|
 
 |
| REVIEW ARTICLE |
|
| Year : 2020 | Volume
: 32
| Issue : 4 | Page : 310-314 |
|
Vogt–Koyanagi–Harada is a curable autoimmune disease: Early diagnosis and immediate dual steroidal and non-steroidal immunosuppression are crucial prerequisites
Ioannis Papasavvas1, Ilknur Tugal-Tutkun2, Carl P Herbort1
1 Retinal and Inflammatory Eye Diseases, Centre For Ophthalmic Specialised Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland
2 Department of Ophthalmology, University of Istanbul, Istanbul, Turkey
| Date of Submission | 10-May-2020 |
| Date of Decision | 07-Jun-2020 |
| Date of Acceptance | 30-Jun-2020 |
| Date of Web Publication | 12-Dec-2020 |
Correspondence Address:
Carl P Herbort
Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialised Care, Rue Charles.Monnard 6, CH.1003 Lausanne
Switzerland
 Source of Support: None, Conflict of Interest: None  | 12 |
DOI: 10.4103/JOCO.JOCO_190_20
Purpose: It is crucial to subdivide Vogt–Koyanagi–Harada (VKH) disease into two subentities, initial-onset disease versus chronically evolving disease. For early diagnosis and precise follow-up of VKH choroiditis, the “Revised criteria for VKH” are no more sufficient for the appraisal of VKH and new biomarkers for disease activity are needed. It has been shown that, if initial-onset disease is treated promptly within the “therapeutic window of opportunity” and long enough with dual steroidal and non-steroidal immunosuppression, the disease can be cured in a large proportion of cases, an approach still contested. The proportion of chronic evolution and/or sunset-glow fundus (SGF) following steroidal monotherapy versus dual steroidal and non-steroidal immunosuppression was compared.
Methods: A literature search was performed, identifying studies on initial-onset VKH treated either by steroidal monotherapy or dual immunosuppression. Evolution toward chronicity and/or SGF was compared in both groups.
Results: Twenty studies were identified with reported long-term outcomes. In 16 studies, 802 patients received steroidal monotherapy, while in 4 studies, 172 patients received dual steroidal and non-steroidal immunosuppression. Chronic evolution and SGF occurred, respectively, in 44% and 59% in the corticosteroid-alone group versus 2.3% and 17.5% in the dual therapy group with no chronic evolution in three studies and no SGF in two studies.
Conclusions: Chronic evolution and SGF are significantly less frequent in initial-onset VKH when treated with immediate dual steroidal and non-steroidal immunosuppression with a high proportion of healed cases. This combined approach seems recommended in the management of initial-onset VKH disease.
Keywords: Chronic evolution, Dual immunosuppression, Sunset-glow fundus, Vogt–Koyanagi–Harada disease
How to cite this article:
Papasavvas I, Tugal-Tutkun I, Herbort CP. Vogt–Koyanagi–Harada is a curable autoimmune disease: Early diagnosis and immediate dual steroidal and non-steroidal immunosuppression are crucial prerequisites. J Curr Ophthalmol 2020;32:310-4 |
How to cite this URL:
Papasavvas I, Tugal-Tutkun I, Herbort CP. Vogt–Koyanagi–Harada is a curable autoimmune disease: Early diagnosis and immediate dual steroidal and non-steroidal immunosuppression are crucial prerequisites. J Curr Ophthalmol [serial online] 2020 [cited 2023 Jun 5];32:310-4. Available from: http://www.jcurrophthalmol.org/text.asp?2020/32/4/310/303212 |
| Introduction | |  |
Vogt–Koyanagi–Harada (VKH) disease is an autoimmune-driven inflammation of ocular, auditory, and meningeal structures that all contain melanocytes, the elective target of the inflammatory reaction.[1],[2] The first structure to be involved in this process is the melanocyte islets in the choroidal stroma, where a stromal choroiditis develops.[3],[4] This inflammatory reaction can be detected early by investigational methods that reveal subclinical signs of choroidal inflammation such as spectral-domain optical coherence tomography (OCT) or indocyanine green angiography (ICGA).[5],[6]
Such an early stage of the disease is accompanied by prodromal symptoms that can include headaches, auditory symptoms, and meningeal signs and symptoms.[7],[8]
In case the early stage of disease is missed and/or not treated, the inflammatory process is spilling over and involves secondarily other ocular structures such as the optic disc and the retina, in a further step progressing to a granulomatous panuveitis and to chronic disease.[9]
It is crucial to distinguish between the early initial-onset stage of disease and the later chronically evolving disease because the impact of therapeutic intervention appears to be different whether applied to acute initial-onset disease or chronically evolving disease. In many past studies and attempts to classify VKH, this important distinction was overlooked.[10] It was shown that the disease can be cured when treatment is initiated at an early stage, within the therapeutic window of opportunity,[11] whereas treatment has to be prolonged and is less successful when intervening on already chronically evolving disease.[12] Early treatment is not the only prerequisite to attempt a cure of the disease. There is growing evidence that the conventional treatment by systemic corticosteroid, even when given early and at adequate dosage, is not sufficient to prevent chronic evolution.[13] An increasing number of reports have become available that show that dual steroidal and non-steroidal immunosuppression given at the stage of initial-onset VKH is needed to prevent chronic evolution and represent an opportunity to cure the disease.[14] The aim of this study was to analyze and compare on one side studies on the treatment of initial-onset disease managed with steroid-only therapy to studies that used combined (dual) steroidal and non-steroidal immunosuppression.
