High prevalence of angle-closure glaucoma in Vogt-Koyanagi-Harada disease

Alvarez-Guzman, Carlos; Valdez-García, Jorge E.; Ruiz-Lozano, Raúl E.; Rodríguez-García, Alejandro; Navas-Villar, Carlos F; Hartleben-Matkin, Curt; Pedroza-Seres, Miguel

doi:10.1007/s10792-022-02412-4

Cited by 5 publications

(6 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Seven percent developed choroidal neovascular membrane (CNVM), and 14% developed chronic vitritis. Secondary glaucoma developed in 22% of patients in the series by Alvarez-Guzman [ 10 ] and 11.7% in the series by Pandey et al, 15.8% being the overall glaucoma prevalence [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Eyes with glaucoma are more likely to present in the chronic recurrent stage of the disease [ 1 , 6 , 10 ]. Patients developing such complications had longer disease durations and recurrences [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Angle-closure glaucoma: This constituted between 30%-44% [ 11 , 12 ] of glaucomas occurring in VKH cases. 82% of the secondary, post-treatment glaucomas seen by Alvarez-Guzman [ 10 ] had angle closure with the presence of anterior and posterior synechiae (in 86% and 76%, respectively), with iris bombe in 25%. 12% of all glaucomas in a series by Pandey et al had acute angle closure crisis at presentation [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Neovascular Glaucoma: A Rare Presenting Feature of Vogt-Koyanagi-Harada Syndrome

Hingorani-Bang,

Kandi,

Iyer

et al. 2024

Cureus

View full text Add to dashboard Cite

Vogt-Koyanagi-Harada syndrome (VKH) is an uncommon multi-system autoimmune inflammatory disorder characterized by bilateral granulomatous panuveitis with serous retinal detachment accompanied by neurological, auditory, and cutaneous manifestations like headache, hearing loss, vitiligo, and poliosis. It has a female preponderance, usually in middle age. We report the case of a 20-year-old male who presented to us with rapidly progressive visual loss accompanying granular panuveitis, complicated cataract, and a mixed mechanism neovascular glaucoma with acute angle closure. He was treated for IOP control and underwent aggressive immunosuppression and, later, bilateral laser iridotomies. It wasn't until one month after the initial presentation that he presented with vitiligo and poliosis of the eyebrows and eyelashes, clinching the diagnosis of VKH syndrome. This case highlights the diagnostic challenge faced due to acute neovascular glaucoma being the initial presenting feature of VKH; hitherto not documented before, although acute angle closure glaucoma or crisis has occasionally been reported at presentation; the classical VKH presentation being an acute posterior segment uveitis or less commonly, a chronic, recurrent panuveitis presenting with/ without complications. This case underlines the importance of considering VKH syndrome in a patient with bilateral granulomatous panuveitis, as dermatological involvement can emerge later in the disease course, by which time vision might have already been compromised significantly.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Neovascular Glaucoma: A Rare Presenting Feature of Vogt-Koyanagi-Harada Syndrome

Hingorani-Bang,

Kandi,

Iyer

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

“… Chronic angle closure: Anterior synechiae formation between the iris and the angle due to the increased coagulative state of the inflamed iris may cause chronic angle closure [ 22 ]. Recently Alvarez Guzman et al reported that the majority (80%) of cases of glaucoma associated with Vogt–Koyanagi–Harada disease were due to angle closure [ 23 ]. In the event of a uveitis that causes significant retinal or ocular ischemia, pronounced neovascularization can affect the trabeculum, with inevitable aqueous flow obstruction and intractable glaucoma [ 24 ].…”

