Abstract
Purpose
Our aim was to determine the recurrence rate of inflammation in Vogt-Koyanagi-Harada (VKH) disease and to describe its clinical features.
Methods
We retrospectively evaluated patients diagnosed as having VKH disease with exudative retinal detachment at the Osaka University Hospital or the Japanese Community Healthcare Organization, Osaka Hospital, between 1998 and 2012. All patients received high-dose corticosteroid therapy as the initial treatment and were followed for at least 6 months. Demographic data, including age, sex, visual acuity (VA) levels at initial presentation and at 1 year after initial therapy, treatment received, and recurrent episodes were reviewed.
Results
Fifty-five consecutive patients with VKH disease were identified (36 women; mean age 38.6 ± 10.4 years). Fourteen patients (25.5 %) had recurrent inflammation, which manifested as posterior uveitis in eight and as anterior uveitis in six of the patients. Recurrent posterior segment inflammation was more likely to develop in patients whose VA at initial presentation was poor (P = 0.039) and in whom orally administered corticosteroid was tapered rapidly (to 30 mg within 3 weeks or less, to 20 mg within 2 months or less, and to 10 mg within 3 months or less) (P = 0.006, P = 0.066, and P = 0.041, respectively).
Conclusions
About 25 % of patients with VKH disease had recurrent inflammation. Poor initial VA and rapid tapering of the corticosteroid were associated with posterior recurrence.
Similar content being viewed by others
References
Ohguro N, Sonoda KH, Takeuchi M, Matsumura M, Mochizuki M. A prospective multi-center epidemiologic survey of uveitis in Japan: a 2009 survey. Jpn J Ophthalmol. 2012;56:432–5.
Yamaki K, Gocho K, Hayakawa K, Kondo I, Sakuragi S. Tyrosine family proteins are antigens specific to Vogt-Koyanagi-Harada disease. J Immunol. 2000;165:7323–9.
Yamaki K, Kondo I, Nakamura H, Miyano M, Konno S, Sakuragi S. Ocular and extraocular inflammation induced by immunization of tyrosinase related protein 1 and 2 in Lewis rats. Exp Eye Res. 2000;71:361–9.
Moorthy RS, Inomata H, Rao NA. Vogt-Koyanagi-Harada syndrome. Surv Ophthalmol. 1995;39:265–92.
Read RW. Vogt-Koyanagi-Harada disease. Ophthalmol Clin North Am. 2002;15:333–41.
Read RW, Rechodouni A, Butani N, Johnston R, Labree LD, Smith RE, et al. Complications and prognostic factors in Vogt-Koyanagi-Harada disease. Am J Ophthalmol. 2001;31:599–606.
Shindo Y, Inoko H, Yamamoto T, Ohno S. HLA-DRB1 typing of Vogt-Koyanagi-Harada’s disease by PCR-RFLP and the strong association with DRB1*0405 and DRB1*0410. Br J Ophthalmol. 1994;78:223–6.
Islam SM, Numaga J, Matsuki K, Fujino Y, Maeda H, Masuda K. Influence of HLA-DRB1 gene variation on the clinical course of Vogt-Koyanagi-Harada disease. Invest Ophthalmol Vis Sci. 1994;35:752–6.
Weisz JM, Holland GN, Roer LN, Park MS, Yuge AJ, Moorthy RS, et al. Association between Vogt-Koyanagi-Harada syndrome and HLA-DR1 and -DR4 in Hispanic patients living in southern California. Ophthalmology. 1995;102:1012–5.
Read RW, Holland GN, Rao NA, Tabbara KF, Ohno S, Arellanes-Garcia L, et al. Revised diagnostic criteria for Vogt-Koyanagi-Harada disease: report of an international committee on nomenclature. Am J Ophthalmol. 2001;131:647–52.
Galor A, Perez VL, Hammel JP, Lowder CY. Differential effectiveness of etanercept and infliximab in the treatment of ocular inflammation. Ophthalmology. 2006;113:2317–23.
Callanan DG, Jaffe GJ, Martin DF, Pearson PA, Comstock TL. Treatment of posterior uveitis with a fluocinolone acetonide implant: three-year clinical trial results. Arch Pohthalmol. 2008;126:1191–201.
Sachdev N, Gupta V, Gupta A, Singh R. Posterior segment recurrences in Vogt-Koyanagi-Harada disease. Int Ophthalmol. 2008;28:339–45.
Lai TY, Chan RP, Chan CK, Lam DS. Effects of the duration of initial oral corticosteroid treatment on the recurrence of inflammation in Vogt-Koyanagi-Harada disease. Eye. 2009;23:543–8.
Rubsamen PE, Gass JD. Vogt-Koyanagi-Harada syndrome: clinical course, therapy, and long-term visual outcome. Arch Ophthalmol. 1991;109:682–7.
Al-Kharashi AS, Aldibhi H, Al-Fraykh H, Kangave D. Abu El-Asrar AM. Prognostic factors in Vogt-Koyanagi-Harada disease. Int Ophthalmol. 2007;27:201–10.
Errera MH, Fardeau C, Cohen D, Navarro A, Gaudric A, Bodaghi B, et al. Effect of the duration of immunomodulatory therapy on the clinical features of recurrent episodes in Vogt-Koyanagi-Harada disease. Acta Ophthalmol. 2011;89:357–66.
Bacsal K, Wen DS, Chee SP. Concomitant choroidal inflammation during anterior segment recurrence in Vogt-Koyanagi-Harada disease. Am J Ophthalmol. 2008;145:480–6.
Taylor S, Lightman S. Recurrent anterior uveitis in patients with Vogt-Koyanagi-Harada syndrome. Arch Ophthalmol. 2004;122:922–3.
Jabs DA, Rosenbaum JT, Foster CS, Holland GN, Jaffe GJ, Louie JS, et al. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel. Am J Ophthalmol. 2000;130:492–513.
Kondo Y, Fukuda K, Suzuki K, Nishida T. Chronic noninfectious uveitis associated with Vogt-Koyanagi-Harada disease treated with low-dose weekly systemic methotrexate. Jpn J Ophthalmol. 2012;56:104–6.
Liu X, Yang P, Lin X, Ren X, Zhou H, Huang X, et al. Inhibitory effect of cyclosporin A and corticosteroids on the production of IFN-gamma and IL-17 by T cells in Vogt-Koyanagi-Harada syndrome. Clin Immunol. 2009;131:333–42.
Nakao K, Abematsu N, Mizushima Y, Sakamoto T. Optic disc swelling in Vogt-Koyanagi-Harada disease. Invest Ophthalmol Vis Sci. 2012;53:1917–22.
Conflicts of interest
C. Iwahashi, None; K. Okuno, None; N. Hashida, None; K. Nakai, None; N. Ohguro, None; K. Nishida, None.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Iwahashi, C., Okuno, K., Hashida, N. et al. Incidence and clinical features of recurrent Vogt-Koyanagi-Harada disease in Japanese individuals. Jpn J Ophthalmol 59, 157–163 (2015). https://doi.org/10.1007/s10384-015-0377-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10384-015-0377-1