Long-Term Outcomes of Pediatric Vogt-Koyanagi-Harada Disease.

Purpose: To study the clinical presentation, outcomes, and factors affecting the final visual outcome of Vogt-Koyanagi-Harada (VKH) disease in the pediatric age group.

Methods: Pediatric patients who were diagnosed with VKH at King Khaled Eye Specialist Hospital (KKESH) between 2007 and 2024. Demographic and clinical data were collected and analyzed for an association with the final visual outcome.

Results: Sixty-nine children (138 eyes) with an age range upon presentation from 2 years old to 18 years old and a mean age of 12.2 ± 4.0 years were included. The mean duration of follow-up was 6.5 ± 3.1 years. There were 35 (50.7%) males and 34 (49.3%) females. Sixty children (86.9%) had initial-onset acute VKH, while 9 children had chronic recurrent VKH. At initial presentation, the mean LogMAR BCVA was 0.6 (Snellen = 20/70) ± 0.6. Children with chronic recurrent VKH presented at an earlier age (p = 0.003), had more severe corneal involvement (p < 0.001) and more severe AC reaction (p < 0.001). Cataract developed in 33 (23.9%) eyes, 54 eyes (39.1%) developed glaucoma, and 36 eyes (26.1%) developed choroidal neovascular membranes (CNVM). Children with chronic recurrent VKH disease had higher rates of pre-existing or developing cataract, glaucoma, and CNVM. On the last visit, the BCVA improved from an average of 20/70 to 20/50. The visual improvement was statistically significant (p = 0.005).

Conclusions: Good visual outcomes can be achieved in the majority of pediatric patients with VKH disease. Children with chronic recurrent VKH disease present with more aggressive anterior segment inflammation, have higher risk of developing ocular complications, and less favorable visual outcomes.