Acute phase clinical manifestations of patients with Vogt-Koyanagi-Harada disease in Southern China

BACKGROUNDS

To characterize the acute phase clinical manifestations and visual outcomes of the patients with Vogt-Koyanagi Harada (VKH) disease in southern China.

METHODS

In total, 186 patients with acute-onset VKH disease were recruited. The demographic data, clinical signs, ophthalmic examinations, and visual outcomes were analyzed.

RESULTS

Among the 186 VKH patients, 3 were diagnosed as complete VKH, 125 as incomplete VKH, and 58 as probable VKH. All patients visited the hospital within 3 months of onset and complained of decreased vision. For the extraocular manifestations, 121 patients (65%) referred neurological symptoms. Anterior chamber activity was negative in most eyes within an onset of 7 days, which increased slightly with onset beyond 1 week. Exudative retinal detachment (366 eyes, 98%) and optic disc hyperaemia (314 eyes, 84%) were commonly observed at presentation. A typical ancillary examination helped with the diagnosis of VKH. Systemic corticosteroid therapy was prescribed. The logMAR best-corrected visual acuity improved significantly from 0.74 ± 0.54 at baseline to 0.12 ± 0.24 at the 1-year follow-up visit. The recurrence rate was 18% in the follow-up visits. Erythrocyte sedimentation rate and C-reactive protein were significantly correlated to VKH recurrences.

CONCLUSION

Posterior uveitis, followed by mild anterior uveitis, is the typical initial manifestation in the acute phase of Chinese VKH patients. Visual outcome improvement is promising in most patients receiving systemic corticosteroid therapy in the acute phase. Detection of the clinical features at the initial onset of VKH could facilitate early treatment and better vision improvement.

Suprachoroidal triamcinolone acetonide injection: a novel therapy for serous retinal detachment due to Vogt-Koyanagi Harada disease

PURPOSE

To assess the efficacy and safety of Suprachoroidal triamcinolone acetonide injection [SCTA] as an adjunctive therapy in management of Vogt-Koyanagi Harada [VKH] serous retinal detachment.

DESIGN

Prospective parallel group study.

PARTICIPANTS

12 eyes of 6 patients with bilateral multiple serous retinal detachment of VKH in acute phase on systemic steroids.

METHODS

Each patient was received single SCTA injection (SCTA group, n = 6 eyes) and the other non-injected eye (Standard treatment group, n = 6 eyes), patients were followed for 1, 3, and 6 months to assess changes in best corrected visual acuity [BCVA], central foveal thickness [CFT] and intraocular pressure [IOP] between both groups.

MAIN OUTCOME MEASURES

The primary end point was changes in BCVA from baseline till 6^th months follow-up. Secondary end points were changes in CFT and IOP from baseline to 6 months of follow-up.

RESULTS

BCVA at one and three months was significantly better in eyes received SCTA than in non-injected eyes (p-value = 0.026 for each). CFT at one and three months was significantly higher in non-injected eyes than in eyes received SCTA (p-value = 0.028 for each). IOP showed no significant differences between both groups.

CONCLUSIONS

SCTA is an effective adjuvant treatment for VKH serous retinal detachment, without any serious ocular adverse effects or increase in IOP and causing significant reduction in CFT and rapid improvement in BCVA when combined with oral steroids.