Usefulness of anterior chamber depth measurement for efficacy assessment of steroid pulse therapy in patients with Vogt-Koyanagi-Harada disease

Abstract

To clarify the usefulness of measuring anterior chamber depth by the IOLMaster for early-stage assessment of the therapeutic effect of steroid pulse therapy in patients with Vogt-Koyanagi-Harada (VKH) syndrome with active uveitis. Seven patients with VKH syndrome (three men and four women) participated in the study (14 eyes). All patients had exudative retinal detachment in addition to iritis, and received steroid pulse therapy: infusion of methylprednisolone (1000 mg × 3 days) followed by tapering oral administration of prednisolone (40, 30, 20, 15, 10, and 5 mg/day) over a week. Corrected visual acuity, manifest spherical equivalent, anterior chamber flare, axial length, and anterior chamber depth were measured before and after the pulse therapy. Anterior chamber flare was measured using a laser flare-cell meter, and axial length and anterior chamber depth were measured using the IOLMaster. After 1 week of steroid pulse therapy, anterior chamber depth significantly increased from the initial value of 2.94 ± 0.34 mm to 3.12 ± 0.38 mm (Wilcoxon signed-rank test, P = 0.002). After 1 month of steroid pulse therapy, significant changes were observed in corrected visual acuity (P = 0.01), manifest spherical equivalent (P = 0.002), anterior chamber flare (P = 0.03), axial length (P = 0.02), and anterior chamber depth (P = 0.002). Measurement of anterior chamber depth using the IOLMaster is useful for early-stage assessment of the effect of steroid pulse therapy in patients with VKH syndrome who develop active uveitis. Change in anterior chamber depth is the most sensitive indicator of inflammatory activity in patients with this syndrome.