New insights into Vogt-Koyanagi-Harada disease

Damico, Francisco Max; Bezerra, Felipe Theodoro; Silva, Gaspar Carvalho da; Gasparin, Fabio; Yamamoto, Joyce Hisae

doi:10.1590/s0004-27492009000300028

Cited by 61 publications

(56 citation statements)

References 38 publications

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“…Subclinical evolution of choroidal inflammation has also been clearly documented by several groups investigating smoldering disease with the help of ICGA [28][29][30][31][32][33], explaining that the development of SGF despite corticosteroid therapy results from the progressive loss of stromal melanocytes due to the ongoing insufficiently controlled immunological process [19,32]. This is a strong incentive to maintain sufficiently dosed therapy including first-line nonsteroidal immunosuppressive drugs, even in the subacute phase and during the corticosteroid tapering process, to be sure to eradicate choroidal inflammation [24][25][26][27][28][29][30][31][32][33]. An Indian group proposed early and highdose triple agent immunosuppression in 2006 and reported favorable outcomes with disease remission in all five reported patients [34].…”

Section: Corticosteroid Monotherapy Has Been Shown To Be Inappropriatmentioning

confidence: 87%

“…Subclinical choroiditis is the reason for chronic evolution and is clearly identified by ICGA, uncovering active choroidal inflammation in an apparently quiescent eye during follow-up while monitoring corticosteroid tapering [28][29][30][31][32][33]. This shows that the standard corticosteroid monotherapy is indeed suppressing clinically apparent disease, but is insufficient to suppress choroidal inflammation [32].…”

Section: Corticosteroid Monotherapy Has Been Shown To Be Inappropriatmentioning

confidence: 95%

“…However, we know by now that all choroidal inflammation may not be silenced even when clinically apparent disease appears to be under control. ICGA monitoring of VKH patients under treatment has shown that choroidal inflammation is still present in most cases once clinical signs as well as morphological and functional parameters have normalized [28][29][30][31][32][33][38][39][40], and the persistence of this choroidal subclinical disease explains the evolution toward SGF in most insufficiently treated cases [20,22,41].…”

Section: Association Of Steroidal and Non-steroidal Immunosuppressionmentioning

confidence: 99%

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

et al. 2018

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Section: Corticosteroid Monotherapy Has Been Shown To Be Inappropriatmentioning

confidence: 87%

Section: Corticosteroid Monotherapy Has Been Shown To Be Inappropriatmentioning

confidence: 95%

Section: Association Of Steroidal and Non-steroidal Immunosuppressionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2018

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“…HLA-DRB1*0405). [1,2] VKHS is responsible for only a small percentage of uveitis (1%-8% depending on the series [3] ). It is more common in women, with a female/male ratio of 2 to 1, and usually occurs between the age of 20 and 50 years, with a peak in the third decade.…”

Section: Introductionmentioning

confidence: 99%

“…methotrexate, azathioprine, cyclosporine, rituximab, adalimumab) is given in case of corticosteroid resistance or side effects. [1][2][3][4][10][11][12][13][14][15] Ocular complications linked to both disease activity and treatment may lead to permanent visual loss after extinction of the uveitic phase. [3,10] The visual prognosis of VKHS varies and depends mainly on early diagnosis and rapid appropriate treatment.…”

Section: Introductionmentioning

confidence: 99%

Vogt-Koyanagi-Harada syndrome: Experience in a Belgian university hospital and review of the literature

Sels

Calster

Vanderschueren

et al. 2017

CRIM

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Introduction: The Vogt-Koyanagi-Harada syndrome (VKHS) is rare in Europe. Bilateral panuveitis is the defining characteristic, but the disease can affect other tissues containing melanin, such as the inner ear, the meninges, and the skin. Therefore, patients may present not only to ophthalmologists, but also to internists, dermatologists, ENT-physicians and neurologists. Early and aggressive immunosuppressive treatment is necessary in order to prevent permanent visual loss or systemic complications. Objective: We retrospectively studied 12 patients diagnosed and treated in a specialized uveitis clinic in Leuven (Belgium) between 2005 and 2013, and we compared our data with literature. Results:The most common extra-ocular manifestations were neurological, with headache (100%) and lymphocytic meningitis (75%) as main findings. Tinnitus was present in 50%, and vertigo in 42%. Vitiligo was the most frequent dermatological manifestation and present in 42%. Uveitis recurred in 67% of patients with 1 to 4 relapses per patient and a median time to recurrence of 6 months (range 1-11). Normal visual acuity was seen in 75% of patients at the end of follow-up (5 to 60 months), but 3 patients had at least some degree of permanent visual impairment in at least one eye. Conclusion: VKHS is a rare, multisystem disorder, characterized by bilateral uveitis and variable neurologic, auditory and skin symptoms. A lumbar puncture increases the diagnostic yield. A fast diagnosis allows timely initiation of adequate therapy, and If treated correctly, VKHS has a favorable prognosis. It is unclear if initial intravenous therapy improves frequency and time to remission.

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Clinical Presentation, Management, and Long‐Term Outcome of Pars Planitis, Panuveitis, and Vogt‐Koyanagi‐Harada Disease in Children and Adolescents

Reiff

2020

Arthritis Care & Research

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Objective. Chronic uveitis is a common manifestation of pediatric rheumatologic conditions and may result in irreversible blindness and long-term disability. While chronic anterior uveitis is the most commonly encountered ocular manifestation of rheumatic disease, little is known about the clinical presentation, management, and long-term outcome of more complex eye conditions such as pars planitis (PP), panuveitis (PU), and Vogt-Koyanagi-Harada disease (VKH). The present study was undertaken to comprehensively assess the long-term safety and efficacy of disease-modifying antirheumatic drugs (DMARDs) and biologics for the treatment of pediatric and adolescent patients with PP, PU, and VKH. Methods. We retrospectively reviewed a cohort of 75 children and adolescents with idiopathic PP (n = 50), PU (n = 11), and VKH (n = 14) followed by the Pediatric Rheumatology Core at Children's Hospital Los Angeles and evaluated referral patterns, clinical presentation, treatment response, and long-term clinical outcome. Results. Patients were followed for an average of 52 months. The mean age at disease onset was 10 years. Bilateral eye involvement was seen in 87% of the patients. At first presentation to an ophthalmologist, glaucoma was noted in 21%, and vision loss (<20/40) in 87% of patients, while legal blindness (≤20/200 in the better-seeing eye) was diagnosed in 18 of 75 (24%) patients (PP 22%, PU 36%, and VKH 21%). The average referral time to a pediatric rheumatologist was 13 months (range 1-96 months). Topical steroids were used in all patients, but 98% of patients required additional DMARDs, and 73% required therapy with biologics. After a mean of 52 months, 35% of patients across all disease groups had significant vision loss or were blind, and only 28% were in clinical remission without medications. The worst outcome was observed in children with PU. Application of regression analysis demonstrated that young age at onset, delayed referral to a pediatric rheumatologist, and chronic disease were strong predictors for the risk of long-term blindness. Conclusion. PP, PU, and VKH involve a high risk of permanent vision loss and should be managed by a skilled rheumatologist as early and as aggressively as possible.

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New insights into Vogt-Koyanagi-Harada disease

Cited by 61 publications

References 38 publications

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

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

Vogt-Koyanagi-Harada syndrome: Experience in a Belgian university hospital and review of the literature

Clinical Presentation, Management, and Long‐Term Outcome of Pars Planitis, Panuveitis, and Vogt‐Koyanagi‐Harada Disease in Children and Adolescents

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