Abstract
Purpose: :
To investigate the effect of immunosuppressive therapy in patients diagnosed with acute posterior multifocal placoid pigment epitheliopathy (APMPPE), ampiginous and/or serpiginous choroiditis.
Methods: :
Retrospective review of medical records of 46 eyes in 26 patients. Recorded data were visual acuity (VA, in LogMAR) at baseline, VA at treatment follow-up (f/u) visit, f/u period, diagnosis, initiation of therapy, therapy strategy, presence of recurrence. In case of bilateral involvement the worst eye at onset was used for statistical analysis.
Results: :
Median age was 25.4 years (range 18.3 - 75.0). APMPPE was diagnosed in 50%, ampiginous in 26.9% and serpiginous in 23.1%. 53.8% was female, and 76.9% had bilateral involvement. Treatment was started in 73.1%, of which 11.5% received steroids only, 53.8% was put on steroids plus cyclosporine, 7.7% received a combination of steroids and azathioprine. In 15.4% of eyes monotherapy was given, 42.3% followed a step-down strategy and 15.4% a step-up strategy. In 38.5% of eyes one or more recurrences were seen during total f/u. Median f/u was 1.6 years (range 0.26 - 26.6), effect of treatment on VA was studied after a median f/u of 0.71 years (0.26 - 1.9). Median (range) VA at baseline for the untreated group was 0.40 (0 - 1.3) and for the treated group 0.40 (0 - 2.0), at the treatment f/u visit VA was 0.15 (0 - 0.5) and 0.10 (0 - 1.8) respectively.No statistically significant difference in VA at baseline and f/u was seen between treated and untreated patients. Wilcoxon testing for paired data showed a significant improvement in VA in the treated group (p = 0.03) but did not in the untreated group (p = 0.116). Only APMPPE patients showed significant improvement in VA (p = 0.01), both treated and untreated. Compared to serpiginous patients VA at f/u was higher in both ampiginous and APMPPE patients, but not statistically significant. Only patients treated in a step-down strategy showed statistically significant improvement in VA (p = 0.018).
Conclusions: :
APMPPE, ampiginous and serpiginous choroiditis can be considered as diagnostic entities within one clinical spectrum, in which APMPPE has the mildest (natural) course. Patients receiving immunosuppressive therapy showed more VA improvement than observed cases. A step-down strategy seemed more beneficial than monotherapy or step-up strategy.
Keywords: uveitis-clinical/animal model • drug toxicity/drug effects • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials