Clinical analysis of acute primary Vogt-Koyanagl-Harada syndrome

Abstract

The clinical characteristics, therapeutic effects and complications of 32 incipient patients with acute Vogt-Koyanagi-Harada (VKH) syndrome admitted in Wuxi Second Hospital during October 2010 to September 2013 were retrospectively analyzed. There were 15 males and 17 females with a mean age of (41.3±14.1) years (22-71 years), the time from the disease onset to treatment ranged from 3 to 20 days. Among 32 cases, 30(94%) had premonitory symptoms. The multifocal bullous neurosensory detachment, optic disk hyperemia and edema in posterior pole of fundus were found in all cases, and exudative retinal detachment was found in 4 cases (6 eyes). The results of optical coherence tomography (OCT) showed the macula neurosensory detachment, thick retinal neuroepithelial layer and wavy RPE layer in all patients. Fundus fluorescein angiography (FFA) showed that scattered hyperfluorescence dots and cystic fluorescein reservoir was observed in early phase and later period respectively. Patients received intravenous methylprednisolone with the onset dose of 80 mg per day for 3-7 days and oral administration followed, which would gradually decrease later; the average treatment duration was (52.9±14.6) weeks. The visual acuity of 40 eyes (22 cases) was recovered to more than 0.8, and no blindness occurred after the treatment. During the treatment hair loss, depigmentation of skin and hair were found in 12 cases (38%), and 2 cases showed short-term elevated intraocular pressure. These symptoms disappeared after drug therapy ceased. And no recurrence was found during the follow-up of 6 months. However, sunset glow fundus was found in 13 patients (26 eyes). The study shows that the diagnosis of VKH syndrome is based on the typical signs of the fundus presented on OCT and FFA. Early and systemic administration of glucocorticoids is important treatment for patients with VHK syndrome, which could decrease systemic and local complications effectively. Key words: Uveitis; Uveomenigo-encephalitic syndrome