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D.A. Goldstein, R. Kapur, M. Farber, K. Narayanan, M. Horsely, H.H. Tessler; Long–Term Follow–Up of Vogt–Koyanagi Harada Syndrome and Sympathetic Ophthalmia . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2841.
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Purpose: Vogt–Koyanagi Harada (VKH) disease & Sympathetic Ophthalmia (SO) are bilateral granulomatous ocular inflammatory disorders. There are many clinical similarities between these 2 diseases. They are almost indistinguishable histologically. We present the long–term follow–up of patients with these 2 disorders. Methods: An electronic database was used to identify patients with VKH & SO seen at the University of Illinois at Chicago uveitis service & the private office of one of the authors (HHT). The charts were reviewed to identify demographic findings, diagnosis, treatment, visual acuity, clinical findings, & complications. Only those patients with a minimum follow–up of 3 months were included in this study. Results: There were 49 patients with VKH (98 eyes) & 20 patients with SO (40 eyes). The mean age for VKH patients at presentation was 35.3 years (range 11–75 years) & for SO was 42.5 (range 7 – 72 years) (p<0.05). 26.5% of VKH patients were male & 85% of SO patients were male. Average follow–up was 286 weeks for VKH & 251 weeks for SO. All VKH patients were treated systemically; 31 with oral steroids alone, & 15 with other immunosuppressive therapy. Average treatment duration was 122 weeks with systemic steroids & 36 weeks with immunosuppresion.19 SO patients were treated with steroids alone, & 9 with other immunosuppression. Average treatment duration was 164 weeks with systemic steroids & 13 weeks with immunosuppresion. Cataract developed in 59% of VKH & 60% of SO patients. Glaucoma developed in 20% of VKH patients and 40% of SO patients. At presentation, 41% of VKH eyes had visual acuity of 20/50 or better, 48% 20/100 or worse. At last follow up (range: 13–1355 weeks) 60% were 20/50 or better & 34% 20/100 or worse. At presentation 37.5% of SO patients saw 20/50 or better, 50% saw 20/100 or worse. At last follow up (range: 15–1124 weeks) 53% saw 20/50 or better & 47.5% 20/100 or worse. Conclusions: As expected, in this large cohort of VKH & SO patients, more SO patients were male than female. It, however, was surprising that the SO patients were, on average, older than the VKH patients. At presentation almost half of VKH eyes had visual acuity of 20/100 or worse, but with an average follow up of 5.5 years (up to 26 years) 60% saw 20/50 or better. Half of SO patients were 20/100 or worse at presentation. This percentage remained stable, with 47.5% at this level at last follow up. The most common complication in both groups was cataract. Glaucoma was twice as likely to occur in SO than VKH. Overall, aggressive systemic therapy resulted in reasonable visual outcomes, with more than half of eyes maintaining 20/50 or better visual acuity.
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