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Kevin Jwo, David C. Gritz; Epidemiology of Chronic-Recurrent Phase Vogt-Koyanagi-Harada Syndrome. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1206.
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To determine the incidence of and risk factors associated with ongoing, chronic inflammation and ocular complications in patients with Vogt-Koyanagi-Harada Syndrome (VKH). To evaluate the relationship between active inflammation 12 months after presentation for treatment and development of complications in these patients.
This is a retrospective cohort study of VKH patients treated at the Aravind Eye Hospital in South India. Inclusion criteria were clinical features sufficient to qualify as at least "probable" VKH, according to the 2001 Revised Criteria, presentation between 1/1/00 and 11/1/09, no prior treatment other than topical medications, and follow-up of at least two years. Medical record review collected data on demographics, clinical features and disease course, diagnostic criteria, diagnostic testing, time from symptom onset to starting therapy, and treatment course. Progression to the chronic-recurrent stage (primary outcome variable) is defined as recurrence of inflammation following resolution with adequate treatment or persistence of inflammation at 12 months. Secondary outcome measures include ocular complications and final visual acuity.
Charts of 155 patients were reviewed of which 107 met VKH diagnostic criteria. Of those, 36 met all inclusion criteria. Of these, 27 (67.7%) had active inflammation and 9 (33.3%) were quiet at 12 months. Neither age (p = 0.10) nor time from symptom onset to treatment (p = 0.61) were associated with active inflammation at 12 months. Females were more likely to have active inflammation at 12 months compared to males (p = 0.024). Progression to the chronic-recurrent phase as defined here was not found to be associated with number of complications (p = 0.13) nor a final visual acuity of worse than 20/200 (p = 0.65).
Using these strict inclusion criteria, disease activity at twelve months was not a useful tool for visual prognosis nor associated with ocular complications. The sample size resulting from these strict inclusion criteria could play a role in these findings.
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