Purchase this article with an account.
Joyce H Yamamoto, Viviane Mayumi Sakata, Carlos E Hirata, Maria Lucia C Marin, Helcio Rodrigues, Walter Y Takahashi, Rogerio A Costa; Clinical course of Vogt-Koyanagi-Harada disease in Brazilian patients. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5799.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: To describe the clinical course of patients with Vogt-Koyanagi-Harada disease (VKHD) treated with a standard high-dose systemic corticosteroid between 1997 and 2013.
This retrospective and longitudinal study included patients with VKHD (Revised Diagnostic Criteria) with a minimum one-year follow-up and early (less than 30 days from disease onset) standard high-dose systemic corticosteroid followed by slow tapering of oral corticosteroids over a minimum of 6 months. Therapy was adjusted according to clinical and fluorescein angiography (FA) evidence of disease activity. Demographic data, disease category, recurrence or chronic inflammation, fundus based severity and ocular complications were noted. Initial and final visual acuity was included. HLA-DRB1 loci were typed by a PCR-SSO-Luminex method. The study protocol followed the statements of the Declaration of Helsinki and was approved by local Institutional Review Board.
29 patients were included. Their clinical characteristics are described in the Table. Concerning the course of the disease, 8 patients (28%) had no clinical and/or FA disease recurrence (group 1) and were all characterized by mild fundus, no ocular complications and final vision ≥0.8. Twenty one patients (72%) had recurrent or chronic inflammation (group 2), among which 10 patients (48%) had subretinal fibrosis (group 2b) and 11 patients (52%) did not (group 2a). Parameters, such as age, interval to treatment, duration of systemic corticosteroid treatment, were similar between groups 1,2a and 2b. Nevertheless, systemic immunosuppressant and ocular complications were more frequent in group 2a/b (p<0.001)). HLA-DRB1*04 allele group frequencies analysis in patients and controls showed a higher frequency in VKH group (p=0.0008; OR 4.8; IC 95%1.95-11.80). A highly significant increase of the HLA-DRB1* 0405 was disclosed upon HLA-DR4 allele typing (p<0.0001; OR 11.38; IC 95% 3.95-32.81). HLA-DRB1*0405 distribution in each clinical group can be observed at Table. Despite the small number of individuals analyzed, this data suggest that HLA-DRB1*0405 may be associated to disease severity.
VKHD may have different clinical course independently of therapy and known prognostic factors. HLA-DRB1*0405 might be associated to disease severity. Further understanding of the spectrum of VKHD is demanded.
This PDF is available to Subscribers Only