Vogt-Koyanagi-Harada, sympathetic ophthalmia appear to have different etiologies

The authors of this study compared the systemic diseases and malignancies diagnosed in patients with Vogt-Koyanagi-Harada (VKH) and those with sympathetic ophthalmia (SO). Their 10-year review of medical records found that 16 percent of the VKH patients were diagnosed with systemic disorders, which included autoimmune diseases and tumors, compared with none of the SO patients, leading the authors to conclude that, despite sharing similar ocular and clinical manifestations, these disorders have different etiologies.

The authors reviewed the records of patients with VKH or SO seen at one hospital in Saudi Arabia during a 10-year period. The mean follow-up period was approximately five years in both groups and was not significantly different. The authors found that 41 of 256 patients VKH were diagnosed with systemic disorders or malignancies compared with none of the 60 patients with SO (P < 0.003). The same level of significance was reached with multivariate analysis after adjusting for age, sex and follow-up.

Ten patients with VKH had rheumatoid arthritis, 12 had diabetes mellitus type 1, three had psoriasis, three had Sjogren syndrome, two had systemic lupus erythematosus, two had hypothyroidism, one had celiac disease and two had prolactinemia. Of the six patients with tumors, one had hepatoma, two had chondrofibromyxoma of the brain, one had Hodgkin disease and two had choroidal melanoma.

This study underscores the fact that the etiology of VKH disease and SO may be different, although there are no laboratory investigations to differentiate one disease from the other. While the diseases are both characterized by immunologic dysregulation with autoimmune insult to melanin-bearing cells, a previous study demonstrated an association with HLA-DRB1 0405 in patients with VKH disease that is not found in patients with SO. Further studies are needed to determine the etiology of these two disorders.