Clinical Outcomes of Vogt-Koyanagi-Harada Disease at a Tertiary Center in 194 Patients: The KKESH Uveitis Survey Study Group

Abstract

Purpose: To describe ocular clinical characteristics, complications, surgical outcomes and treatment among patients with Vogt-Koyanagi-Harada (VKH) disease in a tertiary center over a 25-year period.

Methods: We retrospectively analyzed 194 patients (382) eyes diagnosed with VKH disease in a tertiary center from January 1986 through December 2011.

Results: VKH disease was diagnosed at a median age of 35.1 ± 12.8 years (range 7 to 68 years), occurred in 135 (69.6%) females, and was bilateral in 188 (96.9%) patients. Mean baseline best-corrected visual acuity (BCVA) was 20/125 (logMAR 0.8 ± 0.72) in both eyes. Symptoms duration was short (< 3 months) in 110 (56.7%) patients. A single episode occurred in 87 (44.8%) patients, and recurrent episodes in 107 (54%) patients. The most common form of presentation was panuveitis in 151 (77.8%) eyes. Retinal detachment (RD) was present in 164 (42.9%) eyes, an exudative retinal detachment (ERD) was diagnosed in 143 (87.2%) eyes, and tractional retinal detachment (TRD) in 21 (12.8%) cases. Oral prednisone was the first line of treatment in 168 (86.6%) patients. Immunosuppressive treatment with cyclosporine was employed in 87 (44.8%) patients, azathioprine in 58 (29.9%), intravenous steroid in 50 (25.8%), mycophenolate mofetil in 18 (9.3%), and methotrexate in 12 (6.2%) patients. During the 25 years of this study, 89 (45.9%) patients (136 eyes) underwent surgery. Visual acuity was better than 20/50 in 240 (62.8%) affected eyes and 20/200 or worse in 72 (18.8 %) affected eyes at the last visit. More common complications at the last visit were glaucoma in 135 (35.3%) eyes, followed by posterior synechia 96 (25.1%), cataract in 25 (6.5%), and choroidal neovascularization (CNV) in 21 (5.5%) eyes.

Conclusions: In Saudi Arabia, VKH uveitis affects predominantly young women. Bilateral panuveitis is the most common ocular manifestation. At presentation, retinal detachment is present in 164 (42.9%) eyes. Oral prednisone is the first line of treatment in these patients. More than 60% of eyes maintain a visual acuity of 20/50 or better.

Keywords: 746 uveitis-clinical/animal model