Clinical features and visual outcomes of 111 patients with new-onset acute Vogt-Koyanagi-Harada disease treated with pulse intravenous corticosteroids

Abstract

An aggressive corticosteroid treatment strategy in a large number of patients with new-onset acute VKH disease, with transitioning to cyclosporine in selected cases, resulted in excellent visual outcomes and low rates of recurrence.

Catching the therapeutic window of opportunity in early initial-onset Vogt–Koyanagi–Harada uveitis can cure the disease

“…With optimal management including early combined steroidal and first-line nonsteroidal immunosuppression, SGF should not be considered part of the natural course of the disease, but rather the result of insufficient treatment that failed to stop subclinical choroidal inflammation [45]. In contrast to many reports, a recent report stated that corticosteroid therapy in initial-onset disease was sufficient to achieve a satisfactory outcome with nonsteroidal immunosuppression necessary in only 15.3% of cases [46]. No information was given, however, on the rate of clinical chronic evolution, nor on occult chronic evolution as ICGA was not performed.…”

Correlation between visual acuity and human leukocyte antigen (HLA)-DRB1*04 in patients with Vogt-Koyanagi-Harada disease

“…The duration from first visit to steroid administration was very short. This was taken as a likely reason for the low recurrence rate for VKH compared with other reports without the use of immunosuppression therapy [7].…”

“…A Korean study found that the HLA DRB1*0405 allele conferred an increased relative risk of developing VKH compared with the general population, and that the HLA DRB1*0405-DQA1*0302-DQB1*0401 haplotype was associated with poorer visual prognosis [6]. On the other hand, despite systemic corticosteroid approach, VKH patients often prove refractory to systemic corticosteroid therapy with long follow-up [7,8]. For predicting prognosis and refractoriness to treatment, the focus in recent years has transitioned from the identification of HLA genes associated with increased risk of VKH to the identification of alternate genes [9,10].…”

Correlation between visual acuity and human leukocyte antigen (HLA)-DRB1*04 in patients with Vogt-Koyanagi-Harada disease

“…A Korean study found that the HLA DRB1*0405 allele conferred an increased relative risk of developing VKH compared with the general population, and that the HLA DRB1*0405-DQA1*0302-DQB1*0401 haplotype was associated with poorer visual prognosis [6]. On the other hand, despite systemic corticosteroid approach, VKH patients often prove refractory to systemic corticosteroid therapy with long follow-up [7,8]. For predicting prognosis and refractoriness to treatment, the focus in recent years has transitioned from the identification of HLA genes associated with increased risk of VKH to the identification of alternate genes [9,10].…”