Sub-Tenon Triamcinolone for Recurrent Vogt–Koyanagi–Harada Disease in an Elderly Patient With Concerns Regarding Systemic Therapy

Abstract Purpose To report the clinical course of recurrent Vogt–Koyanagi–Harada (VKH) disease treated with posterior sub-Tenon triamcinolone acetonide (STTA) in an elderly patient with concerns regarding additional systemic therapy, with longitudinal assessment of structural and hemodynamic changes using optical coherence tomography (OCT) and laser speckle flowgraphy (LSFG). Case Report A 75-year-old man with VKH disease was initially treated with intravenous methylprednisolone pulse therapy followed by oral prednisolone. During pulse therapy, he developed delirium, and VKH disease recurred early during oral corticosteroid tapering. Given his advanced age, newly diagnosed diabetes mellitus, and corticosteroid-associated delirium, further escalation of systemic corticosteroid therapy raised safety concerns, and bilateral STTA was administered. The clinical course was monitored using swept-source OCT to measure central choroidal thickness (CCT) and LSFG to assess choroidal mean blur rate (MBR). Results Following STTA, serous retinal detachment resolved and choroidal folds disappeared, with no further recurrence during follow-up. CCT decreased rapidly after STTA, whereas MBR increased more gradually over approximately two weeks. Thus, structural improvement and recovery of choroidal hemodynamics showed different temporal patterns after local corticosteroid treatment. Conclusion In this elderly patient with recurrent VKH disease and concerns regarding further systemic corticosteroid exposure, STTA was followed by resolution of ocular inflammation without further recurrence during follow-up. Serial OCT and LSFG measurements demonstrated different short-term temporal patterns of structural and hemodynamic response after STTA.