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Luis A. Gonzalez, Rene A. Cervantes-Castañeda, Miguel Cordero Coma, Taygan Yilmaz, C Stephen Foster; Efficacy of Combined Cyclosporine A and Mycophenolate Mofetil in the Treatment of Patients with Birdshot Retinochoroidopathy: A 12-month follow-up. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4263.
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To report the results of combined systemic cyclosporine A (CsA) and mycophenolate mofetil (MM) in controlling inflammation and preventing vision deterioration in patients with birdshot retinochoroidopathy (BSRC).
Retrospective, non-comparative, interventional case series. Eighty eyes of 40 patients with BSRC who received CsA and MM for a minimum of one year at one referral center were included in the study. All patients were followed for at least five visits during the study. Outcome measures included best-corrected logMAR visual acuity, vitreous inflammation, fluorescein angiographic features, electroretinogram recordings, reported side effects to therapy, and number of relapses. Student’s t-test, Pearson’s chi-square test, and Fisher’s exact test were used for statistical analysis.
Mean logMAR visual acuities were not statistically significantly different after the 1-year time point in either the right or left eye (p=0.434; p=0.180), i.e., no deterioration in vision occured. Vitreous inflammation scores at baseline and at 1-year were statistically significant reduced in both eyes, i.e.,there was less inflammation at the follow-up (p<0.0001; p<0.0001). The presence vasculitis and cystoid macular edema at the 1-year follow-up were both significantly reduced (p=0.025; p<0.001). Comparisons of both 30 Hz amplitude and 30 Hz implicit times revealed no significant reduction between baseline and 1-year values for either eye (p=0.14 OD; p=0.17 OS).,i.e., no deterioration in retinal function occurred. In three patients, the combined therapy failed to achieve inflammation control. Side effects included leukopenia in two patients, transient elevation of blood urea nitrogen in 10 patients, and hypercholesterolemia in 4 patients.
These results suggest that combined therapy with CSA and MM for BSRC is both well-tolerated and effective in reducing deterioration in vision function in patients with BSRC. More definitive studies on this matter will require multicenter studies in order to conduct masked, placebo-controlled randomized trials.
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