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T. Ito, K.-H. Sonoda, K. Hijioka, T. Fujimoto, T. Ishibashi; The Clinical Features of Recurrent Vogt-Koyanagi-Harada Disease in Japan. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5858.
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Although Vogt-Koyanagi-Harada (VKH) disease has relatively good visual prognosis, some cases cause frequent recurrence and sight-threatening complications. We herein report the clinical features of Japanese patients who suffered recurrent VKH disease in the past seven years at Kyushu University Hospital.
We performed retrospective review of fifty-seven VKH patients (thirty males and twenty-seven females, average 45.4 years old) from December 2002 to April 2009. For background, because our hospital is the principal medical center in our district, many refractory patients were consulted and some of them were already treated by systemic corticosteroids in the other clinic.
The diagnosis of VKH was performed based on the international criteria.Nineteen of 57 patients were considered to be recurrent cases, and we found two clinical patterns of recurrence. The first pattern is ‘acute retinal detachment (RD) type’ which had recurrence with serous RD (SRD) more than two times. The second is ‘chronic inflammation type’ which had mild but containing ocular inflammation. In our 19 recurrent cases, 11 patients were classified into ‘acute RD type’, and 8 patients were ‘chronic inflammation type’. Eight of 11 patients of ‘acute RD type’ were well controlled by systemic corticosteroids and/or cyclosporine treatment, but other 3 patients raised intraocular proliferative change, caused tractional RD and performed vitrectomy. Five of 8 patients of ‘chronic inflammation type’ were basically able to care by topical corticosteroids, but 3 patients had prolonged vitreous opacity and were performed vitrectomy.
There are some patients who require additional treatments other than corticosteroids in recurrent VKH disease. The combination therapy of systemic corticosteroid/cyclosporine was effective for the ‘acute RD type’ and, as a result, we can terminate these drugs earlier than single corticosteroid therapy. Vitrectomy is another option and secure for the cases with intraocular proliferative changes or prolonged vitreous opacity due to chronic inflammation.
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