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Vogt-Koyanagi-Harada disease in pediatric, adult and elderly: clinical characteristics and visual outcomes

  • Inflammatory Disorders
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Abstract

Purpose

To depict a whole spectrum of clinical feartures and visual prognosis among pediatric, adult, and elderly Vogt-Koyanagi-Harada disease (VKH) patients.

Methods

Retrospective chart review was conducted in 2571 VKH patients diagnosed from April 2008 to January 2022. Based on age of disease onset, patients were divided into pediatric (age ≤ 16 years), adult (16 < age < 65 years), and elderly (age ≥ 65 years) VKH group. Ocular and extraocular manifestations were compared among these patients. Visual outcomes and complications were evaluated using logistic regression models and restricted cubic splines analysis.

Results

The median follow-up time was 48 (IQR, 12–60) months. Pediatric, adult and elderly VKH were found in 106 (4.1%), 2355 (91.6%), and 110 (4.3%) patients, respectively. All of the patients showed similar ocular manifestations in the context of disease phasing. The proportion of neurological and auditory manifestations in pediatric (42.3% and 7.5%) VKH patients was significantly lower than that in adults (66.5% and 47.9%) and elderly (68.2% and 50%) (both p < 0.0001). An increased risk of macular abnormalities was seen in adults (OR, 3.43; 95% CI, 1.62–7.29) compared with elderly VKH. An inverted-U-shaped pattern was observed between disease onset age and a poor visual outcome (visual acuity 6/18 or worse) according to OR value in VKH patients. The highest risk of BCVA ≤ 6/18 was observed in 32 years at disease onset (OR, 1.51; 95% CI, 1.18–1.94). A higher risk of visual loss was observed in adult VKH patients (OR, 9.06; 95% CI, 2.18–37.6) compared with elderly VKH patients. And stratified by macular abnormalities, the interaction test was not significant (P = 0.634).

Conclusion

Our study identified, for the first time, a whole spectrum of clinical features of VKH based on a large cohort of Chinese patients. Adult VKH patients have an increased risk of poor visual outcomes, possibly due to increased frequency of macular abnormalities.

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Funding

This work was supported by National Natural Science Foundation Key Program (81930023), Chongqing Outstanding Scientists Project (2019), Chongqing Chief Medical Scientist Project (2018), Key Project of Chongqing Science and Technology Bureau (CSTC2021jscx-gksb-N0010), Chongqing Science & Technology Platform and Base Construction Program (cstc2014pt-sy10002) Chongqing Key Laboratory of Ophthalmology (CSTC, 2008CA5003).

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Authors and Affiliations

  1. The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Youyi Road 1, Chongqing, 400016, People’s Republic of China

    Peizeng Yang, Weiting Liao, Yanlin Pu, Zhenyu Zhong, Hongmiao Wang, Qiuyue Yu, Jinyu Cai, Wujiao Wang & Guannan Su

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  1. Peizeng Yang
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  2. Weiting Liao
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Correspondence to Peizeng Yang.

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This study adhered to the Declaration of Helsinki and was approved by the institutional review board of the First Affiliated Hospital of Chongqing Medical University (no. 2021–769).

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Yang, P., Liao, W., Pu, Y. et al. Vogt-Koyanagi-Harada disease in pediatric, adult and elderly: clinical characteristics and visual outcomes. Graefes Arch Clin Exp Ophthalmol 261, 2641–2650 (2023). https://doi.org/10.1007/s00417-023-06058-5

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