Vogt-Koyanagi-Harada Disease: A Case Series in a Tertiary Eye Center (original) (raw)
Related papers
Background: Vogt-Koyanagi-Harada (VKH) disease is an autoimmune inflammatory disease characterized by bilateral panuveities affecting the young adults. Approximately 3% of the uveitis patients are VKH patients. Objective: To assess the clinical profile of patients with Vogt-Koyanagi-Harada (VKH) disease. Methods: This cross-sectional observational study was conducted over 30 diagnosed patients of VKH disease in uvea clinic of National Institute of Ophthalmology and Hospital (NIO&H), Dhaka, Bangladesh. Patients were selected according to specific selection criteria. All the relevant data were recorded in a pre-designed data collection sheet. Results were analyzed by statistical tests. Results: The mean age of the study patients was 40.2±6.53 years, range 26-59 years. Out of 30 patients; 9(30%) were male and 21(70%) were female. Male to female ratio was 1:2.3. In this study we found all VKH diseases (100% cases) were in both eyes. The clinical type of VKH disease was classified as complete in 2 patients (4 eyes), incomplete in 17 patients (34 eyes), and probable in 11 patients (22 eyes). Regarding clinical presentation; posterior uveitis was in 14 eyes and panuveitis in 46 eyes. Twenty-six eyes (43.3%) had acute VKH disease, 24 eyes (40%) had convalescent stage, and 10 eyes (16.7%) had recurrent uveitis. Meningism [17(56.7%)] and headache [16(53.3%)] were the commonest acute presentations followed by vitiligo [10(33.3%)] and poliosis [3(10.0%)]. Sensorineural hearing loss was present in 2(6.7%) chronic cases. The ocular findings of slit-lamp examination were circumciliary congestion in 32 eyes (53.3%), keratic precipitates in 30 eyes (50.0%) and iris nodules in 10 eyes (16.7%). Fundus examination revealed that vitritis in 60 eyes (100%), optic disc involvement in 34 eyes (56.7%), exudative retinal detachment in 38 eyes (63.3%), sunset glow fundus in 32 eyes (53.3%), Dalen-Fuchs nodules in 16 eyes (26.7%) and choroidal detachment in 4 eyes (6.7%). We found 71.7% of VKH patients had substantial vision loss. Conclusion: Vogt-Koyanagi-Harada disease is a bilateral, diffuse, granulomatous panuveitis, affects more in females of the middle age. Most of our VKH patients were in the chronic stage of the disease and had substantial vision loss. Early recognition and aggressive treatment of VKH disease result in good visual outcome.
Vogt Koyanagi Harada disease: treatment and visual prognosis
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2013
Vogt Koyanagi Harada (VKH) disease is a chronic, bilateral, granulomatous panuveitis associated with central nervous system, auditory and integumentary manifestations. The study was conducted from January 2001 to December 2010 at the Department of Ophthalmology, Khyber Teaching Hospital, Peshawar. A total of 9 patients with diagnosis of Vogt Koyanagi Harada disease were included in the study. Extracted data included age, gender, duration of disease, initial and final visual acuities, treatment and complications. Initial visual acuity was ranging from 6/24 to perception of light. All the patients were treated with systemic and topical corticosteroids. In addition, one patient also received cytotoxic therapy. Final visual acuity was 6/18 or better in all cases (100%). One patient developed bilateral cataract, glaucoma and subretinal fibrosis at the macula. The cataract and glaucoma were managed as per established protocols. The visual prognosis of Vogt Koyanagi Harada disease is gener...
Ocular Immunology and Inflammation, 2019
Purpose: To investigate incidence, risk factors, and surgical outcomes of cataract among uveitis patients. Methods: Retrospective review of 1000 patients (1582 eyes). Results: At initial presentation, cataract was diagnosed in 290 (18.3%) eyes and was most common in eyes with anterior uveitis. Fuchs' uveitis, herpetic uveitis, and presumed tuberculous uveitis were leading clinical entities associated with cataract at presentation. During follow-up, cataract developed in additional 200 (12.6%) eyes and was most common in eyes with anterior uveitis. Significant risk factors at presentation included age >18 years, female gender, presence of keratic precipitates, hypopyon, and posterior synechiae. Among the 490 eyes with cataract, 204 underwent cataract extraction during follow-up period. Best corrected vision of ≥20/40 was achieved in 122 (60.1%) eyes. Conclusions: Incidence of cataract differed depending on anatomic and etiologic diagnoses of uveitis. There is a significant association between severity of inflammation at presentation and development of cataract.
