Management of ocular complications of Vogt-Koyanagi-Harada syndrome.
BACKGROUND
Vogt-Koyanagi-Harada syndrome (VKH) is a multisystem disorder, characterized by the T-cell-mediated autoimmune process directed against melanocytic antigens in the ocular, nervous, auditory and integumentary systems. The ocular hallmarks of the disease involve severe bilateral panuveitis associated with exudative retinal detachment.


METHODS
We report a pediatric case of probable VKH Syndrome with isolated ocular findings, in which bilateral vitritis, papillitis and serous retinal detachments involving the macula with intra-retinal edema and choroideal thickening were detected.


METHODS
Subtenon triamcinolone acetonide injection was performed in addition to systemic corticosteroid and cyclosporine treatments. Evolution Prompt improvement was seen in the ocular manifestations of VKH syndrome, which persisted for at least 4 months. Subtenon corticosteroid injection, together with systemic corticosteroid and cytotoxic treatment, prevented the ocular complications of invasive intraocular treatment modalities, and at the same time reduced the systemic corticosteroid dosage.


CONCLUSIONS
We recommend use of ocular invasive treatment modalities in Vogt-Koyanagi-Harada Syndrome only if the disease progression cannot be controlled. If systemic medications fail to stop the progression of the disease activity, subtenon injections may be considered before intraocular treatment modalities.
Perente
Irfan
I
Eye Clinic, Turkiye Hospital, Istanbul, Turkey.
Utine
Canan Asli
CA
Cakir
Hanefi
H
Kaya
Vedat
V
Tutkun
Ilknur Tugal
IT
Yilmaz
Omer Faruk
OF
D000293:Adolescent; D016572:Cyclosporine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005128:Eye Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D009901:Optic Nerve Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D012163:Retinal Detachment / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D041623:Tomography, Optical Coherence; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D014463:Ultrasonography; D014607:Uveomeningoencephalitic Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014822:Vitreous Body / Q000000981:diagnostic imaging / Q000473:pathology*
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D014222:Triamcinolone Acetonide