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Gueorgui Markov, Kittikamol Vongpaisarnsin, C. Stephen Foster; Immunomodulatory therapy and multiple sclerosis-associated uveitis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2047.
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To assess the efficacy of immunomodulatory therapy in achieving remission and long-term control of inflammation in patients with multiple sclerosis-associated uveitis.
A retrospective case series study on the clinical records of 10 consecutive patients with uveitis and multiple sclerosis, treated at the Massachusetts Eye Research and Surgery Institution. Period of study was from July 2005 to November 2012. Evaluation of effectiveness was based on findings from the clinical exam and specialized imaging tests.
All 10 patients (100%) were female, white. Mean age of presentation at our institution was 49.3 years. Mean follow-up was 70.4 months. Intermediate uveitis was diagnosed in 6 cases (60%), panuveitis - in 3 (30%), posterior - in 1 (10%). Bilateral involvement was present in all (100%) patients. Active uveitis was observed in 6 (60%) and quiescent in 4 (40%), initially. Immunomodulatory medications as monotherapy included azathioprine in 1 patient (10%), methotrexate - in 5 (50%), mycophenolate mofetil - in 4 (40%), cyclosporin - in 1 (10%), Daclizumab - in 2 (20%), and cyclophosphamide - in 2 (20%). Combined therapy was used with mycophenolate mofetil and cyclosporin in 4 cases (40%), cyclosporin and azathioprine - in 2 (20%), and methotrexate and cyclosporin - in 1 (10%). Corticosteroids, by various routes, were utilized in all patients (100%). 6 patients (60%) were corticosteroid-dependent. 7 patients (70%) had systemic therapy for multiple sclerosis with Glatiramer acetate in 3 (30%) of them, interferon beta-1a - in 3 (30%), and interferon beta-1b - in 1 (10%). At the end of follow-up, 1 patient (10%) was in remission for 19 months following azathioprine therapy, 2 (20%) - quiescent with no immunomodulatory therapy or corticosteroids for 6 and 12 months, with no previous stable remission, 1 (10%) - stable on mycophenolate mofetil and cyclosporin for 21 months, 2 (20%) - maintained on immunomodulatory therapy and corticosteroids for 8 and 37 months, 5 eyes of 3 patients - quiescent after fluocinolone acetonide intravitreal implant for as long as 60 months, 3 eyes of 2 patients had signs of active disease.
Uveitis, associated with multiple sclerosis, is characterized by a protracted and complicated course. Remission is possible with the use of immunomodulatory agents. In addition, the intravitreal fluocinolone implant could present a reasonable alternative in recalcitrant cases.
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