An exploratory study of ranibizumab for treatment of quiescent uveitic patients with refractory cystoid macular oedema (The LIMO Study)

Abstract

Purpose: To explore the efficacy and safety of intravitreal ranibizumab in patients with uveitic cystoid macular oedema (CMO).

Methods: Open label, prospective non-randomised interventional case series. Patients with quiescent uveitis and CMO ineligible for, or refractory to, standard therapy were enrolled. Subjects received 3 initial monthly injections of ranibizumab in the study eye, and subsequent monthly retreatment based on clinical need. Follow up was 12 months. Patients underwent baseline and serial assessments including best-corrected visual acuity (BCVA), contrast sensitivity, reading speed, microperimetry, and optical coherence tomography (OCT). Endpoints included change in central macular thickness (CMT) and BCVA at 6 and 12 months.

Results: Ten patients (5 male) were enrolled. Median age was 56.1 years (IQR 37.4, 68.2), median duration of macular oedema was 30 months (22, 45) and median BCVA in the study eye was 64 ETDRS letters (58, 68). One patient (10%) had anterior uveitis, six (60%) had intermediate uveitis, one (10%) had posterior uveitis, and two (20%) had panuveitis. The median number of intravitreal injections over the study period was 7.5 (5, 9.5). At 6 months and at 12 months median BCVA was 68 (53, 80) and 60 (42, 78) respectively. Three patients (30%) gained more than 15 letters and 3 patients (30%) gained more than 10 letters; 3 patients (30%) lost more than 15 letters and no patient lost more than 30 letters. Median CMT was 474 µm (407, 603) at baseline and decreased by 42.5 µm (-140, 4) and 5 µm (-183, 100) at 6 and 12 months respectively. There was no change in contrast sensitivity, but reading speed improved by a median 21.5 words per minute (-50, 36), and macular sensitivity on microperimetry improved by 7.5 dB (-0.2, 13.2). One patient (10%) developed significant cataract during the study. There were no serious adverse events.

Conclusions: A variable response to intravitreal ranibizumab was observed in our small cohort of patients with chronic macular oedema and quiescent uveitis. This pilot study suggests further investigation in a larger cohort would be worthy of consideration.