Vogt-Koyanagi-Harada disease in children

Abstract

Purpose To identify prognostic factors for outcome in children with Vogt-Koyanagi-Harada (VKH) disease. Methods All children 16 years and younger with acute uveitis associated with VKH disease treated between 1999 and 2006 were reviewed. Results Twenty-three children (46 eyes) were identified; 20 (87%) girls and three (13%) boys with a mean age at presentation of 12.572.4 years. Mean follow-up period was 48.6730.8 months. Visual acuity of 20/40 or better was achieved in 38 (82.6%) eyes. Eleven eyes developed at least one complication, including cataract in eight eyes, glaucoma in eight eyes, subretinal neovascular membranes in two eyes, and subretinal fibrosis in one eye. Disease recurred during follow-up in 18 eyes. Development of complications was negatively associated with final visual acuity of 20/20 (P ¼ 0.0317). Shorter interval between symptoms and treatment was a predictor of final visual acuity of 20/20 (odds ratio ¼ 10.4; 95% confidence interval ¼ 1.61-67.3). Recurrence of inflammation was significantly associated with development of complications (P ¼ 0.003), worse visual acuity (P ¼ 0.022) and presence of posterior synechiae of the iris at presentation (P ¼ 0.0083), longer interval between symptoms and treatment (P ¼ 0.013), initial treatment with intravenous corticosteroids (P ¼ 0.0012), and rapid tapering of corticosteroids (P ¼ 0.0063). Conclusion Visual prognosis of VKH in children is generally favourable. Clinical findings at presentation, development of complications, interval between symptoms and treatment, recurrence of inflammation, use of intravenous corticosteroids, and method of tapering of systemic corticosteroids were significant prognostic factors.

Prevalence, Clinical Characteristics, and Causes of Vision Loss in Children With Vogt-Koyanagi-Harada Disease in South India

“…6,10,12 This was confirmed by our study, in which ;60% of the 22 children with VKH disease were girls. Only one pediatric series had a greater total number of affected boys.…”

“…The mean age of our patients was 12.6 years (range, 8 years to 16 years), which was similar to that found in previous reports in which the mean age ranged from 10 to 12.5 years. 10,11,12 The youngest reported patient was a 3-year-old Saudi Arabian girl. 33 Our youngest child was 8 years of age.…”

“…However, those authors reported that compared with the sex ratio in their entire clinic population, this was a relatively higher number of girls than would be expected. 12 Review of information available from the total 128 cases of pediatric VKH showed a total of 63.6% of affected girls. However, it is unclear whether this sex difference reflects an overall preponderance of women in the country's population, an overrepresentation of women in health care clinics, or a greater susceptibility of women to VKH disease.…”

“…Although a final vision of #20/200 has been reported in up to 20% to 61% of children, 10,11 1 study reported vision #20/100 in only 4.3% of children. 12 Although the clinical characteristics of VKH disease have been well described in adults, only isolated case reports and small case series exist for children (Table 1) Moreover, there have been no cohorts of VKH disease in children specifically from the Indian subcontinent. We therefore investigated the prevalence, clinical characteristics, and causes of vision loss in children with VKH disease seen during a 10-year period at a uveitis referral center in South India.…”

Choroidal neovascularization in 36 eyes of children and adolescents

“…21,22 In children with VKH, the incidence of CNV is estimated to be as high as 70%. [23][24][25] CNV in VKH is known to have a poor visual prognosis. 26 Treated with systemic steroids for associated active ocular inflammation, no treatment for CNV.…”