Pathophysiology Analysis of Vogt-Koyanagi-Harada Disease by Analysis of Intraocular Fluid

2022 Fiscal Year Final Research Report

• Project/Area Number: 19K09972
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 56060:Ophthalmology-related
• Research Institution: Kyoto Prefectural University of Medicine
• Principal Investigator: Nagata Kenji 京都府立医科大学, 医学部附属病院, 専攻医 (00457988)
• Project Period (FY): 2019-04-01 – 2023-03-31
• Keywords: Vogt-小柳-原田病 / ぶどう膜炎

Outline of Final Research Achievements

The presence or absence of various viral DNA in spinal fluid was examined as a candidate cause for triggering the onset of Vogt-Koyanagi-Harada (VKH) disease, but all were negative, suggesting that a specific pathogen is unlikely to be involved.
Ciliochoroidal detachment was detected in 83.3% of eyes at the initial visit and improved within 2 months. The ciliary body was thickened at the onset of VKH disease and gradually decreased with treatment, reaching a plateau within 2 months. Our findings suggest that anterior segment-OCT is useful for diagnosis and follow up. Univariate analysis showed that older age, a longer elapsed time from the awareness of ocular symptoms to initial presentation, and the use of generic drugs for steroid pulse therapy (SPT) were significantly associated with the recurrence of VKH disease. Logistic regression analysis findings revealed that when performing SPT, the use of generic drugs was significantly associated with a higher risk of recurrence.

Free Research Field

ぶどう膜炎

Academic Significance and Societal Importance of the Research Achievements

Vogt-小柳-原田病の発症の誘因には特定のウイルスは検出されず、異なる病態を検討する必要がある。髄液で病態にかかわる炎症性サイトカインを同定した。これまで診断・経過観察にほとんど用いられていなかった前眼部OCTが原田病の診断および治療の評価に有用なことが分かった。これによってより良い治療につながると考えられる。また治療にはステロイドパルス療法に後発医薬品を用いた場合、再発のリスクが有意に上昇することが分かった。近年後発医薬品の使用が増えている中で、原田病のような急性期の治療が重要な関しては先発品の使用が望ましいことが分かり、今後の本疾患の予後改善につながる成果である。