VKH disease in the elderly: Variations in clinical course as compared to VKH disease in adults

• Published in: Indian journal of ophthalmology 2024-07, Vol.72 (Suppl 4), p.S580-S583
• Main Authors: Kaza, Hrishikesh, Cherukuri, Navya, Tyagi, Mudit, Basu, Soumyava, Pappuru, Rajeev R, Murthy, Somasheila
• Format: Article
• Language: English
• Subjects: Acuity; Aged; Anterior chamber; Corticosteroids; Diabetes; Diabetes mellitus; elderly; Eye diseases; Female; Fluorescein Angiography - methods; Follow-Up Studies; Fundus Oculi; Glucocorticoids - therapeutic use; Humans; Hyperemia; Immunosuppressive agents; India - epidemiology; Male; Middle Aged; Original; panuveitis and granulomatous uveitis; Patients; Retrospective Studies; Steroid hormones; Steroids; Uveomeningoencephalitic Syndrome - diagnosis; Uveomeningoencephalitic Syndrome - drug therapy; Visual Acuity - physiology; vkh syndrome; vogt–koyanagi–harada disease
• ISSN: 0301-4738; 1998-3689; 1998-3689
• DOI: 10.4103/IJO.IJO_2185_23

To describe disease characteristics and outcomes of Vogt-Koyanagi-Harada (VKH) disease in elderly patients. Retrospective analysis of patients older than 50 years with VKH disease at two referral centers in India. Demographics, extraocular and ocular involvement, treatment, complications, and visual acuity outcomes were noted. In total, 69 patients (mean age at presentation: 56.4 ± 4.7 years) were analyzed; 6/69 patients had diabetes mellitus at presentation, and 10/69 had hypertension. Clinical signs included anterior chamber cells >2+ (29%), granulomatous keratic precipitates (23%), disc hyperemia (26%), neurosensory retinal detachment (34.7%), and "sunset-glow" fundus (52.1%). Patients were classified as probable (n = 50, 72.4%), incomplete (n = 18, 26%), and complete VKH (n = 1, 1.4%). The mean follow-up period was 20.2 ± 19.4 months. Improvement in mean BCVA of (0.63 LogMAR, 6 Snellen lines) was noted on the last follow-up. Patients receiving systemic steroids with immunosuppressants ( P < 0.0001) had better visual outcomes at final follow-up compared to steroids alone ( P = 0.103). Eight patients (11.6%) had complications due to systemic immunosuppressants, and 17 patients (24.6%) developed diabetes mellitus or had worsening of diabetes while on systemic corticosteroids. Few patients presented with systemic manifestations in our cohort. Those treated with steroids and concurrent immunosuppressants had better outcomes. However, therapy with immunosuppressants was encountered with major dose-limiting complications in a significant number of elderly patients with VKH syndrome.