Prognostic factors for clinical outcomes in patients with Vogt-Koyanagi-Harada disease treated with high-dose corticosteroids.

Abstract

PURPOSE:

To determine prognostic factors in patients with Vogt-Koyanagi-Harada (VKH) disease who were treated with high-dose corticosteroids.

METHODS:

Retrospective analysis of 87 patients (174 eyes).

RESULTS:

At presentation, there were 53 patients with initial-onset acute VKH disease and 34 patients with chronic recurrent VKH disease. Chronic recurrent presentation was significantly associated with more severe anterior segment inflammation at presentation as indicated by presence of mutton-fat keratic precipitates, anterior chamber reaction ≥2+, iris nodules and posterior synechiae (p < 0.001 for all comparisons), less exudative retinal detachment at presentation (p < 0.001), more complications during the follow-up period (p < 0.001) and a worse visual outcome (p < 0.001). The use of immunomodulatory therapy (cyclosporine and mycophenolate mofetil) as first-line therapy significantly reduced the development of complications in the whole study group (p = 0.006) and in initial-onset acute group (p = 0.024) and improved visual outcome in the whole study group (p = 0.004) and in chronic recurrent group (p = 0.024). In the whole study group, final visual acuity of 20/20 was significantly associated with good initial visual acuity of >20/200 [odds ratio = 4.25; 95% Confidence interval (CI) = 1.53-11.89] and age older than 16 years was significantly associated with the development of complications (odds ratio = 3.15; 95% CI = 1.04-9.48).

CONCLUSIONS:

Chronic recurrent VKH disease is significantly associated with more severe anterior segment inflammation and less exudative retinal detachment at presentation, more ocular complications and a worse visual outcome than initial-onset acute VKH disease. Use of immunomodulatory therapy significantly improved the clinical outcomes.

• Authors: Ahmed M Abu El-Asrar, Mamdouh Al Tamimi, Suhail Hemachandran, Hani S Al-Mezaine, Abdulrahman Al-Muammar, Dustan Kangave
• Journal: Acta ophthalmologica (Acta Ophthalmol) Vol. 91 Issue 6 Pg. e486-93 (Sep 2013) ISSN: 1755-3768 [Electronic] England
• PMID: 23575246 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by Blackwell Publishing Ltd.

Chemical References

• Immunosuppressive Agents
• Cyclosporine
• Mycophenolic Acid

Topics

• Acute Disease
• Adolescent
• Adult
• Child
• Child, Preschool
• Chronic Disease
• Cyclosporine (administration & dosage, adverse effects, therapeutic use)
• Drug Therapy, Combination
• Female
• Fluorescein Angiography
• Humans
• Immunosuppressive Agents (administration & dosage, adverse effects, therapeutic use)
• Male
• Middle Aged
• Mycophenolic Acid (administration & dosage, adverse effects, analogs & derivatives, therapeutic use)
• Prognosis
• Recurrence
• Retrospective Studies
• Treatment Outcome
• Uveomeningoencephalitic Syndrome (diagnosis, drug therapy)
• Visual Acuity
• Young Adult