Outcomes of early treatment in acute Vogt-Koyanagi-Harada disease: a 24-month retrospective analysis.
6 affiliations
- 1Department 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.
- 2Department 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. [email protected].
- 3West Coast Medical Group, San Francisco, CA, USA.
- 4Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA.
- 5Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA.
- 6The Francis I Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA.
Abstract
Background
To 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
This 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
At 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
Early 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.
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BibTeX
@article{lavezzo2026outcomes,
title = {{Outcomes of early treatment in acute Vogt-Koyanagi-Harada disease: a 24-month retrospective analysis.}},
author = {Marcelo Mendes Lavezzo and Camillo Carneiro Gusmão and Viviane Mayumi Sakata and Fernanda Maria S Souto and Ruy Felippe B G Missaka and Priscilla Figueiredo C da Nóbrega and Emmett T Cunninghan and Maria Kiyoko Oyamada and Carlos Eduardo Hirata and Joyce Hisae Yamamoto},
journal = {International journal of retina and vitreous},
year = {2026},
month = aug,
doi = {10.1186/s40942-026-00898-z},
url = {https://europepmc.org/article/MED/42968144},
note = {CC BY},
}
RIS
TY - JOUR
TI - Outcomes of early treatment in acute Vogt-Koyanagi-Harada disease: a 24-month retrospective analysis.
AU - Marcelo Mendes Lavezzo
AU - Camillo Carneiro Gusmão
AU - Viviane Mayumi Sakata
AU - Fernanda Maria S Souto
AU - Ruy Felippe B G Missaka
AU - Priscilla Figueiredo C da Nóbrega
AU - Emmett T Cunninghan
AU - Maria Kiyoko Oyamada
AU - Carlos Eduardo Hirata
AU - Joyce Hisae Yamamoto
PY - 2026
DA - 2026/08/01
JO - International journal of retina and vitreous
DO - 10.1186/s40942-026-00898-z
UR - https://europepmc.org/article/MED/42968144
AB - Background To 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 This 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 At 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 Early 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.
SN - 2056-9920
ER -