Vogt-Koyanagi-Harada syndrome. Clinical course, therapy, and long-term visual outcome
P. E. Rubsamen and J. D. Gass
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, School of Medicine, FL 33101.
We reviewed data from 26 patients with Vogt-Koyanagi-Harada syndrome who
presented at the Bascom Palmer Eye Institute between March 1969 and
February 1990. Visual outcomes were good, with final visual acuity of
better than 20/30 in 29 (66%) of 44 eyes and of worse than 20/400 in only
three (7%) of 44 eyes. A poor prognosis was associated with the development
of choroidal neovascular membranes or chronic uveitis. All patients were
treated with systemic corticosteroids. Corticosteroid therapy averaged 6
months, but was prolonged (48 months) in patients who developed chronic
uveitis. Disease recurred in nine (43%) of 21 patients in the first 3
months, usually in association with a rapid tapering of steroid dosage. We
recommend the early, aggressive use of systemic corticosteroids in patients
with Vogt-Koyanagi-Harada syndrome and a gradual tapering of drug dosage
for 6 months after presentation.
