Clinical Features of Recurred Vogt-Koyanagi-Harada Syndrome during Oral Steroids Tapering Therapy

Purpose: To evaluate the clinical features of recurrent Vogt-Koyanagi-Harada syndrome during steroid tapering after high-dose intravenous steroid therapy. Methods: We retrospectively reviewed the medical records of eight patients who were diagnosed and treated for Vogt-KoyanagiHarada syndrome from January 2010 to December 2017. Recurrence was defined as the occurrence of uveitis or serous retinal detachment during oral steroid tapering. We grouped the patients into two groups according to recurrence, and compared the best-corrected visual acuity, maximum height of subretinal fluid, central subfield thickness, choroidal thickness, average steroid tapering period and images from optical coherence tomography. Results: Seventeen patients were included and five patients (29.4%) recurred during oral steroid tapering. Patients with recurrent episodes were treated with increasing doses of oral steroid and/or oral immunosuppressant and sub-tenon injection of triamcinolone. Serous retinal detachment was completely absorbed after 24 weeks of treatment in all 17 patients, including the recurrence group and the best-corrected visual acuity was not significantly different between the two groups. The heights of the subretinal fluid and thicknesses of the central subfield before treatment were significantly higher in the recurrence group than in the non-recurrence group. Conclusions: Serous retinal detachment can recur during oral steroid tapering after high-dose intravenous steroid treatment in patients with Vogt-Koyanagi-Harada syndrome suggesting that the height of the subretinal fluid at the fovea and central subfield thickness before treatment are factors associated with recurrence. Even in the case of recurrence, good visual prognosis can be expected after additional treatment according to the clinical situation.