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Outcomes of patients with acute Vogt–Koyanagi–Harada disease treated with intravenous corticosteroid pulse followed by the slow tapering of oral corticosteroid therapy

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Abstract

Purpose

To elucidate the intravenous corticosteroid pulse treatment outcomes of patients with acute Vogt–Koyanagi–Harada (VKH) disease and assess the differences between patients with no inflammation worsening and those with persistent or worsening inflammation. Potential factors responsible for eyes with low visual outcomes were also investigated.

Methods

We retrospectively reviewed the clinical records of patients with acute VKH disease who first visited us between 2009 and 2018 and were followed up for > 300 days. Clinical characteristics, treatments, and posttreatment conditions were assessed. Patients were classified into no inflammation worsening (acute–resolved [AR]) and inflammation worsening (chronic–recurrent [CR]) groups based on conditions after 6 months from disease onset.

Results

This study included 60 eyes from 30 patients (mean age: 52.7 years). Patients were treated with methylprednisolone pulse followed by the slow tapering of oral prednisolone; 73% of patients developed AR and 27% CR, and the best-corrected visual acuity (BCVA) was ≥ 1.0 in 83% of eyes at 6 months following the introduction of treatment. Although the total prednisolone dose was higher in patients with CR disease, no significant difference was noted in the final BCVA. Among the patients, five eyes had a final BCVA of ≤ 0.5 due to anisometropic amblyopia, diabetic maculopathy, pre-existing macular hole, epiretinal membrane, and ellipsoid zone loss.

Conclusions

Patients with acute VKH disease treated with corticosteroid pulse appear to demonstrate good visual outcomes, including patients with CR; the majority of eyes with low visual outcomes have pre-existing conditions that explain the low vision.

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Acknowledgements

The authors express their sincere gratitude toward Dr. Yasuo Yanagi and Akitoshi Yoshida for providing valuable advice on data analysis. The authors would like to thank Enago (www.enago.jp) for the English language review.

Funding

The authors declare that no funds, grants, or other support were received related to the work.

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Authors and Affiliations

  1. Department of Ophthalmology, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510, Japan

    Rui Fushitsu, Masataka Murono & Reiko Kinouchi

  2. Japanese Red Cross Kitami Hospital, Hokkaido, Japan

    Akihiro Ishibazawa

  3. Medicine and Engineering Combined Institute, Asahikawa Medical University, Hokkaido, Japan

    Reiko Kinouchi

Authors
  1. Rui Fushitsu
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  2. Akihiro Ishibazawa
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  3. Masataka Murono
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Contributions

Managed the patients: RK, AI, and M.M.; Conceptualization and Methodology: RK; Data collection: all authors; Formal analysis and investigation: RF and RK; Writing—original draft preparation: RF and RK; Writing—review and editing: All authors; Supervision: RK All authors read and approved the final manuscript.

Corresponding author

Correspondence to Reiko Kinouchi.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the institutional review board of Asahikawa Medical University (approval number: 18257).

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The requirement to obtain informed consent was waived by the institutional review board of Asahikawa Medical University.

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Fushitsu, R., Ishibazawa, A., Murono, M. et al. Outcomes of patients with acute Vogt–Koyanagi–Harada disease treated with intravenous corticosteroid pulse followed by the slow tapering of oral corticosteroid therapy. Int Ophthalmol 43, 431–440 (2023). https://doi.org/10.1007/s10792-022-02440-0

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