Effect of the COVID-19 pandemic on Vogt-Koyanagi-Harada disease

Abstract

To determine the disease prevalence rate and clinical characteristics of Vogt-Koyanagi-Harada (VKH) disease among new patients before and after the declaration of a state of emergency (April 7, 2020) in Japan. New patients and patients with newly diagnosed VKH disease were categorized into "Before" and "After" groups based on the initial visit. The prevalence rate, sex ratio, and age of patients newly diagnosed with VKH were compared between the groups. Best-corrected visual acuity (BCVA) and recurrence rates were compared among 59 patients observed for > 12 months after receiving pulse steroid therapy. For reference, we also examined the prevalence rate of patients newly diagnosed with acute angle closure (AAC) in the Before and After groups. The prevalence rates of VKH disease among newly diagnosed patients (P < 0.05) or patients with AAC (P < 0.001) were significantly higher in the After group. No significant differences in sex ratio or age of VKH disease were observed in both groups. BCVA and recurrence rates showed no significant differences. The COVID-19 pandemic increased the prevalence of VKH disease among new patients compared with that of AAC. However, the clinical features of VKH disease were unlikely affected by the COVID-19 pandemic.

Keywords: COVID-19; Pandemics; Prevalence; Sex ratio; Visual acuity; Vogt–Koyanagi–Harada disease.

Figure 1

(a) Longitudinal changes in the best-corrected visual acuity (BCVA) as the logarithm of the minimal angle of resolution for both the Before and After groups without a significant difference between the groups. (b) The anterior chamber volume at pretreatment and months 1, 6, and 12 without significant difference. (c) The anterior chamber depth at pretreatment and months 1, 6, and 12 with significant differences at months 6 and 12. (d) The peripheral anterior chamber depth at pretreatment and months 1, 6, and 12 without significant difference. (e) The anterior chamber angles at the pretreatment and months 1, 6, and 12 with significant differences at pretreatment and months 6 and 12. (f) The pupil diameter at the pretreatment and months 1, 6, and 12 with significant differences at pretreatment. (g) The axial length at pretreatment and months 1, 6, and 12 without significant difference. (h) The spherical equivalent at pretreatment and months 1, 6, and 12 without significant difference. (i) The retinal foveal thickness at pretreatment and months 1, 6, and 12 without significant difference. (j) The choroidal foveal thickness at pretreatment and months 1, 6, and 12 with significant difference at pretreatment. ACA anterior chamber angle, ACD anterior chamber depth, ACV anterior chamber volume, AL axial length, BCVA best-corrected visual acuity, CFT choroidal foveal thickness, MAR minimal angle of resolution, RFT retinal foveal thickness, SE spherical equivalent.

Figure 2

(a) Bilateral subretinal dye pooling was observed on fluorescein angiography. (b) Many hypofluorescent dark dots and a fuzzy vascular pattern of large stromal vessels were noted in the vascular arcade area on indocyanine green angiography.

Figure 3

(a) Photo of non-sunset glow fundus at 12 months after pulse steroid therapy. There was little difference between the normal retina and non-sunset glow fundus. (b) Photo of mild sunset glow fundus at 12 months after pulse steroid therapy. Several choroidal vessels were translucent because of mild depigmentation in the retinal pigment epithelium and choroid. Translucent vessels in the choroid. (c) Photo of sunset glow fundus 12 months after pulse steroid therapy. Because many of the choroidal vessels were translucent, the color tone became vermilion.