Accorinti Massimo, Saturno Maria Carmela, Iannetti Ludovico, Manni Priscilla, Mastromarino Davide, Pirraglia Maria Pia
Ocular Immunovirology Service, Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy.
J Clin Med. 2022 Jun 23;11(13):3632. doi: 10.3390/jcm11133632.
Background: Vogt−Koyanagi−Harada (VKH) disease is a form of uveitis that is rare in Western countries. The aim of this study was to report on the long-term real-life treatment and prognosis of VKH in Italy. Methods: The clinical features, complications, and final visual acuity were retrospectively evaluated in 38 patients with VKH (mean follow-up: 120 months) globally, according to oral or intravenous corticosteroid treatment at onset and subsequent immunosuppressive therapy. Results: The mean final visual acuity was 0.13 ± 0.4 logMAR, which was a significant increase from the baseline (p < 0.0001). The patients who received intravenous rather than oral corticosteroids relapsed less (p = 0.026), with fewer relapses/patient/month of follow-up (p < 0.0001), and showed less frequent sunset glow fundus (33.3% versus 55%) and more relapse-free cases after induction therapy (p = 0.007). Delayed immunosuppressive therapy (median: 180 days from the onset of symptoms) reduced the rate of sunset glow fundus. The onset of sunset glow fundus was associated with a worse final visual acuity (p = 0.006). Conclusion: The long-term prognosis of VKH is quite good. Intravenous corticosteroids given at the onset of VKH are more effective than oral corticosteroids. Even if it is not given immediately after symptoms onset, immunosuppressive therapy is able to reduce the incidence of sunset glow fundus and to improve the final visual prognosis.
伏格特-小柳-原田（VKH）病是一种葡萄膜炎，在西方国家较为罕见。本研究旨在报告意大利VKH病的长期实际治疗情况及预后。方法：回顾性评估38例VKH病患者（平均随访时间：120个月）的临床特征、并发症及最终视力，根据发病时口服或静脉注射糖皮质激素治疗及随后的免疫抑制治疗进行综合分析。结果：最终平均视力为0.13±0.4 logMAR，较基线有显著提高（p<0.0001）。接受静脉注射而非口服糖皮质激素治疗的患者复发较少（p = 0.026），随访期间每月复发次数较少（p<0.0001），落日征眼底出现频率较低（33.3%对55%），诱导治疗后无复发病例较多（p = 0.007）。延迟免疫抑制治疗（中位数：症状出现后180天）可降低落日征眼底的发生率。落日征眼底的出现与最终视力较差相关（p = 0.006）。结论：VKH病的长期预后相当良好。VKH病发病时给予静脉注射糖皮质激素比口服糖皮质激素更有效。即使在症状出现后未立即给予，免疫抑制治疗也能够降低落日征眼底的发生率并改善最终视力预后。
