title: The spectrum of Vogt-Koyanagi-Harada disease in Tunisia, North Africa.
abstract: OBJECTIVE
  To analyze the clinical profile of Vogt-Koyanagi-Harada (VKH) disease in Tunisia, North Africa.
  
  
  METHODS
  We retrospectively reviewed the clinical records of 49 patients diagnosed with VKH disease at the Department of Ophthalmology of Fattouma Bourguiba University Hospital, Monastir, Tunisia, between January 1994 and September 2005.
  
  
  RESULTS
  Of all the uveitis cases diagnosed during the study period, VKH disease was the fourth most commonly occurring type (7.4%). Thirty-two patients (65.3%) were female, and 17 patients (34.7%) were male. The mean age at disease onset was 35 years (range: 16-54 years). The majority of patients (51%) had probable VKH disease, followed by incomplete type (47%); only 2% had the complete type. At presentation, 47 patients (96%) had bilateral ocular involvement. Clinical presentation was a panuveitis in 25 patients (51%) and a posterior uveitis in 24 patients (49%). Visual acuity (VA) at presentation ranged from less than 20/200 (40.8%) to more than 20/40 (28.5%). All patients were treated with systemic corticosteroids for 2-19 months (mean: 10.5 months). Four patients (8%) were treated with cyclosporin because of serious systemic side effects of corticosteroids. Complications included cataract in 18 eyes (33.9%), glaucoma in nine eyes (16.96%) and choroidal neovascularization in one eye (1%). Fifty-eight eyes (59%) had a final VA of 20/40 or better. Factors associated with a poor VA at the final follow-up were the presence of a poor VA at presentation (P = 0.02), the occurrence of complications (P = 0.001) and/or recurrences (P = 0.02).
  
  
  CONCLUSIONS
  In Tunisia, VKH disease is a common cause of uveitis that predominantly affects young women. The overwhelming majority (98%) have probable or incomplete VKH disease, presenting as panuveitis or posterior uveitis. More than 50% of patients undergoing treatment with corticosteroids will maintain a VA of 20/40 or better.
authors.affiliation: Department of Ophthalmology, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia. moncef.khairallah@rns.tn
authors.forename: Moncef
authors.initials: M
authors.lastname: Khairallah
authors.forename: Sonia
authors.initials: S
authors.lastname: Zaouali
authors.forename: Riadh
authors.initials: R
authors.lastname: Messaoud
authors.forename: Sami
authors.initials: S
authors.lastname: Chaabane
authors.forename: Sonia
authors.initials: S
authors.lastname: Attia
authors.forename: Salim
authors.initials: S
authors.lastname: Ben Yahia
authors.forename: Kamel
authors.initials: K
authors.lastname: Hmidi
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017678:Sex Distribution; D014416:Tunisia / Q000453:epidemiology; D014607:Uveomeningoencephalitic Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D014792:Visual Acuity
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents