Title : A mysterious case of unilateral disc edema
Abstract:
A 43- year female presented with diminished vision in her right eye since 5 months (visual acuity of FCCF) associated headache. On examination she had grade 5 disc edema with peripapillary fluid and partial macular star. Fellow eye was clinically normal. All investigations were negative. OCT scans passing through the macula showed RPE undulations, two separate subretinal fluid pockets at macula and bacillary layer detachment (BLD). OU Sub foveal choroid was thickened. FFA showed pin point hyperfluorescence at the posterior pole with evidence of late pooling of dye inferior to disc. Left eye also showed pin point hyperfluorescence at the macula. A diagnosis of atypical VKH was made and she was started on oral steroids (1mg/kg) and immunosuppressants(IST). The subretinal fluid, BLD and disc edema showed resolution in 4weeks following treatment initiation. At 6 month follow up the patient presented with similar findings in fellow eye. She had stopped treatment. After reinitiation of treatment, patient showed signs of resolution and has been doing fine till 1 year follow up.Both eyes showed resolution of disc edema and clearing of fluid on OCT with improvement of visual acuity after treatment. The patient has been doing fine till one year follow up on maintenance dose of Azathioprine. VKH can present as neuroretinitis and should be kept in the differentials of disc edema where other diagnosis have been ruled out. FFA/ICGA should be performed in all suspicious cases. Long term maintenance dose of immunosuppressants is required in these cases to prevent recurrences.
