Carl P Herbort1,2, Ahmed M Abu El Asrar3, Masuru Takeuchi4, Carlos E Pavésio5, Cristobal Couto6, Alireza Hedayatfar7, Kazuichi Maruyama8, Xi Rao9, Sukhum Silpa-Archa10, Thanapong Somkijrungroj11. 1. Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Rue Charles-Monnard 6, 1003, Lausanne, Switzerland. cph@herbortuveitis.ch. 2. Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland. cph@herbortuveitis.ch. 3. Department of Ophthalmology and Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia. abuelasrar@yahoo.com. 4. Department of Ophthalmology, National Defence Medical College, Tokorozawa, Saitama, Japan. 5. National Institute for Health Research, Biomedical Research Centre at Moorfields Eye Hospital, NHS Foundation Trust and UCL, Institute of Ophthalmology, London, UK. 6. Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina. 7. Noor Eye Hospital and Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. 8. Department of Innovative Visual Science, Graduate School of Medicine, Osaka University, Osaka, Japan. 9. Department of Ophthalmology, General Police Hospital, University of Chile, Santiago, Chile. 10. Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand. 11. Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Abstract
PURPOSE: Vogt-Koyanagi-Harada (VKH) disease is a primary autoimmune granulomatous choroiditis that begins in the choroidal stroma. The aim of this review was to gather a body of evidence for the concept of a window of therapeutic opportunity, defined as a time interval following initial-onset disease during which adequate treatment will substantially modify the disease outcome and possibly even lead to cure, similar to what has been described for rheumatoid arthritis. METHODS: We reviewed the literature and consulted leading experts in VKH disease to determine the consensus for the notion of a therapeutic window of opportunity in VKH disease. RESULTS: We found a substantial body of evidence in the literature that a therapeutic window of opportunity exists for initial-onset acute uveitis associated with VKH disease. The disease outcome can be substantially improved if dual systemic steroidal and non-steroidal immunosuppressants are given within 2-3 weeks of the onset of initial VKH disease, avoiding evolution to chronic disease and development of "sunset glow fundus." Several studies additionally report series in which the disease could be cured, using such an approach. CONCLUSIONS: There is substantial evidence for a therapeutic window of opportunity in initial-onset acute VKH disease. Timely and adequate treatment led to substantial improvement of disease outcome and prevented chronic evolution and "sunset glow fundus," and very early treatment led to the cure after discontinuation of therapy in several series, likely due to the fact that the choroid is the sole origin of inflammation in VKH disease.
PURPOSE: Vogt-Koyanagi-Harada (VKH) disease is a primary autoimmune granulomatous choroiditis that begins in the choroidal stroma. The aim of this review was to gather a body of evidence for the concept of a window of therapeutic opportunity, defined as a time interval following initial-onset disease during which adequate treatment will substantially modify the disease outcome and possibly even lead to cure, similar to what has been described for rheumatoid arthritis. METHODS: We reviewed the literature and consulted leading experts in VKH disease to determine the consensus for the notion of a therapeutic window of opportunity in VKH disease. RESULTS: We found a substantial body of evidence in the literature that a therapeutic window of opportunity exists for initial-onset acute uveitis associated with VKH disease. The disease outcome can be substantially improved if dual systemic steroidal and non-steroidal immunosuppressants are given within 2-3 weeks of the onset of initial VKH disease, avoiding evolution to chronic disease and development of "sunset glow fundus." Several studies additionally report series in which the disease could be cured, using such an approach. CONCLUSIONS: There is substantial evidence for a therapeutic window of opportunity in initial-onset acute VKH disease. Timely and adequate treatment led to substantial improvement of disease outcome and prevented chronic evolution and "sunset glow fundus," and very early treatment led to the cure after discontinuation of therapy in several series, likely due to the fact that the choroid is the sole origin of inflammation in VKH disease.
Entities:
Keywords:
Autoimmune disease; Immunosuppressive therapy; Indocyanine green angiography; Sunset glow fundus; Therapeutic window of opportunity stromal choroiditis; Vogt–Koyanagi–Harada disease
Authors: Carlos Alvarez-Guzman; Jorge E Valdez-Garcia; Raul E Ruiz-Lozano; Alejandro Rodriguez-Garcia; Carlos F Navas-Villar; Curt Hartleben-Matkin; Miguel Pedroza-Seres Journal: Int Ophthalmol Date: 2022-07-05 Impact factor: 2.031
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Authors: Alejandro Gómez-Gómez; Alfredo Madrid-Garcia; Lara Borrego-Sanz; Paula Álvarez-Hernández; Pedro Arriola-Villalobos; Inés Pérez-Sancristobal; José M Benítez Del Castillo; Rosalía Mendez-Fernandez; Esperanza Pato-Cour; David Díaz-Valle; Luis Rodriguez-Rodriguez Journal: Ophthalmol Ther Date: 2022-10-20