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N. V. Potapova, S. Yeh, J. A. Smith, G. Jirawuthiworavong, N. Mahdi, C.-C. Chan, R. B. Nussenblatt, G. A. Levy-Clarke; Ocular Complications in Vogt-Koyanagi-Harada Disease. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5145.
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Vogt-Koyanagi Harada (VKH) disease is a bilateral, granulomatous panuveitis associated with systemic manifestations including headaches, dysacusis, meningismus, poliosis, and vitiligo. Visual loss from VKH may occur due to exudative detachments during the acute phase of the disease or from structural complications including cataract, glaucoma, macular edema, subretinal neovascularization and fibrosis and epiretinal membrane formation. The purpose of this study is to evaluate the spectrum of ocular complications in VKH patients observed on presentation to a tertiary referral center.
25 patients with VKH seen at the National Eye Institute from January 1974 to July 2006 were reviewed for the presence of ocular complications. Demographic information was collected. Visual acuity on presentation, associated systemic findings, anatomic type of uveitis, and the presence of ocular complications were reviewed.
19 (76%) of 25 patients diagnosed with VKH were female and 6 (24%) were male. Panuveitis was observed in 96% of patients while posterior uveitis was observed in 4% of patients. 56% of patients were African-American, 28% of patients were Caucasian, 12% were Southeast Asian, and 4% were South American. 16% of patients reported Native American heritage. Systemic findings were seen in 64% of patients and included headache (56%), dysacusis or tinnitus (36%), vitiligo (8%) and poliosis (4%). Immunosuppressive medications (systemic corticosteroids or steroid-sparing agents) were being used on presentation in 76% of patients. 16% of these patients were using steroid-sparing agents. 50 eyes in 25 patients were reviewed for the presence of ocular complications. Initial mean visual acuity was 20/112 (Range: 20/16 to no light perception). The prevalence of structural complications was as follows: posterior synechiae 34%, cataract 30%, cystoid macular edema 26%, exudative retinal detachment 24%, glaucoma 8%, vitreous hemorrhage 4%, subretinal fibrosis 4%, subretinal neovascular membrane 2%, band keratopathy 2%, and hypotony 2%.
The most common complications of VKH were posterior synechiae, cataract, cystoid macular edema, and exudative retinal detachment. Headache was the most frequently associated systemic symptom. A significant number of patients were using immunosuppressive medications, but relatively few patients were using steroid-sparing agents on referral to our service. Further studies are needed to determine whether increasing use of steroid-sparing agents will decrease the prevalence of ocular complications of VKH.
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