Urzua Cristhian A, Velasquez Victor, Sabat Pablo, Berger Osvaldo, Ramirez Sebastian, Goecke Annelise, Vásquez Darío H, Gatica Hector, Guerrero Julia
Uveitis Department, Salvador's Hospital, Santiago, Chile.
Ophthalmology Department, University of Chile, Santiago, Chile.
Acta Ophthalmol. 2015 Sep;93(6):e475-80. doi: 10.1111/aos.12648. Epub 2015 Jan 7.
To evaluate clinical outcomes of first-line immunomodulatory therapy (IMT) and prednisone alone or late IMT in Vogt-Koyanagi-Harada disease.
Retrospective cohort study of 152 patients with Vogt-Koyanagi-Harada disease evaluated in a referral uveitis clinic in Chile from 1985 to 2011. Medical records of these patients were reviewed. Demographic data, clinical evaluation, type of treatment, functional outcomes, glucocorticoid (GC) dose and complications were recorded. Multivariate logistic regression was used to identify prognostic factors of poor response to GC.
There were no significant differences between first-line IMT group and prednisone alone/late IMT group in terms of visual acuity (VA) improvement, complications and GC sparing effect. There was a trend for a higher frequency of systemic adverse effects leading to discontinuation of treatment in patients receiving IMT than in those receiving prednisone (14.6% and 6.5%, respectively). The subgroup of patients with poor response to GC who showed functional improvement had a significantly earlier time to IMT initiation than the patients who had no improvement. We identified following prognostic factors of poor response to GC: VA ≤ 20/200, fundus depigmentation, chronic disease and tinnitus at diagnosis. Patients with a prognostic factor (excluding tinnitus) and VA improvement had an earlier IMT initiation than those who had worse functional outcome.
There were no differences in outcomes between first-line IMT and prednisone alone/late IMT in the entire VKH group. However, in a subset of patients, there was a significant better functional outcome with earlier IMT initiation.
评估一线免疫调节治疗（IMT）联合泼尼松单独治疗或晚期IMT治疗Vogt-小柳-原田病的临床疗效。
对1985年至2011年在智利一家转诊葡萄膜炎诊所评估的152例Vogt-小柳-原田病患者进行回顾性队列研究。回顾了这些患者的病历。记录人口统计学数据、临床评估、治疗类型、功能结局、糖皮质激素（GC）剂量和并发症。采用多因素逻辑回归分析确定对GC反应不佳的预后因素。
一线IMT组与单独使用泼尼松/晚期IMT组在视力（VA）改善、并发症和GC节省效应方面无显著差异。接受IMT治疗的患者因全身不良反应导致停药的频率有高于接受泼尼松治疗患者的趋势（分别为14.6%和6.5%）。对GC反应不佳但功能有改善的患者亚组开始IMT治疗的时间明显早于无改善的患者。我们确定了以下对GC反应不佳的预后因素：诊断时VA≤20/200、眼底色素脱失、慢性病和耳鸣。有预后因素（不包括耳鸣）且VA改善的患者开始IMT治疗的时间早于功能结局较差的患者。
在整个VKH组中，一线IMT与单独使用泼尼松/晚期IMT的疗效无差异。然而，在一部分患者中，早期开始IMT治疗的功能结局明显更好。
