Vogt-Koyanagi-Harada disease presenting as angle closure was diagnosed late

Design

Retrospective case series, single tertiary centre in India

Population

18 patients (36 eyes) among 768 with VKH who presented with angle closure

Primary outcome

Diagnostic delay and final best-corrected visual acuity

Effect

Delay 1 month to 7 years; presenting acuity independently predicted outcome (p=0.039)

A retrospective study from a tertiary eye centre in India (Indian Journal of Ophthalmology, 16 October 2026) reviewed 768 patients with Vogt-Koyanagi-Harada disease from 2013 to 2020. Eighteen patients (36 eyes, 3.9%) had first presented with angle closure - 18 eyes as primary angle closure and 18 as secondary angle closure glaucoma. Most were women (89%), with a mean age of 44.

Fundus examination was often deferred because of media opacity, and the diagnosis of VKH was delayed by between one month and seven years. Choroidal thickening and ciliochoroidal effusion were seen on imaging in four eyes. Delay beyond a month and poorer presenting vision were associated with worse final vision; presenting vision remained significant on multivariable analysis.

VKH is relatively common in Indian and other pigmented populations, and choroidal inflammation can rotate the ciliary body forward and close the angle. A patient treated as primary angle closure, particularly with bilateral disease, a shallow chamber in a non-hyperopic eye or any inflammation, deserves posterior segment imaging when the fundus cannot be seen.

• Image the posterior segment with B-scan, OCT or ultrasound biomicroscopy when the fundus view is poor in angle closure
• Suspect VKH in bilateral angle closure with inflammation, headache, tinnitus or poliosis
• Look for choroidal thickening and ciliochoroidal effusion on imaging
• Start uveitis assessment promptly - delay was linked to worse vision

Why it matters

A disease needing immunosuppression can be treated for years as a pressure problem.

Don't overread it

A small retrospective series from one referral centre; the proportion may differ elsewhere.

The statistics, in plain English

Eighteen patients is a small group, so the associations with final vision are indicative. Only presenting vision remained significant once other factors were accounted for; the effect of delay itself is suggestive rather than proven.

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