Abstract
Purpose To identify prognostic factors for outcome in children with Vogt-Koyanagi-Harada (VKH) disease.
Methods All children 16 years and younger with acute uveitis associated with VKH disease treated between 1999 and 2006 were reviewed.
Results Twenty-three children (46 eyes) were identified; 20 (87%) girls and three (13%) boys with a mean age at presentation of 12.5 +/- 2.4 years. Mean follow-up period was 48.6 +/- 30.8 months. Visual acuity of 20/40 or better was achieved in 38 (82.6%) eyes. Eleven eyes developed at least one complication, including cataract in eight eyes, glaucoma in eight eyes, subretinal neovascular membranes in two eyes, and subretinal fibrosis in one eye. Disease recurred during follow-up in 18 eyes. Development of complications was negatively associated with final visual acuity of 20/20 (P = 0.0317). Shorter interval between symptoms and treatment was a predictor of final visual acuity of 20/20 (odds ratio 10.4; 95% confidence interval = 1.61-67.3). Recurrence of inflammation was significantly associated with development of complications (P = 0.003), worse visual acuity (P = 0.022) and presence of posterior synechiae of the iris at presentation (P = 0.0083), longer interval between symptoms and treatment (P = 0.013), initial treatment with intravenous corticosteroids (P = 0.0012), and rapid tapering of corticosteroids (P = 0.0063).
Conclusion Visual prognosis of VKH in children is generally favourable. Clinical findings at presentation, development of complications, interval between symptoms and treatment, recurrence of inflammation, use of intravenous corticosteroids, and method of tapering of systemic corticosteroids were significant prognostic factors.