Long-term Outcomes of Uveitis Associated with Vogt-Koyanagi-Harada Disease in the Pediatric Age Group

PURPOSE

To investigate the outcomes of uveitis associated with Vogt-Koyanagi-Harada (VKH) disease in pediatric age group (aged 16 years and under).

METHODS

A retrospective review of patients with VKH disease.

RESULTS

Among the 244 patients identified, 38 (76 eyes) were children. Among them, five had insulin-dependent diabetes mellitus. 21 presented with initial-onset acute disease and 17 with chronic recurrent disease. The mean follow-up period was 59.1 months. At presentation, chronic recurrent disease was associated with more severe inflammation as indicated by the presence of mutton-fat keratic precipitates (p < .001), iris nodules (p = .005) and posterior synechiae (p < .001). During follow-up, the rate of complications was higher in children with chronic recurrent disease compared with initial-onset acute disease (p < .001). 92.4% of the eyes with initial-onset acute disease achieved a final visual acuity of ≥20/40 compared with 70.6% of the eyes with chronic recurrent disease (p = .013).

CONCLUSIONS

Chronic recurrent VKH disease in children is associated with worse outcomes.

Vogt-Koyanagi-Harada Disease and Systemic Lupus Erythematosus Occurring during Adalimumab Therapy for Ulcerative Colitis

We report the case of a 36-year-old male patient known to have ulcerative colitis on adalimumab treatment for 2 years who presented with initial-onset acute uveitis associated with Vogt–Koyanagi–Harada disease. Uveitis was treated successfully with systemic corticosteroids combined with mycophenolate mofetil. The patient had complete resolution of posterior segment inflammation and exudative retinal detachment. One year after the initial presentation, the patient was diagnosed to have systemic lupus erythematosus and adalimumab was discontinued. This case suggests that adalimumab could induce severe autoimmune inflammatory diseases.