Urzua Cristhian A, Herbort Carl, Valenzuela Rodrigo A, Abu El-Asrar Ahmed M, Arellanes-Garcia Lourdes, Schlaen Ariel, Yamamoto Joyce, Pavesio Carlos
Department of Ophthalmology, Faculty of Medicine, University of Chile, Independencia, 1027, Santiago, Chile.
Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile.
J Ophthalmic Inflamm Infect. 2020 Sep 14;10(1):23. doi: 10.1186/s12348-020-00214-2.
To describe distinctive stages of Vogt-Koyanagi-Harada (VKH) disease: initial-onset acute versus chronic recurrent disease.
A comprehensive literature review regarding stages and clinical presentations of VKH disease was conducted.
Despite a list of signs that has been described as characteristic features of early or late phases of VKH disease, the current classification -developed by an international committee and published in 2001- does not consider a distinction regarding the time from onset of disease symptoms, and specific findings observed at certain time point from the symptoms presentation and outcomes related to the stage of VKH disease. In that sense, chronic recurrent VKH disease is more refractory to treatment and is associated with a higher rate of complications. Accordingly, this subset of VKH patients has poorer functional and anatomical outcomes than patients with an initial-onset acute disease.
An early clear distinction of VKH phenotype [Initial-onset acute versus chronic recurrent disease] should be considered in each clinical scenario, evaluating the delay in diagnosis and the clinical presentation, since it may help clinicians to perform a correct disease prognosis categorization and thus to make treatment decisions in terms of potential refractoriness or expected clinical outcomes.
描述葡萄膜大脑炎（VKH）疾病的不同阶段：初发性急性疾病与慢性复发性疾病。
对VKH疾病的阶段和临床表现进行了全面的文献综述。
尽管有一系列体征被描述为VKH疾病早期或晚期的特征，但由一个国际委员会制定并于2001年发表的现行分类并未考虑疾病症状出现时间的差异，以及在症状出现后的特定时间点观察到的具体发现和与VKH疾病阶段相关的结果。从这个意义上说，慢性复发性VKH疾病对治疗更具难治性，且并发症发生率更高。因此，与初发性急性疾病患者相比，这部分VKH患者的功能和解剖学预后更差。
在每种临床情况下，应考虑早期明确区分VKH表型[初发性急性疾病与慢性复发性疾病]，评估诊断延迟和临床表现，因为这可能有助于临床医生进行正确的疾病预后分类，从而根据潜在的难治性或预期的临床结果做出治疗决策。
