Session Title: Quick Fire Free Paper 2
Session Date/Time: Thursday 11/09/2014 | 11:00-12:30
Paper Time: 11:50
Venue: Boulevard D
First Author: : S.Jordan SPAIN
Co Author(s): : O. Garcia-Garcia O. Subirà H. Brosa S. Jordán
We describe and analyze the presentation, diagnosis, management, complications, and outcomes of a series of cases of Vogt-Koyanagi-Harada syndrome (VKH).
The population of patients diagnosed and treated for VKH at the uveitis unit in our hospital from 1993 to 2014.
We employ a retrospective chart review of 32 patients. Each individual file was searched for details in the initial complaint and other symptoms and signs present at the moment of diagnosis. Additionally, we recorded the average time from first consultation until diagnosis. Results of audiometry and lumbar puncture (LP) were also registered. Every case was classified as a complete or uveomeningeal form of VKH. Furthermore, we searched for data related to treatment: initial treatment, response, and the need for modifications. We also searched for the presence of complications and their assessment. Finally, we analyzed the first and last best-corrected visual acuity (BCVA) in every case.
The most common initial complaint was headache (81%), followed by bilateral vision loss (72%). Other complaints included red eye, hearing loss, and vertigo. The average time to diagnosis was 36.9 days. Audiometry and LP were positive in 70% of the cases. Twenty-eight patients (87.5%) showed uveomeningeal VKH and 4 patients (12.5%) exhibited complete VKH. All patients received treatment with topical dexamethasone and oral prednisone; 6 patients (19%) required an intravenous megadose and 9 patients (28%) required a combination of an immunosupressant drug, mainly cyclosporine. Complications included glaucoma, cataract, epiretinal membrane, and choroidal neovascularization; 8 patients (25%) required ocular surgery. On follow-up, 15 patients (48%) were healed, 11 (34%) evolved to a recurrent form, and 6 (17%) to a chronic form. BCVA improved 5.3 Snellen lines on average in 43 eyes (67.8%), remained stable (+/- 1 Snellen line) in 17 eyes (26%), and decreased in 4 eyes (6%).
The results of this series are similar to those in the published literature. Nevertheless, the proportion of complete forms of the disease is smaller than in older references and there are more cases of healing with fewer cases of chronification. This finding is probably related to early energical treatment, which prevents the disease from fully developing. Adequate treatment with a prompt response to complications provides a generally good visual prognosis for patients with VKH.