Prognostic Factors of Vogt-Koyanagi-Harada Disease in Singapore

PURPOSE: To determine prognostic factors of Vogt-Koyanagi-Harada disease (VKH). DESIGN: Retrospective noninterventional. METHODS: Chart review of VKH patients of Singapore National Eye Centre for age at onset (age), gender, race, presenting visual acuity (VA) and VA at one month after starting treatment, severity of inflammation, treatment regime, and hearing loss. Outcome measures were: VA, persistent inflammation, cataracts, glaucoma, macular lesions, chorioretinal degeneration, and vitiligo at three years after onset. RESULTS: There were 134 eyes of 67 patients. Majority were Chinese (n = 53, 79.1%) and female (n = 40, 59.7%). Median duration of follow-up was 9.1 years (range, 3.0 to 53.6 years). Median age was 42.3 years (range, 5.4 to 70.9 years). Main prognostic factors were VA at one month, age, and treatment regime. Good VA at one month was associated with greater likelihood of good VA at three years (odds ratio [OR], 43.9; P = .02), less persistent inflammation (OR, 0.5; P = .006), cataract (OR, 0.10; P = .01), and chorioretinal degeneration (OR, 0.2; P = .04). Older age was associated with higher likelihood of cataract (OR, 1.1; P =.02), chorioretinal degeneration (OR, 1.1; P = .03), and vitiligo (OR, 1.1; P = .004). Early treatment with high-dose systemic corticosteroids resulted in less persistent inflammation (OR, 0.2; P = .04). Late high corticosteroid treatment was associated with greater risk of cataract (OR, 9.6; P = .03). 0 CONCLUSION: Good VA at one month, younger age at onset, and early treatment with high-dose corticosteroids were associated with better outcomes. (Am J Ophthalmol 2009;147:154-161. (C) 2009 by Elsevier Inc. All rights reserved.)