Identifying the Risk of Development of Macular Edema in Patients with Vogt-Koyanagi-Harada Disease

Abstract

Purpose : To identify the incidence of macular edema after intraocular surgery in patients with Vogt-Koyanagi-Harada (VKH) disease

Methods : In this case control study, patients with diagnosis of VKH managed in the Department of Ophthalmology, Hospital Universitario Austral, Buenos Aires, Argentina between 2009 and 2017 were analyzed. The patients were divided into two groups based on the presence or absence of macular edema. Medical records were reviewed for the history of intraocular surgery. Patients were included in the study if they met the following criteria: 1) Confirmed diagnosis of VKH with and without the history of intraocular surgery; 2) Inactive VKH disease for at least three months prior to the intraocular surgery; 3) No complication associated with the surgery; 4) No history of any other ocular condition (i.e. diabetes, age-related macular degeneration) that may cause macular edema. All the patients received corticosteroids pre- and post-operatively. Age-matched analysis was performed utilizing logistic regression with propensity matching to compare the odds of a patient with VKH developing macular edema with a history of intraocular surgery to those with VKH developing macular edema without a history of intraocular surgery

Results : Forty-six (46) patients with a confirmed diagnosis of VKH disease were included in the study. Six patients (13.04%) had developed macular edema over the course of the disease, whereas 40 patients (86.96%) did not have a history of macular edema. Among the six patients with macular edema, five patients (83.33%) had a history of cataract surgery. Among the 40 patients without macular edema, four (10%) had undergone cataract surgery. None of the 46 patients underwent any other type of intraocular surgery. The odds of a patient with VKH developing macular edema after cataract surgery was 5 times compared to the odds of age-matched VKH patients developing macular edema without history of cataract surgery (p<0.0001)

Conclusions : Macular edema is a relatively rare finding in patients with VKH. However, cataract surgery significantly predisposes these patients for the development of macular edema, even with peri-operative anti-inflammatory treatment. Our findings highlight the role of other mechanisms beyond inflammation as the underlying cause of retinal edema in these patients

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.