The effect on choroidal changes of the route of systemic corticosteroids in acute Vogt-Koyanagi-Harada disease

Abstract

To determine whether route of corticosteroid administration during the acute stage of Vogt-Koyanagi-Harada (VKH) disease affects depigmentary change and subfoveal choroidal thickness (SCT) during the convalescent stage. In this retrospective comparative study, VKH patients with the interval between diagnosis and final follow-up of ≥24months were divided into two groups according to route of systemic corticosteroid; intravenous pulse therapy (IV pulse group) and oral administration (oral group). Sunset glow fundus (SGF) scores determined by ultra-wide field retinal imaging and SCT determined by enhanced depth imaging optical coherence tomography were compared. Forty eyes (20 patients) were included in the IV pulse group and 33 eyes (18 patients) in the oral group. At final follow-up, the IV pulse group showed significantly lower mean SGF score, indicating less advanced depigmentary change (3.7±1.5 vs. 5.1±1.2, P=0.007) and greater mean SCT (239.7±71.1μm vs. 183.8±72.6μm, P=0.012) than the oral group. However, visual acuities did not differ (P=0.245). In a cross-sectional evaluation at multiple time points from disease onset, the IV pulse group showed significantly lower SGF scores from 1 to 6years and greater SCTs from 2 to 5years. Multivariable regression analysis showed that IV pulse therapy and less frequent and shorter duration of inflammation predicted a lower SGF score (R2=0.291, P<0.001), and young age, IV pulse therapy, and shorter duration of inflammation predicted greater SCT (R2=0.27, P<0.001). Compared to oral administration, high dose IV pulse corticosteroids during the acute stage of VKH disease resulted in less choroidal change during the convalescent stage.