Section: Pathophysiology Of Uveitic Glaucomamentioning

confidence: 99%

Update on Diagnosis and Treatment of Uveitic Glaucoma

Halkiadakis,

Konstantopoulou,

Tzimis

et al. 2024

JCM

View full text Add to dashboard Cite

Glaucoma is a common and potentially blinding complication of uveitis. Many mechanisms are involved alone or in combination in the pathogenesis of uveitic glaucoma (UG). In terms of diagnostic evaluation, the effects of inflammatory activity in the retinal nerve fiber layer may be a source of bias in the interpretation of optical coherence tomography measurements. For the successful treatment of UG, the control of intraocular inflammation specific to the cause or anti-inflammatory treatment, combined with IOP management, is mandatory. The early institution of specific treatment improves the prognosis of UG associated with CMV. The young age of UG patients along with increased failure rates of glaucoma surgery in this group of patients warrants a stepwise approach. Conservative and conjunctival sparing surgical approaches should be adopted. Minimally invasive surgical approaches were proved to be effective and are increasingly being used in the management of UG along with the traditionally used techniques of trabeculectomy or tubes. This review aims to summarize the progress that recently occurred in the diagnosis and treatment of UG.

show abstract

“…Recurrent VKH is more prominent in anterior segments, with more prevalent mutton-fat keratic precipitates, cells and flare in the anterior chamber, posterior synechiae, and iris nodules, and less prominent SRD [5]. Recurrent anterior uveitis is associated with higher complication rates of cataracts, glaucoma, and neovascular membranes, for which stronger and prolonged systemic immunosuppression and additional treatments are needed [5][6][7][8]. More prolonged and stronger immunosuppression at the time of the initial acute-onset VKH disease may help to reduce the rate of chronic recurrent evolution of the disease when risk factors for recurrent anterior uveitis are considered.…”

mentioning

confidence: 99%

Incidence and Risk Factors of Recurrent Anterior Uveitis in Initial Acute-Onset Vogt-Koyanagi-Harada Disease

Lim¹,

Byon²,

Kim³

et al. 2023

Korean J Ophthalmol

View full text Add to dashboard Cite

Purpose: We report the estimated incidence of, and risk factors for, recurrent anterior uveitis in patients with initial acute-onset Vogt-Koyanagi-Harada (VKH) disease using survival analyses.Methods: Patients who were diagnosed with initial acute-onset VKH disease during 2003–2022 at two university hospitals were included. Recurrent anterior uveitis was defined as the first occurrence of the granulomatous anterior uveitis with anterior chamber cells and flare of 2+ or more by the Standardization of Uveitis Nomenclature (SUN) Working Group grading scheme, after the disappearance of conspicuous uveitis and serous retinal detachment for at least 3 months, regardless of systemic or local treatment. The univariate log-rank test and multivariate Cox regression analyses were performed, including patients’ demographic characteristics, underlying diseases, presence of prodromal symptoms, duration of visual symptoms, visual acuity, slit-lamp and fundus findings, and height of serous retinal detachment. The treatment method and response to treatment were also included.Results: The estimated incidence was 39.3% at 10 years. Fifteen of 55 patients (27.3%) had recurrent anterior uveitis during the mean follow-up of 4.5 years. The presence of focal posterior synechiae at the diagnosis increased the risk of recurrent anterior uveitis 6.97-fold compared to the absence of synechiae (95% confidence interval [CI], 2.20–22.11; <i>p</i> < 0.001). Use of systemic high-dose steroid therapy more than 7 days after the development of visual symptoms resulted in a hazard ratio of 4.55 (95% CI, 1.27–16.40; <i>p</i> = 0.020).Conclusions: This study reports the estimated incidence and risk factors of recurrent anterior uveitis in VKH disease from survival analyses. However, because of the retrospective nature of this study, it is hard to confirm the consistency of the medical records regarding risk factors, thus, the presence of focal posterior synechiae can be inconclusive as a risk factor. Further studies are warranted.

show abstract

High prevalence of angle-closure glaucoma in Vogt-Koyanagi-Harada disease

Cited by 5 publications

References 34 publications

Neovascular Glaucoma: A Rare Presenting Feature of Vogt-Koyanagi-Harada Syndrome

Neovascular Glaucoma: A Rare Presenting Feature of Vogt-Koyanagi-Harada Syndrome

Update on Diagnosis and Treatment of Uveitic Glaucoma

Incidence and Risk Factors of Recurrent Anterior Uveitis in Initial Acute-Onset Vogt-Koyanagi-Harada Disease

Contact Info

Product

Resources

About