept-source optical coherence tomography demonstrated choroidal thickening and folds predominantly in the left eye. Additionally, serous retinal detachment (SRD) was much more evident in the left eye than in the right eye. Subfoveal choroidal thickness (SCT) was 417 μm in the right and over 800 μm in the left eye. Cerebrospinal fluid examination revealed lymphocyte-dominant hypercellularity. Based on these findings, we diagnosed the patient with VKH disease and treated her with a high-dose systemic corticosteroid. One month after the initiation of treatment, SRD in both eyes fully resolved, and SCT decreased to 105 μm in the right and 311 μm in the left eye.
The marked discrepancy in axial length between the right and left eyes might contribute to the different severity of inflammation in VKH disease.
报告一名患有极端屈光参差的Vogt-小柳-原田（VKH）病患者。
一名56岁女性被转诊至我院。她既往有右眼弱视病史。初诊时，右眼小数最佳矫正视力（BCVA）为0.03（Snellen等效视力5/160），左眼为0.03（Snellen等效视力5/160），眼轴长度分别为28.44mm和22.36mm。前房炎症主要见于右眼，有纤维蛋白渗出物。扫频光学相干断层扫描显示脉络膜增厚和褶皱主要见于左眼。此外，浆液性视网膜脱离（SRD）在左眼比右眼更明显。右眼黄斑下脉络膜厚度（SCT）为417μm，左眼超过800μm。脑脊液检查显示淋巴细胞为主的细胞增多。基于这些发现，我们诊断该患者为VKH病，并用高剂量全身糖皮质激素治疗。治疗开始1个月后，双眼SRD完全消退，右眼SCT降至105μm，左眼降至311μm。
左右眼眼轴长度的显著差异可能导致VKH病炎症严重程度的不同。
