The spectrum of Vogt-Koyanagi-Harada disease in South India

To report the clinical spectrum of Vogt-Koyanagi-Harada (VKH) disease in a tertiary care center in South India.

Medical records of patients diagnosed with VKH disease who presented between January 1995 and December 2003, with a minimum follow-up of one year were reviewed.

Of the 45 patients, 38 (84.44%) were female. The median age was 37 years (SD +/- 14.23) and median duration of symptoms was 30 days (range 1 day to 1 year). 75.5% (34/45) presented with bilateral anterior uveitis. Posterior segment presentation included disc edema (31/45), bilateral serous retinal detachments (26/45), vitritis (17/45) and sunset glow (8/45). Extra ocular manifestations were seen in only 4/45 (tinnitus: 2, meningismus: 1, poliosis: 1). 97.7% (44/45) received oral Prednisolone (1 mg/kg body weight) for a median duration of 14 months. 69% (31/45) received additional three pulses of intravenous methylprednisolone and 22% (10/45) received a single infusion of intravenous Cyclophosphamide. One patient received intravitreal triamcinolone injection 53.33% (24/45) were treated with additional immunosuppressants. At the first visit, best corrected visual acuity (BCVA) was > or =20/40 in 23 eyes (25.55%) and < or =20/400 in 37 eyes (41.11%). At one year, 61 eyes (67.77%) achieved BCVA of > or =20/40 while 12 eyes (13.33%) had BCVA < or =20/400. Complicated cataract, glaucoma and macular scar were the major complications encountered.

Majority of patients with ocular VKH presented with anterior uveitis and serous retinal detachments and disc edema. Extra-ocular signs are rare in our patients. Visual prognosis is good with treatment with adequate long-term corticosteroids and immunosuppressive agents.