Abstract
Abstract: :
Background: Controversy exists over the initial dose of corticosteroids for the treatment of Vogt–Koyanagi–Harada (VKH) disease with serous retinal detachments. We reviewed treatment outcomes of pulse intravenous methylprednisolone. Methods: Records of 38 consecutive Japanese patients with new onset VKH disease who presented between June 1999 and May 2004 were reviewed. 34 patients had acute disease (decreased vision < 2 weeks) and 4 patients had subacute disease (decreased vision > 2 weeks). 30 patients received intravenous methylprednisolone 1000 mg/d for 3 days (one pulse) followed by oral prednisolone 1 mg/kg/d for 1 week, at which time a second pulse was considered for inadequate response. Oral therapy was tapered over 4 to 6 months when possible. When the duration of corticosteroid monotherapy was anticipated to exceed 6 months, combination cyclosporine therapy was initiated. Pulse therapy was not used in 8 patients for either systemic contraindications or disease judged to be mild. Patients were followed for a mean of 22 months. Results:29 of the 34 patients with acute disease received pulse therapy. The mean pre–treatment VA was 0.7 and the mean post–treatment VA was 1.1 (n = 58 eyes), with 7 patients having inflammatory recurrences (anterior chamber cells, chorioretinitis or cystoid macular edema). 2 patients had mild cataract progression but otherwise no ocular (cataract, glaucoma, choroidal neovascularization, subretinal fibrosis or foveal atrophy) or systemic (vitiligo, poliosis or alopecia) complications were observed. 5 patients with acute VKH disease received lower initial doses of corticosteroids. 4 of these patients had mild disease and good visual recovery. The remaining patient had systemic contraindications and experienced inflammatory recurrences as well as ocular complications. Of the 4 patients with subacute disease, 1 patient received pulse therapy, 2 patients received lower doses of corticosteroids, and 1 patient received cyclosporine only. These patients also had good visual recovery, although all had inflammatory recurrences. Ocular complications were noted in 2 patients and systemic complications in 3 patients. Patients with subacute disease required longer durations of immunosuppression. Conclusions: Excellent treatment outcomes were observed in patients with acute VKH disease treated initially with pulse intravenous methylprednisolone. Patients with acute VKH disease and systemic contraindications not treated with pulse therapy, or with subacute VKH disease, had higher rates of inflammatory recurrences and complications.
Keywords: uveitis-clinical/animal model • corticosteroids • chorioretinitis