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Vogt-Koyanagi-Harada Disease and Sympathetic Ophthalmia

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Posterior Uveitis

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

Abstract

Vogt-Koyanagi-Harada disease (VKH) and sympathetic ophthalmia (SO) are bilateral, autoimmune granulomatous intraocular inflammatory conditions with nearly identical findings on ophthalmic exam. Both can reveal serous retinal detachments, optic disc edema, vitritis, and Dalen-Fuchs nodules, but they differ in key facets such as a history of penetrating ocular injury in SO and greater systemic associations in VKH. Diagnosis is aided by multimodal imaging, and its advances are resulting in earlier diagnosis, enhanced understanding of the disease process, and improved monitoring. Ocular coherence tomography (OCT) has largely replaced other imaging modalities in the diagnosis of VKH and SO by revealing exudative retinal detachments and choroidal thickening in the acute stage and demonstrating choroidal thinning in the chronic stage. However, characteristic findings on fluorescein angiography (FA), indocyanine green angiography (ICG), fundus autofluorescence (FAF), and B-scan ultrasound are still essential for many cases. Treatment of these diseases is initially with corticosteroids with a transition to immunomodulatory drugs for long-term control. Prompt and aggressive treatment can lead to good final visual outcomes and avoid complications such as sunset glow fundus, subretinal fibrosis, and choroidal neovascularization.

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Conflict of Interest

Jeffrey J. Tan and Narsing A. Rao declare that they have no conflict of interest.

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Authors and Affiliations

  1. USC Roski Eye Institute, Department of Ophthalmology, Los Angeles, CA, USA

    Jeffrey J. Tan

  2. Ophthalmology, USC Roski Eye Institute Ophthalmology, Los Angeles, CA, USA

    Narsing A. Rao

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  1. Jeffrey J. Tan
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Correspondence to Narsing A. Rao .

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Editors and Affiliations

  1. Ophthalmology, USC Roski Eye Institute Ophthalmology, Los Angeles, CA, USA

    Narsing A. Rao

  2. Department of Ophthalmology and Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA

    Julie Schallhorn

  3. Department of Ophthalmology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA

    Damien C. Rodger

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Tan, J.J., Rao, N.A. (2019). Vogt-Koyanagi-Harada Disease and Sympathetic Ophthalmia. In: Rao, N., Schallhorn, J., Rodger, D. (eds) Posterior Uveitis. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-030-03140-4_3

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