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Long-Term Outcomes of Pediatric Vogt-Koyanagi-Harada Disease
Dhabiah Saeed AlQahtani1, Abeer Habeeb Almutairi2, Ibrahim Saud Ababtain3
1Vitreoretinal and Uveitis Divisions, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
Insights
Vogt-Koyanagi-Harada (VKH) disease in children can lead to good visual outcomes, but chronic recurrent cases present with more severe inflammation and higher risks of complications. Early detection and management are crucial for better visual prognosis in pediatric VKH patients.
Area of Science:
- Ophthalmology
- Immunology
- Pediatric Medicine
Background:
- Vogt-Koyanagi-Harada (VKH) disease is a rare, idiopathic, systemic inflammatory disorder affecting melanin-rich tissues, particularly the eyes.
- Pediatric VKH disease requires specific attention due to potential long-term visual impairment and developmental consequences.
- Understanding the clinical course and prognostic factors in children is essential for optimizing management strategies.
Purpose of the Study:
- To investigate the clinical presentation, treatment outcomes, and factors influencing final visual acuity in pediatric patients diagnosed with VKH disease.
- To identify specific characteristics associated with poorer visual outcomes in children with VKH.
- To analyze the long-term visual results in a cohort of pediatric VKH patients.
Main Methods:
- Retrospective analysis of demographic and clinical data from pediatric patients diagnosed with VKH between 2007 and 2024 at King Khaled Eye Specialist Hospital (KKESH).
- Evaluation of presenting visual acuity, ocular inflammation, complications, and final visual outcomes.
- Statistical analysis to determine associations between clinical features, disease course (acute vs. chronic recurrent), and final visual outcome.
Main Results:
- The study included 69 children (138 eyes), with a mean age of 12.2 years; 60 had acute VKH and 9 had chronic recurrent VKH.
- Children with chronic recurrent VKH presented earlier, exhibited more severe corneal and anterior chamber inflammation, and had higher rates of cataract, glaucoma, and choroidal neovascular membranes (CNVM).
- Despite initial visual acuity averaging 20/70, final visual acuity improved significantly to 20/50, though chronic recurrent cases had less favorable outcomes.
Conclusions:
- Pediatric VKH disease generally achieves good visual outcomes, but chronic recurrent forms are associated with increased ocular inflammation and complications.
- Ocular complications such as cataract, glaucoma, and CNVM are more prevalent in children with chronic recurrent VKH.
- Aggressive management tailored to the disease course is necessary to mitigate complications and improve long-term visual prognosis in pediatric VKH patients.
Purpose:
To study the clinical presentation, outcomes, and factors affecting the final visual outcome of Vogt-Koyanagi-Harada (VKH) disease in the pediatric age group.
Methods:
Pediatric patients who were diagnosed with VKH at King Khaled Eye Specialist Hospital (KKESH) between 2007 and 2024. Demographic and clinical data were collected and analyzed for an association with the final visual outcome.
Results:
Sixty-nine children (138 eyes) with an age range upon presentation from 2 years old to 18 years old and a mean age of 12.2 ± 4.0 years were included. The mean duration of follow-up was 6.5 ± 3.1 years. There were 35 (50.7%) males and 34 (49.3%) females. Sixty children (86.9%) had initial-onset acute VKH, while 9 children had chronic recurrent VKH. At initial presentation, the mean LogMAR BCVA was 0.6 (Snellen = 20/70) ± 0.6. Children with chronic recurrent VKH presented at an earlier age (p = 0.003), had more severe corneal involvement (p < 0.001) and more severe AC reaction (p < 0.001). Cataract developed in 33 (23.9%) eyes, 54 eyes (39.1%) developed glaucoma, and 36 eyes (26.1%) developed choroidal neovascular membranes (CNVM). Children with chronic recurrent VKH disease had higher rates of pre-existing or developing cataract, glaucoma, and CNVM. On the last visit, the BCVA improved from an average of 20/70 to 20/50. The visual improvement was statistically significant (p = 0.005).
Conclusions:
Good visual outcomes can be achieved in the majority of pediatric patients with VKH disease. Children with chronic recurrent VKH disease present with more aggressive anterior segment inflammation, have higher risk of developing ocular complications, and less favorable visual outcomes.
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