The place of dexamethasone implant in patients with Vogt–Koyanagi–Harada disease who experienced systemic treatment-related hepatic dysfunction: A case series

Abstract

We presented our observation with dexamethasone (DEX) implant in six eyes of three patients with Vogt–Koyanagi–Harada (VKH) disease who experienced hepatic dysfunction due to the systemic immunosuppressive therapy during their follow-up. Three cases who could not continue with the azathioprine (AZA) or adalimumab (ADA) treatment due to elevated liver enzymes were given consecutive bilateral DEX implant injections during the follow-up. In the first case, oral AZA was discontinued due to an elevation of the liver enzymes at the 2nd month of AZA treatment, and then she received five bilateral DEX implant administrations during the follow-up of 61 months without any intraocular pressure rise or disease recurrence. The remaining two patients had an elevation of the liver enzymes when ADA treatment was added to the prophylactic isoniazid therapy and they each received three bilateral DEX implant administrations within a year again without any complications and disease recurrence. DEX implant can be a safe and effective alternative for individuals with VKH disease whose systemic treatment is ceased due to adverse effects of the systemic treatment and intravitreal therapy with DEX implant can be beneficial to achieve a recurrence-free follow-up.

Keywords

• adalimumab
• azathioprine
• dexamethasone implant
• hepatic dysfunction
• serous retinal detachment
• vogt–koyanagi–harada disease