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Marcelo Mendes Lavezzo, Viviane Mayumi Sakata, Ever Ernesto Caso Rodriguez, Smairah Frutuoso Abdallah, Cintia Kanenobu, Celso Morita, Maria Kiyoko Oyamada, Carlos Eduardo Hirata, Joyce H Yamamoto; Suclinical signs persistance in Vogt-Koyanagi-Harada disease (VKHD) patients treated with early high-dose corticosteroids and immunosuppressive therapy (IMT). Invest. Ophthalmol. Vis. Sci. 2018;59(9):422. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the impact of early IMT over subclinical inflammation in VKHD, besides corticosteroid-sparing effect.
VKHD patients in the acute phase were prospectively included, with a minimum 12-m follow-up. They were treated with methylprednisolone pulsetherapy followed by oral prednisone (1mg/Kg/d with slow tapering) and early IMT (within 2 m). Azathioprine was used as first choice drug; mofetil mycophenolate was used if there was clinical intolerance, toxicity and/or drug resistance. Follow-up protocol included every 3-m clinical and imaging exams [indocyanine green and fluorescein angiographies and enhanced depth imaging optical coherence tomography] performed with Spectralis HRA+OCT. Full-field electroretinogram (ffERG) was carried out at inclusion, 6 and 12 m. Eyes were categorized in 2 different groups based on scotopic ffERG parameters: fluctuation ≥ 30% (worsening group) or stable visual function group. Subclinical signs were defined as: optic disc or perivascular leakage; dark dots and/or subfoveal choroidal thickness increase. Clinical signs were determined as: cells in anterior chamber; choroidal neovascularization (CNV) and/or macular edema. Changes in treatment were based on presence of clinical signs and/or ≥ 30% ERG parameters worsening in 2 consecutive exams. Descriptive statistics, Fisher exact and Mann-Whitney tests were used to analyze data. This study was approved by Institutional Ethics Committee and followed the Helsinki declaration.
Eleven women were included, with median age at diagnosis of 37 yo and median time from symptoms till treatment of 23 d (range, 8-67 d). During follow-up, 4 eyes (18.2%) were defined as ffERG worsening group and 18 eyes (81.8%) as ffERG stable group. Both groups presented clinical and subclinical signs of inflammation in a similar proportion. However, marked pleocytosis (p=0.042) and choroidal folds (p=0.002) were more frequent on ffERG worsening group. There was no CNV during 12-m follow-up. Other results are shown in Table 1.
In this limited sample of patients, subclinical inflammation signs persisted, despite optimal early IMT. Worsening ERG group had indicators of a more severe disease from the onset.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Table 1 – Scotopic full-field electroretinogram parameters-based groups of patients with Vogt-Koyanagi-Harada disease and their clinical characteristics
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