Studies on Corticosteroid Therapy in Vogt-Koyanagi-Harada Disease

Abstract

We evaluated the significance of corticosteroid therapy on 47 new patients with Vogt-Koyanagi-Harada disease examined in the Uveitis Survey Clinic of the Hokkaido University Hospital. All patients were treated with topical corticosteroids, with or without systemic corticosteroids. 18 patients received systemic corticosteroid as pulse therapy, 20 patients received high-dose corticosteroid starting with prednisolone 200 mg, 2 patients received conventional-dose corticosteroid and 7 patients received no systemic corticosteroid therapy. When we evaluated the results 6 months after the initiation of treatment, anterior chamber inflammation was significantly less in patients with pulse and high-dose corticosteroid therapy than in those without systemic corticosteroid therapy. Furthermore, final visual acuity was significantly better in patients with pulse and high-dose corticosteroid than in those without them. However, there was no significant difference between patients with pulse therapy and those with high-dose corticosteroid therapy. The findings are in support of systemic corticosteroid therapy (pulse and high-dose) in the treatment of Vogt-Koyanagi-Harada disease.

Effects of the duration of initial oral corticosteroid treatment on the recurrence of inflammation in Vogt-Koyanagi-Harada disease

“…3,6 In cases with severe ocular inflammation associated with acute VKH, intravenous pulse steroid therapy has also been advocated. 5,12 A recent study by Read et al, 7 however, showed no detectable difference in the visual outcome and complications in the route of corticosteroid administration, and therefore we preferred to use oral corticosteroid for the patients as they do not require hospitalization. The therapeutic effect of systemic corticosteroid lies mainly on its anti-inflammatory and immunosuppressant properties.…”

“…2,3 During the acute stage of VKH, treatment usually requires aggressive systemic corticosteroid therapy to prevent irreversible damage causing visual loss. [5][6][7] However, recurrence of inflammation is not uncommon after cessation of corticosteroid therapy, especially when the steroid is tapered too rapidly. 6 Therefore, in acute VKH, it has been recommended to maintain high dose oral corticosteroid therapy and taper it gradually over at least 3-6 months.…”

Differentiating Vogt-Koyanagi-Harada syndrome from recurrent optic neuritis: a case report and review of the literature concerning Hispanic patients

“…On the other hand, neurological signs and dysacousia are quite common (74-76%) among Japanese patients [23,28], while intertegumentary signs are more often seen in Chinese patients (39-41%) [29]. When looking at ocular manifestations, studies conducted on South American patients are concordant in rating a optic disc swelling occurrence significantly lower than in Asian patients (8,6% -9% versus 50-73%, respectively) [26][27][28][29][30] Giordano et al) [26,30]. Response to therapy and complication rates are reported to be similar among ethnic groups [26].…”

Vogt—Koyanagi—Harada syndrome (clinical cases)

“…Лечение синдрома Фогта-Коянаги-Харада ба-зируется на системном, агрессивном применении кортикостероидов и иммуносупрессоров (цитоста-тики) [7,10,11].…”

“…Локальное применение кортикостероидов (дек-саметазон) оказывает не только противовоспали-тельное, но и иммуносупрессивное действие [10,12], поэтому такая схема не должна использоваться в лечении аутоиммунных воспалительных процес-сов с развитием панувеита. Прямыми показаниями к системному применению кортикостероидов слу-жат поражения органа зрения и увеаретинального тракта, запущенные или осложненные случаи за-дних увеитов или панувеитов.…”