Catching the therapeutic window of opportunity in early initial-onset Vogt–Koyanagi–Harada uveitis can cure the disease

• Published in: International ophthalmology Vol. 39; no. 6; pp. 1419 - 1425
• Main Authors: Herbort, Carl P., Abu El Asrar, Ahmed M., Takeuchi, Masuru, Pavésio, Carlos E., Couto, Cristobal, Hedayatfar, Alireza, Maruyama, Kazuichi, Rao, Xi, Silpa-archa, Sukhum, Somkijrungroj, Thanapong
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.06.2019; Springer Nature B.V
• Subjects: Arthritis; Autoimmune diseases; Choroiditis; Chronic illnesses; Evolution; Immunosuppressive agents; Medical treatment; Medicine; Medicine & Public Health; Ophthalmology; Perspectives or Expert Opinions; Rheumatoid arthritis; Stroma; Uveitis; Windows (intervals); Indocyanine green angiography; Autoimmune disease; Vogt–Koyanagi–Harada disease; Immunosuppressive therapy; Therapeutic window of opportunity stromal choroiditis; Sunset glow fundus
• ISSN: 0165-5701; 1573-2630; 1573-2630
• DOI: 10.1007/s10792-018-0949-4

Purpose Vogt–Koyanagi–Harada (VKH) disease is a primary autoimmune granulomatous choroiditis that begins in the choroidal stroma. The aim of this review was to gather a body of evidence for the concept of a window of therapeutic opportunity, defined as a time interval following initial-onset disease during which adequate treatment will substantially modify the disease outcome and possibly even lead to cure, similar to what has been described for rheumatoid arthritis. Methods We reviewed the literature and consulted leading experts in VKH disease to determine the consensus for the notion of a therapeutic window of opportunity in VKH disease. Results We found a substantial body of evidence in the literature that a therapeutic window of opportunity exists for initial-onset acute uveitis associated with VKH disease. The disease outcome can be substantially improved if dual systemic steroidal and non-steroidal immunosuppressants are given within 2–3 weeks of the onset of initial VKH disease, avoiding evolution to chronic disease and development of “sunset glow fundus.” Several studies additionally report series in which the disease could be cured, using such an approach. Conclusions There is substantial evidence for a therapeutic window of opportunity in initial-onset acute VKH disease. Timely and adequate treatment led to substantial improvement of disease outcome and prevented chronic evolution and “sunset glow fundus,” and very early treatment led to the cure after discontinuation of therapy in several series, likely due to the fact that the choroid is the sole origin of inflammation in VKH disease.