| Methods | | |
A literature search on the PubMed database was performed, using the search term Vogt-Koyanagi-Harada. Every article or part of an article giving clear information on whether the cases reported were initial-onset disease was considered. It included observational studies, clinical trials, and case series, but no reviews. Additional inclusion criteria comprised (1) clear indication of the treatment performed at the moment of presentation, either corticosteroid monotherapy or corticosteroids associated with immunosuppressive therapy, and (2) whether there was clear information on the rate of chronic evolution and/or sunset-glow fundus. Studies were subdivided into two groups according to whether they had been treated with systemic corticosteroids alone or dual steroidal and non-steroidal treatment.
| Results | | |
Up to June 30, 2019, 1249 articles referenced in the PubMed database contained the term Vogt-Koyanagi-Harada. Twenty studies or part of series were eligible as they responded to the required criteria: (1) they concerned only acute initial-onset patients that (2) had received systemic treatment immediately at presentation, corticosteroids alone, or dual steroidal and non-steroidal immunosuppressants, and (3) contained clear information on the evolution of the disease, chronic evolution, and/or sunset-glow fundus (SGF) versus absence of chronic disease and/or absence of SGF.
Because the distinction between initial-onset VKH and chronic VKH was not made in most studies in the past, the number of studies that could be included were strikingly few. Sixteen studies were identified that reported treatments using systemic corticosteroids alone [Table 1]. Of these studies, 11/16 (69%) were performed before 2015. Four studies reported treatments combining steroidal and non-steroidal immunosuppression which were all performed after 2011 (1 study in 2011, 2 in 2017 and 1 in 2018) [Table 2]. With time, the proportion of studies using dual immunosuppressive treatments increased, 1/11 before 2015 versus 3/5 after 2015. | Table 1: Studies reporting on results of corticosteroid monotherapy in patients presenting with initial-onset Vogt-Koyanagi-Harada disease
Click here to view |
 | Table 2: Studies reporting on results of dual corticosteroid and non-steroidal treatment in patients presenting with initial-onset Vogt-Koyanagi-Harada disease
Click here to view |
[Table 1] lists the 16 studies of initial-onset VKH patients treated with systemic corticosteroids as unique systemic treatment. The total number of initial-onset VKH patients treated with systemic corticosteroids as unique systemic treatment amounted to 802. To establish the proportion of chronic evolution, 700 patients were available for analysis, of which 306 (44%) had a chronic course that could not be avoided by corticosteroid treatment alone. To establish the proportion of cases that developed SGF, 391 patients were available from 6 studies where this complication was reported. A total of 230/391 (59%) patients developed SGF when corticosteroid treatment was given alone, indicating smoldering progression of choroiditis.
