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Urzua CA, Velasquez V, Sabat P, Berger O, Ramirez S, Goecke A, Vásquez DH, Gatica H, Guerrero J. Earlier immunomodulatory treatment is associated with better visual outcomes in a subset of patients with Vogt-Koyanagi-Harada disease. Acta Ophthalmol 2015; 93:e475-80. [PMID: 25565265 DOI: 10.1111/aos.12648] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/24/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate clinical outcomes of first-line immunomodulatory therapy (IMT) and prednisone alone or late IMT in Vogt-Koyanagi-Harada disease. METHODS Retrospective cohort study of 152 patients with Vogt-Koyanagi-Harada disease evaluated in a referral uveitis clinic in Chile from 1985 to 2011. Medical records of these patients were reviewed. Demographic data, clinical evaluation, type of treatment, functional outcomes, glucocorticoid (GC) dose and complications were recorded. Multivariate logistic regression was used to identify prognostic factors of poor response to GC. RESULTS There were no significant differences between first-line IMT group and prednisone alone/late IMT group in terms of visual acuity (VA) improvement, complications and GC sparing effect. There was a trend for a higher frequency of systemic adverse effects leading to discontinuation of treatment in patients receiving IMT than in those receiving prednisone (14.6% and 6.5%, respectively). The subgroup of patients with poor response to GC who showed functional improvement had a significantly earlier time to IMT initiation than the patients who had no improvement. We identified following prognostic factors of poor response to GC: VA ≤ 20/200, fundus depigmentation, chronic disease and tinnitus at diagnosis. Patients with a prognostic factor (excluding tinnitus) and VA improvement had an earlier IMT initiation than those who had worse functional outcome. CONCLUSION There were no differences in outcomes between first-line IMT and prednisone alone/late IMT in the entire VKH group. However, in a subset of patients, there was a significant better functional outcome with earlier IMT initiation.
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Affiliation(s)
- Cristhian A. Urzua
- Uveitis Department; Salvador's Hospital; Santiago Chile
- Ophthalmology Department; University of Chile; Santiago Chile
- Physiology Program; Faculty of Medicine; University of Chile; Santiago Chile
| | - Victor Velasquez
- Uveitis Department; Salvador's Hospital; Santiago Chile
- Ophthalmology Department; University of Chile; Santiago Chile
| | - Pablo Sabat
- Uveitis Department; Salvador's Hospital; Santiago Chile
- Ophthalmology Department; University of Chile; Santiago Chile
| | - Osvaldo Berger
- Ophthalmology Department; Catholic University; Santiago Chile
| | | | - Annelise Goecke
- Physiology Program; Faculty of Medicine; University of Chile; Santiago Chile
- Rheumatology Department; University of Chile Clinical Hospital; Santiago Chile
| | | | - Hector Gatica
- Physiology Program; Faculty of Medicine; University of Chile; Santiago Chile
- Rheumatology Department; University of Chile Clinical Hospital; Santiago Chile
| | - Julia Guerrero
- Physiology Program; Faculty of Medicine; University of Chile; Santiago Chile
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Cunningham ET, Rathinam SR, Tugal-Tutkun I, Muccioli C, Zierhut M. Vogt-Koyanagi-Harada Disease. Ocul Immunol Inflamm 2014; 22:249-52. [DOI: 10.3109/09273948.2014.939530] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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TREATMENT OF PERSISTENT SEROUS RETINAL DETACHMENT IN VOGT–KOYANAGI–HARADA SYNDROME WITH INTRAVITREAL BEVACIZUMAB DURING THE SYSTEMIC STEROID TREATMENT. Retina 2014; 34:490-6. [DOI: 10.1097/iae.0b013e3182a0e446] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sakata VM, da Silva FT, Hirata CE, de Carvalho JF, Yamamoto JH. Diagnosis and classification of Vogt-Koyanagi-Harada disease. Autoimmun Rev 2014; 13:550-5. [PMID: 24440284 DOI: 10.1016/j.autrev.2014.01.023] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 11/16/2022]
Abstract
