Bilateral Shallow Anterior Chamber And Transient Myopia As A Presenting Feature Of Vogt Koyanagi Harada Syndrome

Abstract

The Vogt-Koyanagi-Harada (VKH) syndrome is a rare systemic disorder of uveitis, dysacousia, vitiligo, premature greying of the hair, eyebrow and eyelashes, and meningoencephalitis. We report a case of a 36 year old type 2 diabetic patient who presented with sudden, painless, progressive blurring of vision in both eyes with shallow anterior chamber and transient myopia. He had history of headache, mild fever, malaise with stiffness in neck and back one week before blurring of vision. Exudative retinal detachment on fundus examination along with optical coherence tomography (OCT) features and fundus fluorescein angiogram (FFA) pattern confirmed our diagnosis as incomplete VKH. The patient responded well with steroid (systemic and topical) and cycloplegic drug. This case highlights the importance of history, careful ocular evaluation, judicious use of OCT and FFA in a patient presenting with bilateral shallow anterior chamber and transient myopia to narrow down the differential diagnosis as incomplete VKH. both eye myopic refraction. Anterior segment of both shallow anterior inflammatory uveitis Posterior segment had mild vitritis in both eyes. In both the eyes, applanation tonometry was 18 millimeters of mercury. Schwalbe’s line was visible on gonioscopy in both eyes and on indentation the angles opened up to scleral spur. Fundus showed multilobular areas of subretinal fluid pockets (exudative retinal detachment) at the posterior pole and mid periphery with creamy yellow choroidal lesions, clinically suggestive of exudative pathology. There were no signs of diabetic retinopathy. On laboratory investigations, complete blood count was within normal limits, erythrocyte sedimentation rate (ESR) was 20mm/hour, Mantoux skin test was negative (3x3 mm), human immune deficiency virus (HIV) and Treponemal pallidum haemagglutination assay (TPHA) were non reactive. Serum angiotensin converting enzyme (ACE) was 24 IU (normal). Chest X ray, HRCT Chest, USG of whole abdomen was normal. Optical coherence tomography at macula of both eyes showed multiple areas of neurosensory detachment with largest volume and subfield thickness at macula & fluorescein angiogram (FFA) of early and mid-phase showed multiple hyperfluorescent Abstract