Top

Published in:

Open Access 01-12-2017 | Review

Reappraisal of the management of Vogt–Koyanagi–Harada disease: sunset glow fundus is no more a fatality

Authors: Carl P. Herbort Jr, Ahmed M. Abu El Asrar, Joyce H. Yamamoto, Carlos E. Pavésio, Vishali Gupta, Moncef Khairallah, Ilknur Tugal-Tutkun, Masoud Soheilian, Masuru Takeuchi, Marina Papadia

Published in: International Ophthalmology | Issue 6/2017

Abstract

Purpose

Vogt–Koyanagi–Harada (VKH) disease is a primary autoimmune stromal choroiditis. Aim of the study was to gather a body of evidence from the literature and from experts that systemic corticosteroid combined with non-steroidal immunosuppressive therapy should become the standard of care in initial-onset VKH disease.

Methods

Literature was reviewed and leading experts in VKH were consulted in different parts of the world in order to put forward a consensus attitude in the management of initial-onset VKH disease.

Results

There was a substantial body of evidence in the literature that early aggressive and sustained corticosteroid and non-steroidal immunosuppressive therapy in initial-onset VKH disease allows to achieve full control of choroidal inflammation, eliminating any subclinical choroidal inflammation, and substantially reduces recurrences with improvement of anatomical and functional outcomes. This was in agreement with experts’ opinion and practice. ICGA was the method of choice to monitor disease evolution.

Conclusion

Since the choroidal space is easily accessible to systemic therapy and because inflammation in VKH disease is exclusively originating from the choroidal stroma, early and sustained treatment right at the onset of the disease process with dual corticosteroid and non-steroidal immunosuppressive therapy can result in full “healing” in many cases preventing sunset glow fundus which results from depigmentation from chronic uncontrolled inflammation.

Moorthy RS, Inomata H, Rao NA (1995) Vogt–Koyanagi–Harada syndrome. Surv Ophthalmol 39:265–292CrossRefPubMed

Gocho K, Kondo I, Yamaki K (2001) Identification of autoreactive T cells in Vogt–Koyanagi–Harada disease. Investig Ophthalmol Vis Sci 42:2004–2009

Damico FM, Cunha-Neto E, Goldberg AC, Iwai LK, Hammer J, Kalil J, Yamamoto JH (2005) Vogt T-cell recognition and cytokine profile induced by melanocyte epitopes in patients with HLA-DRB1*0405-positive and -negative Vogt–Koyanagi–Harada uveitis. Investig Ophthalmol Vis Sci 46:2465–2471CrossRef

Sugita S, Takase H, Taguchi C, Imai Y, Kamoi K, Kawaguchi T, Sugamoto Y, Futagami Y, Itoh K, Mochizuki M (2006) Ocular infiltrating CD4+ T cells from patients with Vogt-Koyanagi-Harada disease recognize human melanocyte antigens. Investig Ophthalmol Vis Sci 47:2547–2554CrossRef

Abu El-Asrar AM, Struyf S, Kangave D et al (2011) Cytokine profiles in aqueous humor of patients with different clinical entities of endogenous uveitis. Clin Immunol 139:177–184CrossRef

Nakamura S, Nakazawa M, Yoshioka M, Nagano I, Nakamura H, Onodera J, Tamai M (1996) Melanin-laden macrophages in cerebrospinal fluid in Vogt–Koyanagi–Harada syndrome. Arch Ophthalmol 114:1184–1188CrossRefPubMed

Noguchi Y, Nishio A, Takase H, Miyanaga M, Takahashi H, Mochizuki M, Kitamura K (2014) Audiovestibular findings in patients with Vogt–Koyanagi–Harada disease. Acta Otolaryngol 134:339–344CrossRefPubMed

Fang W, Yang P (2008) Vogt–Koyanagi–Harada syndrome. Curr Eye Res 33:517–523CrossRefPubMed

Yang P, Ren Y, Li B, Fang W, Meng Q, Kijlstra A (2007) Clinical characteristics of Vogt–Koyanagi–Harada syndrome in Chinese patients. Ophthalmology 114:606–614CrossRefPubMed

10.

