VKH outcomes with pulse IV steroids
Reviewed by Jonathan Chan

This is a retrospective review of clinical case notes records of 111 Vogt-Koyanagi-Harada (VKH) patients between 1999 and 2015 from a single centre in Tokyo, Japan. The mean age at presentation was 41 years and the median follow-up period was 36 months. Sixteen had complete, 90 had incomplete and five had probable VKH disease. Exudative retinal detachment (202 eyes) and optic disc hyperaemia (89 eyes) were noted at presentation. Forty-five of 48 patients were test positive for the human leucocyte antigen DR4, and 63/77 had cerebrospinal fluid pleocytosis. All patients had initial pulse intravenous corticosteroid therapy (a single pulse of 1000mg/day for three consecutive days) followed by oral steroid at a dose of 0.8–1.0 mg/kg/day. Anterior and / or posterior uveitis was seen in 25 patients (22.5%). Seventeen patients (15.3%) was changed to Cyclosporin (CSA), for steroid sparing (six patients), or for recurrent uveitis (11 patients), with good control of ocular complications. Ocular complications were observed in 47 eyes (21.2%); mostly cataracts; 8.1% had developed systemic complications, (mostly hypertension and diabetes); 93% of eyes (167/178 eyes) achieved a visual acuity of > or = to 1.0 at one year after presentation. The authors concluded that with an aggressive steroid treatment regime with new-onset acute VKH disease, with transitioning of selective patients to CSA, good visual outcomes and low recurrence rates are achievable.

Clinical features and visual outcomes of 111 patients with new-onset acute vogt-koyanagi-harada (VKH) disease treated with pulse intravenous corticosteroids.
Nakayama M, Keino H, Watanabe T, Okada AA.
BRITISH JOURNAL OF OPHTHALMOLOGY
2019;103:274-8.