Characteristics of Vogt-Koyanagi-Harada Disease in a French Cohort: Ethnicity, Systemic Manifestations, and HLA Genotype Data

Bibliometric analysis of the Vogt‒Koyanagi‒Harada disease literature

PURPOSE

As an autoimmune disease, Vogt‒Koyanagi‒Harada disease (VKHD) is a main type of uveitis in many countries and regions, significantly impacting patient vision. At present, information regarding VKHD is still limited, and further research is needed. We conducted a bibliometric analysis to characterize the overall status, current trends, and current focus of VKHD research.

METHOD

Literature published from 1975 to 2022 was obtained from the Web of Science core collection and analysed with the R-language packages Bibliometrix, VOSviewer, and CiteSpace software.

RESULTS

A total of 1050 papers on VKHD were retrieved from 261 journals, and 16,084 references were obtained from the papers in the original search. The average annual number of published articles was approximately 21.9, and the number of publications rapidly increased after 2004. The journal Ocular Immunology and Inflammation published the most papers on VKHD, while the American Journal of Ophthalmology has the highest citation frequency. The leading countries were Japan, China (PRC), and the United States of America (USA). Yang PZ from Chongqing Medical University was the most prolific and cited author. The most frequently cited study discussed revision of VKHD diagnostic criteria. An analysis of the highest frequency keywords showed that most research focused on the treatment, diagnosis, and pathogenesis of VKHD and its relationship with other related diseases. At present, the most urgent research direction is in the relationship between COVID-19 or COVID-19 vaccines and VKHD and the corresponding mechanisms underlying it.

CONCLUSION

Utilizing dynamic and visualization tools, bibliometrics provides a clear depiction of the research history, development trends, and research hotspots in VKHD It serves as a valuable tool for identifying research gaps and areas that necessitate further exploration. Our study revealed potential directions for future VKHD research, including investigating specific molecular mechanisms underlying the disease, exploring the clinical utility of optical coherence tomography angiography and other diagnostic techniques, and conducting clinical research on novel therapeutic drugs.

Do not discount the diagnosis of VKH based on race: self-reported race and ethnicity of patients with Vogt-Koyanagi-Harada disease in a predominantly white population

BACKGROUND

We examined the racial and ethnic distribution of patients with Vogt-Koyanagi-Harada disease (VKH) in a Midwestern US population through a retrospective chart review of patients with VKH seen in a tertiary referral centre between 2012 and 2017. All patients were diagnosed by one uveitis specialist (DAG). We identified 32 patients with VKH seen during this time period. The mean age at diagnosis was 37.7 ± 15.7 years, 7 were male, 25 female. Mean follow-up was 36.7 ± 21.7 months. Nine patients reported themselves as White non-Hispanic, (28.1%), 9 as Black/African-American (28.1%), 2 as Asian (6.3%) and 9 as Hispanic or Latino (28.1%). Three patients (9.4%) were of Middle-Eastern origin. The 2010 census results for race and ethnicity in the state of Illinois were: 71.5% White, 14.5% Black/African-American, 4.6% Asian, and 6.7% as Some Other Race. From the total population 15.8% reported themselves as Hispanic or Latino (of any race).

CONCLUSIONS

VKH was much more frequent among white non-Hispanic patients (28.1%) and Black/African-American patients (28.1%) in our patient population than in previous reports from the US (3-14% and 4-23% respectively). While Hispanic patients in this series were over represented in the VKH population compared with the overall census data, the percentage of VKH patients in this series who were White non-Hispanic and Hispanic was the same. The diagnosis of VKH should be considered in any patient with the appropriate clinical features, regardless of race or ethnicity.

Vogt-Koyanagi-Harada disease: a retrospective and multicentric study of 41 patients

Background

East and South East Asian subjects as well as Amerindians and Hispanic subjects are predominantly affected by Vogt-Koyanagi-Harada disease.

In Europe, only few studies have described the clinical features and treatment of this disease, especially in France.

