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