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Shilpi Kapoor and Sanjay Sachdeva
This previously healthy 42YO male presented with 5 days of painless bilateral blurred vision, headache, and photophobia. He denied tinnitus, vitiligo, alopecia, or poliosis. Vision was 20/120 OU. Slit lamp examination showed mild bilateral anterior chamber cells.
Color photography shows multifocal yellow-white subretinal lesions scattered throughout each posterior pole. OCT scanning shows a bilaterally thickened choroid with overlying chorioretinal folds, multifocal bacillary layer detachments (BALAD), and pockets of subretinal fluid.
Learning Points:
Harada disease is characterized by relatively acute bilateral panuveitis, optic nerve swelling, thickened choroid, chorioretinal folds, multifocal serous exudative retinal detachments, and bacillary layer detachments. Patients with only ocular findings have Harada disease (as in our patient), whereas those with additional systemic findings (including vitiligo, poliosis, headache, vertigo, and hearing loss) have Vogt-Koyanagi-Harada disease.
BALAD appears as a unique dome-shaped collection of intraretinal fluid from photoreceptor splitting. These detachments can be observed in an increasing number of conditions, most classically Vogt-Koyanagi-Harada disease (Cicinelli et al, Ophthalmology Retina 2020;4:454-456).
Our patient was treated initially with 3 days of intravenous methylprednisolone followed by oral prednisone 1mg/kg/day. There was marked improvement in the exudative fluid within 1 week, with vision improving to 20/40 OD and 20/30 OS. The oral steroids were gradually tapered over 6 months, and steroid-sparing immunomodulatory therapy with mycophenolate mofetil was started.
J Vitreoretin Dis. 2026 Mar 2:24741264261423313. doi: 10.1177/24741264261423313.
Bilateral MacTel2 has high coexisting diabetes and obesity — Retrospective, TriNetX database.
Purpose: To compare systemic comorbidities in bilateral retinal telangiectasia, a proxy for macular telangiectasia (MacTel) type 2, vs matched controls.
Methods: We conducted a retrospective cohort study of a large electronic health research network of patients who were older than 45 years at bilateral retinal telangiectasia diagnosis vs controls receiving eye care. Patients with macular edema or exudative age-related macular degeneration were excluded. Propensity score matching was performed on demographics. The prevalence of hypertension, diabetes mellitus, obesity, hyperlipidemia, and death within 5 years of retinal telangiectasia diagnosis or eye care visit were compared.
Results: 2320 patients with bilateral retinal telangiectasia and 1 671 600 patients with an eye care visit were included. After matching, no demographic differences persisted. Bilateral retinal telangiectasia (vs control) patients had higher rates of type 2 diabetes mellitus (32.8% vs 20.7%; odds ratio [OR], 1.87; 95% CI, 1.64-2.14; P < .005) and obesity (19.9% vs 16.9%; OR 1.22; 95% CI:1.05-1.42; P = .01) and a lower rate of hyperlipidemia (32.0% vs 39.5%; OR 0.71; 95% CI, 0.63-0.80; P < .005). No differences occurred in hypertension or death.
Conclusions: Retinal telangiectasia and MacTel type 2 are uncommon and poorly understood, with high coexisting rates of diabetes and obesity. Systemic disease associations should be investigated to identify disease interactions, the impact of systemic interventions, and leads for potential new treatments.
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