Methods

This retrospective case series was based on data collected from patients with a VKH disease diagnosed from January 2000 to March 2017, provided by three French Tertiary Centers.

Results

Forty-one patients (16 men and 25 women) were diagnosed: average age at diagnosis was 38.7 years. Patients were mainly from Maghreb (58%), but ethnic origins were multiple. Pleiocytosis was observed in 19 cases (63%) and 17 out of 41 patients showed audio vestibular signs (41%), and 11 showed skin signs (27%). Thirty-four were treated with corticosteroids (83%), 11 with an immunosuppressant treatment (27%) and 5 with biological therapy drugs (13%). Relapse was observed in 41% patients, even though final average visual acuity had improved. We did not find any significant clinical difference in the population from Maghreb compared to other populations, but for age and sex trends, since there was a majority of younger women.

Conclusion

We report here the second largest French cohort reported to date to our knowledge. The multiethnicity in our study suggests that VKH disease should be evoked whatever patients’ ethnicity.

[Vitiligo revealing Vogt -Koyanagi-Harada disease]

Le vitiligo est une dermatose chronique auto-immune, souvent associé ou fait découvrir d'autres pathologies auto-immunes. Son association à une atteinte ophtalmologique à type de pan uvéite et /ou une atteinte neurologique à type de méningite et/ou de l'oreille interne à type de surdité détermine la maladie ou le syndrome de Vogt-Koyanagi-Harada (VKH). Nous rapportons le cas d'une jeune femme qui consultait pour des uvéites récidivantes depuis un an, Et ce n'était qu'avec l'apparition des lésions de vitiligo que le diagnostic de maladie de VKH a été évoqué et confirmé.

Vogt-Koyanagi-Harada Syndrome in a Group of Patients in Two Ophthalmology Referral Centers in Bogotá, Colombia

PURPOSE

To describe the clinical presentation of Vogt-Koyanagi-Harada (VKH) syndrome in a group of patients in Colombia.

METHODS

Retrospective review of 2638 medical records of patients with uveitis in two centers during 17 years.

RESULTS

A total of 25 patients with uveitis were diagnosed with VKH syndrome (0.95%), 23 patients were included in the data analysis (0.87%), 78.3% females, and mean age of diagnosis was 37 years (SD ± 29). Main complaints: blurred vision (87%), headaches (47.8%), tinnitus (26.1%), and hearing impairments (21.7%). Ophthalmic findings: bilateral serous retinal detachment (73.9%) and non-granulomatous uveitis (52.3%). Most of the patients were diagnosed with probable disease (56.5%). Mean duration of follow-up was 14 months; disease relapse was encountered in 26% of patients despite treatment.

CONCLUSION

Patients in Colombia with VKH had clinical features similar to those reported in other Hispanic populations, except for the non-granulomatous uveitis. This disease may be considered as having variation of clinical manifestations across population groups.

[Management of uveomeningitis in internal medicine: Proposal for a diagnostic work-up]

Uveomeningitis relates to an inflammatory state extending from iris and ciliary bodies to the choroid behind the eye. Because of a close contact between eye and brain, and barrier disruption, the inflammation can spread into the central nervous system (CNS). We review the clinical manifestations of uveitis, which are known to provide helpful clues to the diagnosis and describe the infectious, inflammatory, and neoplastic conditions classically associated with the uveomeningitis. Inflammatory or auto-immune diseases are probably the most common clinically recognized causes of uveomeningitis associated with a significant pleiocytosis. These entities often cause inflammation of various tissues in the body, including ocular structures and the meninges (i.e., sarcoidosis, Behçet's disease, and Vogt-Koyanagi-Harada syndrome). The association of an infectious uveitis with an acute or a chronic meningo-encephalitis is unusual but occasionally the eye examination may suggest an infectious etiology or even a specific organism responsible for an uveomeningitis. One should consider the diagnosis of primary ocular-CNS lymphoma in patients of 40 years of age or older with bilateral uveitis, especially with prominent vitritis, showing poor response to corticosteroid therapy. Finally, an algorithm for the diagnostic approach of uveomeningitis is proposed.

