High rate of clinical recurrence in patients with Vogt–Koyanagi–Harada disease treated with early high-dose corticosteroids

Purpose To analyse the rate of clinical recurrences in Brazilian patients with Vogt–Koyanagi–Harada (VKH) disease after early high-dose corticosteroid treatment. Methods Retrospective study including patients treated with early high-dose corticosteroids (prednisone, 1–1.5 mg/kg/day, or 3-day 1 g met...

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Published in:Graefe's archive for clinical and experimental ophthalmology 2015-05, Vol.253 (5), p.785-790
Main Authors: Sakata, Viviane M., da Silva, Felipe T., Hirata, Carlos E., Marin, Maria Lucia C., Rodrigues, Helcio, Kalil, Jorge, Costa, Rogerio A., Yamamoto, Joyce H.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Brazil - epidemiology
Child
Chronic Disease
Female
Fibrosis
Fluorescein Angiography
Glucocorticoids - administration & dosage
HLA-DRB1 Chains - genetics
Humans
Inflammatory Disorders
Male
Medicine
Medicine & Public Health
Methylprednisolone - administration & dosage
Middle Aged
Ophthalmology
Polymerase Chain Reaction
Prednisone - administration & dosage
Prognosis
Pulse Therapy, Drug
Recurrence
Retina - pathology
Retrospective Studies
Uveomeningoencephalitic Syndrome - diagnosis
Uveomeningoencephalitic Syndrome - drug therapy
Uveomeningoencephalitic Syndrome - epidemiology
Young Adult
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Summary:Purpose To analyse the rate of clinical recurrences in Brazilian patients with Vogt–Koyanagi–Harada (VKH) disease after early high-dose corticosteroid treatment. Methods Retrospective study including patients treated with early high-dose corticosteroids (prednisone, 1–1.5 mg/kg/day, or 3-day 1 g methylprednisolone pulsetherapy) within 1 month from disease onset followed by slow taper (at least 6 months). Patients with a minimum 12-month follow-up were subdivided based on the presence of disease recurrence or persistence after 6 months from initial presentation into: acute–resolved (AR, no recurrences), chronic–recurrent (CR), and chronic–recurrent with subretinal fibrosis (SRF). Recurrences were defined as the presence of clinical and/or fluorescein angiography findings. Results Twenty-nine patients (58 eyes) with a median follow-up of 65 months were included. Six (21 %), 11 (38 %) and 12 (41 %) patients were allocated to AR, CR, and SRF groups respectively. Though having received treatment within 1 month of onset, median time to initial treatment differed among groups (11, 15, and 25 days, in AR, CR, and SRF groups respectively). Intensity of immunosuppression, cataract development, and longer time to achieve logMAR visual acuity ≤0.8 differed significantly among the groups, being more severe in SRF group. HLA-DRB1*0405 allele followed the same trend, though not reaching significance (0.5 in AR group, 0.6 in CR, and 0.8 in SRF). Conclusion VKH disease in Brazilian patients evolved to chronic–recurrent disease in 79 % of cases; 38 % developed subretinal fibrosis, in spite of similar initial treatment regimens. Time to initiate treatment influenced outcomes.
ISSN:0721-832X
1435-702X
DOI:10.1007/s00417-014-2904-z