Therapeutic window of opportunity in the acute uveitic phase of Vogt-Koyanagi- Harada disease: prevention of late autoimmune complications by early intervention
Purpose
To determine the relationship between the timing of treatment initiation and disease outcomes and whether a therapeutic window of opportunity exists in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada (VKH) disease.
Methods
Retrospective analysis of 112 patients (224 eyes). Main outcome measures were final visual acuity, progression to chronic recurrent evolution, development of complications, particularly “sunset glow fundus”, and drug-free remission cure of uveitis.
Results
Forty-six patients (92 eyes) presented in the phase preceding anterior segment (AS) inflammation (early presentation) and 66 patients (132 eyes) had AS inflammation at presentation (late presentation). In significantly more eyes in the early presentation group (85.9%), final visual acuity of 20/20 was achieved compared with those in the late presentation group (66.7%) (p=0.001). None of the eyes in the early presentation group progressed to chronic recurrent evolution and none developed “sunset glow fundus”, whereas in the late presentation group, 28.8% of the eyes progressed to chronic recurrent evolution (p<0.001) and 56.1% developed “sunset glow fundus” (p<0.001). Patients in the early presentation group were able to discontinue treatment without relapse of inflammation at significantly shorter time intervals compared to patients in the delayed presentation group (p<0.001).
Conclusion
Our findings suggest that the window of opportunity lies in the phase preceding anterior segment inflammation and initiation of effective treatment during this phase results in the cure of uveitis and prevents blinding complications.
Conflict of interest
No
Authors 1
Last name
ABU EL-ASRAR
Initials of first name(s)
A
Department
Ophthalmology
City
Riyadh
Country
Saudi Arabia
Authors 2
Last name
Al Rashed
Initials of first name(s)
F
Department
Ophthalmology
City
Riyadh
Country
Saudi Arabia
Authors 3
Last name
Al Bloushi
Initials of first name(s)
A
Department
Ophthalmology
City
Riyadh
Country
Saudi Arabia
Authors 4
Last name
Tobaigy
Initials of first name(s)
M
Department
Ophthalmology
City
Riyadh
Country
Saudi Arabia
Authors 5
Last name
Gikandi
Initials of first name(s)
P
Department
Ophthalmology
City
Riyadh
Country
Saudi Arabia
Authors 6
Last name
Herbort
Initials of first name(s)
C
Department
Ophthalmology
City
Lausanne
Country
Switzerland
Authors 7
Last name
Opdenakker
Initials of first name(s)
G
Department
Microbiology and Immunology and Transplantation
City
Leuven
Country
Belgium
This website uses cookies to ensure you get the best experience on our website.
Learn more