eMedicine Specialties > Ophthalmology > Unclassified Disorders

Vogt-Koyanagi-Harada Disease: Follow-up

Author: R Christopher Walton, MD, Professor, Director of Uveitis and Ocular Inflammatory Diseases Service, Assistant Department of Ophthalmology, Assistant Dean for Graduate Medical Education and Continuing Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital
Contributor Information and Disclosures

Updated: Jan 5, 2008

Follow-up

Further Outpatient Care

  • This chronic disorder requires monitoring for many years.

Complications

  • Cataract
  • Glaucoma
    • Closed-angle glaucoma - Pupillary block, forward rotation of the ciliary body
    • Open-angle glaucoma
  • Subretinal fibrosis
  • Choroidal neovascularization
  • Neovascularization of the disc
  • Pigmentary changes of the fundus
  • Optic atrophy

Prognosis

  • Visual loss in patients with VKH disease often is due to cataracts, glaucoma, and choroidal neovascularization. However, choroidal neovascularization is a major cause of late visual loss.
  • The prognosis may be improved by the use of early high-dose corticosteroids during the acute phase of the disease and afterward a slow tapering reduction in dosage until therapy is discontinued. In most cases, therapy should not be discontinued during the 3 months after onset of the disease because of the high rate of recurrence during this period. Many patients require at least a 3- to 6-month tapering period (or longer) before the corticosteroids can be discontinued.

Patient Education

  • Patients need to be educated so that they will have proper monitoring and care.

Miscellaneous

Medicolegal Pitfalls

  • Misdiagnosis of infectious uveitis can lead to inappropriate treatment and potential toxicity, while losing valuable ground without the needed steroid therapy. On the other hand, infectious uveitis misdiagnosed as VKH disease and treated with systemic immunosuppression can lead to disastrous results. In particular, syphilis and tuberculosis may demonstrate significant deterioration when treated with steroids alone prior to aggressive appropriate antibiotic therapy.
 


More on Vogt-Koyanagi-Harada Disease

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Follow-up: Vogt-Koyanagi-Harada Disease
Multimedia: Vogt-Koyanagi-Harada Disease
References
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Further Reading

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Keywords

Vogt-Koyanagi-Harada syndrome, VKH syndrome, VKH disease, Harada disease, Vogt-Koyanagi syndrome, uveoencephalitis, uveomeningitis, granulomatous panuveitis

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Contributor Information and Disclosures

Author

R Christopher Walton, MD, Professor, Director of Uveitis and Ocular Inflammatory Diseases Service, Assistant Department of Ophthalmology, Assistant Dean for Graduate Medical Education and Continuing Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital
R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society
Disclosure: Nothing to disclose.

Medical Editor

John D Sheppard, Jr, MD, MMSc, Associate Professor of Ophthalmology, Microbiology and Immunology, Director for Thomas R Lee Center for Ocular Pharmacology, Director, Uveitis Service, Eastern Virginia School of Medicine; Consulting Staff, Virginia Eye Consultants
John D Sheppard, Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Contact Lens Association of Ophthalmologists
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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