Correlation between peripapillary atrophy and corticosteroid therapy in patients with Vogt-Koyanagi-Harada disease.
OBJECTIVE
To determine the correlation between systemic corticosteroid therapy and the occurrence and size of peripapillary atrophy (PPA) in patients with Vogt-Koyanagi-Harada (VKH) disease.


METHODS
All patients with VKH disease were retrospectively reviewed for their corticosteroid regimen. The extent of the PPA, if present, was measured using digitized imaging software, by two masked observers. Eyes with myopia greater than 6 dioptres or glaucoma were excluded. The patients were classified into three groups: early high (EH), late high (LH), and low dose (LD), according to the dose and timing of corticosteroids received during the acute phase of the disease.


RESULTS
There were 40 eyes in the EH group, 25 eyes in the LH group, and 23 eyes in the LD group. Multivariate analysis showed that corticosteroid therapy was the main determinant of PPA occurrence. All the eyes in the LD group had PPA and eyes in the LH groups were 4.02 times (95% confidence interval 1.24-13.07) more likely to develop PPA than those in the EH group. The LD group also had larger PPA to disc ratios than the EH group. (Mean of 2.83 vs0.19, P<0.001).


CONCLUSIONS
The development and extent of PPA in patients with VKH disease appear to be dependent on the dose and timing of systemic corticosteroids.
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Singapore National Eye Centre, Singapore, Singapore.
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D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009896:Optic Atrophy / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D011239:Prednisolone / Q000008:administration & dosage* / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D014607:Uveomeningoencephalitic Syndrome / Q000150:complications / Q000188:drug therapy* / Q000473:pathology
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D011239:Prednisolone