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David S. Ehmann, Chris J. Rudnisky, Riz Somani, Matthew T. Tennant; Vogt-Koyanagi-Harada Disease in First Nations Canadians of Northern Alberta: a retrospective review. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3201. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the incidence, manifestations, and visual outcomes in First Nations (i.e. aboriginal) Canadians presenting with Vogt-Koyanagi-Harada disease (VKH).
This retrospective observational case series involved the review of electronic records for a 17-year period (1994-2010) to identify patients diagnosed with VKH. Nineteen First Nations Canadians resident in Northern Alberta were identified. Paper charts were reviewed for patient ethnicity, age, gender, length of follow up, location of primary residence, diagnostic criteria met at presentation, disease stage at presentation, duration of symptoms prior to presentation, ocular and extraocular manifestations at presentation, initial and interval visual acuities, treatments, compliance, and complications.
Of 515 patients identified with uveitis, 26 (5.0%) were found to have VKH disease; 19 of these 26 (73%) were First Nations individuals. The average age at initial presentation was 30.8 years and 16 (84%) patients were female. At presentation, 2 (11%) patients were classified as complete, 12 (63%) as incomplete and 5 (26%) as probable VKH. No patient presented in the prodromal stage, 11 (58%) during the acute uveitic stage, 7 (37%) in the convalescent stage, and 1 (5%) in the chronic recurrent stage. Among all individuals, and consistent with a uveitic condition, the most common presenting symptom and sign was blurred vision (89%) and anterior segment inflammation (89%) respectively. Fifteen (79%) patients presented with extra-ocular manifestations. At presentation, the mean logMAR visual acuity was 1.03 ± 0.91 (20/214) (n=38 eyes) and at 1 year follow-up 0.72 ± 0.84 (20/105) (n=28 eyes). All patients were initially treated with corticosteroids; immunomodulatory therapy was utilized for 2 (11%) patients. Twelve (63%) patients developed ocular complications with cataracts the most common (58%).
This report highlights VKH disease among First Nations Canadians resident in Northern Alberta. The features of VKH in First Nations individuals are most similar to reports from affected individuals having South Asian or Hispanic ancestry. Further studies describing VKH in First Nations Canadians are needed.
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