AUTHOR=Choo Charlene H. , Acharya Nisha R. , Shantha Jessica G. 

TITLE=Common practice patterns in the diagnosis and management of Vogt–Koyanagi–Harada syndrome: a survey study of uveitis specialists

JOURNAL=Frontiers in Ophthalmology

VOLUME=Volume 3 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/ophthalmology/articles/10.3389/fopht.2023.1217711

DOI=10.3389/fopht.2023.1217711

ISSN=2674-0826

ABSTRACT=Introduction: Vogt-Koyanagi-Harada (VKH) syndrome is an inflammatory condition characterized by bilateral, granulomatous panuveitis with or without systemic manifestations, and accounts for up to 18% of referrals for panuveitis at tertiary centers in the United States.Despite ongoing research, there is limited evidence and no clear consensus on how to diagnose and treat patients with VKH, leading to variations in practice patterns among uveitis specialists.Methods: An anonymous, online survey was distributed to uveitis specialists in the American Uveitis Society (AUS). The survey included 21 questions that asked for nonidentifiable demographics and covered topics such as preferred imaging modalities, treatment for the first episode of VKH, and perceived efficacy of immunomodulatory therapy (IMT).Results: A total of 104 surveys were included for analysis, representing a 38.4% response rate from the AUS listserv. A majority of respondents were uveitis fellowship-trained and practiced in North America in an academic setting. Fluorescein angiography and enhanced depth imaging optical coherence tomography were rated as the most consistently useful for the diagnosis of VKH. For treatment of acute initial-onset VKH, responses were divided between a preference for high-dose systemic corticosteroids with IMT (61.5%) or without IMT (37.5%). Methotrexate and mycophenolate mofetil were the most common IMT to be used as first-line, but adalimumab and infliximab were perceived to be the most effective for the treatment for VKH.Discussion: While there are some common trends in the practice patterns for the diagnosis and treatment of patients with VKH, there was no clear consensus on the topic of IMT. There was a slight preference of uveitis specialists to use both IMT and systemic corticosteroids for the first episode of acute VKH.