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Johnstone M. Kim, Sunil Srivastava, Bryan Schwent, Chris Bergstrom, Blaine Cribbs, Jiong Yan, G. Baker Hubbard, III, Timothy W. Olsen, Steven Yeh; Vogt-Koyanagi-Harada Syndrome: Baseline Clinical Characteristics And Long-term Clinical Outcomes. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2746.
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To evaluate the baseline characteristics and long-term clinical outcomes of patients with Vogt-Koyanagi-Harada (VKH) disease followed for at least 12 months.
Retrospective, tertiary referral-based case series. Medical records were reviewed for baseline demographics, moderate (VA < 20/50 and ≥ 20/200) or severe visual impairment (VA ≤ 20/200), prevalence of ocular complications, local and systemic corticosteroid treatment, and need for steroid-sparing immunosuppression.
Thirteen patients (26 eyes, 2 men and 11 women) diagnosed with VKH were followed for a median of 36 months (Range 12 - 180 months). The median presenting age was 35 years (range 18-66). Eleven of 26 eyes (42%) had severe visual impairment, 9 (34%) had moderate visual impairment; 24% presented with VA of 20/40 or better. Secondary complications included cataract (92%), ocular hypertension (27%), cystoid macular edema (15%), epiretinal membrane (8%), choroidal neovascularization and/or subretinal fibrosis (4%). At final follow-up, 13 eyes (50%) had severe visual impairment, 2 (8%) were moderately impaired and 11 eyes (42%) were 20/40 or better. Long-term complications included cataract (100%), ocular hypertension (31%), choroidal neovascularization/subretinal fibrosis (23%), hypotony (19%), posterior synechiae (8%), and epiretinal membranes (8%). Local and systemic immunosuppressive strategies employed (no. of patients) included fluocinolone implantation (3), oral prednisone (5), mycophenolate mofetil (1) and cyclophosphamide (1).
Moderate or severe visual impairment was seen in the majority of VKH patients at baseline. Secondary ocular complications including cataract, ocular hypertension and cystoid macular edema were common at baseline evaluation while hypotony and subretinal fibrosis/choroidal neovascularization were seen more frequently at long-term follow-up. Patients presenting with severe visual impairment infrequently improved; patients with moderate visual impairment derived greater visual benefit with local and systemic immunosuppression.
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