Abu El-Asrar AM, Al Tamimi M, Hemachandran S, Al-Mezaine HS, Al-Muammar A, Kangave D (2013) Prognostic factors for clinical outcomes in patients with Vogt–Koyanagi–Harada disease treated with high-dose corticosteroids. Acta Ophthalmol 91:e486–e493CrossRefPubMed

11.

Sukavatcharin S, Tsai JH, Rao NA (2007) Vogt–Koyanagi–Harada disease in Hispanic patients. Int Ophthalmol 27:143–148CrossRefPubMed

12.

Khairallah M (2014) Headache as an initial manifestation of Vogt–Koyanagi–Harada disease. Saudi J Ophthalmol 28:239–242CrossRefPubMed

13.

Kosma KK, Kararizou E, Markou I, Eforakopoulou E, Kararizos G, Mitsonis C, Gkiatas K (2008) Headache as a first manifestation of Vogt–Koyanagi–Harada disease. Med Princ Pract 17:253–254CrossRefPubMed

14.

Bouchenaki N, Herbort CP (2001) The contribution of indocyanine green angiography to the appraisal and management of Vogt–Koyanagi–Harada disease. Ophthalmology 108:54–64CrossRefPubMed

15.

Mantovaqni A, Resta A, Herbort CP, Abu El Asrar A, Kawaguchi T, Mochizuki M, Okada AA, Rao N (2007) Work-up, diagnosis and management of acute Vogt–Koyanagi–Harada disease: a case of acute myopization with granulomatous uveitis. Int Ophthalmol 27:105–115CrossRef

16.

Bouchenaki N, Herbort CP (2004) Stromal choroiditis. In: Pleyer U, Mondino B (eds) Essentials in ophthalmology: uveitis and immunological disorders. Springer, Berlin, pp 234–253

17.

Bouchenaki N, Cimino L, Auer C, Tran VT, Herbort CP (2002) Assessment and classification of choroidal vasculitis in posterior uveitis using indocyanine green angiography. Klin Monbl Augenheilkd 219:243–249CrossRefPubMed

18.

Papadia M, Herbort CP, Mochizuki M (2010) Diagnosis of ocular sarcoidosis. Ocul Immunol Inflamm 18:432–441CrossRefPubMed

19.

Papadia M, Herbort CP (2013) Reappraisal of birdshot retinochoroiditis (BRC): a global approach. Graefe’s Arch Clin Exp Ophthalmol 251:861–869CrossRef

20.

Khalifa Y, Loh AR, Acharya NR (2009) Fluocinolone acetonide intravitreal implants in Vogt–Koyanagi–Harada disease. Ocul Immunol Inflamm 17:431–433CrossRefPubMed

21.

Latronico ME, Rigante D, Caso F, Cantarini L, Costa L, Nieves-Martin L, Traversi C, Franceschini R (2015) Bilateral dexamethasone intravitreal implant in a young patient with Vogt–Koyanagi–Harada disease and refractory uveitis. Clin Rheumatol 34:1145–1148CrossRefPubMed

22.

Herbort CP, Mantovani A, Bouchenaki N (2007) Indocyanine green angiography in Vogt–Koyanagi–Harada disease: angiographic signs and utility in patient follow-up. Int Ophthalmol 27:173–182CrossRefPubMed

23.

Da Silva FT, Hirata CE, Sakata VM, Olivalves E, Preti R, Pimentel SL, Gomes A, Takahashi WY, Costa RA, Yamamoto JH (2012) Indocyanine green angiography findings in patients with long-standing Vogt–Koyanagi–Harada disease: a cross-sectional study. BMC Ophthalmol 13(12):40. doi:10.1186/1471-2415-12-40 CrossRef

24.

Bouchenaki N, Herbort CP (2011) Indocyanine green angiography guided management of Vogt–Koyanagi–Harada disease. J Ophthalmic Vis Res 6:241–248PubMedPubMedCentral

25.