Vogt-Koyanagi-Harada (VKH) disease is a systemic autoimmune disorder that affects pigmented tissues of the body, with its most dire manifestations affecting the eyes. This review focuses on the diagnostic criteria of VKH disease, including some information on history, epidemiology, appropriate clinical and classification criteria, etiopathogenesis, treatment and outcomes. Expert review of most relevant literature from the disease's first description to 2013 and correlation with the experience in the care of VKH disease patients at a tertiary Uveitis Service in Brazil gathered over the past 40 years. The clinical manifestations and ancillary assessment of VKH disease have been summarized in the Revised Diagnostic Criteria proposed in 2001 in a manner that allows systematic diagnosis of both acute and chronic patients. It includes the early acute uveitic manifestations (bilateral diffuse choroiditis with bullous serous retinal detachment and optic disk hyperemia), the late ocular manifestations (diffuse fundus depigmentation, nummular depigmented scars, retinal pigment epithelium clumping and/or migration, recurrent or chronic anterior uveitis), besides the extraocular manifestations (neurological/auditory and integumentary). There are two exclusion criteria, i.e. absence of previous ocular penetrating trauma or surgery and any other ocular disease that could be confounded with VKH disease. HLA-DRB1*0405 plays an important role in pathogenesis, rendering carriers more susceptible to disease. The primary ocular pathological feature is a diffuse thickening of the uveal tract in the acute phase. Later on, there may be a compromise of choriocapillaris, retinal pigment epithelium and outer retina, mostly due to an "upstream" effect, with clinical correlates as fundus derangements. Functional tests (electroretinogram and visual field testing) as well as imaging modalities (retinography, fluorescein/indocyanine green angiography, optical coherence tomography and ultrasound) play an important role in diagnosis, severity grading as well as disease monitorization. Though high-dose systemic corticosteroids remain gold-standard therapy, refractory cases may need other agents (cyclosporine A, anti-metabolites and biological agents). In spite of good visual outcomes in the majority of patients, knowledge about disease progression even after the acute phase and its impact on visual function warrant further investigation.
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Affiliation(s)
- Viviane Mayumi Sakata
- Department of Ophthalmology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Felipe Theodoro da Silva
- Department of Ophthalmology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Eduardo Hirata
- Department of Ophthalmology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Joyce Hisae Yamamoto
- Department of Ophthalmology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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Fraser-Bell S, Pavesio C. Advances in the treatment of intermediate and posterior uveitis. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.3.4.449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Attia S, Khochtali S, Kahloun R, Zaouali S, Khairallah M. Vogt–Koyanagi–Harada disease. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.12.63] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ozdal P, Ozdamar Y, Yazici A, Teke MY, Ozturk F. Vogt-Koyanagi-Harada disease: clinical and demographic characteristics of patients in a specialized eye hospital in Turkey. Ocul Immunol Inflamm 2013; 22:277-86. [PMID: 24328424 DOI: 10.3109/09273948.2013.856448] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate clinical and demographic features of Vogt-Kayanagi-Harada disease (VKH) disease in Turkish patients and compare them with previously published data. METHODS Demographic and clinical features of 32 patients diagnosed as VKH in a tertiary referral center were retrospectively reviewed. RESULTS The mean age at presentation was 33.6 ± 10.4 years. Seventy-five percent of the patients were female and 62.5% of the patients presented during the last 2 years. The disease was complete in 31.2%, incomplete in 50%, and probable in 18.8% of the patients. The clinical course was acute in 50%, chronic recurrent in 34.4%, and chronic in 15.6%. The most common findings were bilateral serous retinal detachment ± papillitis in acute cases and retinal pigment epithelial changes of the macula in chronic cases. CONCLUSIONS Although rare in Turkey, VKH disease seems to have increased during the last few years. The disease is incomplete and acute in half of the patients and has a quite good visual prognosis.
