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Chloe Turpin, Jr., Olivier Lebreton, Michel Weber; Effectiveness Of Interferon Alpha-2a And Peg Interferon Alpha-2b In The Management Of Refractory Uveitic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1183.
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Uveitic macular edema is one of the main cause of decreased visual acuity in chronic uveitis. When refractory to oral corticosteroids, and/or to immunosuppressive drugs, interferon therapy is one of the alternative treatment. The objective of this study was to determine whether interferon therapy was effective in the management of refractory uveitic macular edema, and to compare effectiveness and tolerance of Interferon Alpha-2a (Ia2a) and PEG Interferon alpha-2b (PEGIa2b).
A retrospective monocentric study was conducted between March 2007 and March 2011 in a tertiary center. Patients included had non-infectious uveitic macular edema, without inflammatory activity, refractory to oral corticosteroids and/or to a first-line immunosuppressive drug. They were treated with subcutaneous Ia2a (3 MUI 3 times a week) and/or PEGIa2b (100 µg once a week). Visual acuity and central macular thickness were measured at baseline, after 3 and 6 months, and after discontinuation of the treatment. Side effects with the two molecules were reviewed.
22 patients were included. 18 were treated by Ia2a and 11 by PEGIa2b. Mean age was 57 years (22-83), sex ratio was 10/12, mean duration of treatment was 5,2 months (Ia2a) and 4,8 months (Ia2bPEG) and mean follow-up was 23,1 months (Ia2a) and 9,7 months (Ia2bPEG). Macular edema was most often related to Birdshot retinochoroidopathy (7/22) or idiopathic intermediate uveitis (6/22). After 3 months with Ia2a, central macular thickness significantly decreased of 206,7 µm (p=0,006) and visual acuity significantly improved of -0,203 logMAR (p=0,026). There was no significant difference in effectiveness between the two molecules. After discontinuation, mean duration before relapse was 9 months with Ia2a and 3 months with PEGIa2b. Side effects were responsible for discontinuation of Ia2a or PEGIa2b in respectively 27,7 % and 45,5 % of patients, mainly because of a flu-like syndrome (60 %). Other side effects included depressive syndrome, digestive disorders and pancytopenia. There was no significant difference of tolerance between the two molecules.
In spite of side effects, that have to be taken into consideration, Interferon therapy (Ia2a as well as PEGIa2b) seems to be effective for uveitic macular edema refractory to oral corticosteroids and/or to immunosuppressive drugs.
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