Vogt-Koyanagi-Harada Diseases Diagnosis by Means of Ocular Multimodal Imaging: A Case Report

Abstract

Aims: Vogt-Koyanagi-Harada (VKH) disease is a rare autoimmune uveo-meningeal disorder with variable clinical presentations. The aim of this report, prepared in accordance with the CARE case report checklist, is to describe a case of purely ocular VKH disease and highlight the role of multimodal imaging and early corticosteroid therapy in its management. Presentation of Case: We report the case of a 37-year-old woman with no history of systemic illness, ocular trauma, or surgery, who presented with acute bilateral visual loss of 15 days’ duration. Ophthalmic examination revealed light perception in both eyes, with normal anterior segment and intraocular pressure. Fundus examination showed multiple bilateral serous retinal detachments. Fluorescein angiography demonstrated delayed choroidal filling, diffuse pinpoint hyperfluorescent leaks, pooling into multifocal serous retinal detachments, and bilateral optic disc edema. Optical coherence tomography confirmed multilobular serous retinal detachments with intraretinal septa. No extraocular manifestations were present, and laboratory and immunologic work-up were unremarkable. The diagnosis of possible VKH disease (purely ocular form) was made. The patient received three consecutive daily intravenous pulses of methylprednisolone (1 g/day), followed by oral prednisone (1 mg/kg/day) with gradual tapering. Functional recovery was rapid, with visual acuity improving to 10/10 in the right eye and 9/10 in the left eye after two months. Discussion: Diagnostic criteria for VKH disease have evolved from the early description of Sugiura to the 2001 First International Workshop classification, which recognizes complete, incomplete, and possible forms. Our case illustrates the importance of considering VKH even in the absence of systemic involvement and demonstrates the diagnostic value of multimodal imaging, especially fluorescein angiography and OCT. Early and aggressive corticosteroid therapy remains the cornerstone of management, with immunosuppressive agents reserved for resistant or recurrent forms. Conclusion: Purely ocular VKH disease is rare and diagnostically challenging in the absence of extraocular signs. However, a high index of suspicion, supported by multimodal imaging, enables early recognition. Prompt initiation of systemic corticosteroid therapy is associated with favorable functional and anatomical outcomes.Koyanagi Harada (VKH) disease is a rare autoimmune uveo-meningeal disorder with variable clinical presentations.