Demography, clinical features, and outcomes of Vogt–Koyanagi–Harada disease presenting with bullous exudative retinal detachment

PURPOSE: To describe the clinical course and treatment outcomes of Vogt-Koyanagi-Harada (VKH) disease presenting with bullous exudative retinal detachment (bullous ERD). METHODS: This retrospective study included all patients diagnosed with VKH presenting with bullous ERD in one or both eyes between 2016 and 2024. Their best-corrected visual acuity (BCVA), clinical presentations, and treatment outcomes were analyzed. RESULTS: Among 646 patients with VKH, 12 (22 eyes) presented with bullous ERD in the early stage of the disease. The mean age at presentation was 38.67 years (range: 22-58 years). Bilateral bullous ERD was noted in 10/12 patients, while two had unilateral involvement. The mean BCVA at presentation and the final follow-up was 1.74 logMAR (SD 0.67, range 0.2-2.3 logMAR) and 0.84 logMAR (SD - 0.57, range 0-2.2), respectively. Anterior segment inflammation was noted in 15 eyes (68.1%), disc edema in 16 (72.7%), and vitritis and choroidal detachment in four eyes each (18.2%). The average choroidal thickness on B-scan ultrasonography was 1.79 mm (range: 1.04-3.57 mm). Six eyes (27%) experienced acute exacerbations, and five eyes (22.7%) had recurrences. The mean follow-up was 17 months (range: 6-61). At final follow-up, sunset glow fundus developed in 17 eyes (72%), secondary glaucoma in eight eyes (36.3%), and subretinal fibrosis in nine eyes (41%). CONCLUSION: Bullous ERD is a rare manifestation of VKH. Although initial visual recovery is promising, these patients are at higher risk for disease exacerbation, recurrences, and complications. Initial aggressive therapy and prolonged follow-up with sustained immunosuppression are essential for optimal outcomes.