[Vogt-Koyanagi-Harada syndrome: glucocorticoid therapy and visual prognosis]

To evaluate the efficacy of glucocorticoid therapy in patients with Vogt-Koyanagi-Harada (VKH) syndrome.

One hundred and thirty-six patients with VKH were treated with two regimens of oral prednisone. Regimen 1: Fifty-one patients with VKH were treated at the uveitic stage with prednisone, starting from 2 mg/kg/day tapering gradually and shifting to alternate-day treatment. The patients were treated for approximately 8 months. Regimen 2: Eighty-five patients with VKH were referrals who were treated elsewhere with systemic glucocorticoid more than 2 months with total dose equivalent to prednisone more than 2 000 mg. Systemic and ocular complications were found in some of these patients. The hypothalamus-pituitary-adrenal axis was markedly inhibited as indicated by decrease in urine free cortisol (UFC). These patients were treated for 6 - 10 months based on the patients' individual ocular situations. The visual results, frequency of recurrence of uveitis and incidence of ocular complications were compared between the two groups.

Visual acuity >/= 0.5 and >/= 0.8 were found to be 94.1% and 79.4% respectively in patients treated with regimen 1 which was far better than the patients treated with regimen 2. On the other hand, recurrence of uveitis and ocular complications were found significantly lower in the patients treated with regimen 1, as compared with that in patients treated with regimen 2 (23.5% vs. 63.5% and 9.8% vs. 49.4% respectively). All the differences are highly significant (P < 0.001). The UFC level in the patients treated with regimen 2 was increased from (5.3 +/- 5.8) microgram/24 h to (21.9 +/- 7.2) microgram/24 h (P < 0.001).

These results indicate that both regimens are feasible for treating patients with VKH. However, regimen 1 is far better than regimen 2 with respect to visual prognosis, frequency of recurrence of uveitis as well as incidence of ocular complications.