A middle-aged patient with no past medical history presented with acute onset vision loss in the left eye with flashes and floaters for one day. Best-corrected visual was 20/80 in the right eye and 20/800 in the left eye. Intraocular pressures were normal. Anterior segment exam was unremarkable. Dilated fundus exam revealed subretinal fluid. Macula optical coherence tomography (OCT) showed a serous retinal detachment in the right eye and multifocal serous retinal detachments in the left eye as well as a significant bacillary layer detachment (BALAD). Uveitis review of systems questionnaire and laboratory work up were both unremarkable. The patient was diagnosed with presumed Vogt-Koyanagi-Harada (VKH) disease and started on high-dose oral prednisone (60 mg daily) with a slow taper. At the three-week follow up, the patient’s visual acuity had improved to 20/30 in the right eye and 20/40 in the left eye, and OCT showed significant improvement in subretinal fluid in both eyes and resolution of BALAD in the left eye. By the six-week follow up, the patient’s visual acuity had improved to 20/25 in the right eye and 20/30 in the left eye. Macula OCT showed complete resolution of subretinal fluid in both eyes.
Presentation Date: 08/03/2023
Issue Date: 08/18/2023