title: Suboptimal therapy controls clinically apparent disease but not subclinical progression of Vogt-Koyanagi-Harada disease.
abstract: OBJECTIVE
  To evaluate clinical and angiographic differences in patients with Vogt-Koyanagi-Harada (VKH) disease during the early 4-month treatment phase with high- or medium-dose systemic corticosteroid therapy.
  
  
  METHODS
  VKH patients treated at the Centre for Ophthalmic Specialized Care, Lausanne, Switzerland (n = 4), or the Department of Ophthalmology, Tokyo Medical and Dental University, Tokyo, Japan (n = 5), underwent a pre-treatment indocyanine green angiography (ICGA) and a follow-up ICGA four months after treatment began. Lausanne patients received high-dose, systemic corticosteroid therapy, with or without immunosuppressive therapy. Tokyo patients received medium-dose systemic corticosteroid therapy that included 3 days of intravenous pulse methylprednisolone. ICGA signs including choroidal stromal vessel hyperfluorescence and leakage, hypofluorescent dark dots (HDD), fuzzy vascular pattern of large stromal vessels and disc hyperfluorescence were retrospectively compared.
  
  
  RESULTS
  The pre-treatment ICGA demonstrated that each of the nine patients had choroidal inflammatory foci, as indicated by HDD. At 4-month follow-up, clinical and fluorescein findings had improved almost equally in both groups. HDD had resolved in the Lausanne group but persisted in the Tokyo group. Sunset glow fundus occurred in three of the Tokyo patients and none of the Lausanne patients.
  
  
  CONCLUSIONS
  Submaximal doses of inflammation suppressive therapy are sufficient to suppress clinically apparent disease but not the underlying lesion process. This explains the propensity for sunset glow fundus in seemingly controlled disease.
authors.affiliation: Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Shintaro
authors.initials: S
authors.lastname: Horie
authors.forename: Nadia
authors.initials: N
authors.lastname: Bouchenaki
authors.forename: Kyoko
authors.initials: K
authors.lastname: Ohno-Matsui
authors.forename: Manabu
authors.initials: M
authors.lastname: Mochizuki
authors.forename: Carl P
authors.initials: CP
authors.lastname: Herbort
mesh_terms: D000208:Acute Disease / Q000628:therapy; D000284:Administration, Oral; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D002829:Choroid / Q000187:drug effects / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D007208:Indocyanine Green; D007262:Infusions, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage*; D013557:Switzerland; D013997:Time Factors; D014041:Tokyo; D016896:Treatment Outcome; D014607:Uveomeningoencephalitic Syndrome / Q000188:drug therapy / Q000473:pathology
chemical_list: D000893:Anti-Inflammatory Agents; D007208:Indocyanine Green; D011241:Prednisone; D008775:Methylprednisolone