Subretinal fibrosis in patients with Vogt-Koyanagi-Harada disease

Objectives To describe subretinal fibrosis as a long-term complication of V ogt-Koyanagi-Harada (VKH) disease. Design: Retrospective, clinic-based, cross-sectional study and clinical cor relation. Participants: Ten patients with VKH disease and subretinal fibrosis were se en at two uveitis referral centers between 1977 and 1997. Interventions A review of the historical, clinical, and fluorescein angiogr aphic features was performed. Main Outcome Measures: The prevalence, demographic and clinical features, a nd time to development of subretinal fibrosis were summarized. Results: Subretinal fibrosis occurred in 20 eyes of 10 patients with VKH di sease, an overall prevalence of 8% between the two institutions. Patient ag e ranged from 16 years to 48 years, with a median of 34.5 years. Five patie nts were Hispanic, one was mixed Hispanic and American Indian, three were A sian or mixed Asian and Caucasian, and one was African-American. Eight of t he 10 patients were men. All patients were in the chronic, recurrent phase of their disease when they had subretinal fibrosis develop, and all patient s had recurrent episodes of posterior uveitis. Presenting vision ranged fro m 20/20 to light perception, with a median acuity of 20/200. All patients w ere initially treated with oral and topical corticosteroids. Four patients required additional noncorticosteroid immunosuppressive therapy. Time from diagnosis of VKH disease to development of subretinal fibrosis ranged from zero (fibrosis present at time of diagnosis) to 27 years, with a median tim e of 10 months. The median time from diagnosis of VKH to development of sub retinal fibrosis in Hispanic patients was 6.5 months, whereas in non-Hispan ic patients it was 6.5 years. Final vision ranged from 20/25 to light perce ption, with a median acuity of 20/60. Seven of 20 eyes had a final visual a cuity of 20/40 or better, and seven eyes saw 20/200 or worse. Five of the e yes with 20/200 or worse vision had fibrosis involving the fovea. Conclusions: Subretinal fibrosis occurs in a sizeable proportion of patient s with VKH disease and may contribute to permanent loss of vision. Ophthalm ology 2000;107:1721-1728 (C) 2000 by the American Academy of Ophthalmology.