Effect of the duration of immunomodulatory therapy on the clinical features of recurrent episodes in Vogt--Koyanagi--Harada disease.
OBJECTIVE
To evaluate the duration of immunomodulatory therapy (corticosteroids, immunosuppressive drugs) with regard to the rate of relapses and clinical features (exudative retinal detachment or anterior uveitis) in inflammatory episodes of Vogt--Koyanagi--Harada disease.


METHODS
Data of all 42 patients diagnosed with acute uveitis associated with VKH disease during the period of January 2005 to December 2008 at the Pitié-Salpêtrière Hospital or at the Lariboisière Hospital in Paris, France were extracted by chart review.


RESULTS
There were 31 patients (73.8%) with episodes of recurrence and were included in the study. At the first recurrence, 81% (13 patients) of exudative retinal detachments (ERD) were associated with an initial immunomodulatory treatment conducted ≤6 months (3.76 months ± 2.67). Conversely, an initial treatment duration of >6 months was associated with anterior uveitis signs for 66% of patients (eight patients) with anterior first recurrence (p = 0.0061). On second episode of recurrence, 75% of patients (three patients) who developed exudative retinal detachment had been managed by immunomodulatory therapy for ≤6 months with the total duration of immunomodulatory treatment ≤6 months during previous inflammatory episodes. Conversely, all 16 patients who presented anterior uveitis with additional manifestations (optic disc oedema, macular oedema, vitritis and/or 'Sunset glow' fundus) have been treated for more than 6 months or treated during the initial occurrence lasting more than 9 months (p = 0.0035).


CONCLUSIONS
The duration of systemic corticosteroids (and/or immunosuppressive drug therapy) for ≤6 months at first and second recurrence was associated with features of further exudative retinal detachment instead of anterior uveitis in VKH disease.
Department of Ophthalmology, APHP, Hôpital Pitié Salpêtrière, Paris, France. mariehelene.errera@free.fr
Marie-Hélène
MH
Errera
Christine
C
Fardeau
David
D
Cohen
Audrey
A
Navarro
Alain
A
Gaudric
Bahram
B
Bodaghi
Mark
M
Westcott
Phuc
P
LeHoang
D000284:Administration, Oral; D000328:Adult; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D012008:Recurrence; D012163:Retinal Detachment / Q000175:diagnosis*; D012189:Retrospective Studies; D013997:Time Factors; D014606:Uveitis, Anterior / Q000175:diagnosis*; D014607:Uveomeningoencephalitic Syndrome / Q000175:diagnosis* / Q000188:drug therapy*; D055815:Young Adult
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011239:Prednisolone