Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; and.
Tangshan Eye Hospital, Tangshan, China.
Retina. 2023 Sep 1;43(9):1496-1505. doi: 10.1097/IAE.0000000000003837.
To report the clinical profile and outcomes of acute Vogt-Koyanagi-Harada disease with a strict immunosuppression regimen and investigate the risk factors for a prolonged disease course.
A total of 101 patients with acute Vogt-Koyanagi-Harada (202 eyes) with more than 24 months of follow-up were recruited from January 2011 to June 2020. They were divided into two groups according to the interval between the onset of Vogt-Koyanagi-Harada and treatment. Oral prednisone was gradually tapered off by a diminished dose according to a relatively strict protocol. Patient responses to the treatment regimen were classified as long-term drug-free remission or chronic recurrent.
Ninety-six patients (95.0%) achieved long-term drug-free remission without recurrence, while 5 (5.0%) had chronic recurrence. Most patients achieved good best-corrected visual acuity (90.6% ≧20/25). A generalized estimation equation model demonstrated that time of visit, ocular complications, and cigarette smoking were independent risk factors for a longer disease course, and smokers required a higher drug dose and longer treatment course than nonsmokers.
An immunosuppressive regimen with an appropriate tapering speed can lead to long-term drug-free remission in patients with acute Vogt-Koyanagi-Harada. Cigarette smoking significantly affects ocular inflammation.
报告采用严格免疫抑制方案治疗的急性 Vogt-小柳-原田病（Vogt-Koyanagi-Harada disease，VKH）的临床特征和转归，并探讨影响疾病病程延长的相关因素。
本研究回顾性分析了 2011 年 1 月至 2020 年 6 月间就诊于我院、符合纳入标准且随访时间超过 24 个月的 101 例急性 VKH 患者（202 只眼）的临床资料。根据 VKH 发病至开始治疗的时间间隔，将患者分为两组。采用逐渐减量的泼尼松口服方案进行治疗，该方案较为严格。根据患者对治疗方案的反应，将其分为长期无激素缓解和慢性复发性缓解。
96 例（95.0%）患者达到长期无激素缓解且无复发，5 例（5.0%）患者为慢性复发性缓解。大多数患者视力较好（90.6% ≧20/25）。广义估计方程模型显示，就诊时间、眼部并发症和吸烟是影响疾病病程延长的独立危险因素，吸烟者所需的激素剂量和治疗时间均长于不吸烟者。
采用合适减药速度的免疫抑制方案可使急性 VKH 患者达到长期无激素缓解。吸烟显著影响眼部炎症反应。
