Clinical Profile of Patients with Vogt–Koyanagi-Harada Disease at a Tertiary Eye Hospital in Bangladesh

Author(s): Arzumand Binte Yousuf Muna, Pankaj Kumar Roy, Tamjida Farhana, Md. Ershadul Haque Rahat, Masmum Sababa, Rehnuma Sadia Siddiqua, A. K. M Shahidur Rahman

Background: Vogt-Koyanagi-Harada (VKH) disease is an autoimmune inflammatory disease characterized by bilateral panuveities affecting the young adults. Approximately 3% of the uveitis patients are VKH patients. Objective: To assess the clinical profile of patients with Vogt-Koyanagi- Harada (VKH) disease.

Methods: This cross-sectional observational study was conducted over 30 diagnosed patients of VKH disease in uvea clinic of National Institute of Ophthalmology and Hospital (NIO&H), Dhaka, Bangladesh. Patients were selected according to specific selection criteria. All the relevant data were recorded in a pre-designed data collection sheet. Results were analyzed by statistical tests.

Results: The mean age of the study patients was 40.2±6.53 years, range 26-59 years. Out of 30 patients; 9(30%) were male and 21(70%) were female. Male to female ratio was 1:2.3. In this study we found all VKH diseases (100% cases) were in both eyes. The clinical type of VKH disease was classified as complete in 2 patients (4 eyes), incomplete in 17 patients (34 eyes), and probable in 11 patients (22 eyes). Regarding clinical presentation; posterior uveitis was in 14 eyes and panuveitis in 46 eyes. Twenty-six eyes (43.3%) had acute VKH disease, 24 eyes (40%) had convalescent stage, and 10 eyes (16.7%) had recurrent uveitis. Meningism [17(56.7%)] and headache [16(53.3%)] were the commonest acute presentations followed by vitiligo [10(33.3%)] and poliosis [3(10.0%)]. Sensorineural hearing loss was present in 2(6.7%) chronic cases. The ocular findings of slit-lamp examination were circumciliary congestion in 32 eyes (53.3%), keratic precipitates in 30 eyes (50.0%) and iris nodules in 10 eyes (16.7%). Fundus examination revealed that vitritis in 60 eyes (100%), optic disc involvement in 34 eyes (56.7%), exudative retinal detachment in 38 eyes (63.3%), sunset glow fundus in 32 eyes (53.3%), Dalen-Fuchs nodules in 16 eyes (26.7%) and choroidal detachment in 4 eyes (6.7%). We found 71.7% of VKH patients had substantial vision loss.

Conclusion: Vogt-Koyanagi-Harada disease is a bilateral, diffuse, granulomatous panuveitis, affects more in females of the middle age. Most of our VKH patients were in the chronic stage of the disease and had substantial vision loss. Early recognition and aggressive treatment of VKH disease result in good visual outcome.