Effectiveness And Safety Study Of Local Injection Corticosteroid In The Treatment Of Vogt-Koyanagi-Harada Disease

Objective: ①Comparison the treatment of pulse corticosteroid in Vogt-Koyanagi-Harada disease,the change of sight and subretinal fluid,effects of long-term after the treatment with local injection corticosteroid.②The study of corticosteroid complications in the treatment of Vogt-Koyanagi-Harada disease with local injection corticosteroid.③The recurrence of local injection corticosteroid for Vogt-Koyanagi-Harada disease.Methods: Data of 13 patients with Harada Disease,coming from The Second Hospital of Hebei Medical University.They were hospitalized and treated with local injection corticosteroid therapy between November 2013 to December 2014.The groups were as follows: ① BCVA > 0.1,18 eyes of 10 patients were treated with intravitreal triamcinolone acetonide(4mg/eye).Triamcinolone Acetomide(20mg/eye/time) was administered by retrobulbar injection according to the situation.②BCVA is < 0.1,6 eyes of 3 patients were treated with pulse corticosteroid therapy(500mg/d) before,then they were treated with intravitreal triamcinolone acetonide(4mg/eye). ③Patients with recurrent episodes were treated with pulse corticosteroid therapy(500mg/d).Check 24 eyes using optical coherence tomography(OCT) at day 0,day 3,day 7, 2weeks,1months,3months and 6months.Check 24 eyes using fundus color photos and fundus fluorescein angiography at day 0 and 6month. Weight,blood pressure,menstruation(in female patients),BCVA, intraocular pressure,and complications.Results: The mean BCVA at 3 days,1 weak,2 weaks,1 month,3 months,6 months after treatment with intravitreal triamcinolone acetonide was 0.39±0.26, 0.20±0.14, 0.05±0.05, 0.02±0.04, 0.02±0.04, 0.02±0.04 respectiv- ely,improved significantly than that before teatment 0.69±0.42.The mean BCVA improved significantly in the first 3-7 days,and had little change in 1 month,then kept steady in 3 months.OCT revealed retinal neuroepithelial edema and serous detachment of retinal neuroepithelia and subretinal septa that divided the subretinal space into several compartment.The mean CRT was 624.13±328.73 μm before treatment,and 337.71±187.59, 278.29±140.52, 253.17±157.68, 242.08±178.53, 217.08±88.31, 182.29±16.10 μm respectively at 3 days, 1 week, 2 weaks, 1 month, 3 months and 6 months post-treatment,the difference had statistics significance( F=16.36,P=0.00).The difference of CRT between pre-treament and 3 days 、1weeks、2weeks after treatment were statistically significant(P<0.05).The difference among the 2weeks and 1month、3 months and 6 months post-treatment was not significant(P>0.05).The average height of retinal detachment was 937.21±316.00 μm before treatment,After therapy,the serous retinal detachment were improved and even resolved completely.FFA reavealed all patients had choroids fluorescein filling later at the post hole of ocular funds.In 22 eyes,multiple small exudation of RPE appeared in the early phase and cystic fluorescein reservoir was observed in the lake phase.Sunset glow fundus were noted in 4 eyes after 6months.Conclusions:1 Intravitreal triamcinolone acetonide can accelerate retinal reattachment, improve visual acuity2 No side-effect was founded in treatment of Vogt-Koyanagi-Harada disease with Intravitreal triamcinolone acetonide.However the clinical curative effect of Intravitreal triamcinolone acetonide needs sizable sample and long term follow-up and observation.3 OCT may show the progress of neuro-retinal recovery and CRT changes, thus provide a valuable method to monitor the diagnosis and predict the prognosis of VKH.