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LETTER TO EDITOR
Year : 2017  |  Volume : 29  |  Issue : 2  |  Page : 146

Bilateral exudative detachments – “All that detaches is not Vogt-Koyanagi-Harada”


Department of Ophthalmology, Al-Salama Hospital, Perinthalmanna, Kerala, India

Date of Web Publication10-Aug-2017

Correspondence Address:
Rajesh Puthussery
Department of Ophthalmology, Al.Salama Hospital, Perinthalmanna, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_88_17

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How to cite this article:
Puthussery R. Bilateral exudative detachments – “All that detaches is not Vogt-Koyanagi-Harada”. Kerala J Ophthalmol 2017;29:146

How to cite this URL:
Puthussery R. Bilateral exudative detachments – “All that detaches is not Vogt-Koyanagi-Harada”. Kerala J Ophthalmol [serial online] 2017 [cited 2021 May 7];29:146. Available from: http://www.kjophthal.com/text.asp?2017/29/2/146/212769



Dear Sir,

I congratulate Dr. Natasha for discussing an interesting case of bilateral serous detachment of retina in the diagnostic and therapeutic section of the Januaray– April 2017 issue of the journal. The doctors who have taken part in the discussion on the above case also have elaborated on the various differential diagnoses one should think about when presented with such a case. The diagnosis of bilateral diffuse uveal melanocytic proliferation (BDUMP) which the author has arrived at is based on the nonresolving nature of the disease with immunosuppression, fluorescein angiographic appearance of early hyper fluorescent spots, and subsequent discovery of breast carcinoma. Interstingly, the optical coherence tomography pictures show the presence of subretinal septae dividing the subretinal space into compartments and undulations of the retinal pigment epithelial; appearances which are commonly seen in relation to Vogt-Koyanagi-Harada (VKH). Hyperfluoresence of the disc on fluorescein angiography also may suggest an inflammatory etiology. Indocyanine green (ICG) may show hypofluoresecnt dots in BDUMP. Hypofluorescent dots on ICG in VKH can disappear while on treatment. The dose of immunosuppressants for treating the systemic disorder may not be sufficient enough to completely control the ocular inflammation leading to masking of many features of the ocular disease. In the given scenario, the best probable diagnosis is BDUMP, although it should be kept in mind that some of the inflammatory disorders can have confusing presentaion or incomplete response to treatment if the immunosuppression is inadequate or not given enough time to act.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.






 

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