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Affiliation(s)
- Pinar Ozdal
- Ulucanlar Eye Education and Training Hospital Ophthalmology Clinic , Ankara , Turkey and
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Reiff A, Kadayifcilar S, Özen S. Rheumatic Inflammatory Eye Diseases of Childhood. Rheum Dis Clin North Am 2013; 39:801-32. [DOI: 10.1016/j.rdc.2013.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abu El-Asrar AM, Al Tamimi M, Hemachandran S, Al-Mezaine HS, Al-Muammar A, Kangave D. Prognostic factors for clinical outcomes in patients with Vogt-Koyanagi-Harada disease treated with high-dose corticosteroids. Acta Ophthalmol 2013; 91:e486-93. [PMID: 23575246 DOI: 10.1111/aos.12127] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine prognostic factors in patients with Vogt-Koyanagi-Harada (VKH) disease who were treated with high-dose corticosteroids. METHODS Retrospective analysis of 87 patients (174 eyes). RESULTS At presentation, there were 53 patients with initial-onset acute VKH disease and 34 patients with chronic recurrent VKH disease. Chronic recurrent presentation was significantly associated with more severe anterior segment inflammation at presentation as indicated by presence of mutton-fat keratic precipitates, anterior chamber reaction ≥2+, iris nodules and posterior synechiae (p < 0.001 for all comparisons), less exudative retinal detachment at presentation (p < 0.001), more complications during the follow-up period (p < 0.001) and a worse visual outcome (p < 0.001). The use of immunomodulatory therapy (cyclosporine and mycophenolate mofetil) as first-line therapy significantly reduced the development of complications in the whole study group (p = 0.006) and in initial-onset acute group (p = 0.024) and improved visual outcome in the whole study group (p = 0.004) and in chronic recurrent group (p = 0.024). In the whole study group, final visual acuity of 20/20 was significantly associated with good initial visual acuity of >20/200 [odds ratio = 4.25; 95% Confidence interval (CI) = 1.53-11.89] and age older than 16 years was significantly associated with the development of complications (odds ratio = 3.15; 95% CI = 1.04-9.48). CONCLUSIONS Chronic recurrent VKH disease is significantly associated with more severe anterior segment inflammation and less exudative retinal detachment at presentation, more ocular complications and a worse visual outcome than initial-onset acute VKH disease. Use of immunomodulatory therapy significantly improved the clinical outcomes.
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Affiliation(s)
- Ahmed M Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Roy M. Vogt–Koyanagi–Harada disease: a forgotten entity in the Canadian uveitis landscape? Can J Ophthalmol 2013; 48:133-4. [DOI: 10.1016/j.jcjo.2013.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 01/31/2013] [Indexed: 10/26/2022]
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Ehmann D, Tennant MT, Somani R, Rudnisky CJ. Vogt–Koyanagi–Harada disease in First Nations and Métis of Northern Alberta. Can J Ophthalmol 2013; 48:146-52. [DOI: 10.1016/j.jcjo.2012.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 07/24/2012] [Accepted: 10/16/2012] [Indexed: 10/26/2022]
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Arcinue CA, Radwan A, Lebanan MO, Foster CS. Comparison of Two Different Combination Immunosuppressive Therapies in the Treatment of Vogt-Koyonagi-Harada Syndrome. Ocul Immunol Inflamm 2013; 21:47-52. [DOI: 10.3109/09273948.2012.728668] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abu El-Asrar AM, Hemachandran S, Al-Mezaine HS, Kangave D, Al-Muammar AM. The outcomes of mycophenolate mofetil therapy combined with systemic corticosteroids in acute uveitis associated with Vogt-Koyanagi-Harada disease. Acta Ophthalmol 2012; 90:e603-8. [PMID: 22971163 DOI: 10.1111/j.1755-3768.2012.02498.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To study the effectiveness of mycophenolate mofetil (MMF) as first-line therapy combined with systemic corticosteroids in acute uveitis associated with Vogt-Koyanagi-Harada (VKH) disease. The outcomes in this group were compared with those of another group of patients with VKH disease who were treated with corticosteroid monotherapy or with delayed addition of immunomodulatory therapy. METHODS This prospective study included 19 patients (38 eyes) diagnosed with acute uveitis associated with VKH disease. RESULTS The mean follow-up period was 27.0 ± 11.1 months (range 16-54 months). Corticosteroid-sparing effect was achieved in all patients. The mean interval between starting treatment and tapering prednisone to 10 mg or less daily was 5.1 ± 1.2 months (range 3-7 months). Ten (53%) patients discontinued treatment without relapse of inflammation. The mean time observed of treatment was 17.3 ± 11.9 months (range 3-41.5 months). Visual acuity of 20/20 was achieved by 38% of the eyes in the corticosteroid group and by 74% in the corticosteroid + MMF group (p < 0.001). Recurrent inflammation of ≥3 times was reduced significantly (p = 0.0383) in the corticosteroid + MMF group (3%) as compared to corticosteroid group (18%). Development of all complications was significantly higher in the corticosteroid group (43%) compared with the corticosteroid + MMF group (8%) (p < 0.001). None of the eyes in the corticosteroid + MMF group developed 'sunset glow fundus'. CONCLUSIONS Addition of MMF as first-line therapy to corticosteroids in patients with acute uveitis associated with VKH disease leads to significant reduction in recurrences of uveitis and development of late complications and significantly improves visual outcome.