Ocular Immunology and Inflammation, 2013
Purpose: To evaluate clinical and demographic features of Vogt-Kayanagi-Harada disease (VKH) disease in Turkish patients and compare them with previously published data. Methods: Demographic and clinical features of 32 patients diagnosed as VKH in a tertiary referral center were retrospectively reviewed. Results: The mean age at presentation was 33.6 AE 10.4 years. Seventy-five percent of the patients were female and 62.5% of the patients presented during the last 2 years. The disease was complete in 31.2%, incomplete in 50%, and probable in 18.8% of the patients. The clinical course was acute in 50%, chronic recurrent in 34.4%, and chronic in 15.6%. The most common findings were bilateral serous retinal detachment AE papillitis in acute cases and retinal pigment epithelial changes of the macula in chronic cases. Conclusions: Although rare in Turkey, VKH disease seems to have increased during the last few years. The disease is incomplete and acute in half of the patients and has a quite good visual prognosis.
Clinical spectrum and management options in Vogt–Koyanagi–Harada disease
Clinical Ophthalmology, 2017
The 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. Method: A 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. Results: A 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. Conclusion: VKH-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.
Presumed Vogt-Koyanagi-Harada disease with unilateral ocular involvement: report of three cases
Graefe's Archive for Clinical and Experimental Ophthalmology, 2009
Aim To report three cases of presumed Vogt-Koyanagi-Harada (VKH) disease with unilateral ocular manifestations. Methods This retrospective study reviewed the long-term follow-up observations of three patients who attended the uveitis clinic at Tokyo Medical University Hospital. The patients were followed for 5-16 years with systemic clinical, ophthalmologic and laboratory examinations. Ophthalmoscopic findings, extraocular manifestations, visual acuity, and response to corticosteroid administration were evaluated. Results Three patients had characteristic clinical features of VKH involving only one eye, including diffuse choroiditis, serous retinal detachment, focal areas of delayed choroidal perfusion, multifocal areas of pinpoint leakage, macular oedema, and optic nerve staining. All patients received systemic corticosteroid therapy during the acute phase of the disease. During the follow-up period (5-16 years), all three patients developed sunset-glow fundus and nummular chorioretinal depigmented scars in the affected eye only, as well as systemic complications of deafness, vitiligo, and poliosis. Conclusion The clinical and laboratory features of all three patients were typical of VKH disease except for the unilateral involvement. It is important for ophthalmologists to recognize unilateral VKH disease, even though it is a rare clinical variant of the disease.
Initial misdiagnosis of Vogt-Koyanagi-Harada disease
Saudi Journal of Ophthalmology, 2019
Purpose: To report the initial misdiagnosis of patients with Vogt-Koyanagi-Harada (VKH) disease. Methods: The medical records of 76 consecutive patients diagnosed with VKH disease were reviewed retrospectively at The Eye Center, Riyadh, Saudi Arabia. Patients were referred to The Eye Center from Saudi Arabia and other Middle Eastern countries. The initial diagnosis was made by an ophthalmologist or neurologist. The main outcome measure was to evaluate cases with VKH disease who were initially misdiagnosed. Results: In 7 (9.2%) out of the 76 patients the initial diagnosis was incorrect. Patients were initially misdiagnosed as optic neuritis (1.3%), intracranial hypertension (1.3%), brain tumor (1.3%), Susac disease (1.3%), migraine (1.3%), rhegmatogenous retinal detachment (1.3%) or anterior granulomatous uveitis of unknown etiology (1.3%). Patients underwent unnecessary tests including MRI and invasive procedures including CSF analysis and anterior chamber paracentesis. Conclusion: The initial diagnosis of patients with VKH disease was incorrect in 9 % of the cases. Delay in the diagnosis of VKH disease may lead to delay in management and may cause irreversible damage to the photoreceptors with poor visual outcome.
Clinical spectrum and management options in Vogt–Koyanagi–Harada disease
Clinical Ophthalmology, 2017
The 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. Method: A 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. Results: A 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. Conclusion: VKH-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.