Clinical and OCT Predictors of Refractory Vogt-Koyanagi-Harada Disease.

Objective: To identify baseline clinical and OCT predictors of refractoriness in Vogt-Koyanagi-Harada (VKH) disease. Design: A retrospective cohort study. Participants: Two hundred thirty-seven patients (472 eyes) with VKH disease seen at Yokohama City University Hospital between November 2009 and March 2024. Methods: Patients were diagnosed according to the revised international diagnostic criteria and all received systemic corticosteroid pulse therapy. Baseline demographic, clinical, and OCT findings were collected, and logistic regression analyses were performed to evaluate associations with refractory disease, defined as ≥2 recurrences or the need for additional immunosuppressive therapy. The study was approved by the institutional review board and conducted in accordance with the Declaration of Helsinki. Main Outcome Measures: Associations between baseline clinical and OCT findings, including visual acuity (VA), central retinal thickness (CRT), bacillary layer detachment (BALAD), and interval from onset to pulse therapy, and the development of refractory VKH. Results: Twenty-six patients (11.0%; 52 eyes) developed refractory VKH, whereas 211 patients (89.0%; 420 eyes) were nonrefractory. In the primary multivariable analysis, worse baseline VA (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.19-1.96; Conclusions: Poor baseline VA was the most consistent predictor of refractory VKH. Greater CRT, delayed initiation of pulse therapy, and female sex showed associations in the primary model but should be regarded as candidate predictors that require confirmation, whereas BALAD was not associated with refractoriness. Financial Disclosures: The authors have no proprietary or commercial interest in any materials discussed in this article.