VKH英文查房201911.6

FFA
1'34'' 6'26''
0'34'' 7'33''
OCTA
A general decline in the sensitivity
disclosed multifocal subretinal fluid, fibrin bands, retinal thickening, and lumpy-bumpy retinal pigment epithelium contour.
• The disease was described at the beginning of the 20th century by Alfred Vogt followed by Yoshizo Koyanagi (1914) and Einosuke Harada (1926) .
• Typical ocular features are chronic, bilateral, non-necrotizing, granulomatous panuveitis with exudative retinal detachment.
• Presenting complaint：This patient presented to a local hospital with complaint of decreased and blurred vision, not preceded by trauma or ocular surgery. There wasn’t headache,dizziness（头晕）, dysacusis(听力下降）, tinnitus（耳鸣）, poliosis（白发）, and vitiligo（白癜风） accompanied his eye complaint.She was diagnosed to be Optic Neuropathy.
Case Report
Neuro-Ophthalmology
Basic information
• Patient: Ms Gao，female , 53 years old
• Chief complaint： Blurring of vision has developed in both eyes for 6 days.
• Past medical history,social history and review of systems: No significant abnormality were observed.
Ocular Examination
Βιβλιοθήκη Baidu
VA：0.4（od）the(BCVA) was 0.6(+1.00DS/-0.75DC×100)

0.3（os） the BCVA was 0.5(+1.00DS/-0.50DC×83)
IOP：15mmHg（ou）
outpatient examination : The ocular anterior segments of both eyes were normal.
opto map
1.Silpa-Archa S,Silpa-Archa N,Preble JM.Vogt-Koyanagi-Harada syndrome:Perspectives for im munogenetics, multimodal imaging, and therapeutic options[J].Autoimmunity reviews,2016, 15(8):809-819.DOI:10.1016/j.autrev.2016.04.001
Vogt–Koyanagi–Harada syndrome
• The Vogt–Koyanagi-Harada (VKH) syndrome is a multisystem disorder characterized by ocular inflammation as well as neurological,audiovestibular, and dermatological symptoms.
7days later
VA： 0.4（od）the BCVA was 0.6 → 0.3（os） the BCVA was 0.5 →
0.8（od）the BCVA was 0.8 0.6（os） the BCVA was 0.8
OCT
Optical Coherence Tomography (OCT) ： indicated subretinal exudation and shallow retinal detachment in both eyes .
Funduscopic examination demonstrated bilateral optic disc edema and retinal folds .
Outpaitent Diagnosis
IDON？ AION？ Uveitis？ Intracranial tumors？
FFA of early to mid-phase revealed classic multifocal areas of pinpoint leakage in both eyes. Late phase of FFA showed more intense leakage resulting in large placoid areas of hyperfluorescence and pooling of dye within subretinal fluid.
OCT
Test
HLA-DR4-DNA and HLA-DRw53-DNA(+)
Diagnosis
Vogt–Koyanagi–Harada syndrome(VKH)
Treatment
Pred Forte ou q2h Pronoprofen Eye Drops ou qid Atropine Sulfate Eye Gel ou tid Shuxuetong Injection 3.0g ivdrip qd Methylprednisolone 1000mg ivdrip qd Liurui capsules 0.5g po bid