The outcomes of indocyanine green angiography monitored immunotherapy in Vogt―Koyanagi― Harada disease

Aims To compare outcomes of indocyanine green angiography (ICGA) versus clinically monitored immunotherapy in Vogt-Koyanagi-Harada (VKH) disease. Methods Consecutive patients of Singapore National Eye Centre with VKH receiving high-dose corticosteroids within 4 weeks of onset of symptoms had therapy titrated to clinical signs of activity (controls) or ICGA findings (ICGA). Charts were reviewed for demographics, interval to treatment, duration of therapy and number of systemic immunosuppressants required. Outcome measures were best corrected acuity, disease activity, presence of sunset glow (SSG) fundus and peripapillary atrophy (PPA) at 2 years. Results 52 patients were included (38 controls, 14 ICGA). Duration of treatment was shorter in the control group (17 vs 42 months, p<0.001) and they required fewer systemic immunosuppressants than the ICGA group (16% vs 96%, p<0.001). The majority (49 eyes, 96.1%) had 6/12 or better vision and were clinically quiet (43 eyes, 84.3%) in both groups. SSG fundus and PPA were similar in both groups. Treatment within 2 weeks of onset was the main factor affecting their occurrence on multivariate analysis (OR 0.18, 95% CI 0.03 to 0.9, p=0.047; OR 0.08, 95% CI 0.01 to 0.51, p=0.007, respectively). Conclusions ICGA-guided immunotherapy did not result in significantly better outcomes with respect to visual acuity and disease activity in VKH eyes treated within 1 month of onset.