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

Abstract

Purpose. To study the clinical spectrum of Vogt-Koyanagi-Harada (VKH) disease in a tertiary eye center in Nepal. Methods. Baseline demographic details and clinical features of six patients diagnosed as VKH in a tertiary eye center were retrospectively reviewed. Examinations included best corrected visual acuity, intraocular pressure, and slit lamp examination of anterior and posterior segments. Baseline blood investigations, chest X-ray, fundus photography, and fundus fluorescent angiography (FFA) were performed on all the patients. Results. The mean age at presentation was 46 ± 8.43 years with female predominance (83.3%). The disease was complete in 16.7%, incomplete in 16.7%, and probable in 66.7% of the patients. Most cases presented in acute uveitis stage (66.7%). The most common finding in acute cases was serous retinal detachment (66.7%), followed by disc edema (58.3%), whereas in chronic cases, depigmented fundus was the most common. All cases had bilateral presentation. Conclusion. VKH is an important cause of bilateral loss of vision and has a good visual prognosis if aggressive treatment is initiated during the early stages.

Neovascular Glaucoma: A Rare Presenting Feature of Vogt-Koyanagi-Harada Syndrome

“…Anterior chamber and vitreous inflammation may be seen. As per the series reported by Shreshta et al [ 9 ] and Lodhi et al [ 4 ], most patients with VKH presented in this phase. A better visual prognosis with aggressive treatment was seen in these cases [ 4 ].…”

“…The mean age of presentation of VKH has been found to be between 32 to 50 years (range 20-65 years) across various reported case series with a strong female preponderance [ 4 - 9 ]. Our patient was a young male presenting at 20 years of age.…”

“…Our patient was a young male presenting at 20 years of age. The clinical presentation is usually bilateral [ 9 ], even though some unilateral presentations have been described [ 4 ]. Our patient also presented with bilateral ocular involvement.…”

“…Many case reports and case series suggest that posterior segment manifestations may be the initial presenting features of VKH. Posterior uveitis [ 4 ], serous or exudative retinal detachment, or disc oedema were likely presentations when the patient presented in the acute phase, while a depigmented sunset-glow fundus was the characteristic presentation of the chronic phase [ 8 , 9 ].…”

“…Early initiation of aggressive treatment with high-dose systemic steroids, especially IVMP, has been combined with peribulbar long-acting corticosteroids [ 4 ] and prolonged immunosuppression (with either corticosteroids alone at appropriate doses [ 9 ] or steroid-sparing immunosuppressants in a combination of both, where a steroid-sparing effect was achieved in 5-6 months with either mycophenolate mofetil or methotrexate) [ 14 , 15 ].…”