[Therapeutic regimen in Vogt-Koyanagi-Harada syndrome]

To compare the effectiveness of therapeutic regimen in Vogt-Koyanagi-Harada (VKH) syndrome and determine the reasonable regimen for different patients.

Data of 82 patients with VKH syndrome, coming from all over China and referred to Zhongshan Ophthalmic Center from January 1996 to December 2000 were retrospectively analyzed. Twenty-eight patients (56 eyes) with first attack of the intraocular inflammation were treated with oral prednisone for more than one year, whereas 54 patients (108 eyes) with recurrent episodes were treated with chlorambucil for more than one year. All patients were treated with a combination of these immunosuppressives with traditional Chinese medicine herbs, and followed up more than one year after systemic treatment. The previous treatment for these 54 patients was also analyzed in an attempt to compare these results with those presented here.

Uveitis was completely controlled in 96.4% of the patients treated with oral prednisone, and all of these patients showed improved vision after treatment. A complete control of uveitis was achieved in 94.4% and improved vision was seen in 88.0% of the patients treated with chlorambucil. All of these 54 patients, although treated with longer but intermittent systemic corticosteroids before installation of chlorambucil, showed a chronic or recurrent uveitis and most cases had markedly decreased vision as compared with those treated by us with regular systemic corticosteroids.

Intensive and prolonged systemic treatment with corticosteroids is recommended for the patients with first attack of VKH syndrome, where as regular treatment with chlorambucil is useful for control of chronic and recurrent uveitis seen in VKH syndrome. Traditional Chinese medicine herbs may be helpful in amelioration of uveitis and reduction of side effects of immunosuppressives.