Título

VOGT-KOYANAGI-HARADA DISEASE (VKHD) AFTER SYSTEMIC TREATMENT DISCONTINUATION (STD)

Objetivo

To describe the clinical course of VKHD after STD

Método

Retrospective study with 11 patients (22 eyes) with VKHD after STD for at least 12mo. All patients were followed from acute disease onset with systematic clinical and imaging evaluation (indocyanine green and fluorescein angiographies and enhanced depth imaging optical coherence tomography (Spectralis HRA+OCT)). They were initially treated with methylprednisolone pulsetherapy followed by oral prednisone (1mg/kg/day) with slow tapering. Presence/fluctuation of clinical (anterior chamber cells (ACC)) and subclinical signs of inflammation (optic disc (OD) or perivascular leakage, dark dots (DD), subfoveal choroidal thickness increase ≥ 30%) and ocular complications were analyzed during treatment period (TP), period after treatment discontinuation (PTD) and at the last visit of each period. Criteria used for STD were: no clinical and stable subclinical signs of inflammation and stable full-field electroretinogram (ffERG) parameters for at least 12mo. Descriptive statistics and generalized estimated equations were used. This study was approved by Institutional Ethics Committee and followed the Helsinki declaration

Resultado

Mean disease duration at TP and PTD was 37.6±15.8mo (12-59mo) and 33.6±21.3mo (12-87mo), respectively. At the last TP visit, visual acuity was 0.1±0.2logMAR; no eyes had ACC; DD were present in all eyes (mean score 5.3±0.9), while OD leakage was observed in 2 eyes (1 patient). During PTD, 1 patient (2 eyes) had ACC, but none had systemic treatment restarted. All evaluated parameters (events/year and at last visit) improved in PTD, with statistical significance for DD score fluctuation (p=0.004). ffERG results remained stable on PTD

Conclusão

Criteria used for STD in VKHD seem adequate in this pioneering analysis. Subclinical inflammation tends to ameliorate during PTD. Further studies are needed to better understand clinical and subclinical inflammation after STD and to detect risk factors for late recurrence.