In a patient with bilateral panuveitis, CNS white matter lesions on MRI, poliosis, vitiligo, and sensorineural hearing loss, the diagnosis is Vogt-Koyanagi-Harada (VKH) disease. The pathognomonic OCT finding in the acute phase is:
- A Epiretinal membrane formation
- B Inner retinal thickening with cystoid spaces
- C Multifocal subretinal fluid pockets with loculation, folds of outer plexiform layer, and serous retinal detachment ✓
- D Full-thickness macular hole
Explanation
VKH disease in its acute uveitic phase shows multifocal serous retinal detachments on fundus exam and on OCT — multiple loculated subretinal fluid pockets, folds of the outer plexiform layer (due to diffuse choroidal thickening compressing the retina), and separation of the neuroretina from RPE. B-scan ultrasonography shows diffuse choroidal thickening and scleral involvement. The pathology is T-cell mediated autoimmune attack against melanocytes in choroid, meninges, inner ear, and skin. High-dose systemic corticosteroids are the mainstay of acute treatment; immunosuppressants are added for chronic/recurrent disease.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.