Bascal K, Wen DS, Chee SP (2008) Concomitant choroidal inflammation during anterior segment recurrence in Vogt–Koyanagi–Harada disease. Am J Ophthalmol 145:480–486CrossRef

26.

Balci O, Gasc A, Jeannin B, Herbort CP Jr (2016) Enhanced depth imaging is less suited than indocyanine green angiography for close monitoring of primary stromal choroiditis: a pilot study. Int Ophthalmol. doi:10.1007/s10792-016-0303-7

27.

Miyanaga M, Kawaguchi T, Miyata K, Horie S, Mochizuki M, Herbort CP (2010) Indocyanine gree angiography findings in initial acute pre-treatment Vogt–Koyanagi–Harada disease in Japanese patients. Jpn J Ophthalmol 54:377–382CrossRefPubMed

28.

Abouammoh MA, Gupta V, Hemachandran S, Herbort CP, Abu El-Asrar AM (2016) Indocyanine green angiography in initial-onset acute Vogt–Koyanagi–Harada disease. Acta Ophthalmol. doi:10.1111/aos12974 PubMed

29.

Nakai K, Gomi F, Ikuno Y, Yasuno Y, Nouchi T, Ohguro N, Nishida K (2012) Choroidal observation in Vogt–Koyanagi–Harada disease using high-penetration optical coherence tomography. Graefe’s Arch Clin Exp Ophthalmol 250:1089–1095CrossRef

30.

Da Silva FT, Sakata VM, Nakashima A, Hirata CE, Olivalves E, Takahashi WY, Costa RA, Yamamoto JH (2013) Enhanced depth imaging optical coherence in long-standing Vogt–Koyanagi–Harada disease. Br J Ophthalmol 97:70–74CrossRefPubMed

31.

Maruko I, Iida T, Sugano Y, Oyamada H, Sekiryu T, Fujiwara T, Spaide RF (2011) Subfoveal choroidal thickness after treatment of Vogt–Koyanagi–Harada disease. Retina 31:510–517CrossRefPubMed

32.

Al-Kharashi AS, Aldibhi H, AL-Fraykh H, Kangave D, Abu El-Asrar AM (2007) Prognostic factors in Vogt–Koyanagi–Harada disease. Int Ophthalmol 27:201–210CrossRefPubMed

33.

Sakata VM, da Silva FT, Hirata CE, Marin ML, Rodrigues H, Kalil J, Costa RA, Yamamoto JH (2015) High-rate of clinical recurrence in patients with Vogt-Koyanagi-Harada disease treated with early high-dose corticosteroids. Graefes Arch Clin Exp Ophthalmol 253:785–790CrossRefPubMed

34.

Chee SP, Jap A, Bascal K (2007) Spectrum of Vogt–Koyanagi–Harada disease in Singapore. Int Ophthalmol 27:137–142CrossRefPubMed

35.

Keino H, Goto H, Usui M (2002) Sunset glow fundus in Vogt–Koyanagi–Harada disease with or without chronic ocular inflammation. Graefe’s Arch Clin Exp Ophthalmol 240:878–882CrossRef

36.

Abu El-Asrar AM, Al Mudhaiyan T, Al Najashi AA, Hemachandran S, Hariz R, Mousa A, Al-Muammar A (2016) Chronic recurrent Vogt-Koyanagi-Harada disease and development of “sunset glow fundus” predict a worse retinal sensitivity. Ocul Immunol Inflamm. doi:10.3109/09273948.2016.1139730 In press

37.

Fang W, Zhou H, Yang P, Huang X, Wang L, Kijlstra A (2008) Longitudinal quantification of aqueous flare and cells in Vogt–Koyanagi–Harada disease. Br J Ophthalmol 92:182–185CrossRefPubMed

38.