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Affiliation(s)
- Ahmed M Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Rituximab in refractory Vogt-Koyanagi-Harada disease. J Ophthalmic Inflamm Infect 2011; 1:177-80. [PMID: 21744181 PMCID: PMC3223341 DOI: 10.1007/s12348-011-0027-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 06/24/2011] [Indexed: 11/22/2022] Open
Abstract
Introduction Vogt–Koyanagi–Harada (VKH) prognosis depends on early recognition and treatment; chronic disease may be developed when either delayed or inadequate treatment is performed, whereas other cases despite correct treatment are refractory to different drugs and also become chronic. We report a case of refractory VKH controlled with rituximab treatment. Case report A 41-year-old female with painful visual loss and headache was examined. (VA 0.4 in RE and hand movements (HM) in LE). Retinal examination demonstrated multiple serous retinal detachments in both eyes. High-dose oral steroids were started, followed by progressive tapering of prednisone. New acute anterior and posterior relapses were achieved, and other immunommodulators were progressively added—new high-dose steroid treatment, adalimumab, cyclosporine, and methotrexate—but patient had new anterior and posterior recurrences associated with tinnitus and headache. Thus, an infusion of 1 g of rituximab was administered after 15 months follow-up; the VA was 0.2 in RE and counting fingers in LE. Three additional doses of 1 g each were administered 1, 6, and 16 months later. We have achieved a final VA after 34 months follow-up of 0.2 in RE and HM in LE, with definitive control of inflammation, without acute relapses since rituximab was administered. Conclusion After searching PubMed/Medline, this is the first report of VKH disease treated with rituximab. Additional studies are warranted to confirm the efficacy of this new approach for inflammatory control in refractory cases of VKH disease.
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Errera MH, Fardeau C, Cohen D, Navarro A, Gaudric A, Bodaghi B, Westcott M, LeHoang P. Effect of the duration of immunomodulatory therapy on the clinical features of recurrent episodes in Vogt--Koyanagi--Harada disease. Acta Ophthalmol 2011; 89:e357-66. [PMID: 21251241 DOI: 10.1111/j.1755-3768.2010.02055.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the duration of immunomodulatory therapy (corticosteroids, immunosuppressive drugs) with regard to the rate of relapses and clinical features (exudative retinal detachment or anterior uveitis) in inflammatory episodes of Vogt--Koyanagi--Harada disease. METHODS Data of all 42 patients diagnosed with acute uveitis associated with VKH disease during the period of January 2005 to December 2008 at the Pitié-Salpêtrière Hospital or at the Lariboisière Hospital in Paris, France were extracted by chart review. RESULTS There were 31 patients (73.8%) with episodes of recurrence and were included in the study. At the first recurrence, 81% (13 patients) of exudative retinal detachments (ERD) were associated with an initial immunomodulatory treatment conducted ≤6 months (3.76 months ± 2.67). Conversely, an initial treatment duration of >6 months was associated with anterior uveitis signs for 66% of patients (eight patients) with anterior first recurrence (p = 0.0061). On second episode of recurrence, 75% of patients (three patients) who developed exudative retinal detachment had been managed by immunomodulatory therapy for ≤6 months with the total duration of immunomodulatory treatment ≤6 months during previous inflammatory episodes. Conversely, all 16 patients who presented anterior uveitis with additional manifestations (optic disc oedema, macular oedema, vitritis and/or 'Sunset glow' fundus) have been treated for more than 6 months or treated during the initial occurrence lasting more than 9 months (p = 0.0035). CONCLUSIONS The duration of systemic corticosteroids (and/or immunosuppressive drug therapy) for ≤6 months at first and second recurrence was associated with features of further exudative retinal detachment instead of anterior uveitis in VKH disease.
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Affiliation(s)
- Marie-Hélène Errera
- Department of Ophthalmology, APHP, Hôpital Pitié Salpêtrière, Paris, France.