[Table 2] lists the four studies of initial-onset acute VKH patients treated with a combination of steroidal and non-steroidal immunosuppression immediately at presentation. The result of these studies showed that chronic evolution was reduced from 44% to 2.3%, a highly statistically significant difference (P<0.000001, Fisher's exact test). In 3 studies comprising 148 patients, chronic evolution was reduced to zero altogether. SGF was reduced from 59% in the corticosteroid-alone group to 17.5%, a highly statistically significant difference (P<0.00001, Fisher's exact test). The different regimens of non-steroidal immunosuppressants used are indicated in the table 2.
| Discussion | | |
The appraisal of VKH disease has been inadequate in the past because it failed to distinguish between two stages of the disease, initial-onset disease and chronic disease, corresponding to different evolutions and to different responses to management.[10] The modality of management of initial-onset VKH disease is still debated. On one side, a substantial number of clinicians, centers, and even countries claim that systemic corticosteroid therapy is sufficient to manage the disease.[29] On the other hand, in recent years, there is an increasing trend, based on reports, some of them conducted in a prospective fashion, putting forward the notion that corticosteroids alone are insufficient and cannot avoid chronic evolution and the development of SGF in a substantial proportion of cases.[13] Combined steroidal and non-steroidal immunosuppression appears to be needed to avoid detrimental evolution.
Our results based on the review and analysis of published studies confirmed the benefit of the combined immunosuppression approach increasingly advocated. When steroidal and non-steroidal immunosuppression is administered, the rate of chronic evolution and the rate of development of SGF are, respectively, reduced from 44% to 2.3% (a 94.8% reduction) and from 59% to 17.5%, highly statistically significant differences for both comparisons. In a recently performed analysis, we showed that the benefit of combined treatment was even more spectacular, coming down from close to 60% to 2.3% for chronic evolution, when Japanese series, in which the disease seems to be less aggressive, were excluded. The combined immunosuppression treatment studies also showed that treatment had to be given as early as possible and had to be prolonged. One study also showed that monitoring of occult subclinical choroidal inflammation using ICGA resulted in the cure of the disease after a treatment duration of 27 months with no recurrence after a treatment-free follow-up period of 26 months.[30] It has been shown that ICGA is the most sensitive modality to follow choroidal involvement in VKH, but enhanced depth imaging OCT is another modality that can be used if ICGA is unavailable.[34],[35] The fact that a disease cure can be expected for this autoimmune disease can be explained by the particular clinicopathology of the disease. VKH is developing in the confined space of the eye and more precisely in the choroidal stroma. Early and aggressive immunosuppressive therapy will then avoid remnant epitope generation in an autoimmune process that is not fully matured and moreover takes place in secluded compartment which the eye is.[36] The first inflammatory event is a stromal choroiditis and in case rapid and aggressive treatment does not confine back the inflammation to its original focus, it will propagate to adjacent eye structures, the optic disc and retina, will spread anteriorly to become a (granulomatous) panuveitis and will produce ear lesions and integumentary manifestations. This natural evolution of the disease was described in detail by the ground-breaking work of Koyanagi in 1929.[37]
Another positive consequence of combined immunosuppressive therapy is the considerable corticosteroid-sparing effect it allows to achieve, as substantially less corticosteroids can be given and consequently their deleterious morbidity can be reduced.
In uveitis and immunogenic inflammatory diseases as a whole the present trend is towards the use of less corticosteroids and more non-steroidal immunosuppression. For VKH such a radical approach has a double advantage. In addition to potent direct inflammation suppressive action, it contributes to the rapid restauration of the blood-ocular barriers, recreating the secluded ocular cocoon, making the cure of the disease possible. Today, we dispose of a large array of immunosuppressive agents which we manipulate more appropriately. When considering the severity of side effects between corticosteroids and conventional immunosuppressants such as mycophenolic acid, azathioprine, or cyclosporine, the balance clearly leans favorably toward the latter and this is even more the case with biologic agents.[38],[39],[40] Taking into account the low proportion of side effects of non-steroidal immunosuppressants and their corticosteroid sparing effect, the benefits largely exceed the inconveniences of their use, when knowing that close to half of initial-onset VKH will be preserved from chronic evolution. When considering SGF, an indicator of ongoing smoldering choroiditis, the benefits are even higher as only 17.5% versus 60% will develop SGF when on combined therapy.[41],[42]
In summary, this study including close to one thousand patients clearly showed in a statistically significant fashion that combined steroidal and non-steroidal immunosuppression can prevent both chronic evolution and SGF after initial-onset VKH disease.
