Abstract
Purpose: :
To evaluate the long-term results in patients who have been treated with interferon alpha (IFN alpha) for chronic uveitic cystoid macular edema (CME).
Methods: :
To be eligible for analysis, patients had to suffer from chronic uveitic CME in at least one eye and had to complete a follow-up period of at least 24 months from start of IFN alpha (independend of how long IFN alpha was given). Treatment with IFN alpha-2a was started at an initial dose of 3-6 million IU per day subcutaneously for approximately four weeks. Afterwards, the dose of IFN alpha-2a was tapered stepwise to the lowest possible dose that keeps CME in remission, and was discontinued finally if possible.
Results: :
Out of 58 patients, in whom we started with IFN alpha for chronic uveitic CME since 2003, 38 patients (14 male, 24 female; mean age 48.9 years, range 13-77 years) completed a follow-up of at least 24 months and thus were eligible for further analysis. Localisation of uveitis was anterior in 6, intermediate in 28, and posterior in 4 patients. IFN alpha was effective (complete and sustained resolution of CME) in at least one eye in 26 patients (68.4%), partly effective (reduction of CME) in 9 patients (23.7%), and not effective (no response or early relapse of CME) in 3 patients (7.9%). Mean follow-up period was calculated as 56.3 months (range 24-104 months). Mean duration of IFN alpha treatment was 47.2 months (range 1-100 months). During follow-up, 6 patients (15.8%) stopped IFN alpha treatment after 1-88 months due to inefficacy or side-effects. In 4 patients (10.5%), IFN alpha could be discontinued in remission of CME after 25-100 months; one patient relapsed after one month. In 28 patients (73.7%), treatment with IFN alpha was still ongoing at last visit in our hospital (duration of IFN alpha treatment 24-100 months).
Conclusions: :
IFN alpha is able to induce complete or partial resolution of chronic uveitic CME in a substantial proportion of affected patients. However, the majority of patients needs long-term treatment with IFN alpha to keep absence of CME.
Keywords: uveitis-clinical/animal model • immunomodulation/immunoregulation