Adding immunomodulators to corticosteroids early can improve VKH syndrome outcomes
DEC 12, 2022
A South Korean study evaluated the potential advantage of adding immunomodulatory therapy to corticosteroid treatment for Vogt-Koyanagi-Harada (VKH) syndrome within 3 months of syndrome onset.
A retrospective observational case series assessed the clinical outcomes of patients with VKH syndrome who were seen between 2006 and 2021. Thirty-eight patients (73 eyes) received either a combination of systemic corticosteroids and early immunomodulatory therapy (IMT), started within 3 months of the onset of VKH syndrome, or conventional treatment with corticosteroids and either delayed IMT (>3 months of onset) or no IMT. Patients were examined for VKH syndrome resolution and recurrence.
Only 4 of the 41 patients in the conventional therapy group were treated with IMT agents, including cyclosporine and azathioprine. The 32 patients in the early IMT group were treated with azathioprine, cyclosporine, and methotrexate. At the last follow-up visit (mean 34–40 months), visual acuity was 20/29 and 20/23 in the conventional therapy and early IMT groups, respectively, a statistically significant difference. For both patient populations, the mean subfoveal choroidal thickness decreased from baseline at all timepoints. Uveitis was resolved in 34% of eyes treated with conventional therapy and 53% of eyes treated with early IMT; progression to chronic or chronic recurrent VKH was seen in 66% and 47% of eyes, respectively.
The limitations of this study include its retrospective nature, the small number of cases, the relatively short follow-up period, and the limited imaging methods used.
Results from this study show that early immunomodulator treatment of acute VKH syndrome was associated with improved long-term visual acuity compared with conventional treatment regimens.