Vogt-Koyanagi-Harada Disease


Four clinical stages:

  1. Prodromal
  2. Acute
  3. Chronic convalescent
  4. Chronic recurrent

Acute stages:

  • Prodromal stage of neurologic and auditory disturbances
  • Bilateral posterior uveitis + diffuse granulomatous choroiditis
  • Vitritis
  • Optic disc oedema
  • Exudative RD – multifocal and shallow RD
  • Retinal +/- choroidal folds

FFA findings:

  • Patchy hypofluorescence (delayed choroidal filling)
  • Early frames – Multiple punctate hyperfluorescent dots at RPE.
  • Late frames – hyperfluorescent dots enlarge and stains surrounding SRF (extent of exudative RD) + optic disc hyperfluorescence.
  • Alternate hypofluorescent / hyperfluorescent bands – indicate folds.

Chronic stages:

  • Variable degree of choroidal depigmentation
  • Sunset glow fundus (loss of choroidal melanocytes)
  • Focal RPE atrophy – nummular depigmented round well-defined chorioretinal scars at mid-peripheral.
  • Hyperpigmented linear focal lesions – RPE migration/clumping.
  • Cutaneous changes – vitiligo, alopeica or poliosis of eyelashes/brows.
  • Granulomatous AAU.

Management:

  1. Systemic corticosteroids.
  2. Immunosuppressive agents
  3. OCT to monitor response to treatment – SRF / RPE undulations
  4. Treat complications – cataract, glaucoma, CNV or subretinal fibrosis accordingly.

Location Birmingham Midlands Eye Centre 76 Dudley Road Birmingham B18 7QH UK Phone 0121 554 3801 Hours Mr Ch'ng | Vitreoretinal Clinic Sessions: Monday: 8.30am - 12.30pm Wednesday (alternate): 8.30am - 5.00pm Thursday: 8.30am - 12.30pm Friday: 8.30am - 12.30pm | Vitreoretinal Theatre Sessions: Wednesday (alternate): 8.30am - 5.00pm & Friday (emergency cases): 1.30pm - 5.00pm | Eye Casualty Session: Monday 1.00pm - 4.30pm |
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