Purchase this article with an account.
I.P. Paredes, M. Ahmed, C.S. Foster; Immunomodulatory Therapy for VKH patients as a First Line Therapy . Invest. Ophthalmol. Vis. Sci. 2004;45(13):2663.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose:Vogt–Koyanagi Harada syndrome (VKH) is a systemic disorder involving multiple organs including the eye. Systemic steroid therapy has inconsistent efficacy and many side effects because of the duration of therapy required. Immunomodulatory therapy(IMT) has been suggested as first line therapy for this debilitating disease by the American Uveitis Society and by the International Uveitis Study Group. Materials and Methods: We reviewed the records of 13 patients diagnosed with VKH and eventually managed by the Ocular Immunology and Uveitis service of the Massachusetts Eye and Ear Infirmary. Treatment regimens (Prolonged steroid with or without delayed addition of IMT or Relatively prompt IMT with or without steroid) and treatment outcomes(visual acuity) were reviewed and compared. Patients were divided into 2 groups. Group 1: Prolonged steroid with or without delayed addition of IMT and Group 2: Relatively prompt IMT with or without steroid. "Delayed" IMT is defined as IMT not given within 6 months of diagnosis and "Relatively Prompt" IMT is defined as IMT given within 6 months of diagnosis. Results: The mean patient age was 40.85 years. Five of the 13 patients were treated with Prolonged steroid with or without delayed addition of IMT (group 1). 8 fell into the Relatively prompt IMT with or without steroid group (group 2). In group 1, 3 patients deteriorated(60%) and 1 had improvement in visual acuity(20%). During the follow up, 1 case had improvement in visual acuity in one eye but decreased visual acuity in the other eye. In group 2, 7 of 8 patients had improvement in their visual acuities(87.5%); 1 deteriorated(12.5%). Conclusions: Although definitive management for VKH is not defined, these outcomes data suggest that IMT as first line therapy for VKH is associated with outcomes superior to steroid as monotherapy or with delayed addition of IMT. No demonstrable side effects were noted with IMT therapy .
This PDF is available to Subscribers Only