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Sophia Zagora, Yi-Hsing Chen, Susan Lightman, Oren Tomkins-Netzer; Causes of vision loss and clinical outcomes over an 18 year period in patients with Vogt–Koyanagi–Harada Disease. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4200.
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We aimed to determine the causes of vision loss and best treatment in patients diagnosied with Vogt–Koyanagi–Harada (VKH). We conducted a long term (18 year period) retrospective clinical study to predict the causes of vision loss and treatment outcomes at Moorfields Eye Hospital so as to improve patient outcomes in the future.
Patients diagnosed with VKH between January 1999 to April 2017 who were seen for at least 6 months were identified and the clinical records were scrutinized for patient demographics, medical and procedural history, and visual outcomes following treatment.
112 patients (224 eyes) were diagnosed with VKH, of which 90 were female (81%). Seven patients (6.3%) were diagnosed as Complete, 31 (26.1%) as Incomplete and 74 (67.6%) as Probable VKH (as per the diagnostic criteria). The mean age was 38.1yrs (Range 5-74.42yrs). Forty-nine (44.1%) patients were Asian, 27 (24.3 %) were Other and 19 (17.1%) were White. Mean follow up was 7.1 years (range 6mths-46.8yrs). Mean baseline best-corrected visual acuity (BCVA) was 20/50 (0.4 logMAR) and mean final BCVA was 20/35 (0.3 logMAR). Patients diagnosed with probable VKH had a significant improvement in baseline verse final visual outcome (p.0002). Thirteen eyes (6%) were defined as having moderate visual loss (MVL; ≤20/50) and 32 eyes (14.7%) had severe visual loss (SVL;≤20/200). Recurrent episodes occurred in 87 (54%) patients. Recurrences = 2.69 per person per year and in Moderate Vision Loss (MVL) or Severe Vision Loss (SVL) = 0.16 per person/year (0.32 eye years). Oral prednisone was administered to 86 patients (77.5%). Fifty-three patients (47.7%) required secondary immunosuppression. The most common complication was Cataract – 66 eyes (30.3% eyes).
The majority of eyes maintained very good vision with patients diagnosed with probable VKH having the most significant improvement in vision between presentation and final review. Kaplan Meier curves showed vision loss occurred mainly during the first two years. There are a large number of recurrences in this young population group, with half the population requiring secondary immunosuppression. Therefore, we hypothesise that VKH requires aggressive steroid sparing immunosuppression early so as to decrease the risk of vision loss.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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