Clinical spectrum and management options in Vogt–Koyanagi–Harada disease

Abstract

PurposeThe aim of this study was to describe the clinical features, treatment options, and visual outcome of Vogt–Koyanagi–Harada (VKH) disease patients over a 9-year period.MethodA retrospective chart analysis of 32 patients with VKH, from January 2007 to December 2015, at a tertiary care government medical college eye hospital in South India.ResultsA total of 32 patients were diagnosed with VKH. The mean age at diagnosis was 32.03±8.8 years. There were 24 patients (42 eyes) with acute VKH and eight patients (16 eyes) with recurrent/chronic VKH. The mean baseline best-corrected visual acuity on presentation in the acute VKH group was 5/60 (1.114±0.565) and at last follow-up it was 6/9 (0.225±0.157). Intravenous methyl prednisolone (IVMP) was administered for 3 days to all patients with acute and recurrent VKH, followed by posterior subtenon triamcinolone (40 mg/mL) and oral azathioprine.ConclusionVKH-related uveitis is more common in the female gender in this South Indian population. Posterior uveitis is the most common initial manifestation. Initial aggressive treatment with IVMP, peribulbar long-acting corticosteroids, and immunosuppressives, avoiding side effects of systemic steroids, gives a good visual outcome without recurrences. Cases of unilateral VKH, seen in six patients, are the initial manifestations in the natural course of the disease, which if managed aggressively at the acute stage prevents recurrence in the other eye.

Vogt-Koyanagi-Harada Disease: A Case Series in a Tertiary Eye Center

“…The mean age and the female predominance in our series correlates with those presented in other literature. Disc hyperemia and serous retinal detachment were the most common posterior segment presentation similar to comparative literature [ 1 ]. Only few cases had extraocular manifestation in this series even though they presented with a typical fundus finding, the possibility of which has been explored in the study by Beniz et al [ 9 ].…”

“…Vogt-Koyanagi-Harada (VKH) is a severe, bilateral, granulomatous panuveitis associated with extraocular manifestations. It is a cell-mediated autoimmune disorder affecting the pigmented tissues leading to amplification of inflammatory cascade against the melanocytes [ 1 , 2 ]. It is more common in the adult population and has a predilection for female gender.…”

“…The four distinct phases of VKH are as follows: prodromal, acute uveitic, convalescent, and chronic recurrent. Low-grade nongranulomatous anterior uveitis along with diffuse choroiditis and exudative retinal detachment (RD) is seen in acute phases, while in chronic recurrent phases, patients present with recurrent granulomatous anterior uveitis [ 1 ]. As the frequency of ocular inflammatory attacks increases, the occurrence of ocular complications increases and is associated with worse visual prognosis.…”

“…High-dose systemic corticosteroids initiated during the early acute uveitis stage followed by slow tapering is required to suppress the inflammation. Addition of immunomodulatory agents along with steroids can improve the visual outcome and can also decrease the risk of cutaneous involvement [ 1 ].…”

Treatment of Vogt-Koyanagi-Harada Disease

“…It was described independently by Vogt, Koyanagi, and Harada as bilateral uveitis, exudative retinal detachments, integumentary disorders, and neurologic abnormalities [2]. Although uncommon, VKH represents 7% to 8% of patients with uveitis in Japan [3]. It is more common in Asian, Middle Eastern, Hispanic, and Native American populations [4].…”