Vogt-Koyanagi-Harada Disease Managed With Immunomodulatory T
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To study the outcome of high-dose corticosteroids with early addition of immunomodulatory therapy (IMT) in patients with Vogt-Koyanagi-Harada (VKH) disease.

Patients with Vogt-Koyanagi-Harada from 2008-2018 were studied. The standardized clinical protocol was intravenous methylprednisolone followed by/or oral prednisolone 1 mg/kg daily with slow taper plus immunomodulatory therapy within 3 months. Researchers collected data on demographics, clinical features, and indocyanine green angiography (ICGA). Uveitis activity was assessed clinically and by indocyanine green angiography. Results were compared when immunomodulatory therapy was given before vs after 6 weeks (late immunomodulatory therapy) and with historical data (IMT added when uveitis uncontrolled).

Fifty-eight eyes of 29 patients were studied. The mean age ± standard deviation was 42.2 ± 13.3 years. Twenty-five patients required 1 IMT and 4 needed 2 drugs. Sunset glow fundus occurred in 34 of 58 eyes. Uveitis resolved in 24 of 58 eyes, became chronic in 30, and required chronic recurrent in 4 eyes. Eyes with immunomodulatory therapy initiated within 6 weeks had a better visual outcome that was significant at 4 years but had a similar occurrence of sunset glow fundus and uveitis. Compared with historical data, the visual outcome was better and was significant at 3 years, and significantly fewer patients developed chronic recurrent disease.

High-dose corticosteroids with immunomodulatory therapy within 3 months resulted in improved visual outcomes and a reduced risk of developing chronic recurrent uveitis compared with immunomodulatory therapy given as clinically indicated.