Treatment Initiation within the Therapeutic Window of Opportunity in Acute Uveitic Phase of Vogt-Koyanagi-Harada Disease Preserves Photoreceptor Function

Purpose To evaluate central retinal sensitivity in patients with initial-onset acute uveitis associated with Vogt–Koyanagi–Harada (VKH) disease treated within (early presentation) or outside (late presentation) the therapeutic window of opportunity after discontinuation of immunosuppressive therapy without relapse of inflammation.Methods In this retrospective study, 19 patients (38 eyes) presented in the phase preceding anterior segment (AS) inflammation (early presentation) and 17 patients (33 eyes) had AS inflammation at presentation (late presentation). MP-1 microperimetric evaluation of retinal sensitivity in the central 12 degrees was assessed at last follow-up after treatment.Results The median follow-up period, duration of treatment, and interval between discontinuation of treatment and last follow-up were 20, 16.5, and 6 months, respectively. None of the eyes in the early presentation group developed “sunset glow fundus” (SGF), whereas in the late presentation group, 81.8% of the eyes developed SGF (p < 0.001). Mean retinal sensitivity was significantly worse in the late presentation group and in the eyes that developed SGF (p < 0.001 for both comparisons).Conclusions Prompt institution of effective immunosuppressive therapy within the therapeutic window of opportunity preserves photoreceptor function.