Short-term outcomes associated with oral prednisolone versus posterior sub-Tenon triamcinolone acetonide in acute ocular Vogt-Koyanagi-Harada disease

Abstract Purpose To describe short-term clinical and anatomical outcomes associated with oral prednisolone and posterior sub-Tenon triamcinolone acetonide as initial corticosteroid-based treatment strategies in acute ocular Vogt–Koyanagi–Harada Disease (VKH). Methods This retrospective comparative cohort study included 30 treatment-naïve patients (60 eyes) with acute ocular VKH treated at a tertiary referral center between January 2021 and December 2025. Patients were classified using a study-specific two-tier designation (definite or probable VKH) derived from the 2001 Revised Diagnostic Criteria. Treatment assignment (oral prednisolone, n = 15, 1.0 mg/kg/day tapered over 3–6 weeks; or PST/STA, n = 15) was guided by clinical severity and systemic involvement. The primary outcome was complete clinical and anatomical ocular control at 3 months, defined as absence of clinically active intraocular inflammation, resolution of subretinal fluid on OCT, and stable or improved BCVA. Secondary outcomes included BCVA over 6 months, OCT-based anatomical recovery, recurrence rates, rescue therapy requirement, and adverse events. Resolution of subretinal fluid was assessed qualitatively on OCT as complete disappearance of the subretinal fluid pocket, with central macular thickness (CMT) recorded in parallel as a supportive structural measure. Statistical analyses included the independent and paired t-tests, two-sided Fisher’s exact test, and Kaplan–Meier analysis with the log-rank test. Results At 3 months, complete clinical and anatomical ocular control was achieved in 12/15 (80.0%) patients receiving prednisolone and 11/15 (73.3%) receiving PST/STA ( p = 1.00, Fisher’s exact test). Resolution of subretinal fluid occurred in 86.7% (13/15) and 80.0% (12/15) of patients, respectively ( p = 1.00, Fisher’s exact test). Mean BCVA improved in both groups over 6 months, with no statistically significant between-group difference. OCT analysis demonstrated no statistically significant between-group differences in the assessed anatomical outcomes. Recurrence occurred in 20.0% of the prednisolone group and 26.7% of the PST/STA group (log-rank p = 0.68). Systemic corticosteroid–related metabolic complications were observed only in the prednisolone group, while PST/STA was associated with transient local discomfort and mild intraocular pressure elevation. No serious ocular complications occurred. Conclusion In this retrospective, non-randomized cohort, no statistically significant differences were detected between oral prednisolone and PST/STA in the short-term clinical and anatomical outcomes assessed. Because treatment allocation was influenced by disease severity and systemic involvement, the sample size was small, no a priori sample-size calculation was performed, and the systemic corticosteroid regimen was abbreviated, these findings should not be interpreted as evidence of therapeutic equivalence or as establishing PST/STA as an alternative to systemic corticosteroid therapy. Prospective, adequately powered studies with standardized assessment of ocular and systemic disease severity are needed. Trial registration ClinicalTrials.gov, NCT07405489. Registered 30 January 2026 (retrospectively registered), https://clinicaltrials.gov/study/NCT07405489 .