Clinical outcomes in acute Vogt-Koyanagi-Harada patients during a 24-month follow-up
Accept poster if oral is not possible ?
Yes
Purpose
To retrospectively evaluate the clinical outcomes of VKHD patients (pt) followed for 24 months (mo) since acute disease onset based on timing of corticosteroid (CS) treatment, associated or not with immunosuppressive therapy (IMT).
Methods
All 35 acute VKHD pt (32F, median age 32 years) included were treated with 3 pulses of intravenous methylprednisolone (1000 mg/day) followed by oral prednisone (1mg/kg/day) with slow taper. CS within 30 days from disease onset defined the early group (n=24 pt): 9 pt with CS only (group 1) and 15 pt with oral IMT within 3 mo from diagnosis (group 2). Those pt with CS after 30 days defined the late group (group 3) (n=11 pt), all with late IMT. Anterior uveitis (AU) recurrence, multimodal image analysis (baseline, M1, M2, M4, M6, than every 3 mo), best-corrected visual acuity (BCVA) and full-field electroretinogram parameters were analyzed.
Results
Median BCVA was logMAR 0 (0-0.4) (p=0.674) at M24, with similar inflammation control (cells in anterior chamber, p=0.542; serous retinal detachment, p=0.741) among the groups. But, group 3 had higher fluorescein angiography total score (p=0.012), more BCVA fluctuation episodes (p=0.004), more AU recurrence (p=0.018) and more sunset glow fundus (p=0.042), fibrosis (p=0.02) and peripapillary atrophy (p=0.003). Groups 1 and 2 had comparable response to therapy in acute disease and also during the 24-mo follow-up. However, group 2 reached prednisone < 10mg/day earlier (p=0.043) and had a lower total prednisone cumulative dose (p=0.015).
Conclusion
Late CS group had worse outcomes emphasizing the importance of early high-dose CS. Association of early IMT had a significant CS sparing effect but comparable response to therapy
Conflict of interest
No
1
Last name
SILVEIRA SOUTO
Initials of first name(s)
FM
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
Sao Paulo
Country
Brazil
2
Last name
LAVEZZO
Initials of first name(s)
M M
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
Sao Paulo
Country
Brazil
3
Last name
BRITO GONCALVES MISSAKA
Initials of first name(s)
R F
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
Sao Paulo
Country
Brazil
4
Last name
CAMPOS DA NOBREGA
Initials of first name(s)
P F
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
Sao Paulo
Country
Brazil
5
Last name
GUSMÃO
Initials of first name(s)
C C
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
Sao Paulo
Country
Brazil
6
Last name
SAKATA
Initials of first name(s)
V M
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
Sao Paulo
Country
Brazil
7
Last name
CUNNINGHAM JR
Initials of first name(s)
E T
Department
West Coast Medical Group, California Pacifical Medical Center, Stanford University, UCSF
City
San Francisco
Country
United States
8
Last name
OYAMADA
Initials of first name(s)
M K
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
Sao Paulo
Country
Brazil
9
Last name
HIRATA
Initials of first name(s)
C E
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
Sao Paulo
Country
Brazil
10
Last name
YAMAMOTO
Initials of first name(s)
J H
Department
Department of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina, LIM 33
City
Sao Paulo
Country
Brazil
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