Prognostic factors for Vogt-Koyanagi-Harada disease

Vogt-Koyanagi-Harada disease is a chronic bilateral granulomatous panuveitis with involvement of the central nervous system, auditory and integumentary systems. The prognosis depends mostly on the development of complications or not. The purpose of this study was to identify the prognostic factors of Vogt-Koyanagi-Harada (VKH) disease.

Retrospective chart review of all the patients diagnosed with VKH disease between 1991 and 2000 was performed. Data recorded included age, sex, clinical features, systemic manifestations, recurrence, HLA typing, treatment, complications, and final visual acuity. Statistical analysis was performed using Statistical Products and Services Solutions.

There were thirty-nine patients, the mean age at presentation was 39.82 +/- 12.38 years. The majority (46.2%) of patients were probable VKH disease, followed by incomplete type (43.5%), with only 10.3% complete type. Ten patients had at least one complication, including cataract in 19 eyes, glaucoma in 4 eyes and choroidal neovascularization in 3 eyes. Fifty eyes (64.1%) had final visual acuity of 6/12 or better. The interval between ocular symptom and treatment had significant effect on the development of complicaion (p = 0.022) and recurrence (p = 0.003), which were also significantly associated with the final visual acuity (p = 0.007). For patients who were diagnosed and treated within two weeks, the extent of exudative retinal detachment correlated significantly with final visual acuity (p = 0.001).

The visual prognosis of VKH disease is generally favorable. The development of complications or recurrence was significantly associated with the visual outcome. Interval between development of ocular symptom and treatment seemed to be an important predictor in the early stage of VKH. It is important to start the treatment early even when the typical features of VKH disease have not completely appeared.