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Takehito Iwase, Hirotaka Yokouchi, Takayuki Baba, Toshiyuki Oshitari, Shuichi Yamamoto; Thalidomide Treatment Reduces Optic Disc Edema in Patients with POEMS Syndrome. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4569.
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© ARVO (1962-2015); The Authors (2016-present)
To determine whether thalidomide treatment can reduce the optic disc edema in patients with the polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome.
This was a retrospective, observational case series. We studied 10 eyes of 5 treatment naïve patients with POEMS syndrome presenting with bilateral optic disc edema at the Chiba University Hospital from June 2013 through May 2015.Thalidomide treatment was initiated with 100 mg combined with 20 mg/m2 dexamethasone daily at monthly intervals, and the thalidomide dose was subsequently increased to 200 mg. The peripapillary retinal nerve fiber layer (pRNFL) thickness was determined by spectral-domain optical coherence tomography (SD-OCT) to assess the degree of optic disc edema. The pRNFL thickness and the foveal thickness (FT) were measured at the baseline, and at 3 and 6 months after the thalidomide treatment. The serum level of VEGF was also determined by enzyme-linked immunosorbent assays (ELISAs) at the baseline, and at 3 and 6 months after beginning the treatment. The Wilcoxon signed-rank test was used to determine if the differences between the pRNFL and the FT at the baseline and 3 and 6 months were significant. We also determined if the differences in the serum levels of VEGF at the baseline and 3 and 6 months after the treatment were significant.
At the baseline, the mean pRNFL was 220 ± 62.8 µm, the mean FT was 239.9 ± 13.1 µm, and the mean serum level of VEGF was 7530 ± 2408 pg/ml. At 3 and 6 months after the thalidomide, the mean serum level of VEGF was significantly decreased to 2795 ± 3069 pg/ml (P<0.05) and 1674±1379 pg/ml (P<0.05), respectively. The pRNFL was significantly decreased to 172.4 ± 56.34 µm (P<0.05) and 137.8±25.3 µm (P<0.01), respectively. However, the mean FT did not change significantly from the baseline (240.8 ± 9.0 µm at 3 months, P>0.05; 240.8 ± 10.0 µm at 6 months; P >0.05).
Our results showed that thalidomide treatment reduced the optic disc edema together with a decrease in the serum VEGF levels. These findings suggest that the optic disc edema might be due to elevated serum levels of VEGF although further studies with a large sample size are needed.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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