Acknowledgment
This article has been accepted and presented at the “Club Jules Gonin Virtual Meeting 2020” , 2-5 September 2020.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Otani S, Sakurai T, Yamamoto K, Fujita T, Matsuzaki Y, Goto Y, et al. Frequent immune response to a melanocyte specific protein KU-MEL-1 in patients with Vogt-Koyanagi-Harada disease. Br J Ophthalmol 2006;90:773-7.  |
| 2. | Gocho K, Kondo I, Yamaki K. Identification of autoreactive T cells in Vogt-Koyanagi-Harada disease. Invest Ophthalmol Vis Sci 2001;42:2004-9. |
| 3. | Bouchenaki N, Herbort CP. Stromal choroiditis. In: Pleyer U, Mondino B, editors. Essentials in Ophthalmology: Uveitis and Immunological Disorders. New York: Springer Berlin, Heidelberg; 2004. p. 234-53. |
| 4. | Elahi S, Herbort CP Jr. Vogt-Koyanagi-Harada disease and birdshot retinochoroiditis. Similarities and differences: A glimpse into the clinicopathology of stromal choroiditis, a perspective and a review. Klin Monbl Augenheilkd 2019;236:492-510. |
| 5. | Elahi S, Gillmann K, Gasc A, Jeannin B, Herbort CP Jr. Sensitivity of indocyanine green angiography compared to fluorescein angiography and enhanced depth imaging optical coherence tomography during tapering and fine-tuning of therapy in primary stromal choroiditis: A case series. J Curr Ophthalmol 2019;31:180-7. |
| 6. | Tagawa Y, Namba K, Mizuuchi K, Takemoto Y, Iwata D, Uno T, et al. Choroidal thickening prior to anterior recurrence in patients with Vogt-Koyanagi-Harada disease. Br J Ophthalmol 2016;100:473-7. |
| 7. | Khairallah AS. Headache as an initial manifestation of Vogt-Koyanagi-Harada disease. Saudi J Ophthalmol 2014;28:239-42. |
| 8. | Attia S, Khochtali S, Kahloun R, Ammous D, Jelliti B, Ben Yahia S, et al. Clinical and multimodal imaging characteristics of acute Vogt-Koyanagi-Harada disease unassociated with clinically evident exudative retinal detachment. Int Ophthalmol 2016;36:37-44. |
| 9. | Herbort CP Jr., Abu El Asrar AM, Yamamoto JH, Pavésio CE, Gupta V, Khairallah M, et al. Reappraisal of the management of Vogt-Koyanagi-Harada disease: Sunset glow fundus is no more a fatality. Int Ophthalmol 2017;37:1383-95. |
| 10. | Hedayatfar A, Khochtali S, Khairallah M, Takeuchi M, El Asrar AA, Herbort CP Jr. “Revised diagnostic criteria” for Vogt-Koyanagi-Harada disease fail to improve disease management. J Curr Ophthalmol 2019;31:1-7. |
| 11. | Herbort CP Jr., Abu El Asrar AM, Takeuchi M, Pavésio CE, Couto C, Hedayatfar A, et al. Catching the therapeutic window of opportunity in early initial-onset Vogt-Koyanagi-Harada uveitis can cure the disease. Int Ophthalmol 2019;39:1419-25. |
| 12. | Abu El-Asrar AM, Al Mudhaiyan T, Al Najashi AH, Hemachandran S, Hariz R, Mousa A, et al. Chronic recurrent Vogt–Koyanagi–Harada disease and development of 'sunset glow fundus' predict worse retinal sensitivity. Ocul Immunol Inflamm 2017;25:475-485. |
| 13. | Sakata VM, da Silva FT, Hirata CE, Marin ML, Rodrigues H, Kalil J, et al. High rate of clinical recurrence in patients with Vogt-Koyanagi-Harada disease treated with early high-dose corticosteroids. Graefes Arch Clin Exp Ophthalmol 2015;253:785-90. |
| 14. | Abu El-Asrar AM, Dosari M, Hemachandran S, Gikandi PW, Al-Muammar A. Mycophenolate mofetil combined with systemic corticosteroids prevents progression to chronic recurrent inflammation and development of 'sunset glow fundus' in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada disease. Acta Ophthalmol 2017;95:85-90. |
