Bilateral intravitreal dexamethasone implant efficacy in an adolescent with refractory macular edema associated with Vogt–Koyanagi–Harada disease

The study aimed to report a case of Vogt–Koyanagi–Harada (VKH) disease with refractory macular edema, which was treated with bilateral intravitreal dexamethasone (DEX) implantation. A 16-year-old male presented with progressive visual impairment over the past year, initially affecting the right eye and subsequently the left eye. Preceding the visual symptoms, the patient experienced tinnitus, headache, and flu-like symptoms. Ophthalmic examination revealed vitreous haze, hyperemic papillae, macular folds, and thickened macula in both the eyes, confirmed by optical coherence tomography (OCT). Enhanced depth imaging OCT scans indicated cystoid macular edema with increased choroidal thickness. Immunotherapy with weekly methotrexate and bilateral intravitreal Ozurdex implants was administered, with subsequent significant improvement in visual acuity (VA) and reduction in macular edema observed at short-term follow-up. After 3 months, VA remained stable, with no reported complications associated with systemic treatment. This case highlights the potentially beneficial role of intravitreal DEX implants in managing refractory macular edema associated with VKH disease. Further research is needed to validate these findings and determine the long-term durability of this therapeutic approach.