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Vogt-Koyanagi-Harada syndrome in children compared to adults
K F Tabbara1, P S Chavis, W R Freeman
1Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Insights
Vogt-Koyanagi-Harada (VKH) syndrome in children presents aggressively, leading to more severe ocular complications and poorer visual outcomes compared to adults. Early-onset VKH requires urgent attention due to its severe impact on vision.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Immunology
Background:
- Vogt-Koyanagi-Harada (VKH) syndrome is a rare, idiopathic, systemic inflammatory disorder affecting pigmented tissues.
- VKH syndrome commonly affects young adults but can occur at any age, including childhood.
Purpose of the Study:
- To investigate the clinical course and visual prognosis of Vogt-Koyanagi-Harada (VKH) syndrome in pediatric patients.
- To compare the outcomes of early-onset VKH (before age 14) with adult-onset VKH.
Main Methods:
- Retrospective review of 97 consecutive VKH patients treated at King Khaled Eye Specialist Hospital.
- Patients were categorized into pediatric (onset ≤14 years) and adult (onset >14 years) groups.
- Comparison of ocular complications, treatment requirements, and final visual acuity between the two groups.
Main Results:
- Pediatric VKH patients exhibited a higher rate of cataract surgery (61% vs. 17%) compared to adults.
- A significantly greater proportion of children experienced severe visual impairment (final visual acuity ≤20/200) at 61% versus 26% in adults (p=0.0103).
- Ocular complications and vision deterioration were more pronounced in the pediatric group despite therapy.
Conclusions:
- Early-onset Vogt-Koyanagi-Harada (VKH) syndrome, occurring before age 14, follows an aggressive clinical course.
- Children with VKH syndrome experience more severe ocular complications and poorer visual outcomes than adult patients.
- Aggressive management is crucial for VKH syndrome in children to mitigate severe and potentially irreversible vision loss.
Purpose:
To study the course and visual outcome of Vogt-Koyanagi-Harada (VKH) syndrome in children.
Methods:
The medical records of 97 consecutive patients with VKH syndrome were reviewed. Patients had been seen at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia. The records were divided into two groups: those in whom the onset of the disease occurred at the age of 14 years or younger (pediatric group) and those in whom the disease manifested after the age of 14 years (adult group).
Results:
Eight (61%) of the 13 children required cataract surgery compared to 14(17%) of 84 adult patients. Despite medical and surgical therapy, eight (61%) of the pediatric group had a final visual acuity of 20/200 or worse compared with 22 (26%) of the 84 adult patients (p=0.0103).
Conclusion:
The course of early-onset VKH (before the age of 14 years) appears to be aggressive. The ocular complications are more severe in children than in adults, leading to rapid deterioration in vision. Despite therapy, the final visual outcome of VKH in children is poor.