Retrospective analysis of Vogt-Koyanagi-Harada’s recurrence within a case series of nineteen patients followed between 2003 and 2018 in an academic center

TL;DR

This study analyzed 19 Vogt-Koyanagi-Harada patients to track recurrence patterns and found that posterior inflammation recurred earlier than anterior, with implications for treatment and visual outcomes.

Contribution

The study provides new insights into the distinct timelines of posterior and anterior inflammation recurrences in Vogt-Koyanagi-Harada disease.

Findings

53% of patients had no recurrence over up to 168 months of follow-up.

Posterior inflammation recurrences occurred within 3.5 months of treatment, while anterior recurrences were more spread out.

Differentiating recurrence types improved visual acuity outcomes in most patients.

Abstract

To define a timeframe of recurrences according to the clinical presentation of inflammation and the course of the disease. This could influence final visual acuity and avoid ocular complication such as cataract, glaucoma, choroidal neovascularization, subretinal fibrosis or fundus depigmentation.

Retrospective study of nineteen patients affected by Vogt-Koyanagi-Harada disease followed between 2003 and 2018.

Within our case series, 53% of patients had no recurrence during a follow-up of up to one hundred and sixty-eight months. Among the nine patients with recurrence, five had at least one episode of posterior inflammation, one exhibited both anterior and posterior recurrence, and five developed at least one recurrence in anterior structures. According to the Kaplan Meier method, the overall recurrence-free survival at three months is 68% ± 11%. All posterior segment inflammatory relapses occurred within three months and a half of systemic treatment initiation. On the other hand, the timeline of anterior recurrence is more scattered. They occurred between two and thirty-seven months of treatment initiation. This careful follow-up, which differentiated between types of inflammatory recurrences, made it possible to observe final visual acuity greater than or equal to 9/10 (equivalent ≥ 20/25), with the exception of one amblyopic eye.

The chronological occurrence of posterior inflammatory episodes is earlier than anteriorly. A posterior recurrence does not increase the risk of anterior inflammation relapse during the follow-up. This distinction is important to understand the course of the disease. In fact, the differentiation between the initial acute phase (mainly posterior inflammations) and chronic recurrences (granulomatous anterior segment inflammation) allows for better adaptation of systemic therapy and better visual prognosis in the long term.

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