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R.W. Read, VKH Therapy Group; A Retrospective Multinational Survey of Current Treatment Patterns in Acute and Subacute Vogt–Koyanagi–Harada Disease . Invest. Ophthalmol. Vis. Sci. 2004;45(13):2664.
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Purpose:Systemic corticosteroid therapy is generally agreed upon as appropriate initial therapy for Vogt–Koyanagi–Harada disease (VKH), while the optimal dosage and route of administration of corticosteroids are not agreed upon. As a function of an ongoing series of international workshops on VKH, the VKH Therapy Group was formed to evaluate these issues. We present a retrospective multinational survey of current treatment patterns of VKH. Methods:Patients were identified from nine centers around the world as having presented with acute (1 month duration of disease but still with acute manifestations) VKH during the period of 01 Jan 1999 through 31 Dec 2001. Demographic, evaluation, and treatment data were collected and analyzed via a standardized data matrix. Results:After exclusions, 76 patients met the study criteria and were analyzed. Mean age at presentation was 39.5 years. Females comprised 60% of patients. Patients presented to a uveitis clinic a mean of 39 days following the onset of ocular symptoms. Asians comprised 66% of patients, Europeans 18%, Hispanic/Mestizos 8%, Middle Easterners 7%, and Asian Indians 1.3%. Forty–nine patients (64%) received intravenous corticosteroids as their initial therapy in a uveitis clinic, while 25 (33%) received oral corticosteroids (1 patient each had either no determinable therapy or subtenon's injections only). Oral corticosteroid dosages ranged from 30mg to 200mg per day (prednisone equivalent). IV corticosteroid dosages ranged from 250mg to 1000mg per day (methylprednisolone equivalent). There was no statistical difference in the age at presentation, days from initial symptoms to presentation, or months of follow–up between the treatment groups. There was a significant difference in the initial visual acuity between groups, with the oral treated group having significantly worse presenting acuities. Conclusions:Use of corticosteroids as the initial treatment of VKH is almost universal but specific usage patterns vary widely among international uveitis centers. The VKH Therapy Group is currently collecting information on outcomes based on initial treatment patterns in an effort to clarify treatment protocols which produce the most favorable outcomes.
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