A 54-year-old Japanese woman presented with bilateral blurring of vision associated with headache that had started 2 weeks earlier. Her general family medical history and her personal medical history, including her history of ocular disease, were unremarkable. The best-corrected visual acuity on presentation was 0.6 in the right eye and 0.1 in the left eye. The intraocular pressure was normal in both eyes. Slit-lamp biomicroscopy showed bilateral anterior chamber cells and posterior synechiae, and fundus examination showed bilateral disc swelling with exudative retinal detachment (fig. ).\nFluorescein angiography detected bilateral multifocal leakage with pooling of dye in the subretinal space in the late phase (fig. ). Indocyanine green angiography showed patches of hyperfluorescence and hypofluorescent spots bilaterally (fig. ). A spectral-domain OCT (Cirrus HD-OCT 4000; Carl Zeiss Meditec Inc.) image of the eyes showed the bilateral presence of subretinal fluid and pigment epithelial detachment. Moreover, only in the left eye was unilateral choroidal excavation detected under the fovea, and the contour of the retinal pigment epithelium appeared to be conforming to the shape of the fibrin (fig. ).\nSystemic workup revealed positive HLA-DR4 as well as cerebrospinal fluid pleocytosis. A diagnosis of VKH was reached soon afterwards. Thus, our patient was treated with intravenous pulse methylprednisolone followed by oral prednisolone (initial dose of 40 mg/day) with tapering over a course of 6 months. Treatment successfully resolved the VKH symptoms, and serial OCT showed a gradual reduction in size and a subsequent disappearance of the subretinal fibrin and fluid (fig. ). However, 1 month after having started treatment, the eye was left with an area of choroidal excavation at the fovea despite a normal contour in the right eye (fig. ). There was a good recovery of visual acuity, with 1.2 and 0.9 in the right and the left eye, respectively. Presently, the patient is being followed-up without complications and medications.
A 17-year-old female presented with metamorphopsia and blurred vision in right eye (OD) since 1 week. Her best corrected visual acuity (BCVA) was 6/9;N8 in OD and 6/6;N6 in left eye (OS). Clinical examination revealed findings suggestive of choroidal neovascular membrane (CNVM). Her spectral-domain optical coherence tomography (SD-OCT) showed an active Type 2 CNVM associated with a FCE, which was confirmed by fundus fluorescein angiography (FFA). She was treated with multiple intravitreal antiVEGF injections. At her follow-up visits there was significant CNVM resolution, but FCE was progressively increasing in depth, as measured from a horizontal line drawn at the level of RPE to the inner margin of FCE, from 121 μm to 256 μm over the period of 2 years, possibly due to the contraction of the underlying scar [].