A 45-year-old woman presents with bilateral painless visual loss and floaters. Fundoscopy shows multifocal choroidal lesions at the level of retinal pigment epithelium, disc edema, and exudative retinal detachment bilaterally. She has a history of vitiligo and poliosis. The mechanism of retinal detachment in this condition is:

• A Retinal break formation due to rhegmatogenous detachment from peripheral uveitis
• B Choroidal effusion causing exudative (serous) retinal detachment due to disrupted blood-retinal barrier ✓
• C Tractional retinal detachment from vitreoretinal proliferative membranes
• D Neovascular membrane formation under the retina causing hemorrhagic detachment

Explanation

Vogt-Koyanagi-Harada (VKH) syndrome is a T-cell-mediated granulomatous autoimmune disease targeting melanocytes in the uvea, skin, inner ear, and meninges (hence vitiligo and poliosis are associated features). The acute/uveitic phase is characterized by bilateral granulomatous choroiditis with massive exudative serous retinal detachments — caused by inflammatory disruption of the outer blood-retinal barrier at the level of RPE, allowing choroidal exudate to accumulate subretinally. There are no retinal breaks and no traction. Early systemic corticosteroids are crucial to prevent 'sunset glow' fundus and chronic sequelae.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.