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Multiple and Recurrent Ocular Manifestations in a Patient of Vogt-Koyanagi-Harada Syndrome
原田氏症在眼睛的多種表現和復發－病例報告
摘要
目的：報告原田氏症在眼睛的多種與復發。 方法：病例報告。 結果：一位十七歲女性雙眼視力模糊一星期，眼底檢查發現雙眼黃斑部漿液性視網膜剝離螢光眼底攝影呈現許多針狀滲漏點，診斷為原田氏症。之後病人髮生五次虹彩炎，對口服、點眼、Tenon下注射類固醇反應良好，雙眼視力均恢復到1.0。眼部後遺症有眼底黃昏光輝狀變化、殘留之視神經水腫，和腿色Dalen-Fuchs結節：皮膚後遺遺症有掉髮和白髮。因萎縮性瘢痕出現於眼底中央凹窩，最後視力降低至右眼0.03和左眼0.4。 結論：此原田氏症病低於眼睛和皮膚有多種表現，並經常復發。類固醇治療效果良好，但減藥速度心謗腹非緩慢，對於嚴重或難治之病人可施予Tenon下triamcinolone注射。年輕型病人肥特別注意其容易復發和視力預後不良。
關鍵字
無資料並列摘要
Purpose: To report a case of Vogt-Koyanagi-Harada (VKH) syndrome with multiple ocular manifestations and recurrences. Methods: Case report. Case Report: A 17-year-old female patient presented with bilateral blurred vision for one week. Fundus examinations showed bilateral macular serous detachment, and fluorescein angiography revealed multiple pinpoint leakages, compatible with VKH syndrome. Subsequently, the patient developed a total of 5 consecutive episodes of anterior uveitis, occurring mostly after steroid tapering or a URI episode. Each attack responded well to oral prednisolone, prednisolone eye drops and sub-Tenon's triamcinolone injection, with a good recovery of visual acuity to 20/20 bilaterally. The oculocutaneous sequelae were a sunset-glow fundus with residual disc edema and depigmented regressed Dalen-Fuchs' nodules and cutaneous changes of hair loss and whitish hair. Because of later development of atrophic scars at the fovea, the final visual acuity deteriorated to 20/600 in the right eye and 20/50 in the left eye. Conclusions: This patient developed multiple ocular and cutaneous manifestations of VKH syndrome with frequent recurrences. Steroid treatments can yield good results but must but be tapered gradually, and sub-Tenon's injection of triamcinolone cam be ised om severe pr omtractable cases. Particular precaution should be taken for young patients for their recurrences and poor visual outcome.