Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China.
BMC Ophthalmol. 2024 Jun 7;24(1):238. doi: 10.1186/s12886-024-03511-9.
This study explores prognostic factors influencing Vogt-Koyanagi-Harada (VKH) disease and observes the efficacy and safety of Adalimumab (ADA) in treating recurrence in Vogt-Koyanagi-Harada (VKH) patients.
A retrospective study was conducted on all patients diagnosed with VKH disease at Beijing Tongren Hospital between 2020 and 2023. Clinical data included initial and final visual acuity, age, gender, ocular complications, treatment modalities, disease duration, and recurrence frequency.
A total of 62 VKH patients were included, comprising 34 in the acute-resolved group and 28 in the chronic-recurrent group. The mean age of patients in the acute-resolved group was 38.29 ± 15.46 years, while the mean age of chronic-recurrent group had a 49.00 ± 16.43 years. Initial best-corrected visual acuity (BCVA) examination at the first visit showed an average BCVA of 0.64 ± 0.29 logMAR in the acute-resolved group and 1.38 ± 0.54 logMAR in the chronic-recurrent group (p = 0.002). During follow-up, ocular complications were observed in 29.4% of the acute-resolved group patients and 41.7% of the chronic-recurrent group patients (P = 0.006). "Sunset glow fundus" was observed in 23.5% of the acute-resolved group and 64.3% of the chronic-recurrent group patients (P = 0.001). Poor initial BCVA (P = 0.046) and the occurrence of "sunset glow fundus" (P = 0.040) were significantly associated with progression to the chronic recurrent phase. Logistic regression analysis revealed that older age at onset (P = 0.042) and the occurrence of "sunset glow fundus" (P = 0.037) were significant predictors for progression to the chronic recurrent phase. ADA significantly reduced anterior chamber inflammatory cells (P = 0.000) and vitreous cavity inflammatory cells (P = 0.001) in the chronic-recurrent group, and markedly decreased the recurrence rate in VKH patients (P = 0.009).
In comparison to acute-resolved patients, chronic-recurrent patients exhibited poorer initial BCVA and a significantly increased incidence of "sunset glow fundus." Older age at onset and the occurrence of "sunset glow fundus" at diagnosis are crucial predictive factors for VKH patients progressing to the chronic recurrent phase. ADA effectively alleviates refractory VKH disease and is generally well-tolerated.
本研究旨在探讨影响 Vogt-Koyanagi-Harada（VKH）疾病的预后因素，并观察阿达木单抗（ADA）治疗 VKH 患者复发的疗效和安全性。
回顾性分析 2020 年至 2023 年期间在北京同仁医院确诊为 VKH 病的所有患者的临床资料。临床数据包括初始和最终视力、年龄、性别、眼部并发症、治疗方式、疾病持续时间和复发频率。
共纳入 62 例 VKH 患者，其中急性缓解组 34 例，慢性复发性组 28 例。急性缓解组患者的平均年龄为 38.29±15.46 岁，慢性复发性组为 49.00±16.43 岁。首次就诊时最佳矫正视力（BCVA）检查显示，急性缓解组平均 BCVA 为 0.64±0.29 logMAR，慢性复发性组为 1.38±0.54 logMAR（p=0.002）。随访期间，急性缓解组患者中有 29.4%出现眼部并发症，慢性复发性组患者中有 41.7%出现眼部并发症（P=0.006）。急性缓解组中有 23.5%的患者出现“落日征”眼底，慢性复发性组中有 64.3%的患者出现“落日征”眼底（P=0.001）。初始 BCVA 较差（P=0.046）和“落日征”眼底（P=0.040）与进展为慢性复发性阶段显著相关。Logistic 回归分析显示，发病年龄较大（P=0.042）和出现“落日征”眼底（P=0.037）是进展为慢性复发性阶段的显著预测因素。ADA 可显著降低慢性复发性组患者前房炎性细胞（P=0.000）和玻璃体内炎性细胞（P=0.001）的数量，并显著降低 VKH 患者的复发率（P=0.009）。
与急性缓解组患者相比，慢性复发性组患者的初始 BCVA 较差，且“落日征”眼底的发生率明显升高。发病年龄较大和发病时出现“落日征”眼底是 VKH 患者进展为慢性复发性阶段的关键预测因素。ADA 有效缓解难治性 VKH 疾病，且一般耐受性良好。
