Initial-onset acute and chronic recurrent stages are two distinctive courses of Vogt-Koyanagi-Harada disease

Abstract

Purpose To describe distinctive stages of Vogt-Koyanagi-Harada (VKH) disease: initial-onset acute versus chronic recurrent disease. Methods A comprehensive literature review regarding stages and clinical presentations of VKH disease was conducted. Results Despite a list of signs that has been described as characteristic features of early or late phases of VKH disease, the current classification -developed by an international committee and published in 2001- does not consider a distinction regarding the time from onset of disease symptoms, and specific findings observed at certain time point from the symptoms presentation and outcomes related to the stage of VKH disease. In that sense, chronic recurrent VKH disease is more refractory to treatment and is associated with a higher rate of complications. Accordingly, this subset of VKH patients has poorer functional and anatomical outcomes than patients with an initial-onset acute disease. Conclusions An early clear distinction of VKH phenotype [Initial-onset acute versus chronic recurrent disease] should be considered in each clinical scenario, evaluating the delay in diagnosis and the clinical presentation, since it may help clinicians to perform a correct disease prognosis categorization and thus to make treatment decisions in terms of potential refractoriness or expected clinical outcomes.

Risk Factors for Secondary Glaucoma in Patients with Vogt-Koyanagi-Harada Disease

“…However, they found a signi cant improvement in VA in eyes unresponsive to oral corticosteroids receiving early IMT (p=0.04) [23]. Moreover, authors describe that delaying IMT in patients with initial SGF (4.4 vs. 12.3 months, p=0.02) or chronic-recurrent disease (6.5 vs. 14.5 months, p=0.01) was associated with a reduced improvement in VA [23]. Similar ndings were described by El-Asrar et al, who reported that the use of IMT was signi cantly associated with a reduced risk of SGF and that SGF was associated with the development of ocular complications, including glaucoma, cataract, and subretinal neovascular membrane formation [17].…”

“…The authors reported no signi cant differences in VA improvement or reduced risk of ocular complications (i.e., glaucoma, OHT, cataract) in patients with or without early IMT (<6 weeks). However, they found a signi cant improvement in VA in eyes unresponsive to oral corticosteroids receiving early IMT (p=0.04) [23]. Moreover, authors describe that delaying IMT in patients with initial SGF (4.4 vs. 12.3 months, p=0.02) or chronic-recurrent disease (6.5 vs. 14.5 months, p=0.01) was associated with a reduced improvement in VA [23].…”

“…Thus, recognizing that oral prednisone exposure might represent a modi able risk factor for the development of glaucoma emphasizes the critical role of early IMT. Urzua et al reported that the chronicrecurrent form of VKH disease, a VA < 20/200, tinnitus, and the presence of SGF at presentation were risk factors for poor glucocorticoid response, which the authors de ned as (1) persistent retinal detachment and (2) absence of visual and (3) in ammatory improvement [23]. The authors reported no signi cant differences in VA improvement or reduced risk of ocular complications (i.e., glaucoma, OHT, cataract) in patients with or without early IMT (<6 weeks).…”

Classification of Non-Infectious and/or Immune Mediated Choroiditis: A Brief Overview of the Essentials

“…VKH disease is newly separated into two phases [ 1 , 115 ]. Initial-onset disease starts with a prodromal stage, including flu-like symptoms, headache, tinnitus, and vertigo, followed within a few days by an acute ocular initial-onset phase, consisting of an acute uveitis with optic disc hyperaemia and swelling, and characteristic multifocal exudative serous retinal detachment ( Figure 47 and Figure 48 ).…”

Clinicopathology of non-infectious choroiditis: evolution of its appraisal during the last 2–3 decades from “white dot syndromes” to precise classification

“…Until recently the importance to distinguish between initial-onset disease and chronic disease (due to delayed or insufficient treatment of initial-onset disease) was not sufficiently taken into account and this hampered the establishment of clear diagnostic criteria. The two subentities, initial-onset disease and chronic disease have to be considered separately as their course and response to therapy is different [48]. Recently practical diagnostic criteria for initial-onset VKH disease have been published [49] (Table 4) allowing for rapid diagnosis that, together with first-line steroidal and non-steroidal immunosuppression, is crucial to manage VKH disease and potentially obtain the cure of the disease [50].…”