Bilateral Retinal Detachments Presenting With Acute Angle Cl
A 60-year-old woman was referred for evaluation of bilateral acute angle closure and retinal detachments. She had emmetropia, and her ocular and medical history were unremarkable. Over the preceding few days, she noticed worsening blurry vision with redness in both eyes associated with headaches, nausea, and severe tinnitus.

On presentation, her best-corrected visual acuity was 20/200 OD and 20/400 OS. Intraocular pressure was 45 mm HgOU. Pupils were 4 mm and minimally reactive. There was 1+ conjunctival injection, diffuse corneal edema with Descemet folds, and the anterior chamber was shallow in both eyes. After the administration ofmultiple rounds of topical and oral medications, her intraocular pressure improved to 18 mm Hg OD and 19 mm Hg OS.

A dilated fundus examination revealed tilted discs, serous retinal detachments, and multiple yellow, depigmented chorioretinal spots throughout the posterior pole in both eyes. B-scan ultrasonography showed shallow retinal detachments, choroidal thickening, and extensive, shallow choroidal detachments extending anteriorly in both eyes (Figure 1A).

A-scan ultrasonography showed normalaxial length of 22mmOU.Optical coherence tomography indicated subretinal fluid and enhanced depth imaging demonstrated significant choroidal thickening in both eyes (Figure 1B). Fluorescein angiography revealed pinpoint hyperfluorescence with leakage. Indocyanine green angiography showed diffuse leakage throughout the posterior pole in both eyes

Final Dx: Vogt-Koyanagi-Harada disease

Vogt-Koyanagi-Harada disease is the diagnosis given bilateral choroidal thickening, serous retinal detachments, and a characteristic pattern of leakage on fluorescein and indocyanine green angiography (Figure 2). Workup for infectious disease and high-dose corticosteroids are the initial treatment of choice for VKHD, and infectious causes must be ruled out before initiation of corticosteroid therapy. Laser iridotomy would help if this was acute primary angle closure; however, in this case the angle closure was secondary to the choroidal thickening and serous detachments causing anterior displacement of the lens-iris diaphragm. Pars plana vitrectomy is not typically indicated for exudative retinal detachments, and sclerectomy is not used to treat VKHD.

Read more here: https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2683724
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