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Pato E, Muñoz-Fernández S, Francisco F, Abad MA, Maese J, Ortiz A, Carmona L. Systematic Review on the Effectiveness of Immunosuppressants and Biological Therapies in the Treatment of Autoimmune Posterior Uveitis. Semin Arthritis Rheum 2011; 40:314-23. [DOI: 10.1016/j.semarthrit.2010.05.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Revised: 05/17/2010] [Accepted: 05/20/2010] [Indexed: 12/14/2022]
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Cuchacovich M, Solanes F, Díaz G, Cermenati T, Avila S, Verdaguer J, Verdaguer JI, Carpentier C, Stopel J, Rojas B, Traipe L, Gallardo P, Sabugo F, Zanoli M, Merino G, Villarroel F. Comparison of the Clinical Efficacy of Two Different Immunosuppressive Regimens in Patients with Chronic Vogt-Koyanagi-Harada Disease. Ocul Immunol Inflamm 2010; 18:200-7. [DOI: 10.3109/09273941003587541] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lipps J, Khan MA. Vogt–Koyanagi–Harada syndrome: a rheumatologic perspective. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/ijr.10.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Liu GT, Volpe NJ, Galetta SL. Vision loss. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Wang Y, Gaudio PA. Infliximab Therapy for 2 Patients with Vogt-Koyanagi-Harada Syndrome. Ocul Immunol Inflamm 2009; 16:167-71. [DOI: 10.1080/09273940802204527] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gallagher MJ, Yilmaz T, Foster CS. Vogt-Koyanagi-Harada Syndrome Associated With Bilateral Serous Macular Detachments Responsive to Immunomodulatory Therapy. Ophthalmic Surg Lasers Imaging Retina 2009; 40:345-7. [DOI: 10.3928/15428877-20090430-25] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
PURPOSE Vogt-Koyanagi-Harada syndrome is a bilateral, chronic, diffuse granulomatous panuveitis frequently associated with neurological, auditory, and integumentary manifestations. It is also one of the most common forms of uveitis among pigmented races including Chinese patients. METHODS This article reviews the current developments of Vogt-Koyanagi-Harada syndrome, including epidemiology, etiology, clinical features, observational techniques, genetics, treatment, and prognosis. RESULTS Increasing reports have been published to describe the clinical features of Vogt-Koyanagi-Harada syndrome in various ethnic populations from different parts of the world. In spite of tremendous progress in laboratory and clinical research, the etiology of Vogt-Koyanagi-Harada syndrome is still not completely known. Numerous studies indicate an autoimmune nature for this disease. A recent study has shown that Th17, a new subset of T cell, plays an important role in the initiation and maintenance of this disease. Early and aggressive systemic corticosteroids are still the mainstay of initial therapy for Vogt-Koyanagi-Harada syndrome. However, nonsteroid immunomodulatory therapy, including cyclosporine, chlorambucil, cyclophosphamide, and azathioprine have brought out encouraging results. Improved visual outcomes in patients with Vogt-Koyanagi-Harada syndrome in recent years have been reported when compared with decades ago, presumably due to the more aggressive use of immunosuppressive agents. CONCLUSION Although the prognosis for VKH syndrome was greatly improved, future prospective, controlled, multi-center studies are needed to determine the optimal treatment regime for this disease. The IL17/23 pathway may provide a novel therapeutic target to control inflammation in VKH syndrome.
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Affiliation(s)
- Wang Fang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China.
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Arellanes García L, Carroll MO, Garza León MA. Vogt-Koyanagi-Harada syndrome in childhood. Int Ophthalmol Clin 2008; 48:107-117. [PMID: 18645404 DOI: 10.1097/iio.0b013e31817d9b70] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Lourdes Arellanes García
- Asociacion para Evitar la Ceguera en Mexico, Dr Luis Sanchez Bulnes, Vicente Garcia Torres 46, Col. San Lucas Coyoacan, CP 04030 Mexico DF, Mexico
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Kim SJ, Yu HG. The use of low-dose azathioprine in patients with Vogt-Koyanagi-Harada disease. Ocul Immunol Inflamm 2007; 15:381-7. [PMID: 17972222 DOI: 10.1080/09273940701624312] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate treatment outcomes with low-dose azathioprine in Vogt-Koyanagi-Harada (VKH) disease patients. DESIGN Retrospective case series. METHODS Medical records of consecutive patients with VKH disease were reviewed. Azathioprine was administered in cases with corticosteroid intolerance or uncontrolled inflammation. Corticosteroid sparing effect, visual acuity, corticosteroid dose, and complication rates were evaluated. RESULTS Sixteen of 34 VKH patients included in this study underwent azathioprine therapy with systemic corticosteroid. Six patients received azathioprine in the acute uveitic phase and 10 patients in the chronic recurrent phase. A corticosteroid sparing effect was achieved in 86.5% of patients given azathioprine in the acute uveitic phase and 90.0% of patients given in the chronic recurrent phase. Median time to corticosteroid sparing effect was 3.5 months. Twelve of 16 patients showed improved activity in 1 month after initiation of azathioprine therapy. CONCLUSION Low-dose azathioprine therapy may be effective as corticosteroid sparing agent in VKH disease.
