Aim To determine risk factors for poor visual outcome following cataract surgery in Vogt–Koyanagi–Harada (VKH) disease.

Methods Retrospective review of all VKH patients who underwent cataract surgery, for demographics, initial corticosteroid dose, treatment outcome, quiescence at time of cataract surgery, perioperative corticosteroid prophylaxis, preoperative best-corrected visual acuity (BCVA), cataract surgery technique, intraocular lens implanted, additional surgical procedures, complications and BCVA at 6 and 12 months postsurgery.

Results 28 of 105 VKH patients (50 eyes) had cataract surgery. The mean age at surgery was 55±13 years. The mean duration of postoperative follow-up was 89.8 months (range 8–252 months). At 12 months postsurgery, no patients lost more than two lines of their preoperative acuity. Forty-one eyes (82%) improved by two or more Snellen lines. Thirty-four eyes (68%) had a BCVA of 20/40 or better. Sixteen eyes (32%) had a poor visual acuity, nine (18%) from pre-existing macular lesions, two from cystoid macular oedema, one from posterior capsule opacification and four from disease recurrence. Recurrent inflammation was the only significant risk factor for poor visual outcome (p=0.004, χ² test).

Conclusion Recurrent inflammation is a critical poor prognostic factor for cataract surgery in VKH, but with appropriate management, good visual outcomes can be achieved.