J Korean Ophthalmol Soc > Volume 59(10); 2018 > Article
Journal of the Korean Ophthalmological Society 2018;59(10):978-983.
DOI: https://doi.org/10.3341/jkos.2018.59.10.978    Published online October 15, 2018.
A Case of Atypical Vogt-Koyanagi-Harada Disease Preceded by Acute Angle Closure Glaucoma.
Min Gyu Choi, Yeoun Sook Chun, Jee Taek Kim
Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea. jeetaek-kim@hanmail.net
급성 폐쇄각녹내장을 동반한 비전형적인 보그트-고야나기-하라다병 1예
최민규⋅전연숙⋅김지택
중앙대학교 의과대학 중앙대학교병원 안과학교실
Correspondence:  Jee Taek Kim,
Email: jeetaek-kim@hanmail.net
Received: 17 May 2018   • Revised: 27 June 2018   • Accepted: 27 September 2018
Abstract
PURPOSE
To report a case of atypical Vogt–Koyanagi–Harada disease that occurred after an acute angle closure glaucoma attack. CASE SUMMARY: A 48-year-old female presented with bilateral visual disturbance accompanied by headache and ocular pain. The patient had no specific past medical or family history except taking oral contraceptives for 10 years. Despite the normalization of intraocular pressure in a local clinic, a shallow-depth anterior chamber and forward displacement of the iris–lens diaphragm remained unresolved. The depth of the anterior chamber had increased in both eyes after laser therapy but without recovery of her visual acuity. B-scans showed ciliochoroidal effusion. Anterior chamber inflammation was observed in both eyes. Optical coherence tomography showed lobulated and serous retinal detachment involving the macula of both eyes. However, fluorescence angiography findings showed no multiple hyperfluorescence, which is unusual for typical cases of Vogt–Koyanagi–Harada disease. The patient was diagnosed with atypical Vogt–Koyanagi–Harada disease and was treated with eyedrops and intravenous steroid pulse therapy, after which she was converted to oral medications with immunosuppressants. After 1 month, no serous retinal detachment was detected. After 3 months, best corrected visual acuity (logMAR) was 0.0 in both eyes, and there has been no recurrence on follow-up. CONCLUSIONS: Atypical Vogt–Koyanagi–Harada disease at presentation can mimic acute attacks of angle closure glaucoma. Therefore, if there is no improvement after treatment for angle closure glaucoma including laser iridotomy, other diseases including Vogt–Koyanagi–Harada disease must be considered and the patient should be closely monitored.
Key Words: Angle closure glaucoma;Atypical;Laser iridotomy;Vogt–Koyanagi–Harada disease


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