Association of systemic steroids and mycophenolate mofetil as rescue therapy for uveitic choroidal neovascularization unresponsive to the traditional immunosuppressants: interventional case series

Int Ophthalmol. 2010 Oct;30(5):583-90. doi: 10.1007/s10792-009-9323-x. Epub 2009 Sep 2.

Abstract

To study the efficacy of systemic steroids (SS) associated with mycophenolate mofetil (MMF) for the control of juxta/sub-foveal uveitic choroidal neovascularization (CNV) unresponsive to the traditional immunosuppressive agents. Patients with juxta/sub-foveal uveitic CNV unresponsive to the traditional immunosuppressive drugs were treated with SS and MMF. The study was designed as a prospective, consecutive, open-label, interventional case series. Visual gain and loss were defined as improving or worsening of two or more lines of best-corrected visual acuity (BCVA), respectively. CNV size outcome was dichotomized as "increased" or "stable/reduced", if increased >200 μm(2), or reduced ≥ 200 μm(2) or not modified by 200 μm(2), respectively. Nine cases (12 eyes) have been considered; ages ranged from 27 to 56 years. The mean follow-up time was 18.2 ± 2.9 months (min: 14 months, max: 23 months). At base-line, the mean BCVA was 0.3 ± 0.17, improving up to 0.57 ± 0.25 and to 0.63 ± 0.22 (P < 0.001, paired t-test) at the 6 and 12-month follow-ups, respectively. At the last follow-up, all the patients had stable/improved BCVA (P < 0.0001, Fisher's exact test) and stable/reduced lesion size (P < 0.0001, Fisher's exact test). None of the patients complained of any severe adverse event during the treatment. The combination of SS and MMF seems to be a promising strategy in order to control uveitic CNVs unresponsive to the traditional immunosuppressive agents. Further studies are needed to validate the data of this case series.

Publication types

  • Case Reports

MeSH terms

  • Administration, Oral
  • Adult
  • Choroidal Neovascularization / complications
  • Choroidal Neovascularization / drug therapy*
  • Choroidal Neovascularization / physiopathology
  • Drug Therapy, Combination
  • Female
  • Fluorescein Angiography
  • Glucocorticoids / administration & dosage*
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Injections, Intravenous
  • Male
  • Methylprednisolone / administration & dosage
  • Middle Aged
  • Mycophenolic Acid / administration & dosage
  • Mycophenolic Acid / analogs & derivatives*
  • Prednisolone / administration & dosage
  • Salvage Therapy*
  • Uveitis / complications
  • Uveitis / drug therapy*
  • Uveitis / physiopathology
  • Visual Acuity

Substances

  • Glucocorticoids
  • Immunosuppressive Agents
  • Prednisolone
  • Mycophenolic Acid
  • Methylprednisolone