{
  "abstract": "Background\n\nTo evaluate structural and functional outcomes in patients with acute Vogt-Koyanagi-Harada (VKH) disease, based on the timing of systemic corticosteroid (CS) initiation and the early introduction of noncorticosteroid immunomodulatory therapy (IMT).Methods\n\nThis retrospective single-centre study included 35 consecutive patients (70 eyes) diagnosed with acute Vogt-Koyanagi-Harada disease at a tertiary center in São Paulo, Brazil. Patients received methylprednisolone pulse therapy (1,000 mg/day, 3 days) followed by gradually tapered oral prednisone (1 mg/kg/day). Patients were classified by the timing of CS initiation. The early treatment group (ETG, n = 24) initiated CS within 30 days of onset and comprised two subgroups: CS monotherapy (Group 1, n = 9) and CS plus IMT within 3 months (Group 2, n = 15). Those treated after 30 days because of late presentation formed the late treatment group (LTG, Group 3, n = 11). Follow-up was 24 months with multimodal imaging and full-field electroretinography.Results\n\nAt 24 months, 98.6% of the eyes achieved BCVA ≤ 0.3 logMAR (Snellen 20/40), with no significant differences among the groups. Compared with Groups 1 and 3, Group 2 achieved a prednisone dose of ≤ 10 mg sooner (7.3 ± 1.8 months; p = 0.043) and had a significantly lower cumulative dose (8,719 ± 3,067 mg; p = 0.02). BCVA worsening episodes occurred less frequently in Group 2 than in Group 3 (6.7% vs. 59.1%; p < 0.001). Compared with the ETG, the LTG presented higher rates of BCVA worsening episodes (59.1% vs. 16.7%; p = 0.004), anterior uveitis recurrences (45.5% vs. 8.3%; p = 0.02), subretinal fibrosis (45.5% vs. 8.3%; p = 0.02), and peripapillary atrophy (72.7% vs. 22.9%; p = 0.003). Adverse events occurred in 7 patients (20%): 6 related to azathioprine and 1 related to CS therapy.Conclusions\n\nEarly initiation of high-dose CS in VKH disease patients was associated with fewer relapses and structural complications. Early IMT introduction provided a CS-sparing effect, although it did not significantly improve visual or structural outcomes. Prompt CS initiation remains critical; further studies should identify patients who may benefit most from early IMT.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Ophthalmology and Laboratory of Investigation in Ophthalmology (LIM 33), Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, St. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP, 05403-000, Brazil.",
    "Department of Ophthalmology and Laboratory of Investigation in Ophthalmology (LIM 33), Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, St. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP, 05403-000, Brazil. camillogusmao@gmail.com.",
    "West Coast Medical Group, San Francisco, CA, USA.",
    "Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA.",
    "Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA.",
    "The Francis I Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
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        0
      ],
      "name": "Marcelo Mendes Lavezzo"
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    {
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        1
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      "name": "Camillo Carneiro Gusmão",
      "orcid": "0009-0003-8350-4537"
    },
    {
      "affs": [
        0
      ],
      "name": "Viviane Mayumi Sakata"
    },
    {
      "affs": [
        0
      ],
      "name": "Fernanda Maria S Souto"
    },
    {
      "affs": [
        0
      ],
      "name": "Ruy Felippe B G Missaka"
    },
    {
      "affs": [
        0
      ],
      "name": "Priscilla Figueiredo C da Nóbrega"
    },
    {
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        2,
        3,
        4,
        5
      ],
      "name": "Emmett T Cunninghan"
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    {
      "affs": [
        0
      ],
      "name": "Maria Kiyoko Oyamada"
    },
    {
      "affs": [
        0
      ],
      "name": "Carlos Eduardo Hirata"
    },
    {
      "affs": [
        0
      ],
      "name": "Joyce Hisae Yamamoto"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/742hjb38cayv8.bib",
  "cited_by": 0,
  "doi": "10.1186/s40942-026-00898-z",
  "fulltext_url": "https://europepmc.org/articles/PMC13726063",
  "id": "742hjb38cayv8",
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    "2056-9920"
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  "landing_url": "https://europepmc.org/article/MED/42968144",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
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  "metadata_licence": null,
  "native_subjects": [
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  "pdf_url": "https://europepmc.org/articles/PMC13726063?pdf=render",
  "pmcid": "PMC13726063",
  "pmid": "42968144",
  "published": "2026-08-01",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/742hjb38cayv8.ris",
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      "field": "medicine",
      "origin": "journal-openalex:2741|Retinal and Macular Surgery",
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  "title": "Outcomes of early treatment in acute Vogt-Koyanagi-Harada disease: a 24-month retrospective analysis.",
  "title_text": "Outcomes of early treatment in acute Vogt-Koyanagi-Harada disease: a 24-month retrospective analysis.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T14:20:58Z",
  "url": "https://research.draconitic.com/paper/742hjb38cayv8",
  "venue": "International journal of retina and vitreous",
  "versions": []
}