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K.M. Narayana, J. Biswas, S.K. Ganesh, A.E. George, S.K. Chopra; Successful Treatment of Vogt–Koyanagi–Harada syndrome(VKH) with Immunosuppressive agents. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):2665.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To describe the long–term visual outcomes of patients with Vogt–Koyanagi–Harada syndrome (VKH) treated with Azathioprine alone or in combination with another immunomodulatory agent (Cyclosporine or Mycophenolate mofetil). Methods: DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Twenty–four patients (48 eyes) with chronic VKH, with or without history of previous steroid therapy, were treated at a tertiary care uveitis referral center between Jan 1998 and Dec 2001. Patients received oral Azathioprine, either alone (22 pts) or in combination with Cyclosporine(1pt) or Mycophenolate mofetil (1pt). Oral Prednisolone also was given initially and was tapered and discontinued. Only patients with a minimum follow–up of 6 months were considered. OUTCOME MEASURES: Visual outcome, recurrence rates before and after immunosuppression, complications, and side effects of immunosuppressive therapy. Results: The follow–up period averaged 36.17 months.(6 –56 months) Patients received immunosuppressive therapy for an average of 60.63 weeks (3 –184 weeks). When compared to the initial vision, the final vision was maintained in 18 eyes (37.50%), improved in 25 eyes (52.08%) and worsened in 5 eyes (10.45%). The improvement in visual acuity was statistically significant (P value 0.047 Chi–square test, Pearson). Change in the number of recurrences before and after immunosuppression was statistically significant (P value 0.009, Fisher exact test). Drug–free remission was achieved in 15 patients for an average period of 25.33 weeks upto a maximum of 142 weeks. Side effects included hypertrichosis (1 pt), bone marrow suppression (2 pts) hepatotoxicity, jaundice, nausea, vomiting and fatigue (in 1 pt) and giddiness, instability and palpitations (1 pt). None of the patients developed malignancies or secondary infections. Cataract (15 eyes, 31.25%) and glaucoma (6 eyes, 12.5%) were the most common complications leading to significant visual loss. There was no eye with subretinal neovascular membrane. Conclusions: Long–term, adequate immunosuppression may favorably alter the long–term visual prognosis of patients with VKH and reduce the recurrence rate. Visual outcomes in VKH are comparable to or slightly better than those reported with long–term steroid therapy in literature. Immunosuppressive therapy may prevent or delay the development of choroidal neovascular membrane in patients with VKH.
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