Choo Charlene H, Acharya Nisha R, Shantha Jessica G
F.I. Proctor Foundation, University of California San Francisco (UCSF), San Francisco, CA, United States.
Front Ophthalmol (Lausanne). 2023 Jul 7;3:1217711. doi: 10.3389/fopht.2023.1217711. eCollection 2023.
Vogt-Koyanagi-Harada (VKH) syndrome is an inflammatory condition characterized by bilateral, granulomatous panuveitis with or without systemic manifestations, and accounts for up to 18% of referrals for panuveitis at tertiary centers in the United States of America. Despite ongoing research, there is limited evidence and no clear consensus on how to diagnose and treat patients with VKH, leading to variations in practice patterns among uveitis specialists.
An anonymous, online survey was distributed to uveitis specialists in the American Uveitis Society (AUS). The survey included 21 questions that asked for non-identifiable demographics and covered topics such as preferred imaging modalities, treatment for the first episode of VKH, and perceived efficacy of immunomodulatory therapy (IMT).
A total of 104 surveys were included for analysis, representing a 38.4% response rate from the AUS listserv. A majority of respondents were uveitis fellowship trained and practiced in North America in an academic setting. Fluorescein angiography and enhanced depth imaging with optical coherence tomography were rated as the most consistently useful methods for the diagnosis of VKH. For treatment of acute initial-onset VKH, responses were divided between a preference for high-dose systemic corticosteroids with IMT (61.5%) and without IMT (37.5%). Methotrexate and mycophenolate mofetil were the most common IMTs to be used as first-line therapies, but adalimumab and infliximab were perceived to be the most effective for the treatment for VKH.
While there are some common trends in the practice patterns for the diagnosis and treatment of patients with VKH, there was no clear consensus on the topic of IMT. There was a slight preference among uveitis specialists to use both IMT and systemic corticosteroids for the first episode of acute VKH.
伏格特-小柳-原田（VKH）综合征是一种炎症性疾病，其特征为双侧肉芽肿性全葡萄膜炎，伴有或不伴有全身表现，在美国三级医疗中心因全葡萄膜炎前来就诊的患者中，该病占比高达18%。尽管研究不断，但关于如何诊断和治疗VKH患者的证据有限，且尚无明确共识，这导致葡萄膜炎专科医生的诊疗模式存在差异。
向美国葡萄膜炎学会（AUS）的葡萄膜炎专科医生发放了一份匿名在线调查问卷。该调查包含21个问题，询问了不可识别的人口统计学信息，并涵盖了诸如首选成像方式、VKH首发 episode的治疗以及免疫调节治疗（IMT）的感知疗效等主题。
共纳入104份调查问卷进行分析，占AUS邮件列表的38.4%回复率。大多数受访者接受过葡萄膜炎专科培训，在北美的学术环境中执业。荧光素血管造影和光学相干断层扫描增强深度成像被评为诊断VKH最常用的方法。对于急性初发性VKH的治疗，回答分为倾向于使用高剂量全身糖皮质激素联合IMT（61.5%）和不联合IMT（37.5%）。甲氨蝶呤和霉酚酸酯是最常用的作为一线治疗的IMT，但阿达木单抗和英夫利昔单抗被认为对VKH治疗最有效。
虽然在VKH患者的诊断和治疗实践模式方面存在一些共同趋势，但在IMT主题上尚无明确共识。葡萄膜炎专科医生在急性VKH首发 episode中稍微倾向于同时使用IMT和全身糖皮质激素。
