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Case report: Bilateral retinal detachments in a 19-year-old
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The authors commented that the patient’s "age, relative acute onset, and lack of medical history make this an atypical presentation.”
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Investigators published a recent case report1 that described the development of bilateral retinal detachments in a teenager.
The patient was an otherwise healthy 19-year-old man who had been referred to the Cole Eye Institute for evaluation of retinal detachments. At presentation, the corrected right and left eye visual acuities (VAs) were, respectively, 20/400 and 20/500.
Ophthalmic evaluation
No anterior chamber cells were observed, and both irises were well dilated; both lenses were clear. The posterior examination showed no vitreous cells, hyperemic and elevated discs, macular edema, and large inferior serous detachments with deep, creamy lesions throughout the posterior pole bilaterally. No retinal breaks were present, the authors reported.
Subretinal and intraretinal fluid was seen in optical coherence tomography (OCT) images of both eyes with a subfoveal bacillary detachment, which they explained was a split at the level of the inner segments of the photoreceptors. B-scan ultrasound confirmed the diagnosis.
Medical examination
The patient had been treated with dextroamphetamine (Adderall) since childhood for attention-deficit/hyperactive disorder. He was negative for headache, altered mental status, chest pain, tinnitus, urinary issues, or trauma before his referral; however, he reported progressive worsening of the VA 1 week before his referral; during which time he had had an upper respiratory tract illness and diarrhea that resolved.
The subsequent medical examination showed a blood pressure of 178/104. The patient was negative for syphilis, tuberculosis, and angiotensin-converting enzyme but the creatine level of 19.12 mg/dL was concerning.
The patient was referred to the emergency department and admitted to the hospital for a hypertensive emergency and kidney failure.
During hospitalization, his blood pressure was controlled with treatment and the systolic pressure decreased below 140.
A kidney biopsy showed severe tubulointerstitial fibrosis and thrombotic microangiopathy without any underlying etiology, and he started hemodialysis. Twelve weeks after his presentation, the vision improved to best-corrected VAs of 20/30 and 20/25 in the right and left eyes, respectively, with resolution of the serous detachments.
Vogt-Koyanagi-Harada (VKH) was considered in this case, because of the exudative detachments.2 However, the lack of both inflammation and choroidal and retinal pigment epithelium undulations on OCT lessened the likelihood of this diagnosis.3 It They advised that intraocular inflammation is not required for diagnosing VKH in the presence of ocular findings such as disc hyperemia and exudative retinal detachments.4 “Careful attention to OCT imaging was important to rule out VKH and avoid high-dose corticosteroids in this patient, which may have worsened his blood pressure,” they stated.
In commenting on this case, the authors said, “This patient’s age, relative acute onset, and lack of medical history make this an atypical presentation.”
They emphasized “the importance of systemic hypertension as a cause of bilateral serous retinal detachments, even in patients who are younger, previously healthy, and without more superficial signs of hypertensive retinopathy. Prompt workup and treatment are important to reduce the chance of short-term and long-term morbidity and mortality from uncontrolled hypertension.”
References:
Bhatter P, Jung E, Mammo DA. Bilateral retinal detachments in a previously healthy 19-year-old. JAMA Ophthalmol. Published online March 13, 2025. doi:10.1001/jamaophthalmol.2025.0112
Herbort CP Jr., Tugal-Tutkun I, Abu-El-Asrar A, et al. Precise, simplified diagnostic criteria and optimised management of initial-onset Vogt-Koyanagi-Harada disease: an updated review. Eye (Lond). 2022;36:29-43. doi:10.1038/s41433-021-01573-3
Baltmr A, Lightman S, Tomkins-Netzer O. Vogt-Koyanagi-Harada syndrome—current perspectives. Clin Ophthalmol. 2016;10:2345-2361. doi:10.2147/OPTH.S94866
Read RW, Holland GN, Rao NA, et al. Revised diagnostic criteria for Vogt-Koyanagi-Harada disease: report of an international committee on nomenclature. Am J Ophthalmol. 2001;131:647-652. doi:10.1016/S0002-9394(01)00925-4
