July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Impact of immunosuppression on inflammatory signs in Vogt-Koyanagi-Harada disease (VKHD) – a 24-mo follow-up
Author Affiliations & Notes
  • Marcelo Mendes Lavezzo
    Ophthalmology, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
  • Viviane Mayumi Sakata
    Ophthalmology, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
  • Ever Ernesto Caso Rodriguez
    Ophthalmology, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
  • Celso Morita
    Ophthalmology, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
  • Cintia Kanenobu
    Ophthalmology, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
  • Smairah Frutuoso Abdallah
    Ophthalmology, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
  • Maria Kiyoko Oyamada
    Ophthalmology, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
  • Carlos Eduardo Hirata
    Ophthalmology, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
  • Joyce Hisae Yamamoto
    Ophthalmology, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
  • Footnotes
    Commercial Relationships   Marcelo Lavezzo, None; Viviane Sakata, None; Ever Rodriguez, None; Celso Morita, None; Cintia Kanenobu, None; Smairah Abdallah, None; Maria Kiyoko Oyamada, None; Carlos Eduardo Hirata, None; Joyce Yamamoto, None
  • Footnotes
    Support  Grant 2014/01222-0 - São Paulo Research Foundation (FAPESP)
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 3503. doi:
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      Marcelo Mendes Lavezzo, Viviane Mayumi Sakata, Ever Ernesto Caso Rodriguez, Celso Morita, Cintia Kanenobu, Smairah Frutuoso Abdallah, Maria Kiyoko Oyamada, Carlos Eduardo Hirata, Joyce Hisae Yamamoto; Impact of immunosuppression on inflammatory signs in Vogt-Koyanagi-Harada disease (VKHD) – a 24-mo follow-up. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3503.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To evaluate the impact of immunosuppressive therapy (IMT) on inflammatory signs in VKHD.

Methods : 11 patients diagnosed with acute VKHD and prospectively followed for a minimum 24-mo were systematically evaluated with clinical, posterior segment inflammatory imaging exams, i.e. fluorescein and indocyanine green angiographies and enhanced depth optical coherence tomography with Spectralis HRA+OCT, and full-field electroretinogram (ffERG) with RETIportsystem. All patients were treated with methylprednisolone pulsetherapy followed by oral prednisone (1mg/Kg/d) with slow tapering and systemic IMT (azathioprine; mofetil mycophenolate, in refractory and/or intolerant cases). Ideal dose of IMT was achieved before M4 in 5 patients (45.5%) and between M4 and M7 in 6 patients (54.5%). Eyes were categorized in 2 different groups based on scotopic ffERG parameters variation ≥ 30% between M12-M24: worsening or stable group. Descriptive statistics, Fisher exact and Mann-Whitney tests were used to analyze data. This study was approved by the Institutional Ethics Committee and followed the Helsinki declaration.

Results : Eleven women (22 eyes), with mean age at diagnosis of 34y and mean time from symptoms till treatment of 28d, were categorized as worsening in 36.4% (8 eyes) and as stable in 63.6% (14 eyes). Anterior chamber cells (ACC) and posterior segment inflammation were detected in 8 eyes (36.4%) and in 22 eyes (100%), respectively during the 24-mo follow-up. DD scores significantly reduced in early IMT group in comparison to late IMT group (Figure 1); a higher DD score at M18 was related with a worse function based on ffERG (p=0.002). Later treatment start was related with more clinical/subclinical signs: ACC (p=0.001); ACC fluctuation (p=0.009) and perivascular leakage (p=0.007). A greater pleocytosis (p=0.038) was related with worsening ERG parameters as described in the 12-mo follow-up results (ARVO 2018). Other results are shown in Table 1.

Conclusions : IMT impacted positively on inflammation and on ffERG parameters; however, it did not completely eliminate clinical and subclinical signs during this 24-mo follow-up.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Table 1 – Scotopic ffERG parameters-based groups of patients with VKHD and their clinical characteristics

Table 1 – Scotopic ffERG parameters-based groups of patients with VKHD and their clinical characteristics

 

Figure 1 – Evolution of dark dots (DD) score during follow-up, based on timing to reach the ideal dose of immunosuppression (IMT): ≤ 4 months and > 4 m (up to 7 m)

Figure 1 – Evolution of dark dots (DD) score during follow-up, based on timing to reach the ideal dose of immunosuppression (IMT): ≤ 4 months and > 4 m (up to 7 m)

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