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N. Stuebiger, C. M. E. Deuter, D. Doycheva, H. Jaegle, M. Zierhut; Treatment of Birdshot Chorioretinopathy With Mycophenolate Mofetil or Mycophenolate Sodium. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2689.
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To evaluate the outcome of patients with birdshot retinochoroidopathy (BRC) treated with mycophenolate mofetil (MMF, CellCept®) or mycophenolate sodium (MPS, Myfortic®).
We retrospectively reviewed the medical charts of patients with BRC who were treated with MMF or MA and were evaluated consecutively at a tertiary-care german uveitis clinic over a 27-year period. Data on age, gender, follow-up time, treatment before and side effects of MMF/MPA treatment were recorded. In addition logMAR visual acuities, electroretinograms (ERGs), and visual field findings were measured for evaluation of disease control.
Fourteen BRC patients (female:male=9:5), all of whom were HLA-B29 positive, with a mean uveitis duration of 55.8 months (range 5-240 months) before MMF or MPS therapy were included. None of the patients in this cohort had sufficient control of inflammation before initiation of MMF or MPS therapy even despite earlier immunosuppressive treatment in three patients (one patient azathioprine, two patients cyclosporine). The follow-up after initiation of MMF or MPS therapy consisted of 38.9±22.8 months (at least 6 months). Three patients were switched on MPS after they disclosed side effects due to MMF and one patient received MPS initially, so, in addition, no patient had to stop treatment due to side effects. Inflammation was reduced or stabilized in 12 patients (86%) and a steroid-sparing effect was achieved in all of the ten patients, who had received corticosteroids at the time of therapy start. Average logMAR visual acuity (VA) at the time before starting the immunosuppressive therapy was 0.36 (right eye) and 0.5 (left eye). Average final logMAR VAs were 0.4 (right eye) and 0.6 (left eye). Visual fields and ERGs were performed regularly over time on 10 of 14 patients; eight of ten patients demonstrated stabilized or even a slightly improvement of visual field and ERG indices.
Preservation of visual function is attainable with systemic MMF or MPS medication in patients with BRC. Prompt treatment with these immunosuppressives may offer a good chance for maintaining retinal function.
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