Retrospective analysis of Vogt-Koyanagi-Harada’s recurrence within a case series of nineteen patients followed between 2003 and 2018 in an academic center

Purpose: to define a timeframe of recurrences according to the clinical presentation of the inflammation and to the course of the disease. This could influence the final visual acuity and avoid ocular complication such as cataract, glaucoma, choroidal neovascularization, subretinal fibrosis or fundus depigmentation. Material and methods: retrospective study of nineteen patients affected of Vogt-Koyanagi-Harada disease followed between 2003 and 2018. Results: within our case series, 53% of our patients had no recurrence during a follow-up up to one hundred and sixty-eight months. Among the nine patients presenting a recurrence, five had at least one episode of posterior inflammation, one exhibited anterior and posterior recurrence, and five developed at least one recurrence in anterior structures. According to the Kaplan Meier’s method, the overall survival without any recurrence at three months is equal to 68% ± 11%. All posterior segment inflammatory relapses occurred within three months and a half of initiation of systemic treatment. On the other hand, the timeline of anterior recurrence is more scattered. They appeared between two and thirty-seven months. This careful follow-up distinguishing the type of inflammatory recurrence made it possible to find final visual acuity greater than or equal to 9/10 (equivalent ≥ 20/25), with the exception of one amblyopic eye. Conclusion: The chronological occurrence of inflammatory episodes is earlier posteriorly than anteriorly. A posterior recurrence does not expose to a higher risk of anterior inflammation relapse during the follow-up. This distinction is important for understanding understandig the course of the disease. In fact, the differentiation between the initial acute phase (mainly posterior inflammation) and chronic recurrences (granulomatous anterior segment inflammation) allows better adaptation of systemic therapy and better visual prognosis in the long term.