FEB 25, 2008
By Russell W. Read, MD
Uveitis
This interventional retrospective case series examines the significant question of whether anterior segment recurrences seen in Vogt-Koyanagi-Harada syndrome (VKH) are associated with choroidal inflammation. Conventional uveitis wisdom considers recurrences in VKH to be typically anterior only and likely to be successfully treated with topical therapy. This may result in progressive visual decline if posterior segment disease is present as well.
The study provides important information regarding the need to search for posterior segment involvement in recurrent disease but does not convey a sense of how often posterior inflammation occurs in these cases.
Included in the study were 12 eyes of nine VKH patients with anterior chamber inflammation after quiescence of at least three months who lacked signs of posterior segment involvement and in whom indocyanine green angiography (ICGA) with or without fundus fluorescein angiography (FFA) was performed during anterior segment recurrence. ICGA indicated choroidal inflammation in some eyes that appeared to have isolated anterior chamber recurrence and in two contralateral eyes without anterior inflammation. Patients were given high-dose systemic steroid therapy that was slowly tapered, which, as demonstrated by subsequent ICGA, successfully treated anterior inflammation and decreased or erased the signs of choroidal involvement seen earlier via ICGA.
Some questions remain unanswered about the study's methodology that may impact the interpretation of its results. Information is lacking regarding the number of patients seen with anterior recurrences that did not meet the study criteria. Also it remains unclear why ICG and FFA were performed in patients with anterior inflammation only. If these studies were conducted due to some evidence, no matter how slight, of posterior disease, then the article is biased toward including only patients who would tend to have anterior and posterior disease.