July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Comparative analysis of different treatment schedules in the course of Vogt-Koyanagi-Harada disease (VKHD)
Author Affiliations & Notes
  • Joyce H Yamamoto
    Ophthalmology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
  • Marcelo Mendes Lavezzo
    Ophthalmology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
  • Viviane Mayumi Sakata
    Ophthalmology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
    Ophthalmology, Universidade Federal do Parana, Curitiba, PR, Brazil
  • Ever Ernesto Caso Rodriguez
    Ophthalmology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
  • Cintia Kanenobu
    Ophthalmology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
  • Smairah Frutuoso Abdallah
    Ophthalmology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
  • Celso Morita
    Ophthalmology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
  • Maria Kiyoko Oyamada
    Ophthalmology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
  • Carlos Eduardo Hirata
    Ophthalmology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
  • Footnotes
    Commercial Relationships   Joyce Yamamoto, None; Marcelo Lavezzo, None; Viviane Sakata, None; Ever Rodriguez, None; Cintia Kanenobu, None; Smairah Abdallah, None; Celso Morita, None; Maria Kiyoko Oyamada, None; Carlos Eduardo Hirata, None
  • Footnotes
    Support  Grant #2011/50936-7, São Paulo Research Foundation (FAPESP)
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 3502. doi:https://doi.org/
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    • Get Citation

      Joyce H Yamamoto, Marcelo Mendes Lavezzo, Viviane Mayumi Sakata, Ever Ernesto Caso Rodriguez, Cintia Kanenobu, Smairah Frutuoso Abdallah, Celso Morita, Maria Kiyoko Oyamada, Carlos Eduardo Hirata; Comparative analysis of different treatment schedules in the course of Vogt-Koyanagi-Harada disease (VKHD). Invest. Ophthalmol. Vis. Sci. 2019;60(9):3502. doi: https://doi.org/.

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

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Abstract

Purpose : To compare clinical and electroretinogram (ERG) outcomes in VKHD patients treated with different treatment protocols.

Methods : Twenty three patients (21 female) with VKHD from acute onset were systematically followed during a minimum 24-mo follow-up as part of an ongoing study started on 2011. All patients were initially treated with 3-day 1g methylprednisolone pulsetherapy followed by 1mg/kg/d oral prednisone with slow tapering. Treatment were corticosteroid only (n=6, group 1), early immunosuppressive therapy (IMT), i.e. ideal IMT before M4 (n=5, group 2), ideal IMT between M4 and M7 (n=6, group 3) and ideal IMT > M7 (n=6, group 4). IMT consisted of azathioprine (2mg/kg/d) followed by mofetil mycophenolate (2g/d) in intolerant or refractory patients. Clinical and posterior segment imaging inflammation on Spectralis HRA+OCT, i.e. fluorescein (FA) and indocyanine green (ICGA) angiographies and enhanced depth optical coherence tomography (EDI-OCT) and full-field (ff) ERG on RETIportsystem were systematically carried out. Variation ≥ 30% of scotopic ffERG parameters represented the ff-ERG based worsening group. Descriptive statistics, Kruskal-Wallis, Likelihood ratio and Dunn’s multiple comparison tests were used to analyze data. This study was approved by the Institutional Ethics Committee and followed the Helsinki declaration.

Results : At disease onset, the four groups did not differ on clinical basis (Table). Nevertheless, group 3 had the worst visual acuity at M1 (p=0.593) during the 24-mo follow-up and the highest pleocytosis (p=0.983) suggesting a more severe disease group from the onset. All eyes from Group 3 had sunset glow fundus (p=0.044). Anterior chamber cells fluctuation was not observed in group 1 (p=0.052). Presence of other inflammatory signs did not differ between treatment groups. Nevertheless, dark dots (DD) scores were significantly lower in group 2 (p-0.022). During follow-up, 14 eyes (30.4%) were defined as ffERG worsening group and 32 eyes (69.6%) as ffERG stable group. FfERG worsening group had no correlation with inflammatory signs neither treatment schedule.

Conclusions : Different treatment schedules, including early IMT, in VKHD, during 24-mo follow-up, did not significantly differ on inflammation control neither on ffERG parameters. Nevertheless, earlier IMT did better control choroidal subclinical inflammation as observed by lowest dark dots score.

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

 

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