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Affiliation(s)
- Sang Jin Kim
- Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea
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Berker N, Ozdamar Y, Soykan E, Ozdal P, Ozkan SS. Vogt-Koyanagi-Harada syndrome in children: report of a case and review of the literature. Ocul Immunol Inflamm 2007; 15:351-7. [PMID: 17763135 DOI: 10.1080/09273940701459453] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This article reviews the therapeutic approaches in children with Vogt-Koyanagi-Harada (VKH) syndrome, and reports on a 9-year-old girl with progressive visual loss due to VKH syndrome in spite of treatment. In previous reports, corticosteroids were found to be the most effective agents in the treatment of VKH syndrome, while combination therapies with cyclosporine, methotrexate, or azathioprine were used with favorable results in refractory cases. In the current case, none of the treatments sufficiently stabilized the vision, but triple combination of corticosteroids, cyclosporine, and methotrexate suppressed the relapses of intraocular inflammation. Treatment of children with VKH syndrome is challenging. Various treatment modalities have been reported with various responses, but there is still no definite treatment regimen, and the treatment is usually individualized in pediatric VKH cases.
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Affiliation(s)
- Nilufer Berker
- Department of Retinal and Uveal Diseases, Ulucanlar Eye Research Hospital, Ankara, Turkey.
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Khairallah M, Zaouali S, Messaoud R, Chaabane S, Attia S, Ben Yahia S, Hmidi K. The spectrum of Vogt-Koyanagi-Harada disease in Tunisia, North Africa. Int Ophthalmol 2007; 27:125-30. [PMID: 17203358 DOI: 10.1007/s10792-006-9013-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Accepted: 11/02/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyze the clinical profile of Vogt-Koyanagi-Harada (VKH) disease in Tunisia, North Africa. METHODS We retrospectively reviewed the clinical records of 49 patients diagnosed with VKH disease at the Department of Ophthalmology of Fattouma Bourguiba University Hospital, Monastir, Tunisia, between January 1994 and September 2005. RESULTS Of all the uveitis cases diagnosed during the study period, VKH disease was the fourth most commonly occurring type (7.4%). Thirty-two patients (65.3%) were female, and 17 patients (34.7%) were male. The mean age at disease onset was 35 years (range: 16-54 years). The majority of patients (51%) had probable VKH disease, followed by incomplete type (47%); only 2% had the complete type. At presentation, 47 patients (96%) had bilateral ocular involvement. Clinical presentation was a panuveitis in 25 patients (51%) and a posterior uveitis in 24 patients (49%). Visual acuity (VA) at presentation ranged from less than 20/200 (40.8%) to more than 20/40 (28.5%). All patients were treated with systemic corticosteroids for 2-19 months (mean: 10.5 months). Four patients (8%) were treated with cyclosporin because of serious systemic side effects of corticosteroids. Complications included cataract in 18 eyes (33.9%), glaucoma in nine eyes (16.96%) and choroidal neovascularization in one eye (1%). Fifty-eight eyes (59%) had a final VA of 20/40 or better. Factors associated with a poor VA at the final follow-up were the presence of a poor VA at presentation (P = 0.02), the occurrence of complications (P = 0.001) and/or recurrences (P = 0.02). CONCLUSION In Tunisia, VKH disease is a common cause of uveitis that predominantly affects young women. The overwhelming majority (98%) have probable or incomplete VKH disease, presenting as panuveitis or posterior uveitis. More than 50% of patients undergoing treatment with corticosteroids will maintain a VA of 20/40 or better.
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Affiliation(s)
- Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia.
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Rao NA. Treatment of Vogt-Koyanagi-Harada disease by corticosteroids and immunosuppressive agents. Ocul Immunol Inflamm 2006; 14:71-2. [PMID: 16597535 DOI: 10.1080/09273940600674368] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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