NEWS & EVENTS
Retinal Review, Issue 53
Authored by Burton Wisotsky, M.D.
A 22 year old woman from El Salvador was referred for vision loss in both eyes. She noted the onset of blurred vision with photophobia and discomfort for three weeks. Past medical history is unremarkable as is past ocular history. On examination, VA was OU 20/200. IOP’s were normal OU. The SLE was significant for 1+ cells and flare OU. DFE showed a mild vitritis OU with retinal findings noted below:
The patient has bilateral choroiditis with retinal vasculitis, vitritis, and serous retinal detachment. The optic nerves are minimally hyperemic but not swollen. There are several cotton wool spots suggesting a retinal vasculitis. She has central depression on her visual field tests, reduced acuity, and multifocal leakage points on her fluorescein angiogram. The differential diagnosis includes multifocal choroiditis with panuveitis, primary retinal vasculitis, and Harada’s disease. Patients with retinal vasculitis should undergo systemic evaluation to look for systemic inflammation/vasculitis. This patient underwent a battery of tests looking for inflammation and autoimmune disease. All the tests were negative. Therefore a primary retinal vasculitis was unlikely. This leaves multifocal choroiditis with panuveitis vs Harada’s disease. The truth is that the actual diagnosis is not critical given that the treatment is identical; however, it is always nice to give a name to an ocular condition. Multifocal choroiditis with panuveitis is often found in young myopic women. Patients have multifocal choroidal lesions with ocular inflammation. It can have an acute, chronic, or relapsing course. During the acute phase there is typically optic nerve edema and moderate vitritis. Harada’s can also have an acute, chronic, or relapsing course. It typically presents in young patients, but is does not have a sex predilection. It is more common in Asians and South/Central Americans. Inflammation can be mild or extensive; the optic nerve may or may not be involved. Although our patient could have fit into either diagnosis, we felt that Harada’s disease was a more likely diagnosis given that she wasn’t myopic, she was from Central America, and her optic nerves were not swollen. We started her on a course of high dose oral prednisone (80mg per day) and within a week she was much improved. On examination the following week, VA was OU 20/25. The serous detachments were gone, and the anterior segments were quiet. OCT confirms the mild residual fluid with marked improvement in subretinal exudation. She was placed on a tapering dose of prednisone and has not had a recurrence.
Dr. Burton Wisotsky
Dr. Danielle Strauss
Dr. George Veliky (Iselin office)
Dr. Mike Veliky (Rochelle Park office)
Dr. Allison LaFata (West Orange office)
Dr. Nazreen Esack (Parsippany office)
Ann Lacey (Marketing Director)