A 35-year-old Japanese woman develops bilateral progressive visual loss with headaches, hearing loss, and tinnitus over 4 weeks. Fundus shows bilateral disc edema and exudative retinal detachments. She is diagnosed with Vogt-Koyanagi-Harada (VKH) disease. The MOST appropriate initial treatment is:
- A High-dose systemic corticosteroids (IV methylprednisolone 1 g/day × 3 days then oral taper) ✓
- B Topical corticosteroids alone
- C Intravitreal anti-VEGF for exudative detachments
- D Cyclosporine alone
Explanation
VKH disease is an autoimmune condition targeting melanocyte-containing tissues (uvea, CNS, skin, ear) causing bilateral granulomatous panuveitis with exudative retinal detachments, meningism, and auditory symptoms. High-dose systemic corticosteroids (IV pulse methylprednisolone 1 g/day × 3 days followed by long oral taper over ≥6 months) is the mainstay of initial treatment to prevent permanent vision loss and prevent recurrences. Topical steroids are inadequate for the systemic inflammation. Anti-VEGF does not address the underlying inflammatory pathology. Cyclosporine is used as a steroid-sparing agent for chronic or recalcitrant disease.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.