A Review of Vogt-Koyanagi-Harada Disease Complicated by Bilateral Adie’s Pupil and Choroidal Blood Flow

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  • Vogt-小柳-原田病経過中に発症したAdie瞳孔と脈絡膜血流の検討―レーザースペックルフローグラフィーを用いて―

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A 34-year-old woman was referred to our hospital with bilateral visual impairment and distortion of images. She was diagnosed with Vogt-Koyanagi-Harada（VKH）disease and treated with a topical steroid and systemic high-dose steroid. One month later, her visual acuity improved but photophobia persisted and both pupils remained unreactive and dilated. The patient was diagnosed with Adie’s tonic pupils as she had a delay in near reaction and denervation supersensitivity to 0.125％ pilocarpine on examination. Epidemiologically, more than 80％ of Adie’s tonic pupils are unilateral but previous reports have found that 8 out of 9 Adie’s tonic pupils accompanied by VKH are bilateral. Therefore, it appears that in bilateral ocular disease such as VKH, Adie’s tonic pupils are likely to occur bilaterally. In a previous report, this development was disproportionate to their visual acuity and their level of inflammation. In this study, however, the choroidal circulation revealed heavy ischemia. Therefore, VKH disease accompanied by bilateral Adie’s tonic pupils may also be associated with choroidal ischemia.

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