Work-up, diagnosis and management of acute Vogt-Koyanagi-Harada disease

Abstract

The diagnostic work-up, investigational tests, and differential diagnosis to confirm or reject the diagnosis of VKH as well as the management of the case will be described by the experts.

Indocyanine green angiography findings in initial acute pretreatment Vogt-Koyanagi-Harada disease in Japanese patients

“…Similarly, OCT allows clear depiction of the height and extension of serous retinal detachments in the macular area, but apart from the high-quality images obtained, it provides no essential additional information that is not already available by clinical examination. 18 The explanation for this is that clinical signs, FA, and OCT, all give merely information on secondary infl ammatory events that occur when infl ammation is spilling over from the choroid. IA has been found to be particularly useful for early disease detection when no secondary spill-over infl ammation is present as yet.…”

Intraocular inflammation: Its causes and investigations

“…In addition to bilateral ocular disease not suggestive of other diseases, evidence of auditory/neurological or integumentary fi ndings is required. Audiology testing is useful; in one series, sensory hearing loss was documented in approximately 50% of patients after a comprehensive assessment [ 30 ]. The diagnosis may also be aided by lumbar puncture, which typically reveals a predominantly lymphocytic pleocytosis that is present in up to 80% of Japanese patients and persists up to eight weeks [ 31 , 32 ].…”

Catching the therapeutic window of opportunity in early initial-onset Vogt–Koyanagi–Harada uveitis can cure the disease

“…It is considered a primary stromal choroiditis because the inflammatory reaction electively starts within the choroidal stroma [9]. The initial-onset acute disease typically exhibits granulomatous choroiditis with exudative retinal detachment and optic disk hyperemia and swelling, followed by anterior segment involvement and eventual development into chronic recurrent granulomatous anterior uveitis if not properly treated, with typical ''sunset glow fundus'' (SGF) and chorioretinal atrophy [10][11][12][13].…”

“…Intraocular inflammation in insufficiently treated VKH disease will proceed to recurrent granulomatous anterior and posterior uveitis and typical sunset glow fundus (SGF), even when systemic monotherapy is given early in disease [10][11][12][13][14][15][16].…”