Demography, clinical features, and outcomes of Vogt-Koyanagi-Harada disease presenting with bullous exudative retinal detachment.

PURPOSE: To describe the clinical course and treatment outcomes of Vogt-Koyanagi-Harada (VKH) disease presenting with bullous exudative retinal detachment (bullous ERD).

METHODS

This retrospective study included all patients diagnosed with VKH presenting with bullous ERD in one or both eyes between 2016 and 2024. Their best-corrected visual acuity (BCVA), clinical presentations, and treatment outcomes were analyzed.

RESULTS

Among 646 patients with VKH, 12 (22 eyes) presented with bullous ERD in the early stage of the disease. The mean age at presentation was 38.67 years (range: 22-58 years). Bilateral bullous ERD was noted in 10/12 patients, while two had unilateral involvement. The mean BCVA at presentation and the final follow-up was 1.74 logMAR (SD 0.67, range 0.2-2.3 logMAR) and 0.84 logMAR (SD - 0.57, range 0-2.2), respectively. Anterior segment inflammation was noted in 15 eyes (68.1%), disc edema in 16 (72.7%), and vitritis and choroidal detachment in four eyes each (18.2%). The average choroidal thickness on B-scan ultrasonography was 1.79 mm (range: 1.04-3.57 mm). Six eyes (27%) experienced acute exacerbations, and five eyes (22.7%) had recurrences. The mean follow-up was 17 months (range: 6-61). At final follow-up, sunset glow fundus developed in 17 eyes (72%), secondary glaucoma in eight eyes (36.3%), and subretinal fibrosis in nine eyes (41%).

CONCLUSION

Bullous ERD is a rare manifestation of VKH. Although initial visual recovery is promising, these patients are at higher risk for disease exacerbation, recurrences, and complications. Initial aggressive therapy and prolonged follow-up with sustained immunosuppression are essential for optimal outcomes.