Efficacy of Surgical Removal of Subretinal Fibrosis in Patients with Vogt-Koyanagi-Harada Disease

  Objective  To evaluate the clinical efficacy of surgical removal of subretinal fibrosis in patients with Vogt-Koyanagi-Harada disease (VKH).

  Methods  The clinical data of VKH patients who underwent trans pars plana vitrectomy and subretinal fibrosis removal in our hospital from January 2008 to December 2011 were retrospectively analyzed.

  Results  Two male and one female VKH patients (4 eyes), with an average age of 40.7 years (31 to 48 years), were included in this case series. Before surgery, of the 4 eyes, all had subretinal fibrosis in the macula, 1 had mild cataract, and 1 had severe cataract. All the 4 eyes underwent conventional 20-gauge trans pars plana vitrectomy, retinotomy and subretinal fibrosis removal, of which 1 eye was tamponed with C₃F₈ and the rest 3 were tamponed with silicon oil. An additional lensectomy preserving the anterior capsule with intraocular lens (IOL) implantation was performed in the eye with severe cataract during vitrectomy. No severe perioperative complication was observed. All the 3 silicon oil tamponed eyes underwent successful surgical removal of silicon oil without retinal detachment during follow-up. The 2 eyes without preoperative cataract developed cataract during the follow-up after subretinal fibrosis removal and were successfully treated with phacoemulsification and IOL implantation. Exacerbation of cataract was observed in the eye with mild preoperative cataract and was treated with trans pars plana lensectomy preserving the anterior capsule with IOL implantation during silicon oil removal surgery. The patients were followed up for 1 to 6 months after the last surgical intervention (3.8 months on average) and no active ocular inflammation was observed. When compared to preoperative conditions, improvement in visual acuity was observed in all the 4 eyes in the last follow up visit.

  Conclusions  Surgical removal may be a potentially effective treatment for subretinal fibrosis in the macula in VKH patients. Cataract is a common complication after this surgery and requires further surgical intervention.