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VOGT-KOYANAGI-HARADA DISEASE WITH INITIAL PRESENTATION AS BILATERAL ACUTE ANGLE-CLOSURE ATTACK: A CASE REPORT
原田氏症病患以雙側急性隅角閉鎖為第一表現之病例報告
摘要
目的：原田氏症病患以雙側急性隅角閉鎖為第一表現之病例報告。方法：病例報告。結果：一名39 歲男性病患，過去無已知系統病史，主訴雙眼急發性視力模糊及脹痛，最佳矯正視力右眼為零點陸，左眼為壹點零，壓平眼壓計測量右眼眼壓為48 毫米汞柱、左眼44 毫米汞柱，雙眼前房淺窄無發炎細胞，隅角鏡見雙眼四象限之隅角閉鎖，間接眼底鏡見雙眼視網膜皺摺併滲液性視網膜剝離，螢光血管攝影見雙眼廣泛針點樣滲漏，左耳耳鳴於視力模糊初發二週後發生，病患被診斷為原田氏症，類固醇療法後病患雙眼最佳矯正視力為壹點零，且眼壓恢復正常。結論：年輕病患表現雙眼急性隅角閉鎖時，即使前房無發炎細胞，也應將原田氏症列入鑑別診斷。
關鍵字
無資料並列摘要
Purpose: To report a case of Vogt-Koyanagi-Harada disease with bilateral acute angle closure attack as initial presentation. Method: Case report and literature review. Results: A 39-year-old man presented with sudden onset of bilateral blurred vision and eye fullness. Ophthalmic examination revealed best corrected visual acuity of 6/10 in right eye and 6/6 in left eye. Goldmann applanation tonometry was 48 mmHg in right eye and 44 mmHg in left one. Anterior chambers were shallow with no cell or flare. Gonioscopy showed appositional angle closure in all quadrants bilaterally. Indirect ophthalmoscopy showed bilateral retina striae with serous detachment. Fluorescein angiography showed diffuse pinpoint dye leakage with localized subretinal fluid temporal to macula in both eyes. Left side tinnitus occurred about two weeks after onset of blurred vision. Vogt-Koyanagi-Harada disease was diagnosed concluding all clinical presentations. His visual acuity recovered to 6/6 bilaterally after steroid treatment and his intraocular pressure returned to normal range. Conclusion: Vogt-Koyanagi-Harada disease should be included in differential diagnosis of young patients with bilateral acute angle-closure attack despite little evidence of anterior segment inflammation.