| 15. | Rubsamen PE, Gass JD. Vogt-Koyanangi-Harada syndrome: Clinical course, therapy, and complications. Arch Ophthalmol 1991;109:682-7. |
| 16. | Nishioka Y, Sakamoto M, Kinukawa N, Sanui H, Inomata H, Nose Y. Recurrence risk factors in patients with the Vogt-Koyanagi-Harada syndrome in Japan. Ocul Immunol Inflamm 1995;3:73-80. |
| 17. | Keino H, Goto H, Usui M. Sunset glow fundus in Vogt-Koyanagi-Harada disease with or without chronic ocular inflammation. Graefe's Arch Clin Exp Ophthalmol 2002;240:878-82. |
| 18. | Keino H, Goto H, Mori H, Iwasaki T, Usui M. Association between severity of inflammation in CNS and development of sunset glow fundus in Vogt-Koyanagi-Harada disease. Am J Ophthalmol 2006;141:1140-2. |
| 19. | Tugal-Tutkun I, Ozyazgan Y, Akova YA, Sullu Y, Akyol N, Soylu M, et al. The spectrum of Vogt-Koyanagi-Harada disease in Turkey: VKH in Turkey. Int Ophthalmol 2007;27:117-23. |
| 20. | Khairallah M, Zaouali S, Messaoud R, Chaabane S, Attia S, Ben Yahia S, et al. The spectrum of Vogt-Koyanagi-Harada disease in Tunisia, North Africa. Int Ophthalmol 2007;27:125-30. |
| 21. | Chee SP, Jap A, Bacsal K. Spectrum of Vogt-Koyanagi-Harada disease in Singapore. Int Ophthalmol 2007;27:137-42. |
| 22. | Lai TY, Chan RP, Chan CK, Lam DS. Effects of the duration of initial oral corticosteroid treatment on the recurrence of inflammation in Vogt-Koyanagi-Harada disease. Eye (Lond) 2009;23:543-8. |
| 23. | Cuchacovich M, Solanes F, Díaz G, Cermenati T, Avila S, Verdaguer J, et al. Comparison of the clinical efficacy of two different immunosuppressive regimens in patients with chronic vogt-koyanagi-harada disease. Ocul Immunol Inflamm 2010;18:200-7. |
| 24. | Errera MH, Fardeau C, Cohen D, Navarro A, Gaudric A, Bodaghi B, et al. Effect of the duration of immunomodulatory therapy on the clinical features of recurrent episodes in Vogt--Koyanagi--Harada disease. Acta Ophthalmol 2011;89:e357-66. |
| 25. | Abu El-Asrar AM, Al Tamimi M, Hemachandran S, Al-Mezaine HS, Al-Muammar A, Kangave D. Prognostic factors for clinical outcomes in patients with Vogt-Koyanagi-Harada disease treated with high-dose corticosteroids. Acta Ophthalmol 2013;91:e486-93. |
| 26. | Ozdal P, Ozdamar Y, Yasici A, Teke MY, Ozturk F. Vogt-Koyanagi-Harada disease: Clinical and demographic characteristic patients in a specialized eye hospital in Turkey. Ocular Immunol Inflammat 2014;22:277-86. |
| 27. | Iwahashi C, Okuno K, Hashida N, Nakai K, Ohguro N, Nishida K. Incidence and clinical features of recurrent Vogt-Koyanagi-Harada disease in Japanese individuals. Jpn J Ophthalmol 2015;59:157-63. |
| 28. | Giordano VE, Schlaen A, Guzmán-Sánchez MJ, Couto C. Spectrum and visual outcomes of Vogt-Koyanagi-Harada disease in Argentina. Int J Ophthalmol 2017;10:98-102. |
| 29. | Nakayama M, Keino H, Watanaba T, Okada AA. Clinical features and visual outcomes of 111 patients with new-onset acute Vogt-Koyanagi-Harada disease treated with polse intravenous corticosteroids. BJO 2019;103:274-8. |
| 30. | Bouchenaki N, Herbort CP. Indocyanine green angiography guided management of Vogt-Koyanagi-Harada disease. J Ophthalmic Vis Res 2011;6:241-8. [Full text] |
| 31. | Abu El-Asrar AM, Dosari M, Hemachandran S, Gikandi PW, Al-Muammar A. Mycophenolate mofetil combined with systemic corticosteroids prevents progression to chronic recurrent inflammation and development of 'sunset glow fundus' in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada disease. Acta Ophthalmol 2017;95:85-90. |