Abu El-Asrar AM, Hemachandran S, Al-Mezaine HS, Kangave D, Al-Muammar AM (2012) The outcomes of mycophenolate mofetil therapy combined with systemic corticosteroids in acute uveitis associated with Vogt–Koyanagi–Harada disease. Acta Ophthalmol 90:e603–e608CrossRefPubMed

39.

Bouchenaki N, Morisod L, Herbort CP (2000) Vogt–koyanagi–Harada disease: importance of rapid diagnosis and therapeutic intervention. Klin Monbl Augenheilkd 216:290–294CrossRefPubMed

40.

Paredes I, Ahmed M, Foster CS (2006) Immunomodulatory therapy for Vogt–Koyanagi–Harada patients as first-line therapy. Ocul Immunol Inflamm 14:87–90CrossRefPubMed

41.

Touitou V, Escande C, Bodaghi B, Cassoux N, Wechsler B, Lemaître C, Tran TH, Fardeau C, Piette JC, LeHoang P (2005) Diagnostic and therapeutic management of Vogt–Koyanagi–Harada syndrome. J Fr Optalmol 28:9–16CrossRef

42.

Sheu SJ (2005) Update on uveomeningoencephalitides. Curr Opin Neurol 18:323–329CrossRefPubMed

43.

Rubsamen PE, Gass JDM (1991) Vogt–Koyanangi–Harada syndrome: clinical course, therapy, and complications. Arch Ophthalmol 109:682–687CrossRefPubMed

44.

Lai TY, Chan RP, Chan CK, Lam DS (2009) Effects of the duration of initial oral corticosteroid treatment on the recurrence of inflammation in Vogt–Koyanagi–Harada disease. Eye 23:542–548

45.

Miyanaga M, Kawaguchi T, Shimizu K, Miyata K, Michizuki M (2007) Influence of early cerebrospinal fluid-guided diagnosis and early high-dose corticosteroid therapy on ocular outcomes of Vogt–Koyanagi–Harada disease. Int Ophthalmol 27:183–188CrossRefPubMed

46.

Damico FM, Bezzera FT, Silva GC, Gasparin F, Yamamoto JH (2007) New insights into Vogt–Koyanagi–Harada disease. Arq Bras Oftalmol 72:413–420CrossRef

47.

Kawaguchi T, Horie S, Bouchenaki N, Ohno-Matsui K, Mochizuki M, Herbort CP (2010) Suboptimal therapy controls clinically apparent disease but not subclinical progression of Vogt–Koyanagi–Harada disease. Int Ophthalmol 30:41–50CrossRefPubMed

48.

Suzuki S (1999) Quantitative evaluation of sunset glow fundus in Vogt–Koyanagi–Harada disease. Jpn J Ophthalmol 43:327–333CrossRefPubMed

49.

Keino H, Goto H, Mori H, Iwasaki T, Usui M (2006) Association between severity of inflammation in CNS and development of sunset glow fundus in Vogt–Koyanagi–Harada disease. Am J Ophthalmol 141:1140–1142CrossRefPubMed

50.

Lee E, Lee S, Yu H (2015) A clinical grading system based on ultra-wide field retinal imaging for sunset glow fundus in Vogt–Koyanagi–Harada disease. Graefes Arch Clin Exp Ophthalmol 253:359–368CrossRefPubMed

51.

Koyanagi Y (1929) Dysakusis, alopecia und poliosis bei schwerer uveitis nicht traumatischen ursprungs. Klin Monatsbl Augenheilkd 82:194–211

52.

Rao NA, Gupta A, Dustin L, Chee SP, Okada AA, Khairallah M, Bodaghi B, LeHoang P, Accorinti M, Mochizuki M, Prabriputaloong T, Read RW (2010) Frequency of distinguishing clinical features in Vogt–Koyanagi–Harasa disease. Ophthalmology 117:591–599CrossRefPubMed

53.

Bouchenaki N, Morisod L, Herbort CP (2000) Vogt–Koyanagi–Harada disease: importance of rapid diagnosis and therapeutic intervention. Klin Monatsbl Augenheilkd 216:290–294CrossRefPubMed

54.

