PMC3218169_01
Case 1. (A) Fundus photograph shows bullous retinal detachment in both eyes at presentation. (B) Multiple leakages and poolings in the late phase of fluorescein angiography were detected. (C) Optical coherence tomography image represents intra- and subretinal fluid (SRF) with subretinal septa. (D) SRF was considerably reduced at 3 days after intravenous (IV) pulse steroid therapy. (E) SRF increased at 3 days after changing treatment from IV to oral steroids. (F) SRF resolved at 4 days after IV pulse steroid therapy was restarted. (G) Bullous retinal detachment developed again after changing to oral steroids. (H) SRF resolved after intravitreal injection of triamcinolone acetonide.
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Multiple pinpoint leakages and late pooling within subretinal fluid (SRF) were detected using fluorescein angiography (FA) (Figure 1A and B). AG, Jena, Germany) (Figure 1C). A diagnosis of incomplete VKH disease was determined and treatment with high-dose IV methylprednisolone pulse therapy (1 g/day) was administered for 3 days. During IV steroid treatment, the patient's SRF decreased and her vision improved to 20/40 in both eyes (Figure 1D). At 3 days after switching, the patient's SRF increased and her vision worsened to 20/160 and 20/60 (Figure 1E). SRF reduced and her visual acuity improved remarkably after 4 days (Figure 1F). Systemic steroids were then changed again to an oral formulation. After restarting oral steroid treatment (1.3 mg/kg/day), the patient's vision decreased gradually as bullous retinal detachment developed (Figure 1G). Systemic steroids were tapered to discontinuation without a relapse of inflammation (Figure 1H).
PMC3218169_02
Case 2. (A) Fundus photograph shows serous retinal detachment in both eyes. (B) Multiple leakages and poolings in the late phase of fluorescein angiography were detected. (C) Optical coherence tomography image represents intraretinal fluid accumulation and subretinal septa in the multilobular serous detachment at initial visit. (D) Subretinal fluid (SRF) was remarkably reduced at 3 days after high-dose intravenous pulse steroid therapy. (E) SRF increased at 5 days after starting oral steroids. (F) After intravitreal injection of adjuvant triamcinolone acetonide, SRF resolved and vision recovered. The patient was successfully tapered off oral steroids without rebound phenomenon.
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FA showed multiple pinpoint leakages and late pooling (Figure 2A and B). SD-OCT detected multilobulated serous detachments ( Figure 2C). Serous retinal detachment decreased and his vision improved to 20/50 in the right eye during the 3 days while on IV steroid treatment (Figure 2D). After 5 days of oral steroid treatment, the patient's SRF increased and his vision worsened (Figure 2E). Visual acuity and serous detachment improved (Figure 2F).