| 32. | Lodhi SA, Reddy JL, Peram V. Clinical spectrum and management options in Vogt-Koyanagi-Harada disease. Clin Ophthalmol 2017;11:1399-406. |
| 33. | Yang P, Ye Z, Du L, Zhou Q, Qi J, Liang L, et al. Novel treatment regimen of Vogt-Koyanagi-Harada disease with a reduced dose of corticosteroids combined with immunosuppressive agents. Curr Eye Res 2018;43:254-61. |
| 34. | Bouchenaki N, Herbort CP. The contribution of indocyanine green angiography to the appraisal and management of Vogt-Koyanagi-Harada disease. Ophthalmology 2001;108:54-64. |
| 35. | Balci O, Gasc A, Jeannin B, Herbort CP Jr. Enhanced depth imaging is less suited than indocyanine green angiography for close monitoring of primary stromal choroiditis: A pilot report. Int Ophthalmol 2017;37:737-48. |
| 36. | Opdenakker G, Abu El-Asrar A, Van Damme J. Remnant epitopes generating autoimmunity: From model to useful paradigm. Trends Immunol 2020;41:367-78. |
| 37. | Koyanagi Y. Dysakusis, alopecia and poliosis bei schwerer uveitis nicht traumatischen ursprungs. Klein Monatsbl Augenheilkd 1929;82:194-211. |
| 38. | Kempen JH, Daniel E, Dunn JP, Foster CS, Gangaputra S, Hanish A, et al. Overall and cancer related mortality among patients with ocular inflammation treated with immunosuppressive drugs: Retrospective cohort study. BMJ 2009;339:b2480. |
| 39. | Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group, Kempen JH, Altaweel MM, Holbrook JT, Jabs DA, Louis TA, et al. Randomized comparison of systemic anti-inflammatory therapy versus fluocinolone acetonide implant for intermediate, posterior, and panuveitis: The multicenter uveitis steroid treatment trial. Ophthalmology 2011;118:1916-26. |
| 40. | Couto C, Schlaen A, Frick M, Khoury M, Lopez M, Hurtado E, et al. Adalimumab treatment in patients with Vogt-Koyanagi-Harada disease. Ocul Immunol Inflamm 2018;26:485-9. |
| 41. | Murata T, Sako N, Takayama K, Harimoto K, Kanda K, Herbort CP Jr., et al. Identification of underlying inflammation in Vogt-Koyanagi-Harada disease with sunset glow fundus by multiple analysis. J Ophthalmol 2019;2019:3853794. |
| 42. | Kawaguchi T, Horie S, Bouchenaki N, Ohno-Matsui K, Mochizuki M, Herbort CP. Suboptimal therapy controls clinically apparent disease but not subclinical progression of Vogt-Koyanagi-Harada disease. Int Ophthalmol 2010;30:41-50. |
[Table 1], [Table 2]
| This article has been cited by | | 1 |
Reduced Dose Methotrexate and Mycophenolate Mofetil in Noninfectious Uveitis: A Sub-Analysis from the First-Line Antimetabolites as Steroid Sparing Therapy (FAST) Trial |
|
| Amol A. Sura, Yuwei Sun, Amit K. Reddy, S. R. Rathinam, John A. Gonzales, Radhika Thundikandy, Rajesh Vedhanayaki, Anuradha Kanakath, Bala Murugan, Thuy A. Doan, Lyndell L. Lim, Eric B. Suhler, Hassan A. Al-Dhibi, Nisha R. Acharya | | Ocular Immunology and Inflammation. 2023; : 1 | | [Pubmed] | [DOI] | | | 2 |
Impact of Initial Management on Disease Evolution in Vogt–Koyanagi–Harada Syndrome: A Retrospective Cohort of 50 Patients |
|
| Alice Fauquier, Thomas Barba, Arnaud Hot, Pascal Sève, Sandra Elbany, Philippe Blanche, Dominique Monnet, Antoine Brézin, Benjamin Terrier, Cécile-Audrey Durel | | Ocular Immunology and Inflammation. 2023; : 1 | | [Pubmed] | [DOI] | | | 3 |
Very early OCT response to intravenous pulse steroid in Vogt-Koyanagi-Harada disease |
|
| Miguel Leitão, Rita Pinto, Vanda Nogueira | | BMJ Case Reports. 2023; 16(5): e255186 | | [Pubmed] | [DOI] | | | 4 |