Read RW, Yu F, Accorinti Bodaghi M, Bodaghi B, Chee SP, Fardeau C, Goto H, Holland GN, Kawashima H, Kojima E, LeHoang P, Lemaitre C, Okada AA, Pivetti-Pezzi P, Secchi A, See RF, Tabbara KF, Usui M, Rao NA (2006) Evaluation of the effect on outcomes of the route of administration of corticosteroids in acute Vogt–Koyanagi–Harada disease. Am J Ophthalmol 142:119–124CrossRefPubMed

55.

Wang Y, Gaudio PA (2008) Infliximab therapy for 2 patients with Vogt–Koyanagi–Harada syndrome. Ocul Immunol Inflamm 16:167–171CrossRefPubMed

56.

Touitou V, Sene D, Fardeau C, Boutin THD, Duhaut P, Piette JC, LeHoang P, Cacoub P, Bodaghi B (2007) Interferon-alpha 2a and Vogt–Koyanagi–Harada disease: a double-edged sword. Int Ophthalmol 27:211–215CrossRefPubMed

57.

Chee SP, Jap A (2013) The outcomes of indocyanine green angiography monitored immunotherapy in Vogt–Koyanagi–Harada disease. Br J Ophthalmol 97:130–133CrossRefPubMed

58.

Knecht PB, Papadia M, Herbort CP Jr (2014) Early and sustained treatment modifies the phenotype of birdshot retinochoroiditis. Int Ophthalmol 34:563–574CrossRefPubMed

59.

Arcinue CA, Radwan A, Lebanan MO, Foster CS (2013) Comparison of two different combination immunosuppressive therapies in the treatment of Vogt–Koyanagi–Harada syndrome. Ocul Immunol Inflamm 21:47–52CrossRefPubMed

60.

Sakata VM et al. (2015) Investig Ophthalmol Vis Sci 56: ARVO E-Abstract 2075

61.

Tugal-Tutkun I, Herbort CP, Khairallah M, Angiography Scoring for Uveitis Working Group (ASUWOG) (2010) Scoring of dual fluorescein and ICG inflammatory angiographic signs for the grading of posterior segment inflammation (dual fluorescein and ICG angiographic scoring system for uveitis). Int Ophthalmol 30:539–552CrossRefPubMed

62.

Tugal-Tutkun I, Herbort CP, Khairallah M, Mantovani A (2010) Interobserver agreement in scoring of dual fluorescein and ICG inflammatory angiographic signs for the grading pf posterior segment inflammation. Ocul Immunol Inflamm 18:385–389CrossRefPubMed

Title: Reappraisal of the management of Vogt–Koyanagi–Harada disease: sunset glow fundus is no more a fatality
Authors: Carl P. Herbort Jr
Ahmed M. Abu El Asrar
Joyce H. Yamamoto
Carlos E. Pavésio
Vishali Gupta
Moncef Khairallah
Ilknur Tugal-Tutkun
Masoud Soheilian
Masuru Takeuchi
Marina Papadia
Publication date: 01-12-2017
Publisher: Springer Netherlands
Published in: International Ophthalmology / Issue 6/2017
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI: https://doi.org/10.1007/s10792-016-0395-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Reappraisal of the management of Vogt–Koyanagi–Harada disease: sunset glow fundus is no more a fatality

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2017

Consistent pattern in positional instability of polyfocal full-optics accommodative IOL

Relationships between vitreous levels of soluble receptor for advanced glycation end products (sRAGE) and renal function in patients with diabetic retinopathy

Limbal stem cell and oral mucosal epithelial transplantation from ex vivo cultivation in LSCD-induced rabbits: histology and immunologic study of the transplant epithelial sheet

Comparing distance visual acuity measurement with a novel eye chart and the Landolt C chart in a population of children aged 6–18 years

Effects of alpha-lipoic acid on retinal ganglion cells, retinal thicknesses, and VEGF production in an experimental model of diabetes

Evaluating the growth of eyelid lesions: comparison of clinical evaluation and a software-based model