Incidence of Cataract Surgery and Postoperative Visual Acuity Outcomes in Patients with Vogt-Koyanagi-Harada Disease

To determine the incidence and predictive factors of visually significant cataracts requiring cataract surgery in patients with Vogt-Koyanagi-Harada (VKH) disease and to evaluate postoperative visual acuity (VA) outcomes.

Medical records of 100 patients (197 phakic eyes) diagnosed with VKH between 2010 and 2023 were reviewed. Kaplan-Meier analysis was used to estimate the cumulative incidence of cataract surgery. Longitudinal postoperative VA outcomes were analyzed using a linear mixed-effects model.

Forty-one eyes from 24 patients developed visually significant cataracts requiring surgery (incidence rate, 5.4% per eye-year; 95% CI, 4.0-7.3). The cumulative incidence of cataract surgery was 27.9% at 5 years after disease onset. Age > 45 years at VKH presentation (adjusted hazard ratio [aHR] = 6.7, p = 0.001), male sex (aHR = 3.8, p = 0.007), prior glaucoma medication use (aHR = 6.3, p = 0.015), prior regional corticosteroid injection (aHR = 8.3, p = 0.015), and inactive uveitis at presentation (aHR = 22.0, p < 0.001) were associated with an increased incidence of cataract surgery. The modeled mean VA improved from 1.2 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.3 logMAR at 6 months postoperatively. Systemic immunomodulatory treatment (IMT) use (adjusted odds ratio [aOR] = 14.2, p = 0.034) and absence of prior regional corticosteroid injection (aOR = 19.3, p = 0.009) increased the likelihood of achieving a VA of ≥20/40 at 6 months postoperatively.

Patients with VKH have a moderate risk of cataract surgery. Cataract surgery is associated with substantial and sustained VA improvement. More favorable outcomes were observed in eyes receiving IMT and in those without a history of regional corticosteroid injection.