Posterior segment recurrences in Vogt-Koyanagi-Harada disease

Abstract

To describe the clinical profile, management, and outcome in seven patients with posterior segment recurrence in Vogt-Koyanagi-Harada (VKH) disease. Retrospective chart review of all the patients of VKH disease presenting to our institute between 2001 and 2005 was carried out. Patients with a documented posterior segment recurrence during follow-up were included in this study. Their history, systemic associations, ocular findings, investigations, management strategies, and treatment response were noted. Out of 82 VKH patients screened, documented posterior segment recurrence was seen in seven patients who included five women and two men, with a mean age of 33.7 years (range 22-55 years). At onset, two patients had incomplete and five had probable VKH disease. At the time of recurrence, four patients were on maintenance dose (5-10 mg/day) of oral corticosteroid while the remaining three were off treatment. The mean interval between the primary episode and posterior segment recurrence was 33.7 weeks (range 16-52 weeks). All posterior segment recurrences were bilateral and were characterized by vitritis (eight eyes), papillitis (14 eyes), multiple yellow-white oval subretinal lesions (six eyes), and exudative retinal detachment (10 eyes). The recurrences were managed with oral corticosteroids (1.0-1.5 mg/day) and Azathioprine (2.0-2.5 mg/day). Subsequently, three patients experienced a second episode of posterior segment recurrence, which also responded to the corticosteroid-Azathioprine combination. Recurrences in VKH disease may involve predominantly the posterior segment, and respond well to the standard treatment.