EFFICACY OF COMBINED SYSTEMIC CORTICOSTEROID AND EARLY IMMUNOMODULATORY THERAPY WITHIN THREE MONTHS OF ONSET IN VOGT–KOYANAGI–HARADA DISEASE |
|
| Hyo Song Park, Hyun Young Park, Christopher Seungkyu Lee, Sung Chul Lee, Ji Hwan Lee | | Retina. 2022; 42(12): 2361 | | [Pubmed] | [DOI] | | | 5 |
Therapeutic window of opportunity in the acute uveitic phase of
Vogt–Koyanagi–Harada
disease: Prevention of late autoimmune complications by early intervention
|
|
| Ahmed M. Abu El-Asrar, Faisal A. Al Rashed, Abdulrahman F. AlBloushi, Mohannad F. Tobaigy, Priscilla W. Gikandi, Carl P. Herbort, Ghislain Opdenakker | | Acta Ophthalmologica. 2022; | | [Pubmed] | [DOI] | | | 6 |
Clinical relevance of fibrin membranous structures in the intra-photoreceptor outer segment separation on spectral domain optical coherence tomography (
SD-OCT
) in initial-onset acute
Vogt-Koyanagi-Harada
|
|
| Shuntaro Motegi, Koichi Nagura, Keisuke Yoneda, Kozo Harimoto, Tomohito Sato, Carl P. Herbort, Masaru Takeuchi | | Acta Ophthalmologica. 2022; | | [Pubmed] | [DOI] | | | 7 |
Vogt-Koyanagi-Harada disease: the step-by-step approach to a better understanding of clinicopathology, immunopathology, diagnosis, and management: a brief review |
|
| Cristhian A. Urzua, Carl P. Herbort, Masaru Takeuchi, Ariel Schlaen, Luz E. Concha-del-Rio, Yoshihiko Usui, Loreto Cuitino, Ioannis Papasavvas | | Journal of Ophthalmic Inflammation and Infection. 2022; 12(1) | | [Pubmed] | [DOI] | | | 8 |
Mechanisms, Pathophysiology and Current Immunomodulatory/Immunosuppressive Therapy of Non-Infectious and/or Immune-Mediated Choroiditis |
|
| Ioannis Papasavvas, Ilknur Tugal-Tutkun, Carl P. Herbort | | Pharmaceuticals. 2022; 15(4): 398 | | [Pubmed] | [DOI] | | | 9 |
Classification of Non-Infectious and/or Immune Mediated Choroiditis: A Brief Overview of the Essentials |
|
| Carl P. Herbort,Alessandro Mantovani,Ilknur Tugal-Tutkun,Ioannis Papasavvas | | Diagnostics. 2021; 11(6): 939 | | [Pubmed] | [DOI] | | | 10 |
Clinicopathology of non-infectious choroiditis: evolution of its appraisal during the last 2–3 decades from “white dot syndromes” to precise classification |
|
| Carl P. Herbort, Piergiorgio Neri, Ioannis Papasavvas | | Journal of Ophthalmic Inflammation and Infection. 2021; 11(1) | | [Pubmed] | [DOI] | | | 11 |
Comparison of combination therapy of prednisolone and cyclosporine with corticosteroid pulse therapy in Vogt–Koyanagi–Harada disease |
|
| Takashi Ono, Hiroshi Goto, Tsutomu Sakai, Fumihiko Nitta, Nobuhisa Mizuki, Hiroshi Takase, Yutaka Kaneko, Junko Hori, Satoko Nakano, Nobuhisa Nao-I, Nobuyuki Ohguro, Kazunori Miyata, Makoto Tomita, Manabu Mochizuki, Manabu Mochizuki, Takashi Ono, Takashi Komizo, Kazurori Miyata, Hiroshi Goto, Akihiko Umazume, Yoshihiko Usui, Tsutomu Sakai, Hideo Kohno, Ranko Aoyagi, Fumihiko Nitta, Kazuichi Maruyama, Nobuhisa Mizuki, Etsuko Shibuya, Yasutsugu Ida, Hiroshi Takase, Shintaro Horie, Mitsunao Ide, Yuko Iwasaki, Koju Kamoi, Yukiko Terada, Yutaka Kaneko, Junko Hori, Tomoko Yui, Ayaka Takeda, Satoko Nakano, Nobuhisa Nao-I, Nobuyuki Ohguro, Makoto Tomita | | Japanese Journal of Ophthalmology. 2021; | | [Pubmed] | [DOI] | | | 12 |
Precise, simplified diagnostic criteria and optimised management of initial-onset Vogt–Koyanagi–Harada disease: an updated review |
|
| Carl P. Herbort,Ilknur Tugal-Tutkun,Ahmed Abu-El-Asrar,Amod Gupta,Masaru Takeuchi,Christine Fardeau,Alireza Hedayatfar,Cristhian Urzua,Ioannis Papasavvas | | Eye. 2021; | | [Pubmed] | [DOI] | |
|
 |
|
|
|
Search Pubmed for