title: Reappraisal of the management of Vogt-Koyanagi-Harada disease: sunset glow fundus is no more a fatality.
abstract: OBJECTIVE
  Vogt-Koyanagi-Harada (VKH) disease is a primary autoimmune stromal choroiditis. Aim of the study was to gather a body of evidence from the literature and from experts that systemic corticosteroid combined with non-steroidal immunosuppressive therapy should become the standard of care in initial-onset VKH disease.
  
  
  METHODS
  Literature was reviewed and leading experts in VKH were consulted in different parts of the world in order to put forward a consensus attitude in the management of initial-onset VKH disease.
  
  
  RESULTS
  There was a substantial body of evidence in the literature that early aggressive and sustained corticosteroid and non-steroidal immunosuppressive therapy in initial-onset VKH disease allows to achieve full control of choroidal inflammation, eliminating any subclinical choroidal inflammation, and substantially reduces recurrences with improvement of anatomical and functional outcomes. This was in agreement with experts' opinion and practice. ICGA was the method of choice to monitor disease evolution.
  
  
  CONCLUSIONS
  Since the choroidal space is easily accessible to systemic therapy and because inflammation in VKH disease is exclusively originating from the choroidal stroma, early and sustained treatment right at the onset of the disease process with dual corticosteroid and non-steroidal immunosuppressive therapy can result in full "healing" in many cases preventing sunset glow fundus which results from depigmentation from chronic uncontrolled inflammation.
authors.affiliation: Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Rue Charles-Monnard 6, 1003, Lausanne, Switzerland. cph@herbortuveitis.ch.|Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland. cph@herbortuveitis.ch.
authors.forename: Carl P
authors.initials: CP
authors.lastname: Herbort
authors.affiliation: Department of Ophthalmology, Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia. abuasrar@ksu.edu.sa.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Abu El Asrar
authors.affiliation: Department of Ophthalmology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Joyce H
authors.initials: JH
authors.lastname: Yamamoto
authors.affiliation: National Institute for Health Research, Biomedical Research Centre at Moorfields Eye Hospital, NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Pavésio
authors.affiliation: Department of Ophthalmology, Post-graduate Institute, Chandigarh, India.
authors.forename: Vishali
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of Ophthalmology, Fattouma Bourghiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia.
authors.forename: Moncef
authors.initials: M
authors.lastname: Khairallah
authors.affiliation: Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Ilknur
authors.initials: I
authors.lastname: Tugal-Tutkun
authors.affiliation: Department of Ophthalmology and Ophthalmic Research Centre, Labbafinejad Medical Centre, Shahid Beheshti Medical University, Teheran, Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Soheilian
authors.affiliation: Department of Ophthalmology, National Defence Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Masuru
authors.initials: M
authors.lastname: Takeuchi
authors.affiliation: Department of Ophthalmology, Ospedale Padre Antero Micone, Genoa, Italy.
authors.forename: Marina
authors.identifier: http://orcid.org/0000-0003-2070-5369
authors.initials: M
authors.lastname: Papadia
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005654:Fundus Oculi; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D012164:Retinal Diseases / Q000517:prevention & control; D014607:Uveomeningoencephalitic Syndrome / Q000188:drug therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents
keywords: Granulomatous uveitis; Immunosuppressive therapy; Indocyanine green angiography; Stromal choroiditis, autoimmune disease; Vogt–Koyanagi–Harada disease