Association of HLA-DR4/HLA-DRB1*04 with Vogt-Koyanagi-Harada disease: a systematic review and meta-analysis

Human leukocyte antigen (HLA)-DR4/HLA-DRB1*04 has been reported to be a risk factor for Vogt-Koyanagi-Harada disease (VKH) with various strength of association. Its sub-alleles were also found to be associated with VKH. However the results were inconsistent. In this study, we systematically searched the related literature, pooled the odds ratios (ORs) and 95% confidence interval (CI) of association of HLA-DR4/HLA-DRB1*04 or its sub-alleles with VKH from individual studies, and explored the potential source of heterogeneity. A total of 1853 VKH patients and 4164 controls from 21 articles were included in this meta-analysis. The pooled OR of association of HLA-DR4/HLA-DRB1*04 and VKH was 8.42 (95% CI: 5.69–12.45). There were significant heterogeneity (I² = 71%). Subgroup analysis indicated that ethnicity was the source of heterogeneity (all I² = 0, ORs ranged from 2.09–13.69 in subgroups). The sub-alleles, HLA-DRB1*0404 (OR = 2.57), 0405 (OR = 10.31) and 0410 (OR = 6.52) increased the risk of VKH; 0401 (OR = 0.21) protected VKH; while other sub-alleles were not associated with VKH. Our meta-analysis confirmed the association between VKH and HLA-DR4/DRB1*04, found the strength of association is different in different ethnic groups, and identified HLA-DRB1*0404, 0405 and 0410 as risk sub-alleles while 0401 as protective sub-allele.

Reversible alopecia in Vogt-Koyanagi-Harada disease and sympathetic ophthalmia

Background

Vogt-Koyanagi-Harada (VKH) disease and sympathetic ophthalmia (SO) are both autoimmune disorders targeting melanin-bearing cells, even though their etiologies are different. Both shared many ocular and systemic manifestations, including integumentary findings. Most of the literature focused on the ocular manifestations and related treatment. Alopecia was seldom mentioned.

Findings

We report one case of VKH disease and one case of SO. Both developed severe alopecia and early sunset glow fundus, which are probably due to incomplete treatment. Fortunately, the alopecia improved soon after systemic steroid treatment.

Conclusions

Early and complete treatments are important in the management of VKH or SO and prevent integumentary manifestation. Alopecia can be reversible after steroid treatment in time.

Is there an association between Vogt-Koyonagi-Harada syndrome and intracranial meningioma?

The authors report a case of Vogt-Koyonagi-Harada syndrome associated with intracranial meningioma. The authors discuss the HLA-DR4 gene as a common and causative factor in both conditions. This case report draws attention to the possibility of a causative association between intracranial meningioma and Vogt-Koyonagi-Harada syndrome, a rare but potentially blinding condition if not detected and treated early.

Killer cell immunoglobulin-like receptor gene-cluster 3DS1-2DL5-2DS1-2DS5 predisposes susceptibility to Vogt-Koyanagi-Harada syndrome in Japanese individuals

Killer cell immunoglobulin-like receptors (KIR) control the effector function of natural killer (NK) cells and subsets of T cell, and the genes encoding KIRs are substantially variable among individuals. A majority (58.4%) of Japanese individuals were found to be homozygous for group A KIR haplotypes that encode only a single activating KIR2DS4. Contrarily, most of Japanese patients with Vogt-Koyanagi-Harada (VKH) disease (69.2%), a panuveitis carry Bx genotypes that encode 2-5 activating KIR receptors. Particularly, individuals carrying three activating KIR genes 3DS1, 2DS1, and 2DS5 are more frequent in patient group compared with the controls (42.2% vs 21.4%, p = 0.02). In addition, the inhibitory KIR gene 3DL1 was significantly decreased in patients compared with controls (76.9% vs 98.8%, p = 0.00006). These data suggest that the genotypes encoding a dominant activating KIR receptor repertoire predispose susceptibility to VKH disease.