Predictors of Recurrence in Vogt-Koyanagi-Harada Disease

PURPOSE:Normally, Vogt-Koyanagi-Harada (VKH) disease has a good prognosis with adequate treatment. However, VKH disease recurs more frequently if diagnosis is delayed or treatment is inadequate. As soon as VKH disease recurs, inflammation is harder to control and the prognosis worsens. Our objective was to study predictors of recurrence in patients with VKH disease. DESIGN:Retrospective case series. PARTICIPANTS:Forty-one eyes of 41 patients (25 women, 16 men) were included in this study. Patients with recurrent attacks of inflammation were classified as recurrent, whereas patients needing only steroid treatment, without any recurrent attacks, were classified as nonrecurrent. METHODS:Descriptive and bivariate analyses were used to characterize disease and outcomes. A blood-flow analysis was performed with laser speckle flowgraphy on days 0, 14, 30, and 60. Choroidal thickness was measured with swept-source OCT, using a 12-radial scan protocol, on the same day as mean blur rate (MBR) measurement. Flare in the anterior chamber also was measured on the same day, using a flare cell meter. MAIN OUTCOME MEASURES:Prevalence of each type of disease pattern and flare, MBR, and thickness of the choroidal layers. RESULTS:The recurrent group initially had lower visual acuity (VA) and higher flare than the nonrecurrent group, but these parameters improved over time and were similar in the groups on days 14, 30, and 60. However, on these days, MBR was significantly lower in the recurrent group than in the nonrecurrent group. Choroidal thickness was not significantly different in the 2 groups at any time point. CONCLUSIONS:We found that patients with recurrent VKH disease had lower VA, higher initial flare number, and a lower response of MBR to treatment than patients with nonrecurrent VKH disease. Thus, VA and flare number during the initial phase, as well as the MBR response to treatment, may be useful in determining the prognosis for VKH disease and choosing therapeutic options.