Clinical Study
Eye (2008) 22, 240–245; doi:10.1038/sj.eye.6702591; published online 15 September 2006
Correlation between peripapillary atrophy and corticosteroid therapy in patients with Vogt–Koyanagi–Harada disease
The Singapore Eye Research Institute was the sponsoring organization
A Jap1,2, C D Luu3, I Yeo1 and S-P Chee1,3,4
- 1Singapore National Eye Centre, Singapore, Singapore
- 2Division of Ophthalmology, Changi General Hospital, Singapore, Singapore
- 3Singapore Eye Research Institute, Singapore, Singapore
- 4Department of Ophthalmology, National University of Singapore, Singapore, Singapore
Correspondence: S-P Chee, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, Singapore. Tel: +65 6227 7255; Fax: +65 6227 7290; E-mail: chee.soon.phaik@ snec.com.sg
Received 27 February 2006; Accepted 8 August 2006; Published online 15 September 2006.
Abstract
Aims
To determine the correlation between systemic corticosteroid therapy and the occurrence and size of peripapillary atrophy (PPA) in patients with Vogt–Koyanagi–Harada (VKH) disease.
Methods
All patients with VKH disease were retrospectively reviewed for their corticosteroid regimen. The extent of the PPA, if present, was measured using digitized imaging software, by two masked observers. Eyes with myopia greater than 6 dioptres or glaucoma were excluded. The patients were classified into three groups: early high (EH), late high (LH), and low dose (LD), according to the dose and timing of corticosteroids received during the acute phase of the disease.
Results
There were 40 eyes in the EH group, 25 eyes in the LH group, and 23 eyes in the LD group. Multivariate analysis showed that corticosteroid therapy was the main determinant of PPA occurrence. All the eyes in the LD group had PPA and eyes in the LH groups were 4.02 times (95% confidence interval 1.24–13.07) more likely to develop PPA than those in the EH group. The LD group also had larger PPA to disc ratios than the EH group. (Mean of 2.83 vs0.19, P<0.001)
Conclusion
The development and extent of PPA in patients with VKH disease appear to be dependent on the dose and timing of systemic corticosteroids.
Keywords:
Vogt–Koyanagi–Harada disease, corticosteroids
