The spectrum of Vogt-Koyanagi-Harada disease in Tunisia, North Africa.
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.
Khairallah
Moncef
M
Department of Ophthalmology, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia. moncef.khairallah@rns.tn
Zaouali
Sonia
S
Messaoud
Riadh
R
Chaabane
Sami
S
Attia
Sonia
S
Ben Yahia
Salim
S
Hmidi
Kamel
K
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
D005938:Glucocorticoids; D007166:Immunosuppressive Agents