[A case of anterior ischemic optic neuropathy associated with Vogt-Koyanagi-Harada disease]

Although optic disc swelling is one of the common findings of Vogt-Koyanagi-Harada (VKH) disease, severe visual field loss from optic disc involvement is not common. We report a case of severe visual field contraction from optic disc involvement in VKH disease.

A 51-year-old woman was diagnosed as having VKH disease and was treated with intravenous pulse methylprednisolone. Exudative retinal detachments disappeared and visual acuity improved, but optic disc swelling was persistent in both eyes. Ten weeks after VKH disease onset, she claimed acute visual field loss in the right eye. Marked optic disc swelling with peripapillary hemorrhages and severe visual field loss were observed in the right eye. Fluorescein angiography showed filling delay and late leakage of the optic disc in the right eye. One month later, right optic disc swelling disappeared, but visual field loss remained. In addition, 5.5 months later, the left optic disc swelled further, and the left visual field was markedly contracted. Hyperbaric oxygen therapy was added. The swelling in the left optic disc gradually decreased and disappeared in one month, but the visual field loss remained.

The optic disc involvement with irreversible visual field loss in this case is thought to be due to anterior ischemic optic neuropathy, which may be a possible complication of VKH disease.