Title : Retinal pigment epithelium tear in vogt-koyanagi-harada disease following treatment
Abstract:
Introduction: Retinal pigment epithelium (RPE) rip in Vogt-Koyanagi-Harada (VKH) disease is a rare complication with only one reported case so far.
Method: Case reports on two patient who presented to Medical Retina referral centre with RPE rip following treatment for VKH. Comparison made with other reported case.
Results: The first case is a 35-year-old Malay woman presented blurring of vision and reduced hearing. Examination noted bilateral panuveitis with multifocal subretinal fluid over the posterior pole, dense subretinal exudates and exudative retinal detachment. IV methylprednisolone was started followed by oral prednisolone. A week later, two large parallel superior & inferior RPE rip was seen in bilateral eyes and her vision remain poor. Optical coherence tomography showed rolled up edges of ripped RPE involving the fovea.
The second case was a 50-year-old Chinese woman, who was referred for second line treatment of VKH. She had history 2 weeks blurring vision and reduced hearing, and had received IV methylprednisolone for 3 days followed by oral prednisolone. Upon review her VA was 6/20 and 6/12 for right and left eye. Fundus of the right eye noted multifocal subretinal fluid and subretinal fibrosis with large, localised RPE rip temporal to fovea, and inferior exudative retinal detachment. Bilateral eye early sunset glow appearance in both eyes.
Conclusion: Only one case of RPE rip in VKH has been reported. Presence of subretinal fibrosis is seen in both our cases, which may contribute to tractional force resulting in RPE rip. However, it was absent in the previous reported case. All three reported cases, developed RPE rip following high dose steroid treatment, possibly due to rapid resolution of subretinal fluid. Thus, RPE rip may be a combination of sequalae of treatment and disease. All cases have presence of large tears.