J Korean Ophthalmol Soc.  2018 Feb;59(2):190-196. 10.3341/jkos.2018.59.2.190.

A Case of Intravitreal Dexamethasone Implantation in a Patient with Vogt-Koyanagi-Harada Disease

• Kim S
• Lee EK

• KMID: 2403815
• DOI: http://doi.org/10.3341/jkos.2018.59.2.190

Abstract

PURPOSE
To report a case of Vogt-Koyanagi-Harada (VKH) disease with chronic recurrence, which was treated with intravitreal dexamethasone implantation.
CASE SUMMARY
A 39-year-old female presented with decreased visual acuities in both eyes accompanied by headaches and tinnitus the previous week. On fundus examination and optical coherence tomography, multiple serous retinal detachments with subretinal septa were observed in both eyes, and she was diagnosed with VKH disease. After undergoing high dose intravenous steroid therapy at another hospital, she was treated with oral prednisolone and immunosuppressant drugs. However, she showed frequent recurrences, and also complained of side effects from prolonged systemic steroids. We then performed intravitreal injections of dexamethasone implants in both eyes at 3-week intervals. One month following the injections, the inflammations in the anterior chamber and vitreous opacities were improved. Until the last visit at 6 months after the injection, there was no significant recurrence of inflammation, although oral prednisolone had been tapered.
CONCLUSIONS
In VKH disease, intravitreal dexamethasone implantation may be an effective treatment option if chronic recurrence occurs, despite systemic steroid and immunosuppressant therapy or sustained treatment being difficult to maintain because of side effects.

Keyword

Intravitreal dexamethasone implant; Uveitis; Vogt-Koyanagi-Harada disease

MeSH Terms

Adult
Anterior Chamber
Dexamethasone*
Female
Headache
Humans
Inflammation
Intravitreal Injections
Prednisolone
Recurrence
Retinal Detachment
Steroids
Tinnitus
Tomography, Optical Coherence
Uveitis
Uveomeningoencephalitic Syndrome*
Visual Acuity
Dexamethasone
Prednisolone
Steroids

Figure

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  Figure 1. Fundus color photographs (A, B) and optical coherence tomography (OCT) images (C, D) at the first visit. Fundus color photographs of right (A) and left (B) eye showed multiple serous retinal detachments. OCT images of right (C) and left (D) eye revealed massive subretinal exudative fluid and subretinal septa. Long thin white arrows indicate OCT scan direction.

• 

  Figure 2. Fundus color photographs (A, B) and optical coherence tomography (OCT) images (C, D) after intravenous steroid pulse therapy following high dose oral steroid. (A, B) Sunset glow fundus with retinal pigment epithelium clumping are shown. (C, D) The serous retinal detachment is greatly improved but shallow subretinal fluid still remained beneath the fovea. Long thin white arrows indicate OCT scan direction.

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  Figure 3. Fundus color photographs (A, B) and optical coherence tomography (OCT) images (C, D) before intravitreal dexamethasone implant injection. (A, B) Severe vitreous opacities are present. (C, D) Although subretinal fluid was absorbed, vitreous opacities with undulation of retinal pigment epithelium are shown and choroidal thickness increased. Long thin white arrows indicate OCT scan direction.

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  Figure 4. Fundus color photographs (A, B) and optical coherence tomography (OCT) images (C, D) at 1 month after intravitreal dexamethasone implant injection. (A, B) The vitreous opacities diminished. (C, D) The vitreous opacities with retinal pigment epithelium undulation were improved and choroidal thickness decreased. Long thin white arrows indicate OCT scan direction.

Reference

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