Spectrum of Vogt-Koyanagi-Harada disease in Singapore

Purpose  Review of all cases of Vogt-Koyanagi-Harada disease (VKH) handled in the Uveitis Clinic of the Singapore National Eye Centre, with the aim of determining the clinical spectrum of this disease in these patients and the outcomes of treatment.

Methods  The case notes were retrospectively analyzed for patient demographics, clinical signs, investigations, complications and treatment received. The treatment groups were classified according to the steroid regimen (dose and timing). The early-high (EH) group received ≥1 mg/kg per day of systemic prednisolone within 2 weeks of presenting with symptoms, the late-high (LH) group received the same dose between 2 and 4 weeks of presenting with symptoms, and the low-dose (LD) group received no or lower doses of oral corticosteroids, or received the same high dose, but only after more than 1 month of presenting with symptoms.

Results  A total of 178 eyes of 89 patients, mainly of Chinese ethnicity, were examined. The mean age of the patients at onset of the study was 41.80 ± 14.65 (SE) years, and there were nearly equal numbers of male and female patients. The mean duration of the follow-up was 9.42 years (±9.87 years). There were 60 eyes in the EH group, 18 in the LH group, and 68 in the LD group. When the results on our patient group were compared to known data on a number of other ethnic groups, our patients were found to be similar to the Japanese with respect to gender distribution and prevalence, to the Hispanics for alopecia, and to the non-Hispanics of North America for tinnitus and vitiligo. The EH group were more likely to achieve complete resolution, with fewer complications, than the LD group, but one third of the former still developed chronic disease.

Conclusion  Higher doses of systemic steroids may be required to ensure adequate immunosuppression in VKH patients.