| Title | Predictive factors of recurrences and complications in Vogt-Koyanagi-Harada uveitis : a retrospective analyse of a Tunisian series |
| Purpose | To investigate predictive factors of recurrences and complications in Vogt-Koyanagi-Harada uveitis, assessed by clinical investigations and ocular multimodal imaging in patients with Vogt-Koyanagi-Harada (VKH) disease. |
| Methods | In total, 53 eyes from 27 patients collected during a period of 10 years (2006-2016) in an university hospital center of Tunis, were retrospectively evaluated. |
| Results | Sex ratio was 0,5, and mean age was 36,22 years-old (SD 16,50years, median=38 years, ranged 12-61 years). The mean duration of the disease at the time of diagnosis was 10 months. Mean best corrected visual acuity (BCVA) at presentation was 1,35 +/- 0,65 logMAR. Anterior uveitis was present in 65,3% of cases. Papillary edema and serous retinal detachment (SRD) were present in fundus in 82,6% of cases, and a SRD with septae in 76% of cases by OCT. The presence of choroidal involvements was a choroidal vasculopathy, in 100% of cases by infracyanine angiography, and a choroidal thickening in 82,9% of cases by ultrasonography. Only 56% of patients presented extraocular manifestations. Initial systemic corticosteroids started at 1,5mg/kg/d for all patient. Mean duration of full dose was 4,2 months , and mean duration of tapered period was 6 months. The addition of conventional immunosuppressive therapy was neccessary in 14 patients. One recurrence or more was noted in 42,8% of patients. After a mean follow-up of 4,4 years, mean BCVA was 0,57 +/-0,84 logMAR. Using logistic regression analysis, delayed diagnosis was factor for complication (p=0,011) and recurrence (p= 0,018). Development of complications was significantly associated with delayed treatement (p=0,021), synechiae (p = 0,029, OR= 10), SRD in echography ( p= 0,017, OR=0,147), recurrence (p=0,040, OR=4), BCVA < 20/200 at one month of treatment (p= 0,032, OR=9). |
| Conclusion | Chronic recurrent presentation and development of complications were associated with delayed diagnosis and delayed treatement. Development of complications were associated with recurrence, synechiae, BCVA < 20/200 at one month of treatment. Theses results suggested that early aggressive treatement is highly recommended in VKH. Further studies are needed to assess the best sensitive imaging methods for screening undetectable subclinical inflammation. |
| Conflict of interest | No |
| Last name | MILI-BOUSSEN |
| Initials of first name(s) | I |
| Department | Department of Ophthalmology. Charles Nicolle University Hospital of Tunis |
| City | Tunis |
| Country | Tunisia |
| Last name | BOUKARI |
| Initials of first name(s) | M |
| City | Tunis |
| Country | Tunisia |
| Last name | KAOUEL |
| Initials of first name(s) | H |
| City | Tunis |
| Country | Tunisia |
| Last name | BRAHAM-ZHIOUA |
| Initials of first name(s) | I |
| City | Tunis |
| Country | Tunisia |
| Last name | AMMOUS |
| Initials of first name(s) | I |
| City | Tunis |
| Country | Tunisia |
| Last name | ERRAIS |
| Initials of first name(s) | K |
| City | Tunis |
| Country | Tunisia |
| Last name | ZHIOUA |
| Initials of first name(s) | R |
| City | Tunis |
| Country | Tunisia |