AB1019 THERAPEUTIC PROFILE OF PATIENTS WITH VOGT KOYANAGI HARADA DISEASE FOLLOWED AT THE HOSPITAL DE CLÍNICAS. SAN LORENZO PARAGUAY.
Authors: N. Colman, J. Losanto, S. Riquelme, M. Melo
Journal: Annals of the Rheumatic Diseases (2020)

Background: Vogt-Koyanagi-Harada Disease (VKHD) is an autoimmune eye disease that causes chronic vision complications in young people. The treatment is based on corticosteroids and immunosuppressants, to which biological drugs are currently added. The visual prognosis depends on the stage in which it is diagnosed and the effective and timely treatment. 1,2 Objectives: Describe the evolution and the therapeutic profile of patients with VKHD who go to the Rheumatology Department of the Hospital de Clínicas. San Lorenzo Paraguay until November 2019 Methods: Descriptive cross-sectional study conducted at the Hospital de Clínicas, San Lorenzo Paraguay, where clinical histories of patients with this disease and who have regular follow-up were reviewed. Results: 21 patients were included, 17 (81%) women, average age of 35 years. The diagnosis and treatment were made 15 (71%) in acute phase, 4 (19%) convalescent phase and 2 (10%) in chronic phase. Corticosteroids: All received corticosteroids at diagnosis. Methylprednisolone IV 1g /day for 3 consecutive days in 8 (44%) cases and for 5 days in 10 (55.5%) cases. The first month everyone received prednisone orally at 1mg / kg / d on average (60-75 mg/d), at 3 months the average dose of prednisone was 37 mg / d, at 6 months of 23 mg/d and at 12 months 10 mg / d months. Immunosuppressive treatment: They received 20 (95%) patients. Induction with monthly intravenous cyclophosphamide was performed in 8 (40%) cases and with Azathioprine in 12 (60%) cases. Of the patients treated with Azathioprine initially, in 5 (23%) patients it was necessary to switch to Cyclophosphamide IV due to failure or intolerance. The maintenance treatment was azathioprine in 13 (62%) of the patients, MTX in 4 (19%) and the association of both drugs was indicated in 3 (14%) patients. One case was refractory and received infliximab and subsequently Rituximab, which resulted in remission. The best final Visual Acuity (AV) was recorded with the Snellen chart in 40 eyes (20 patients), 27 (67.5%) patients with good vision (20/20 to 20/50), 8 (20%) patients with decreased VA (20 / 50-20 / 200), and 5 (12.5%) with legal blindness (&lt;20/200) and of these only 3 patients had unilateral involvement and one patient with bilateral blindness. Sequelae / complications: 6 (28.5%) patients presented cataracts and finally 3 (14%) glaucoma, 5 (24%) anterior / posterior synechiae. Conclusion: The majority of patients in this series presented a good vision when the inflammatory process was resolved (AV 20 / 20-20 / 50), this probably related to early diagnosis and initial aggressive treatment with intravenous corticosteroid pulses and its association with immunosuppressants of entry as mentioned in the literature. The worst vision, (visual acuity &lt;20/200) occurred in 5 of 40 eyes, corresponding to 4 patients, two of them diagnosed and treated in the chronic stage. Timely treatment improves visual prognosis. References: [1]Lodhi SAK, Lokabhi Reddy JM, Peram V. Clinical spectrum and management options in Vogt–Koyanagi–Harada disease. Clin Ophthalmol. 2017;11:1399–406. [2]Concha-del Río LE, Gómez L, Arellanes-García L. Corticotherapy vs. Corticotherapy Plus Immunosuppressive Therapy in Acute Vogt-Koyanagi-Harada Disease. Arch Soc Esp Oftalmol [Internet]. 2018;93(5):225–30. Available from: https://doi.org/10.1016/j.oftal.2017.09.010 Acknowledgments: Department of Rheumatology Department of Ophthalmology Disclosure of Interests: None declared