Risk factors for secondary Glaucoma in patients with Vogt-Koyanagi-Harada disease Academic Article in Scopus uri icon

abstract

  • © 2022, The Author(s).Background/purpose: Identify the prevalence and risk factors for secondary glaucoma among Mexican-mestizo patients with Vogt-Koyanagi-Harada Disease (VKH). Methods: Retrospective cohort study analyzing the demographic, clinical, and epidemiological variables. Risk estimates were calculated using a Cox proportional hazards regression model. Results: One hundred eyes of 50 patients, 44 (88%) women and 6 men (12%) with a median age of 35.5 years (IQR 29¿46) and a median follow-up time of 72 months (IQR 13.7¿126.7) were analyzed. The prevalence of glaucoma was 20%, with angle-closure accounting for 70% of all cases. Significant clinical risk factors for glaucoma development were a chronic recurrent stage at presentation (RR 2.88, 95% CI 1.11¿12.63, p = 0.037), ¿ 2 episodes of recurrent anterior uveitis (RR 8.52, 95% CI 2.02¿35.92, p < 0.001), angle-closure disease (ACD, RR 7.08, 95% CI 2.44¿20.48, p < 0.001), iris bombé (RR 5.0, 95% CI 2.10¿11.90, p < 0.001), and peripapillary atrophy (RR 3.56, 95% CI 1.43¿8.85, p < 0.001). Exposure to > 24 months of oral (RR 9.33, 95% CI 2.21¿39.28, p < 0.001) or > 12 months of topical corticosteroids (RR 3.88, 95% CI 1.31¿11.46, p = 0.007) were associated with an increased likelihood for secondary glaucoma development. Conclusion: Glaucoma is a frequent complication of VKH, often attributed to mixed pathogenic mechanisms. Chronic disease at presentation, recurrent inflammation, angle-closure mechanisms, iris bombé, and peripapillary atrophy represent clinically significant risk factors for developing secondary glaucoma. Prompt and aggressive steroid-spearing immunosuppressive therapy for adequate inflammation control may lower the risk of glaucoma in VKH.

publication date

  • December 1, 2022