Título

DO TREATMENT INTERFERE IN THE COURSE OF VOGT-KOYANAGI-HARADA DISEASE (DVKH)?

Objetivo

To compare clinical and electroretinogram (ERG) outcomes in VKHD patients treated with different treatment protocols.

Método

23 patients with VKHD from acute onset were systematically followed during a minimum 24-mo follow-up as part of an ongoing study started on 2011. All patients were initially treated with 3-day 1g methylprednisolone pulsetherapy followed by 1mg/kg/d oral prednisone with slow tapering. Treatment were corticosteroid only (n=6, group 1), IMT before M4 (n=5, group 2), IMT between M4 and M7 (n=6, group 3) and IMT > M7 (n=6, group 4). IMT consisted of azathioprine (2mg/kg/d) or mofetil mycophenolate (2g/d). Clinical and posterior segment imaging inflammation on Spectralis HRA+OCT and full-field (ff) ERG on Retiport, Roland were systematically carried out. Variation ≥ 30% of scotopic ffERG parameters represented the worsening group. Descriptive statistics, Kruskal-Wallis, Likelihood ratio and Dunn’s multiple comparison tests were used to analyze data. This study was approved by the Institutional Ethics Committee.

Resultado

At disease onset, groups did not differ on clinical basis (Table). Nevertheless, group 3 had the worst visual acuity at M1 (p=0.593) and the highest pleocytosis (p=0.983) suggesting a more severe disease group from the onset. Further, all eyes from Group 3 had sunset glow fundus (p=0.044). Anterior chamber cells fluctuation was not observed in group 1 (p=0.052). Presence of other inflammatory signs did not differ between treatment groups. Nevertheless, dark dots (DD) scores were significantly lower in group 2 (p-0.022). During follow-up, 14 eyes (30.4%) were defined as ffERG worsening group and 32 eyes (69.6%) as stable group. FfERG worsening group had no correlation with inflammatory signs neither treatment schedule.

Conclusão

Earlier IMT did better control choroidal subclinical inflammation as observed by lowest DD score. Nevertheless, clinical inflammation control neither ffERG results differed between treatment different groups.