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J. H. Yamamoto, F. T. B. G. da Silva, Sr., F. M. Damico, M. Marin, A. Goldberg, C. Hirata, E. Olivalves; The Revised Diagnostic Criteria for Vogt-Koyanagi-Harada Disease in Brazilian Patients and Clinical Considerations. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3904.
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To analyze the application of the Revised Diagnostic Criteria (RDC) for Vogt-Koyanagi-Harada (VKH) disease in a Brazilian population. To verify the association between different categories of the disease, its severity and the presence of HLA-DRB1*0405.
A retrospective observational case series. Medical charts of 68 patients (10-64 years old; 12 men and 56 women), Uveitis Service, Department of Ophthalmology, Univ São Paulo School of Medicine, São Paulo, Brazil. Patients had been previously diagnosed with VKH disease using the criteria proposed by the American Uveitis Society. At presentation, 47 patients (69.1%) were in the acute phase and 21 patients (30.9%) were in the chronic or recurrent phase. The mean time from disease onset to treatment was 36 days (range 1-180 days). All patients underwent retrospective classification with the RDC for VKH disease of the International Comittee on Nomenclature and the degree of concordance among the two criteria was assessed. Fourty four patients (64.7%) were typed for HLA-DRB1*0405 by PCR-SSP and PCR-SSOP. Fifty-five (80.1%) patients with a follow-up longer than one year were analysed according to previously defined clinical parameters and disease category.
There were 100% of concordance between the two criteria. Disease was classified as complete in 14.7% of patients, incomplete in 29.4% and probable in 55.9%. 90% of patients with complete and incomplete VKH were on acute phase, while 55% patients on the chronic or cicatricial phase were classified as probable VKH (p<0.05). There was no correlation between disease categories, the presence of HLA-DRB1*0405 and disease severity.
The RDC proved useful in making the diagnosis of VKH in our cohort. To establish whether the different categories have clinical relevance or are indicative of prognosis, a minimum follow-up period should be included in the RDC and prospective studies should be designed.
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