Abstract
Objective To analyze the clinical profile of Vogt-Koyanagi-Harada (VKH) disease in Tunisia, North Africa.
Methods We retrospectively reviewed the clinical records of 49 patients diagnosed with VKH disease at the Department of Ophthalmology of Fattouma Bourguiba University Hospital, Monastir, Tunisia, between January 1994 and September 2005.
Results Of all the uveitis cases diagnosed during the study period, VKH disease was the fourth most commonly occurring type (7.4%). Thirty-two patients (65.3%) were female, and 17 patients (34.7%) were male. The mean age at disease onset was 35 years (range: 16–54 years). The majority of patients (51%) had probable VKH disease, followed by incomplete type (47%); only 2% had the complete type. At presentation, 47 patients (96%) had bilateral ocular involvement. Clinical presentation was a panuveitis in 25 patients (51%) and a posterior uveitis in 24 patients (49%). Visual acuity (VA) at presentation ranged from less than 20/200 (40.8%) to more than 20/40 (28.5%). All patients were treated with systemic corticosteroids for 2–19 months (mean: 10.5 months). Four patients (8%) were treated with cyclosporin because of serious systemic side effects of corticosteroids. Complications included cataract in 18 eyes (33.9%), glaucoma in nine eyes (16.96%) and choroidal neovascularization in one eye (1%). Fifty-eight eyes (59%) had a final VA of 20/40 or better. Factors associated with a poor VA at the final follow-up were the presence of a poor VA at presentation (P = 0.02), the occurrence of complications (P = 0.001) and/or recurrences (P = 0.02).
Conclusion In Tunisia, VKH disease is a common cause of uveitis that predominantly affects young women. The overwhelming majority (98%) have probable or incomplete VKH disease, presenting as panuveitis or posterior uveitis. More than 50% of patients undergoing treatment with corticosteroids will maintain a VA of 20/40 or better.
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References
Moorthy RS, Inomata H, Rao NA (1995) Vogt-Koyanagi-Harada syndrome. Surv Ophthalmol 39:265–292
Khairallah M, Yahia SB, Ladjimi A, Messaoud R et al (2006) Pattern of uveitis in a referral center in Tunisia, North Africa. Eye 2006:1–7
Read RW, Holland GN, Rao NA et al (2001) Revised diagnostic criteria for Vogt-Koyanagi-Harada disease: report of an international committee on nomenclature. Am J Ophthalmol 131:647–652
Mondkar SV, Biswas J, Ganesh SK (2000) Analysis of 87 cases with Vogt-Koyanagi-Harada disease. Jpn J Ophthalmol 44:296–301
Rajendram R, Evans M, Rao NA (2005) Vogt-Koyanagi-Harada Disease. Int Ophthalmol Clin 45:115–134
Read RW, Rao NA, Cunningham ET (2000) Vogt-Koyanagi-Harada disease. Curr Opin Ophthalmol 11:437–442
Belfort Junior R, Nishi M, Hayashi S et al (1988) Vogt-Koyanagi-Harada's disease in Brazil. Jpn J Ophthalmol 32:344–347
Bykhovskaya I, Thorne JE, Kempen JH et al (2005) Vogt-Koyanagi-Harada disease: clinical outcomes. Am J Ophthalmol 140:674–678
Tabbara KF, Chavis PS, Freeman WR (1998) Vogt-Koyanagi-Harada syndrome in children compared to adults. Acta Ophthalmol Scand 76:723–726
Rathinam SR, Vijayalakshmi P, Namperumalsamy P et al (1998) Vogt-Koyanagi-Harada syndrome in children. Ocul Immunol Inflamm 6:155–161
Touitou V, Escande C, Bodaghi B et al (2005) Diagnostic and therapeutic management of Vogt-Koyanagi-Harada syndrome. J Fr Ophtalmol 28:9–16
Beniz J, Forster DJ, Lean JS et al (1991) Variations in clinical features of the Vogt-Koyanagi-Harada syndrome. Retina 11:275–280
Ohno SMR, Matsuda H (1988) Clinical studies on Vogt-Koyanagi-Harada disease. Jpn J Ophthalmol 32:334–343
Bouchenaki NHC (2001) The contribution of indocyanine green angiography to the appraisal and management of Vogt-Koyanagi-Harada Disease. Ophthalmology 108:54–64
Nakamura S, Nakazawa M, Yoshioka M et al (1996) Melanin-laden macrophages in cerebrospinal fluid in Vogt-Koyanagi-Harada syndrome. Arch Ophthalmol 114:1184–1188
Rubsamen PE, Gass JD (1991) Vogt-Koyanagi-Harada Syndrome: clinical course, therapy and long-term visual outcome. Arch Ophthalmol 109:682–687
Paredes I, Ahmed M, Foster CS (2006) Immunomodulatory therapy for Vogt-Koyanagi-Harada patients as first-line therapy. Ocul Immunol Inflamm 14:87–90
Yamaki K, Hara K, Sakuragi S (2005) Application of revised diagnostic criteria for Vogt-Koyanagi-Harada disease in Japanese patients. Jpn J Ophthalmol 49:143–148
Sugiura S (1978) Vogt-Koyanagi-Harada disease. Jpn J Ophthalmol 22:9–35
Fujioka TFM, Okinami S (1980) A statistic study of Vogt-Koyanagi-Harada syndrome. Acta Soc Ophtalmol Jpn 84:1979–1982
Rao NA (1997) Mechanisms of inflammatory response in sympathetic ophthalmia and VKH syndrome. Eye 11:213–216
Read RW, Rechedouni A, Butani N et al (2001) Complications and prognostic factors in Vogt-Koyanagi-Harada disease. Am J Ophthalmol 131:599–606
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Khairallah, M., Zaouali, S., Messaoud, R. et al. The spectrum of Vogt-Koyanagi-Harada disease in Tunisia, North Africa. Int Ophthalmol 27, 125–130 (2007). https://doi.org/10.1007/s10792-006-9013-x
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DOI: https://doi.org/10.1007/s10792-006-9013-x