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   Table of Contents      
LETTER TO THE EDITOR
Year : 2021  |  Volume : 69  |  Issue : 1  |  Page : 183

Comments on: Vogt - Koyanagi - Harada disease associated with anterior ischemic optic neuropathy in a young woman presenting as acute angle-closure glaucoma


Aravind Eye Hospital, Madurai, Tamil Nadu, India

Date of Web Publication15-Dec-2020

Correspondence Address:
Dr. George Varghese Puthuran
Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai - 625 020, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2784_20

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How to cite this article:
Wijesinghe HK, Puthuran GV, Krishnadas SR. Comments on: Vogt - Koyanagi - Harada disease associated with anterior ischemic optic neuropathy in a young woman presenting as acute angle-closure glaucoma. Indian J Ophthalmol 2021;69:183

How to cite this URL:
Wijesinghe HK, Puthuran GV, Krishnadas SR. Comments on: Vogt - Koyanagi - Harada disease associated with anterior ischemic optic neuropathy in a young woman presenting as acute angle-closure glaucoma. Indian J Ophthalmol [serial online] 2021 [cited 2021 Jan 16];69:183. Available from: https://www.ijo.in/text.asp?2021/69/1/183/303320



Dear Editor,

We read with interest the case reported by Patyal et al.[1] on Vogt-Koyanagi-Harada (VKH) disease associated with anterior ischemic optic neuropathy (AION) in a young woman presenting as acute angle-closure glaucoma. We are surprised by the authors' decision to attribute the disc damage to AION. Anterior ischemic optic neuropathy is typically associated with optic disc edema with neuroretinal rim pallor in majority.[2] It is also associated with “flu”-like symptoms, weight loss, fever of unknown origin, headaches, scalp tenderness, neck pain, jaw claudication and anemia, none of which were reported in this case. Investigational evidence such as delayed filling and late leakage at optic disc in fluorescein angiography (FA) and elevated erythrocyte sedimentation rate and C-reactive protein levels were also not reported. Nakao et al. in a series of 52 VKH patients reported 6 patients who developed non-reversible visual field loss attributed to AION.[3] All these eyes exhibited disc edema and AION features in FA, in addition to the systemic manifestations.

In the interest of the readership, we would like to know from the authors how secondary angle-closure glaucoma (SACG) due to ciliary body swelling and suprachoroidal fluid accumulation in VKH was ruled out. We attribute the advanced glaucomatous disc damage seen at presentation to the recurrent SACG insult in the past as the authors themselves had suggested in the discussion. We also noted that the disc photo at 1-year follow-up did not display segmental pallor, especially in the inferior rim although the authors attribute the superior arcuate visual field defect to AION. There was no mention of the details of further glaucoma treatment in this young female with advanced disc damage. Thus, the diagnosis of this reported case is not agreeable to us.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Patyal S, Narula R, Thulasidas M. Vogt-Koyanagi-Harada disease associated with anterior ischemic optic neuropathy in a young woman presenting as acute angle closure glaucoma. Indian J Ophthalmol 2020;68:1937-8.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Hayreh SS. Ischaemic optic neuropathy. Indian J Ophthalmol 2000;48:171-94.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Nakao K, Mizushima Y, Abematsu N, Goh N, Sakamoto T. Anterior ischemic optic neuropathy associated with Vogt–Koyanagi–Harada disease. Graefes Arch Clin Exp Ophthalmol 2009;247:1417-25.  Back to cited text no. 3
    




 

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