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

Seondo Kim; Eun Kyoung Lee

doi:10.3341/jkos.2018.59.2.190

Journal List > J Korean Ophthalmol Soc > v.59(2) > 1010860

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Kim and Lee: A Case of Intravitreal Dexamethasone Implantation in a Patient with Vogt-Koyanagi-Harada Disease

Original Article

J Korean Ophthalmol Soc 2018;59(2):190-196.

Published online: 25 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.2.190

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

Seondo Kim, MD, Eun Kyoung Lee, MD

Department of Ophthalmology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea

Address reprint requests to Eun Kyoung Lee, MD Department of Opthalmology, Jeju National University Hospital, #15 Aran 13-gil, Jeju 63241, Korea Tel: 82-64-717-1730, Fax: 82-64-717-1029 E-mail: righthanded8282@gmail.com

Received 17 August 2017 Revised 25 October 2017 Accepted 18 January 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Intravitreal dexamethasone implant, Uveitis, Vogt-Koyanagi-Harada disease

References

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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.

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.

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.

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