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Abstract
Purpose
To evaluate the clinical features of recurrent Vogt-Koyanagi-Harada syndrome during steroid tapering after high-dose intravenous steroid therapy.
Methods
We retrospectively reviewed the medical records of eight patients who were diagnosed and treated for Vogt-Koyanagi-Harada syndrome from January 2010 to December 2017. Recurrence was defined as the occurrence of uveitis or serous retinal detachment during oral steroid tapering. We grouped the patients into two groups according to recurrence, and compared the best-corrected visual acuity, maximum height of subretinal fluid, central subfield thickness, choroidal thickness, average steroid tapering period and images from optical coherence tomography.
Results
Seventeen patients were included and five patients (29.4%) recurred during oral steroid tapering. Patients with recurrent episodes were treated with increasing doses of oral steroid and/or oral immunosuppressant and sub-tenon injection of triamcinolone. Serous retinal detachment was completely absorbed after 24 weeks of treatment in all 17 patients, including the recurrence group and the best-corrected visual acuity was not significantly different between the two groups. The heights of the subretinal fluid and thicknesses of the central subfield before treatment were significantly higher in the recurrence group than in the non-recurrence group.
Conclusions
Serous retinal detachment can recur during oral steroid tapering after high-dose intravenous steroid treatment in patients with Vogt-Koyanagi-Harada syndrome suggesting that the height of the subretinal fluid at the fovea and central subfield thickness before treatment are factors associated with recurrence. Even in the case of recurrence, good visual prognosis can be expected after additional treatment according to the clinical situation.
Figures and Tables
Figure 1
Optical coherence tomography images at baseline and Subretinal fluid height obtained from recurrent group. (A) Right eye of case 1. (B, C) Right and left eyes of case 2. (D, E) Right and left eyes of case 4. (F) Left eye of case 5. (G, H) Right and left eyes of case 9.
Figure 2
Optical coherence tomography (OCT) serial images obtained from case 1 of recurrent group. Left column (A–D) was OCT images of right eye, right column (E–H) was OCT images of left eye. (A, E) Serous retinal fluid (SRF) and choroidal thickening was observed at pretreatment state in both eyes. (B, F) SRF was subsided and choroidal thickness was decreased after high-dose intravenous steroid treatment. (C, G) SRF was recurred at perifoveal area during oral steroid tapering in right eye. The patient was treated with increased dose of oral steroid, oral immunosuppressant, and sub-tenon injection of triamcinolone. (D, H) SRF was completely absorbed after 24 weeks of steroid treatment.
Figure 3
Optical coherence tomography (OCT) serial images obtained from case 8 of non-recurrent group. Left column (A–C) was OCT images of right eye, right column (E, F) was OCT images of left eye. (A, D) Serous retinal fluid (SRF) and choroidal thickening was observed at pretreatment state in both eyes. (B, E) SRF was subsided and choroidal thickness was decreased after high-dose intravenous steroid treatment. (C, F) OCT images after 24 weeks of high-dose intravenous steroid treatment. There was no recurrence during oral steroid tapering in both eye.
Table 1
Characteristics of 17 patients
‘Tapering Period’ means Duration of oral steroid tapering, ‘Initial Dose’ means Initial Oral steroid dose.
F/U = follow up period; BCVA = best corrected visual acuity; logMAR = logarithm of the minimal angle of resolution; AC = anterior chamber; OD = oculus dexter; OS = oculus sinister; SRF = serous retinal fluid; CSMT = central subfield macular thickness; Sx to Tx = symptom to treatment; Tx to Improve = duration until improvement after treatment; Recur = recurrence during oral steroid tapering; Tx to Recur = duration from treatment start to recurrence; STTA = sub-tenon triamcinolone injection; F = female; M = male; OU = oculus unitas; Tr = trace.
*Monocular patient.
Table 2
Characteristics in each group
Values are presented as mean ± standard deviation (median, range) unless otherwise indicated. ‘Group A’ means recurrence group during oral steroid tapering, ‘Group B’ means no recurrence group.
M/F = male/female; BCVA = best corrected visual acuity; logMAR = logarithm of the minimal angle of resolution; SRF = subretinal fluid; Sx to Tx = symptom to treatment; PD = prednisolone; IV = intravenous.
*The significance of the difference was assessed by the Mann-Whitney U test; †The significance of the difference was assessed by the Fisher's exact test.
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